Idea Transcript
Board Part I
MEETING
20 July 2016 09:30 PUBLISHED
15 July 2016
WANDSWORTH CCG WANDSWORTH CCG
PAGE 1 OF [X] PAGE 1 OF 2
Board Agenda 8th June 2016 10:00-12:30 East Putney
Meeting of the Wandsworth CCG Board Held at 73-75 Upper Richmond Road, East Putney SW15 2SR, on Wednesday, 20th July 2016, at 9:30 PART A | MEETING OPEN
START
DURATION
A01
Apologies, Declarations, Quorum
9:30
5 mins
A02
Clinical Chair’s Opening Remarks
NJ
9:35
5 mins
A03
Minutes – 8th June 2016: Approval & Status of Actions (p.5)
NJ
9:40
10 mins
A04
Items for AOB
NJ
9:50
00 mins
AM
9:50
25 mins
LW
10:15 25 mins
SM
10:40 25 mins
PART B | DECISIONS & DISCUSSIONS
B01 B02 B03
Clinical Focus – Primary Care Quality (p.20) Mental Health Estates Modernisation Programme (p.31) Operational Focus – Performance End of Year Report (p.41)
B04
Nine Elms Vauxhall (p.55)
AM
11:05 15 mins
B05
Stakeholder Survey and action plan (p.66)
SM
11:20 15 mins
B06
Board Assurance Framework (p.76)
SM
11:35 15 mins
GM/NJ
11:50 5 mins
NM
11:55 10 mins
PART C | MANAGEMENT REPORTS
C01
Executive Report (p.116)
C02
Finance Report (p.121)
WANDSWORTH CCG
PAGE 2 OF 2
PART D | BOARD GOVERNANCE
Summary Minutes: D01
Integrated Governance Committee (p.146) Finance Resource Committee (p.148)
D02
AOB & Other Matters to Note
D03
Open Space: Public’s Questions Members of the public present are invited to ask questions of the Board relating to the business being conducted. Priority will be given to written questions that have been received in advance of the meeting
12:05 5 mins
12:10 5 mins
NJ
12:15 10 mins
PART E | MEETING CLOSE
E01
E02
E03
Clinical Chair’s Closing Remarks:
NJ
To resolve that the public now be excluded from the meeting because publicity would be prejudicial to the public interest by reason of the commercially sensitive or confidential nature of the business to be conducted in the second part of the agenda Part II Agenda items: SWL Collaboration Remuneration Committee Recommendations
Next meeting of the Board: 14/09/2016 10:00-12:30 East Putney
12:25
00 mins
Page
1. Part A: Meeting Open
4
1.1. A01 Apologies, Declarations, Quorum 1.2. A02 Clinical Chair's Opening Remarks 1.3. A03 Minutes: Approval and Status of Actions 1.4. A04 Items for AOB
5
1. Part A: Meeting Open 2. Part B: Decisions and
Part A: Meeting Open
3. Part C: Management 4. Part D: Board 5. Part E: Meeting Close 4
Minutes of a meeting of the Board held on 8th June 2016 Present:
Nicola Jones (NJ) Graham Mackenzie (GM) Neil McDowell (NM) Stephen Hickey (SH) Carol Varlaam (CV) Andrew Neil (AN) Di Caulfeild-Stoker (DCS) Zoe Rose (ZR) Rumant Grewal (RG) Mike Lane (ML) Seth Rankin (SR) Sean Morgan (SM)
In attendance: Jamie Gillespie (JG) Sandra Allingham (SA)
Healthwatch Wandsworth (Minutes)
16/052 Apologies for Absence Received from Nicola Williams and Dawn Warwick. The meeting was quorate. 16/053 Declarations of Interest The updated Register of Interests was included with the meeting papers.
16/054 Minutes from the previous meeting held on 13th April 2016 and Extra-Ordinary meeting held on 25th May 2016 13th April 2016 – The Minutes were agreed as being an accurate record. 25th May 2016 – The Minutes were agreed as being an accurate record.
16/043 Ex-service men – This was scheduled for discussion at the Technical Reference Group later today. Prescriptions – This was being taken forward through the Local Pharmaceutical Committee. All other actions were noted as completed.
5. Part E: Meeting Close
16/055 Matters Arising 13th April 2016 16/038 Performance Report – Work was in progress to include the trend information in the year-end report.
4. Part D: Board
Item B02 Enhanced Care Pathway Procurement – all GPs present. The Rapid Response element of the ECP could be commissioned by individual practices.
3. Part C: Management
Lucie Waters (LW) Andrew McMylor (AM) Houda Al-Sharifi (HAS) Cathy Kerr (CK)
CCG Clinical Lead (Chair) Chief Officer Acting Chief Finance Officer Lay Member Governance Lay Member Patient and Public Involvement Secondary Care Doctor Registered Nurse West Wandsworth Joint Locality Lead West Wandsworth Joint Locality Lead Wandle Joint Locality Lead Wandle Joint Locality Lead Director of Corporate Affairs, Performance and Quality Chief of Commissioning Operations Director of Primary Care Development Wandsworth Director of Public Health Wandsworth/Richmond Director of Adult and Community Services
1. Part A: Meeting Open 2. Part B: Decisions and
A03
Page 1 of 7
5
25th May 2016 - None 16/056 Operational Focus – Quality Report Eileen Bryant (EB), attended to present the report, which pulled together the work of the Quality team to ensure quality in major providers, including main issues identified, work being undertaken with care homes, themes from Serious Incidents and Make A Difference alerts. The following points were highlighted:
5. Part E: Meeting Close
4. Part D: Board
3. Part C: Management
St George’s Hospital (SGH): o There were a number of areas of good practice. o There were a number of quality concerns some of which were related to the significant financial challenge – there was good engagement from the Trust on these and actions plans were in place. o Issues identified from the staff survey, which link to the vacancy rates – these were being addressed. o An outpatient transformation plan was being developed to address the issues with outpatient capacity and organisation. o Quality issues had been identified around Cancer waits. o Serious Incidents – The team was working with the Trust around timeliness of reporting. o Community Services – Staffing and vacancy rates was the main quality issue. Chelsea and Westminster: o Following the recent merger with the West Middlesex Hospital, the team had been working with the Trust to ensure reporting systems were appropriate. o End of Life Care (EOLC) – Issues had been identified, with an action plan put in place. Significant improvement has been made with the Trust now being one of the first to work towards accreditation on the Gold Standard framework. Mental Health Trust: o A number of areas had been identified, including the number of suicides. The team was working with the Trust to address this. Care UK (GP Out of Hours provider): o A number of issues had been identified relating to staffing and recruitment. o Infection Control – Action plans were in place to address quality issues. Serious Incidents: o Themes identified from the incidents reported at SGH included Never Events. Work had been done with the Trust – the number of reported incidents had reduced significantly, with one incident to date this year. Make A Difference alerts: o The system works well to provide early warning signs of issues, e.g. on delays with urgent referrals being seen. o A thematic analysis of alerts was undertaken, with focused workshops and actions plans held for specific areas of concern. Complaints: o These include complaints, general enquiries, and MP enquiries. o The main theme for complaints relate to Continuing Health Care (CHC) funding issues. Primary Care: o This had been a focus area of work preparing for delegation of the commissioning function to the CCG with effect from April 2016. o During 15/16 the team had worked with the Primary Care team to set up
1. Part A: Meeting Open 2. Part B: Decisions and
A03
Page 2 of 7
6
a Clinical Quality Review Group (CQRG) to review quality in primary care from this year. Safeguarding: o From April 2015, the CCG has a statutory responsibility for adults in the same way as for children. Systems were in place to meet those statutory requirements. o The team has been working with the Local Authority (LA) around quality in care homes, and in CHC. o Systems to assure the CCG on quality were in place for all main providers. Going forward, work is ongoing to look at smaller contracts, including care homes, mental health placements etc, to make sure robust systems were in place. o A quality dashboard for care homes has been developed with the LA. Risks: o A register of quality risks was reviewed by the Quality Group – this links to the corporate risk register. Summary: o A good system was in place for all larger contracts. o The team works closely with providers around quality concerns. o Need to develop systems further. o Further work was required around smaller contracts.
5. Part E: Meeting Close
4. Part D: Board
Quality was at the heart of the CCG, with a significant amount of work done over the past three years. The report was well received – the format would evolve over time to enable the Board to understand the risks. Future format for the report could include: o Dashboard to benchmark against similar organisations o Description of performance expectation for each of the standards Perinatal mortality at Kingston Hospital – Need to follow-up the position following the issue raised by the CQC. There are two networks that review maternity issues – the Perinatal Group reviews these factors. Interventional Radiology and Vascular Surgery and impact on patient outcomes – Following removal of medical training posts from the service in November 2015, a Risk Summit was held around the potential impact on patient care and safety. No negative impact was identified. Monthly meetings are held to monitor the service and progress against the action plan. Never Events – In comparison with Trusts across London, SGH performance was in the middle ground, taking account of its size. Where incidents are reported, a Root Cause Analysis (RCA) and deep dive is undertaken to understand the issues, which is then reviewed at the CQRG. Workshops are held to look specifically at issues identified through the CQRG, the outcomes of which are reported back to the CQRG. Team capacity issues and opportunities for future developments – The quality function continues to grow. The work and resource of the Quality Team is currently being reviewed by the Quality Group. Complaints – The complaints received relate to services commissioned by the CCG, rather than complaints regarding providers. The main themes were around CHC criteria and funding, Children’s commissioning, and Individual Funding Request (IFR) decisions. Complaints relating to Children’s services were around a small number of complex cases, which were being worked through in collaboration with the LA. Complaints to providers – These were reviewed as part of the CQRG report from providers. Assurance around quality for individual placements and smaller contracts – A
3. Part C: Management
Comments and questions were invited from members of the Board:
1. Part A: Meeting Open 2. Part B: Decisions and
A03
Page 3 of 7
7
piece of work was currently in progress to provide an oversight of all contracts. The Quality team was working with contract managers to identify gaps in quality. It is the aim to have similar systems in place for smaller contracts as was currently in place for larger contracts, taking account of differences in size. The joint work between the LA, CCG and Healthwatch was good, with the Quality Board providing a good place to avoid duplication, share intelligence, and work on common issues together.
Following on from the discussion, the Board acknowledged that this initial report was a good starting point, noting that future reports would be further developed to provide assurance on the systems and processes in place. The Quality team would continue to build on the work already done over the past three years. It was proposed that the format of the report be discussed at the Integrated Governance Committee. 16/057 Enhanced Care Pathway Procurement Katie Denton (KD) and Peter Wheelwright (PW) attended to present the paper. The significant work of Rebecca Wellburn in the development of the Enhanced Care Pathway (ECP) was acknowledged.
Rapid Response – An urgent home visit within two hours - this was available to all Wandsworth adult patients Pharmacy Reviews Phlebotomy service for housebound patients Wound care Health and Social Care Coordinators to be established in each practice.
Details of the market testing and open procurement process were noted. Two expressions of interest were received at stage one – only one bid passed the evaluation process. The bidder was invited to submit a tender, which passed the criteria and met the affordability threshold. The bidder was then invited to stage three of the process, where the Evaluation Panel agreed a recommendation for the award of the contract to Battersea Healthcare Community Interest Company (CIC), subject to a number of key areas:
The CCG has held a series of assurance meetings with Battersea Healthcare CIC. A detailed process pathway for Health and Social Care Coordinators has been developed, and meetings have been held with GPs as providers, pharmacies, and domiciliary providers. Battersea Healthcare CIC has demonstrated that they have sufficient capacity and capability to deliver the contract.
5. Part E: Meeting Close
Additional assurance regarding the proposed model to deliver within the agreed budget; Further information regarding spending relating to the Health and Social Care Coordinator posts; Evidence of initial engagement with key stakeholders.
4. Part D: Board
The ECP will enable collaborative management of five hundred of the most vulnerable patients in Wandsworth – this would reduce the number of unplanned secondary care admissions.
3. Part C: Management
The ECP would be managed in a multi-disciplinary approach for the top five hundred patients identified with Long Term Conditions (LTC) within PACT (Planning All Care Together), to provide a more coordinated approach for care. The main elements of the ECP included:
SM/ EB
1. Part A: Meeting Open 2. Part B: Decisions and
A03
Page 4 of 7
8
The Board is asked to approve the recommendation for award of the contract from 1st July 2016 to 31st March 2019 to Battersea Healthcare CIC. Comments and questions were invited from members of the Board:
4. Part D: Board
3. Part C: Management
Market assessment of likely providers – The service specification had been designed with a marginal profit level potential. The situation of having a single bidder was not unexpected, however, the procurement process had been no less robust – the CCG was particularly keen to make sure that the right bidder was appointed. Rapid Response element – As part of the assurance session an exercise was undertaken to understand how this element would be delivered and integrated with primary care, and how relationships would be established to meet the requirement for visits within two hours. A CQRG type approach would be put in place to closely monitor this different type of model. Two hour access – This was a very important standard and would be closely monitored. Value for money – A Due Diligence process had been undertaken for both initial bidders. Indicative budgets only had been identified to test the innovation of the providers, behind which there would be a range of minimum expected activity levels. This was reflected within the contract. The budget released would be based on actual expenditure with a level of Key Performance Indicators (KPIs) to be delivered. Health and Social Care coordination – There was a good record of integrated working between health and social care for PACT patients. It was recognised that many patients do not have separate health and social needs. The Coordinators will be based in general practice and link in to other teams. Social Care posts are also included in the Community Adult Health Service (CAHS) team. The key coordination mechanism to link organisations together will be through the weekly Multi-Disciplinary Team (MDT) meetings. Patients will be flagged up on the systems within each organisation as an ECP patient with a joint care plan. The Health and Social Care Coordinator will be part of the contract with Battersea Healthcare CIC - the statutory Social Service function will not be part of the contract but will be part of the team to enable the pathways to be joined together. Health and Social Care Coordinators need to be fully sighted on the social care element and a lot of training will be required. Relationship with Community Services – Positive engagement has been received from Community Services, who have been involved in the mobilisation meetings along with Social Care, CIC, and SGH CAHS team. Equalities Impact Assessment (EIA) – A series of workshop sessions had been held on the development of the pathway, with presentations to Locality Patient Groups. Two Lay Members were involved in the bid evaluation process.
