the annex, tomlinson centre, queensbridge road, london, e8 … us...7d pages 65-87 8. healthier city...

Chair: Dr Clare Highton Accountable Officer: Jane Milligan Acting Managing Director: David Maher

NHS City and Hackney Clinical Commissioning Group (CCG) Governing Body

Friday 23 February 2018, 1430 – 1630

The Annex, Tomlinson Centre, Queensbridge Road, London, E8 3ND

AGENDA

Chair: Dr Clare Highton, CCG Chair Please look over the agenda and think about which of these topics might present an area of interest for you. This means an item where a decision or recommendation made may advantage you, your family and/or your workplace. These advantages might be financial or in another form, perhaps the ability to exert unseen influence. Where anything on the agenda has the potential to put you in such a position, or raised in the meeting along the way, you should tell us all about it. This means we can ensure that our decision, recommendations or actions can be guarded from the impact of any possible conflict you or others could have and be seen to be so. If you are unsure it is always best to raise the possibility with the chair before the meeting, or at any point during the meeting if a possible interest strikes you. This openness is important as we can all discuss how to manage decision making in a complex environment and learn together how to manage these issues well. We are agreed that we will all challenge each other on areas of interest or possible conflict as we recognise that sometimes these issues can be overlooked. Agenda Items Led by & Appendix

number Timing

1. Welcome and introductions. Clare Highton Verbal

1430-1435 (5 mins)

2. CCG Committee business: a. Declarations of Interest; b. Minutes of the last meeting; c. Action tracker; d. Matters arising.

Clare Highton Papers 2a, 2b & 2c Pages 4-30

1435-1440 (5 mins)

3. Questions from the public Clare Highton Verbal

1440-1445 (5 mins)

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4. Board Assurance Framework Summary Sunil Thakker Papers 4a & 4b Pages 31-38

1445-1450 (5 mins)

5. Accountable Officer / Managing Director update Jane Milligan / David Maher Paper 5a Pages 39-41

1450-1455 (5 mins)

FOR DECISION 6. NEL Commissioning Alliance update:

a. Recommended changes to CCG Constitutions and Schemes of Reservation and Delegation.

Clare Highton / Jane Milligan Papers 6a, 6b, 6c & 6d Pages 42-64

1455-1510 (15 mins)

7. Finance & Performance update: a. Month 10, 2017/18; b. Framework for Risk Sharing in 2017/18.

Sunil Thakker Papers 7a, 7b, 7c & 7d Pages 65-87

8. Healthier City and Hackney Fund governance request for pre-endorsement

Silvia Scalabrini Paper 8a Pages 88-103

1510-1520 (10 mins)

9. Recommendations from the January 2018 Local GP Provider Contracts Committee

Catherine Macadam Paper 9a Pages 104-108

1520-1525 (5 mins)

10. CCG Statement on Modern Slavery David Maher Paper 10a Pages 109-112

1525-1530 (5 mins)

FOR DISCUSSION 11. East London Health Care Partnership update Jane Milligan

Papers 11a & 11b Pages 113-120

12. NHSE consultation on conditions for which the over the counter (OTC) items should not be routinely prescribed

Haren Patel Paper 12a Pages 121-139

1530-1540 (10 mins)

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13. 2018/19 Planning Guidance and Operating Plan. Sunil Thakker Papers to follow

Pages TBC

1550-1600 (10 mins)

14. Integrated Commissioning update:a. Output from clinical practitioner discussion;b. Discussion on outpatients transformation;c. Learning Difficulties service model;d. Progress with further pooling.

David Maher / Devora Wolfson Papers 14a & 14b

Pages 140-145

1600-1610 (10 mins)

15. Public and Patient Involvement update Silvia Scalabrini Paper 15a

Pages 146-151

1610-1620 (10 mins)

FOR INFORMATION 16. 2017/18 CCG Annual Report plan David Maher

Paper 16a

Pages 152-154

1620-1625 (5 mins)

17. Updates and minutes from other bodies and

subcommittees of the Governing Body

MINUTES:a. Friday 22 December 2017 Local GP Provider

Contracts Committee (Primary CareCommittee);

b. ?? November / December 2017 Sustainabilityand Transformation Plan (STP) Board MeetingMinutes;

c. Wednesday 13 December 2017 IntegratedCommissioning Boards.

SUMMARY NOTES: d. Wednesday 24 January 2018 Finance and

Performance Committee; e. Thursday 25 January 2018 Public and Patient

Involvement Committee; f. Friday 26 January 2018 Safeguarding Group;

Clare Highton Papers 17a, 17c, 17d, 17e, 17f & to follow

Pages 155-181

1625-1630 (5 mins)

18. Draft Friday 23 March 2018 Governing Body Agenda Clare HightonPaper 18

Pages 182-184

1630-1635 (5 mins)

19. Any Other Business Clare Highton Verbal

1635-1640 (5 mins)

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Paper Title

CCG Committee business, incorporating: Paper 2a - Minutes of the last meeting; Paper 2b - Action tracker; Paper 2c - Register of Interests.

Paper Author Matthew Knell

Lead Presenter Clare Highton

Paper Summary (3 bullet points of relevant background to the paper)

Standing items of the CCG Governing Body, comprising the previous meetings minutes for discussion and approval, the current action tracker for discussion and the latest Register of Interests.

Purpose (delete unnecessary)

For approval and information

Recommendation (state what you are asking for (eg support a proposal, debate and decide options, provide feedback etc. List all that's applicable)

The Governing Body is hereby asked to: 1. Discuss and agree any needed changes to the

previous meetings minutes, decisions and/or actions;2. Agree the previous meetings minutes as a true

record of the discussions, potentially on the conditionthat any changes are actioned.

3. Recognise and discuss the current action trackerarising from previous Governing Body meetings;

4. Recognise and raise any issues with the latestRegister of Interests.

Where else has this paper been discussed?

Not applicable

What was the outcome of previous discussions?

Not applicable


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DRAFT MINUTES OF THE NHS CITY AND HACKNEY CLINICAL COMMISSIONING

GROUP GOVERNING BODY MEETING

HELD ON FRIDAY 26 JANUARY 2018

AT

THE ANNEXE, TOMLINSON CENTRE, QUEENSBRIDGE ROAD, LONDON, E8 3ND PRESENT: Dr Clare Highton (CCG Chair)

Dr Haren Patel (CCG Clinical Vice Chair) Dr Gary Marlowe (CCG Governing Body GP) Catherine Macadam (CCG Lay Member for Public and Patient Involvement) Sue Evans (CCG Lay Member for Governance) Honor Rhodes (CCG Lay Member) Siobhan Clarke (CCG Governing Body Nurse) Dr Christine Blanshard (CCG Governing Body Secondary Care Consultant) Jane Milligan (NEL Accountable Officer) Sunil Thakker (CCG Joint Chief Financial Officer)

ATTENDING: David Maher (CCG Acting Managing Director)

Dr Mark Rickets (CCG Chair Elect) Dr Nikhil Katiyar (CCG Governing Body GP Elect) Matthew Knell (CCG Head of Corporate Services) Dr Rhiannon England (CCG Clinical Lead GP for Mental Health) for agenda item 5 Jenny Singleton (CCG Head of Quality) for agenda item 7 Dr Penny Bevan (LBH & CoL Director of Public Health) Gail Beer (City of London Health Watch)

APOLOGIES: Jon Williams (London Borough of Hackney HealthWatch) Agenda Item 1 – Welcome, introductions and declarations of interests Dr Clare Highton (CH), the CCG Chair welcomed members to the January 2018 meeting of the NHS City and Hackney Clinical Commissioning Group (CCG) Governing Body (GB). Two members of the public were in attendance at the meeting. Apologies were noted as indicated above and CH confirmed that the GB was quorate for decisions. CH acknowledged that the GPs present at the meeting held conflicts of interests as providers of primary care, and that as such, agenda item 6 - recommendations on future funding arrangements for non-recurrent CCG contracts would be chaired by the Governing

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Bodies Lay Member for Public and Patient Involvement, Catherine Macadam (CM). Any decisions taken under that agenda item would be under the Governing Body’s quorum for conflicted decisions without GP members voting. Agenda Item 2 – CCG Committee business Minutes of the last meeting The CCG GB accepted the minutes of the previous meeting as a true record of the meeting. DECISION: The CCG GB approved the minutes of the previous meeting as a true record of the meeting. Register of Interest The CCG received the latest register of interests and acknowledged the declarations contained within. No additional conflicts of interest were declared by members. Action Tracker The GB received the action tracker, noting the updates provided and outstanding actions to be pursued. Sunil Thakker (ST) noted that with regards to action GB0068, prescription costs were being looked at with North East London (NEL) CCGs and should be closed at the local level. ST confirmed that these costs would be split care sector, including public health. Honor Rhodes (HR) raised that the action GB0084 regarding GP Confederation commissioning intentions was somewhat unclear but was perhaps related to the inclusion of Adverse Childhood Experiences (ACEs) as part of the outcomes covered within the Children, Young People’s and Maternity (CYPM) Workstream. Rhiannon England (RE) confirmed that this was case. Matters Arising No matters arising were discussed. Agenda Item 3 – Questions from the public Michael Vidal (MV), in attendance as a member of the public posed the questions circulated with meeting papers, firstly asking whether the GB would agree not to move any further along the path to an Accountable Care Organisation (ACO) / Accountable Care System (ACS) until there is a proper legal framework for these organisational forms. CH responded that there had been a national response to this issue in the last couple of days, with the Secretary of State (SoS) for Health confirming that moves in this area of work were now on pause. CH confirmed that the CCG had consequently paused its own work in this area and that the GB would be kept updated on any future changes. MV drew the GBs attention to his second circulated question, expressing concerns around a possible cut to the CCGs prescribing budget for 2018/2019 from the current 2017/2018

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financial year. ST responded that any figures under discussion at this time were draft and had been under several revisions since those discussed with MV some weeks ago. All CCG budgets would remain in draft under details of the 2018/19 NHS Planning Guidance had been received from NHS England (NHSE). ST continued that there wouldn’t be any cut to the CCGs prescribing budgets, but that as part of the planning process for 2018/19, the budget would be re-based to align with the current years spend. The GB would be kept up to date as information in this area becomes firmer. David Maher (DM) added that SoS for Health’s pause had been directed at formal movements into ACO/ACS contracts but had also emphasised that moves towards making NHS organisations accountable to local populations were positive.a Haren Patel (HP) agreed with ST’s statement, adding that there were still unknown risks present, making planning in the prescribing area in particular challenging. ST agreed, noting that the No Cheaper Stock Obtainable (NCSO) costs in particular were presenting a pressure. Gary Marlowe (GM) thanked all prescribers in the area for their sterling work in keeping a close watch on their practice. CH added that the CCG was reporting the tightest control on prescribing costs in England, which was a huge achievement. CB highlighted that was worth emphasising, especially in the current climate of drug price volatility and shortages. Agenda Item 4 – Board Assurance Framework ST drew the GBs attention to the circulated papers, setting out the background to the latest iteration of the Board Assurance Framework (BAF), changes in risks over the previous month and plans for further work in this area. Penny Bevan (PB) asked how the relationship between the Integrated Commissioning Boards (ICBs) and CCG GB would function if there ever arose a disagreement on a decision made by the ICBs. SE responded that the GB remained responsible for decisions made under delegated powers to the ICBs, even if those decision making powers were currently limited. CH supported this assessment, noting that the CCG was the statutory body with clear responsibilities and the final say on matters within its jurisdiction. PB asked for clarification that this meant the CCG was able to overrule elected members of the Council. DM responded that this was the case, within the CCGs statutory powers, that all the parties in the integrated commissioning work were aware of this and that this was covered in the Memorandum of Understanding (MoU) in place. GM raised that in relation to the risk regarding rent re-evaluations, he was aware of several GP practice premises up for renewal, with NHSE seeking independent evaluation. The process was not at all clear however and many practices were receiving mixed messages from the involved parties. ST thanked GM for the information and noted that he would pick up the information outside the meeting to look into. ST briefed the GB that the scale of rent increases across the area was under discussion with NHS Property Services (NHSPS) currently and that a clear position was being sought for inclusion in planning by the end of March 2018.

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CH noted that the risk currently held on the Primary Care Quality Programme Board (PCQPB) risk register regarding electronic mobile phone application GP services had possibly increased since it was assessed, with a recent request for physical premise space in Hackney. The risks associated with these types of service were not only clinical and financial for the CCG, but also had a political dimension. GM agreed with this assessment, noting that his own practice had encountered patients who were not aware that use of the application removed patients from their practice list and registered them in Hammersmith. Jane Milligan (JM) highlighted that the financial risk associated with this was somewhat mitigated in the short term by the approximate two year delay in any movement of capitation funding from Hackney practices to other areas. JM agreed that co-ordinated communications were needed to make clear that patients would be moving practice through the use of the application. Mark Rickets (MR) noted that it wasn’t too challenging to change practice back and forth using transferable patient records. Christine Blanshard (CB) asked if there had been any clear indications of patient harm through the use of the electronic mobile phone application GP service to date. GM responded that he was not aware of any, but that this area had not been looked at yet. One of his own concerns was regarding antibiotic resistance and the potential to undo years of work that the CCG and local GP practices had undertaken to reduce prescribing. MV asked whether the proposal for the CCG and Integrated Commissioning partners to pool funding in the Continuing Healthcare (CHC) would help address the risk indicated in risk PHE07. CH responded that it would probably be a bit speculative to support this at this stage, but the proposal would be coming to a future GB for a detailed discussion. Agenda Item 5 – 2018/19 Recurrent Mental Health Investment RE briefed the GB that six schemes were before the meeting for approval, four with East London Foundation Trust (ELFT) and two with Homerton University Hospital NHS Foundation Trust (HUHFT). All the schemes were being funded from the CCGs parity of esteem funding pool and had been consulted on across the CCG and integrated commissioning structures. HR thanked RE for the proposals, noting that many of the services detailed in the proposals were exciting and vital for local residents, particularly the Adult ADHD Clinic at ELFT. GM flagged some concern that there may have been a fairly recent trend of anxiety disorder being misdiagnosed as ADHD, with significant numbers of patients returning to GP practice with an ADHD diagnosis. GM added that ADHD medications were expensive and required careful monitoring by clinicians. HP asked why the CCG was funding ELFT for completion of dementia care plans, noting that GP practices already undertook this work. RE responded that ELFT were being bought into line with the process already present in GP practice and that the funding was needed to provide training and increased capacity to allow comprehensive planning to be undertaken. CH asked how many patients within ELFT were admitted with existing plans, noting that the CCG should expect the numbers to decrease over time as GPs produced more and more plans.

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Cynthia White (CW), in attendance as a member of the public, asked whether the CCGs work with the Co-ordinate My Care (CMC) care planning software was a local approach. CH responded that the software was in use around the country. CW noted that the sharing of plans seemed to vary from area to area. Catherine Macadam (CM) agreed, adding that she had encountered similar concerns. CH responded that patient consent was required to make the plans available for sharing and that some variability was to be expected. Nikhil Katiyar (NK) added that the patient’s capacity to agree to sharing also factored into this availability. CH raised that while the street triage service detailed in the circulated papers had proven itself as a valuable, high quality service, its money saving ambitions were possibly overstated. RE agreed, adding that the situation in the City of London meant that savings were potentially being seen by other areas CCGs due to the movement of people through the area. CB praised the inclusion of a physical health nurse in the eating disorder service, which was becoming vital to mental health focused services. CB asked what the meal support mentioned in the proposal entailed. RE responded that this aspect of the service would liaise with family, GPs and other clinicians to support continuity of care and familiar meals into the service. MV noted that the proposals had originated across three of the integrated commissioning workstreams (Unplanned Care, Planned Care and CYPM) but that only one of those workstreams had consulted their public representatives. MV encouraged all workstreams to develop their working practices in this area. GM raised that the psychosexual service needed to interface with neurology and gynaecology to ensure that physical health care remains co-ordinated. NK flagged that the proposal on care plans was encouraging, but would need to be a first stage towards improving the quality of care plans. RE agreed with this assessment. DECISION: Six proposals for investment with ELFT and HUHFT from the CCGs parity of esteem funding were agreed by the GB, as indicated in circulated papers. Agenda Item 6 – CCG Prioritisation and Investment Committee recommendations on future funding arrangements for non-recurrent CCG contracts CM chaired this item, with the GPs present (CH, HP and GM) not taking part in the decisions under this agenda item due to their conflicts of interest as local GP providing some of the services under discussion. DM briefed the GB that the Prioritisation and Investment Committee (PIC) had met on Tuesday 23 January 2018 and produced a hierarchy of proposals that was being tabled before the GB. CM informed the GB that she had chaired the session, which had been made aware of the financial climate in which it was meeting and resulted in a set of prioritised proposals. CM confirmed that there was no recommendation for immediate funding before the GB at this

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time, but that GB approval to fund the proposals in prioritised order was being sought, if and when funding became available. CM continued that the PIC had continued its process used in previous meetings – the Committee undertook evidence based and comprehensive review of each proposal and their impacts. CM highlighted that the PIC had concluded that some of the proposals may be able to secure funding elsewhere in CCG budgets, outside of the non-recurrent (NR) funding pool. ST confirmed that those seeking funding from the NR pool would only be awarded one year of funding and that much of this work was contingent on the national NHS planning guidance. GM asked if the immunisation support proposal involved clinicians going out into the community to deliver immunisations. HP confirmed that this was the case. GM flagged that while this was a valuable service, it had been impacted by data issues in the past and that care needed to be taken to log activity. PB added that the service would also support Saturday morning clinics in the north of the Borough, which had proven effective. CW highlighted that the bereavement service had received widespread praise from users. CM thanked the GB for their feedback and confirmed that any funding in the future would be subject to national guidance and planning for 2018/19. DECISION: The GB agreed the prioritised list of proposals tabled at the meeting, recommended from the PIC meeting in January 2018. These proposals would be funded in their prioritised order depending on national guidance and funding availability. CH asked if the tongue tie service had been asked to wind down following the PICs discussions. ST confirmed that it had been served three months’ notice. Agenda Item 7 – Safeguarding Supervision Policy Jenny Singleton (JS) joined the GB to present the new Safeguarding Supervision Policy, setting out the CCGs processes for clinical supervision of the few staff requiring it. The policy had been discussed and recommended by the Safeguarding Group. The GB thanked JS for the policy and agreed the document. DECISION: Safeguarding Supervision Policy as circulated with meeting papers agreed for implementation in the CCG. Agenda Item 8 – Emergency Planning, Preparedness and Response update DM briefed the GB that the 2016/17 assurance assessment from NHSE had been received for the CCGs Emergency Planning, Preparedness and Response (EPRR) work. While the previous year had resulted in a ‘non-compliant’ rating, the work carried out over the year had resulted in a ‘substantial assurance’ rating for this year. DM noted that there were some recommended actions detailed in the circulated paper and thanked the team at the CCG for their work in the area.

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PB noted that the CCG could commit to seasonal awareness raising of the local influenza plans. JM noted that this was one of work areas that may benefit from improved support at the NEL level. Agenda Item 9 – Changes to “Working in City and Hackney CCG” (including employment policies) DM drew the GBs attention to the circulated changes to the CCGs ‘Working in City and Hackney CCG’ package of HR policies, which had been updated to take account of recent changes in the management structure. The GB agreed the changes for implementation. DECISION: The GB agreed the circulated ‘Working in City and Hackney CCG’ package of HR policies. Agenda Item 10 – Approval of appointment to the CCG Governing Body and change to the Constitution DM drew the GBs attention to the circulated papers, which had been agreed by the January 2018 Members Forum and the process for extending GB Nurse and Consultant beyond the initial four year term refined by Members. CH added that the CCG had only received a single application for the Consultant role which had been eligible for appointment. The GB discussed the proposed appointments and changes to the Constitution, concluding that all proposals should be accepted. DECISION: The appointment of Chris Gallagher as GB Secondary Care Consultant from 01/04/2018 was approved. DECISION: The GB agreed the proposed changes to the CCG’s Constitution to remove term limits for the GB Nurse and Secondary Care Consultant on the proviso that a fair and transparent recruitment is undertaken after two terms of two years have been served. DECISION: The GB agreed to appoint Siobhan Clarke (SC) for serve a new two term as GB Nurse from 1 April 2018. Agenda Item 11 – NEL Commissioning update JM briefed the GB on the circulated Accountable Officers update, adding that NHSE and NHS Improvement (NHSI) appeared to be moving towards working closer together and it was hoped that this would allow more co-ordinated engagement across the NHS. JM expanded on the information on the stocktakes underway across NEL CCGs included in the circulated paper, including that this work would help inform ways of working across all

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involved CCGs in 2018/19 and that the acting Managing Director roles were moving onto a substantive appointment footing in the near future. JM continued to outline the work underway on the Joint Commissioning Committee (JCC), noting that it was hoped that the Committee would be running in a shadow form in April 2018, but that further work was needed on the information flows into the Committee. JM flagged that both CH and Paul Haigh were involved in work on the Clinical Senate and outpatient department (OPD) transformation. JM stated that she wanted to start spending time in each CCG office and already started meeting local stakeholders, including the Local Medical Committee (LMC) Chairs. PB asked if there was any indication for the release of the national planning guidance. JM responded that it was expected at any time. CM drew the GBs attention to page 109 of the circulated papers and asked what proposals were being worked on with regards to the indicated shared functions. JM responded that this was an area of work being driven by the stocktakes and that all involved had open minds currently. It was thought that any proposals in this area could mirror that in place already in the Mental Health Collaboration, where NEL CCGs have been working together with the two providers for some time. JM added that prescribing teams were also working together strongly across the area. CM noted that the circulated paper indicated that only 3 of the 8 local councils were proposed to be present at the JCC. JM responded that this should indicate all 8 and included all the councils and City of London Corporation. CB asked how work was progressing on the Clinical Senate. CH responded that the group was involving all local Medical Directors, Directors of Nursing, Public Health Directors and CCG Chairs. While it was hard to get all involved around a table, discussions to date had proven valuable, particularly those focused on OPD transformation. Some of the discussions had also proven easier than expected, with, for example, initial discussions on a possible movement away from the Payment by Results (PbR) tariff in the OPD area supported around the table. JM flagged that it might be positive to also involve CCG GB Consultants and Nurses in this group for their input. GM highlighted that he was unaware of the Senates work or direction of travel, either in his role as GB GP Member or Planned Care Clinical Lead GP for the CCG. JM responded that the discussions were in early stages and focused on the big area wide issues. CB welcomed the approach to OPD transformation, adding that there was real value to be gained from looking at this area of work on an area wide basis, particularly in the use of novel technologies for non face to face work. It was unlikely that any single of the involved Trusts could afford to invest in this area alone, but could approach this together as a group. SC stated that care needed to taken in this work across NEL and with the JCC with governance not always the best solution to keeping relationships positive. SC continued that in the current climate, any Clinical Senate should consider involvement from outside the traditional medical field, for instance whether Heads of Social Work should be involved.

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CW asked if there was any new developments on public and patient involvement (PPI) at the NEL level. JM responded that a series of meetings with public representatives were coming up and that everyone involved would be kept up to date. CH asked whether the CCGs concerns around the proposed JCC governance arrangements were in the process of being addressed. JM responded that this was being worked on, with a final paper expected in February or March 2018. SE added that the NEL Governance Group was meeting the following week to discuss this area of work. Agenda Item 12 – Integrated Commissioning update DM updated the GB on the work underway within the CCG and partners integrated commissioning programme. The Transformation Board (TB) had met the previous week to look at business cases for the further pooling of budgets across the partners to cover prevention, continuing care and residential care. Further work in this area was required and it was thought that the proposals may be ready for GB discussion in March 2018. DM continued that details of how the workstreams will be delivering the integrated commissioning operating plan should be expected in April 2018, with the results of the ongoing Governance Review expected shortly after that. DM flagged that the interim Director of Integrated Commissioning and interim Governance Support were due to leave their roles in April 2018 and that the current thinking was that the partners would seek a full time, permanent Integrated Commissioning Director. DM continued that further work was planned to look at workstream inputs and how the involved finance and contracting teams were working together. GM briefed the GB on some of the early thinking about the future of clinical leadership across the area and the need for a vision of the future based on clear outcomes. CH added that the Clinical Executive Committee (CEC) would be joined by wider practitioners in the area in February 2018 for a workshop to explore this area and that it was hoped that this would just be the first in a series of similar meetings. DM added that further thinking on what input the GB may want to be assured of the status of services in the area may be needed, along with thinking on how the GB can stay clinically led through upcoming changes. CM asked if similar thinking was planned for patient leadership, noting that the enabler group was now up and running under the integrated commissioning programme. CM noted that change was already starting to be recognised, with, for instance, the last PPI Committee seeing concern expressed over the Local Authorities contracting for the advocacy service. MV agreed that this was a vital point and added that the circulated papers had stated that all integrated commissioning proposals would be supported by service users. CH responded that proposals going through the integrated commissioning governance structure did require PPI to be documented. MV responded that a fuller discussion and plan on how wider input could be sought would be better. Agenda Item 13 – Finance & Performance update ST updated the GB on the CCGs latest financial and performance information, noting that Barts Health performance had decreased noticeably in the last month, with £1 million of

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costs pressures materialising unexpectedly. The CCG was working to look at the detail behind this figure and hoped to work with partner CCGs to mitigate the impact across the area. In the meantime, the CCG had released some of its contingency funding to address the cost pressure. ST drew the GBs attention to the circulated risks and opportunities information, noting that the CCG was still forecasting a breakeven at year end and the return of the previously discussed £1.4 million to NHSE. CB flagged that the CCG should consider checking the phrasing of Barts Health cost improvement plan (CIP), with some Trusts having backloaded costs to the end of the year to secure sustainable transformation funding (STF) from NHSE. JM responded that it was hoped that the CCGs and Barts Health would be able to agree a year end deal. ST briefed the GB that discussion was underway on triggering the risk share agreement across NEL and that NHSE had confirmed that they were happy for this to proceed in line with national guidance. ST highlighted that in order to comply with national guidance, the transfers would need to have taken place by mid February 2018 and that the involved Chief Financial Officers (CFOs) needed to satisfied with risk assessments and profiles before any action was taken. ST asked how the GB wanted to proceed on this point, with the options including the delegation of decision making power on this matter to the CFO, Accountable Officer (AO) and Chair or through a virtual email meeting of the GB. ST added that he would need to involve KPMG, the CCGs external auditors to provide the GB with satisfactory assurance on any proposed transfer. SE agreed that KPMGs assurance was vital. CH asked that a paper setting out any proposal for transfer with clear details of the patient benefit illustrated be circulated to GB member by email. CH emphasised that any transfer should support transformation and not be a ‘bail out’. The GB agreed to proceed with a virtual meeting. DECISION: Paper outlining proposals for risk share transfer to be circulated to GB members seeking virtual approval in time to meet national deadlines. Agenda Item 14 – Joint local area SEND inspection in Hackney HR thanked all those involved in the recent Ofsted inspection of SEND services in the area, resulting in the positive assessment circulated with papers. HR highlighted that the inspection had really noticed the choice available to local residents. CB agreed with HRs assessment, noting that the information provided on childrens health services was fantastic as well. Agenda Item 15 – Minutes from other bodies and summaries from subcommittees of the Governing Body The GB received the circulated papers for information.

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Agenda Item 16 – Friday 23 February 2018 Governing Body Draft Agenda The GB received the draft February 2018 GB agenda, noting that items addressing the 2018/19 planning guidance, CCGs operating plan and updates from the NEL transformation programmes would be added. Agenda Item 17 – Any Other Business SE flagged that the long awaited NHSE online training on Conflicts of Interest had been launched earlier in the day. CH drew the GB’s attention to the Friday 23 March 2018 retirement party that she would be hosting with Paul Haigh. No other business was raised. AGREED BY: AGREED ON:

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NEEDS AN UPDATE

POSSIBLY COULD BE CLOSED Subject to

update

CAN BE CLOSED

Ref No Action Assigned to CCG Lead

Assigned from Assigned date Due date Status Update Update provided by

GB0074 Sunil Thakker to investigate 2017/18 STP running costs and update the GB

Sunil Thakker CCG Governing Body 26/05/2017 30/06/2017 Open No confirmation of the expected contribution to Sustainable Transformation Plan (STP) support had been received yet, but was expected to be in the region of £150,000.

MK

GB0076 Dan Burningham to keep GB updated on progress towards signature of the Access to Mental Health Inpatient Services in London Compact agreement and to investigate whether HLP may be able to support its agreement if needed

Dan Burningham CCG Governing Body 26/05/2017 27/04/2018 Open HLP has informed the CCG that the London Compact is still in draft form. DB is co-chairing an HLP committee on mental health cross payments for 136, A&E and inpatient services. DB will report findings of the committee in April 2018 and any developments in the London compact to the GB.

GC

GB0085 LW to include, in the revised CCG procurement policy (under involvement and consultation) reference to the adoption of a co-production approach to patient involvement and consultation at the design stage of a service.

Lee Walker CCG Governing Body 22/12/2017 26/01/2018 Closed Changes incorporated in final version. LW

GB0086 LW to consider inclusion, in the revised CCG procurement policy, how providers relate to older people.


GB0088 LW to update the revised CCG procurement policy, a reference to workstream and Managing Directors (Appendix 3, page 108).


GB0089 ST to investigate potential recipients plans for a claim on the risk pool funds.

Sunil Thakker CCG Governing Body 22/12/2017 26/01/2018 Open This was discussed recently by the NEL CFOs. An action to address this matter assigned to NEL STP Finance Lead to take forward with NHSE as guidance expected will require the 0.5% SR to be released to improve the control total position of the CCG.

GB0090 JS to include as focus on Children and Young People in a future quality report

Jenny Singleton CCG Governing Body 22/12/2017 31/12/2018 Open Will return in a quality report before the end of 2018. JS

GB0091 JS to consider how to measure the impact of poor administration on quality of care at Barts Health and report back to GB. Suggestion made to liaise with healthwatvh Tower Hamlets

Jenny Singleton CCG Governing Body 22/12/2017 29/06/2018 Open Under development with further information expected before the end of June 2018.

JS

GB0092 DM to check whether the GP OP referrals for City and Hackney have increased (as stated in the report) or decreased.

David Maher CCG Governing Body 22/12/2017 26/01/2018 Open

2017-18 NHS City and Hackney CCG Governing Bodies Action Tracker (OPEN)

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Forename Surname Date of Declaration CCG Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest Actions taken to mitigate risk

Gail Beer 19/11/2016 City of London HealthWatch Representative Guys and St Thomas's NHS Foundation

Trust

Employed as Interim Director of Operations Non-financial

professional interest

Should this NHS provider be specifically discussed in a commissioning

capacity, the individual will be asked to leave the room or not take part

in the meeting when the matter is being discussed and when any

decisions are being taken. The action taken should depend on the

involvement of the provider in the matter under discussion.

Should broader commissioning matters be discussed that might be

attractive to this provider, the individual will be allowed to participate in

some or all of the discussion when the matter is being discussed but

asked to leave the meeting or not take part when decisions are being

taken.

Penelope Jane Bevan 20/10/2017 Director of Public Health LB Hackney and City of London

Corporation

Attends Clinical Effectiveness Committee, Prioritisation

Committee and Governing Body

Advises on clinical and public health issues

Signatory to the CCG/Public Health Core Contract

City of London Corporation Employer Non-financial


Organisation is a commissioning partner of the CCG. Should a situation

arise where the organisation is being discussed in a commissioning (or

joint management of commissioning) capacity, the individual will be able

to participate in some or all of the discussion when the matter is being

discussed but asked to leave the meeting, or not take part where


involvement of the partner in the matter under discussion.


Corporation





Faculty of Public Health Fellow at this Public Health Specialist Body Non-financial


Organisation is not a provider of services to CCGs. Should a situation

arise where the organisation is being discussed in a commissioning

capacity, the individual will be able to participate in some or all of the

discussion when the matter is being discussed but asked to leave the

meeting, or not take part where decisions are being taken. The action

taken should depend on the involvement of the organisation.


Corporation





London Borough of Hackney Employer Non-financial










Corporation





Member of Association of Directors of

Public Health London

Public Health Specialist Body Non-financial









Corporation





Member of Association of Directors of

Public Health UK

Public Health Specialist Body Non-financial








Jaime Bishop 20/01/2017 Associate Lay Member and Chair of the Primary Care

Committee (Formerly the LGPPCC)

Barretts Grove Surgery Registered patient at CHCCG member practice Barretts

Grove.

Non-financial

personal interest

Should a situation arise where the GP provider is being specifically

discussed in a commissioning capacity by the CCG, the individual will be

asked to not take part in discussions, leave the room when the relevant

matter is being discussed and/or when any decisions are being taken.

The action taken should depend on the involvement of the GP provider.

NHS City and Hackney Clinical Commissioning Group

February 2018 Register of Interests

Last Updated 14/02/2018

Declarations more than six months out of date are indicated in an italic type. Please complete a declaration and return to the CCGs

Corporate Services on [email protected] as soon as possible.

of 184




Fleet Architects LTD Director and Shareholder. Fleet is an architecture

practice focussing primarily in public sector work

including housing, health and education.

Financial interest Organisation is not a provider of services to CCGs. Should a situation








Healthports Ltd Director and Shareholder. Dormant property

development company.









Pattern Investments Ltd Director and Shareholder. Property development

company co-owned by the directors of Fleet Architects

Ltd.







Christine Blanshard 06/11/2017 Secondary care consultant member of governing body Salisbury Hospital NHS Foundation

Trust

Medical Director at Salisbury Hospital NHS Foundation

Trust that does not hold any contracts with the CCG.

Non-financial











taken.

Dan Burningham 25/10/2017 Mental Health Programme Director East London NHS Foundation Trust Art

Therapies Service

Wife is employed as Head Art Therapist- if I was required

to assess the service or enagage in any comissioning

decisions relating to the service would defer to my CCG

colleagues.

Indirect interest Should a situation arise where the NHS provider is being specifically




The action taken should depend on the involvement of the provider.

Dan Burningham 25/10/2017 Mental Health Programme Director MIND Coach 2 managers within the organisation to develop

their leadership skills. I separate my coaching work with

my contractual relationship with MIND & I have made it

clear to my coachees

Non-financial


Should this charity be specifically discussed in a commissioning capacity,

the individual will be asked to leave the room or not take part in the

meeting when the matter is being discussed and when any decisions are

being taken. The action taken should depend on the involvement of the

provider in the matter under discussion.





taken.

of 184


Siobhan Clarke 24/11/2016 CCG Governing Body Registered Nurse Albion Care Alliance CIC Director Non-financial


Should this Social Enterprise provider be specifically discussed in a

commissioning capacity, the individual will be asked to leave the room

or not take part in the meeting when the matter is being discussed and

when any decisions are being taken. The action taken should depend on

the involvement of the provider in the matter under discussion.





taken.

Siobhan Clarke 24/11/2016 CCG Governing Body Registered Nurse Albion Healthcare Alliance LTD Director Non-financial


Should this private provider be specifically discussed in a commissioning









taken.

Siobhan Clarke 24/11/2016 CCG Governing Body Registered Nurse Albion Outlook Director Non-financial


Should this private provider be specifically discussed in a commissioning









taken.

Siobhan Clarke 24/11/2016 CCG Governing Body Registered Nurse Transform Research Alliance CIO Trustee of organisation which facilitates and promotes

research and engagement between its constituent

organisations

Non-financial








Siobhan Clarke 24/11/2016 CCG Governing Body Registered Nurse Your Healthcare CIC Managing Director & Shareholder for Provider of Health

and Social Care services for the NHS and Local Authority

commissioned provider

Financial interest Should this Social Enterprise provider be specifically discussed in a









taken.

Sue Evans 16/10/2017 CCG Associate Lay Member for Governance Worshipful Company of Glass Sellers of

London (City Livery Company)

Charitable Fund

Company Secretary/Clerk to the Trustees Non-financial

professional







of 184


Sue Evans 16/10/2017 CCG Associate Lay Member for Governance Loughton Youth Project (registered

charity)

Trustee and Treasurer Non-financial

professional







Sue Evans 16/10/2017 CCG Associate Lay Member for Governance Barts Health Trust Self and family are potential patients/users of hospital

health care services in the local area of the NE London

STP.

Non-financial

personal interest






Paul Fleming 23/12/2016 Healthwatch Hackney Chair Healthwatch Hackney Chair Non-financial


Should this Public and Patient Involvement partner organisation be

specifically discussed in a commissioning capacity, the individual will be

asked to leave the room or not take part in the meeting when the

matter is being discussed and when any decisions are being taken. The

action taken should depend on the involvement of the provider in the

matter under discussion.


attractive to this organisation, the individual will be allowed to

participate in some or all of the discussion when the matter is being

discussed but asked to leave the meeting or not take part when

decisions are being taken.Paul Fleming 23/12/2016 Healthwatch Hackney Chair Shakespeare Schools Foundation Director of Income Generation and Communications at

this registered charity that works to improve life skills of

young people

Non-financial








Anna Garner 16/10/2017 Head of Performance and Alignment Declared they have no Interest Declared they have no Interest N/A N/A

Clare Highton 25/10/2017 CCG Chair Body and Soul Daughter in Law works for this HIV charity. Indirect interest Should this Charity provider be specifically discussed in a commissioning





Clare Highton 25/10/2017 CCG Chair CHUHSE Sorsby and Lower Clapton Group Practice's are members Financial interest Should this Social Enterprise provider be specifically discussed in a









taken.

of 184


Clare Highton 25/10/2017 CCG Chair GP Confederation Sorsby and Lower Clapton Group Practice's are members

and shareholders

Financial interest Should this Community Interest Company provider be specifically

discussed in a commissioning capacity, the individual will be asked to

leave the room or not take part in the meeting when the matter is being

discussed and when any decisions are being taken. The action taken

should depend on the involvement of the provider in the matter under

discussion.





taken.Clare Highton 25/10/2017 CCG Chair Local residents Myself and extended family are Hackney residents and

home owner and registered at Hackney practices, 2

grandchildren attend a local school.

Non-financial

personal interest






Clare Highton 25/10/2017 CCG Chair Lower Clapton Group Practice (CCG

Member Practice)

Partner at a GMS and an APMS practices which provide a

full range of services including all GP Confederation and

the CCG's Clinical Commissioning and Engagement

contracts, and in addition child health, drug, minor

surgery and anticoagulation clinics. We host CAB, Family

Action, physiotherapy, counselling, diabetes and other

clinics. The buildings are leased from PropCo, and also

house community health services. The practices are

members of CHUHSE and the GP Confederation. Lower

Clapton is a teaching, research and training practice, and I

am a GP trainer. I am a member of the BMA and Unite.

One partner is a member of the LMC.

Financial interest Should this GP provider be specifically discussed in a commissioning









taken.

Clare Highton 25/10/2017 CCG Chair Sorsby Group Practice (CCG Member

Practice)

Partner at a GMS and an APMS practices which provide a

full range of services including all GP Confederation and

the CCG's Clinical Commissioning and Engagement

contracts, and in addition child health, drug, minor

surgery and anticoagulation clinics. We host CAB, Family

Action, physiotherapy, counselling, diabetes and other

clinics. The buildings are leased from PropCo, and also

house community health services. The practices are

members of CHUHSE and the GP Confederation. Lower

Clapton is a teaching, research and training practice, and I

am a GP trainer. I am a member of the BMA and Unite.

One partner is a member of the LMC.

Financial interest Should this GP provider be specifically discussed in a commissioning









taken.

Clare Highton 25/10/2017 CCG Chair Tavistock and Portman NHS Trust Husband is Medical Director of Tavistock and Portman

NHS FT which is commissioned for some mental health

services for C&H CCG.

Non-financial

personal interest










taken.

of 184


Clare Highton 25/10/2017 CCG Chair Daughter is a trainee Psychiatrist, not within the City and

Hackney area.

Non-financial

personal interest

Should this provider be specifically discussed in a commissioning









taken.

Neal Hounsell Not yet received CoL Director of Community & Children’s Services City of London Corporation Not yet received Not yet received Not yet received

Dr Prakash Kakoty Not yet received City of London HealthWatch Representative City of London HealthWatch Not yet received Not yet received Not yet received

Matthew Knell 19/10/2017 CCG Head of Corporate Services Queensbridge Group Practice (CCG

Member Practice)

Patient at Queensbridge Group Practice, a CCG member

practice.

Non-financial

personal interest






Glyn Kyle 05/01/2017 City of London HealthWatch Chair Age UK East London Trustee Non-financial


Should this Charity provider be specifically discussed in a commissioning









taken.

Glyn Kyle 05/01/2017 City of London HealthWatch Chair Age Concern Hackney Trustee Non-financial











taken.

Glyn Kyle 05/01/2017 City of London HealthWatch Chair Age Concern Newham Trustee Non-financial







Glyn Kyle 05/01/2017 City of London HealthWatch Chair Age Concern Tower Hamlets Trustee Non-financial







of 184


Glyn Kyle 05/01/2017 City of London HealthWatch Chair GLA Strategic Asset Panel Chair Non-financial








Glyn Kyle 05/01/2017 City of London HealthWatch Chair Heart of England Housing Association Independent Board Member Non-financial








Glyn Kyle 05/01/2017 City of London HealthWatch Chair Orbit South Housing Association Independent Board Member Non-financial








Glyn Kyle 05/01/2017 City of London HealthWatch Chair Paviors Company Liverymens' Committee Member Non-financial








Glyn Kyle 05/01/2017 City of London HealthWatch Chair Swan Housing Association Independent Committee Member Non-financial








Philippa Lowe 19/10/2017 CCG Joint Chief Financial Officer GreenSquare Group Board Member, Group Audit Chair and Finance

Committee member for GreenSquare Group, a group of

housing associations. Greensquare comprises a number

of charitable and commercial companies which run with

co-terminus Board.

Non-financial








Philippa Lowe 19/10/2017 CCG Joint Chief Financial Officer NHS Oxford Radcliffe Hospital Member of this Foundation Trust Non-financial

personal interest






Philippa Lowe 19/10/2017 CCG Joint Chief Financial Officer PIQAS Ltd Director at PIQAS Ltd, dormant company. Non-financial








Catherine Macadam 10/05/2017 Lay Member of Governing Body with responsibility for

Patient and Public Involvement

Ann Sanders Consultancy Services Ann Sanders, close friend, owner of Ann Sanders

Consultancy Services which does business with health or

social care organisations

Indirect interest Should this private provider be specifically discussed in a commissioning





of 184




Catherine Macadam,

Coaching/Mentoring and OD

Consulting

Owner/Sole Trader; occasional contracts with health and

social care organisations

Financial interest Should this private provider be specifically discussed in a commissioning









taken.

Catherine Macadam 10/05/2017

Lay Member of Governing Body with responsibility for


City and Hackney Carers Centre Volunteer and occasional sessional worker at City and

Hackney Carers Centre; carers “champion” within CCG

(as part of PPI role)

Non-financial











taken.

Catherine Macadam 10/05/2017

Lay Member of Governing Body with responsibility for


People Opportunities Ltd Associate for People Opportunities Ltd (POL); Deborah

West, close friend, part owner of POL; POL regularly does

business with health and social care organisations

Financial interest Should this private provider be specifically discussed in a commissioning









taken.



Volunteer Centre Hackney Contractor for Volunteer Centre Hackney Non-financial











taken.

David Maher 13/09/2017 CCG Acting Managing Director Cross sector Social Value Steering

Group

Convenor of Cabinet Office, DH, NHSE, PHE, RSA and

others - supporting Michael Marmot and the SDU reduce

improve life chances by supporting policy development

which reduces health inequalities.

Non-financial


Organisation is a public sector partner of the CCG. Should a situation







David Maher 13/09/2017 CCG Acting Managing Director Global Action Plan Board member: supporting environmental and social

sustainability.

Non-financial


Company is not active in the CCG area or provider of health services and

highly unlikely to provide services to CCG patients. Should a situation

arise where the provider is being discussed in a commissioning capacity

by the CCG, the individual will be asked to leave the room when the

relevant matter is being discussed and when any decisions are being

taken.

of 184


David Maher 13/09/2017 CCG Acting Managing Director NHS England, Sustainable Development

Unit

Social Value and Commissioning Ambassador: supporting

the development of sustainable commissioning models

Non-financial

personal interest



David Maher 13/09/2017 CCG Acting Managing Director Social Value UK Council member – supporting the promotion of social

value best practice and policy development

Non-financial




arise where the provider is being discussed in a commissioning capacity

by the CCG, the individual will be asked to leave the room when the

relevant matter is being discussed and when any decisions are being

taken.

David Maher 13/09/2017 CCG Acting Managing Director World Health Organisation Member, Expert Group to the Health System Footprint on

Sustainable Development

Non-financial


Should this NHS related organisation be specifically discussed in a





Gary Marlowe 16/10/2017 Planned care clinical lead, joint chair SW consortium,

member of Governing Body

British Medical Association (BMA) Chair of London Regional Council Non-financial









C&H GP Confederation Member, provider local NHS contracts Financial interest Should this Community Interest Company provider be specifically





discussion.





taken.Gary Marlowe 16/10/2017 Planned care clinical lead, joint chair SW consortium,


De Beauvoir Surgery GP partner/provider GMS contract Financial interest Should this GP provider be specifically discussed in a commissioning









taken.



Homerton Hospital/ Local GP practice Used by members of my family, including current on-

going care

Non-financial

personal interest








Labour party NHS campaigner Non-financial

personal interest

None applicable

Jonathan McShane 08/12/2014 London Borough of Hackney Councillor Health, Social Care and Culture,

Hackney Health and Well Being Board

Cabinet Member

Jonathan McShane 08/12/2014 London Borough of Hackney Councillor LBH, Hackney Health and Wellbeing

Board

Chair

Jonathan McShane 08/12/2014 London Borough of Hackney Councillor Shoreditch Town Hall Trust Director

of 184


Jane Milligan 02/01/2018 NHS North East London Commissioning Alliance Single

Accountable Officer

North East London Commissioning

Support Unit

Partner is employed substantively by NEL CSU as Director

of Business Development and from 2nd January 2018 on

secondment to NHSE as London Regional Director for

Primary Care.

Indirect interest Organisation is a provider of services to the CCG. Should a situation

arise where the organisation is being discussed in a provider capacity,

the individual will be able to participate in some or all of the discussion

when the matter is being discussed but asked to leave the meeting, or

not take part where decisions are being taken. The action taken should

depend on the involvement of the partner in the matter under

discussion.


Accountable Officer

NHS England Partner is employed substantively by NEL CSU as Director

of Business Development and from 2nd January 2018 on

secondment to NHSE as London Regional Director for

Primary Care.

Indirect interest Organisation is a commissioning partner of the CCG. Should a situation








Accountable Officer

Family Mosaic Housing Association Non-Executive Director at this housing association Non-financial



capacity, the individual will be asked to not take part in discussions or to

leave the room when the matter is being discussed and when any


involvement of the GP provider.


Accountable Officer

Stonewall Ambassador for this charity Non-financial








Accountable Officer

Peabody Housing Association Board Non-Executive Director at this housing association Non-financial









Accountable Officer

North East London Sustainability and

Transformation Partnership

Senior Responsible Officer for the STP Non-financial










Accountable Officer

Newham CCG Accountable Officer for this CCG Non-financial










Accountable Officer

Tower Hamlets CCG Accountable Officer for this CCG Non-financial









of 184



Accountable Officer

Waltham Forest CCG Accountable Officer for this CCG Non-financial










Accountable Officer

Barking and Dagenham, Havering and

Redbridge (BHR) CCGs

Accountable Officer for this CCG Non-financial









Deputy Joyce Nash 03/01/2017 Chairman of City of London Health and Wellbeing Board City of London Corporation Declared they have no Interest N/A N/A

Haren Patel 17/10/2017 Chair of CCG Clinical Executive Committee

GP Board Member of City & Hackney CCG

Prescribing Lead for City & Hackney CCG

Klear Consortia Lead of City & Hackney CCG

Member of NHS England Regional Medicine Optimization

Committee

Acorn Lodge Nursing Home NHS Service Provider for Acorn Lodge Nursing Home Financial interest Should this NHS provider be specifically discussed in a commissioning









taken.





GP Member of NHS England Regional Medicine

Optimization Committee

City & Hackney GP Confederation One of the paying members of the confederation Financial interest Should this Community Interest Company provider be specifically





discussion.





taken.Haren Patel 17/10/2017 Chair of CCG Clinical Executive Committee






City & Hackney Local Medical

Committee

GP Member of LMC paying subscription Non-financial













Latimer PMS Plus Practice (CCG

Member Practice)

Senior GP at this practice Financial interest Should this GP provider be specifically discussed in a commissioning









taken.

of 184








Newcare Pharmacy in Brent Joint Director with 4 other family members Financial interest Should this private provider be specifically discussed in a commissioning









taken.

Honor Rhodes 19/10/2017 CCG Lay Member Barton House Practice I, partner and one child are patients at Barton House

Practice (CCG Member Practice)

Non-financial

personal interest






Honor Rhodes 19/10/2017 CCG Lay Member Early Intervention Foundation Trustee and Company Secretary of Early Intervention

Foundation

Non-financial







Honor Rhodes 19/10/2017 CCG Lay Member Oxleas CAMHS Partner is Consultant Family Therapist at Oxleas CAMHS Non-financial

personal interest






Honor Rhodes 19/10/2017 CCG Lay Member Tavistock Relationships Employed as Director at Tavistock Centre for Couple

Relationships

Non-financial







Honor Rhodes 19/10/2017 CCG Lay Member The School & Family Works Special advisor (paid) to this charity Non-financial







Honor Rhodes 19/10/2017 CCG Lay Member Homerton University Hospital NHS

Foundation Trust

As of 16/10/2017, daughter is employed by HUHFT as

Assistant Psychologist in the Hackney Ark service

Indirect interest Should this service be specifically discussed in a commissioning capacity,

the individual will be asked to leave the room or not take part in the

meeting when the matter is being discussed and when any decisions are

being taken. With regards to wider services at this provider, no

significant conflict exists.

Mark Rickets 10/05/2017 North West Hackney Consortia Lead

Primary Care Quality Programme Board Chair (GP Lead)

GP Confederation Nightingale Practice is a Member Financial interest Should this Community Interest Company provider be specifically





discussion.





taken.

of 184




HENCEL I work as a GP appraiser in City and Hackney and Tower

Hamlets for HENCEL

Professional

financial interest









Homerton University Hospital NHS

Foundation Trust

CCG Representative on board of Governors Professional

financial interest

Should this Provider organisation be specifically discussed in a









taken.



Nightingale Practice (CCG Member

Practice)

Sessional GP Financial interest Should this GP provider be specifically discussed in a commissioning









taken.

Geoffrey Rivett 20/11/2016 City of London HealthWatch Representative Declared they have no interest Retired; no financial or other conflicts of interest N/A N/A

Fiona Sanders 19/01/2017 LMC Chair

GP Partner

Arsenal Football Club Contractor Non-financial









GP Partner

Heron Practice GP partner Financial Interest Should this GP provider be specifically discussed in a commissioning









taken.


GP Partner

NHS England GP appraiser Non-financial




joint management of commissioning) capacity, the individual will be

able to participate in some or all of the discussion when the matter is

being discussed but asked to leave the meeting, or not take part where



Silvia Scalabrini 23/10/2017 Engagement Manager, NHS City and Hackney CCG Declared they have no Interest Declared they have no interest N/A N/A

Jenny Singleton 05/01/2017 CCG Head of Quality Declared they have no Interest Declared they have no Interest N/A N/A

Sunil Thakker 16/10/2017 CCG Joint Chief Financial Officer Declared they have no Interest Declared they have no Interest N/A N/A

of 184


Jonathan Gruffydh Williams 27/02/2017 Director, Healthwatch Hackney, engaged with following

CCG meetings: CCG Governing Body, Patient and Public

Involvement Committee, Mental Health Programme

Board and Local GP Provider Contracts Committee

Healthwatch Hackney Director of Healthwatch Hackney (public voice

organisation for Hackney residents on issues of health

and social care), lead organisation, responsible for

strategy and operational management and fundraising

Non-financial


Should this Public and Patient Involvement partner organisation be

specifically discussed in a commissioning capacity, the individual will be

asked to leave the room or not take part in the meeting when the

matter is being discussed and when any decisions are being taken. The

action taken should depend on the involvement of the provider in the

matter under discussion.


attractive to this organisation, the individual will be allowed to

participate in some or all of the discussion when the matter is being

discussed but asked to leave the meeting or not take part when

decisions are being taken.Devora Wolfson 04/05/2017 Integrated Commissioning Programme Director Local Authority Pensions Fixed-term

contrat with London Borough of

Hackney on behalf of the partners

Pensions Non-financial


of 184

Paper Title Summary Board Assurance Framework (BAF)

Paper Author Matthew Knell

Lead Presenter Sunil Thakker


Following on from the January 2018 Governing Body discussion, the current BAF in its summary format is provided to the Governing Body for discussion.


For information and discussion


The Governing Body is hereby asked to: Acknowledge the highlights for consideration in the

summary paper; Consider and discuss the BAF itself and the impact

any of the indicated risks may have on the GoverningBodies discussions;

Make any requests or recommendations on furtherwork to be undertaken or refinement of the BAF.


In previous versions, at preceding Governing Bodies and Audit Committees.


The BAF is a living document and receives input from the across the CCG, Audit Committee and Governing Body. Specific changes to the BAF are recorded in Audit Committee and Governing Body minutes.

Chair: Dr Clare Highton Accountable Officer: Jane Milligan Accountable Officer: Jane Milligan

of 184

Board Assurance Framework Summary

Report to the Friday 23 February 2018CCG Governing Body

of 184

The Governing Body is receiving the summary Board Assurance Framework (BAF) report this month.

The Integrated Commissioning Boards (ICBs) are using a similar process to the CCG to monitor and address risk, with the workstreams taking ownership of risk and escalating through the Integrated Commissioning structure as required. The first substantial ICB discussion of this work is due in the February 2018 ICB meeting and the results of those discussions will be reflected in the March 2018 CCG BAF.

Further work is underway in the CCG to look at the dual processes and templates and come to agreement on how both teams should work in this area. The CCG has engaged RSM, our Internal Auditors in this discussion and changes to the CCGs BAF and risk management processes will be debated internally, with the Audit Committee and agreement sought from the Governing Body. The timetable towards completion of this work has been updated in this paper.

Background

of 184

Highlights for Consideration• Risk IH01 in the Integrated Commissioning section of the report has been removed from

the BAF following its movement from 15 to 10 residual risk score at the end of quarter three and as outlined in the January 2018 BAF update report;

• No risks have been added in February 2018;• No risks have changed in impact or likelihood from January to February 2018, however

risks GV06, PC01 and PHE03 have received narrative updates on current mitigations, actions and progress on work in these areas.

of 184

Timetable for BAF and risk workTask Responsible Deadline

Discussion with Integrated Commissioning governance team to confirm risk transfer and escalation processes

Matthew Knell / Matthew Hopkinson

21/02/2018

Comparison of ICB and CCG processes to inform options for future of CCG BAF and risk process

Matthew Knell 28/02/2018

Redesign of potential BAF format to take account of feedback, compatibility with ICB BAF and workstream risk registers


Production of standard potential CCG risk registers to promote easy escalation into the BAF


Paper to March 2018 Governing Body setting out options for the future focus and format of the CCG BAF and risk management processes


Update of CCG Risk Policy to take account of Integrated Commissioning and changes in risk management and BAF


New CCG BAF and Risk Management Policy to be presented to Governing Body


Any CCG / Integrated Commissioning staff training to be complete

Matthew Knell / Matthew Hopkinson

29/06/2018

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Residual

Risk Score

2016/17

Inherent

risk score

Risk

tolerance Q4 Q1 Q2 Q3 Q4

IC1 15 tbc 15 15 15 15 15

GV06 20 4 N/A N/A N/A 20 20

PC01 15 TBC N/A N/A N/A 15 15

PC02 20 TBC N/A N/A N/A 15 15

Objective 4 CCG Governance

Objective 5) Primary Care

Increased rental charges due to retrospective rent revaluation by lanlords could

erode available headroom and possibly cause a financial deficit situation

Objective 6) Productive Health Economy

Objective 3 Integrated Commissioning

Objective 2 Commissioning System Development

No risks to report on CCG GB BAF

Working with NHS property services and using their expertise in re‐negotiating

the value and terms and conditions of leases current and retrospective to

mitigate the liability to GPs and the CCG

Ensuring that the value of the rent increase propsed has been professionally

assessed by an independent party [property assessor] to ensure rent is in line

market value / value trends

Monthly meetings with NHS Property Services

Scrutiny of the lease renegotiation process for Hackney practices impacted

Ensure governance arrangements are watertight - Governance reviewed by

legal advisors and Auditors and Terms of Reference for the Transformation

Board and ICBs have been prepared for approval by statutory bodies in

February. Minutes of Governing Body, governance documents and escalation

of risks through a BAF vital.

Insufficiently robust framework of assurance provided by the ICBs to statutory

bodies delegating authority whilst retaining responsibility could result in them

not delivering their legal duties.

Adult Safeguarding Manager post is vacant leading to lack of advice and

support to staff and clinical leads. This could lead to wrong decisions and

absence of safeguarding actions, with risk of harm, lack of confidence and

reputational damage, as well as the CCG not being compliant with the Care Act

2014.

Head of Quality trained to level two Safeguarding Adults and MCA. Will

provide interim cover until post is filled. NHSE available to provide expert

advice on request. Post has been advertised and shortlisting now taking place

(Feb 2018).

CCG Governing Body Assurance Framework - February 2018

Further delays in getting ETTF funds released puts the Adams House

development at risk with potentially serious consequences on Springfield‐

Tollgate's ability to deliver its own core services. This also potentially has

financial consequences for the CCG

Draft leases have been issued and are awaiting signature. Once these are

agreed, monies can be relased and works commence.

Residual Risk Score 2017/18

Objective 1 Improve the health of our patients

Description

Risk movement Monthly progress on action plan (March)



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IH02 15 15 10 15 15 15 15

IH09 20 15 N/A N/A 10 15 15

20

16

PHE07

As a result of cuts to local authority statutory services there is the potential for

demand on Continuing Healthcare to increase placing a significant strain on

CCG finances.

20 9 16 20 20

20

20

Mechanism in place to review CHC care packages & forecast future activity.

Best practice would involve regular package reviews - Forecast Planning has

improved with a more refined process in place. There has been a slight

financial impact on the CCG as a result of the refined forecasting but the

process is now more accurate.

Carry our an independent review of the CHC service to better understand ways

which costs can be contained and a quality service delivered. Implement

recommendations via an action pla - Independent review of CHC underway.

Reduce patient waiting time through increase monitoring of performance

Discuss performance at PB meeting bi-monthly, minutes and papers. Discuss

monthly at FPC meetings, FPC Minutes and papers, F&A Report Produced

Monthly. PD review provider performance targets on a monthly basis, F&A

Report. Attend NEL CCB - Minutes . Contracts Team meet monthly with

Providers to discuss performance, and NEL Teleconference - Minutes of these

meetings

Increasing pressue on HUH to consistantly achieve the 62 day target - A letter

has been sent in December regarding FPC feedback on the HUH position that

patient choice of attending appointments is the primary reason for missing the

target.

Work with NEL CCB to address Bart's Performance issues - no current issues

Objective 6) Productive Health Economy

Objective 2 Commissioning System Development

Objective 3 Integrated Commissioning

As a result of increased pressure on the services in acute trusts there is a risk

that people will not be seen and/or treated in a timely manner (Constitution

rights - 18 weeks RTT, 62 Day Cancer waits) and may therefore experience a

less than optimal outcome and/or poor patient experience

PHE03

HUHFT has experienced significant increases in CYP Crisis attendance at A&E, a

large proportion of these cases relate to self harm : Oct = 7; Nov=10; Dec = 9;

Jan =17; Feb=21; Mar=20. Over half of those who die by suicide have a history

of self harm; this increase in CYP who are presenting for self harm significantly

increases City and Hackney's risk of high suicide levels in our young people later

in their childhood / adolescence, or in adulthood. This increase demand is also

impacting on the A&E 4 hour target.

Crisis workstream - CAMHS Alliance (Improving the crisis pathway) which links

with some of the MHPB's work with schools - Self harm reduction rates

evidenced by Audit data

24/7 all age crisis resolution / increase capacity in CYP Psych Liaison at HUH -

Improved management of self-harm and reduced re-attendance/ reduction in

repeat acts of self harm / reduction in A&E breaches

CAMHS Alliance Workstream deliverable - prevention through to Crisis

Pathway redesign

24/7 all age crisis resolution / increase capacity in CYP Psych Liaison at HUH

Ongoing work to develop a new model of integrating all primary care services -

expectation that this will protect GP resource;

CHUHSE contract budget has been modelled to accommodate increased hourly

rates required for interim, face to face Out of Hours GPs;

CEPN Enabler Group to explore ways to address challenges recruiting GPs.9 16 16

Ongoing difficulties in recruiting staff within OOH, A&E and Primary Care will

lead to - difficulties in covering rotas (OOH)

- increases in waiting time (A&E)

- inability to deliver enhanced services (Primary Care)

This impact on primary care capacity will place further strain on A&E through

increased attendance.

Transfer to the Integrated Commissioning Board in progress

1616

Objective 1 Improve the health of our patients

No risks to report on ICB BAF

No risks to report on ICB BAF

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PHE09 20 9 N/A N/A 20 20 20

Concessionary pricing & No cheaper stocks obtainable (NCSO) -applies to

concessions that the DoH grants for the reimbursement of specific drugs

prescribed in primary care. A number of factors - compounded by the MHRA

closing down a couple of generic drug manufacturers recently has put

significant cost pressures on CCGs' prescribing budget in recent months. In

C&H the cost impact of NCSO to us in the 1st 6 months (Apr-Sep2017) of

2017/18 is £692,347, thus forecast impact of £1.3M for 2017/18

Team will continue to review monthly the products within and the cost impact

of the national NCSO - and where possible attempt to 'forsee' any such cost

pressures & make recommendations for alternative products / brands as done

for pregabalin. Safe, less costly and reasonable alternatives may not be

available - as in case of olanzapine & quetiapine - Alternative products in use

and reduction in cost impact- this can be limited option.

Utilising Optimise Rx as new prescribing decision aid- will help to support giving

prescribers alternatives in a timely manner - as a central national team is

dedicated to identifying issues and offering alternatives to CCGs and

prescribers - Optimise Rx tool being piloted 18/12/17 till end of Jan2018; if

PPB agree to proceed with Optimise Rx - reports will show savings made.

Monthly reviews of NCSO products

Forward planning on shortages and demand

Optimise Rx

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Chair: Dr Clare Highton Accountable Officer: Jane Milligan Managing Director: David Maher

Paper Title

Accountable Officer / Managing Director update

Paper Author

Jane Milligan

Lead Presenter

Jane Milligan


Update from Jane Milligan to the February 2018 CCG Governing Body for information and discussion.


For Information


The Committee/Governing Body is hereby asked to: 1. Note and discuss the following paper.


N/A


N/A

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Accountable Officer update

Update to the February 2018 Governing Body

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North East London Commissioning AllianceWe held a further session on 14 February to help establish the NEL Joint Commissioning Committee. Although we ran this as an OD session, part of the session was simulating a JCC considering a number of reports around the planning guidance, maternity and a risk register. The session went well and showed good participation from all members taking a NEL approach to issues (rather than more parochial stances) with a strong focus on improving services and outcomes and making a difference. It also highlighted a number of areas to improve on before the JCC goes live including the layout of the room, the overall format of papers and having sharper, more action focused reports that are presented jointly by the lead JCC member and officers.The stocktake of arrangements across NEL CCGs is coming to the end of Phase 1 and I will be discussing with the CCG Chairs the particular areas to focus on to improve collaboration across NEL.We continue to work on our recruitment and I hope that we will advertise the permanent MD roles by the end of February I will be bring forward proposals for the Chief Financial Officer following further discussions with the CCG Chairs.I continue to get out and about meeting stakeholders and staff across North east London and I see this as a key part of my role. In the last few weeks I have met with LMC chairs and attended the ONEL Joint Overview and Scrutiny Committee. I have now met with a number of the PE groups and we are looking to form a network for PPE leads across NEL to learn from each other and spread good practice. With the planning guidance being published I have also attended workshops for the STP leads across London to consider the implications for London and how it can help promote our ambitions around integrated care partnerships. I also attended the ONEL Joint Overview and Scrutiny committee. I continue to meet with staff and by mid-April I will have attended all CCGs staff awaydays.

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Chair: Dr Clare Highton Single Accountable Officer: Jane Milligan

Paper Title

New Shared Commissioning Arrangements for North East London

Paper Author

Alan Steward, System OD and Transition SRO, BHR CCGs

Lead Presenter

Dr Clare Highton, Chair, NHS City and Hackney CCG

Paper Summary

The report asks the NHS City and Hackney CCG Governing Body to support proposals for new commissioning and governance arrangements across North East London. It builds on the updates provided at each Governing Body. This paper: Advises the governing body of the membership and

leadership of the shadow Joint Commissioning Committee. Sets out the proposed arrangements for establishing the

Joint Commissioning Committee including the Scheme of Reservation and Delegation

Sets out the constitutional changes required by NEL CCGs to establish the JCC and ensure it operates effectively.

Purpose For Discussion and approval

Recommendation

The Governing Body is hereby asked to: Note the membership and leadership of the Joint

Commissioning Committee Review and approve the Scheme of Reservation and

Delegation for the Joint Commissioning Committee Approve the proposed constitutional changes for consultation

with member practices.


There has been no presentation of this paper at any previous meeting for City and Hackney CCG. It builds on the reports provided to each Governing Body since September 2017. This paper will be presented to all 7 NEL CCGs in February / March 2018. This paper is the product of discussions across the 7 CCGs lead by the Single Accountable Officer and CCG Chairs.