1. Part A: Meeting Open 2. Part B: Decisions and
A03
Following the detailed discuss, the Board approved the award of the contract for the Enhanced Care Pathway to Battersea Healthcare CIC.
16/059 Performance Report The following key points were noted:
Improving Access to Psychological Therapies (IAPT) – Final data was not yet available to confirm that the target has been achieved. C.Difficile – Year-end performance was below the maximum target set by
5. Part E: Meeting Close
16/058 Executive Report The content of the report was noted.
Page 5 of 7
9
1. Part A: Meeting Open 2. Part B: Decisions and
A03
NHSE. A year on year decrease was noted. Diagnostics – Target was now consistently being achieved. Dementia Diagnosis – Target was being achieved. A&E – Performance had improved over the past few weeks, but this would need to be sustained. Referral to Treatment (RTT) – SGH was not achieving the target. Additional activity was being transferred by SGH to other local providers (a mix of NHS and independent). Some additional capacity was also being provided internally. Outpatient Transformation Plan – This was currently being implemented at SGH. Cancer – Standards for two-week urgent referrals and sixty-two day waits were not being achieved. Regular meetings were being held with the Trust. Some improvements had been made but a lot of further work was required. Changes would be made to the reporting format for 2016/17 data to reflect the new national CCG Assessment and Development Framework, which will include sixty metrics. An initial rating for 2015/16 performance against six high priority areas was due to be published in June.
Comments and questions were invited from members of the Board: Prescription of antibiotics – This area was included in the Quality Premium but was not a national standard. This was reviewed by practice through the Delivery Group, with visits made to practices by the Pharmacy Team. Rates had already improved in 2015/16 across the CCG. A breakdown of the data for this can be provided in the next report.
The content of the report was noted. 16/060 Finance Report It was noted that the information in the report mirrored the information previously presented to the Board as part of the annual accounts. The Annual Accounts for 15/16 were submitted as required on Friday, 27th May.
16/061 Summary Minutes The content for each of the Committee summaries was noted. 16/062 Any Other Business None.
4. Part D: Board
The content of the report was noted.
SM
3. Part C: Management
16/063 Open Space Written questions had been submitted from M Squires, who was not in attendance. A written response would be forwarded, and included within the July Board meeting papers for information. Peter West, Healthwatch – CQRG reports from providers includes information on safety but very little information regarding Caring. Was this an area of concern? Response – Caring comes under the domain of Patient Experience. It was acknowledged that the reports were not as robust as they should be to capture real quality of responses from patients. The SGH Quality Accounts is light on evidence regarding Caring. The CQRG
5. Part E: Meeting Close
Page 6 of 7
10
1. Part A: Meeting Open 2. Part B: Decisions and
A03 does look at patient experience in a number of ways including Complaints and Make A Difference alerts. The CCG is also involved in quality walk arounds in the Trust, where participants are invited to ask a detailed series of questions to any patients. The CCG also participates in mock CQC inspections. The Board acknowledged the challenge, and this would be raised with the Quality team and brought to the Integrated Governance Committee for discussion. The CCG welcomed any suggestions from Healthwatch on ways to take this forward.
Malik Gul – The EIA on the Enhanced Care Pathway stated that issues relating to race, religion belief, or sex were non-applicable – these were all applicable issues. Response – The EIA had been done through the lens of equality and diversity relating to the specific identified cohort of the five hundred patients. The EIA would need to go further and deeper as the service grows and is extended as part of the evaluation process.
3. Part C: Management
Bibi Qureshi – Cancer care is excellent at SGH, with well qualified staff, and very good care from consultants. This was reflected through patient surveys which stated that all staff work together well. Response – The positive comments on the cancer service at SGH were noted and gratefully received.
16/064 Meeting Close There being no further business, the meeting closed at 11:25. Date of next meeting: 20th June 2016, 9:30-12:30
Ref No.
Item
Lead
16/056
Quality Report – Format of report to be further developed, discussion at IGC.
SM
16/059
Performance Report – Breakdown of Antibiotic Prescribing data to be included in next report.
SM
4. Part D: Board
ACTIONS
5. Part E: Meeting Close
Page 7 of 7
11
From:
Response from:
1. Have Wandsworth's three MPs, the Health and Adult Care Overview and Scrutiny Committtee and the Wandsworth public been informed of yet another rushed major reorganisation of the NHS in the form of the reborn area health authorities, now to be called STPs?
M Squires
1. The STP planning process is nationally mandated. We are working with key partners across the NHS and local government in south west London to develop the STP for our area. Our 3 local MPs are aware of the planning process underway and Wandsworth Borough Council are active participants in STP process. Briefings on progress have been provided to the Wandsworth Health & Wellbeing Board and we expect to be able to share the work to date with local people later this summer.
2. Given the introduction of yet another layer of bureaucracy in the NHS that will inevitably lead to the disappearance of CCGs what plans have the Board made for winding up the organisation?
4. Is there a conflict of interest for Board members who sit on both the governing bodies of the CCG and the St George's Hospital Foundation Trust? 5. Will patients be offered a choice of MCPs as stated in the Constitution?
3. £8.5m 4. It is correct that, if an individual was a member on both Boards this would present a conflict of interests. Currently, we do not have this position. 5. The term MCP refers to a number of clinical services which will be overseen by a Lead Provider. The role of the Lead Provider will be to ensure that the services operate in a more integrated way. There will only be one MCP in Wandsworth however patients will continue to have the same level of choice over which services they access as they do at present.
4. Part D: Board Governance 5. Part E: Meeting Close
2. Clinical Commissioning Groups are statutory bodies. We are not aware of any proposals to close the organisation. We recognise however, the imperative to ensure that we utilise all our available resources to secure the best possible healthcare for local people. Where we believe that we can achieve more through stronger collaboration with fellow commissioners or other NHS bodies and local authorities, then we will continue to pursue these opportunities.
3. Part C: Management Reports
3. For the financial year 2015/16 has much was taken out of reserves. Was it nine or eight million?
2. Part B: Decisions and Discussions
Question:
1. Part A: Meeting Open
SUMMARY OF QUESTIONS – Wandsworth CCG Board meeting – June 2016
12
1. Part A: Meeting Open 2. Part B: Decisions and Discussions
3. Part C: Management Reports
4. Part D: Board Governance 5. Part E: Meeting Close
13
1. Part A: Meeting
Summary of discussion from Part II of the Board meeting held on 8th June 2016
South West London Sustainability and Transformation Plan – The Board was asked to consider the strategic priorities and work going forward as described in the draft plan. The document was not yet in the public domain, in accordance with national guidance. Plans would be published nationally across the forty-four planning areas in July. Comments from the discussion would be fed back to the SWL team.
2. Part B: Decisions and
Feedback was received from the members of the Board on the Part I meeting.
3. Part C: Management 4. Part D: Board 5. Part E: Meeting Close 14
Role
8/14/2015 Clinical Chair
Status Board Voting Member
Name Nicola Jones
Board Voting Member
Graham Mackenzie
8/13/2015 Chief Finance Officer
Board Voting Member
Hardev Virdee
8/24/2015 Lay Member - Governance
Board Voting Member
Stephen Hickey
8/14/2015 Lay Member - Patient and Public Involvement
Board Voting Member
Carol Varlaam
Andrew Neil
8/14/2015 Registered Nurse
Diana Caulfeild-Stoker
5/1/2015
Battersea Locality Commissioning Group Joint Lead
1/31/2015 Battersea Locality Commissioning Group Joint Lead 9/3/2015
Board Voting Member
Wandle Locality Commissioning Group Joint Lead
8/20/2015 Wandle Locality Commissioning Group Joint Lead
Jonathan Chappell Board Voting Member
Nicola Williams
Board Voting Member
Michael Lane
Board Voting Member
Seth Rankin
Comments
Commissioning Reference Group; Primary Care Implementation Group SWL: Joint Committee for Primary Care CoCommissioning; System Resilience Group' Clinical Lead for SWL Transforming Primary Care Programme Health and Wellbeing Board None Wandsworth CCG: Board; Integrated Governance Committee; Management Team (Chair); Finance Resource Committee; Audit Committee; GP Resources Committee; Workforce Committee (Chair) SWL: Joint Committee for Primary Care CoCommissioning; System Resilience Group; SWL Collaborative Commissioning Programme Wandsworth Health and Wellbeing Board Healthy London Partnership - SRO for Personalisation and Participation Trustee - Point of Care Foundation (Charity); Member of CIPFA (accountancy body) Wandsworth CCG: Board; Integrated Governance Health Panel; Member of CIPFA Council (CIPFA is a Charity as well) Committee; Management Team; Finance Resource Committee; Audit Committee; Delivery Group; GP Resources Sub Committee SWL: SWL Collaborative Commissioning CFO lead and Estates lead Chair - St George's Hospital Charity; Community Transport Association UK; Member - St Wandsworth CCG: Board; Integrated Governance George's University Hospitals Foundation Trust; Chair - Community Transport Committee; Audit Committee (Chair); Finance Resource Association (UK); Shaw Trust - member of Disabled Living Foundation Advisory Board Committee (Chair); Remuneration Committee (Chair); GP Resources Committee (Chair); Workforce Committee SWL: South West London Financial Risk Committee Wandsworth Health and Wellbeing Board Trustee - St George's Hospital Charity; Trustee - Wandsworth Care Alliance; Member - St Wandsworth CCG: Board; Integrated Governance George's University Hospital Foundation Trust; family member is resident in a local Committee; Audit Committee; Remuneration nursing home receiving NHS Continuing Care funded by Wandsworth CCG Committee; GP Resources Committee; PPI Reference Group (Chair); Primary Care Commissioning Implementation Group; Communications and Engagement Working Group SWL: Joint Committee for Primary Care CoCommissioning (Chair) None Wandsworth CCG: Board; Integrated Governance Committee; Information Governance Steering Group (Chair) Trustee Cavell Nurses Trust; Member - Moorfields NHS Trust Wandsworth CCG: Board; Integrated Governance Committee; Quality Group (Chair); Safeguarding Committee (Chair) Practice is a member of Battersea Healthcare CIC - Dr Chappell holds no director post Wandsworth CCG: Board; Integrated Governance and has no specific responsibilities within that organisation other than those of other Committee; Management Team; Finance Resource member GPs. Committee GP Partner Battersea Rise Practice. Practice is a member of Battersea Healthcare CIC Wandsworth CCG: Board; Management Team; Delivery - Dr N Williams holds no director post and has no specific responsibilities within that Group
3. Part C: Management
8/18/2015 Secondary Care Clinician; Caldicott Guardian Lead for Board Voting Member Community Development
Committee membership
2. Part B: Decisions and
8/13/2015 Chief Officer
Details of Declaration
Managing Partner - Brocklebank Group Practice, and St Paul’s Cottage Surgery (both Wandsworth CCG: Board (Chair); Integrated Governance practices hold PMS contract). Practice is a member of Battersea Healthcare CIC - Dr N Committee (Chair); Management Team; Cardiovascular Jones holds no director post and has no specific responsibilities within that organisation Disease CRG (Chair); St George's Hospital Clinical other than those of other member GPs
organisation other than those of other member GPs GP Partner, Grafton Medical Partners; GP Partner - Lambton Road Medical Partnership; Director - Raynes Park Health Ltd (building management company); London Maternity Lead, Royal College of General Practitioners; Member - London Clinical Senate Forum; Member - agenda advisory panel, UK Health Informatics Forum; Practice is a member of Battersea Healthcare CIC- Dr Lane holds no director post and has no specific responsibilities within that organisation other than those of other member GPs.
Wandsworth CCG: Board; Management Team; Integrated Governance Committee; Communications and Engagement Working Group; Wandle Locality Forum (co-Chair); Quality Group; Clinical Scrutiny Group; Primary Care Transformation Group SWL: Clinical Advisory Group member; Clinical Lead for Maternity Clinical Working Group St George's Clinical Quality Review Group Partner - Wandsworth Medical Centre; Member of Battersea Healthcare CIC, holding no Wandsworth CCG: Board; Management Team; Delivery director post and no specific responsibilities within that organisation other than those of Group; PACT project; CAHS project; Frailty Pathway other member GPs; Director - London Travel Clinic Ltd providing private travel project; CQRG and CCRG;
Board Voting Member
West Wandsworth Locality Commissioning Group Lead
Zoe Rose Rumant Grewal
GP Partner Commissioning Lead Member of LCG Management Board and Locality Forum for Putneymead Practice Manager - Lead in GP Federation
Wandsworth CCG: Board; Management Team
Appointed wef 01/04/2016
Wandsworth CCG: Board; Management Team
Appointed wef 01/04/2016
Wandsworth CCG: Board Wandsworth CCG: Board Wandsworth CCG: Board; Management Team; Integrated Governance Committee; Workforce Committee; Delivery Group (Chair) SWL: System Resilience Group Wandsworth CCG: Board; Management Team; Integrated Governance Committee; Delivery Group; GP Resources Committee; Primary Care Implementation Group; Primary Care Transformation Group (co-Chair); Estates Steering Group; Business Intelligence Group
8/17/2015 Director of Public Health 8/19/2015 Director ofChildren's Services 9/4/2015 Director of Corporate Affairs, Performance and Quality
Board Non-Voting Member Board Non-Voting Member Board Non-Voting Member
Houda Al-Sharifi Dawn Warwick Sandra Iskander
None None None
9/11/2015 Director of Primary Care Development
Board Non-Voting Member
Andrew McMylor
None
Lucie Waters
None
8/19/2015 Director of Corporate Affairs, Performance and Quality (maternity cover)
Board Non-Voting Member
Sean Morgan
Substantive employer is South East Commissioning Support Unit
8/13/2015 Wandsworth Healthwatch
Board Non-Voting Member
James Gillespie
Executive member Healthwatch Wandsworth; Family member employed by SLAM; Affiliations - 38 Degrees member, SNP member
1/21/2015 Associate Lay Member
Kimball Bailey
1/7/2015
Chris Savory
Director of Alastor - an independent management consultancy practice that has, over the past five years, carried out work directly or indirectly for the Department of Health and various NHS Trusts and other organisations (including Springfield Hospital). None of this has had a direct impact on commissioning nor is material to my role as Associate Lay Member for Governance; member of Essentia advisory board Advisor Interserve PLC Ltd; Advisor to Liberata and Capacity Grid; Member of the Dorset NHS Trust
Director of Commissioning and Planning
Associate Lay Member
Wandsworth CCG: Integrated Governance Committee, Audit Committee, Remuneration Committee, GP Resources Committee; Estates Committee (Chair) Wandsworth CCG: Integrated Governance Committee, Audit Committee, Finance Resource Committee, Remuneration Committee, GP Resources Committee
8/17/2015 Advisor to the Board
Board Non-Voting Member
Tom Coffey
GP Partner - Brocklebank Group Practice; Medical advisor - EY (Ireland); MICAS Wandsworth CCG: Board; Management Team; Finance Advisor - Battersea Healthcare CIC; Practice is a member of Wandsworth Integrated Resource Committee Healthcare Limited - Dr Coffey holds no director post but is the Clinical Lead for the MSK service.
2/20/2015 West Wandsworth Locality Commissioning Group Lead
Board Voting Member
Peter Ilves
GP Partner - Danebury Avenue Surgery. Practice is a member of Battersea Healthcare Wandsworth CCG: Board; Management Team; Delivery Resigned wef 31/03/2016 CIC - Dr Ilves holds no director post and has no specific responsibilities within that Group organisation other than those of other member GPs. Primary Care and commissioning advisor for Big White Wall Ltd. Occasional tutor and advisor for Connecting with People.
Resigned wef 10/09/2015
5. Part E: Meeting Close
Board Non-Voting Member
9/8/2015
SWL: SRO 111/Out of Hours Procurement; SRO SWL Out of Hospital Clinical Delivery Group Wandsworth CCG: Board; Management Team; Integrated Governance Committee; Primary Care Transformation Group (co-Chair) SWL: System Resilience Group; CCG Directors of Commissioning; CCG Directors of Commissioning and Chief Finance Officers; Wandsworth CCG: Board; Management Team; Integrated Governance Committee; Workforce Committee; Delivery Group (Chair) SWL: System Resilience Group Wandsworth CCG: Board
4. Part D: Board Governance
vaccinations; Director - London Doctors Clinic Ltd providing primate GP services; Director - Medilaser Ltd (trading as Wandsworth Village Skincare) providing cosmetic and medical laser therapy not available on the NHS; Director - Rankin Press Ltd (dormant) intending to publish books; Director - Healthy Lifestyle Enterprises (dormant) intended to provide and deliver weight management programmes; Director - Ezimed Ltd intended to sell networked panic alarm buttons to GP surgeries; Trustee - Sustainable Medical Charities International (CIO) providing the resources to deliver healthcare to the people of Darsilameh Village in the Upper River Region of The Gambia; Consulted by Circle Partnership in Community Services Redesign; Advisor/consultant to the Nuffield Trust about Virtual Wards in Community Services; Consulted by The Sollis Partnership about risk prediction modelling of patients in primary care
West Wandsworth Locality Commissioning Group Lead
1. Part A: Meeting Open
Declarations of Interest - Board Members 2015
Date
St George's Clinical Quality Review Group (Chair)
15
Last updated 02/06/2016
Name Dr Nicola Jones
Details of Declaration Managing Partner Brocklebank Group Practice and St Paul's Cottage Surgery. Both practices hold PMS contracts.
Chief Officer
Voting Member
Graham Mackenzie
Spouse is employed by Imperial College NHS Trust.
Chief Finance Officer
Voting Member
Neil McDowell
Spouse employed by Guildford and Waverley CCG
Lay Member for Governance, Vice Chair
Voting Member
Stephen Hickey
Chair, St George's Hospital Charity; Chair Community Transport Association; Member DLF Advisory Board; Member Shaw Trust.
Secondary Care Doctor
Voting Member
Andy Neil
Registered Nurse
Voting Member
Diana Caulfield-Stoker Trustee Cavell Nurses Trust; Member Moorfields NHS Trust
West Wandsworth Joint Locality Lead
Voting Member
Dr Zoe Rose
GP Partner Putneymead Group Medical Practice (Holds PMS contract). Practice is a member of the Wandsworth GP Federation(Battersea Healthcare CIC). No roles or responsibilities held in GP Federation
Dr Rumant Grewal
GP Principal, Lead for Mental Health, Substance Misuse, Primary Care Research, Referrals Management.
None
Wandsworth CCG - Governing Body; Integrated Governance Committee; Information Governance Committee (Chair) Wandsworth CCG - Governing Body; Integrated Governance Committee (Vice Chair); Quality Group (Chair); Safeguarding Committee (Chair) Wandsworth CCG - Governing Body; Management Team; West Wandsworth Locality Forum and Management Team; Primary Care Committee; Primary Care CQRG (Chair) Wandsworth CCG - Governing Body; Management Team
Wandsworth CCG - Governing Body; Management Team; Integrated Governance Committee; Finance Resource Committee; Communications and Engagement Group; Quality Group; St George's Clinical Quality Review Group; Community Services Wandsworth Clinical Quality Review Group (co-Chair); Clinical Scrutiny Group; Primary Care Transformation Group; Wandle Locality Forum (co-Chair) South West London - Clinical Advisory Group member; Clinical Lead for Maternity Clinical Design Group Wandsworth CCG - Governing Body; Management Team; CAHS Project
Dr Michael Lane
GP Partner, Grafton Medical Partner; GP Partner, Lambton Road Medical Partnership; Director, Raynes Park Health Ltd (building management company; London Maternity Lead, Royal College of General Practitioners; Volunteer Doctor, Crisis homeless charity; Member Agenda advisory panel, UK Health Informatics Forum; Member London Clinical Senate Forum; Non-voting Member of the Clinical Expert Panel for Maternity of the CCG Improvement and Assessment Framework (IAF)
Wandle Joint Locality Lead
Voting Member
Dr Seth Rankin
Partner - Wandsworth Medical Centre; Director - London Travel Clinic Ltd providing private travel vaccinations; Director - London Doctors Clinic Ltd providing primate GP services; Director - Medilaser Ltd (trading as Wandsworth Village Skincare) providing cosmetic and medical laser therapy not available on the NHS; Director - Rankin Press Ltd (dormant) intending to publish books; Director - Healthy Lifestyle Enterprises (dormant) intended to provide and deliver weight management programmes; Director - Ezimed Ltd intended to sell networked panic alarm buttons to GP surgeries; Trustee Sustainable Medical Charities International (CIO) providing the resources to deliver healthcare to the people of Darsilameh Village in the Upper River Region of The Gambia; Consulted by Circle Partnership in Community Services Redesign; Advisor/consultant to the Nuffield Trust about Virtual Wards in Community Services; Consulted by The Sollis Partnership about risk prediction modelling of patients in primary care
Battersea Joint Locality Lead
Voting Member
Dr Nicola Williams
Partner Battersea Rise Practice
Wandsworth CCG - Governing Body; Delivery Group; Management Team; Primary Care Transformation Group; Primary Care Quality Group
Dr Jonathan Chappell
Battersea Fields Practice
Wandsworth CCG - Governing Body; Management Team; Integrated Governance Committee; Finance Resource Committee; Wandsworth CCG - Governing Body; Management Team; Integrated Governance Committee; Finance Resource Committee; Audit Committee; Remuneration Committee; Primary Care Committee; Workforce Committee South West London - System Resilience Group Wandsworth CCG - Governing Body; Management Team; Integrated Governance Committee; Workforce Committee; Information Governance Group Wandsworth CCG - Governing Body; Management Team; Integrated Governance Committee; Workforce Committee; Information Governance Group Wandsworth CCG: Board; Management Team; Integrated Governance Committee; Delivery Group; GP Resources Committee; Primary Care Implementation Group; Primary Care Transformation Group (co-Chair); Estates Steering Group; Business Intelligence Group
Chief of Commissioning Operations
Non Voting Member
Lucie Waters
None
Director of Corporate Affairs, Performance and Quality Director of Corporate Affairs, Performance and Quality (Maternity Leave) Director of Primary Care Development
Non Voting Member
Sean Morgan
Substantive employer is South East CSU
Non Voting Member
Sandra Iskander
None
Non Voting Member
Andrew McMylor
None
Director, Commissioning and Planning Local Authority Director of Public Health Local Authority Director of Children's Services Healthwatch Wandsworth Associate Lay Member
Non Voting Member
Rebecca Wellburn
None
Non Voting Member
Houda Al Sharifi
None
SWL: SRO SWL Out of Hospital Clinical Delivery Group Wandsworth CCG - Management Team; Integrated Governance Committee Wandsworth CCG - Governing Body
Non Voting Member
Dawn Warwick
None
Wandsworth CCG - Governing Body
Non Voting Member
Jamie Gillespie
Executive member Healthwatch Wandsworth; Family member employed by SLAM; Affiliations - 38 Degrees member, SNP member
Wandsworth CCG - Governing Body
Chris Savory
Advisor Interserve PLC Ltd; Advisor to Liberata and Capacity Grid; Member Wandsworth CCG - Integrated Governance Committee; of the Dorset NHS Trust Finance Resource Committee; Audit Committee;
Associate Lay Member
Kimball Bailey
SGH CQRG Clinical Lead
Tom Coffey
Director of Alastor - an independent management consultancy practice that has, over the past five years, carried out work directly or indirectly for the Department of Health and various NHS Trusts and other organisations (including Springfield Hospital). None of this has had a direct impact on commissioning nor is material to my role as Associate Lay Member for Governance; member of Essentia advisory board
Practice is a member of Battersea Healthcare CIC but Dr Rankin holds no director post and has no specific responsibilities within that organisation other than those of other Member GPs.
Practice is a member of Battersea Healthcare CIC but Dr Williams holds no director post and has no specific responsibilities within that organisation other than those of other Member GPs. Practice is a member of Battersea Healthcare CIC but Dr Chappell holds no director post and has no specific responsibilities within that organisation other than those of other Member GPs.
5. Part E: Meeting Close
Voting Member
4. Part D: Board Governance
Wandle Joint Locality Lead
Practice is a member of Battersea Healthcare CIC but Dr Rose holds no director post and has no specific responsibilities within that organisation other than those of other Member GPs. Practice is a member of Battersea Healthcare CIC but Dr Grewal holds no director post and has no specific responsibilities within that organisation other than those of other Member GPs. Practice is a member of Battersea Healthcare CIC but Dr Lane holds no director post and has no specific responsibilities within that organisation other than those of other Member GPs.
3. Part C: Management Reports
Carol Varlaam
Battersea Joint Locality Lead
Comments Practice is a member of Wandsworth Integrated Healthcare Ltd but Dr Nicola Jones holds no director post and has no specific responsibilities within that organisation other than those of other member GPs.
Wandsworth - Health and Wellbeing Board Trustee & Vice Chair, St George's Hospital Charity; Trustee, Wandsworth Wandsworth CCG - Governing Body; PPI reference Care Alliance; Member St George's University Hospital Foundation Group (Chair); Primary Care Commissioning Committee Trust (Chair elect); Audit Committee; Integrated Governance Committee; Remuneration Committee; Communications and Engagement Working Group.
Lay Member for Patient and Voting Member Public Involvement
West Wandsworth Joint Locality Lead
Committee membership Wandsworth CCG - Governing Body (Chair); Integrated Governance Committee (Chair); St George's Hospital Clinical Commissioning Reference Group (Chair); Management Team SWL - Chair System Resilience Group; Clinical Lead SWL & Surrey Downs Health Care Partnership Clinical Board and Programme Board; Clinical Lead for SWL Transforming Primary Care Programme; System Resilience Group (Chair) Wandsworth - Health and Wellbeing Board Wandsworth CCG - Governing Body; Management Team; Integrated Governance Committee; Finance Resource Committee; Audit Committee; Remuneration Committee; Primary Care Committee; Workforce Committee SWL - System Resilience Group Wandsworth - Health and Wellbeing Board Wandsworth CCG - Management Team; Audit Committee; Finance Resouce Committee Wandsworth CCG - Governing Body (Vice Chair); Finance Resource Committee (Chair); Audit Committee (Chair); Remuneration Committee (Chair); Workforce Committee; Primary Care Committee
2. Part B: Decisions and Discussions
Chair
Status Voting Member
1. Part A: Meeting Open
Role
Declarations of Interest - Board Members 2016
Remuneration Committee Wandsworth CCG - Integrated Governance Committee; Audit Committee; Remuneration Committee; Estates Committee
Partner, Brocklebank Group Practice; MICAS Advisor/OD Lead Battersea Wandsworth CCG - Management Team; SGH CQRG Healthcare CIC; Clinical Assistant A&E Charing Cross Hospital; Advisor EY (Chair) (Ireland); Informal advice to London Mayoral candidate Sadiq Khan
16
1. Part A: Meeting Open 2. Part B: Decisions and Discussions
3. Part C: Management
4. Part D: Board Governance 5. Part E: Meeting Close
17
1. Part A: Meeting
Meeting Minute date No.