N/A

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Introduction and Purpose

1. This report updates all North east London (NEL) CCG Governing Bodies on the establishment of the new commissioning arrangements. It builds on the previous Governing Body reports and discussions at Board Development sessions and the shadow meetings of the Joint Commissioning Committee. The paper recommends that GBs agree formally to establish the Joint Commissioning Committee and move to consult with member practices to amend CCG constitutions to allow these changes.

2. These new arrangements are vital to deliver North east London’s:

Strategic alignment with the NHS Five Year Forward View and in particular the commitment to develop Accountable Care Systems (ACS)

Sustainability for the whole system including providers, commissioners and partners Improvements in outcomes, quality and performance and reducing variation across

North east London. North East London Commissioning Arrangements

Governance 3. The proposed new commissioning arrangements require robust North east London

governance. This is being driven through a wider group of CCG lay members and partners. Through a number of engagement sessions the proposals have been developed to provide the further detail needed to recommend the required NEL CCG governance and any changes. These are how the Joint Commissioning Committee will be established and work with the seven CCG Governing Body’s and sets out how decision making will happen. It is recognised that the future Integrated Care System will require integrated commissioning arrangements with Councils. The Joint Commissioning Committee membership includes non-voting local authority representation. The membership of the JCC is set out below.

CCG Chair Lay Member LA Rep

Barking & Dagenham

Kash Pandya (acting Chair until elections complete)

Kash Pandya Mark Tyson

Havering Dr Atul Aggarwal Richard Coleman Mark Ansell Redbridge Dr Anil Mehta Khalil Ali Adrian Loades City & Hackney Dr Clare Highton.

Mark Ricketts (new Chair from 1 April 2018)

Sue Evans Ellie Ward (City of London) Gareth Wall (Hackney)

Waltham Forest Dr Anwar Khan Alan Wells Linzi Roberts-Egan Newham Dr Prakash Chandra Andrea Lippett Grainne Siggins Tower Hamlets Dr Sam Everington Noah Curthoys Denise Radley

Recruitment of the Nurse and secondary care consultant will commence in March.

4. At the December GB meeting, the Terms of Reference of the Joint Commissioning

Committee were agreed to operate in shadow form through to March 2018. The JCC has met twice in shadow form. Firstly with all Chairs and Lay Members to focus on the key elements where further clarity and develop a joint understanding of the role and responsibilities so the JCC. The second meeting included the proposed CCG members of the JCC (Chair and Lay Member) and included a session in shadow form to look at the requirements needed to have an effective JCC before it goes live in April 2018. The final terms of reference will be submitted to GBs in March to allow an April go-live. This will reflect the lessons learned from the shadow sessions.

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Leadership of Joint Commissioning Committee 5. A part of establishing the NELCA Joint Commissioning Committee and under its

Shadow Terms of Reference agreed at all GB in December 2017, three leadership positions were agreed. These are: 1. Chair to be selected and elected by the CCG Chairs only 2. Deputy-Chair to be selected by the Chair from the CCG chairs. 3. Vice Chair must be a Lay Member to chair any meetings or undertake any other

duties where the Chair / Deputy has a COI or a perceived COI. The Vice Chair is to be selected and elected by the Lay Members alone.

6. The CCG Chairs and Single Accountable Officer agreed the job description for the Chair

of the JCC and this is attached at Appendix A.

7. Nominations were invited from the shadow JCC members with provision to run a ballot should there be more than one nomination for each position. Only one nomination was received for the Chair and Vice-Chair and subject to ratification at the JCC’s first formal meeting, these will be agreed. The Chair will be Dr Anwar Khan and the Vice Chair will be Kash Pandya. Dr Khan has selected Dr Prakash Chandra to be his deputy through to the end of his term as a CCG Chair (June 18). From July 18, he has selected Dr Anil Mehta to be his deputy.

Constitutional Changes 8. To establish the new joint commissioning arrangements requires changes to some CCG

constitutions. The changes required to each CCG constitution to enable the Joint Commissioning Committee and the Single Accountable Officer to operate within the framework agreed by the seven CCGs are set out below. The proposed changes reflect the advice given by each Governing Body when making the original decision to increase collaborative working in 2017 plus the advice received from the solicitors Capsticks and Beachcroft.

9. CCG GBs will then need to consult with member practices to approve the changes. In

so doing the previous legal advice provided by legal representatives has been taken into account. As this will require constitutional changes we have also taken the opportunity to reflect the latest Conflict of Interest guidance and update the Primary Care Commissioning Committee’s terms of reference where relevant as this does not apply to all CCGs. There will also be a proposed terms of reference for Committees in Common. This is a matter of good governance to ensure that there is a common understanding of how Committees in Common will function in North East London. The section will also deal with voting and with the process to elect a Chair.

10. Scheme of Reservation and Delegation (App B) sets out the services and functions that

the NEL CCG Governing Bodies wish to delegate to the newly established Joint Commissioning Committee. These align to the outline scheme of delegation proposed in the September 2017 Governing Body report.

Single Accountable Officer / Managing Director 11. The existing Constitutions allow the CCG to share staff with other CCGs for delivering

commissioning functions in the section “Joint commissioning arrangements with other Clinical Commissioning Groups”. These clauses do not extend to allow the joint appointment of a single Accountable Officer for the seven CCGs as membership of the Governing Body and responsibility of non-commissioning functions are outside their remit.

12. The ability of the single Accountable Officer to attend all the meetings of the seven member Councils, Governing Bodies and their committees will be challenging. It is

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inevitable that a number of management techniques will need to be used to allow the normal operating of the governance functions for the CCGs. In most cases careful integrated planning between the Governing Body secretaries will be sufficient and easily undertaken within the existing Constitution powers. There are however three techniques that require amendments to the Constitution: Deputisation for Joint Appointments Joint Commissioning Committee Committees in Common

13. It is expected that the management of the CCGs functions will be split between those that could benefit from an economy of scale and therefore be handled at a NEL CCG level, whereas other functions remain best managed by a local CCG team. Senior managers would be required to lead both the NEL teams and the local teams. The Managing Director from each of the CCGs would be nominated as a deputy for the Accountable Officer and provide the necessary cover at a Governing Body / Committee meeting. There are a number of advantages of having a named deputy in each CCG, rather than appointing an additional local senior CCG manager to the Governing Body. These advantages are: The existing balance of clinical/non-clinical membership remains unchanged. The Accountable Officer continues to retain the accountability and consistency of the

input to decision-making from the staff. It is considerably easier to maintain the quorum for governing body / committee

meetings.

14. As a result of the newly created Managing Director post, the CCG constitutions will be amended to reflect the respective responsibilities of the Accountable Officer and Managing Director including financial thresholds. It is proposed to move to a standard form across NEL that sets out the responsibilities at each level.

Joint Commissioning Committee 15. The NEL CCGS have agreed to set up a Joint Commissioning Committee (JCC) to

enable collaborative commissioning for the whole of North East London.

16. The CCG Constitution template has a section titled: “Joint commissioning arrangements with other Clinical Commissioning Groups”. This is present in all NEL CCG constitutions. The provisions of this section should be sufficient to enable each CCG to establish a JCC and committees in common. However for some CCGs, it is necessary to name them in the main body of the constitutions as a generic new committee clause is absent. Since it is likely that the JCC will be making significant strategic decisions, it would be good practice to add the JCC to the list of Governing Body committees in the main body of all NEL CCG Constitutions.

17. All seven CCG constitutions must specify how the governance of the JCC operates and what functions have been delegated to it. This information is recorded in the Constitution appendices: “Scheme of Reservation and Delegation” and referenced in the JCC’s “Terms of Reference”.

18. The attachments for the Scheme of Reservation and Delegation (SORD), Joint Commissioning Committee (App B), sets out the key function of the Joint Commissioning Committee to provide assurance that there will be no duplication with CCG Boards. The SORD JCC will be reviewed towards the end of 2018/19 to ensure that it reflects accurately the role of the Committee.

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Committees in Common 19. The Joint Commissioning Committee has a number of limitations and in order for the

Single Accountable Officer to work effectively across North East London, the Constitutions need to add a greater degree of collaborative flexibility. This can be achieved through the use of “Committees in Common” arrangement.

20. A “Committees in Common” arrangement is where the same committee from more than one CCG meets at the same time, same place with the same agenda and makes the same decisions.

21. The limitations of the Joint Commissioning Committee are: Legally, it can only consider commissioning functions To be quorate it must have all CCGs present. This makes it difficult to decide upon

matters that involve only six or fewer CCGs. It is unable to include other CCGs in its decision making on an adhoc basis.

22. By contract the “Committees in Common” arrangement may:

Consider any function or use any power delegated by the Governing Body to the specific committee that is meeting in common.

Set up an arrangement of any two or more CCG committees as required by the matter to be decided upon;

Invite the same committees from non-NEL CCGs to join a “Committees in Common” arrangement as required by the matter to be discussed.

23. Technically, there is no requirement for any change of an individual CCG Constitution to enable the use of the “Committees in Common” arrangement. In its purist form, each of the same committees hold their meeting at the same time in the same place with the same agenda and each has its own set of minutes.

24. However there are some practical details that make the use of the purist form of “Committees in Common” impractical. These are: A meeting is not effective if it has more than one chair person and especially if there

are seven chair persons. A meeting is not effective if there is a very large number of members present. A meeting is not effective if there are more than one sets of Terms of Reference. A meeting is not effective if the Governing Body has a perception that there is a

majority vote that overrules its committee’s decision.

25. A solution to these shortfalls is to provide in the CCG Constitution enabling clauses. These give consent / encouragement to the CCG’s Committees to work collaboratively with the same committee in other CCGs. It also provides an addendum to all CCG committee Terms of Reference setting out how the “Committees in Common” meeting will be conducted.

26. The detailed recommendations for change to constitutions are set out below. 27. Recommendation 1: The following clause is added to the NEL CCG Constitutions at the

section listed below the text:

X.X Joint Appointments with other Organisations The CCG may make joint appointments including joint appointments with other CCGs. Any such joint appointments will be supported by a memorandum of understanding between the organisations that are party to these joint appointments.

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Where a Joint Appointment is made, the appointee may choose a named deputy in each of the CCGs. The named deputy must be agreed by the chair of the Governing Body.

CCG Insertion Point Barking & Dagenham CCG:

After 7.9 (Deputy clause only)

City & Hackney CCG: After 7.4 (nb 7.14 covers is a different issue) Havering CCG: After 7.9 (Deputy clause only) Newham CCG: After 7.3 (Except first sentence.) Redbridge CCG: After 7.9 (Deputy clause only) Tower Hamlets CCG: After 6.5 Waltham Forest: After 7.9 (Deputy clause only)

28. Recommendation 2: The following line is added to the NEL CCG Constitutions, where

appropriate, at the section listed below the text: Heading Number Current Joint Arrangements Sub- Heading No. Joint Commissioning Committee The Joint Commissioning Committee has been established to include the seven North East London CCGs. The committee will exercise such commissioning powers as are delegated to it by the Governing Body and set out in the Scheme of Reservation and Delegation approved by the Governing Body. Any decision must be made unanimously (as described by the Committee Terms of Reference) with the other partner CCGs listed in the Terms of Reference. CCG Insertion Point Barking & Dagenham CCG:

After 6.6.11.8 becomes 6.6.12

City & Hackney CCG: After 7.6.1 becomes 7.6A (or 7.7 with all future paragraphs increased by one)

Havering CCG: After 6.6.11.8 becomes 6.6.12 Newham CCG: After 6.7.11 becomes 6.8 Redbridge CCG: After 6.7.11.8 becomes 6.7.12 Tower Hamlets CCG: Replace whole of section 6.7.12 and replace 6.7.12 with

“Not Used” Waltham Forest: After 6.5.4d New Heading 6.5.4e

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29. Recommendation 3: The following line is added to the NEL CCG Constitutions “Scheme of Reservation and Delegation” at the section listed below the text using one of the formats:

Policy Area Decision Joint

Commissioning Committee

COMMISSIONING & CONTRACTING FOR CLINICAL SERVICES

The committee will exercise such delegated powers as are transferred to it by the Governing Body and set out In the Terms of Reference approved by the Governing Body. Any decision must be made unanimously (as described by the Committee Terms of Reference) with the other partner CCGs listed in the Terms of Reference.

30. Recommendation 4: The JCC Terms of Reference with its Schedules and Annex are

added as an appendix to each of the NEL CCG Constitutions. 31. Recommendation 5: The following paragraph is added to the NEL CCG Constitutions,

where appropriate, at the section listed below the text: Committees in Common Arrangement

All Governing Body Committees may meet with similar committees of other CCGs, using the “Committees in Common” arrangement, where the committee chair considers there is a value of working collaboratively on one or more specific issues. When the Committee Chair chooses to meet using a “Committees in Common” arrangement, the additional Terms of Reference for “Committees in Common” will be applied to the usual Committee’s Terms of Reference.

32. Recommendation 6: The Terms of Reference Addendum for the use of a “Committees

in Common” meeting arrangement (Appendix B) is added as an appendix to each of the NEL CCG Constitutions.

33. Recommendation 7: The following clauses add the requirement for a Conflict of Interest

Guardian to the Constitution

The CCG shall appoint a Conflict of Interest Guardian who will normally be the Audit Committee Chair and whose responsibilities shall be to: a) Act as a conduit for GP practice staff, members of the public and healthcare

professionals who have any concerns with regards to conflicts of interest; b) Be a safe point of contact for employees or workers of the CCG to raise any

concerns in relation to this policy; c) Support the rigorous application of conflict of interest principles and policies; d) Provide independent advice and judgment where there is any doubt about how to

apply conflicts of interest policies and principles in an individual situation; e) Provide advice on minimising the risks of conflicts of interest.

34. Recommendation 8: To approve for recommendation to member practices the draft

CCG constitution that sets out all the changes required.

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Next Steps

35. To ensure that the North east London commissioning arrangements are implemented formally from 1 April 2018, the following next steps are proposed. CCG GBs undertake consultation with member practices to approve the

constiutional changes JCC continues to meet in shadow form with lessons learnt being submitted to CCGs

in March for final proposals. Recruitment commences on the vacant JCC positions of nurse and secondary care

consultant Appendices Appendix A – JCC Chair of Chairs JD Appendix B – Scheme of Reservation and Delegation Appendix C – Addendum for Committees in Common Appendix D – Addendum for Primary Care Committees

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NEL Chair of Chairs of Joint Commissioning Committee Job Description

Job purpose The Chair of Chairs will be responsible for leading the NEL Joint Commissioning Committee (JCC) and the collective commissioning arrangements in the ELHCP. This will involve providing strategic direction, leadership and influence, clinical engagement, financial management and service redesign and development. An overview of NEL clinical areas will be required to influence and deliver the NEL commissioning strategy initiatives with NEL CCG chairs and wider clinical leaders. The Chair of Chairs must: Lead the NEL JCC to:

drive improvements in health outcomes and experience of care for local people and reduce variation in quality and services in NEL

drive sustainability for NEL commissioners, providers and partners align and deliver the NHS Five Year Forward View and develop accountable care systems ensure that services commissioned by the NEL JCC align with those commissioned locally so that

a coherent clinical strategy is in place

Engage with NEL CCG Chairs and other clinical leaders and organisations to deliver the priorities set out in the NEL Commissioning Plan and ensure effective CCG and clinical participation to accelerate the improvements in health services.

Ensure that NEL has appropriate arrangements in place to exercise its delegated functions effectively,

efficiently and economically and in accordance with the principles of good governance. Enable NEL to develop further its commissioning capability and track record of delivery.

Work collaboratively with counterpart clinical leadership roles across London to support the devolution

agenda Job role The Chair of Chairs of the NEL JCC will be NEL CCGs Clinical Leader and the role and responsibilities will include those as set out in Section X of NEL CCGs’ Memorandum of Understanding (MOU). The Chair of Chairs’ roles and responsibilities will also include:- Leading the NEL JCC, ensuring it discharges its duties and responsibilities as set out in the NEL

CCGs’ MOU / Terms of Reference - in conjunction with the Single Accountable Officer and supported by the Director of Strategic Commissioning

Ensuring proper constitutional and governance arrangements are in place and support the Single

Accountable Officer in upholding these Work with the Vice Chair (Lay Member) to ensure any potential conflicts are managed

Lead the building of the shared vision of the aims, values and culture of the NEL JCC taking account of

the views of local people and stakeholders To act as ambassador and champion for NEL CCGs. Providing the support to foster the development of local accountable care systems, integrated

commissioning and provider collaboration

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Engage actively with local people, clinicians and community representatives to shape NEL health services by promoting co-design and collaboration between clinicians, practitioners and local people.

Act as convener and champion for NEL and the NEL JCC at local, regional and national meetings and

events including regional assurance meetings with regulators To lead the planning and delivery of opportunities to improve health outcomes across NEL by linking to

the NEL clinical senate and ensuring its plans are delivered

To promote and champion with providers the delivery of high quality and cost effective services to improve health outcomes and satisfaction with local health and social care services.

To ensure transparency and personal accountability for all NEL JCC decisions including finance, quality and performance.

To communicate effectively with constituent CCGs and wider stakeholders to deliver the NEL JCC commissioning plan through co-design and collaboration.

To role model the values and ambitions of the NEL JCC To lead the regular evaluation of the performance of the NEL JCC, its sub-committees and members

To undertake the objective setting and appraisal with the SAO on behalf of all CCG chairs

To ensure the effective flow of business between the NEL JCC and CCG Governing Bodies

Establish the operating model for specialised and services commissioned by the NEL JCC.

Key Deliverables Chair 80% of NEL JCC formal meetings Prepare and deliver the Chair’s Annual Report on the NEL JCC business and achievements To manage the NEL JCC business effectively and to the highest standards of governance particularly

around conflict of interest and confidentiality Provide leadership, advice and guidance to NEL JCC members Objective setting and appraisal for the SAO Work with the SAO to ensure the NEL JCC is effective and undertake set the objectives and undertake

appraisals of NEL JCC members Support and encourage NEL JCC members to monitor, scrutinise and challenge on the business of the

NEL JCC

To deliver its agreed strategic objectives, improved health outcomes; reduced health inequalities and improved quality and patient experience

Engagement with clinical and practitioner leaders to promote collaboration and joint working

Close and effective working with the local authority leaders (political and executive) on joint

commissioning and the integration of services Foster and promote transparent accountability within NEL JCC member organisations, wider ELHCP

members and NHSE

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Promote the sustainable, effective and efficient use of resources to deliver the NEL commissioning strategy

Put a focus on local people at the heart of the NEL JCC and especially disadvantaged groups

This job description gives a general outline of the post and is not intended to be inflexible or a final list of duties. It may therefore be amended from time to time in consultation with the post holder. Tenure The appointment would be for 2 years. Remuneration The Chair of Chairs would be expected to undertake their duties within 1 session per week. This would be additional to any other duties they were required to carry out for their “home” CCG. Remuneration would be in line with their “home” CCG.

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Person Specification Criteria Essential Desirable Education and knowledge

Knowledge of NHS Governance systems, codes of practice etc.

Knowledge of establishing corporate structures and frameworks

Experience

Chairing complex professional meetings at a senior level and ability to chair in an efficient manner

Significant experience of working with boards Experience in resolving transactional

conflicts to deliver both high quality services and the highest value for money for stakeholders

Experience of working across agency and professional boundaries and collaborative and partnership working

Experience of chairing a similar board

Experience of chairing joint committees

Experience of working with professionals and members of the public to improve services and create value for money for stakeholders

Experience of managing strategic change in a political context

Skills

Communication skills: interpersonal presenting, media relations, maintaining a positive public and professional profile.

Ability to influence key stakeholders and decision makers in a multi-agency/partner environment.

Assertive, Clear thinking and able to negotiate.

Ability to generate and develop good working relations across partnership board member organisations at Board and senior management levels.

Problem solving skills: Ability to identify issues and areas of risk and lead partners to effective resolution and decision.

Chairing skills: Ability to organise, co-ordinate and follow through on key decisions, manage competing or differing views and positively challenge to achieve the desired outcome.

Significant skills in negotiating to assist in managing and resolving conflict.

Ability to recognise discrimination in its many forms and promote Equal Opportunities policies within the operation of the NEL JCC.

Ability to ensure high standards of confidentiality in terms of individual cases and sensitive cross organisational matters.

Enthusiasm, commitment and a determination to carry forward a complex agenda.

Ability to enthuse and gain the commitment of others.

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Appendix B

Scheme of Reservation & Delegation (Functions related to NEL Commissioning arrangements)

This Scheme of Reservation & Delegation relates primarily to those functions considered as part of the North East London Commissioning arrangements and provides clarity on some of the other key issues to avoid any misunderstandings. It is not intended to be a comprehensive scheme relating to all CCG functions and responsibilities.

Delegation from

Members Practice

CCG Board -

Services Functions Joint

Commissioning Committee -

Services

Functions

Children’s services (NHS and joint)

Business cases and service change requests

Needs assessment and demand and capacity planning

Procurement Contracting and

contract management

Joint work with LA Setting outcomes for

providers Outcome monitoring Decommissioning

services Consultation and

engagement – local people, members, local organisations (providers, councils, VCS)

Specialised commissioning

Business cases and service change requests

Needs assessment and demand and capacity planning

Contracting and contract management

Joint work with LA Setting outcomes for

providers Outcome monitoring Decommissioning

services Consultation and

engagement – local people, members, local organisations (providers, councils, VCS) – done via local CCG arrangements

Primary care development, contracting, prescribing

LAS

Termination of Pregnancy

IUC

Joint Commissioning with LA – Learning Disability / CHC / prevention / elderly / BCF

Maternity Planning

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Delegation from Members Practice

CCG Board -

Services Functions Joint

Commissioning Committee -

Services

Functions

Community Services contracting

Mental health (acute beds only)

MH contracting – except inpatients

NHSE assurance (except through exception done elsewhere eg A&E)

Acute Commissioning and contracting (local)

Approve ACS framework

Borough workforce delivery

Integrated Care Development

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2018/19 JOINT COMMISSIONING COMMITTEE – DETAILED SCHEME OF DELEGATION The Scheme of Delegation 2018-19 sets out those functions that are to be delegated by the CCGs to the JCC and those that are reserved for individual CCGs. It is intended to be reviewed in March 2019 at which time other functions may be delegated. As the experience of CCG Boards suggest there is unlikely to be many votes taken, in the unlikely event that there is, the Joint Commissioning Committee membership and voting system relies on all CCGs agreeing with a proposal for recommendations to be implemented. It is also the case that the subsidiarity principle applies and that the Joint Commissioning Committee will be dealing with matters that apply to all or most of the CCGs. The functions identified below emanate from previous discussions with Chairs and are reflected in the terms of reference of the JCC. There are also a series of corporate functions such as financial, quality and performance that would be core activity for any key commissioning body. Finally, it is the case that the scheme will need to be regularly reviewed to ensure that the JCC is considering issues that allow the Committee to fulfil its role. It is also a recognition that some issues will only become material once the Committee starts meeting formally. The Joint Commissioning Committee will have the following role for services and budgets delivered across NEL CCGs. With respect to the Sustainability and Transformation Plan (STP) Operational responsibility for the work which needs to be undertaken to implement

the STP Strategy and Priorities from the commissioners perspective that impact on all seven CCGs and in so doing integrate into the STP process as the representative voice of NEL CCGs.

With respect to the commissioning of LAS, 111, and Specialised Services Approve a common NEL wide Commissioning Strategy for these services Approve needs assessment, demand management and capacity planning

assumptions Approve a commissioning plan for each service Approve arrangements for consultation and engagement with Patients, Providers,

Local Authorities and Members Review and monitor recovery plans for pathways or contracts that are significantly

off track Approve the decommissioning of delegated services Approve the contracting approach with Providers and any contract management in

relation to those contracts Approve financial contributions and incentive payments Approve the business cases. With respect to Maternity Services Approve Maternity Services Capacity Planning for NEL With respect to NHSE Assurance Approve assurance process and approach with CCGs that feeds into the NHSE

assurance process.

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With respect to Infrastructure Approve NEL Workforce strategy to support the commissioning and financial strategy

and monitor progress and implementation Approve IT digital Strategy for NEL to support the commissioning and financial

strategy and monitor implementation Approve Estates Strategy framework for NEL CCGs and monitor implementation of

the action plan

With respect to Financial Strategy Approve JCC Financial Strategy and ensure alignment with the STP Financial

Strategy Approve Provider Payment Mechanisms to replace Payment by Results Approve revised payment mechanism strategy for acute services To adopt risk sharing agreements for CCGs that take into account the services

commissioned locally and their effectiveness Approve core financial processes, timetable and plans including operating financial

plans, CCG and STP Financial strategies and agreements, budget setting and risk assessment.

Monitor and oversee programme, administrative, collaborative (STP/TST etc.) and capital budgets and financial performance.

Review business cases and proposed procurement financial components for services within the remit of the JCC to ensure appropriate identification and management of financial risk (including QIPP schemes, Transformation schemes, investment proposals and funding bids).

Identify and recommend allocation or reallocation of resources where appropriate for services within the remit of the JCC to improve performance or ad hoc performance and financial issues that may arise.

Review reporting arrangements to ensure these remain fit for purpose and appropriate to meet the JCC accountabilities and assurance in collaborative arrangements.

With respect to Quality and Performance Continuous improvement in the quality of services commissioned on behalf of the

CCGs through the development of a common quality assurance and reporting framework and quality improvement strategy

For consideration in 2019/20 There are a number of other possible areas that could be included in the scheme of delegation but should be considered as part of the review for 2019/20. In particular: Approve a Provider Commissioning Framework to align Acute Services across NEL Approve an Alignment Framework for the development of Out of Hospital and

Primary Care at Scale Approve needs assessment, demand and capacity planning, provider outcomes

and outcome monitoring for these strategies Agree the contracting approach to acute and mental health providers New and revised clinical pathways for services that impact upon all or most of the

CCGs It should be noted that local acute responsibilities will continue to stay with CCGs.

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Appendix C

XXX CCG(Add name of CCG) Terms of Reference

Addendum for Committees in Common arrangement

Introduction 1. This Terms of Reference Addendum is to be added to the CCG’s Committee Terms of Reference,

when the Committee wishes to meet with other similar committees from other CCGs using the “Committee in Common” (CIC) meeting arrangement. The terms in this paper should be read in conjunction with the main Terms of Reference of the Committee wishing to use them.

2. The CCG has a number of established Governing Body Committees. The NEL CCG Governing Bodies have instructed that their Committees may meet using a CIC arrangement where the business is common to two or more CCGs. These additional Terms of Reference set out the special membership, remit, responsibilities and reporting arrangements of a meeting using the CIC arrangement and are incorporated into each Clinical Commissioning Group’s Constitution.

Purpose 3. The purpose of the Committee wishing to use the CIC meeting arrangement remains unchanged

from its Terms of Reference and the Scheme of Reservation and Delegation.

4. The CiC may consider any matter that is of interest to two or more CCGs.

5. The CiC has the same authority, as its constituent committees, to commission any reports or surveys it deems necessary to help fulfil its obligations.

Membership 6. The CiC membership is made up of:

The participating CCG Committees (Voting)

Meetings 7. The CiC will adopt the Newham CCG Standing Orders relating to the conduct of meetings, agendas

and declaration of interest with the exception of the clauses in this addendum.

Meeting Chair 8. The CiC membership will appoint a CCG lay member to be the chair.

Frequency 9. The Committee Chairs will agree an annual schedule of meetings with the CiC meeting secretary.

The programme will be circulated to all CiC members.

Quoracy 10. Quorum for each of the participating committees will be the current quorum specified for each CCG

within their current terms of reference.

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Decision making 11. A decision made at a CIC meeting shall be binding on the constituent CCGs when the following

criteria have been met:

The decision is within the bounds of the CIC delegated functions;

Each CCG Committee has one vote;

A decision has been unanimously agreed.

Voting 12. Voting will be by consensus with the outcome clearly recorded in the minutes of each Committee.

13. Should the participating Committees have a differing view and decision, a vote will be taken with each CCG Committee having one vote. A record will be made in the minutes and the item deferred to the following meeting with advice sought from the participating CCG Chairs.

14. Should consensus still not be achieved at the next meeting, the decision made will represent that of each of the individual Committees. A record of the decisions will be added to the minutes and a notification made to each of the CCG Governing Bodies. For clarity, in this scenario the different decisions of each of the committees are not binding on the other participating CCG Governing Bodies.

In Attendance 15. The CiC Convenor will agree with the Committee Chairs the attendance of other individuals required

to enable effective decision-making.

16. Where individuals attend a CiC meeting, this will be noted as “in-attendance” in the minutes.

Conflicts of Interest 17. For clarity - The Conflicts of Interest policies of Newham CCG apply to the working of the CiC.

Reporting arrangements 18. The minutes of the CiC will consist of a set of identical minutes for each of the participating CCGs.

19. The minutes of each Committee will be reported to each of the participating Governing Bodies for information when agreed as accurate by the CiC. The individual CCG reporting arrangements to the Governing Body is set out in their Constitution.

20. The CiC will present an Annual Report to each Governing Body on the actions taken by the CiC to comply with its Terms of Reference.

Administration 21. Support for the CiC will be arranged by the Accountable Officer.

Review of Terms of Reference Addendum 22. The Committee will review this Terms of Reference Addendum annually at one of its meetings.

Changes in the Terms of Reference Addendum need to be approved by each Governing Body and reflected in each CCG’s Constitution.

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Appendix D

XXX CCG(Add name of CCG)

Primary Care Commissioning Committee Terms of Reference

1. Introduction 1.1. In accordance with its statutory powers under section 13Z of the National Health Service Act

2006, NHS England has delegated the exercise of the functions specified in Schedule 2 of the Delegation Agreements to these Terms of Reference to xxx CCG.

1.2. The CCG has established the Xxx CCG Primary Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

1.3. The ongoing relationship the Primary Care Commissioning Committee will have with NHS England will be revised on an ongoing basis, though this will be outlined in Schedule 4 of the Delegation Agreement.

1.4. It is a committee comprising representatives of the following organisations:

xxx CCG

NHS England

LB xxx

Local Medical Committee (LMC)

Healthwatch

2. Statutory Framework 2.1. NHS England has delegated to the CCG authority to exercise the primary care commissioning

functions set out in Schedule 2 of the Delegation Agreements in accordance with section 13Z of the NHS Act.

2.2. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the NHS England Board and the CCG.

2.3. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

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c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

2.4. The CCG will also need to specifically, in respect of the delegated functions from NHS England,

exercise those set out below:

Duty to have regard to impact on services in certain areas (section 13O);

Duty as respects variation in provision of health services (section 13P).

2.5. The Committee is established as a Committee of the Xxx CCG Governing Body in accordance with Schedule 1A of the “NHS Act”.

2.6. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

3. Role of the Committee 3.1. The Committee has been established in accordance with the above statutory provisions to

enable the members to make collective decisions on the review, planning and procurement of primary care services in Xxx, under delegated authority from NHS England.

3.2. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Xxx CCG, which will sit alongside the Delegation Agreement and terms of reference.

3.3. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

3.4. The role of the Committee shall be to carry out the functions relating to the commissioning of primary care services under section 83 of the NHS Act.

3.5. This includes the following:

GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

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3.6. The Committee will also carry out the following activities: a) To plan, including needs assessment, primary care services in Xxx; b) To undertake reviews of primary care services in Xxx; c) To co-ordinate a common approach to the commissioning of primary care services

generally; d) To manage the budget for commissioning of primary care services in Xxx.

3.7. The Committee is accountable for exercising the agreed delegated functions from NHS England; these functions operate at practice level and not at individual Primary Care Contractor level.

4. Geographical Coverage 4.1. The Committee will comprise of decisions relating to Primary Care in Xxx.

5. Membership 5.1. The Committee shall consist of:

Chair – Lay Member

Lay member (Vice Chair)

Associate Lay Members X2

Chief Accountable Officer

CCG Chair

Director of Primary Care Development

CCG Chief Finance Officer

Secondary Care consultant

General Practitioner (not within North East London)

Director of Commissioning & Planning (or equivalent)

Director of Quality & Performance (or equivalent)

Non Voting Members

GP Locality Clinical Leads x3 Representatives

NHS England (London Regional Team) Representative

HealthWatch Representative

LMC Representative

Health & Wellbeing Board Representative

5.2. The Chair of the Committee shall be a CCG Lay Member and will be appointed at the first meeting of the Committee.

5.3. The Vice Chair of the Committee shall be a CCG Lay Member and will be appointed at the first meeting of the Committee.

5.4. The Committee may invite ad-hoc members to advise it on specific matters within its Terms of Reference from time to time as appropriate.

5.5. There will be an annual review of the Committee’s Membership and Terms of Reference to support it efficient functioning.

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6. Conflicts of Interest 6.1. Conflicts of Interests will be managed in accordance with the CCG‘s current policy; ‘Standards

of Business Conduct and Managing Conflicts of Interest Policy’.

6.2. Any conflicted Members may be required to leave the meeting for the relevant discussions, as appropriate under direction by the Chair.