Lead
16/056 Quality Report
SM
16/057 Enhanced Care Pathway Procurement
AM
16/060 Finance Report
GM/NJ SM NM
Board approved award of the contract for the Enhanced Care Pathway to Battersea Healthcare CIC
Action
Target Date
Format of report to be further developed, discussion at IGC
Breakdown of Antibiotic Prescribing data to be included in next report
Progress
Date Completed
Conflicts of Interest
Action to manage Conflicts
Request for Chair's Apologies Quorate Action None
All GPs present - the Rapid Response element of the ECP could be commissioned by individual practices Jul-16
No action was required
DW, NW
Yes
5. Part E: Meeting
16/058 Executive Report 16/059 Performance Report
Decision
3. Part C: 4. Part D: Manageme Board
6/8/2016
Item
2. Part B: Decisions
LOG OF DECISIONS AND ACTIONS - Board 8/6/16
18
Page
2. Part B: Decisions and Discussions
19 20
2.2. B02 Mental Health Estates Modernisation Programme
31
2.3. B03 Operational Focus - Performance End of Year Report
41
2.4. B04 Nine Elms Vauxhall
55
2.5. B05 Stakeholder Survey and action plan
66
2.6. B06 Board Assurance Framework
76
2. Part B: Decisions and 3. Part C: Management
2.1. B01 Clinical Focus - Primary Care Quality
1. Part A: Meeting Open
Part B: Decisions and Discussions
4. Part D: Board 5. Part E: Meeting Close 19
PAGE 1 OF [X] PAGE 1 OF 11
Approach to Quality in Primary Care Author: Emma Gillgrass
Sponsor: Andrew McMylor, Dr Zoe Rose Date: 20/07/16
Context Wandsworth CCG has always had a responsibility to assist and support NHS England to secure continuous improvement in the quality of primary medical services. With the CCG taking on delegated responsibility for the Wandsworth GP contracts from April 2016 this included responsibility for assessing and assuring quality and outcomes of these services. This paper sets out how the CCG plans to achieve this, for the delegated contracts, at both a practice and borough wide level. This approach has been developed within Wandsworth CCG in order to ensure the CCG can meet its responsibilities with regard to primary care quality.
Question(s) this paper addresses 1. How has the CCG’s approach to quality been developed? 2. What is the CCG’s approach to quality in primary care? 3. How will the CCG manage its approach to quality? 4. What are the next steps in developing this approach?
1. The CCG has developed an approach working at individual practice as well as
borough level, through engaging with practices, patients and wider stakeholders 2. The CCG’s approach includes a Members Quality and Engagement Scheme, a
Quality Contract, collation and review of data and support to practices
4. Part D: Board
Conclusion
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
3. The CCG has developed an overarching approach to monitoring, reviewing and
improving primary care quality to ensure all services are delivered to the same high level
development of supporting policies and the on-going identification of issues and support to practices
Input Sought We would welcome the Board’s support regarding the approach to quality in primary care.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
4. A work plan has been developed with key areas including continued engagement,
20
PAGE 2 OF 11
The Report FURTHER CONTEXT
ANALYSIS
1) How has the CCG’s approach to quality been developed? Wandsworth CCG has been developing its approach to quality, building on the quality improvement work already undertaken by practices, through schemes such as the Members Development Programme, Referral Management Programme and Prescribing Incentive Scheme. a) Member Engagement
A second session held in May 2016 built on the earlier session and the work that has been done since with practices asked to consider what quality in primary care looks like and how this could be measured now and in the future. Practices were then provided with an update on the work that has been taking place in relation to quality and asked, using a number of scenarios, what should the process be for reviewing issues, what support should be offered to practices and at what point should issues be escalated and what would this look like. The feedback from this event has fed in to the development of the information sharing and escalation policy. Both events have also provided an opportunity to ensure that the member practices are involved and on board with the CCG’s approach to quality improvement.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
b) Patient and Public Engagement Following engagement of the Member practices the next step is to engage with patients and the public, as key stakeholders, and users of primary care services. This will be taking place during July 2016, initially through the Locality Patient Groups, which have representatives from the practice patient groups in each locality. The groups will be asked what they think good quality primary care looks like and their views on how this should be
4. Part D: Board
As well as discussions within the CCG and with other organisations such as the CQC and NHSE the approach to quality has also been discussed and developed with member practices. A first event was held in November 2014 where practices were asked to review different data that was available and suggest how this could be used to identify potential issues, as well as once issues were identified what the CCG could do to support practices. From this session the Local Quality Tracker and Practice Support Team evolved.
2. Part B: Decisions and 3. Part C: Management
From April 2016 Wandsworth CCG took on delegated commissioning from NHS England for the Wandsworth GP contracts, including responsibility for assessing and assuring quality and outcomes of these services. The delegation agreement between NHSE and the CCG sets out the expected responsibilities of the CCG with regard to quality in the management of GP contracts. The key responsibility being that the CCG must improve the quality of services and improve efficiency in the provision of the services. In order to discharge these responsibilities WCCG has been developing its own overarching approach to quality and quality improvement in primary care, to be delivered at an individual practice as well as borough level.
1. Part A: Meeting Open
WANDSWORTH CCG
21
PAGE 3 OF 11
measured and managed, which will then feed into the overall approach to quality improvement. Following this initial engagement and the response future engagement will be planned. Patient representation is also being sought for the Primary Care Quality Review Group. 2) What is the CCG’s approach to quality in primary care?
a) Members Quality and Engagement Scheme The Members Quality and Engagement Scheme is new for 2016-17 and builds on previous schemes undertaken by practices. This enables practices to engage with the wider CCG as well as undertake quality improvement work at an individual practice level. The scheme includes continued engagement of practices as members of the CCG and commissioners, through locality Members Forums and Joint Locality Members Forums. The main focus of the scheme is the development of Quality Coordinators within each practice, to support delivery of the CCG Quality agenda and engage with the Provider of the Quality Contract, to delivery specific outcomes as agreed. All practices have signed up to take part in this scheme.
The contract is focused around the CCG quality areas of patient safety, patient experience and clinical effectiveness, along with an additional area on workforce. The overall aims of the contract are to improve overall standards of quality, reduce unwarranted variation in primary care quality across Wandsworth and develop collaborative working and shared learning between practices.
c) Practice Support Team The Practice Support Team was created to provide additional support to practices, with regard to quality. This is provided by a multidisciplinary team with experience of primary
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
Taking a borough wide approach to delivering this work, through a single Provider working collaboratively with practices, will ensure all practices have equal access to expertise and support to achieve improvements in delivery of high quality primary care. The CCG is working closely with Battersea Healthcare Community Interest Company (The Federation), as the Provider of this contract, to develop and ensure that it is implemented and practices are engaging with the work.
4. Part D: Board
b) Quality Contract Wandsworth CCG has developed a Quality Contract, “Improvement of Quality across Local General Practices” that will consolidate and build on existing quality programmes. It will utilise a more targeted approach and enable early identification and resolution of potential gaps in quality, supporting practices to deliver high quality care for their patients, whilst addressing current variation. This will be delivered at a borough wide as well as individual practice level, supporting the development of the Multispecialty Community Provider model for Wandsworth, which will see GPs working collaboratively to develop a sustainable, holistic and high quality model for primary care.
2. Part B: Decisions and 3. Part C: Management
With the responsibility of delegated commissioning for primary care from April 2016 the CCG has needed to develop an overarching, unified approach to monitoring, reviewing and improving quality, to ensure that all services commissioned in primary care are delivered to the same high level. The different aspects of this approach are set out below.
1. Part A: Meeting Open
WANDSWORTH CCG
22
PAGE 4 OF 11
care, education and embedding quality, to ensure all practices are supported to provide high quality primary care services. The team is formed of local GPs, Practice Managers, Practice Nurses, along with Locality Managers and other CCG staff where relevant. This team sits within the Quality Contract being delivered by Battersea Healthcare.
d) Local Quality Tracker A local quality tracker has been developed, collating information and data about individual practices, from a variety of sources. The aim is to provide an overview of how practices are delivering services, and their engagement with quality improvement schemes. This will help to identify, in conjunction with existing quality measures and other available data, practices that may need additional support. The tracker is updated on a regular basis as new data becomes available and reviewed to prioritise practices for visits from the Practice Support Team and identify specific areas where support may be required at practice and borough wide level. e) Make a Difference Alerts WCCG has been running a successful programme “Make a Difference” since July 2013 to allow healthcare professionals to submit quality concerns and feedback on services commissioned by Wandsworth CCG. This provides valuable soft intelligence about services as well as early warning on potential quality concerns.
The areas covered by the Quality Contract are all areas that will be reviewed through the CQC visits. Through practices participating in the Members Quality and Engagement Scheme they will be able to ensure they can address all these areas for CQC. One of the Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
f) Care Quality Commission (CQC) By April 2017 the CQC plan to have visited and rated all general practices. In Wandsworth 22 practices have so far been visited under the new inspection regime. The CCG have met with the CQC to discuss the process of visits, how information can be shared between the CCG and CQC and how practices can be supported. The CCG is informed in advance of CQC visits, and have the ability to share information about practices with the CQC if it is felt necessary.
4. Part D: Board
Now the CCG has taken on responsibility for Primary Care Contracts it is exploring the opportunity to extend this tool to allow reports to be made about primary care. It is proposed to pilot this with a small number of specialities at a local acute provider from August 2016. The aim will be to collate themes regarding primary care, rather than issues about specific practitioners. This will then be used to address issues at a borough level. If a theme appears to relate to a specific practice then this will be addressed with the individual practice, with learning shared across all practices.
2. Part B: Decisions and 3. Part C: Management
Routine visits are carried out to each practice in Wandsworth where the team works with the practices to review their data and identify both areas of good practice that can then be shared wider and areas where the practice may need additional support. At the end of each visit a number of actions are agreed between the team and the practice. Where particular practices are identified as needing additional support the Practice Support Team will visit to focus on specific areas with the practice.
1. Part A: Meeting Open
WANDSWORTH CCG
23
PAGE 5 OF 11
development events under the Quality Contract will specifically focus on CQC visits and enable practices to share information about preparation, what to expect and how to stay prepared.
One area already been identified as a common theme in a number of the reports related to storage of vaccines, fridge temperatures and cold chain polices. This was raised with prescribing team who produced a newsletter focusing on this issue for the practices with a reminder of the process for monitoring fridge temperatures, and where practices could access additional guidance.
3) How will the CCG manage its approach to quality? a) Information, Data Sharing and Escalation As part of the wider primary care quality work the sharing of information is key to enable an overall picture of the borough to be established and quality improvement work to be undertaken. This information is held by a number of different organisations, with some publically available. As well as hard data there is a large amount of “soft” intelligence that can help in providing context to an issue as well as alerting to potential concerns.
Once potential issues are identified there will be a range of responses that can be undertaken to address these, and where appropriate these will be escalated. This is set out in in Appendix 1.
The Primary Care Quality Review Group will meet on a monthly basis, monitor national and local quality standards as well as holding Providers to account for any contractual requirements relating to clinical quality and safety of the services. This group will review the work areas described above to direct areas of focus and inform decisions, or recommend where issues need to be escalated further for information or decision. The
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
b) Governance: Primary Care Quality Review Group As the CCG has taken on responsibility for quality of GP contracts there needs to be a single forum that will oversee, monitor and review issues relating to the quality of these services. For other key provider services, such as St Georges Hospital, a Clinical Quality Review group takes on this role. An equivalent group has been set up to oversee the primary care contracts delegated by NHSE.
4. Part D: Board
As the approach to quality has been developed it has become clear that additional policies are required in order to set out how information and data is shared between various organisations and how potential issues are identified, managed and where appropriate escalated. This will include complaints, incidents and serious incidents, CQC reports, Make a Difference alerts, as well as data such as Quality and Outcomes Framework (QoF) and Friends and Family Test.
2. Part B: Decisions and 3. Part C: Management
As the reports on Wandsworth practices are published these are reviewed and areas of outstanding practice as well as areas for improvement are identified. These will be shared will all practices to support their learning and development. Where a common theme is identified further support may be offered.
1. Part A: Meeting Open
WANDSWORTH CCG
24
PAGE 6 OF 11
PCQRG will report in to the Integrated Governance Committee, and where appropriate to the Primary Care Committee. 4) What are the next steps in developing this approach?
CONCLUSION
Wandsworth CCG has developed a process for identifying, reviewing and managing quality issues within primary care. There is ongoing development of aspects of the quality work. This is overseen by the Primary Care Quality Review Group and involves working closely with other organisation, mainly NHSE, CQC and The Federation to assure the quality of primary care in Wandsworth.
2. Part B: Decisions and 3. Part C: Management
A work plan is being developed (appendix 2) that sets out the next steps in developing the CCG’s approach to quality as well as implementing it within the borough. Key areas include patient and public involvement, the development of the managing quality in primary care policies and the on-going identification of issues and support to practices. Also the work already undertaken will be reviewed to identify any lessons learnt that can be used to further progress and develop this workstream.
1. Part A: Meeting Open
WANDSWORTH CCG
4. Part D: Board
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
25
PAGE 7 OF 11
Appendix 1 – Escalation Process As potential issues are identified there will be a range of responses that can undertake to address them.
Examples: Concern over delivery of a local contract / scheme Review of data shows one or two red areas / significant number amber areas Not engaging with CCG as a member practice Serious incidents / significant events Level Two: Practice Support Team (sitting within the Quality Contract delivered by the Federation) visit practice to discuss and identify issues and work with the practice to develop an action plan, identifying the support required to address the issues. Following each Practice Support Team visit a report will be written incorporating agreed actions and with recommendations for any further actions. These will then be reviewed by the PST to ensure actions are completed and identify any additional support needs. Examples Local Level 1 response unsuccessful CQC improvement notices issued Review of data shows a number of red areas or one or two reds plus significant number of amber areas Serious incidents / significant events
Examples Unresolved concerns relating to contracts held by other bodies Serious performance issues Serious incidents / significant events
The flow chart below shows what happens once the level of response is agreed and where and how issues may be escalated.
5. Part E: Meeting Close
Practices may move between levels of response as appropriate. Movement between levels does not have to be progressive (e.g. a practice could move from level 1 to level 3 if the issues identified require).
4. Part D: Board
Level Three: Referral to another body such as NHS England / Care Quality Commission. Before any referral is made a report and recommendations will be submitted to Primary Care Quality Review Group and the Primary Care Committee for agreement.