7. Meetings and Voting 7.1. The Committee will operate in accordance with the CCG’s Standing Orders. The Business

Manager for Xxx CCG will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 5 working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

7.2. Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus by decision-making wherever possible.

7.3. The Chair shall determine if any conflicted member should leave the discussion or be excluded from the decision making process.

8. Quorum 8.1. The Committee will be quorate with 7 out of the 12 voting Members in attendance, with at

least one Lay Member Present who is not the Chair (but can include Associate Lay Members), and the Chief Accountable Officer or Chief Finance Officer in attendance.

9. Frequency of meetings 9.1. The Committee shall meet at least quarterly in public with the inclusion of ad hoc seminars

held in private for developmental purposes.

10. Meetings of the Committee 10.1. Meetings of the Committee shall:

a) be held in public, subject to the application of 31(b);

10.2. the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

10.3. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

10.4. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest..

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10.5. The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

10.6. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Constitution.

10.7. The Committee will present its minutes to the London Area Team of NHS England and the governing body of Xxx CCG for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 34 above.

10.8. The CCG will also comply with any reporting requirements set out in its Constitution.

11. Decisions 11.1. The Committee will make decisions within the bounds of its remit.

11.2. The decisions of the Committee shall be binding on NHS England and Xxx CCG.

11.3. The Committee will produce an executive summary report which will be presented to the London Area Team of NHS England and the governing body of Xxx of the CCG.

12. Reporting 12.1. The Committee will report to the CCG Governing Body on the decisions made within the

bounds of its remit.

13. Immediate and urgent decisions 13.1. There may be instances when the Committee is required to make a decision in advance of the

regular full committee meetings in light of unforeseen circumstances. Depending on the urgency of the matter such decisions may need to be immediate (i.e. to be made in 24 hours) or urgent (i.e. to be made in timeframes longer than 24 hours but in advance of the next scheduled meeting).

13.2. The Director of Primary Care Development will decide when an immediate or urgent decision is required and will initiate the decision making process.

13.3. In the instances where an immediate decision is needed the Director of Primary Care Development will arrange a meeting with the Chair or Vice Chair (if Chair is not available) and the CCG Accountable Officer to take the decision. Such decisions will only be taken in exceptional circumstances, such as the need to close a practice due to clinical reasons or contractor death. Any immediate decisions taken under this procedure will be presented at the next Committee meeting.

13.4. In the instances when the Director of Primary Care Development deems it necessary to request an urgent decision the Chair will be contacted. The Chair or Vice Chair (if Chair not available) may deem it necessary to call a meeting at short notice outside the regular full committee meetings as set out in paragraph 27 above.

14. Review 14.1. It is envisaged that these Terms of Reference will be reviewed bi-annually in Year 1 and then

annually thereafter, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

15. Primary Care Commissioning Committees in Common 15.1. The Primary Care Commissioning may meet as a “Committees in Common” with other CCGs

using additional terms as set out in the addendum.

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Paper Title

Finance & activity report, month 10 - 2017/18

Paper Author

Sunil Thakker

Lead Presenter

Sunil Thakker


Attached is the regular summary of the month 10 financial position and month 9 activity to the Governing Body. In 2016/17 City & Hackney CCG deployed its 1% uncommitted strategic reserve totalling £3.7m on a non recurrent basis, via the Framework Agreement for Risk-Sharing. The arrangement was extended in-year to include all seven CCGs within NEL with BHR CCGs as the new entrant into the scheme. The process of agreeing the 2016/17 arrangement was time consuming and included discussions with external audit about engaging in the risk share and specifically cost pressures identified elsewhere in the NEL system and in particular BHR. External audit considered the risk this posed to City & Hackney CCG, its main provider, the Homerton, and patients and considered it legitimate to support BHR in the arrangement without compromising statutory responsibilities, subject to proper governance. Based on the review by external audit that allowed the risk sharing to progress, this set the precedent for it to continue to include all seven CCGs, subject to proper governance.


For Discussion & Approval

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The Governing Body is hereby asked to:

1. Receive and discuss the latest Finance and Activity report for the CCG;

2. Note the detail/papers presented and the process followed in deploying the 2017/18 non-recurrent risk share totalling £1.4m in support of system stabilisation, transformation and stability from a provider and patient perspective;

3. Note external audit support in deploying the risk share.

4. Note that in M11 the CCG control total will move from £31.6m surplus to a £30.2m surplus representing the £1.4m transfer to BHR CCGs.

5. Note that in M12 in line with national guidance the control total will move from £30.2m surplus to a £32.1m surplus representing the internal release of the 0.5% SR.

6. Note that the control total may further improve if NHSE decide to transfer the benefit of Cat M drug saving as a pass through.


An expanded version of this report will be discussed in depth at the Wednesday 21 February 2018 Finance and Performance Committee.


Discussions will be updated on verbally at the Governing Body.

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NHS CITY & HACKNEY CCG

23 February 2018

FINANCE & ACTIVITY REPORT

Month 10 - 2017/18

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Contents

Executive summary

Finance and activity dashboard & trend

Key risks narrative

Running costs performance

Financial Statements

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Executive Summary A review of month 10 financial position and month 9 activity was undertaken to compile this report. At month 10 City & Hackney CCG declared a favourable £1.2m surplus against plan. This represented the

continued recognition of additional year to date savings previously reported. The acute portfolio was riskassessed with increased cost pressures recognised totalling £1.6m net, part contained by deploying the in yearAcute Reserve. The non-acute portfolio recognised continued cost pressures relating to CHC and FNC(£0.4m) and Commissioning (£0.3m). These were managed and contained by recognised underspends acrossthe remainder of the portfolio including Reserves and Running Costs.

The headline £30.19m forecast outturn surplus was risk assessed with delivery expected to be on-target aswas the underlying surplus of £31.6m. The position was maintained by deploying the Contingency to manageand contain the impact of increased cost pressures attributable to Bart’s and other out of area providers.

The non-recurrent programme for 2017/18 is a key deliverable with all agreements formalised in contractualarrangements. All investments on an individual basis continue to be reviewed and monitored.

At the time of writing this report the CCG initiated the Risk Share arrangement passing £1.4m to BHR CCGson a non-recurrent basis to be recognised in M11. This represented the additional in-year surplus the CCGcommitted to delivering. The process was reviewed and supported by external audit. The 0.5% SR totalling£1.9m was excluded from the Risk Share and will be released in month 12 improving the CGG control total.This is in-line with national guidance received from NHSE.

Previously reported disputes from prior years are expected to be concluded during the course of the financialyear.

The Dashboard (page 4) highlights a GREEN RAG rating against the CCG Income & Expenditure position. QIPP for month 9 delivered a GREEN RAG rating with the expectation that it will be maintained for the full

year.

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INCOME & EXPENDITURE MONTHLY ACTUAL YTD vs BUDGET EXPENDITURE YEAR END FORECAST v PLAN

TREND4795

ACUTE SPEND HUHT SPEND VARIANCE vs PLAN (%) ALL ACUTE SPEND VARIANCE vs PLAN (%) NCA SPEND VARIANCE vs PLAN (%)

TREND

-8442 Total of pre GW3 CRES ideas - valued at 35% which is the % required to be achieved of general CRES schemes

THIS IS THE ACHIEVEMENT OF YTD PLAN, UNDERLYING PERFORMANCE AND PROJECTED FORECAST.

THIS IS THE DELIVERY OF QIPP AGAINST THE PROFILED ANNUAL

PLAN. THE TREND REPRESENTS THE FULL YEAR DELIVERY

AGAINST TARGET WHICH WAS A MARGINAL

OVERACHIEVEMENT AT MONTH 10.

THIS IS THE SPEND ON PRIMARY MEDICAL SERVICES BUDGETS

VS ANNUAL PLAN. MONTH 10 FORECAST OUTTURN IS

BREAKEVEN.

THIS IS THE SPEND ON NON-RECURRENT INVESTMENTS VS

ANNUAL PLAN.

THIS IS THE ACUTE PERFORMANCE AGAINST PLAN. THE TREND REPRESENTS THE RAG RATED MONTH ON MONTH CHANGE.

£15m

£25m

£35m

£45m

£55m

£65m

1 2 3 4 5 6 7 8 9 10 11 12£395m

£400m

£405m

£410m

£415m

£420m

£425m

£430m

£435m

£440m

£445m

1 2 3 4 5 6 7 8 9 10 11 12

-30%

-20%

-10%

0%

10%

20%

30%1 2 3 4 5 6 7 8 9 10 11 12

-30%

-20%

-10%

0%

10%

20%

30%1 2 3 4 5 6 7 8 9 10 11 12

FINANCEDASHBOARD

QIPP PERFORMANCE vs PLAN

Sep

PRIMARY MEDICAL SERVICES PERFORMANCE vs PLAN

Sept

NON-RECURRENT INVESTMENTSPERFORMANCE vs PLAN

-30%

-20%

-10%

0%

10%

20%

30%1 2 3 4 5 6 7 8 9 10 11 12

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Key Risks - Finance The Finance & Performance Committee will review the month 10 financial position on 21 February and any further issues will be reported to the Governing Body members

thereafter on 23 February 2018. The year to date acute position declared across the portfolio was £1.6m adverse to plan. Activity issues within the portfolio persist. The recent system IT issues have been

resolved. All agreements relating to acute SLAs have been addressed. Homerton shows the year-to-date position as being on plan at £104.7m with a forecast underspend totalling £1.1m including £0.5m QIPP to be delivered. Work continues with

the Homerton to collectively develop and deliver sustainable transformation schemes that will deliver savings for the CCG and reduce and eliminate costs within the providersetting.

Bart’s Health year-to-date position was recognised as being £1.0m adverse to plan with the full year forecast expected to be £1.2m adverse. The CCG adopted a prudent viewin setting the full year forecast deciding on a mid-point view between the likely and worst case scenario situation whilst a year end deal is negotiated. As previously reported, thissituation was not limited to CH CCG but has impacted the NEL system. The CCG recognised higher spend across Critical Care, OP and Elective activity. The CCG is workingclosely with NEL CSU to assess and understand the situation and risk.

During 2017/18 the Finance and Performance Committee will continue to undertake monthly “deep dives” in rotation of Worksteams as in the previous year with ProgrammeBoards.

Actions: Understand the adverse Bart’s movement and consider and deploy applicable mitigations. Pursue the claims challenges across the acute portfolio. Review, monitor and manage the impact of Specialist misattributions.

Non-Acute portfolio reported a net forecast over spend of £1.2m mainly due to CHC, FNC and LD. Work continues on these areas to manage and contain cost pressures . Theposition is noted within the Risks and Opportunities table.

Primary Medical Services was reported on plan, however, there are developing risks with rental charges where landlords in some cases are pursuing retrospective rentrevaluations resulting in possible increased rental charges. This situation is compounded by the impact of rates increases due to increases in property rateable values. City &Hackney CCG is liaising with NHS Property Services on this matter.

Prescribing expenditure on a year-to-date basis was favourable to plan with a full year underspend of £0.2m expected due to a combination of QIPP and Scriptswitchunderspend.

QIPP delivery totalling £5.0m was on plan on a year-to-date and full year basis. The additional QIPP identified of £1.4m which is over and above the £5.0m target is reflected in M10 position and will be transferred to BHR CCGs in M11 as part of the Risk Share arrangement.

The non-recurrent (NR) investment programme in 2017/18 was risk assessed and considered to be on plan. The risk around non delivery and slippage will be managed accordingly. All investments will be recognised through contract and or contract variations.

Significant progress was made during the financial year to agree and settle prior year disputes. Work continues in resolving other areas of long standing prior year disputes with an anticipation that these disputes will be concluded in 2017/18. The CCG has assessed the risks in making year end provisions to cover these known risks.

Action: Monitor, manage and mitigate where possible CHC and FNC cost pressures. Work with NHS Property Services and practices to manage and mitigate the impact of rent increases. Monitor, manage and mitigate any residual slippage within the NR programme of spend. Conclude in 2017/18 long standing disputes.

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Running CostsPerformance on CCG Running Costs is shown below. The CCG is not permitted to exceed its allocated RunningCost Allowance, but is permitted to allow any unspent balances to be used for Commissioning. The 2017/18Running Costs allocation is £6.215m with a £600k QIPP commitment. The risk attached to this is minimal.

- Total Planned Spend

- CSU Planned Spend

- CCG Planned Spend

Monthly Running Costs vs.Plan

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Risks and Opportunities

Description Risks/ (Opps) £'000

Prob. %

Adj. Recurrent

£'000

Adj. Non Recurrent

£'000Narrative

1 Homerton Acute performance 1,000 0% 0 0 Gross position based on historic trend. Net risk based on the trend inclusive of claims and challenges.

2 Bart's Acute performance 2,000 78% 1,552 0 Material adverse movement within CH and across NEL system. Subject to review.

3 Outer sector - Acute performance 2,600 81% 2,094 0 Increased NCL provider over-performance risk contained by reserves.

4 Non-Contracted Activity (NCA) performance 600 67% 400 0 Gross and net risk based on recent change in trend profile.

5 Continuing Healthcare, LD & EOL 1,435 74% 1,066 0 Risk relating to activity increase above plan, high cost patients packages and service provision. Gross risk high given worsening trends and FNC tariff pressure.

6 Non Acute performance 300 19% 56 0 Non acute cost pressure across the portfolio.

7 Programme Costs 200 0% 0 0 In-year non-recurrent costs in support of the integrated commissioning programme and other non-recurrent schemes.

8 Property Costs 300 0% 0 0 Property services cost pressure.

9 Non Recurrent Investment Cost Pressure 3,000 30% 0 900 Underwriting NR investment programme, dispute resolution and other pressures.

10 Primary Care - Rent Revaluation 750 0% 0 0 Retrospective rent increases.

11 Primary Care - Rates 250 0% 0 0 Increased rateable value on properties.

12 QIPP Under Delivery 200 0% 0 0 Under-delivery for schemes within the Operating Plan.

12,635 48% 5,168 900

1 Acute contract Claims and Challenges (2,200) 64% (1,408) 0 Gross position based on historic trend, revised to reflect current probability.

2 Acute Reserves (1,190) 100% (1,190) 0 Release of reserve to contain pressures.

3 Programme Costs (200) 0% 0 0 Breakeven forecast.

4 Contingency (0.5%) (1,867) 91% (1,707) 0 Release of contingency.

5 Prescribing (300) 62% (187) 0 Net underspend across portfolio.

6 Property Costs (1,000) 89% (890) 0 Benefits recognised following negotiated settlement.

7 Running Costs (1,400) 87% (1,220) 0 Headroom declared to contain non acute pressures and savings delivery.

8 Prior year Items (4,000) 23% 0 (900) Opportunities arising from settlement of disputed items, accruals etc. invoices provided for in prior year resulting in an in-year benefit.

9 Non Recurrent Investment slippage (300) 0% 0 0 Reviewed and risk assessed and position contained at month 10.

10 QIPP Over Delivery (200) 0% 0 0 Expectation is on-plan delivery of £5.0m QIPP declared in the Operating Plan.

(12,657) 59% (6,602) (900)

(1,434) 0

(1,434)

(30,198)

(31,632)

Total Opportunities

Net Underlying Forecast Outturn

Net Cumulative Brought Forward surplus

Headline Forecast Outturn Cumulative

Summary and Progress Report on Financial Risks and Opportunitiesto 31 January 2017

Ref:

Risk

Total Risks

Opps

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ACUTE ACTIVITY

PLANNED CARE ACTIVITY ALL PLANNED ADMISSIONS VARIANCE vs PLAN (%) ALL OUTPATIENT VARIANCE vs PLAN (%)

TREND

URGENT CARE ACTIVITY ALL A&E ACTIVITY vs PLAN (%) ALL ADMISSIONS vs PLAN (%) HUHT ADMISSIONS vs PLAN (%)

TREND

THIS IS THE ACUTE ACTIVITY PERFORMANCE AGAINST PLAN. THE TREND REPRESENTS THE RAG RATED MONTH ON MONTH CHANGE.

THIS IS THE ACUTE ACTIVITY PERFORMANCE AGAINST PLAN. THE TREND REPRESENTS THE RAG RATED MONTH ON MONTH CHANGE.

ACTIVITYDASHBOARD

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1 2 3 4 5 6 7 8 9 10 11 12

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1 2 3 4 5 6 7 8 9 10 11 12

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1 2 3 4 5 6 7 8 9 10 11 12

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1 2 3 4 5 6 7 8 9 10 11 12

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1 2 3 4 5 6 7 8 9 10 11 12

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Financial Statements - 1

INCOME & EXPENDITURE ACCOUNTAnnual

Budget

£’000

YTD Budget

£’000

YTD Actual

£’000

YTD

(Under)/

Overspend

£’000

Forecast

Actual

£’000

Forecast

(Under)/

Overspend

£’000

Improvement/

Deterioration

vs M9

Improvement/

Deterioration

vs M9

£'000

In Area Acute Trusts 125,657 104,714 104,714 0 124,601 (1,056) (500)

Out of Area Acute Trusts 77,388 64,490 67,304 2,814 80,767 3,379 132

Other Acute 7,152 6,158 4,898 (1,260) 6,278 (874) 748

Subtotal Acute 210,198 175,363 176,916 1,554 211,646 1,449 380

Mental Health Services 51,139 41,798 41,798 0 51,139 0 0

Community Health Services 35,460 29,550 29,523 (26) 35,416 (44) 3

Other Non Acute 38,277 31,731 32,507 776 39,482 1,205 240

Subtotal Non Acute 124,875 103,078 103,829 750 126,036 1,161 243

Prescribing 28,776 23,980 23,749 (231) 28,629 (147) (57)

Primary Care Co-Commissioning 44,183 35,161 35,161 (0) 44,183 0 0

Other Primary Care Services 15,465 12,867 12,722 (144) 15,384 (81) (138)

Subtotal Primary Care 88,424 72,008 71,633 (375) 88,196 (228) (196)

NHS Property Services 3,166 2,639 2,077 (562) 2,277 (890) (414)

Reserves 3,797 1,324 0 (1,324) 2,091 (1,707) (13)

Subtotal Other 6,964 3,963 2,077 (1,886) 4,367 (2,596) (427)

Total Programme 430,460 354,412 354,455 43 430,246 (214) 0

Corporate 6,215 5,276 4,000 (1,276) 4,995 (1,220) 0

Total Corporate 6,215 5,276 4,000 (1,276) 4,995 (1,220) 0

Grand Total 436,675 359,688 358,455 (1,233) 435,241 (1,434) 0

Total Resource Limit (466,873) (384,853) (384,853) 0 (466,873) 0 0

Surplus (30,198) (25,165) (26,398) (1,233) (31,632) (1,434) 0

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KEY BALANCE SHEET INDICATORS

Compliance with Public Sector Payment Performance Target 96%

Financial Statements - 2

National cash balance target of 1.25% was in January.

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Framework for Risk Sharing in 2017/18

Update to the GB on the outcome of the 2017/18 Risk Share

23 February 2018

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Background to the Framework for Risk Sharing

• In 2016/17 City & Hackney CCG deployed its 1% uncommitted strategic reserve totalling £3.7m on a non recurrent basis, via the Framework Agreement for Risk-Sharing. The arrangement was extended in-year to include all seven CCGs within NEL with BHR CCGs as the new entrant into the scheme.

• The process of agreeing the 2016/17 arrangement was time consuming and included discussions withexternal audit about engaging in the risk share and specifically cost pressures identified elsewhere inthe NEL system and in particular BHR. External audit considered the risk this posed to City & HackneyCCG, its main provider, the Homerton, and patients and considered it legitimate to support BHR in thearrangement without compromising statutory responsibilities, subject to proper governance.

• Based on the review by external audit that allowed the risk sharing to progress, this set the precedentfor it to continue to include all seven CCGs, subject to proper governance.

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2017/18 Framework for Risk Sharing

• In 2017/18 the draft STP Framework for Risk Sharing was re-written by the City & Hackney CCG JointCFO incorporating principals taken from CIPFA best practice guidance. The document was alsoshared with and reviewed by the CFOs of Tower Hamlets CCG, Waltham Forest CCG, Newham CCGand BHR CCGs.

• The STP Framework for Risk Sharing was subsequently approved at the GB in September 2017.• The full agreement accompanies this document.• Principals embedded include:

• That the seven CCGs within NEL STP have agreed to work in collaboration and the Framework for Risk Sharing sitswithin the collaborative partnership

• That the use of the risk share was based on real risks that can't be mitigated based on transparent sharing of financialpositions

• That the management of this should be though CCG CFOs group and their respective Governing Bodies• That the decision to deploy the strategic reserve should not be externally influenced as funding originates from 2017/18

CCG funding allocation• Consequently, management of the agreement will be through the NEL CFOs group, with a report to the ELHCP FSC and

their Board

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GB Meeting 26 January 2018• At the January GB Members agreed to delegate responsibility for deploying the risk share, if

applicable, to Jane Milligan (Single AO), Sue Evans (Lay Member for Governance), David Maher(Acting MD) and Sunil Thakker (Joint CFO). This was due to the national timeline for transacting thetransfer being mid-February, ahead of the next GB meeting.

• The recipient counter party of support was acknowledged as BHR CCGs.• The value of the available uncommitted non-recurrent 0.5% SR totalled £1.9m.• Additionally, CH CCG committed to deliver an additional £1.4m in-year surplus generated by QIPP.

This was initially to underwrite some of the unidentifiable QIPP across NEL system. NHSE thenrebadged it as mitigation to be recognised in the forecast out-turn as an offset to when BHR CCGsmoved off their plan control. But, it could be redirected into the risk share subject to local STPagreement, NHSE and governance.

• Members requested confirmation from NHSE that the risk share arrangement could be deployed andrecognised this was part of a NEL arrangement.

• Members also requested that the deployment of the risk share was supported by external auditunderpinned by a business case and financial analysis reviewed and approved by GB members whohad been delegated responsibility.

• GB members recognised and acknowledged the importance of working as one system in NEL and atthe same time were clear that CH CCH did not breach its statutory responsibility.

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The Process• External audit confirmed that the business case to comply with governance requirements should

articulate the following reasons for investment by BHR CCGs:• The benefit to patients within counterparty CCGs geography.

• The impact on CH CCG system; patients and provider.• The impact and benefit to system transformation.• The impact of system stabilization.

• External audit also advised that in considering the business case there should be clinical scrutiny.Sunil Thakker explained that Dr Clare Highton, GP and CCG Chair would provide this. External auditwere satisfied.

• The business case and financial analysis was received from Tom Travers, BHR CCGs CFO on Friday9 February 2018 and circulated to members.

• Dr Clare Highton provided feedback in the first instance with comments which were reflected in thebusiness case supported by the BHR CFO.

• All other members confirmed their support providing support in deploying the risk share.• NHSE confirmed only the £1.4m could be deployed and the 0.5% SR should be released in M12 in

line with national guidance.

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The Process• All members confirmed their support of the risk share by Tuesday 13 February 2018.• The business case, financial analysis and applicable information was shared with external audit

thereafter on the same day and discussed and reviewed at a pre-arranged teleconference. Externalaudit agreed the paper was well presented and clear, other than perhaps emphasis of this being a oneyear non-recurring agreement and transaction.

• During the review with external audit Sunil Thakker had explained that by the very nature of the riskshare framework and the money badged as non recurrent uncommitted 0.5% SR under NHSEbusiness rules, the default positon was that it was non-recurrent. However, this would be re-emphasised in the update to the GB on Friday 23 February 2018 and the communication to BHRCCGs when the transactions was processed close of business 13 February 2018.

• Attached to the appendices to this report are the following documents:• A1 – BHR CCGs business case• A2 – BHR CCGs Financial analysis• A3 – Email confirming support by members and communication from external audit

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Recommendation• City & Hackney CCG Governing Body is asked to note the detail/papers presented and the process

followed in deploying the 2017/18 non-recurrent risk share totalling £1.4m in support of systemstabilisation, transformation and stability from a provider and patient perspective.

• City & Hackney CCG Governing Body is asked to note external audit support in deploying the riskshare.

• City & Hackney CCG Governing Body is asked to note that in M11 the CCG control total will movefrom £31.6m surplus to a £30.2m surplus representing the £1.4m transfer to BHR CCGs.

• City & Hackney CCG Governing Body is asked to note that in M12 in line with national guidance thecontrol total will move from £30.2m surplus to a £32.1m surplus representing the internal release ofthe 0.5% SR.

• City & Hackney CCG Governing Body is asked to note that the control total may further improve ifNHSE decide to transfer the benefit of Cat M drug saving as a pass through.

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Risk Share Business Case Introduction This Business Case is submitted to City & Hackney CCG to support the governance on the £1.4m deployable resource from the 17/18 risk share budget. BHR CCG Risk assessment BHR CCGs are requesting support via the STP risk share agreement to mitigate financial risk to the CCGs’ year-end position. The CCGs have a revised control total of £20.4m in-year deficit agreed with NHSE. Delivery of this year end position is a requirement of the Financial Legal Directions obligations on the CCGs. From the attached proforma risk assessment, the risk to the CCGs’ control total is estimated at £20m. Mitigating Actions in support of the Risk Share To mitigate these risks, the CCGs continue to;

Deliver on the most challenging QIPP programme in NEL, forecasting a £32m delivery with a 96% achievement of identified schemes through strong financial and delivery governance arrangements as evidenced in the independent Deloitte reviews

Ensure that all budgetary and balance sheet opportunities are committed in support of the year-end position

Have reached agreement with NHSE that the NCOS drug pressure is an allowable

variance to control total in recognition of the BHR financial challenges and the CCGs ability to absorb these unanticipated costs

Challenge the provider positions, with the BHRUT contract being escalated to

National Expert Determination and supporting lead commissioners in their negotiations with Bart’s Health

Consequence of failure to mitigate risk Failure to mitigate the risks to year end in part through the use of the risk share would result in:

BHR, constituting 42% of the Commissioning Collaborative within the STP, failing to discharge its Legal Directions

The RAB impact into 18/19 of an increased deficit. The planning guidance already require BHR CCGs to plan for breakeven in 18/19, a £20m (2%) improvement on control total before 18/19 cost pressures

Further increase in QIPP requirement will necessitate further, deeper

decommissioning and service restriction decisions over and above the two Spending Money Wisely consultations BHR will be implementing through 18/19. This will have direct implications for C&H patients who access BHR provision

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Further increase in QIPP requirement which will directly affect all acute providers including the Homerton. The value of the BHR contract with the Homerton in 17/18 is £8.2m and is currently forecast to overspend by £1.3m (broadly equivalent to the C&H ask through the risk reserve)

Removal of the opportunity to generate additional funds to prime pump transformational change at scale including primary care improvements and removal of the ability to support the targeted intervention areas of the Clinical senate

Introducing further restrictions on services available to patients in BHR runs the risk of

introducing a post code lottery. The BHR system require transformation investment to enable them to enhance primary and community care services so they can shift from acute hospital spend.

The consequence of the above would be to further increase patient health and service inequalities in BHR and widen the gap between inner and outer North east London

Conclusion C&H are asked to note the risk assessment, the mitigating actions already in place in BHR and the consequences to C&H and the wider health economy if the financial risks are not mitigated. C&H are asked to approve the release £1.4m from the contribution to the STP risk reserve to support the mitigating actions in place in BHR to manage the risks to BHR and STP control total.

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9 Change Month

Trust / Service

Mapping Budget Actual Variance Budget Reported

ForecastVariance Gross Risk

Gross Risk

VarianceMitigated Risk

Mitigaated

Risk variance

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Revenue Resource Limit ConfirmedConfirmed 810,840 810,840 0 1,094,208 1,094,208 0 0 0

Brought Forward 16/17 Deficit (3,570) (3,570) 0 (4,760) (4,760) 0 0 0

PotentialPotential 0 0 0 0 0 0 0 0

Revenue Resource Limit Total 807,270 807,270 0 1,089,448 1,089,448 0 0 0 0 0

Acute

Acute & Integrated Care NHS SLA - In SectorBARTS HEALTH NHS TRUSTBarking, Havering and Redbridge Hospital NFT 253,944 260,087 (6,143) 338,190 348,343 (10,153) 19,573 (29,726) 10,771 (20,924)

Acute & Integrated Care NHS SLA - In SectorHOMERTON UNIHOSP NHS FTBarts and The London NHS Trust 70,482 76,652 (6,171) 93,353 101,313 (7,960) 5,287 (13,247) 4,486 (12,446)

Homerton Foundation Trust 6,184 7,249 (1,065) 8,214 9,525 (1,310) (1,310) (1,310)

Other in sector-2 0 0 0 0 0 0 0 0

Other in sector-3 0 0 0 0 0 0 0 0

Sub-Total In Sector SLAs 330,610 343,988 (13,379) 439,757 459,181 (19,423) 24,860 (44,284) 15,258 (34,681)

Acute & Integrated Care NHS SLA - Out of SectorGOSH NHS FOUNDATION TRUST

Acute & Integrated Care NHS SLA - Out of SectorGUYS ST THMAS NHSFTUCLH 6,899 6,777 121 9,207 9,162 45 45 45

Acute & Integrated Care NHS SLA - Out of SectorKINGS COLL HOSP NHSFTMoorfields 6,819 7,255 (436) 9,100 9,779 (679) (679) (679)

Acute & Integrated Care NHS SLA - Out of SectorN MIDDLESEX HOSP NHSTGuys & St Thomas 4,804 5,051 (248) 6,408 6,640 (232) (232) (232)

Acute & Integrated Care NHS SLA - Out of SectorROYAL NAT ORTHOPAEDIC HOSPITAL NHSTMid Essex 3,737 3,780 (44) 4,988 5,021 (33) (33) (33)

Acute & Integrated Care NHS SLA - Out of SectorROY BROMP HARE NHSFTRNOH 2,136 1,895 241 2,850 2,529 321 321 321

Acute & Integrated Care NHS SLA - Out of SectorROYAL FREE NHS FTPrincess Alexandra 1,285 1,236 49 1,714 1,648 67 67 67

Acute & Integrated Care NHS SLA - Out of SectorMOORFIELDS EYE HOSPITAL NHS FTRoyal Free 2,421 2,482 (61) 3,231 3,300 (69) (69) (69)

Acute & Integrated Care NHS SLA - Out of SectorST GEORGES HC NHSTGOSH 828 1,051 (223) 1,103 1,394 (291) (291) (291)

Acute & Integrated Care NHS SLA - Out of SectorWHITTINGTON HOSP NHSTLewisham Hospital 0 0 0 0 0 0 0 0

Acute & Integrated Care NHS SLA - Out of SectorBHR UNIV HOSP NHSTImperial (Hammersmith & St Mary's) 1,203 1,167 35 1,606 1,534 72 72 72

Acute & Integrated Care NHS SLA - Out of SectorTHE ROYAL MARSDEN NHSFTKings College Hospital 764 1,105 (340) 1,018 1,406 (387) (387) (387)

Acute & Integrated Care NHS SLA - Out of SectorUNIV COLL LON NHSFTNorth Middlesex 972 1,227 (255) 1,296 1,583 (287) (287) (287)

Acute & Integrated Care NHS SLA - Out of SectorIMP COLLEGE HC NFTNorth West London Hospitals 554 554 0 739 738 1 1 1

Acute & Integrated Care NHS SLA - Out of SectorCHEL WESTMS HOSP NHS FTRoyal Brompton 529 488 41 706 645 62 62 62

Acute & Integrated Care NHS SLA - Out of SectorNW LONDON HOSP NHSTRoyal Marsden 287 277 10 388 366 22 22 22

Acute & Integrated Care NHS SLA - Out of SectorMID ESX HOSP SVC NHSTWhittington 287 345 (59) 383 461 (78) (78) (78)

Acute & Integrated Care NHS SLA - Out of SectorLEWISHAM AND GREENWICH NHSTChelsea & Westminster 608 636 (28) 813 832 (20) (20) (20)

Acute & Integrated Care NHS SLA - Out of SectorBMI HEALTHCARE LTDBasildon & Thurrock 2,611 3,017 (405) 3,474 3,973 (499) (499) (499)

Acute & Integrated Care NHS SLA - Out of SectorBARNT/CHSE FM HOSP NHSTSt Georges 447 423 24 590 558 32 32 32

Acute & Integrated Care NHS SLA - Out of SectorDefaultDefault 0 0 0 0 0 0 0 0

Other out of sector-1 0 0 0 0 0 0 0 0




Sub-Total Out of Sector SLAs 37,189 38,767 (1,578) 49,615 51,570 (1,954) 0 (1,954) 0 (1,954)

Acute LAS Acute LASLONDON AMBULANCE NHSTLondon Ambulance Service 21,806 21,806 0 29,074 29,074 0 0 0

Independent Sector Acute ReadmissionsIndependent Sector 11,166 15,011 (3,845) 14,888 20,015 (5,126) 500 (5,626) 250 (5,376)

Extended Choice Operational Resilience - Tower Hamlets Extended Choice 11,698 15,320 (3,622) 15,598 20,427 (4,829) (4,829) (4,829)

Urgent Care Urgent Care 984 984 0 1,312 1,312 0 0 0

Other Acute Other AcuteOther Acute 11,253 5,979 5,275 16,713 15,439 1,275 3,474 (2,199) 1,737 (462)

NCAS/OATS NCAS/OATSNCAS/OATS 7,069 7,569 (500) 9,377 10,092 (715) (715) (715)

Acute Total 431,775 449,424 (17,649) 576,336 607,109 (30,773) 28,834 (59,607) 17,244 (48,017)

Full Year

CCG Delegated Budgets

Acute & Integrated Care NHS SLA - In

Sector

Acute & Integrated Care NHS SLA -

Out of Sector

BHR CCG's Detailed Report - Month 9 2017/18

YTD Full Year

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Non Acute

Mental Health Mental Health - NHSNELFT MH 59,310 58,658 652 79,081 78,096 984 984 984

Mental Health CAMHS 1,331 802 530 1,727 1,170 557 557 557

Mental Health Adults 1,765 1,053 713 2,866 1,547 1,319 1,319 1,319

Mental Health Other 7,019 7,729 (710) 8,583 9,980 (1,397) (1,397) (1,397)

Learning Difficulties 1,766 1,559 207 2,355 2,676 (321) (321) (321)

Sub Total Mental Health 71,192 69,800 1,392 94,611 93,469 1,142 0 1,142 0 1,142

Community Services Sector CHSNELFT CHS 56,839 57,034 (195) 75,529 76,520 (991) (991) (991)

Hospices 2,333 2,240 93 3,111 3,012 99 99 99

Other CHS ProvidersOther CHS Providers 4,677 4,693 (15) 6,236 6,403 (166) (166) (166)

Sub-Total Community Services 63,849 63,967 (117) 84,877 85,935 (1,058) 0 (1,058) 0 (1,058)

Continuing Care Services CHC Fully Funded - Spots CHC Adult Fully Funded 30,126 28,530 1,596 40,427 40,824 (397) 400 (797) 200 (597)

CHC Fully Funded - Complex Children CHC Adult Joint Funded 737 1,019 (282) 983 1,023 (40) (40) (40)

CHC Fully Funded - Mental Health Funded Nursing Care 5,034 5,942 (908) 6,712 6,855 (143) (143) (143)

Funded Nursing CareCHC Children 5,135 4,112 1,023 6,813 6,897 (83) (83) (83)

CHC Personal Health BudgetsCHC Adult Fully Funded Personal Health Budget 1,080 2,978 (1,898) 1,439 1,509 (69) (69) (69)

Other CHC 1,983 2,073 (90) 2,644 2,346 298 298 298

Sub-Total Continuing Care Services 44,094 44,653 (558) 59,019 59,454 (435) 400 (835) 200 (635)

Other Non Acute End Of Life Care ContractsOther Non Acute 24,109 16,845 7,263 41,387 24,874 16,513 16,513 16,513

Sub-Total Other Non Acute 24,109 16,845 7,263 41,387 24,874 16,513 0 16,513 0 16,513

Primary Care PrescribingPrescribing 77,931 76,653 1,278 103,139 100,542 2,598 5,105 (2,508) 2,553 45

Sub-Total Prescribing 77,931 76,653 1,278 103,139 100,542 2,598 5,105 (2,508) 2,553 45

Primary Care Co-CommissioningPrimary Care Co-Commissioning 75,246 73,984 1,261 100,334 98,684 1,650 1,650 1,650

Other Primary care 17,681 17,454 227 23,045 22,898 147 147 147

Sub-Total Primary Care 92,926 91,438 1,488 123,379 121,582 1,797 0 1,797 0 1,797

0

0

Non Acute Total 374,101 363,356 10,745 506,412 485,855 20,557 5,505 15,052 2,753 17,804

Total Commissioning Expenditure 805,877 812,780 (6,904) 1,082,748 1,092,964 (10,216) 34,339 (44,555) 19,997 (30,213)

Operating Costs CCG Running Cost (Excl CSU)CCG Running Cost (Excl CSU) 12,613 12,613 0 16,819 16,819 0 0 0

Operating Costs Total 12,613 12,613 0 16,819 16,819 0 0 0 0 0

1% Non-Recurrent Reserve1% Non-Recurrent Reserve 0 0 0 4,842 4,842 0 0 0

Reserves and Contingencies Total 0 0 0 4,842 4,842 0 0 0 0 0

Total Expenditure 818,490 825,393 (6,904) 1,104,408 1,114,625 (10,216) 34,339 (44,555) 19,997 (30,213)

In Year Surplus / Deficit 2% Surplus (7,649) (14,553) (6,904) (10,200) (20,416) (10,216) (34,339) (44,555) (19,997) (30,213)

Cumulative Surplus / Deficit (11,219) (18,123) (6,904) (14,960) (25,176) (10,216) (34,339) (44,555) (19,997) (30,213)

SIGN OFF

Name: Signature:

Position: Date:

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Paper Title

Governance request for Governing Body pre-endorsement in relation to recommendations for funding related to the Healthier City and Hackney Fund

Paper Author

Silvia Scalabrini

Lead Presenter

Silvia Scalabrini


The purpose of the paper is to receive the Governing Body’s members pre-endorsement in relation to the Healthier City and Hackney Fund recommendations for funding. The request for pre-endorsement is due to the fact that London Borough of Hackney will not be able to make any decision after 22nd March 2018 due to the purdah regulations.


For Approval


The Governing Body is hereby asked to: 1. Note the attached paper and discuss; 2. Approve the request and confirm pre-endorsement.


n/a

What was the outcome of previous

n/a

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discussions?

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1. Purpose of the paper

The purpose of the paper is to outline the decision making process and recommendations for funding in relation to the Healthier City and Hackney Fund. Governing Body members are asked to pre-endorse the schedules of grant awards listed in Table 1 and in Section 3. Pre-endorsement is requested because the March CCG Governing body meeting takes place on the 23rd March 2018, the day after London Borough of Hackney enters pre-election purdah on the 22nd. Consequently, the London Borough of Hackney Cabinet will discuss and is expected to agree the funding recommendations at its meeting on 19th March 2018. The final decision in relation to the recommendations for funding will be made at the London Borough of Hackney Cabinet on 19th March 2018 with a CCG Governing Body member in attendance. The CCG Lay Member for Patient and Public Involvement will be attending the Cabinet meeting: this role has been fundamental in ensuring that the Patient and Public Involvement Committee voice was embedded in the process from the very start of the joint Fund. The CCG Lay Member for Patient and Public Involvement has also been fully briefed with regards to the schedules of recommended grants awards and has expressed support to it. 2. Detail

2.1 Background

The Healthier City and Hackney Fund combines the former CCG innovation fund and the Public Health Services Healthier Hackney Fund. This year is a particularly exciting and innovative scheme that supports the benefits of our developing Integrated Commissioning arrangements. The total fund is £500,000 with £250,000 from the council’s Public Health Service and £250,000 from the CCG. An additional £50,000 from the Public Health service is spent on administration. This grant scheme demonstrates a joint commitment between Hackney Council, City and Hackney CCG and the City of London Corporation to trial new approaches that address entrenched problems, and to identify issues that lie outside of the remit of our commissioned services.

An additional £25,000 has been allocated to Healthy Next Generation Grants by Public Health at London Borough of Hackney. Grant funding offers a flexibility and a different interaction to commissioning, benefitting from the experience of the non-profit sector and their relationships with local communities. The Governing Body members, however, are not asked to agree the expenditure of this money.

2.2 The offer

The fund is separated into three strands, aiming to attract different groups with a mix of expertise. The strands are:

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Healthy Activities: from £5,000 to £60,000 to run practical activities that address one or more of the following priority issues:

mental wellbeing at times of change

supporting disabled young people to be physically active

improving uptake of cancer screening

helping people to get home from hospital

Healthy Ideas: up to £20,000 to develop and pilot new approaches to one or more of the following priority issues:

community-led approaches to multiple health risk

developing a 'Welcome Hackney Baby' offer

assistance with outpatient appointments

end of life care

The four priority areas each for Healthy Ideas and Health Activities were shortlisted by Integration workstreams’ Directors, and the final list was shared with the Patient and Public Involvement Committee for comments and suggestions. The four priority issues for each stream reflect the four work streams which sit under Integrated Commissioning: Planned Care, Unplanned Care, Prevention and Children and Young People.

2.3 Promotion

The scheme was launched at an event in October 2017, attended by 140 representatives from a broad range of non-profit organisations. The Public Health team and CCG published a regular newsletter (received by over 250 individuals), and attended numerous events to present the principles and format of the fund to key stakeholders. We also ran a successful matchmaking event where applicants had the chance to hear from an expert panel of representatives from digital SMEs, providing an opportunity for organisations to network and meet potential bid partners. This resulted in multiple partnership bids by organisations who attended the event, some choosing to partner with the digital SMEs from our panel.

2.4 Application process

Applications opened to Voluntary and Community Sector organisation and social enterprises in mid-October. The first stage invited a short ‘expressions of interest’, which focussed on the key concept of the proposal but did not ask applicants to cost their proposals.

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After an initial sift, 81 applicants were invited to deliver a pitch presentation to a panel of volunteer assessors from the council, CCG, City of London Corporation, VCS and academic partners, over three days in December 2017. Feedback was emailed to applicants after the presentation.

56 Successful bidders were then invited to complete a full application (55 applicants completed their application), including the budget sheet and project schedule.

2.5 Assessment of Applications

Volunteers from across the council, CCG, City of London Corporation and VCS scored a pack of second stage applications in pairs or threes within a particular grant stream. Scores were then moderated, and shortlisting sessions took place a week after scoring, bringing together all volunteers who had scored submissions within a priority topic into a panel. Applications were ranked by priority. This ranking was then brought to workstream directors who had final say.

2.6 Assurance process

- 23rd February 2018 - CCG Governing Body to pre-endorse the schedules of

grant awards;

- 28th February 2018– City of London Corporation/CCG Integrated Commissioning Board and London Borough of Hackney/CCG Integrated Commissioning Board;

- 9th March 2018 – CCG Transformation Board;

- 19th March 2018 – London Borough of Hackney Cabinet with member of the

CCG Governing Body in attendance.

2.7 Monitoring and Evaluation

Successful organisations will be asked to produce quarterly monitoring reports outlining progress and any issues encountered throughout the duration of the funding. These reports will be submitted to London Borough of Hackney grants officer and will then be shared with CCG and Public Health officers.

Organisations will also be asked to supply case studies as part of the monitoring and evaluation processes.

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2.8 Funding by priority issue

Table 1 below outlines the number of applications by priority issue and the total amount of funding. The schedule of grants recommended for funding in 2018/18 totalling £469.931.50 for 13 projects.

Table 1: Recommendations and funding by priority issue

Fund Priority Issue Total bids Recommended Applications Total

Healthy Activities

Supporting disabled young people to be physically active

9 4 £108,916.50

Helping people to get home from hospital

3 1 £59,452.00

Improving uptake of cancer screening 3 1 £58,000.00

Mental wellbeing at times of change 28 4 £185,733.00

Sub total 43 10 £412,101.50

Healthy Ideas

Community based approaches to multiple health risk.

5 2 £37,830.00

Developing a ‘Welcome Hackney baby’ offer

5 1 £20,000.00

Assistance with outpatient appointments

1 0 £0.00

End of life care. 1 0 £0.00

Sub total 12 3 £57,830.00

Total 55 13

£469,931.50

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3. Full schedule of applications recommended for funding

Healthy Activities: Mental wellbeing at times of change

Topic Focus: We asked for bids which explored the provision of advice and tools that staff and volunteers in local organisations can use to promote mental wellbeing at key change points in people’s lives, for example changing school, coming out as LGBT, moving house or being bereaved.

Organisation Project Title Request Amount

Mind in the City, Hackney and Waltham Forest

Young people will be supported to deliver MH Awareness, First Aid, Five-to-Thrive, and signposting sessions to workers in schools/community centres, equipping them to recognise stressors in YP during periods of change and access relevant services.

£42,746.00

Core Arts Core Resilience: innovative creative support sessions, tackling physical/mental health for discharged clients at risk of relapse due to severe mental ill-health, who are not in receipt/eligible of other services at a crucial time of transition/change.

£60,000.00

Redthread Youth Ltd

Redthread’s Youth Violence Intervention Programme works with young victims of violence, empowering them to engage with services to support both their physical and emotional recovery, improve their mental health, and break the cycle of violence.

£60,000.00

Tender Education & Arts

An innovative approach to promoting mental wellbeing by empowering young people to form healthy relationships: using LGBTQ-inclusive, arts-based abuse-prevention workshops to improve young people's confidence, resilience and safety.

£22,987.00

Healthy Activities: Improving uptake to cancer screening

Topic focus: We asked for bids which raise awareness of the importance of cancer screening and increasing the take-up within the different communities of Hackney and the City of London. We were particularly interest in bids which target specific groups with higher rates of cancer than the general population to increase screening rates. We were also interested in proposals for improving the targeting of screening, for example by identifying high risk individuals that could then be targeted for screening.

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Hackney Council for Voluntary Services

The project aims to increase the awareness of bowel cancer and the uptake of bowel cancer screening in the older African community through targeted outreach and working with GPs in low uptake areas

£59,452.00

Healthy Activities: Supporting disabled young people to be physically active

Topic Focus: Disabled residents are much less physically active than those without disabilities. We asked for bids which aimed to reduce the health inequalities in access to local services, and in how disabled young people and their families can be supported to find their own ways of increasing or maintaining good levels of physical activity in Hackney and the City of London.

Royal Society for Blind Children (RSBC)

The project will help 15 blind children aged 11-15 to gain the confidence, motivation and resilience to participate in physical activities and introduce them to local organisations to sustainably continue the activity of their choice.

£21,419.50

Disability Sports Coach

Providing sports/physical activity training and coaching for disabled children in Hackney and coaching other charities' staff to gain sustainability so they are able to continue coaching sessions in-house.

£21,937.00

Hackney Play Association

This project will enable disabled children and young people, their families and friends to be active, have fun and make friends, through inclusive play and sport at local adventure playgrounds.

£45,000.00

The SONshine Club

The grant will build on existing motor skill groups for C&YP with mild to moderate disabilities such as Cerebral Palsy, Downs Syndrome, Global delay and other neurological conditions thereby aiding participants on to mainstream sports.

£20,560.00

Healthy Activities: Helping people to get home from hospital

Topic focus: For many people, returning home after time in hospital is much harder than it should be. We asked for bids form applicants who were looking to work closely with hospital services, social services and other statutory organisations to support individuals to return in a safe and timely way to their place of residence. Charities can supplement existing services and provide a holistic, person centred approach which

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offers benefits beyond the practical needs of the service users, and encompasses an important befriending role and providing emotional support.

East End Citizens Advice Bureau

The Getting Home Project will provide holistic advice and support to help people get home from hospital. This will include complex casework and community navigators to resolve problems and re-establish people in their homes.

£58,000.00

Healthy Ideas: Community led approaches to multiple health risks

Topic focus: ‘Multiple health risk’ refers to a combination of factors such as high levels of smoking, alcohol and substance misuse, physical inactivity, poor mental health, obesity, etc. In some communities and areas these multiple risks are more prominent than others. Reducing multiple health risk in these communities and areas is often best achieved when led by the people affected themselves. For this priority we asked for bids which develop a working model for health assets based on research evidence sorting the concept of health assets and incorporate asset-based approaches into mainstream public service activity.

MISGAV Can a range of asset-based group therapy courses, improve the physical health of learning disabled women in Hackney? This grant will fund the test, design and delivery of the program.

£17,984.00

Terrence Higgins Trust

What are the lived experiences of LGBTQ+ people of colour in Hackney, and how do racism and hetero-sexism act as barriers to accessing services and better health outcomes for this meta-marginalised group?

£19,846.00

Healthy Ideas: Welcome to Hackney baby offer

Topic focus: Many health challenges and inequalities have foundations in early childhood, with the poorest families experiencing the worst health outcomes. We asked for practical and engaging offers, contributing positively to health of the first 1001 days of our new residents. We wanted bids which offered innovative development of a package that will increase awareness of, and access to local

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services, as well as including practical resources for new families. Bids were encouraged to be inclusive for Hackney’s diverse population and relevant to the families it will support, while developing a feeling of civic pride in new parents by welcoming their babies to Hackney.

Manor Gardens Welfare Trust

Does the provision of antenatal advice and workshops for refugees and migrant families, delivered in their own language in community venues, improve the baby's start in life, parents' mental health and improve take-up of services?

£20,000.00

A full list of non-recommended applications for 2018-2019 is included in Appendix 1. 4. Conclusion The Governing Body is asked to pre-endorse the schedules of grants awards listed in Table 1 and Section 3.

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Appendix 1:

Healthy Activities: Mental wellbeing at times of change

Diverse Voices This project will deliver a Theatre in Education project that supports young people in schools at a critical time of change helping with moving schools and developing emotional wellbeing, confidence, self-expression and empathy.

£37,941.00

Artis Foundation

We are looking for funding for a 6-week performing arts project in Hackney. The programme, Artis Bounce, will offer 120 children and 40 teachers the opportunity to explore mental health and wellbeing in young people.

£5,000

Headway East London

The project will improve mental well-being and reduce distress by providing information, advocacy and support to people affected by brain injury (& transitioning from hospital) and improve continuity between inpatient care and community support.

£44,276.00

FRAMPTON PARK BAPTIST CHURCH

To lift people out of depression/anxiety caused through unmanageable debt by providing one to one support and training sessions during the process of getting debt free.

£16,780.00

Terrence Higgins Trust

Terrence Higgins Trust (THT) will deliver a three-tiered mental health service in Hackney to address the deficit in provision, specifically targeting LGBTQ+ people in Hackney "coming-out", to support them to negotiate significant life events.

£50,354.00

The Huddleston Centre in Hackney

Huddleston Network A one stop shop providing access to information and opportunities for disabled young people at times of transition in education and training. Providing support and advice to reduce anxiety and depression.

£55,179.00

Hands Inc The grant will fund continuation and extension of our successful menopause project, using a variety of approaches to inform, support and empower women to better manage the emotional, psychological and physical symptoms of the menopause.

£58,275.00

Settle Support Our project is a tenancy mentoring service that supports care leavers who are moving into their

£53,875.00

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first home. We expect our project to improve the mental wellbeing of Hackney's care leavers.

Triangle Community Services

Smart Stroke: Supporting stroke survivors to go digital through group training sessions to go online and access essential and community services to improve their independence and enhance their wellbeing.

£29,731.23

Breakthrough - Deaf / DeafPlus

"Living with Hearing Loss" Project for hard of hearing people aged 45+ including 4 x 7-week lip reading/developing coping strategies course, 1:1 support, advice and information. To raise awareness of age-related hearing loss and dementia.

£31,117.00

Duckie Ltd A Healthy Activities grant will support a new Outreach Worker post and the delivery of 20 Posh Club events for Hackney residents over 65 to support their continued wellbeing through key life changes.

£59,539.00

Outdoor People

Hackney Wild Walks 2, A Bigger Adventure making better use of outdoor spaces to support families with children at risk of poor mental health as they transition between schools

£59,446.50

Body & Soul You Are Not Alone H&C aims to reduce the number of suicide attempts and self-harm among Hackney residents aged 18 - 30 experiencing times of change through courses of Dialectical Behaviour Therapy and practical support.

£59,720.00

The Access to Sports Project

The Access To Sports project will deliver a sport/physical activity mental wellbeing programme in Hackney aimed at Year 6&7 children changing school with the support of Mind in the City, Hackney, Waltham Forest.

£48,373.95

Royal Society for Public Health

This project is to run a series of five holiday courses for up to 250 Year 6 children who are transferring to secondary schools in Hackney during the summer of 2018.

£55,924.69

East London Advanced Technology Training

Changing Times, Stronger Minds will provide training to volunteers in supporting vulnerable migrant communities in Hackney at risk of poorer mental health as a result of confrontation with critical points of change in their lives.

£50,338.00

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Hoxton Health We will co-ordinate and provide a range of services including massage, acupuncture, reflexology, cranial osteopathy and counselling for patients who want to die at home, and their families to be supported to achieve this.

£60,000.00

Groundwork London

The project will improve the mental wellbeing of isolated migrant women through activities based on the 5 to thrive model and building public/VCSE organisations’ knowledge through the production/dissemination of a toolkit to share best practice.

£59,995.00

Rising Stars Support CIC

A martial arts and mentoring project to support young refugees who are going through a stressful and challenging time transitioning into life in the UK.

£23,182.00

Shoreditch Trust

Supporting the mental wellbeing of vulnerable women in pregnancy and parenthood through the development of a digital solution to support multi-agency workers to connect with each other and make the most of each client contact.

£57,065.00

Skyway Charity

The project seeks to increase knowledge of mental health amongst young people and will lead to more young people knowing how to respond to their own mental health needs and where to access appropriate support

£32,824.00

Cordwainers Grow CIC

A hub and network of supported pathways to and from community gardens for new carers (and others) to develop independence and resilience through the health and social benefits provided by garden-based community groups.

£37,460.00

Bikur Cholim Ltd

a team of volunteers will be trained and supervised to provide specialist trauma support and crisis intervention to children, young people and adults from the Charedi community in the aftermath of trauma

£20,775.00

Refuge The Healthy Activities fund would be used to support women and children with their mental health at times of change by developing and delivering a tailored programme to support mental wellbeing within our Hackney Refuges

£43,958.59

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Healthy Activities: Supporting disabled young people to be physically active and mental wellbeing at times of change:

St Mary's Secret Garden

We will provide nature inspired gardening gym activities in our garden and on local estates for young people with leaning and/or physical disabilities. Supporting and signposting each individual to greater and further opportunities to grow.

£42,570.00

Healthy Activities: Supporting disabled young people to be physically active

Bike works CIC

The grant will fund inclusive, All Ability cycling sessions in primary and secondary schools to encourage young people with disabilities to start cycling and get active.

£22,032.00

KEEN London Free sports, games and recreation sessions with one-to-one support for children with a wide range of disabilities and their siblings.

£32,447.00

Step By Step 40 weekly Yoga, Pilates, Dance & Movement (YPDM) sessions; 48 new users, hard-to-reach disabled Children and Young People, meeting their needs for: tailored exercises delivered in small groups, in sensory appropriate environment, with 1:1/2 support and accessible transport.

£42,300.00

Lord's Taverners

The Lord's Taverners London Disability Cricket Championships (LTDCC) will provide inclusive cricket participation opportunities for disabled young people across Hackney.

£10,800.00

Healthy Activities: Improving uptake of cancer screening

Renaisi Healthy Together - Promote and improve the uptake of cancer screenings amongst migrant and refugee communities through the delivery of ESOL and wellbeing workshops in 4 schools and 2 community hubs.

£60,000.00

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Healthy Activities: Helping people to get home from hospital and mental wellbeing at times of change

Westminster Drug Project Hackney

Our aim is to improve health/treatment provision to targeted patients with multiple and complex needs who frequently attend, utilise ambulances and are admitted to Homerton Hospital, ultimately reducing the cost of effective treatment.

£60,000.00

The British Red Cross Society

BRCs Next Steps project will use a person-centred approach to support people aged 18+ to return home from hospital quickly and safely, prevent re-admission and frequent attendance, strengthen social connections and ultimately build independence.

£60,000.00

Healthy Activities: Helping people to get home from hospital

Appt-Health A programme of community consultation to evaluate the success of a pilot of an SMS appointment booking platform, improving the rate of cancer screening in the City & Hackney through the use of targeted messaging.

£36,493.00

Healthy Ideas: Community led approaches to multiple health risks

Age UK East London

How can we digitally enable an asset based older people’s peer support network to maximise its impact as a community health asset for older people facing multiple health risk due to loneliness and isolation?

£18,844.00

Mentor Foundation UK

Is Hackney ready and open to receive a community-led, systems-change approach to preventing substance misuse among young people?

£19,998.00

The Boiler House Community Space

How can participation in resident-designed, community-led weekly Health and Well-Being Days at BHCS positively impact residents’ well-being and reduce their multiple health risks through changing behaviours and developing skills as connectors.

£20,000.00

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Healthy Ideas: Assistance with outpatient care

Hoxton Health To what extent can we enable a group of patients to make lifestyle changes to manage their arthritis condition and what is the consequent impact on the amount of medication and GP/outpatient appointments they use?

£19,959.00

Healthy Ideas: End of life care

Ezra Umarpeh Ltd

Can using a community asset approach (Ezra Umarpeh Last Years of Life Support Service) solve the problems (conflicting ideology regarding end of life care) specific to that community (Charedi Jewish)?

£19,967.00

Healthy Ideas: Welcome to Hackney baby offer

Hackney Playbus

Can inclusion in 'Welcome Hackney Baby' offer be achieved for babies and their parents/carers living in Hackney's hostels by delivering an 'in hostel' service where they can build trust and be supported to better engagement?

£16,028.00

Shift Can a nearly-new baby shop attract parents from lower socio-economic backgrounds and increase their likelihood of accessing high quality social, emotional and informational support during the critical first 1,000 days of their child's life?

£20,000.00

Volunteering Matters

The project will test the idea that the non-clinical health and wellbeing outcomes of the Family Nurse Partnership can be delivered by trained volunteers, who will use their lived experience to mentor vulnerable young parents.

£19,961.00

East London Advanced Technology Training

Can a targeted community learning intervention for new and expectant migrant parents effectively support the physical, mental and emotional health of young children and maternal health of parents?

£17,613.00

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Paper Title Recommendations and decisions from the Friday 26 January 2018 Local GP Provider Contracts Committee

Paper Author Jennifer Nabwogi / Lee Walker

Lead Presenter Catherine Macadam


The payment and contract decisions and recommendations made at the LGPPCC meeting on 26th January 2018 – presented for endorsement and information to the Governing Body.


For approval / information.


The Governing Body is hereby asked to: 1. Review the recommendations made by the

LGPPCC, note the payment recommendation andapprove the recommendations for award ofcontracts;

2. The members of the Contracts Committee havereviewed the requests for payments and requests forissuing contracts to primary care providers, on behalfof the GB, without potential conflict of interests.


LGPPCC 26th January 2018


Approval of payments as indicated in the attached paper and agreement to a series of recommendations to the Governing Body for their approval.


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Recommendations from the Friday 26 January 2018 Local GP Provider Contracts Committee

Recommendations and decisions made by the January 2018 Local GP Provider Contracts

Committee to the Governing Body

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• The LGPPCC debated the following proposals for the award of a contract for the delivery of services and it is recommending that the Governing Body agrees to enter into contracts with these providers:

Contract name Contract provider

Contract summary Contract length

Contract amount

Notes

Clinical Commissioningand Engagement

All 42 GP Practices

Variation to the 2 year contract for the 2nd year (2018/19) implementing changes to specification agreed with LMC and CEC

The remaining term of the CCE Contractfrom 1st April 2018

No change

Clinical Commissioningand Engagement

All 42 GP Practices

Variation to the 2 year contract allocating £275K non-recurrent funding (divided between 42 practices) toexpand Patient Participation Groups.

The remaining term of the CCE Contractfrom 1st

February 2018

£275,000 Non-recurrent funding which is additional to the ‘core’ CCE contract specification

Recommendations from the LGPPCC (for approval) – CCG FUNDED

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• The LGPPCC approved the following payments for the delivery of contracted services:

Contract name Provider Contract summary Paymentperiod

Payment amount

Notes

Post operative Wound Care

City and Hackney GP Confederation

Post-operative wound care in a primary care setting

Q4 2016/17 £44,960

Post Operative Wound Care


Post-operative wound care in a primary care setting

Q2 2017/18 £43,368

Community Phlebotomy


Practice based blood collection service

Q2 2017/18 £72,358.80

GP Out of Hours City and Hackney Urgent HealthcareSocial Enterprise

Payment of contract value linked to successful KPI achievement

Q2 2017/18 £63,147.51

GP Out of Hours City and Hackney Urgent HealthcareSocial Enterprise

Payment of contract value linked to successful KPI achievement

Q3 2016/17 £276.97 This residual amount was omitted from the Q3 payment approval for this quarter by error

Payments agreed by the LGPPCC (for information)

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Contract name Provider Contract summary Paymentperiod

Payment amount

Notes

Duty Doctor City and Hackney GP Confederation

GP same day clinical triage / consultations & rapid response to HCP queries

Q2 2017/18 £370,293.75

Acorn Lodge Nursing Home

Latimer Health Centre

Enhanced provision of care for nursing home residents

Q2 2017/18 £18,168.07

St. Anne’s Nursing Home

Barton HousePractice

Enhanced provision of care for nursing home residents

Q2 2017/18 £5,999

Anti-coagulation primary care services

19 C&H GP Practices

Anticoagulation primary care monitoring service

Q2 2017/18 £39,155

Anti-coagulation primary care services

18 C&H GP Practices

Anticoagulation primary care monitoring service

Q3 2017/18* £23,290 *Contract Q3 is for 2 months only due to contract expiry

Payment withheld from Southgate Road for failing to provide WEQAS sample within acceptable range – QA requirements not met

Payments agreed by the LGPPCC (for information)

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Paper Title

Statement Re: Modern Slavery

Paper Author

Tim Wiseman

Lead Presenter

David Maher


1. The Modern Slavery Act 2015 2. Statutory requirement of organisations turning over

£36m+ to produce & publish a statement on the matter

3. The NHSE drive to heighten awareness and training on the question of modern slavery as a fundamental aspect safeguarding


For Approval


The Committee/Governing Body is hereby asked to: 1. Approve the draft statement attached, which will then

posted on the CCG Website


Not applicable


Not applicable

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City & Hackney CCG: Statement on Modern Slavery, Forced Labour and Human Trafficking

1. The Modern Slavery Act 2015 was introduced to addresses issues of slavery, servitude, forced or compulsory labour, and human trafficking.

2. The law now requires large businesses to be clear and transparent in describing the measures they take to ensure their direct undertakings and supply chains are free from any of these pernicious elements.

3. Commercial organisations supplying goods and/or services, with a turn-over of £36 million or more per year, are required to produce a “slavery and human trafficking statement” each financial year. This should set out what steps the organisation takes, where legally appropriate, to ensure its own activities and supply chains are free from the listed forms of slavery. This needs to be approved by the board of the organisation, signed by a director and prominently displayed on the organisation’s website.

4. As both a local leader in commissioning health care services for the population within our area and as a local employer, City & Hackney Clinical Commissioning Group (CCG) provides the following statement in respect of our commitment to, and efforts in, preventing modern slavery and human trafficking practices in our supply chain and employment practices.

5. Our Organisation

5.1. As an authorised statutory body, the CCG is the lead commissioner for health care services (including acute, community, mental health) within our defined geographical boundaries. These cover a population in excess of 312,000.

6. Our Commitment

6.2. The Governing Body, Senior Management Team and all employees of the CCG are committed to ensuring that there is no modern slavery or human trafficking in any part of our activity and that, in so far as it is possible, we hold our suppliers to account to do likewise.

7. Our Approach

7.1. Our overall approach will be governed by compliance with legislative and regulatory requirements and the application of good practice in the fields of contracting and employment.

8. Recruitment

8.1. Our recruitment processes are robust – requiring practices that adhere to safe recruitment principles. This includes strict requirements in respect of identity checks, work permits and criminal record checks.

9. Policies and Procedures

9.1. We have a range of policies, contained in our document “Working in City & Hackney: A guide (including employment policies) for all members of staff”. Thissuch as our gives staff information in relation to problems with colleagues Bullying and Harassment policy,, Ggrievances and policy and W “whistleblowing” policy, andwhich p prrovides an additional platform for our employees to raise concerns about poor working practices.

Formatted: Font: Bold, Italic

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10. Procurement

10.1. The CCG will add a provision to its tender documentation which includes the mandatory exclusion of any bidder who has been convicted of an offence under section 1, 2 or 4 of the Modern Slavery Act 2015. The CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking and will exclude any bidder who has been convicted of an offence under section 1, 2 or 4 of the Modern Slavery Act 2015.

10.2. When procuring goods and services, we apply NHS Terms and Conditions (for non-clinical procurement) and the NHS Standard Contract (for clinical procurement). Both require suppliers to comply with the Modern Slavery Act 2015 legislation.

11. Raising Awareness

11.1. On a continuing basis and by a variety of means we strive to raise awareness of the Modern Slavery Act 2015 with our staff internally (see appendix 1, attached) .

12. Contracting and Commissioning

12.1. All of our contracting and commissioning staff are suitably qualified and experienced in managing healthcare contracts.

12.2. During 2017/18 we will write to all our main providers requesting evidence of their compliance with the Act.

13. This statement is made pursuant to section 54(1) of the Modern Slavery Act 2015 and constitutes our slavery and human trafficking statement for the financial year ending 31st March 2018.