2. Part B: Decisions and 3. Part C: Management
Level One: Local coordinated response for one/two issues that can be managed by relevant leads such as a contract lead, prescribing advisor, or Locality Manager or Locality clinical lead
1. Part A: Meeting Open
WANDSWORTH CCG
26
PAGE 8 OF 11
Escalation Flowchart
Potential issues / concerns identified
Level 1
Appropriate leads reviews issue Discussion with Practice Action plan and support agreed Review
Locality Leads contact practice to offer PST support
Information passed on to Federation
Practice Support Team visit Practice Issues identified and discussed
Action plan and support agreed and implemented
Review of action plan
Completed
Incomplete
Actions not completed
Referral to Primary Care Committee
4. Part D: Board
Actions completed
Level 3
Level 2
2. Part B: Decisions and 3. Part C: Management
Level of response agreed
1. Part A: Meeting Open
WANDSWORTH CCG
Regular Review of Quality information
5. Part E: Meeting Close
PCQRG
27
1. Part A: Meeting Open
WANDSWORTH CCG
PAGE 9 OF 11
Appendix 2 – Primary Care Quality Work Plan, June 2016
EG
Engagement Practice Engagement Joint Localities Members Forums / Members Forums Weekly Updates Quality update / newsletter Patient Engagement Initial discussion to be had with Locality practice patient groups Other stakeholder engagement
EG
3)
Integrated Reporting Develop reporting that triangulates quality, activity and financial information on practices
EG / KS
4)
Incidents Encourage practice use of National Reporting and Learning System (NRLS) to report all incidents and serious incidents Utilise Quality contract – Task/event to support reporting and learning E-Form to be made available on DXS Confirm process for management and roles of NHSE and CCG
July – September 2016
5)
CQC
Ongoing
2)
October 2016
Ongoing
July 2016
October 2016
4. Part D: Board Governance 5. Part E: Meeting Close
Develop policy – Managing Quality in Primary Care Expand on Information sharing and escalation policy already developed to include additional areas: Information Management – Complaints, Make a Difference alerts, incidents, CQC reports Support to practices Managing Risk Reporting and Governance
1)
Timescale
3. Part C: Management Reports
Lead
2. Part B: Decisions and Discussions
Actions
28
PAGE 10 OF 11
6)
Make a difference alerts Set up Make a Difference system for secondary care, community services and other providers to be able to report concerns about primary care Initial specialities to be agreed Engagement with practices through Members Forums
EB
August 2016
7)
Soft Intelligence Develop process for capturing “soft” intelligence about practices CRM to be reviewed as an option for collating information
EB
September 2016
8)
Local Quality Tracker Update as data available Identify additional data that can be included Review and identify areas of focus
EG
Ongoing
9)
Practice Support Team Routine visits Targeted visits where potential issues are identified or practices request support
Fed
Ongoing
10) Risk Register Develop primary care quality risk register and link with Corporate register
EG / EB
August 2016
11) Primary Care Quality Review Group Develop role of this group
ZR / EG
Ongoing
4. Part D: Board Governance 5. Part E: Meeting Close
Timescale
3. Part C: Management Reports
Lead
2. Part B: Decisions and Discussions
Actions Information sharing Review of reports Identification of areas for improvement and outstanding areas – shared learning Actions for Requires Improvement or Inadequate reports
1. Part A: Meeting Open
WANDSWORTH CCG
29
PAGE 11 OF 11
For Reference 1. The following were considered when preparing this report:
[Yes] [Yes] [Yes] [Yes] [No] [Not applicable] [Not applicable] [No]
Please explain your answers:
2. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities [Yes]
Make the best use of resources, continually improve performance and deliver statutory responsibilities [Yes]
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities [No]
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting [No]
Develop the CCG as a continuously improving and effective commissioning organisation [No]
Please explain your answers:
4. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does comply]
5. Part E: Meeting Close
3. Executive Summaries should not exceed 1 page. [My paper does comply]
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances Equality impact assessment Patient and public involvement
1. Part A: Meeting Open
WANDSWORTH CCG
30
PAGE 1 OF [X] PAGE 1 OF 2
Mental Health Estates Modernisation Programme Author: Dr Phil Moore, Kingston CCG Sponsor: Lucie Waters
Date: 07/16
Context The CCG Board approved the Strategic Outline Case (SOC) for the South West London and St George’s Mental Health NHS Trust (SWL&SGH) Estates Modernisation Programme (EMP) in March 2015. Since that time commissioners and the trust have been working together to implement services that achieve outcomes for patients, including length of stay reductions, that will enable the EMP to be taken forward as planned. This report is presented by Kingston CCG, lead for mental health strategy in SW London, and updates the CCG Board on the ‘demand and capacity’ modelling which has been undertaken to support the direction of travel in the EMP.
Question(s) this paper addresses Pages 4 – 6 of the report outlines the questions that seek to establish if progress has been made in line with the Estates Modernisation Programme.
The report concludes that progress is being made in the implementation of community services across CCGs in SW London to ensure the bed numbers in the EMP will provide sustainable services for patients.
4. Part D: Board
Conclusion
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
Input Sought
Further background detail can be accessed through the following link: http://www.wandsworthccg.nhs.uk/aboutus/OurBoard/Pages/Board-Papers.aspx
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
We would welcome the board’s input regarding the level of assurance needed, at what milestones, to ensure the alignment between commissioned service, performance/outcomes and the proposals for estate modernisation.
31
PAGE 2 OF 2
For Reference Edit as appropriate: 1. The following were considered when preparing this report:
[Yes] [Yes] [Yes] [Yes] [Yes [Yes] [No] [No]
Please explain your answers:
1. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities [Yes]
Make the best use of resources, continually improve performance and deliver statutory responsibilities [Yes]
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities [No]
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting [Yes]
Develop the CCG as a continuously improving and effective commissioning organisation [No]
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances Equality impact assessment Patient and public involvement
1. Part A: Meeting Open
WANDSWORTH CCG
Please explain your answers:
3. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does not comply]
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
2. Executive Summaries should not exceed 1 page. [My paper does comply]
32
Paper for CCG Go er i g Bodies regardi g de a d a d capacity
ork
In 2014, the five CCGs1 that predo i a tl use “outh West Lo do a d “t George s Me tal Health
1. Part A: Meeting Open
DRAFT NHS Trust (SWLStG) consulted on changes to services to enable the modernisation of the inpatient Scrutiny Committee (JHOSC) of all six south-west London local authorities2 subject to more detail on investment in community services and the number of beds required in the medium to long term. To achieve this, the CCGs and SWLStG jointly commissioned Mental Health Strategies (MHS) to conduct modelling to estimate the number of beds required if no change were made and if a number of potential changes were to be made in community based services. This work, which has lo all
ee referred to as de a d a d apa it , i luded a large number of meetings with users,
carers and health & social care professionals to establish the views on what services in the community should be considered. MHS extracted 3 years of anonymised episode level data from SWLStG and ran a programme using discrete event simulation modelling. The
odelli g e a led a
fails i ser i es to e ide tified
over the next five years. A fail is any occasion where a service tries to operate above its defined capacity, waiting times or needs to use outlying inpatient beds. The limits can be defined and are altered by modelling staffing levels and skill mix.
2. Part B: Decisions and 3. Part C: Management
estate for the Trust. This consultation was completed and approved by the Joint Health Oversight &
The modelling is run on a statistical basis hundreds of times (the so-called Monte Carlo simulation) otherwise given the parameters defined. Ha i g ru a
o ha ge s e ario, arious adjustments to community based services are modelled
to assess the quantum of change these can make. The assessments were based on available evidence for the service changes proposed. Some were run and made little difference. Others had
4. Part D: Board
until relatively stable figures are reached. This enables the ability of the services to cope or
variable effects. As a final step, all the community based changes chosen were amalgamated into a single model to assess the overall effect on required bed numbers.
1.
1 2
Wandsworth, Merton, Sutton, Richmond and Kingston The five above plus Croydon
Page 1 of 8
5. Part E: Meeting Close
This following paragraphs are now based on the report produced by MHS and attached as Appendix
33
In summary the modelling suggested that if there was no change, there would be escalating demand for beds with increasing overspill. Clearly a no change option was not acceptable.
1. Part A: Meeting Open
DRAFT A series of community improvements (some of which are already in place for some CCGs) had a have been carefully selected as potentially the most plausible, individually useful, and consistent with what is understood to be local strategy and intentions, supported by both the provider and commissioners and at a level deemed to be achievable.
Equalising the diversion rate of CMHTs
Achieving 50% of the estimated levels of supported housing requirement
Introducing crisis cafes, achieving only 20% of the early impact seen in Surrey
Rolling out the challenging behaviour services across South West London
Adopting the Sutton model of community practice across the Trust
Diverting patients in cluster 18 away from secondary care, following a 60-day assessment episode
This suggests that with 133 working age + 35 older adult beds (scenario 2 in the report) with 19/20 PICU eds the s ste
ould ope at a epta le le els. The detail of hat it
ea s to ope follo .
Using the main optimisation as above, the estimated median occupancy levels over the modelling period for this bed configuration would be: Working age
79.1%
Acute older adult
55.9%
PICU
85.7%
This model assumes a maximum bed occupancy of 100%. If leave beds are permitted to be used, and occupancy to rise periodically above 100%, it may be considered that the estimated levels of overspill could in fact be managed by permitting ward occupancies above 100% for periods of time.
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
further effect. The key changes that are predicted to have greatest effect on bed usage follow. These
Relatively conservative assumptions were made as to the impacts of each of the initiatives, allowing for some not proceeding, proceeding only on a phased basis, or having a lesser impact than hoped. If
An optimisation was also prepared eliminating any benefit from supported housing, as this is less directly in the gift of NHS commissioners and providers. This shows that the remainder of the community changes, taken together, still produce a substantial improvement on the baseline, but at a lesser level. However it still suggests that the 133 working age + 35 older adult + 19/20 PICU beds would be manageable. Page 2 of 8
5. Part E: Meeting Close
ambition/optimism is greater locally, better effects could be assumed.
34
Further improvements could be achieved by reducing length of stay but these have not been modelled in the above conclusions.
number of days when the service would have insufficient capacity. With four female PICU beds, it was estimated that a local service would have insufficient capacity on approximately 10% of days. To achieve a level of over-capacity days below 3% (i.e. approximately less than once a month) the service would need to have 6 beds. MH“ s o lusio a out this ed o figuratio is, The
+
optio
ould ork ith more
conservative assumptions about the impact of community service changes, and has good levels of tolerance in expected occupancy levels. There could still be peaks of demand above levels of provision, but it is possible that those could be managed by occasional use of leave beds above a otio al
%, a d/or fle i ilit
et ee adult a d older people s eds.
As a final piece of evidence for local consideration, the report considered the question of bed numbers separately from that of the three main options under local discussion, assuming the pattern of optimisations is introduced, as in the rest of this discussion. Rather than test specific bed configurations, the modelling here considers the bed numbers required to achieve a median fail rate of less than 2.5 % i.e. a bed is not available immediately on around 1 in 40 occasions when it is
2. Part B: Decisions and 3. Part C: Management
From repeated modelling runs, MHS estimated the impact of differing female PICU ward sizes on the
1. Part A: Meeting Open
DRAFT
sought. This does not mean that a patient would not be admitted to any bed in such circumstances; be managed by use of second choice or leave beds. Application of this target proved somewhat complex, given that new optimisation services cannot be assumed to have an immediate impact. They have therefore permitted slightly higher fail rates in the first year, provided those bed numbers settle to a fail rate under the 2.5% target.
4. Part D: Board
this is a rate which, within a bed pool of the South West London size, could probably operationally
On this basis, we estimate that the following bed numbers would be required: Year 1
2
3
4
5
Working Age – proposed 133
127
127
128
130
132
Acute Older Adult –proposed 35
27
27
27
27
28
PICU – proposed 13 male & 6/7 female
19
19
19
20
20
Page 3 of 8
5. Part E: Meeting Close
Bed Pool
35
These would, we estimate, produce the following median fail rate (generally speaking a fail rate under 2.5% is considered manageable and acceptable):
1. Part A: Meeting Open
DRAFT Year 1
2
3
4
5
Working Age
3.1%
0.0%
0.2%
0.3%
2.0%
Acute Older Adult
3.9%
0.0%
1.5%
1.4%
2.0%
PICU
1.7%
2.1%
2.4%
1.8%
1.2%
(These figures have prompted agreement with the Trust for additional beds for 2016/17 with the intention that the numbers should be progressively reduced as the effect of the community based services are realised.) ….a d the
ould operate at the follo i g
edian occupancy rates: Year
Bed Pool
1
2
3
4
5
Working Age
78.1%
79.8%
81.9%
84.5%
87.4%
Acute Older Adult
67.2%
68.9%
71.2%
69.6%
74.3%
PICU
63.8%
64.4%
64.9%
61.7%
61.1%
2. Part B: Decisions and 3. Part C: Management
Bed Pool
Ward size is ideally 18 beds but could be stretched to 20. It will be seen that these estimates are local female PICU with 6 or 7 beds. They, however, suggest a number of older age beds which falls inconveniently between ward sizes. If two small older adult wards are not considered desirable, it may be that the ward designations could be adjusted, for example, to allow for 8 adult wards (8 wards of 18/19 beds = 148) and 1 older adult ward of 20 beds. This detail needs further discussion but does not alter the overall conclusions.
4. Part D: Board
consistent with the 7 ward working age adult option (19 beds per ward), and with the creation of a
Questions that may be raised by CCG Governing Bodies How achievable are these numbers in the context of the increase in beds commissioned from the trust for 2016/17? The three tables above predict the numbers of beds required within the modelling parameters to a hie e a epta le fail a d o upa
rates. This
odelli g ould appear to e etter tha
any other predictive model available to commissioners and providers at this time. The additional beds commissioned for 2016/27 should be sufficient to deal with the predicted need over the Page 4 of 8
5. Part E: Meeting Close
36
next year. Future projections are dependent on the CCGs introducing the community based services to enable the bed numbers proposed.
The report uses a aseli e of
adult eds ut the prese t u
er i ludes
outlier eds i
The modelling starts from the existing baseline but models actual numbers required in the future rather than changes from a baseline. While the report compares projections to the baseline, those comparisons do not affect the projected numbers. Thus the absolute numbers are still considered robust. In the report, option 2 data only work by allowing "internal overspill". This means putting adults o to older people s ards or vice versa. This is presently against policy. Should this not be acknowledged and either the policy changed or the analysis re-done with no internal overspill. It is correct that the current policy carefully controls cross-over use of beds. It closely defines a careful risk assessment and minimises any length of stay if such bed usage is proposed for a patient. However, it is accepted as the exception. On page
of the report, the riteria used are set out as usi g, a
edia fail rate of less tha
2.5 % i.e. a bed is not available immediately on around 1 in 40 occasions when it is sought. This
2. Part B: Decisions and 3. Part C: Management
East London. Does this not suggest all the bed totals need to be increased?