Formatted: Font: Italic, Font color: Red

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Appendix 1

Modern Slavery: Note on Raising of Staff Awareness within the CCG

This will be achieved by the following means:

Highlighting the issue periodically via the weekly staff bulletin, weekly team brief & quarterly Staff Council

This will include reference to the following e-learning resources for general staff awareness:

o www.e-lfh.org.uk/programmes/modern-slavery/ o https://www.england.nhs.uk/ourwork/safeguarding/our-work/modern-slavery/ o http://www.gla.gov.uk/who-we-are/modern-slavery/who-we-are-modern-

slavery-spot-the-signs/

This is in addition to any specific safeguarding training undertaken by staff in appropriate to their roles.

Formatted: List Paragraph, Bulleted + Level: 1 + Aligned at: 0.63 cm + Indent at: 1.27 cm

Formatted: List Paragraph, Bulleted + Level: 2 + Aligned at: 1.9 cm + Indent at: 2.54 cm

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http://www.e-lfh.org.uk/programmes/modern-slavery/

https://www.england.nhs.uk/ourwork/safeguarding/our-work/modern-slavery/

http://www.gla.gov.uk/who-we-are/modern-slavery/who-we-are-modern-slavery-spot-the-signs/

http://www.gla.gov.uk/who-we-are/modern-slavery/who-we-are-modern-slavery-spot-the-signs/


Paper Title

East London Health Care Partnership: Update

Paper Author

Alan Steward, System OD and Transition SRO, BHR CCGs

Lead Presenter

Jane Milligan, Single Accountable Officer, NHS City and Hackney CCG

Paper Summary

The report updates the NHS City and Hackney Board on the progress made by the East London Health and Social Care Partnership to deliver the NEL Sustainability and Transformation Plan. It briefly sets out: The proposed changes to the governance arrangements to

enhance the effectiveness of the ELHCP and ensure it can drive the changes required to improve services and health outcomes;

The latest summary of progress on the main transformation programmes delivered through the ELHCP;

The work of the Clinical Senate; The bid for Local Health and Care Record Exemplars; The review of ELHCP organisational development; The main communication and engagement developments in

the last quarter.

Purpose For information

Recommendation

The Governing Body is asked to: Note the report.


There has been no presentation of this paper at any previous meeting for City and Hackney CCG.


N/A

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Report 1. The East London Health and Care Partnership (ELHCP) brings together the 12 local NHS

organisations (commissioners and providers) and eight local councils to improve health and care services and outcomes. It takes the lead around the NEL Sustainability and Transformation Plan (STP). This report sets out: the proposed changes to the governance arrangements to enhance the effectiveness of

the ELHCP and ensure it can drive the changes required to improve services and health outcomes

the latest summary of progress on the main transformation programmes delivered through the ELHCP

the work of the Clinical Senate the bid for Local Health and Care Record Exemplars the review of ELHCP organisational development the main communication and engagement developments in the last quarter.

2. It is intended to provide an update on the ELHCP at each meeting of the CCG GB.

ELHCP Governance 3. The ELHCP has been operating for over 12 months bringing together commissioners, providers

and other partners including local councils and the voluntary and community sector. Over the last two quarters (and emphasised in the new planning guidance issued by NHSE), it is timely to review the ELHCP governance. This is driven by two elements, the focus on developing and accelerating integrated care partnerships (formerly accountable care systems) and the establishment of the NEL Commissioning Alliance and the appointment of a Single Accountable Officer.

4. In January both the ELHCP Board and Executive agreed to:

strengthen the Partnership Executive so that it meets monthly and is composed of the Chief Executives and other senior leaders from across NEL including all major providers, CCGs, primary care, local councils and the Clinical Senate. The CCGs are represented on the Executive through the Single Accountable Officer and the NELCA Chair of Chairs (Dr Anwar Khan)

change the Board to an NEL Assembly that meets every 3 months with a range of stakeholders. This will take a themed approach to each meeting with an overall focus on health and wellbeing, prevention and self-care. It will provide strategic advice to the Executive as it looks to deliver the key ambitions and transformation set out in the STP.

5. Further work was requested to define more closely the links between the ELHCP Executive and

the three System Delivery Boards established to deliver the local integrated care partnerships and around the relationship and reporting to regulators (assurance). Future ELHCP updates will ensure CCG GBs are updated on the progress being made.

6. The ELHCP has also started a review of the current NEL Sustainability and Transformation

Plan. This is to take account of the updates to the Five Year Forward View, the latest Planning Guidance issued by NHSE and the formation of the NEL Commissioning Alliance. This will set out the key decisions and deliverables for 2018/19. An update will be provided to the next GB meeting on the outcomes of the refresh.

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Delivery of the NEL Sustainability and Transformation Plan (STP) 7. The ELHCP drives the transformation programmes within the NEL Sustainability and

Transformation Plan. A monthly summary that sets out the progress, key delivery risks and any mitigating action is attached at Appendix A.

8. Key progress areas to note are:

Primary Care: A common provider development framework has now been established. The framework has 5 key elements that help move the federations in the 7 CCG areas along their development journey, developing clear system plans to ensure each is moving towards our aspirations and goals.

UEC: The IUC 111 and Clinical Assessment Service (CAS) has now been awarded to LAS. The CAS service will enable patients to receive fast efficient clinical advice, with improved onward referral pathways, reducing the number of steps in key pathways into pharmacy, primary care, UTC, social care and mental health.

Cancer: Focus on achieving and maintaining cancer waiting time targets. Preliminary figures on 12 January 2018, show that the system will remain above trajectory for those treated in December. Focus of the NEL 62 day group remains on delivery, achieved through working with providers in NEL and NCL such as UCLH, sharing learning across the system and carrying out root cause analysis (RCA) to prevent re-occurrence of problems and with the support of the regional cancer delivery board.

Mental Health: ELHCP Mental Health workstream's Delivery Group 2 'Improving Access and Quality' has prioritised IAPT service transformation across East London to ensure all CCGs can improve and maintain their services and support delivery of IAPT access standards.

Clinical Senate 9. The Clinical Senate is developing its 2018/19 priorities and it is currently focusing on 4 areas:

at the January meeting it was agreed to prioritise a systematic NEL approach to Outpatients transformation and a delivery plan will be presented to the April JCC outlining the Senate’s recommendations for implementation. This priority was supported by the ELHCP Executive and Board.

the February meeting reached agreement on the clinical model for mental health support to primary care and agreed that a local mental health network be established to develop the delivery plan

a survey is being undertaken of views on the Senate’s role and its operating model and this will be discussed in March with recommendations to come to the ELHCP Executive for agreement.

the forward business plan for the senate is under development and should be available by March. This will focus on those areas which the Senate wants to prioritise this year and the frame for their work and also those STP programme areas where there is a need for debate about the clinical model.

Digital: Local Health and Care Record Exemplars 10. NHS England (NHSE) is about to launch a call for proposals for up to five Local Health and

Care Record Exemplars (LHCREs) programmes that can ‘raise the bar’ in how the NHS, and its partners, share data to help deliver better care for our citizens. Each exemplar will be granted £7.5m available from 18/19 to 19/20 for each locality – matched with local investment and resource to implement and roll out their exemplar programme. Up to 5 of these will be awarded nationally. The LHCREs will show how data can be shared appropriately, and for what purposes, across venues of care within localities at scale and adhering to secure, robust and transparent information governance frameworks. They will demonstrate practical approaches

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to continuous patient, professional and public engagement and show how appropriate and compliant data sharing directly improves the quality and efficiency of care while reducing health care inequalities.

11. North east London is further ahead with this work compared to other areas across the country,

with significant and ongoing work on the eLPR (east London Patient Record) and Discovery/Population Health programmes. Following discussion with NHSE, it is now confirmed that north east London (ELHCP Informatics Group) will lead on the development of this pan London proposal in collaboration with the full London system. Active discussions are underway with the five London STPs to seek support for and frame the bid. It is anticipated that the NHSE call will be launched towards the end of February 2018 with a six-week timeline for submission and a decision on the successful LHCRE bids by the end of April 2018.

12. The ELHCP Board supported both a NEL bid and that NEL is leading the bid for London.

Individual CCGs are being engaged and the programme is being discussed in more detail at the next NEL Informatics Steering Group on 6 March 2018.

Organisational Development 13. Alongside the refresh of the Sustainability and Transformation Plan, a review of the ELHCP

organisational development strategy and plan is underway. It will build on the early successes of the programme in securing support from Staff College to support medicines optimisation, end of life care and diabetes work and with the Dartmouth Institute to support Integrated Care Partnerships. This will be integrated into the enabler workstream around workforce and seek to link together the organisational development needed to deliver the STP priorities in 18/19 and beyond.

Communication and Engagement 14. The ELHCP undertakes communication and engagement across NEL on some areas of the

STP. In the last quarter, the Partnership’s external website www.eastlondonhcp.nhs.uk has been rebuilt with an improved structure to bring it in line with industry standards. One of the site’s new features is a section devoted to health and care workforce recruitment and retention. This is work in progress but a preview is available at http://elhcpcareers.speedwaystaging.co.uk/.

15. There is a significant focus on improving recruitment and retention as one of the key enablers for the STP. The maternity transformation workstream is running a campaign to attract more midwives – Careers are born in east London - that is being launched at the end of February. There is also support to the primary care quality improvement programme to promote the significant improvements in primary care since the launch of the programme and there is a stakeholder event for the digital workstream on 21 February, focusing on shared patient records and telehealth.

16. Finally, a report on the successful ELHCP Health and Housing Conference last October has now been published on the Partnerships website. The key findings will be taken into account in the refresh of the STP.

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http://www.eastlondonhcp.nhs.uk/

http://elhcpcareers.speedwaystaging.co.uk/

Transformation Highlight Report

North East London STPJanuary 2018

Mehreen Arshad

NCEL STP Aligned Lead

NHS England Newham

Barking and Dagenham

Havering

Redbridge

Tower Hamlets

City & Hackney

Appendix A

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2

The one accountable officer appointment by the seven CCG governing bodies has been completed, System winter resilience is underway in primary, community and secondary care; including the appointment of directors for winter, General Practice resilience planning and AEDB winter monitoring. Accountable Care Systems – development of the sub-systems and their relationship with North East London Commissioning Board to improve provider and commissioner relationships in system delivery NEL Joint Commissioning Committee agreed – go live April 2018

STP Headlines

Progress against national priority programmes

PRIMARY CARE

Established a provider development framework for at-scale primary care providers Clear action plans for developing increased workforce Developed NEL international GP recruitment bid

UEC

CANCER

MENTAL HEALTH

THEME Progress

Progressed against provider development frameworks for at-scale primary care providers

Meeting with CCGs and at-scale providers to ensure plans are in place for further improvements in preparation for 2018/19

Progress LAS mobilisation plan to meet Go Live date Roll out of 111 bookable appointments to GP Hubs TH and WF CCG Early adopter programme to book 111 appointments into NEL GP practices 111 MH Warm Transfer SOP to C&H/TH/WF being developed UTC Designation dates for other sites underway

Map screening uptake levels in NEL and conduct gap analysis on challenges within primary care in implementing cancer pathways

Increase % seen in week 1, aiming to reducing timelines towards day 28, in 2020 of informing of diagnosis and onward referral by day 38 where appropriate.

Baseline and bid for IPS schemes complete Development of comparative framework for IAPT services Engagement plan for review of psychosis pathways Learning and recommendations from Liverpool suicide prevention and others Improving access and quality, dementia, access standards and waiting times

Next Steps

Consistent CWT performance since compliance against the 62 day standard for Q3 Shared learning across system, all Root Cause Analysis to prevent recurrence of avoidable breaches Collaboration and pathway work across the NEL and NCL STP with particular reference to Prostate

IUC 111 and CAS awarded to London Ambulance Service with expected Go Live date Summer 2018 NHS Online commenced 18th January for BHR and WF CCG 111 Bookable appointments to GP Hubs in BHR operational 111 MH Warm Transfer SoP to MH BHR /WF services to be signed imminently UTC Designation sign off for Queens and KGH

Implemented governance framework for five workstreams: NEL wide suicide strategy; improving quality and access for IAPT – meeting future targets; demand and capacity: Develop effective psychosis pathway and review pathways for other conditions; Improve whole system outcomes - achieve physical health check targets; Commissioning and New Models of Care - align focus of commissioning and contracting to support new models of care

Risk / Issue Mitigation1 Quality standards: There is a risk that with the focus being on financial or performance

delivery, the quality and clinical standards will not be central to planning and approval of transformation plans. This could impact on the quality and clinical impact on patients

NHSI providing input to support the system to control this risk. New operating model for CCGs and systems will support monitoring and managing risk (set up of quality surveillance group) to look at quality outcomes

2 Programme Outcomes: There is a risk that there is variation across all services clinical standards for primary and community services. This will impact on the quality outcomes for the various populations NEL services delivery

The Clinical Senate is currently informed by variation benchmarking presenting from work streams, Right Care and annual contracting information. The development of a NEL wide quality group will support the monitoring of risk of variation, approval process of business cases and escalating severe variation risk

3 Although contracts have been agreed with all providers, there is a risk of a financial gap opening up if the transformation, QIPP and CIP schemes do not deliver and some are high risk.

Operational Delivery Group to review high risk CIP and QIPP to identify work stream level mitigation plans. Plan to develop joint approach to the identification and implementation of CIP and QIPP

4 Due to limited funding for initiatives, there is a risk of prioritisation from other parts of the system, including the potential knock on effect from any reductions in Local Authority funding

Confirm through next stage of ELHCP design and Operating Framework

5 There is a risk that there is insufficient programme resource to deliver the ELHCP programmes Funding proposal developed and potential sharing of programme funding. Recruitment of central PMO roles, possibility of secondments. Review of programme structure underway

STP Risks / Issues

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3

Full year extrapolation forecasting at £260m deficit. At month 8 the reported full year forecast was £94.9m. Financial strategy: The ELHCP Payment Development Steering Group reviewed and summarised feedback on the Payment Reform consultation. The reform will help develop payment to support health and care objectives in NEL.

Engagement with stakeholder has helped identify perceptions of stakeholders, emerging principles, and areas that need further research. Next steps are to collaborate and shape upcoming discussions of the ELHCP working towards our aim of better serving our population.

Enabler Headlines

Risk / Issue Mitigation

1Finance: There is a risk of £165.05m within the full year forecast position. This is particularly the case for Barts and BHRUT who are currently forecasting significant improvements in their positions in comparison to their YTD deficits. This £165m risk relates to significant back-loading of efficiency plans across both commissioner and provider plans.

The main contributors to the system deficit position are Barts Health and BHRUT. Both organisations are currently in discussions with regulators with a view to improving their forecast position.

2Estates: The size of East London Health and Care Partnership/ NEL footprint means there is a risk that the capacity to manage the population growth is at stake. This will make it difficult to implement the necessary change programmes (particularly Whipps Cross proposals).

1. Development of estates strategy and function should be in place particularly for Whipps Cross2. All organisations need to demonstrate adherence to the estates strategy3. Securing funding to implement the strategy is essential for successful implementation4. An agreed Memorandum of Understanding should be circulated across all organisation with a NEL wide estates function.

Enabler Risks / Issues

Progress against Enabler Programmes

THEME Progress Next Steps

FINANCE

WORKFORCE

DIGITAL

ESTATE

Month 8 Contract Triangulation gap £31m and £41m forecast. Month 8 System gap excluding triangulation gap £147.3m and £173.3m including triangulation. Forecast full year deficit at month 8 excluding triangulation was £53.2m and £94.9m including triangulation.

Month 8 year to date forecast is £173.3m deficit. Refresh control total tool for month 8 Successful bids for maternity and CYP Transformation funding and National Mental Health winter funding

Well-established shared record system in INEL eLPR used in the Newham UCC to view GP records, and in the pilots that are underway to test new ways of

working in Outpatients Discovery programme receiving data from Homerton, Barts Health and the majority of GPs, combined to give a

single view of the patient record

Next Gateway requires London partners to complete a robust London Capital Plan by end of this FY, consolidation of STP Plans, working at a centralised capital total requirement for NEL and an agreed prioritisation matrix to be able to ranked different projects

Draft ELHCP Estates Strategy – to be signed off by the STP Executive committee Agreed Asset Management and Utilisation Strategy across ELHCP including void liability for the commissioners Progressing with the Back office consolidation strategy including all providers and commissioners – linked to

Productivity work stream

LWAB established and HEE resource provided New Role Development – including funding for MAs, PAs, NA System level interventions including a review to inform system level response and apprenticeships strategy GP International Recruitment Programme Primary care modelling and enabler programme implemented

Payment reform consultations responses review. Refresh control total tool for month 9 Develop financial model to evidence the potential additional staffing

requirements or not of implementing continuity of care model.

Expansion of the eLPR into BHR. BHRUT and Barking & Dagenham GPs have committed to connecting. Work underway with suppliers

Connection of eLPR to London Health and Care Information Exchange NELFT and LB Newham contributing data to eLPR City of London Corporation and LB Hackney connecting to eLPR

Finalise strategy and prioritisation list for London Plan Void management plan with action plan per building setting financial targets per

CCG for 17/18 Infrastructure Delivery Plan showing project interdependencies between systems

Require service location data from providers (Nov – Jan) Finalise asset database to allow for mapping (Jan – March) Estate Reconfiguration options explored

ELHCP wide development of apprenticeship plan Economic review of embedding the NA role across ELHCP

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4

Progress against STP local themes

AO and Commissioning

Landscape Arrangements

Operating model design in progress (proposal team of system leaders and corporate directors) Interim SMT posts established (MDs, Director of Strategic Commissioning) ELHCP Governance being amended to compliment and align System stakeholder session delivered in December 2017 Stocktake of CCG arrangements underway to identify opportunities for shared approaches and good practice

Development of ACSs

ACS plans have been developed on three footprints: BHR / WEL / C&H Governance structures developing over 18 months to support new vision, largely advisory however successful in

bringing partners together to explore new operating models Joint Commissioning arrangements and supporting governance have been established Contract payment mechanism under review following system consultation Detailed self assessment update was developed for STP SROs Workshop in January 2018

Contract Round

Barts and NELCA working to agree year end deal in 2 weeks and making progress on 2018/19 contract. Escalation for latter due this month.

BHRUT and NELCA agreeing scope of expert determination with a view to rapid conclusion via national regulators agreeing impact on 2018/19 as soon as possible. Intention is to minimise scope of national arbitration through engaging with Trust.

King George Hospital

Public statement with BHRUT/ELHCP and NHSI published Nov 17 and BHR Integrated Care Partnership Board updated on December 2017

STP letter on congruence of KGH SOC and WX SOC and alignment with out of hospital strategy submitted to NHSI in January 2018

THEME Progress

Detailed governance (and CCG constitutional changes) Substantive Recruitment of MDs and other Executive posts underway Formal JCC members in recruitment (Lay members and others) System stakeholder session planned for March 2018 to review and launch OD plan in delivery Jan – Mar (JCC and Executive sessions) Stocktake outcomes Phase 1 – Jan / Feb, Phase 2 to consider opportunities

Assessing London Devolution implications Developing NEL ACS strategic framework Clinical strategy development Provider alliance development and response to commissioning test areas Next steps on the STP/commissioning agenda and the ACS programme

STP has systems in place to meet deadline of 28th February. All other contracts expected to be achieved except for some risk on ELFT CHS.

Public statement published NHSI preparing approvals report with a view to submission to NHSI Resources Committee in February 2018

Submission of approvals report to NHSI Resources Committee in February 2018

Next Steps

Winter

All tranches of winter funding now received i.e. acute, mental health, 111 and UEC totalling £6,270,257. Tracking of scheme implementation and impact across all tranches of received funding is in progress and reported to NHSE/I as appropriate

Heightened daily focus and priority is managing pressures relating to increasing circulating flu as measured by confirmed cases in ITU/HDU, in other beds and number of daily newly diagnosed cases

Focus on Christmas and New Year wash up ensuring clarity on refining high impact interventions in and out of hospital to support delivery against Q4 STF i.e. performance and streaming.

Communications and Engagement

Established online information and resource centre for Partnership organisations – The Briefing Room Rebuilt Partnership external website for ease of use Organised Health & Housing conference to identify actions in relation to the wider determinants on health Produced simpler narrative on transformation programmes to explain what we are doing and what it means Produced initial Live & Work in East London brochure to support workforce recruitment and retention

Recruitment and retention campaigns for maternity and workforce programmes Campaign to support quality improvement in primary care Developing stakeholder relations with east London voluntary sector, Healthwatch,

local colleges and universities Continuing to build relationships with local authorities and encouraging

involvement in transformation programmes

Support Requirements

Support Request Action Required

1 At present the approach to the distribution of transformation funding is fragmented and not always best targeted at local priorities.

A more locally tailored and targeted approach of transformation funding enabling STPs to have greater influence on the process, aligned with prioritisation in line with London Devolution.

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Paper Title

Conditions for which Over the Counter (OTC) items should not to be routinely prescribed - NHSE Consultation

Paper Author

Rozalia Enti

Lead Presenter

Haren Patel


NHSE has on the 20th of Dec 2017, issued a 2nd consultation (following the July-Oct2017 consultation on the MOLV-LIST of 18 products) – this time on a detailed proposal “Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs” This paper to the GB outlines the conditions (plus 2 product groups) included in this current consultation as well as identified exceptions to implementation of the final guidance. There are general exceptions suggested in the consultation as well as exceptions to certain specific conditions. The consultation runs until 14th March 2018.


For Discussion


The Governing Body is hereby asked to:

1. To consider the proposals outlined in the paper and through the weblinks to the NHSE consultation (provided below*) and provide feedback on all / any of the conditions included in the consultation;

2. The GB is also asked to provide specific feedback on patient groups likely to be disproportionately affected by implementation of the proposed guidance;

3. The full consultation is available through the link below: https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/

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https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/




Joint Prescribing Group meetings Jan 2018, Meetings planed for stakeholders in line with the 1st consultation in 2017 for the MOLV-LIST


No outcome sought from the JPG at this stage – other than agreement for a summary of the consultation to be made available to HUHFT clinicians and for HUHFT Pharmacy to collate any feedback to be brought to future JPG meetings and preliminary views from JPG members.

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Rozalia Enti Assistant Director Medicines ManagementNHS City& Hackney CCG

Conditions for which over the counter (OTC) items should not routinely be

prescribed in primary care

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BackgroundGB members may recall a national consultation, led by NHSE-NSCC on items which should not

routinely be prescribed in primary care NHSE-NHSCC which run from July-Oct 2017 [MOLV-LIST]

This paper here outlines the 2nd ‘wave’ of national consultation running till March 2018 This current consultation sets out proposals for national guidance for CCGs on over the counter (OTC)

products for 35 minor and/ or self-limiting conditions

Who is leading on this work?NHSE and NHS Clinical Commissioners have established a joint clinical working group with representatives from national stakeholders including:• Royal College of General Practitioners, Royal Pharmaceutical Society,• the BMA, NICE, MHRA • Department of Health, CCG representatives, PrescQiPP

Stakeholders who were involved in this proposal Patient Association, National Voices and HealthWatch England

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BackgroundWhat are we asking of general practice members? Please review the documents underpinning the national consultation available at:-https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/The Prescribing Programme Board seeks to: 1. Raise awareness on the national consultation on “Conditions for which over the counter items

should not routinely be prescribed in primary care: A consultation on guidance for CCGs”

2. Listen to feedback / comments / concerns from prescribers, CCG Committees about the proposals

We are also: • Continuing discussions through Joint Prescribing Group • Raising awareness with local patient/ public groups • Reviewing what the local minor ailment scheme offers

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What is the issue being tackled In the year prior to June 2017, the NHS spent approx. £569M on prescriptions for products for minor ailments

which could otherwise be purchased over the counter (OTC)These prescriptions include items for a condition:a. That is considered to be self-limiting & so does not need treatment as it will heal of its own accord b. Which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical advice and can manage the condition by purchasing OTC items OR items:c. That can be purchased OTC, sometimes at lower cost than that which would be incurred by the NHS (e.g. anti-sickness tablets OTC costs- £2.18, cost of tablets +dispensing to NHS £3.00, total actual cost to the NHS including GP consultation & other admin costs >£35)d. For which there is little evidence of clinical effectiveness

By reducing spend on treating conditions that are self-limiting or which lend themselves to self-care, these resources can be used for higher priority areas that have a greater impact for patients, support improvements in services & deliver transformation that will ensure the long term sustainability of the NHS NHSE estimates that restricting for minor conditions may save up to £136M once discounts and clawbacks have been accounted for A wide range of information is available to the public on subjects of health promotion & management of minor self treatable illnesses through the Self Care Forum & NHS Choices & through community pharmacies, many of which are opened extended hours and at week ends

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General ExceptionsFor the category of conditions identified as being appropriate for self-care, this guidance is intended to encourage people to self-care for minor

illnesses as the first stage of treatment.

Clinicians should continue to prescribe taking account of:

NICE guidance as appropriate for the treatment of long term conditions (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease),

for the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to over the counter medicines) and for those patients that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms such as cough lasting longer than three weeks.)

Treatment for complex patients (e.g. immunosuppressed patients) and patients on treatments that are only available on prescription should continue to have these products prescribed on the NHS.

Patients prescribed OTC products to treat an adverse effect or symptom of a more complex illness and/or prescription only medications should continue to have these products prescribed on the NHS.

CCGs should ensure that community pharmacists are reminded of ‘red flag’ symptoms for patients presenting with symptoms related to the conditions covered by this consultation. GPs and/or pharmacists should refer patients to NHS Choices, the Self Care Forum or NHS 111 for further advice on when they should seek GP Care.

Prescriptions for the conditions listed in this guidance should also continue to be issued on the NHS for:

Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant or breast-feeding. Community Pharmacists will be aware of what these are and can advise accordingly.

Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC product.

Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor ailment.

Circumstances where the prescriber believes that in their clinical judgement, exceptional circumstances exist that warrant deviation from the recommendation to self-care.

Patients where the clinician considers that their ability to self-manage is compromised as a consequence of social, medical or mental health vulnerability to the extent that their health and/or wellbeing could be adversely affected if left to self-care.

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Consultation Questions A. Equality and health inequalities

Do you feel there are any groups, protected by the Equality Act 2010, likely to be disproportionately affected by this work?

Do you feel there is any further evidence we should consider in our proposals on the potential impact on health inequalities experienced by certain groups?

B. Proposals for CCG commissioning guidance

Do you agree with the three proposed categories for [items] or [conditions] as below:An item of low clinical effectiveness, where there is a lack of robust evidence for clinical effectiveness;A condition that is self-limiting and does not require medical advice or treatment as it will clear up on its own; orA condition that is a minor illness and is suitable for self-care and treatment with items that can easily be purchased over the counter from a pharmacy

C. Do you agree with the general exceptions proposed?

D. Should we include any other patient groups in the general exceptions?

E: Drugs with limited evidence of clinical effectiveness

Do you agree with the recommendation to: Advise CCGs to support prescribers in advising patients that [item] should not be routinely prescribed in primary care due to limited evidence of clinical effectiveness? Please see Table 1.

F: Self-limiting conditions

Do you agree with the recommendation to: Advise CCGs to support prescribers in advising patients that a prescription for treatment of [condition] should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment? Please see Table 1.

G: Minor ailments suitable for self-care

Do you agree with the recommendation to: Advise CCGs to support prescribers in advising patients that a prescription for treatment of [condition] should not routinely be offered in primary care as the condition is appropriate for self-care? Please see Table 1.

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Table:1 Conditions within scope of current national consultation

Category AreaNHS annual spend Rationale

ExceptionsSee NHSE guidance for list of general exceptions Example products

1 Probiotics £1,100,000

Insufficient clinical evidence to support prescribing of probiotics within the NHS for the treatment or prevention of diarrhoea of any cause.

ACBS approved indication or as per local policy Probiotic sachets

1 Vitamins & minerals £48,100,000

Insufficient high quality evidence to demonstrate the clinical effectiveness of vitamins & minerals. They do not have to go through the strict criteria laid down by the Medicines and Health Regulatory Authority (MHRA) to confirm their quality, safety and efficacy before reaching the market.

Does not apply to Healthy Start Vitamins (not currently prescribed on NHS Rxn) Iron deficiency anaemiaDemonstrated vitamin D deficiency (NB not maintenance)Calcium & vitamin D for osteoporosisMalnutrition including alcoholism

Vitamin B Compound tablets, Vitamin C effervescent 1g tablets, Multivitamin preparations

2 Acute sore throat < £100,000.00

There is little evidence to suggest that treatments such as lozenges or throat sprays help to treat the cause of sore throat and patients should be advised to take simple painkillers and implement some self-care measures such as gargling with warm salty water instead. No exceptions have been identified Lozenges or throat sprays

2 Cold sores < £100,000.00

Cold sores caused by the herpes simplex virus usually clear up without treatment within 7 to 10 days. To be effective, these treatments should be applied as soon as the first signs of a cold sore appear. Using an antiviral cream after this initial period is unlikely to have much of an effect.

This guidance does not apply to complex patients (i.e. immunocompromised patients)No exceptions have been identified Antiviral cold sore cream

2 Conjunctivitis £500,000

Treatments for conjunctivitis can be purchased over the counter however almost half of all simple cases of conjunctivitis clear up within ten days without any treatment. No exceptions have been identified

Antimicrobial eye drops and eye ointment

2

Coughs & colds & nasal congestion £1,300,000

Most colds start to improve in 7 to 10 days. Most coughs clear up within 2-3 weeks. Both conditions can cause nasal congestion. Neither condition requires any treatment. No exceptions have been identified

Cough mixtures or linctus, Saline nose drops, Menthol vapour rubs, Cold and flu capsules or sachets

2

Cradle cap (seborrhoeicdermatitis – infants) £4,500,000

Cradle cap is harmless and doesn’t usually itch or cause discomfort. It usually appears in babies in the first two months of their lives, and clears up without treatment within weeks to a few months. No exceptions have been identified Emulsifying ointment, shampoos

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Category AreaNHS annual spend Rationale


2 Mild cystitis £300,000

Mild cases can be defined as those that are responsive to symptomatic treatment but will also clear up on their own. Symptomatic treatment using products that reduce the acidity of the urine to reduce symptoms are available, but there's a lack of evidence to suggest they're effective. If symptoms don’t improve in 3 days, despite self-care measures, then the patient should be advised to see their GP. No exceptions have been identified

Sodium bicarbonate or potassium citrate granules

3 Contact dermatitis £14,500,000

Treatment normally involves avoiding the allergen or irritant and treating symptoms with over the counter emollients and topical corticosteroids.

No routine exceptions have been identified. General exceptions may apply. Emollients, steroid creams

3 Dandruff £4,500,000

Dandruff is a common skin condition; it isn't contagious or harmful and can be easily treated with over the counter anti-fungal shampoos.

No routine exceptions have been identified. General exceptions may apply.

Antidandruff shampoos, antifungal shampoos

3 Diarrhoea (adults) £2,800,000

Diarrhoea normally affects most people from time to time and is usually nothing to worry about. However it can take a few days to a week to clear up. OTC treatments can help replace lost fluids or reduce bowel motions.

This recommendation does not apply to children. No routine exceptions have been identified. General exceptions may apply.

Loperamide 2mg capsules, rehydration sachets

3

Dry eyes / sore tired eyes £14,800,000

Most cases of sore tired eyes resolve themselves. Patients should be encouraged to manage both dry eyes and sore eyes by implementing some self-care measures such as good eyelid hygiene and avoidance of environmental factors alongside treatment. Drops, gels and ointments can be easily be purchased over the counter.


Eye drops for sore tired eyes, hypromellose 0.3% eye drops

3 Earwax £300,000

A build-up of earwax is a common problem that can often be treated using eardrops bought from a pharmacy. These can help soften the earwax so that it falls out naturally.


Drops containing sodium bicarbonate, hydrogen peroxide, olive oil or almond oil

3

Excessive sweating (hyperhidrosis) £200,000

First line treatment involves simple lifestyle changes. It can also be treated with over the counter high strength antiperspirants. An antiperspirant containing aluminium chloride is usually the first line of treatment and is sold in most pharmacies.


Aluminium chloride sprays, roll-ons, solutions

3 Head lice £600,000

Head lice can easily be treated with wet combing or over the counter medicines that can be purchased from a pharmacy. Everyone in the household needs to be treated at the same time - even if they don't have symptoms.


Creams or lotions for head lice

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Category Area

NHS annual spend Rationale


3

Indigestion & heartburn £7,500,000

Most people have indigestion at some point. Usually, it’s not a sign of anything more serious and can be treated at home without the need for medical advice, as it's often mild and infrequent and specialist treatment isn't required. Most people are able to manage their indigestion by making simple diet and lifestyle changes, or taking medication such as antacids.


Antacid tablets or liquidsRanitidine 150mg TabletsOTC PPIs e.g. omeprazole 10mg capsules.Sodium alginate, calcium carbonate or sodium bicarbonate liquids.

3 Infrequent constipation £22,800,000

Constipation can affect people of all ages and can be just for a short period of time. It can be effectively managed with a change in diet or lifestyle and short term use of over the counter laxatives.


Bisacodyl tablets 5mg, ispaghula Husk granules, lactulose solution

3 Infrequent migraine £700,000

Mild infrequent migraines can be adequately treated with over the counter pain killers and a number of combination medicines for migraine are available that contain both painkillers and anti-sickness medicines.