1. Part A: Meeting Open
DRAFT
does not mean that a patient would not be admitted to any bed in such circumstances; this is a a aged
use of se o d hoi e or lea e eds. The figures do ot a ou t for lea e eds
therefore oth fail a d o upa
rates e lude bed availability from leave. In addition the bed
numbers in the first table above demonstrate some surplus on the figures provided.
The estimated median occupancy quoted is not consistent with the MHS analysis (p 48) which is
4. Part D: Board
rate which, within a bed pool of the South West London size, could probably operationally be
93.6%, 91% and 71.9% respectively. These figures relate to the baseline case and the adjustments following introduction of community services are further down the same page. The figures in the table above are taken
Do the figures suggest e eed
ore adult a d fe er older people s eds?
Page 5 of 8
5. Part E: Meeting Close
from the conclusion of the report (p 55).
37
Quite probably. The main priority of the paper was to produce evidence for the number of beds needed in total given proposed work in the community, as the total number will determine the number of wards that need to be built as part of the Estate Modernisation Programme (EMP). er of adult a d older people s
beds and how this can be addressed to ensure appropriate care of adults and older people is being worked through as part of the detailed planning of the estate. The commitment to the policy that any cross placing patients should be exceptional and for minimal time remains.
How robust are the proposals to align community investment, delivery by the trust of reduced admissions and LOS i.e. will we have to extend this investment in additional beds beyond 2016/17? The modelling done predicts that as the community services become operational over the next year the predicted bed numbers are appropriate to manage the demand. This will, of course, depend on the performance of the community services but the predictions for performance have been kept at very conservative levels and have not included other possible work such as reductions in length of stay. This is detailed in the paragraphs above. The s e ario referred to as supported housi g relates to the pro le
of people sta i g i
acute care for more than 60 days. The target effect is that stays of more than 60 days should be
2. Part B: Decisions and 3. Part C: Management
The i te tio is that there eeds to e so e fle i ilit i the u
1. Part A: Meeting Open
DRAFT
reduced to 60 days; local discussion indicated that the main thing preventing this was access to stays. In the main optimisation, we have assumed that half of this target effect can be secured i.e. half of all stays of longer than 60 days can be reduced to 60 days.
What is the impact on this on the original EMP that went to the Board (timescales, affordability)?
4. Part D: Board
supported housing, but there may of course be other factors contributing to relatively long
The findings above work well with the original proposals of the EMP. In the report to JHOSC at appendix 2, investment in and timescales for community services is detailed. Using the modelling it is clear that the risk year is the first year (16/17) which is why additional beds have at a pace commensurate with community service performance. The requirements remain that each CCG working together with its neighbours will need to ensure investment in and development of its community services to deliver the level of bed usage set out, even if the details vary from CCG to CCG. Page 6 of 8
5. Part E: Meeting Close
been commissioned for that period and will be kept under quarterly review thereafter to reduce
38
1. Part A: Meeting Open
DRAFT
Tonia Michaelides
Mental Health Clinical Lead SW London
Mental Health SRO SW London
2. Part B: Decisions and 3. Part C: Management
Phil Moore
4. Part D: Board 5. Part E: Meeting Close
Page 7 of 8
39
Appendix 1 – Full report from mental Health Strategies
2. Part B: Decisions and 3. Part C: Management
Appendix 2 – Report to JHOSC on mental health investment
1. Part A: Meeting Open
DRAFT
4. Part D: Board 5. Part E: Meeting Close
Page 8 of 8
40
PAGE 1 OF 6 PAGE 1 OF 6
Performance Report Author: Iain Rickard
Sponsor: Sean Morgan
Date: Wednesday 20th July 2016
Context This paper details the current and year-to-date performance against all NHS Constitution indicators (subject to available data). A provisional report on performance against the new Improvement and Assessment Framework indicators has been provided by NHS England. This is the subject of a separate paper this month, but will be included in this report in the future. There has been a delay in receiving data for overall CCG performance for some indicators for months 1 and 2, therefore this report focuses slightly more on the performance of our local providers and, in particular, St. George’s progress against its Sustainability and Transformation Plan trajectories.
Looking Back WHAT HAS GONE WELL?
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
4. Part D: Board
C. Difficile Infection Rates Two cases of C-Difficile were reported in May. However, we remain within our YTD maximum trajectory 6-Week Diagnostics Waiting Time Diagnostic 6-week wait performance has recovered from last month to 99.1% in May. IAPT Waiting Times 6 and 18 week waiting time targets for IAPT continue to be met and were consistently achieved during 2015/16. Early Intervention in Psychosis 2-week Target This target is being met, although performance is sensitive to small numbers of patients. Dementia Diagnosis Rate We have been consistently achieving this target throughout the year. However, we do not anticipate achieving higher than around 73% going forward as work to identify patients, share information and record diagnoses is nearing completion.
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
41
PAGE 2 OF 6
WHAT HAS NOT GONE WELL?
5. Part E: Meeting Close
Board Intelligence Hub template
4. Part D: Board
Strictly Confidential
2. Part B: Decisions and 3. Part C: Management
A&E 4 Hour Waiting Time A&E waiting time performance has been improving steadily at St. George’s since April 2016. Performance is still below the 95% target, but has been above STP trajectory plan in April and May and just 0.1% below plan in June. 18-Week Referral to Treatment Waiting Time (Incomplete Pathways) Data is not yet available for the CCG overall, but St. George’s reported achieving 90.6% in May, which is below target, but above their STP trajectory plan of 89.6%. Following a recent investigation into data quality and waiting list management at St. George’s, the Trust has requested permission to stop reporting RTT performance national returns until issues are resolved. Cancer Waiting Times Provisional data shows that 4 of the 9 Cancer Waiting Time Standards were achieved in May 2016. The two week all cancer and the 62 day standards were not achieved. Numbers of breaches are not yet available, but underperformance was driven by St. George’s and the Royal Marsden not achieving the 2 week and 62day standards. St. George’s is not achieving its STP trajectory for the 62-day standard. Ambulance Response Times Category A 8-minute response times have been below target throughout the year. The London Ambulance Service continues to experience high levels of demand and is focusing on maintaining quality and patient safety. IAPT Recovery Rates IAPT recovery rates are just below the 50% target, but compare favourably to the national average. We are working with the Wandsworth IAPT service, with input from the Intensive Support Team, to examine how recovery rates could be improved.
1. Part A: Meeting Open
WANDSWORTH CCG
42
1. Part A: Meeting Open
WANDSWORTH CCG
PAGE 3 OF 6
Scorecard Integrated Report KPI Scorecard CCG
NHS WANDSWORTH CCG
08X May-16
Health Outcomes Framework / Every one Counts
Target 0 8 92% 0 99% 93% 93% 96% 94% 98% 94% 85% 90% 90% 0 95% 75% 95% 50% 50% 67%
75% 75% 95%
Breaches
91.5% 3 726 98.4% 86.7% 97.7% 96.5% 100.0% 100.0% 94.6% 91.3% 80.0% 100.0% 0 96.2% 97.1% 99.8% 47.8% 66.7% 72.7%
91.5% 3 726 99.1% 87.6% 95.5% 97.4% 90.9% 97.7% 96.9% 78.8% 81.8% 100.0% 0 95.6% 98.5% 99.5% 49.7% 66.7% 73.1%
2126 3
528 1955 2483 1952 9116
528 1955 2483 1952 9116
89.7% 94.2% 95.0% 94.9% 91.9% 0 0 0 0 0
89.7% 94.2% 95.0% 94.9% 91.9% 0 0 0 0 0 72.2% 71.7% 97.4%
0 (YTD) 0 (YTD)
43
0 6 3 1
1416 1275 460 626 1220 0 0 0 0 0
Latest Data May-16 May-16
Previous Months Apr-16 Mar-16 Feb-16 1 2
0 3
Apr-16 Apr-16 Apr-16 May-16 May-16 May-16 May-16 May-16 May-16 May-16 May-16 May-16 May-16 May-16 Mar-16 May-16 May-16 May-16 Apr-16 May-16
91.5% 3 726 97.7% 86.7% 97.7% 96.5% 100.0% 100.0% 94.6% 91.3% 80.0% 100.0% 0
90.5% 1 736 99.2% 90.4% 93.8% 98.8% 100.0% 100.0% 100.0% 83.7% 90.9% 100.0% 0
96.3% 100.0% 45.8% 40.0% 72.3%
92.4% 97.9% 37.2% 100.0% 72.4%
92.1% 1 629 99.5% 92.4% 96.8% 97.5% 100.0% 100.0% 100.0% 84.8% 83.3% 100.0% 3 95.7% 93.2% 98.6% 48.2% 66.7% 72.1%
► ► ▲ ► ▼ ► ► ▲ ► ► ▲ ► ▲ ▼ ► ► ▲
Apr-16 Apr-16 Apr-16 Apr-16 Apr-16
506 2053 2559 1913 9060
526 2101 2627 1940 9250
480 2042 2522 2003 9021
► ▲ ▲ ► ►
Apr-16 Apr-16 Apr-16 Apr-16 Apr-16 Apr-16 Apr-16 Apr-16 Apr-16 Apr-16
86.5% 93.7% 92.4% 90.9% 87.9% 2 0 0 0 0
83.2% 93.9% 90.8% 93.0% 90.0% 0 0 0 0 0
88.7% 95.4% 91.7% 92.1% 93.5% 0 0 0 0 0
▼ ▼ ► ► ▼ ► ▼ ► ► ►
May-16 May-16 May-16
78.6% 72.1% 97.7%
71.8% 69.2% 95.9%
67.6% 60.7% 96.4%
▲ ▲ ►
Latest Month data shows an increase over previous 12 months (using 6 sigma methodology), which is an Improvement in performance Latest Month data shows an increase over previous 12 months (using 6 sigma methodology), which is a Deterioration in performance Latest Month data shows an Decrease over previous 12 months (using 6 sigma methodology), which is an Improvement in performance Latest Month data shows an decrease over previous 12 months (using 6 sigma methodology), which is a Deterioration in performance Latest Month data is within normal variation of previous months data and is neither showing a statistical increaase or decrease Achieving Target Failing Target
Strictly Confidential
Board Intelligence Hub template
12M Trend ► ▼
0 3
►
▲ ▲ ▼ ▼ ►
4. Part D: Board Governance 5. Part E: Meeting Close
95% 95% 95% 95% 95% 0 0 0 0 0
Performance Month 0 2
3. Part C: Management Reports
Safe environment and protecting MRSA - Incidence of HCAI YTD C. difficile - Incidence of HCAI YTD from avoidable harm NHS Constitution RTT incomplete RTT RTT 52+ week waiters RTT Admitted Backlog Diagnostics Diagnostics - 6 weeks + Cancer - 2 weeks 2 week wait Breast symptoms 2 week wait 31 day first definitive treatment Cancer - 31 days 31 day subsequent treatment surgery 31 day subsequent treatment drug 31 day subsequent treatment radiotherapy Cancer - 62 days 62 day standard 62 day screening 62 day upgrade Trust Measures Mixed-sex accommodation breaches CPA follow up within 7 days IAPT 6 week target Mental Health IAPT 18 week target IAPT Recovery Rate Early Intervention Psychosis 2 week target Dementia Activity & Efficiency G and A elective FFCEs G and A daycase FFCEs Activity G and A total FFCEs Non elective FFCEs All first outpatient attendances A&E 4 Hour Waits % within 4 hours ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST % within 4 hours CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST % within 4 hours KINGSTON HOSPITAL NHS FOUNDATION TRUST % within 4 hours EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST A&E % within 4 hours GUY'S AND ST THOMAS' NHS FOUNDATION TRUST Trolley Waits >12Hrs ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Trolley Waits >12Hrs CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST Trolley Waits >12Hrs KINGSTON HOSPITAL NHS FOUNDATION TRUST Trolley Waits >12Hrs EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST Trolley Waits >12Hrs GUY'S AND ST THOMAS' NHS FOUNDATION TRUST Ambulance Red 1 LAS Red 2 Cat A19
Performance YTD 0 5
2. Part B: Decisions and Discussions
South East CSU
43
Sustainability & Transformation Programme Trajectories
1. Part A: Meeting Open
2. Part B: Decisions and Discussions
3. Part C: Management Reports
4. Part D: Board Governance 5. Part E: Meeting Close
Board Intelligence Hub template Strictly Confidential
PAGE 4 OF 6 WANDSWORTH CCG
44
PAGE 5 OF 6
Looking Ahead In 2016/17, our performance will be measured against indicators in the CCG Improvement and Assessment Framework. Please refer to the separate report for opportunities and risks identified from the indicators that have been published.
The Board is asked to note current performance for the year to-date, current risks and mitigating action and governance arrangements and to recommend any further action that may be required.
2. Part B: Decisions and 3. Part C: Management
Input Sought
1. Part A: Meeting Open
WANDSWORTH CCG
4. Part D: Board
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
45
PAGE 6 OF 6
For Reference Edit as appropriate:
1. Part A: Meeting Open
WANDSWORTH CCG
1. The following were considered when preparing this report:
The performance report provides a view of current performance and, based on this and wider intelligence, likely future trends. If future performance is expected to be below targets or expected levels, then this is highlighted as a risk. Our performance relates to the work of our providers in many areas and is a reflection of our reputation and the quality of care our patients are receiving. 2. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities
Make the best use of resources, continually improve performance and deliver statutory responsibilities
Develop the CCG as a continuously improving and effective commissioning organisation
Our overall performance and performance in specific areas reflects how successfully we are meeting these objectives. 3. Executive Summaries should not exceed 1 page. [My paper does not comply]
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers
4. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does comply]
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
46
PAGE 1 OF [8] PAGE 1 OF 8
Improvement & Assessment Framework Indicators Author: Iain Rickard
Sponsor: Sean Morgan
Date: July 2016
Context In the Government’s mandate to NHS England, a new CCG Improvement and Assessment Framework (IAF) takes an enhanced and more central place in the overall arrangements for public accountability of the NHS. The framework is intended to bring clarity, simplicity and balance to discussions between NHS England and CCGs. It draws together in one place NHS Constitution and other core performance and finance metrics, outcome goals and transformational challenges, to capture the multi-faceted role of CCGs. The 60 indicators underpinning the CCG IAF will be released throughout 2016/17. To aid transparency for the public and to support CCG benchmarking against peers, the framework will present both overall ratings for CCGs and relative performance on metrics, and these will be published through a range of channels including the MyNHS website. In the meantime, NHS England have issued a dashboard, which draws together 42 of the 60 indicators currently available. A number of the indicators are still in development and will undergo further iterations as part of the assurance process during ‘16/17, this should be considered when using the content to support discussion.