Those with severe or recurrent migraines should continue to seek advice from their GP.

General exceptions may apply.

Migraine tabletsPainkillersAnti-sickness tablets

3 Insect bites & stings £5,300,000

Most insect bites and stings are not serious and will get better within a few hours or days. Over-the-counter treatments can help ease symptoms, such as painkillers, creams for itching and antihistamines.

No routine exceptions have been identified. General exceptions may apply. Steroid creams or creams for itching

3 Mild acne £800,000

Several creams, lotions and gels for treating acne are available at pharmacies. Treatments can take up to three months to work.


Benzoyl peroxide productsSalicylic acid products

3 Mild dry skin / sunburn £100,000

Most people manage dry skin or sun burn symptoms themselves or prevent symptoms developing, using sun protection, by using products that can easily be bought in a pharmacy or supermarket.

ACBS approved indication of photodermatoses (skin protection in)General exceptions may apply.

Emollient creams, ointments and lotionsAfter sun creamSun creams

3

Mild to moderate hayfever/ seasonal rhinitis £1,100,000

There's currently no cure for hay fever, but most people with mild to moderate symptoms are able to relieve symptoms with OTC treatments recommended by a pharmacist.


Antihistamine tablets or liquids.Steroid nasal spraysSodium cromoglicate eye drops

3 Minor burns & scalds £200,000 Depending on how serious a burn is, it is possible to treat burns at home. Antiseptic creams and treatments for burns should be included in any products kept in a medicine cabinet at home.

No routine exceptions have been identified. General exceptions may apply.more serious burns always require professional medical attention. Burns requiring hospital A&E treatment include but are not limited to:• all chemical and electrical burns;• large or deep burns;• burns that cause white or charred skin;• burns on the face, hands, arms, feet, legs or genitals that cause blisters.

Antiseptic burns cream, cooling burn gel

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Table:1 Conditions within scope of current national consultation Category Area

NHS annual spend Rationale


3 Mouth ulcers £5,500,000

Mouth ulcers are usually harmless and do not need to be treated because most clear up by themselves within a week or two. Mouth ulcers are common and can usually be managed at home, without seeing your dentist or GP. However, OTC treatment can help to reduce swelling and ease any discomfort.

No routine exceptions have been identified. General exceptions may apply. Antimicrobial mouthwash

3 Nappy rash £500,000

Nappy rash can usually be treated at home using barrier creams purchased at the supermarket or pharmacy. Nappy rash usually clears up after about three days if recommended hygiene tips are followed.

No routine exceptions have been identified. General exceptions may apply. Nappy rash creams

3 Oral thrush £4,500,000

Oral Thrush is a minor condition that can be treated without the need for a GP consultation or prescription in the first instance. It can easily be treated with over the counter gel.


3

Prevention of dental caries < £100,000.00

The dentist may advise on using higher-strength fluoride toothpaste if you are particularly at risk of tooth decay. Higher fluoride toothpastes and mouthwashes can be purchased over the counter.


Fluoride toothpastesMouthwashes

3 Ring worm/ athletes foot £3,000,000

Ringworm is a common fungal infection that can cause a red or silvery ring-like rash on the skin. Athlete's foot is a rash caused by a fungus that usually appears between the toes. These fungal infections are not serious and are usually easily treated with over the counter treatments. However, they are contagious and easily spread so it is important to practice good foot hygiene.


Athlete's Foot CreamAntifungal creams or sprays

3

Teething – mild toothache £5,500,000

Teething gels often contain a mild local anaesthetic, which helps to numb any pain or discomfort caused by teething and these can be purchased from a pharmacy. If baby is in pain or has a mild raised temperature (<38C) then paracetamol or ibuprofen suspension can be given. Mild toothache in adults can also be treated with OTC painkillers.


Antiseptic pain relieving gelClove OilPainkillers

3 Threadworms £200,000

Threadworms can be effectively treated without the need to visit the GP. Treatment (chewable tablet or liquid) for threadworms can easily be bought from pharmacies. Strict hygiene measures can also help clear up a threadworm infection and reduce the likelihood of reinfection.

No routine exceptions have been identified. General exceptions may apply. Mebendazole 100mg tablets

3 Travel sickness £4,500,000

Mild motion sickness can be treated by various self-care measures (e.g. stare at a fixed object, fresh air, listen to music); more severe motion sickness can be treated with OTC medicines.


Travel sickness tablets

3 Warts & verrucae £900,000

Most people will have warts at some point in their life. They are generally harmless and tend to go away on their own eventually. Several treatments can be purchased from a pharmacy to get rid of warts and verrucae more quickly if patients require treatment.


Creams, gels, skin paints and medicated plasters containing salicylic aciddimethyl ether propane cold spray of 184

Cost estimates (not savings) for self care areasCosts for some Self Care areasfor C&H and across NEL STP

C&H Est annual Costs(extrapolated from Apr-Oct17 data)

NEL Est annual Costs(extrapolated from Apr-Oct17 data)

Analgesia (excl POM and cough&cold, incl migraine) £216,898 £1,610,991

Antihistamines (excl POM, incl nasal preps) £95,760 £756,427

Cold Sore £2,937 £22,349

Colic £1,423 £18,801

Conjunctivitis £84,571 £621,831

Cough and Cold £8,537 £39,609

Eczema £19,853 £131,283

Skin Rash £12,295 £109,010

Emollients (OTC) [incl dandruff & nappyrash] £581,283 £4,822,848

Fungal Infection [not incl oral thrush] £39,262 £241,462

Haemorrhoid £11,234 £68,055

Head Lice & Scabies £13,440 £88,212

HeartBurn and Indigeston £54,557 £568,267

Threadworm £1,250 £9,123

Travel Sickness £10,524 £91,425

Upset Stomach (incl diarrhoea & constipation) £260,253 £2,071,368

Total for 21 of the 35 areas (60% of the NHSE areas) £1,414,077 £11,271,062

KEY to categories on previous slides

Category Category

1 Items of low clinical effectiveness

2 Self-limiting conditions

3 Minor ailments suitable for self-care of 184

Communications and EngagementThe communications and engagement team is seeking as part of the consultation, engagement with patients, the public, GPs and other stakeholders about guidance and feedback on the items which are being suggested, should not routinely be prescribed in primary care. Engagement activities will involve local people and stakeholders, particularly those likely to have an interest in these services, so that NHS England receives strong feedback, which is representative of the views of local people.

Communications and engagement objectives1. To understand the views of stakeholders on the guidance proposals, to help inform decisions

and processes2. To be open and honest about why these proposals are being made, the financial position of

the NHS and its possible consequences.3. To engage with key stakeholders so they understand the rationale behind the guidance4. To ensure a smooth transition to the point where items may be stopped being prescribed

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Comms and Engagement activitiesCity and Hackney CCG are responsible for engaging with stakeholders, to ensure their views help to shape any changes. Our comms and engagement team have/ will: • manage proactive and reactive media on the issue• manage public affairs (communications with local politicians and political groups)

in tandem with our local authorities who have existing relationships • manage two way stakeholder communications including making use of our own

channels• advise on engagement with staff and service users• engage with and update our GP members on the issue• draft comms materials as required• Ensure feedback is recorded and presented in the right way

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Stakeholder Activity ResponsibilityPatients and the public Engage via media, digital channels and patient

groups and offer to present at meetings and send through proposals for them to considerPress release sent out to local pressPublic webinar link also distributed to various stakeholdersInclusion in Hackney Today in ‘Have your say section.’

Communications manager

Head of Medicines ManagementEngagement manager

Clinicians, staff, service providers Email advising of engagement Send engagement document and questionnaireStories in newsletters/internal comms

Head of GP membership engagement and engagement officer

Councils and elected representatives Email advising of engagement Send engagement document and questionnaireAsk councils/MPs to mention in their internal comms/newsletters/websitesOffer briefing in person

CCG communications manager to distribute comms

Community and voluntary groups Actively engage with key groups and request to speak at their meetings CCG to present and provide opportunity for

feedbackNational groups Email advising of engagement

Send engagement document and questionnaireNEL CSU to approach

NHS England Keep updated as required Briefings team - CSUMedicines management team – CCG

Media Through media releases and offer interviews/case studies to explain detail

CCG communication manager to draft and manage media, as required

Comms and Engagement Stakeholder activities

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Feedback received to date Much of the following comes from comments provided during the 1st wave consultation General agreement that:• In City & Hackney we continue to have available the community pharmacy minor ailment scheme [Pharmacy First] to

manage minor ailments for patients registered with a local GP – and that this is very helpful • the Pharmacy First scheme needs a relaunch to

• make residents & patients aware of the scheme• That it covers the conditions for which the initial national proposal suggests restrictions for • Accompany a wider educational programme to help raise public awareness about self-care especially when it is

safe to self treat and when to self-refer to a pharmacist / to a GP • Increase GPs awareness of what products are accessible through Pharmacy First Other feedback received includes:-• In much of the feedback received by the CCG to date, concerns have been raised that the exceptional levels of

deprivation in City & Hackney restricts many local patients’ ability to purchase OTC, in a way that would significantly restrict full implementation of any national policies/ guidance on stopping the supply of OTC products through GP prescriptions.

• Though Pharmacy First is free of charge (to those meeting free NHS prescription criteria), other patients who are on lower incomes but not on benefits who require multiple products would be severely disadvantaged

• Pharmacy First may not meet needs of some patients e.g. homeless, and those not C&H GP registered, other vulnerable groups, those requiring OTC product for a non-minor ailment

• Concern raised by HUHFT A&E consultant that patients not receiving OTC products may turn up at A&E, thus increasing pressure on A&E and hospital drug budgets and clinical deterioration of patients e.g. children not receiving antipyretics from their GP

• Consultants at HUHFT seeking clarity that restrictions on vitamins and minerals will not affect access to such products when required for diagnosed clinical deficiency

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City & Hackney Pharmacy First - current provisionNo. Included in NHSE proposal Included in C&H Pharmacy First No. 2 Included in NHSE proposal 3 Included in C&H Pharmacy First 4

1 Acute sore throat Y 19 Mild acne N

2 Cold sores Y 20 Mild cystitis N

3 Conjunctivitis Y 21 Mild dry skin / sunburn N

4Contact dermatitis

Y22

Mild to moderate hayfever/ seasonal rhinitis

Y - as Hayfever

5Coughs & colds & nasal congestion

Y- as Cough; Viral upper respiratory infection

23 Minor burns & scalds N

6

Cradle cap (seborrhoeic dermatitis – infants)

N

24

Minor conditions associated with pain, discomfort and/fever (e.g. aches & sprains, headache, period pain, back pain)

Y- as Headache; Fever; primary dysmenorrhoea; soft tissue injury

7 Dandruff N 25 Mouth ulcers Y

8 Diarrhoea (adults) Y 26 Nappy rash Y

9 Dry eyes / sore tired eyes N 27 Oral thrush N

10 Earwax N 28 Prevention of dental caries N

11Excessive sweating (hyperhidrosis) N

29 Probiotics N/A

12 Haemorrhoids Y 30 Ring worm/ athletes foot Y- as athletes foot

13 Head lice Y 31 Teething – mild toothache Y

14 Indigestion & heartburn Y 32 Threadworms N

15 Infant colic N 33 Travel sickness N

16 Infrequent constipation Y 34 Vitamins & minerals N/A

17 Infrequent migraine N 35 Warts & verrucae Y

18 Insect bites & stings Y

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NHSE (London) Review of minor ailments schemesNHSE have in recent weeks issued CCGs with a series of reviews of the pharmacy schemes that

NHSE London Area Team (LAT) administers on behalf of CCGs In its review on minor ailment schemes, NHSE LAT makes the following recommendation “NHS

England London Region to decommission the existing services as they are no longer fit for purpose; based on national developments in unscheduled care pathways and the national consultation to encourage and promote self-care for minor conditions”

NHSE LAT gave medicines management teams the opportunity to respond to their review of pharmacy services and the C&H prescribing programme board has responded to NHSE LAT expressing disappointment at the recommendation from NHSE LAT and making clear that there is a need for a pharmacy based minor ailment scheme in City&Hackney and as such we are not in support of decommissioning our local service.

Pharmacy First (the name of the C&H minor ailment scheme) currently provides 60,880 consultations through 52 C&H pharmacies. Decommissioning of this service would create a significant pressure on an already stretched general practice service.

The prescribing programme board are about to embark on a survey of- GPs, Community pharmacists, service users and residents with regards to their views /

concerns / recommendations on the current Pharmacy First scheme to help inform future provision of Pharmacy First

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MEETING PAPER COVER SHEET

Meeting Title City and Hackney CCG Governing Body

Meeting Date 23 February 2018

Paper Title Update on Progress of Integrated Commissioning

Paper Number

Paper Author Devora Wolfson, Programme Director: Integrated Commissioning

Lead Director David Maher, Managing Director

FOI status Available under FOI

Paper Summary The purpose of this report is to update members of the Governing Body on the progress that has been made by the commissioning partners in furthering the Integrated Commissioning programme in City & Hackney.

Purpose

For Noting

Recommendation The Committee/Governing Body is hereby asked to: NOTE the update on activity within the Integrated

Commissioning Programme since the last update in December 2017;

NOTE the current position on the further pooling of workstream budgets;

NOTE the update on the proposed Integrated Commissioning Clinical / Practitioner Forum;

NOTE the updates on Outpatients Transformation and the Hackney Integrated Learning Disabilities Service.

Where this paper was previously discussed?

n/a

What was the outcome?

n/a

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Main Report

1. Draft Business Cases for further Pooling of Workstream Budgets As set out in the report to 27 January Governing Body meeting, outline Business Cases have been developed for the pooling of Residential and Continuing Care budgets within the Planned Care workstream, and for further pooling of budgets relating to the Prevention workstream.

The plans for Prevention budgets are currently being discussed further by the partner organisations and a final business case will be brought to the Governing Body in due course after endorsement by the Integrated Commissioning Boards.

Proposals for the pooling of Residential and Continuing Care budgets within the Planned Care workstream have been endorsed by the Transformation Board, subject to a due diligence review by partners’ financial teams. An outline business case is being taken to the Integrated Commissioning Boards for endorsement on 28 February 2018. The proposals will then be submitted to the CCG Governing Body and local authority governance structures for approval in March and to NHS England for ratification.

2. Integrated Commissioning Clinical / Practitioner Forum Following consideration of the paper ;Service Redesign and Leadership’ at CEC and the Governing Body in January 2018, a workshop was held on 14 February 2018 to discuss proposals to extend practitioner engagement and input in to the development of services and pathways across integrated commissioning by establishing a systems practitioner/clinician forum. These proposals built upon earlier discussions with the Transformation Board in January, which endorsed the idea of a broader system practitioner cabinet with wide engagement between primary, secondary and social care practitioners.

To test out how such a forum might operate, the workshop used Outpatient Transformation as a ‘live scenario’, to sense check ideas and proposals looking in detail at diabetes and endocrine pathways. A range of clinicians attended including GPs, nurses, social workers and consultants from across ELFT, the Homerton, LBH, CoLC and a voluntary sector representative.

There was good engagement in the discussion and a level of consensus about what could be taken forward. It was agreed that in future, attendance would be improved with more notice of both the date and the subject to be discussed and there was significant support and enthusiasm for establishing such a forum. It was agreed that events should be held on a quarterly basis, including one workshop to be scheduled in the evening to encourage attendance by secondary care practitioners.

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It is proposed that the month in which the forum is held, there will not be a CEC meeting.

See following paper for a summary of the discussions.

3. Outpatients Transformation

On 9 February 2018, the Transformation Board received a draft proposal and project plan from the Planned Care workstream, for the workstream with the Homerton University Hospital to systematically review 12 outpatient specialities in order to maintain a more efficient health economy and effective service across the sector. The reviews would focus on specialty administration, advice and guidance to primary care, first and follow-up arrangements, clinical pathways and linked community services.

The Transformation Board was supportive of the principle and ambition of the proposals. It was agreed that further work should be undertaken to refine the scope of the project and its timescales and that the refined proposals should be taken to the Integrated Commissioning Boards on 21 March 2018. An update will be reported to the Governing Body on 23 March 2018.

4. Transforming Hackney’s Integrated Learning Disabilities Service

The February Transformation Board received an update on progress on the review of the Integrated Learning Disabilities Service (ILDS), which is jointly commissioned by LBH and the CCG... The purpose of the review is to improve the quality of health and social care provision and in doing so achieve a greater degree of integration and multi-disciplinary working between the various professionals involved, as well as contributing to a financially sustainable operating model in the future.

Phase one of the review involved extensive consultation with health and social care ILDS staff and engagement with service users and carers. From this, four potential operating models were developed (see table, below), and options appraisals were carried out on each model.

Options Summary description

1 The structure of existing provision would remain unchanged, but we would add in a new, multi-disciplinary and more clearly defined Transitions care pathway. This would improve the way we support young people (aged 14 to 23) to transition into adulthood so that service users and carers feel less anxious about the future.

2

This would require a modest change to existing provision. We would introduce the new Transitions pathway and in addition we would set up a dedicated multi-disciplinary Review Team, to focus exclusively on ensuring that planned annual reviews occur on time and that the

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service has the flexibility and capacity to respond in a timely manner to unplanned reviews.

3

This would require a bigger change to existing provision. In addition to introducing a new Transitions pathway and setting up a Review Team, we would redesign the workflows to make them more integrated. This would ensure that health and social care support is better planned and organised in future.

4

(Preferred)

This would require a more significant change to existing provision. In addition to introducing a new Transitions pathway, setting up a Review Team and designing more integrated workflows, we would set up a specific team to support people who have both learning disabilities and mental health needs. This would ensure that service users always get access the right type/level of support at the right time and presents the biggest opportunity for integration across health and social care pathways.

The Transformation Board supported the preferred option set out in the report (Option 4 above) and the report will be taken to the Integrated Commissioning Boards on 28 February for approval .

Further details will be reported to the Governing Body in March 2018.

Supporting Papers and Evidence: Appendix 1 - Business Case for pooling of Residential and Continuing Care budgets

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Summary of the Extended Clinical Executive Committee session held on Wednesday February14th

2018

The purpose of the session was to test the concept of an extended practitioner forum to initiate

ideas for service transformation as part of the Hackney Integrated Care Programme. The session was

attended by current CEC members but extended for practitioners and managers drawn from LBH,

the Voluntary Sector, HUHT,ELFT, the GP Confederation and the CCG.

Clare Highton opened the session by commenting on the considerable progress that has been made

through the Integrated Care Programme. Clinicians have been actively involved in shaping the

programme by involvement in the 4 workstreams and participation at key committees and fora. But

there is a desire to extend this involvement to practitioners across all organisations and sectors to

optimise experience and energy of those who at the end of the day will take responsibility for

delivering new forms of care. The concept is to run an extended meeting of practitioners quarterly

to engage at early stage in redesigning care and then later in the process to sense test specific

proposals. The meeting is not seen as a formal part of decision taking on change but very influential

on what might be taken forward by workstreams.

To test the value of this, participants looked at two particular pathways, Diabetes and Endocrine,

and engaged in a discussion of the current problems trying to identify different was of thinking

about solutions.

All groups engaged in a broader consideration of the psychological and social issues affecting

patients as they became aware of their condition and engaged with care and maintenance. In

looking at it in this way, groups were moving away from the rather linear thinking about the

contribution of generalists and specialists in established pathways. Amongst the ideas getting

traction, were:

Getting behind the aggregate data to understand the different behaviours and needs of very

specific groups and to really understand the more complex psychological and social issues;

this would help target more specific individual approaches

The active enablement of self management through greater use of Health Coaches

The greater use of technology (e.g. patient friendly Apps) to monitor self and to manage

better

Extending the range and contribution of community based practitioners including the

voluntary sector and improving the integration of information and experience across the

practitioners

Focussing hospital based specialists on the more critical end (i.e. Urgent and Emergency

Care)

A full set of issues and solutions are contained in more detailed flip chart output and this has been

forwarded to Dr Gary Marlowe and Siobhan Harper who initiated the case study material.

Reflection and Learning from the Case Study work

Participants then reflected on what they had discussed and what this suggested about the value of

having this kind of extended practitioner engagement.

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Summary of the Extended Clinical Executive Committee session held on Wednesday February14th

2018

2 | P a g e

Generally participants concluded the following:

There was value in having a meeting of this type outside of the normal governance and

workstream processes and beyond the customary patterns of clinical engagement

The value is very much at the early stage of thinking, the generation of ideas, but also

downstream as propositions and solutions need to be tested for practicality and impact

Such meetings are more valuable if they focus on 1 or 2 key areas

Participation should be dependent on the subjects being discussed and so there would not

be a standing conference but there might be a core group of attendees

The notion of “practitioners” is important, moving beyond the customary patterns of

engagement and involving a wider range of expertise and perspective. This would include

social care and the voluntary sector

The subjects chosen for meetings should meet some criteria to do with scale and impact of

issues for the community and for the system, and conditions where we can/should be able

to do something more effectively

Meetings should be prepared in advance with data and a review of evidence base

Meeting preparation might be aided by the use of technology (e.g. What’s App) to gain

some background ideas and thinking in advance of sessions

The process of the meetings would benefit from facilitation

The process is more effective if there is appropriate use of small and large group work

There needs to be a clear follow through after the meeting to retain the confidence and

commitment of practitioners. It should be clear where the ideas will be progressed whether

this by through to the workstreams or elsewhere. In any case the overall conclusions should

be communicated to Transformation Board.

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Paper Title

Patient and Public Involvement Update

Paper Author

Silvia Scalabrini

Lead Presenter

Catherine Macadam


The purpose of this report is to update members of the Governing Body on the CCG patient and public involvement activities.


For Information


The Committee/Governing Body is hereby asked to:

Receive the attached update notes and discuss


n/a


n/a

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City and Hackney CCG

Patient and Public Involvement Update

Governing BodyFriday 23rd February 2018

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Patient and Public Involvement update

• The CCG is currently seeking to co-produce an alliance model of PPI support, which should bealigned to the local integrated commissioning landscape. The purpose of the InvolvementAlliance is to support the delivery of the CCG’s priorities and legislative duties around patient andpublic involvement. The proposed engagement platform should also have a key role in reducinghealth inequalities; in ensuring that engagement opportunities are fully accessible to people inour communities; in working more closely with GP practices and their Patient ParticipationGroups (PPGs) and to find new ways of engaging patients with their local primary care servicesas well as with their own health care.

• The PPI Team is working closely with the GP Confederation to develop a new model of patientinvolvement in general practice that. The aim is to develop fully inclusive and accessible PPGsdrawing on the principles of the Co-Production Charter.

• The CCG will retain the three PPI grants agreements in place with Healthwatch Hackney, AgeUK East London and Hackney CVS for 2018-2019, which provide engagement platforms forlocal people respectively through NHS Community Voice, Older People’s Reference Group,Health and Social Care Forum and Hackney Refugees Forum. The new service specificationswill be aligned to the integrated commissioning landscape and will also be shaped by the workbeing carried out on the Involvement Alliance and patients’ involvement in primary care services.

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Patient and Public Involvement update (2)

• The CCG has taken part in the new NHSE Assessment against the new Patient and CommunityEngagement Indicator. The CCG has received a green rating with 12 points out of 15. Two areasfor improvement have been highlighted (closing the engagement cycle and providing furtherinstructions about getting information in different formats, e.g. easy-read, braille, etc.). Thefollowing actions will be taken:

1. Case studies illustrating impact on people and their health from changes made based onfeedback from patients and the public will be gathered and added to the public-facing website.These will be also shared and disseminated with local organisations and groups to ensure thatpositive stories are celebrated in our communities. This could be helpful to encourageparticipation, retain and motivate current volunteers and support the CCG commitment tomeaningful engagement;

2. Social media/online methods will remain one of the important dimensions of closing theengagement cycle;

3. Other ways of feeding back will include: producing a regular ‘You said, We did’ feature, whichmay be online and shared with local groups/organisations; regular social media updates; feedingback at public/community events/groups sessions/online communities; getting quarterly feedbackfrom the public reps for the workstreams and share that widely; identify a PPI champion within theworkstreams who can help identify examples/case studies to feed back; ad-hoc feed-backevents.

4. The 360 survey for 2017 will be added to the public-facing website; of 184

Patient and Public Involvement update (3)

Continued…

1. In order to ensure that information on services and opportunities for engagement is fullyaccessible to people, collaborative working with the voluntary sector, PALS, Healthwatch andlocal groups will have to be strengthened. Ways to provide a wide range of support will also haveto be explored as part of the role of the Involvement Alliance;

2. Other CCGs public facing websites and engagement strategies are being reviewed to learn bestpractices and gather some evidence in relation to what may work, and therefore may bereplicated in City and Hackney.

• The Healthier City and Hackney Fund demonstrated a joint commitment between the CCG,London Borough of Hackney and City of London Corporation to find collaborative ways ofmeeting local health needs. Fifty-five full applications were received in total and thirteen havebeen recommended for funding following a democratic process of scoring and moderationinvolving a broad range of people from the CCG, PPI Committee members, the two LocalAuthorities concerned, the local VCS and Healthwatch.

• The Homerton University Hospital Person-Centred Care Showcase Event on 29th January 2018was attended by the CCG Clinical Lead for PPI. This was an inspiring and innovative sessionreflecting individual and team journeys to patient- led quality care.

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For discussion

• What areas of work in relation to patient and public involvement should we especiallyconcentrate on over the next year?

• Any other suggestion/recommendation?

Many thanks in advance for your feedback and input.

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Paper Title

2016-17 Annual Report production plan

Paper Author

Matthew Knell

Lead Presenter

David Maher


The following paper sets out a high level plan for the discussion and agreement of the 2016/17 CCG Annual Report.


For Information


The Governing Body is hereby asked to: 1. Discuss the following plan and give any feedback

needed.


N/A


N/A

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2016-17 Annual Report production plan

Update for information to the Friday 23 February 2017 CCG Governing Body

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Plan towards 2016-17 Annual Report publication

Task DeadlineFirst draft Governance Statement discussed at March 2018 Audit Committee Thursday 8 March 2018

Third draft full Annual Report discussed at April 2018 CCG Governing Body Friday 27 April 2018

Final draft full Annual Report discussed and recommendation sought at May 2018 Audit Committee

Thursday 10 May 2018

Final draft full Annual Report presented for agreement, with Audit Committee recommendation at May 2018 CCG Governing Body

Friday 25 May 2018

Full audited and signed annual report submitted to NHS England Tuesday 29 May 2018

CCGs to publish their Annual Report and Accounts in full on their public website Friday 15 June 2018

CCGs should hold an Annual General Meeting (AGM) public meeting Saturday 29 September 2018

• Work is underway to produce the 2016/17 CCG Annual Report with a summary of the timeline available below;

• The 2016/17 Annual Report will need to cover both core CCG business in the year and the work under the Integrated Commissioning Boards;

• A more detailed timeline is available on request that details all internal dates.

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Paper Title

Minutes from other bodies and summaries from subcommittees of the Governing Body:

Paper Author

Matthew Knell

Lead Presenter

Clare Highton


The Governing Body receives summary update notes from its Sub Committees.


For information and discussion


The Governing Body is hereby asked to: 1. Receive the attached update notes and discuss.


These minutes have been discussed and agreed at their respective Boards / Committees.


Not applicable.

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Chair: Dr Clare Highton Chief Officer: Paul Haigh

MINUTES OF THE NHS CITY AND HACKNEY CLINICAL COMMISSIONING GROUP LOCAL GP PROVIDER CONTRACTS COMMITTEE MEETING

HELD ON FRIDAY 22 December 2017

AT

ANNEXE, TOMLINSON CENTRE, QUEENSBRIDGE ROAD, LONDON E8 3ND 10.15 – 12.00

Part 1 (PRIMARY CARE COMMITTEE)

(10.15 – 11.30) PRESENT: Honor Rhodes, Chair (CCG Governing Body Lay Member)

Sunil Thakker (CCG Joint Chief Financial Officer) Jaime Bishop (CCG Governing Body Associate Lay Member) Dr Christine Blanshard (CCG Governing Body Secondary Care Consultant) Dr Mike Fitchett (CCG Independent GP Advisor)

IN ATTENDANCE: Dr Mark Rickets (CCG Clinical Lead, Primary Care)

Alison Goodlad (NHSE Head of Primary Care Commissioning - NEL) Lee Walker (CCG Senior Contracts Manager) Richard Bull (CCG Programme Director, Primary Care) Angela Ezimora-West (NHSE Assistant Head of Primary Care Commissioning - NEL) David Maher (CCG Acting Managing Director) Jennifer Nabwogi (CCG Senior Corporate Services Officer) Tim Wiseman (CCG Head of Operations)

APOLOGIES: Siobhan Clarke (CCG Governing Body Nurse) Dr Penny Bevan (LBH Director of Public Health) Geoffrey Rivett (City of London HealthWatch) Joyce Nash (Chair City of London Health and Wellbeing board)

Agenda Item 1 – CCG Committee business The Chair welcomed everyone to the meeting, presented the register of conflicts of interest and called for any further conflicts that may not yet be registered. No further declaration of interests were made. Apologies were received as above. The meeting was not quorate when it started. The Chair suggested that the meeting commences as they await the arrival of the remaining member. The Chair welcomed Tim Wiseman, who had recently joined the CCG as Director of Operations, and called for table introductions for Tim’s benefit. The Chair also welcomed David Maher in his new capacity as acting CCG Managing Director and Mark Rickets as designated CCG Chair. Siobhan Clarke joined the meeting at 10.21 at which point it became quorate.

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Minutes of the previous meeting The Chair introduced the minutes of the 24 November 2017 meeting and called for observations on accuracy. Decision: The committee approved the minutes of the 24 November 2017 meeting as an accurate record of the meeting. Action PCC0039 - To put together the Primary Care Commissioning Committee line of inquiry for the proposed City and Hackney GP practice visits. Geoffrey Rivett had written a note in response to the action. The Chair expressed regret that Geoffrey Rivett was not at the meeting but thanked him for his written response to the action. The committee discussed the response in detail. Richard Bull suggested that the CCG carries out three light touch visits a year to various practices. Action PCC0042: Ensure that PPGs are included in the planned CCG visits to City and Hackney practices and that visits don’t seem like an inspection. (David Maher) The committee discussed the possibility of linking the planned visits with those of the Healthwatch groups but some of the committee members expressed concern that the visits had been initiated to allow the committee to get closer to the services the CCG commissions and that objective may be limited by linking the visits with other groups. Decision: The committee agreed to consider linking the planned City and Hackney GP visits with those of the Healthwatch. Get guidance from Healthwatch on what practices to visit. The Chair commended Geoffrey Rivett for the response to the GP visit enquiry plans. Matters Arising There were no matters arising that were not on the agenda. Action Tracker The committee reviewed the action tracker and received the following updates from Richard Bull; PCC0028 - To bring the two MoUs that clarify the level of NHSE’s support to the CCG’s primary care commissioning to the Oct PCCC. The MOUs were not yet available. Action to remain open. PCC0033 - To take the Sorsby strategic review paper to either the Jan or Feb PCCC. This was scheduled for Feb 18 meeting. Action to remain open. PCC0034 - Bring the 18/19 headroom proposal to the Dec PCCC. On today’s meeting. To close action. PCC0035 - To bring to the Nov 2017 PCCC, having consulted with the GP Confederation, a specification for a PPG support programme. The Primary Care Quality Board had not supported the GP Confederation’s proposal. Action to remain open. PCC0038 - RB to share blank NHSE resilience self-assessment with the Primary Care Commissioning Committee. Complete. To close action. PCC0039 - To put together the Primary Care Commissioning Committee line of inquiry for the proposed City and Hackney GP practice visits. On today’s agenda. To close action.

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PCC0040 - To liaise with the CCG’s Communications team with the view to publish the achievement in QOF performance. Complete. To close action. PCC0041 - To share the QOF performance information with integrated commissioning workstreams (already shared with Prevention Workstream). The workstreams will own all the QOF areas, so it was important that they were aware of current performance and had plans in place to ensure that performance would be sustained. Complete. To close action. Agenda Item 2 – Refreshed Primary Medical Care Policy and Guidance Manual (summary) Angela Ezimora-West presented the paper. This was to inform the committee that a new primary medical care policy and guidance was in place. Angela outlined the specific areas that had been updated in the new guidance;

Commissioning and regulating – partnership working with the care quality commission GP patient registration and who can access primary care Temporary suspension to patient registration Special allocation scheme Discretionary payments made under section 96 Unscheduled and unavoidable practice close down.

All the above areas were already included in GP practice contracts although practices didn’t always refer to them. NHS England planned to highlight key areas that practices need to be able to vary their contracts as well as some of the most important issues for GPs. The committee discussed in detail the updated guidance about removing patients who were violent from their practice list and the discretionary payments made under section 96, and most specifically if there would be oversight of this work from NHSE. The committee noted the update. Agenda Item 3 – Performance: e-declaration summary paper Alison Goodlad presented the annual GP Practice self-declaration return. The item was for information only. It is a mandatory return from practices to NHS England, first introduced in April 2013, which replaced variable arrangements (such as annual report submissions) that existed prior to that time. City and Hackney had achieved 100% submission. The outcome from the return would be available around early 2018. The committee noted the update. Agenda Item 4 – DES performance/payments 17/18 Alison Goodlad presented the paper which was an update for DES activity for Q1 and Q2 207/2018 for the following services;

Minor surgery

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Extended Hours Out of Area registration and Learning disabilities.