Questions this paper addresses
Conclusion 1. A comparison against the national average performance has been provided by NHS England for 30 of the 42 indicators. We have performed above national average for 13 indicators and we are highlighted as performing in the lowest quartile for 9 indicators. These are set out below (data period is 2015/16 unless stated otherwise). Performance in Lowest Quartile
Maternal smoking at delivery
Injuries from falls in people aged 65 and over per 100,000 population
Diabetes patients that have achieved all 3 NICE recommended treatment targets (2014/15)
People offered choice of provider and team when referred for a 1st elective appointment
People with diabetes diagnosed less than a year who attend a structured education course (2014/15)
People with a long-term condition feeling supported to manage their condition
Strictly Confidential
5. Part E: Meeting Close
Performance Above National Average
4. Part D: Board
1. How have we performed against the indicators that have been published? 2. Where our performance is highlighted as being in the lowest performance quartile, what is driving this and how can we improve?
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
Board Intelligence Hub template
47
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Personal health budgets per 100,000 population
One-year survival from all cancers (2013)
Women’s experience of maternity services
IAPT recovery rate
Financial Plan
People with 1st episode of psychosis starting treatment with a NICE recommended package of care treated with 2 weeks of referral
% of deaths which take place in hospital
People with a learning disability and/or autism receiving specialist inpatient care per million population Neonatal mortality and stillbirths per 1000 births (2014/15) Estimated diagnosis rate for people with dementia % patients admitted transferred or discharged from A&E within 4 hours Delayed transfers of care attributable to the NHS and Social Care per 100000 population Patient experience of GP services 2. Full analysis of indicators where performance is in the lowest quartile is given in the
main report. This includes where there are opportunities to improve performance or ongoing risks, based on work programmes in place and the level of control we have over the drivers of performance.
The Board is asked to note performance against the indicators published to date and, where performance is poor, where there are opportunities to improve performance in the future and where risks remain.
4. Part D: Board
Input Sought
2. Part B: Decisions and 3. Part C: Management
People with urgent GP referral having 1st definitive treatment for cancer within 62 days
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The Report
Looking Back WHAT HAS GONE WELL?
WHAT HAS NOT GONE WELL?
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5. Part E: Meeting Close
Injuries from falls in people aged 65 and over per 100,000 population Falls are the largest cause of emergency hospital admissions for older people. The risk of falls increases with age and the risk is also increased for older people in residential care. This indicator is a proxy for adherence to the NICE clinical standard for post fall assessment and prevention and of how the NHS, public health and social care are working together to reduce the risk of falls. Performance against this indicator is dependent on quality of coding at acute trusts. CCGs with large activity flows to specific acute trusts show similar performance, including ourselves and Merton CCG. (Unfortunately, it is not clear from the initial national dashboard what period this data relates to.) People offered choice of provider and team when referred for a 1st elective appointment This indicator is based on percentage of referrals made using the e-referrals service as a proxy for the proportion of patients being offered choice of provider and team as is their legal right. Utilisation of e-referrals in Wandsworth is low, driven mainly by issues with publication
4. Part D: Board
Maternal smoking at delivery Diabetes patients that have achieved all 3 NICE recommended treatment targets People with diabetes diagnosed less than a year who attend a structured education course People with urgent GP referral having 1st definitive treatment for cancer within 62 days One-year survival from all cancers IAPT recovery rate People with 1st episode of psychosis starting treatment with a NICE recommended package of care treated with 2 weeks of referral People with a learning disability and/or autism receiving specialist inpatient care per million population Neonatal mortality and stillbirths per 1000 births Estimated diagnosis rate for people with dementia % patients admitted transferred or discharged from A&E within 4 hours Delayed transfers of care attributable to the NHS and Social Care per 100000 population Patient experience of GP services
2. Part B: Decisions and 3. Part C: Management
This report highlights the indicators where we have performed well and gives greater detail on the areas where we have been highlighted as performing in the lowest quartile nationally. For each of these indicators, detail of the drivers and issues is given. The next section of the report identifies where there are opportunities to improve on any indicators going forward and also any risks or concerns, i.e. where there is little or no scope to improve in-year. The conclusions of this report are based on the limited number of indicators with national comparisons that have been published by NHS England in advance of the official publication of the initial dataset on myNHS. The full data dashboard, split into four domains, has been included at the end of this document.
1. Part A: Meeting Open
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Looking Ahead OPPORTUNITIES?
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5. Part E: Meeting Close
People offered choice of provider and team when referred for a 1st elective appointment There is potential for the usage of e-referrals to improve following successful completion of the outpatient improvement programme at St. George’s, one aim of which is to improve appointment availability. People with a long-term condition feeling supported to manage their condition A successful BCF programme will deliver improvements in how supported patients feel to manage their long-term condition. The Wandsworth Self-Management Programme, the Expert Patient Programme and the Wellbeing Hub will also contribute to this. Personal health budgets The CCG has established its offer which is being marketed to priority care groups. % of deaths which take place in hospital
4. Part D: Board
of timely appointment slots at St. George’s. It is possible that Wandsworth GPs are offering a high proportion of patients choice, but referrals are not made electronically. People with a long-term condition feeling supported to manage their condition This indicator is based on the proportion of people reporting they have a Long Term Condition (LTC) in the GP Patient Survey who report that they receive enough support from local services or organisations to help manage their LTC. Joint working with social care under the Better Care Fund (BCF) programme supports performance against this indicator, which is included in a suite of indicators to monitor progress of the BCF programme. However, this indicator is sensitive to the methodological issues inherent with the GP Patient Survey, which includes a sample proportion of the total population. Personal health budgets per 100,000 population The metric tracks the commitment in the NHSE Mandate and the Five Year Forward View to increase the number of people having a personal health budget. Nationally CCGs are expected to increase the numbers by 10 – 20 fold to meet the 2020 target, and as of Q4 of 2015/16 the CCG was at a low level. Women’s experience of maternity services This is a measure based on responses to questions in the 2015 CQC maternity survey to look at reported user experience across the maternity pathway. The indicator is a composite value, calculated as the average of six survey questions. Financial Plan This indicator is rated red as we will not be able to meet the business rule of retaining a 1% surplus this year. This position is unlikely to change in-year. There is a chance that the overall rating will be weighted to reflect performance against this indicator in preference to others. % of deaths which take place in hospital The purpose of the indicator is to encourage questioning of whether the reported level is in line with people’s needs and choices. Nationally, 47% of people die in hospital, and in Wandsworth 51% did in Q3 of 2015/16. There has been little change in the trend in Wandsworth in recent years, although the End of Life Coordination Centre is now expected to be having an impact on this.
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The End of Life Coordination Centre should be having a positive impact, although up to Q3 of 2015/16 the overall percentage of people dying in hospital was in line with recent years. RISKS OR CONCERNS?
In Conclusion IMPLICATIONS?
On balance we have performed well against the indicators published to date. We have work programmes in place that give us opportunities to improve against indicators where we are in the lowest quartile. There is a good chance of the CCG achieving a good rating, depending on how the overall rating is derived from performance against the indicators.
There are a small number of indicators which are not supported by work programmes or which have determinants that are difficult for a CCG to influence, certainly in the short term. We don’t yet know how the overall rating will be derived, therefore there is a risk that it may be weighted towards specific indicators that we are performing poorly against, e.g. financial plan, and our final rating may be low and not fully reflect areas of success.
4. Part D: Board
CONFIDENCE?
2. Part B: Decisions and 3. Part C: Management
Women’s experience of maternity services Given the nature of this indicator, improvements in local services may not be reflected in responses to the CQC maternity survey. Financial plan There is little scope to improve performance against this indicator in year. If the overall rating is weighted on achievement of this target, the CCG is likely to be scored down. However, the methodology for deriving the overall rating is not yet known. Injuries from falls in people aged 65 and over per 100,000 population There are a number of determinants, some of which a CCG would not be able to significantly impact on. The value in this indicator is dependent on quality of coding at acute trusts, CCGs utilising specific acute trusts appear to show similar performance, including ourselves and Merton CCG.
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Data Dashboard
2. Part B: Decisions and Discussions
Better Health Domain
3. Part C: Management Reports
Better Care Domain
1. Part A: Meeting Open
4. Part D: Board Governance 5. Part E: Meeting Close
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Sustainability Domain
2. Part B: Decisions and Discussions
Well Led Domain
1. Part A: Meeting Open
3. Part C: Management Reports
4. Part D: Board Governance 5. Part E: Meeting Close
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For Reference Edit as appropriate: 1. The following were considered when preparing this report:
2. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities
Make the best use of resources, continually improve performance and deliver statutory responsibilities
Develop the CCG as a continuously improving and effective commissioning organisation
4. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does comply]
4. Part D: Board
3. Executive Summaries should not exceed 1 page. [My paper does not comply]
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances
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PAGE 1 OF 9 PAGE 1 OF 11
Nine Elms Vauxhall - Update Author: Chris Rowland, Sponsor: Andrew McMylor/Neil McDowell, Clinical lead: Dr Nicola Williams, Date: 14 July 2016
Context 1.0 Nine Elms Vauxhall (NEV) involves the building of 18,276 new homes, the creation of 25,000 new jobs, 34,707 new inhabitants, new schools, parks, etc. in both the London Boroughs of Wandsworth and Lambeth by 2030. 2.0 Meeting the new NEV population’s healthcare needs will require about 19 new GPs by 2030 (assuming 1,800 list size per GP as recommended by NHS England) and an increase of other health services by about 6%.
Questions addressed in this report 1. What is the proposed option to meet the healthcare requirements of the area? 2. What are the risks to each organisation and the local communities? 3. What do we need to do to progress and what are the next stages?
Conclusion
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
CLINICAL COMMISSIONING GROUP PAPER
Clinical Commissioning group
1. The NEV Health Project is proposing to develop three existing practices in Lambeth,
4. Part D: Board
followed by building two new practices in Wandsworth. 2. Risks include: financial risks - over or under capacity planning; a lack of health care services for local communities; reputational risks to organisations. 3. We need to agree to support the proposal with Lambeth CCG and NHS England in order to successfully bid for appropriate capital funding through the Outline Business Case to Wandsworth and Lambeth Councils for Community Infrastructure Funding.
Input Sought 5. Part E: Meeting Close
The decision(s) &/or advice we would like from the Governing Body is to: - endorse the direction of travel as set out in the paper. - It is anticipated the Outline Business Case will be presented to the CCG Governing Body for approval in September subject to confirmation of final NHS sign-off deadlines.
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The Report What is the need or opportunity and why now?
0.2 Both Wandsworth and Lambeth CCGs have a clear vision for their populations which are: Improving Health and Reducing Health Inequalities in Lambeth’ and to provide ‘Better Care and a Healthier Future for Wandsworth’. 0.3 Meeting the new NEV population’s healthcare needs will require circa 19 new GPs by 2030 (see Map 1), at a patient list size of 1800 per full time Equivalent (FTE) GP as recommended by NHS England, and an increase in the capacity of other local health services by about 6%. 0.4 The NEV area contains an existing deprived population: Queenstown Ward in Wandsworth has one of the most deprived lower super output areas (LSOAs) in the UK (four LSOAs in the bottom 40%), while Bishop’s Ward, Oval Ward, Prince’s Ward and Stockwell Ward in Lambeth between them have 13 LSOAs in the “most deprived” category. Map 1: NEV Opportunity Area with CCG Boundaries and GP Practices
2. Part B: Decisions and 3. Part C: Management
0.1 NEV is a multi-billion UK pounds private investment programme to transform Nine Elms from a semi-derelict, light industrial zone into an ultra-modern residential and business distinct. It involves the building of 18,276 new homes with 34,707 new inhabitants (Appendix 3), the creation of 25,000 new jobs, new schools, parks, etc. in both the London Boroughs of Wandsworth and Lambeth by 2030.
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1. Part A: Meeting Open
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2. Part B: Decisions and 3. Part C: Management 4. Part D: Board
0.6 As a result of this requirement for a phased plan for healthcare, the NEV Health Project, in conjunction with Lambeth and Wandsworth CCGs, NHS England and other key stakeholders has developed an Outline Business Case for the requirements of healthcare to support the new and existing populations.
5. Part E: Meeting Close
0.5 The healthcare requirements of the new and existing populations within the NEV opportunity area will steadily increase over the 15 years of the development. Currently there is the opportunity to develop a clear plan for healthcare that will be able to change and adapt to the increasing demands of the population and allow strategic increases in healthcare capacity where and when required.
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What do we propose to do and why? 0.7 To achieving each CCG’s vision and supporting the healthcare requirements of the new and existing populations the NEV Health Project has worked through an options appraisal (available on request) to develop a definitive plan for the healthcare resources required to meet the needs of the local population.
0.9 The capacity of existing practices will be exceeded by 2020/21 and in order to accommodate the increasing demands on primary healthcare capacity from the new residents of the development, phase two of the four phase delivery plan will provide an additional 9 consultation rooms across three existing practices.
0.11 In the medium term, as the new population move into the area, an additional site will be required, which is proposed to be on Sleaford Street (Battersea Power Station Development Company). 0.12 The results of a feasibility study (available on request) carried out on the general growth in North Lambeth demonstrate that between 2011 and 2030, the population of North Lambeth will increase by 61%. As a result, this will increase demands on the existing capacity highlighted to support the incoming population of the NEV development.
5. Part E: Meeting Close
Table 1: Lambeth and Wandsworth Population Growth 2015-2030 (HUDU, June 2016)
4. Part D: Board
0.10 In North East Battersea (Wandsworth) there is minimal existing capacity to support an increase in demand on primary healthcare. The branch surgery of Battersea Fields Practice, located on Thessaly Road has the ability to increase capacity in the short term.