The update was for information only. The committee received the update. Agenda Item 5 – Primary care headroom priorities 17/18 and 18/19: update Richard Bull presented the paper, a summary of the primary care headroom priorities for 2017/18 and 2018/19.

a. The CCG’s primary care team had asked the City and Hackney GP Confederation to consider the possibility of carrying out a small scale quality improvement training to compliment the CCG’s Quality Improvement contract. The team was waiting for the project costs from the Confederation.

b. 300k to go to practices for the Clinical Commissioning and Engagement (CCE) contract.

c. PPG support programme – The GP Confederation’s two year PPG proposal had been rejected by the primary care quality board at their 14/12/2017 meeting. It would be reconsidered at the board’s 8/2/2018 meeting.

d. CCG’s extended access contract. The cost of the extension is 300k to end of Mar 2019. The CCG’s primary care team would also like to use the headroom to fund cost pressures for the later part of 17/18 and then for 18/19 at a cost of £280k.

e. Package of support to Newman practice by GP Confederation. The CCG and City of London Corporation had agreed to jointly undertake an options appraisal. No additional resourcing was required at this stage.

Decision: The committee approved £300k + £280k for the continuation of the CCG’s Extended Access in principle but asked for more information about the proposal. Action PCC0044: Richard to write a short paper about the 2017/18 and 2018/19 Extended Access investment proposal and circulate to committee members. The paper should highlight the amount that has been approved in principle. (Richard Bull) Agenda Item 6 – Standing items Tranche 5 mobilisation Richard Bull gave the following verbal update; Sandringham practice – Post mobilisation review planned Springfield – This was all about future accommodation. Two options were available; Adams House and the Belfast Road property owned by the London Borough of Hackney (LBH). The current plan

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was to continue with the Adams House proposal but continue talking to LBH about the second option. There had been other prior options which had eventually been ruled out. The above were the final two options available. Action PCC0043: Sunil Thakker to share the LBH report on the Belfast Road property with the Primary Care Commissioning committee members. 8-8 access Richard Bull presented the paper which was an analysis of the data from the Extended Access Hub. So far, the Hub had been unable to fill all of the GP rota. It had been agreed to have two six hour slots to see if those would be easier to fill. The committee reviewed the day by day data provided in the report and discussed service utilisation. Action PCC0045: To insert another column in the table presented on page 59 of the Part 1 LGPCC papers provided at the 22 December 2017 meeting. The new column should represent the percentage of booked DNA and should be located between booked DNA and the grand total. (Richard Bull) City and Hackney had been successful in putting in place arrangements to provide a full service on holidays, for example, Christmas and bank holidays. PMS review Richard provided a verbal update informing the committee that City and Hackney had received formal sign-off by London LMC. Consequently, the CCG would be making a formal offer to practices. Finance CCG Sunil Thakker presented the paper. The CCG was on track to deliver the control total, that is, breakeven. There was headroom as well as plans to utilise it. The finance team was working with external auditors KPMG to ensure that the CCG received a clean audit. KPMG would put more focus on the primary care portfolio planning and financial management. Sunil assured the committee that the CCG was in a good place financially and that there was sufficient headroom to manage risk. He put more emphasis on ensuring that all services the CCG commissions were embedded within contracts. Risk register Richard presented the risk register. A new risk had been added; PCC03 – New out of area e-practices have the potential to financially destabilise local primary care by attracting a healthier cohort of patients. The committee discussed how risks should be monitored. Action PCC0046: Assess new risk PCC03 – New out of area e-practices have the potential to financially destabilise local primary care by attracting a healthier cohort of patients and decide if it should be added to the CCG’s BAF. (Sunil Thakker and Richard Bull) Agenda Item 7 – Items for information and any other business:

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This section was presented for information only PCCC forward planner

Richard Bull presented an outline of the items to be discussed at future meetings. The joint Chief Financial Officer suggested that a paper be brought to the committee about the operating plan for 2018/19.

It was agreed that the PPG support specification should be presented at the February 2018 meeting and not the January meeting.

NHSE/CCG fortnightly meeting action tracker The committee noted the planner. Resilience self-assessment checklist The committee noted the checklist Agenda item 8 - Date and time of future meetings The dates of future PCCC meetings were agreed as;

26 Jan, 12.15-1.15 (1hr) 23 Feb, 12.45-2.15 (1.5hrs) 23 Mar, 10.00-11.00 (1hr)

The meeting ended at 11.24 AGREED BY: AGREED ON:

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Meeting-in-common of the City & Hackney Clinical Commissioning

Group and London Borough of Hackney

Hackney Integrated Commissioning Board

and the

Meeting–in- common of the City & Hackney Clinical Commissioning Group and City of London Corporation

City Integrated Commissioning Board

Meeting of 13 December 2017

ATTENDANCE FOR HACKNEY ICB MEMBERS Hackney Integrated Commissioning Committee Cllr Jonathan McShane, Chair, Lead Member for Health, Social Care and Devolution, London Borough of Hackney Cllr Rebecca Rennison, Cabinet Member for Finance & Housing Needs Cllr Anntoinette Bramble, Lead Member for Children’s Services, London Borough of Hackney City and Hackney CCG Integrated Commissioning Committee Jane Milligan, Accountable Officer, City & Hackney CCG Haren Patel – GP Member, City & Hackney CCG Governing Body Honor Rhodes – Governing Body Lay Member, City & Hackney CCG FORMALLY IN ATTENDANCE Anne Canning – Group Director, Children, Adults and Community Health, London Borough of Hackney Mark Rickets - GP Member, City & Hackney CCG Governing Body Philippa Lowe – Joint Chief Finance Officer, City & Hackney CCG

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STANDING INVITEES Penny Bevan – Director of Public Health, London Borough of Hackney and City of

London Corporation Jake Ferguson – Chief Executive, Hackney Council for Voluntary Services Jon Williams – Director, Hackney Healthwatch OFFICERS PRESENT Devora Wolfson – Programme Director, Integrated Commissioning Amy Wilkinson – Workstream Director – Children, Young People and Maternity Nina Griffith – Workstream Director – Unplanned Care Matt Hopkinson - Integrated Commissioning Governance Manager (minutes) APOLOGIES Clare Highton - Chair, City & Hackney CCG Governing Body ATTENDANCE FOR CITY ICB

MEMBERS City Integrated Commissioning Committee Cllr Randall Anderson – Deputy Chairman, Community and Children’s Services Committee, City of London Corporation (Chair) Cllr Ruby Sayed – Member, Community and Children’s Services Committee, City of London Corporation Cllr Marianne Fredericks – Member, Community and Children’s Services Committee, City of London Corporation City and Hackney CCG Integrated Commissioning Committee Jane Milligan - Accountable Officer, City & Hackney CCG Haren Patel – GP Member, City & Hackney CCG Governing Body Honor Rhodes – Governing Body Lay Member, City & Hackney CCG FORMALLY IN ATTENDANCE Andrew Carter - Director of Community and Children’s Services, City of London

Corporation Philippa Lowe – Joint Chief Finance Officer, City & Hackney CCG Mark Rickets - GP Member, City & Hackney CCG Governing Body

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STANDING INVITEES Penny Bevan – Director of Public Health, London Borough of Hackney and City of

London Corporation Jake Ferguson – Chief Executive, Hackney Council for Voluntary Services Geoffrey Rivett - City of London Healthwatch OFFICERS PRESENT Neal Hounsell - Assistant Director of Commissioning and Partnerships, City of London Corporation Mark Jarvis – Director of Finance, City of London Corporation Devora Wolfson –Programme Director, Integrated Commissioning Amy Wilkinson – Workstream Director – Children, Young People and Maternity Nina Griffith – Workstream Director – Unplanned Care Matt Hopkinson - Integrated Commissioning Governance Manager (minutes) APOLOGIES Clare Highton - Chair, City & Hackney CCG Governing Body

1. Introductions

1.1.1.Randall Anderson welcomed members and attendees to the meeting, noting that it was a joint meeting of the two Integrated Commissioning Boards and it had been agreed between the Chair of the Hackney ICB and the Chair of the City ICB that Randall Anderson of the City ICB would facilitate the joint meeting. Decisions made by the two boards would be done so separately and independently, and this would be reflected both in the minutes and in the recommendations set out in future agenda papers.

2. Declarations of Interest

2.1. There were no declarations of interest made in respect of items on the agenda.

2.2. The City ICB NOTED the Register of Interests.

2.3. The Hackney ICB NOTED the Register of Interests.

3. Questions from the Public

3.1. There were no questions from members of the public.

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4. Minutes of the previous Meeting

4.1. The City Integrated Commissioning Board:

• APPROVED the minutes of the Joint ICB meeting on 15 November 2017; and

• NOTED progress on actions recorded on the action log

4.2. The Hackney Integrated Commissioning Board:

• RATIFIED the recommendations and endorsements made at the Joint ICB meeting on 15 November 2017;

• APPROVED the minutes of the Joint ICB meeting on 15 November 2017; and

• NOTED progress on actions recorded on the action log

4.3. ACTION ICB DEC17-1: To circulate the prioritization process exclusion criteria, as a reminder to members. (Anna Garner)

5. Care Workstream Assurance Review Point 1 – Children, Young People and Maternity Workstream

5.1. Amy Wilkinson presented an update on progress made to date by the Children & Young People and Maternity (CYPM) Care Workstream, since it began its work in October 2017. The paper aimed to provide assurance on the proposed governance, membership, delivery framework, key principles and identification of the transformation priorities. It set out the financial position and workstream budget, and options for future financial arrangements.

5.2. The paper had been discussed and endorsed by the Transformation Board on 8 December, and key points had been raised on the governance arrangements and workstream priorities, including affirmation of the principle that workstreams are led equally by the Senior Responsible Officer (SRO), the Clinical Lead and the Patient/Public Representative. It had been agreed that the business as usual elements of community health services and hospital paediatrics should be fully reflected in the workstream workplan.

5.3. Amy Wilkinson reported that each priority area would have key lines relating to the City of London. A meeting at CoLC was taking place later that day to discuss the matter.

5.4. Jake Ferguson endorsed the priorities set out in the report, and suggested that in order to help improve the alignment of the voluntary and public sector, he

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would welcome the opportunity to host a meeting with the CYPM workstream leads in the new year.

5.5. ACTION ICB DEC17-2: To set up a meeting with the CYPM workstream leads in the new year. (Jake Ferguson)

5.6. The following key points were noted:

• Wider work on the overlap with safeguarding is ongoing, and this was discussed at the Safeguarding Children Board on 12 December. Nevertheless, the Boards noted that the workstream submission could have more explicitly referenced safeguarding.

• A pathway should be developed for supporting parents and young people to become more resilient.

• Adverse childhood experience should be considered in formulating the desired outcomes for the workstream.

• Emphasis should be given to the need for links with primary care, and on the need for awareness of potential impact on areas which are not priorities within the workstream (such as diabetes and asthma).

5.7. The City Integrated Commissioning Board:

• APPROVED the submission from the Children, Young People and Maternity Workstream (CYPM) in relation to Assurance Review Point 1; including the governance arrangements for the work stream, and progress to date;

• APPROVED the proposal for moving budgets and services across workstreams (Appendix 2); and note that further report setting out the proposal for pooling and aligning CYPM budgets will be brought to ICB in early 2018; and

• APPROVED the priorities being taken forward by the workstream, noting that they are broadly aligned to our strategic priorities.

5.8. The Hackney Integrated Commissioning Board:

• APPROVED the submission from the Children, Young People and Maternity Workstream (CYPM) in relation to Assurance Review Point 1; including the governance arrangements for the work stream, and progress to date;

• APPROVED the proposal for moving budgets and services across workstreams (Appendix 2); and note that further report setting out the proposal for pooling and aligning CYPM budgets will be brought to ICB in early 2018; and

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• APPROVED the priorities being taken forward by the workstream, noting that they are broadly aligned to our strategic priorities.

6. Discharge to Assess Pilot

6.1. Nina Griffith presented the report, which sought approval to use the Hackney Better Care Fund money, for an initial period of 12 months, at a cost of £341,341 for the proposed Discharge to Assess (D2A) Pilot project; it will operate as an extension to the Integrated Independence Team. Discharge to Assess will help to improve Delayed Transfers of Care (DToC) performance.

6.2. It is important that the pilot includes strong patient feedback and that patient experience of the service is good. It was noted that the Unplanned Care team have already discussed this pilot at the Patient User Engagement Group. With regards to user experience, Nina noted that this had been to the Older People’s Reference Group and that all of the feedback received was in favour of D2A. The main driver for this work is the strong evidence showing the positive impact of early discharge on recovery times.

6.3. Neal Hounsell noted that this was useful from a City of London point of view, as it would provide useful benchmarking data for comparison with the scheme in place in the City.

6.4. Jane Milligan noted that this was an opportunity to look at other capacity for step-up / step-down beds to improve the quality of outcomes for patients.

6.5. Hackney Integrated Commissioning Board:

• AGREED the proposal to implement a Discharge to Assess model of care across Hackney, to run for 12 months

• APPROVED the Business Case for Discharge to Assess

• APPROVED expenditure of £341,314 of the Hackney BCF to implement the model.

7. Neighbourhood Development Business Case

7.1. Tracey Fletcher and Nina Griffith presented a business case to support the planning and design phase for the City & Hackney Neighbourhood Programme. It is intended that a further business case will be submitted for the programme once a detailed specification has been worked up following this initial phase. The programme would involve fundamental changes to service delivery around population segments of 30-50,000. This was small enough to allow detailed understanding of local health needs, but big enough to allow for provision of a

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broad range of services. The model would deliver on all four Better Care Fund (BCF) metrics, quality metrics and sustainability needs, and funding for the programme would come from the Hackney BCF and the City BCF.

7.2. The set-up phase would be funded non-recurrently and it was intended that detail on financial sustainability and system-wide savings to be generated by the new ways of working would be available by March 2018. It was not anticipated that the programme would have recurrent costs. It was emphasised that investment was not to supplement core services, but to transform care delivered at a local level.

7.3. The Transformation Board had discussed the report on 8 December and had raised a question about the need to confirm the contracting model, since any resources will need to flow through a contract and such a contract would set out accountability, etc. Tracey Fletcher noted that the long term contracting structure would be confirmed, subject to further discussions and the development of the programme.

7.4. The Transformation Board also voiced a concern that Neighbourhoods would run as a parallel system to care workstreams and this would lead to duplication of cost and effort. Tracey Fletcher noted that while the neighbourhood programme is being led by the Unplanned Care workstream, it involves all four workstreams. The Neighbourhood Steering Group membership is being expanded to include representation from each of the workstreams, and a mapping exercise will be undertaken in relation to the workstream and neighbourhood structures and arrangements. The Senior Responsible Officers of the Planned Care and Prevention workstreams both endorsed the Neighbourhoods model, whilst noting the complexity of the overlaps between workstreams relating to the programme. The Boards noted that workstream alignment is critical to success.

7.5. Jonathan McShane strongly advocated the proposals as the building blocks for future delivery, and noted that it is important that sufficient time and space is given to develop the approach.

7.6. Mark Rickets questioned the Value for Money assumptions in the business case, since Hackney and City have already seen significant investment in improving primary care (through the GP Confederation, etc.) and the impact would not, therefore, be as significant as it has been in benchmarked areas where the starting position was poorer. Tracey Fletcher responded that this is an evolving approach, and that the Transformation Board will be kept up to date to ensure satisfaction with the direction and outcomes of the programme including value for money.

7.7. Members welcomed the intention set out in the business case for engaging with the voluntary sector.

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7.8. Neal Hounsell expressed support for the proposal from a City of London point of view, as neighbourhoods would give City residents and workers greater clarity on local service pathways, and the ability to tailor local services would suit the City’s high proportion of older residents.

7.9. Whilst recognising that the development and design of the neighbourhood model would take time to develop, Jon Williams noted that there is an urgent need to be able to describe this approach to residents; particularly as this is potentially the first tangible manifestation of the integrated commissioning approach which local people can engage with and be excited about.

7.10. Honor Rhodes noted that the success of a pilot would depend on a robust IT structure with compatibility between partner systems. Tracey Fletcher responded that the IT Enabler Group has been leading on development of approaches to resolving these issues, and discussions are beginning with the workstreams to understand what they need in order to deliver their priorities. Jon Williams advised that the Discovery Programme is being developed, which will deliver a central repository and resource to enable better understanding the relationship between input and outcomes and will support connectivity between acute and primary care.

7.11. The Hackney ICB:

• ENDORSED the proposed Neighbourhoods service model and implementation plan;

• APPROVED the Business Case for initial planning and design and delivery costs; and

• APPROVED expenditure of £818,314 unallocated component of the Hackney BCF to implement the model.

7.12. The City ICB is asked to:

• ENDORSED the proposed Neighbourhoods service model and implementation plan, and to confirm it is comfortable that the model will meet the interests of the City.

• APPROVED the Business Case for initial planning and design and delivery costs; and

• APPROVED expenditure of £40,081 unallocated component of the City BCF to implement the model.

8. Better Care Fund Performance Update - Quarter 2

City of London

8.1. Neal Hounsell introduced the update on the position of the City of London’s performance against Better Care Fund (BCF) targets at Quarter 2. Performance

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for the City is generally good. The paper showed poor performance on Delayed Transfer of Care (DToC); however, since the Q2 report was submitted to NHSE, over 200 days had been successfully challenged as being wrongly attributed to the City, and these would be removed from the figures.

8.2. Geoffrey Rivett noted that City of London Healthwatch would like to be able to support individual patients with delayed transfers of care. It was noted that patient identifiable information could not be included in reports, but if patients consented, then they might be contacted by Healthwatch. This was a matter to be taken up outside of the ICBs.

8.3. The City ICB NOTED the report.

Hackney

8.4. Anne Canning introduced the report on the position of Hackney’s performance against Better Care Fund (BCF) targets at Quarter 2. Performance on three of the four metrics was good, with targets being met or exceeded. Metric 4, Delayed Transfers of Care (DToC), remains an area of challenge for Hackney as a health and care system. A plan has been developed by the partnership to deliver and sustain improved performance, both through management actions and transformational change. It was noted that more recent performance in relation to this target has improved. It was expected that the Discharge to Assess pilot scheme would lead to improved performance in this area.

8.5. Jon Williams stressed the importance of step-up / step-down provision and involving patients as much as possible. Given the choice, many patients would rather receive treatment at home rather than be admitted to hospital.

8.6. The Hackney ICB NOTED the report.

9. Development of City and Hackney System Outcomes Framework

9.1. Anna Garner presented a high level proposal for the development of a City & Hackney outcomes framework, including principles, engagement plan, ambitions and outputs. The Transformation Board discussed the paper at its December meeting and noted that this approach is at the heart of City & Hackney’s journey towards being an effective Accountable Care System that is engaged in improving outcomes and experience for local communities. A workshop is being planned to consider the way forward in detail.

9.2. The City ICB:

• CONSIDERED the recommendations on the method for drafting an outcomes framework

• APPROVED the consultation process and timelines.

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• CONSIDERED the recommendations on the method for drafting an outcomes framework

• APPROVED the consultation process and timelines.

10. Update on Transformation Board

10.1. David Maher gave a brief update on the discussions at the Transformation Board meeting on 8 December.

11. Reflections on ICBs Meeting

11.1. It was noted that the ICB had not received the Month 7 Finance Report in the paper this month, though it had been discussed at the Transformation Board. It was noted that this would be included on future ICB agendas as a standing item. Consideration should be given to the nature of this report, since it would be more useful to focus on the pooled budget areas.

11.2. ACTION ICB DEC17-3: To consider the format of future finance reports to the ICB and how they can be focused on Integrated Commissioning. (Philippa Lowe)

11.3. ACTION ICBDEC17-4: To bring proposals to the ICBs in February on how best to engage with the public around the outcomes of Integrated Commissioning. (Jon Williams / Catherine Macadam)

12. Any Other Business

12.1. The Board thanked Neal Hounsell for his outstanding contribution to Integrated Commissioning and congratulated him on his retirement.

PART 2 - SESSION CONDUCTED IN PRIVATE

13. Contract Award Recommendation for the Evaluation of Integrated Commissioning in City & Hackney

13.1. Anna Garner presented a report outlining the procurement process and recommendations for the provision of evaluation services for Integrated Commissioning in City and Hackney.

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13.2. Following a full procurement exercise, the report sought the ICBs’ approval of the contract award to Cordis Bright for a three year term.

13.3. It was noted that the evaluation would be a continuous one, over a three year period, which would enable the evaluation to influence change and improvement as the Integrated Commissioning programme progressed.

13.4. Members stated that the evaluation team must be encouraged to pay particular attention to the patient involvement elements of the evaluation. It was noted that there would be clear key performance indicators built into the contract and the Evaluation Steering Group would oversee performance in this and all areas.

13.5. Honor Rhodes noted that the evaluation needs to be an iterative process over the whole of the programme. Given that there is little or no evidence-based literature on this kind of health system transformation, it would be good if City and Hackney was one of the first areas to contribute this. As a member of the Evaluation Steering Group, Honor was pleased and impressed with the procurement process and result.

13.6. The City ICB:

• ENDORSED the procurement process as robust enough to be assured of the capability of the highest scoring provider in carrying out the evaluation; and

• APPROVED proceeding to contract discussion and the contract award of £350k to Cordis Bright.


• ENDORSED the procurement process as robust enough to be assured of the capability of the highest scoring provider in carrying out the evaluation; and

• APPROVED proceeding to contract discussion and the contract award of £350k to Cordis Bright.

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FINANCE & PERFORMANCE COMMITTEE (FPC)

February 2018 Report

Report to CCG Governing Body from FPC meeting held on 24 January 2018

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The Finance & Performance Committee met on 24 January 2018. This report provides a summary of the key issues discussed at that meeting.

Month 9 Finance and Performance ReportThe CCG was still on track to deliver the control total agreed in the operating plan submission.The CCG was also on track to deliver the £1.4m surplus agreed as part of the East London Health Care Partnership.The committee was informed of a step change in the Bart’s forecast outturn as at month 8. Bart’s, which had previously declared a breakeven position, had now declared a substantial forecast outturn over-performance of £1.2m. The CCG was working closely with the CSU to rectify the position.

Primary Care Quality ReportThe committee received a detailed primary care quality report. Committee members were informed of funds that the CCG had received from the Home Office towards the health care of 19 Syrian refugees in City and Hackney. The funds worked out at £2600 per patient. The CCG’s Primary Care Director proposed that the money be granted to the local refugee forum instead. The committee agreed that the funds could be granted to the local refugee forum subject to a specification of the refugees’ needs and assurance over how the forum would provide advocacy for those refugees.

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Performance reporting under Integrated Commissioning

Members reviewed the updated committee terms of reference. Starting from 1 April 2018 the FPC will take on a wider role of scrutinising performance under integrated commissioning. This will require a two part meeting. ‘Part One’ of the meetings will focus on business specific to the CCG with outcomes passing onto the Governing Body. ‘Part Two’ will conduct business in respect of the City & Hackney Integrated Commissioning arrangements with outcomes passing on to the Integrated Commissioning Board.

Enhanced PUCC - Recurrent funding

The committee reviewed a proposal from the Unplanned Care worsktream. The proposal was to make the existing non-recurrent funding for PUCC recurrent because, within its current form, the PUCC delivered a system saving.

The committee did not support the Unplanned Care business proposal as presented but recommended that it is reconfigured to take into consideration CHUHSE, ED, PUCC, HOPs & CHAPs, Primary care and non-clinical navigators.

14 February 2018

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Patient & Public Involvement Committee January 2018 Summary

Barts Health, Patient Experience and Engagement: the Committee was provided a detailed update in relation to a number of patient experience and engagement related aspects, including: the number of complaints received; the activity of PALS across the Trust and the learning opportunities emerging from the comments received; specific figures on the Friends and Family Test, how this is administered across the whole Trust, how the data gathered is used to inform improvement plans, and how staff members are supported to make the best use of the feedback received to improve the patient experience. In addition, the presentation covered the data gathered through the yearly national surveys, NHS Choice and Care Opinion. Future plans in relation to improving the Trust’s patient experience were discussed as well as a summary of key engagement activities aiming at building stronger links with the community and the local voluntary sector. The Committee was particularly interested in the Trust’s Patients Forum and how they could become involved in opportunities to shape services. Commissioning Intentions for Unplanned Care: the Director for the Unplanned Care workstream presented their strategic priorities, which are the Neighbourhoods model, urgent care and discharge. She explained how patients and the public’s voices inform the workstream (primarily through a patients panel and public representatives) and some areas for further development were highlighted. These included: the need to get more representation from the City; more detailed improvement work with more time/space to shape and discuss services in a more informal setting; to develop an asset-based approach to engagement to ensure that the wide range of experiences/skills and knowledge can be used to design responsive services. The Co-Production Charter was also discussed at one of the Unplanned Care Board meeting, and more work will be carried out to ensure that its principles are meaningfully embedded throughout the workstream governance.

Equity of access to fertility treatment services: The Orthodox Jewish Community raised concerns that they could not use fertility services in accordance with their religious teachings. It was explained that the CCG met with representatives of the community in order to agree what changes needed to be made to services to ensure that the Orthodox Jewish Community could use them. As a result, the amended service specification includes the requirements of the Orthodox Jewish Community, but it is also a general specification that outlines the requirements of all patient groups.

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The service specification are in the process of being reviewed by the main providers

of fertility services- the Homerton Hospital, Bart’s Health, Guy’s and St. Thomas’s.

Any other business: The Committee was notified of the fact that the CQC is about to inspect Homerton acute services, and the CCG would need to share views on the quality and safety of these services. The Committee was asked to share any feedback on these specific service areas.

The Committee expressed a keen interest in the NHS England led public consultation on ‘Conditions for which over the counter items should not routinely be prescribed in primary care’. The Committee will therefore receive information on the consultation at the February meeting, and the Chief Officer of the City and Hackney Local Pharmaceutical Committee will also be in attendance to provide further clarification on the role of pharmacists in the community.

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CCG Clinical Executive Committee (CEC)

Report to CCG GB on the CEC meeting held on Wednesday 13 December 2017

For information only.

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• Safeguarding Adult Board Annual Report –

• The following key aspects of the report were highlighted:• Modern Slavery – a piece of work carried out jointly with Children and Families;• Self-neglect Policy – arising from findings from a Safeguarding Adults Reviews (SAR) in the previous year;• Supported Housing – sexuality, consent and sexual relations when working with older people; • Learnings – there is evidence in City & Hackney of SAR work being undertaken to improve practice;• Data – looking at how information about risks reaches the Board about what is happening in the City & Hackney local

resident population;• Adult Reviews – four (4) reviews were reported in City & Hackney in 2017 and, as a result they are mentioned in the

report. Several themes emerged from the reviews which will be followed up.; and• Sheltered / Supported Housing - 3 of the 4 reviews carried out, involved people living in supported / sheltered / supervised

housing; housing that is not necessarily Care Quality Commission (CQC) regulated unless the provider is providing personal care, the housing won’t be inspected by CQC.

• Temporary Housing – Healthy London are carrying out a piece of work in conjunction with the London Safeguarding Adult Board investigating people, (children, young people, people with mental health conditions, etc.) trapped in temporary accommodation that is no longer temporary.

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• Adult Safeguarding Report –• Risks - the Adult Safeguarding Manager role, vacated by Barbara North at the end of 2017 and recently advertised

has been included in the BAF. The GP Adult Safeguarding Lead role is also vacant. • Training – has recently been provided for GPs and a training needs analysis has been created for the Safeguarding

Board to determine future safeguarding training needs across City & Hackney.• Enforcement notice – a domiciliary care provider in Hackney has been issued with an enforcement notice which is

now being monitored by London Borough of Hackney Social Care. A meeting has been set up to discuss the notice, the likely outcome being that Hackney patients will be moved to another provider.

• Modern Slavery and Human Trafficking – an information sharing group recently set up with London Borough of Hackney Social Care will shortly be producing a statement on Modern Slavery and Human Trafficking for publication on the CCG website. Staff will be trained and all providers will be monitored in the future to ensure they are delivering.

• Looked After Children Annual Report - In future The City of London and City of Hackney would report separately on LAC. The key points in this report were - every child in City that is a looked after child was audited; three out of four reviews were carried out within the timescale; care leavers received a health summary; immunisations for young people, looked after for 12 months or longer, were up to date;

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• Hackney SEND / Ofsted Inspection – The Ofsted report for the inspection of SEND services in Hackney carried out on 22 November 2017 was very positive. Some actions are required by the CCG, in particular, that the Dedicated Medical Officer (DMO) has support from a Dedicated Clinical Officer (DCO) and that children with significant medical needs which could impact their education should be coming to the panel. The Ofsted inspection for SEND services in The City has yet to be done.

• Children Safeguarding Report• Serious Case Review – a new case was agreed in November 2017 with significant learning for health services.

Chronologies for this case going back 10 years are being collated by an external provider commissioned by the Homerton University Hospital

• Review of Child C – the review is shortly due to be published. The coroner concluded that the education system was geared to the management of absence rather than the implications for vulnerable children.

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NHS City and Hackney Clinical Commissioning Group (CCG) Governing Body

Friday 23 March 2018, 1430 – 1630

The Annex, Tomlinson Centre, Queensbridge Road, London, E8 3ND

DRAFT AGENDA

NOTE THAT THE MARCH 2018 CCG GOVERNING BODY IS MEETING ON FRIDAY 23 MARCH 2018, A WEEK EARLIER THAN USUAL DUE TO THE EASTER HOLIDAYS. Chair: Dr Clare Highton, CCG Chair Please look over the agenda and think about which of these topics might present an area of interest for you. This means an item where a decision or recommendation made may advantage you, your family and/or your workplace. These advantages might be financial or in another form, perhaps the ability to exert unseen influence. Where anything on the agenda has the potential to put you in such a position, or raised in the meeting along the way, you should tell us all about it. This means we can ensure that our decision, recommendations or actions can be guarded from the impact of any possible conflict you or others could have and be seen to be so. If you are unsure it is always best to raise the possibility with the chair before the meeting, or at any point during the meeting if a possible interest strikes you. This openness is important as we can all discuss how to manage decision making in a complex environment and learn together how to manage these issues well. We are agreed that we will all challenge each other on areas of interest or possible conflict as we recognise that sometimes these issues can be overlooked. Agenda Items Led by &

Appendix number

Timing

1. Welcome and introductions. Clare Highton Verbal

1430-1435 (5 mins)

2. CCG Committee business: a. Declarations of Interest; b. Minutes of the last meeting; c. Action tracker; d. Matters arising.

Clare Highton Papers TBC Pages TBC

1435-1440 (5 mins)

3. Questions from the public Clare Highton Verbal

1440-1445 (5 mins)

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4. Board Assurance Framework Summary Sunil Thakker Papers TBC Pages TBC

1445-1450 (5 mins)

5. Accountable Officer / Managing Director update Jane Milligan / David Maher Verbal

1450-1455 (5 mins)

FOR DECISION 6. NEL Commissioning update:

a. TBC Clare Highton / Jane Milligan Papers TBC Pages TBC

1455-1510 (15 mins)

7. Integrated Commissioning update: a. Care Workstream Assurance Review Point 4; b. TBC.

David Maher / Devora Wolfson Papers TBC Pages TBC

1510-1525 (15 mins)

8. Primary Care at Scale Lee Walker / David Maher Papers TBC Pages TBC

1525-1535 (10 mins)

9. Revised Terms of Reference: a. Local GP Provider Contracts Committee; b. Clinical Executive Committee.

David Maher Papers TBC Pages TBC

1535-1540 (5 mins)

10. 2018/19 CCG Governing Body GP members clinical sessions


1540-1545 (5 mins)

FOR DISCUSSION 11. Month 11, 2017/18 Finance & Performance update Sunil Thakker

Papers TBC Pages TBC

1545-1555 (10 mins)

12. 111 Procurement update: a. TBC

Lee Walker / David Maher Papers TBC Pages TBC

1555-1605 (10 mins)

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13. Quarter 3, 2017/18 Quality Report Jenny Singleton Papers TBC Pages TBC

1605-1615 (10 mins)

14. Quarter 3, 2017/18 Performance Report Anna Garner Papers TBC Pages TBC

1615-1625 (10 mins)

FOR INFORMATION 15. Updates and minutes from other bodies Subcommittees

of the Governing: MINUTES:

a. TBC SUMMARY NOTES:

a. TBC


1625-1630 (5 mins)

16. Draft Friday 27 April 2018 Governing Body Agenda Clare Highton Papers TBC Pages TBC

1630-1635 (5 mins)

17. Any Other Business Clare Highton Verbal

1635-1640 (5 mins)

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