2. Part B: Decisions and 3. Part C: Management
0.8 The proposed plan to deliver additional NHS healthcare capacity can be broken down into four distinct phases: i) Utilisation of existing capacity in local practices – Lambeth: Riverside Medical Centre (relocation of some services located on-site); Mawbey Brough Health Centre; South Lambeth Road Practice; Binfield Road Surgery; and Wandsworth: Battersea Fields Practice – Thessaly Road branch practice. ii) Expansion of three existing practices – Lambeth: Mawbey Brough Health Centre; South Lambeth Road Practice; and Binfield Road Surgery. iii) Development of a primary healthcare facility on Sleaford Street site, part of the Battersea Power Station (BPS) development in Wandsworth. iv) Development of a primary healthcare facility on the Nine Elms Square site, part of the New Covent Garden Market Authority (NCGMA) development
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0.15 This conflicting demand on capacity from the general growth of North Lambeth and the new residents of NEV will result in in the long term for an additional estate being required in the development by 2024. This is proposed to be on the Nine Elms Square site.
4. Part D: Board
0.14 Around 80% of projected growth in NEV is on the Wandsworth side however, the impact on health services will be felt on both sides of the Wandsworth and Lambeth border.
2. Part B: Decisions and 3. Part C: Management
0.13 The population change in Map 1 shows the location of the NEV Opportunity Area and the concentration of growth within and around it relative to other parts of Lambeth and Wandsworth.
1. Part A: Meeting Open
Clinical Commissioning group
What are the costs of the proposal and how will it be funded?
0.17 There are essentially 5 funding issues as a result of the development: Capital costs of the development; cost of fitting out the development; project management costs; revenue costs of the facility overall and the revenue costs of the overall population consuming healthcare resources such as community and secondary care.
5. Part E: Meeting Close
0.16 In addition to proposing a clear plan for healthcare delivery to support the NEV development, this Outline Business Case is required to secure funding from available sources for capital investment required for the development of healthcare services in the NEV opportunity area.
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0.18 The CIL/DIF bid is for 100% of capital cost of the unit, made up of the acquisition of the shell from the developer BPS and the fit-out to be provided by NHSPS. Once acquired, ongoing revenue costs of the facilities will be funded by the NHS. These comprise rates, utilities, service charge etc.
0.20 In parallel to the bid to NHS England, the Outline Business Case will be submitted as a Delivery and Investment bid for capital funding to Wandsworth and Lambeth Councils. This bid is required for November 2016 to enter the two Borough’s capital planning projections in January 2017. 0.21 Any funding awarded for the ETTF bid will reduce the requirement on the Delivery and Investment bid to the two Councils. 0.22 The Health Project is seeking assurance around the allocation for Clinical Commissioning Groups (CCGs) for increases in patient numbers. General allocations to CCGs have a lag period of three years before the CCGs are reimbursed for increases in patient numbers however, in cases of rapid influx of population to an area, the Health Project would look to negotiate with NHS England around a reduction in this lag period of allocation.
2. Part B: Decisions and 3. Part C: Management
0.19 The NEV Health Project has submitted a bid to NHS England to draw from the Estates, Technology and Transformation Fund (ETTF). The purpose of the ETTF is to help practices establish infrastructure which enables extra capacity for appointments in hours and at evenings and weekends to meet locally determined demand. Bids for this fund were required in June 2016 with the successful applications being informed in October 2016.
1. Part A: Meeting Open
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Clinical Commissioning group
0.23 The case identifies a funding requirement for £25,370,000. The funding is required in three stages. However, confirmation of stages 1 and 2 is required by April 2017.
Stage Description Funding: 1 o Interim 3 GP development 2 o Sleaford Street 1
3 3
Cost
April 2017 April 2017
£1,753,000 £12,991,000 £14,744,000
Total bid Completion: o 3 GP Interim facilities
April 2018
Completion: o Sleaford Street facility
2020/21
Funding: Nine Elms Square
April 2020
Completion: Nine Elms Square facility
2023/24
£10,626,000
5. Part E: Meeting Close
2
Delivery Date
4. Part D: Board
Table 1: Investment stages
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0.24 The outcome of this proposal is to provide a staggered increase in healthcare capacity to the NEV opportunity area over the 15 years of the development enabling patients to easily access primary care health services to improve their health and reduce attendance and admissions at local acute hospitals.
0.25 The NEV Health Project proposal has identified a capital funding requirement of £25,370,000. Failure to secure this funding will result in a lack of capacity within primary healthcare services to account for the influx of population over the 15 years of the development. Even if we received a large proportion of the funding any shortfall is not guaranteed to be found from other sources. The only mitigation to this would be to fund expansion using existing premises (option 0B1 below) which is not realistic.or scale back from two healthcentres to one. 0.26 There will be additional financial risk around the revenue costs from project management and property revenue costs for the capital builds. No mitigation has been identified for this risk other than through an accelerated and increased allocation 0.27 Wandsworth and Lambeth CCGs will receive an uplift to their funding allocation as the new population register with local GP practices however, this will potentially have a three year lag period. The NEV Health Project is in discussion with NHS England about under what circumstances a CCG may get special dispensation to bring forward funding in line with the population growth or costs.
0.29 In addition to the costs of directly funding the revenue implications of the primary care development the extra allocation referred to in 0.27 will need to cover the additional costs for these patients consuming healthcare resources outside of primary care i.e. secondary care, out of hospital, mental heath etc.
0.31 There are options for the CCG to reduce its ongoing revenue costs of the building by securing the freehold purchase of the property in lieu of a market rent based lease of the shell. This will be achieved by securing additional income from a development infrastructure fund (DIF).
5. Part E: Meeting Close
0.30 There is a clear risk that as a consequence of the capacity of healthcare services in the area not meeting the demand of the patients requiring healthcare services, there will be an increase in patients attending acute care services including urgent care or accident and emergency. This will lead to increase pressures on the capacity of these services and have negative financial implications to CCGs as well as potential performance issues at the providers of those services
4. Part D: Board
0.28 There is an inherent risk to the reputation of all stakeholders involved if the project does not achieve the objectives of the proposal. This will be as a consequence of the other key risks including: funding; capacity planning; and financial revenue projections
2. Part B: Decisions and 3. Part C: Management
What are the risks with the proposal and how can these be mitigated?
1. Part A: Meeting Open
Clinical Commissioning group
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Who has been involved in the project and what are the reporting arrangements? 0.32 The NEV Health Project has directly involved a number of key stakeholders in the governance of the Project, including: NHS England; Lambeth CCG; Wandsworth CCG; Lambeth Council (including Public Health); Wandsworth Council (including Public Health); Healthy Urban Development Unit (HUDU).
0.34 The reporting and engagement arrangements of the NEV Health Project are in diagram 1, which shows the various levels of engagement through the project. Diagram 1: Governance structure of NEV Health Project
0.37 The population increase will directly impact health services and therefore forecasting the potential service impact of the development will be required as an on-going requirement of the health proposal.
5. Part E: Meeting Close
0.36 The key summary findings were around: pollution due to the overlapping of three main building projects; public safety due to increased traffic movement; sexual health and other health risk behaviours of construction workers; constraints on local business due to traffic movement; and increased utilisation of local walk-in centres by construction workers.
4. Part D: Board
0.35 Due the nature and scale of the NEV Health Project, the Project Group agreed in conjunction with Public Health Wandsworth and Lambeth to undertake a bespoke screening Health Impact Assessment (HIA) and Equality Impact Assessment (EIA).
2. Part B: Decisions and 3. Part C: Management
0.33 In addition, the Health Project has involved: NHS Property Services; local patient and resident groups; Health and Wellbeing Boards; and Local NHS Trusts – four acute and one Mental Health Trust.
1. Part A: Meeting Open
Clinical Commissioning group
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0.38 There is an on-going and immediate need to prevent ill-health occurring to reduce the pressure on local services and it is therefore the desire to reduce prevalence rates over time with appropriate prevention programmes. Without such programmes existing service rates can expect to continue.
What options did we consider? 0.40 The NEV Health Project shortlisted five main options for healthcare planning to consider regarding the NEV Development Table 6. Outline business Case Options Scope
OB1
Extending room utilisation to the practical maximum of 80% on throughout the 69 hours Relocation and extending room utilisation across the area towards 80%. Add some new build. Relocation and extending hours at current utilisation rates. Add some new build. Build on s106 sites and extend 3 Lambeth practices New 2600 sq m building, extensions to working week and improvements to room utilisation
OB2
OB3
OB4 OB5
Increase existing capacity by extending opening hours to 69 hours per week. Relocation of Sexual Health and Sick Doctor service and extending operating hours to 69 hours per week Relocation of Sexual Health and Sick Doctor service and extending opening hours to 69 hours per week All new build in NEV and extensions in Lambeth. Joint redevelopment of Doddington site for NEV and Doddington Estate
0.41 Each option was reviewed and scored against a number of critical success factors and benefits to patients and other stakeholders in order to produce the preferred proposal for healthcare in NEV.
4. Part D: Board
Option Description
2. Part B: Decisions and 3. Part C: Management
0.39 The key clinical areas that will be required to support both the existing and new populations of the development and the surrounding area are: Drugs and Alcohol; Sexual Health; Mental Health; Long Term Conditions; and Children’s Services.
1. Part A: Meeting Open
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Clinical Commissioning group
What do we need to do next to progress?
0.43 The proposal produced from the NEV Health Project has been sent to Lambeth CCG Governing Body (July 2016) and will be taken to NHS England’s Finance, Invesment Procurement Audit (FIPA) group (August 2016) for final NHS approval. 0.44 With support from the NHS, the NEV Health Project will seek support for the proposal from the NEV Partnership, including the Leaders of the two Councils, Transport for
5. Part E: Meeting Close
0.42 The next stages (diagram 2) of the NEV Health Project will be to obtain support and approval from the Lambeth and Wandsworth CCGs, NHSE and support from the NEV Partnership.
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London, Greater London Authority and the c.21 developers within the opportunity area (September 2016).
Diagram 2: Timeline for NEV Health Project Outline Business Case / Delivery and Investment bid
0.48 Ongoing support is requested from the Governing Body through future Board Seminar meetings and Chairs Action. 0.49 Delaying the support for this proposal will result on the inability to submit the bid for Community Infrastructure Levy / Development Infrastructure Funds
5. Part E: Meeting Close
0.47 To implement the proposed option requires commitment to expansion of existing practices and two new facilities. This will enable NHS Property Services to sign of Heads of terms for the two new facilities at Sleaford Street and Nine Elms Square sites.
4. Part D: Board
0.46 There are still some un-answered questions regarding elements within the proposal which will need to be fully answered before full approval of the proposal can be achieved. These questions relate to: Availability of capital funding for the project – on-going discussions with NHS England and Wandsworth and Lambeth Councils Ongoing revenue implications to the two CCGs – on-going discussions with NHS England Temporary facility to absorb the short term impact of the development – on-going review around short term feasibility and long term plans; and discussions with Wandsworth Council around available space.
2. Part B: Decisions and 3. Part C: Management
0.45 With support for the health proposal from the NEV Partnership, the next stage will be to submit this as a Delivery and Investment bid for funding from Wandsworth and Lambeth Councils (October 2016) to support the capital costs that will be incurred by the NHS in setting up new health infrastructure for NEV. This will then enter the two Council Capital Planning cycles.
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Clinical Commissioning group
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For Reference Edit as appropriate:
1. Part A: Meeting Open
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Clinical Commissioning group
1. The following were considered when preparing this report:
[Yes] [Yes] [Yes] [Yes] [Yes] [Yes] [Yes] [Yes]
2. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities [Yes]
Make the best use of resources, continually improve performance and deliver statutory responsibilities [Yes]
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities [Yes]
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting [Yes]
Develop the CCG as a continuously improving and effective commissioning organisation [Yes]
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances Equality impact assessment Patient and public involvement
3. Executive Summaries should not exceed 1 page. [My paper does comply]
[My paper does comply]
5. Part E: Meeting Close
4. Papers should not ordinarily exceed 10 pages including appendices.
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PAGE 1 OF [X] PAGE 1 OF 8
CCG Stakeholder Survey Report 2015/16 Author: Sean Morgan
Sponsor: Graham Mackenzie
Date: 20 July 2016
Context The annual CCG stakeholder survey report for 2015/16 is attached for consideration. This report summarises the key points and also outlines an action plan to address the issues raised from the stakeholder feedback. The survey was undertaken online during March 2016. The report was compiled by Ipsos MORI on behalf of NHS England.
Question(s) this paper addresses 1. What are the areas where improvement during 2015/16 is reflected in the results
from the survey? 2. What are the areas where results have either declined or where the results have remained lower than we would be satisfied with? 3. What actions can we take in 2016/17 to address the areas where the scores are low or have declined?
Conclusion
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
1. The overall results are very positive
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Board Intelligence Hub template
5. Part E: Meeting Close
decisions and on the dynamic of engagement with stakeholders so that they feel they have been listened to and their views have been taken on board, and there is a particular need to ensure engagement with Member Practices is effective. The issue of confidence in the CCG’s contribution to the adult and child safeguarding partnership boards was also raised, which is already being addressed and will continue to be a priority area. 3. Given stakeholders feedback on our monitoring of the quality of services (presumably given the financial context of our main acute provider and the wider financial context in the NHS), we could engage more with stakeholders to ensure our approach to quality monitoring is understood and that we take on board any concerns and demonstrate more visibly that we are acting on them
4. Part D: Board
2. We could focus more on communicating the reasons for our commissioning
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Input Sought
We would welcome the Governing Body’s input in confirming which issues ought to be a focus in 2016/17 and in agreeing the action areas identified that the CCG will prioritise.
2. Part B: Decisions and 3. Part C: Management
The actions relating to Member Practice engagement were agreed at a meeting of Locality Clinical Leads on 15 June.
1. Part A: Meeting Open
WANDSWORTH CCG
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The Report FURTHER CONTEXT
N/A
What were the response rates by stakeholder group? The overall response rate was 54%, compared with 59% for England as a whole. The response rates in other SWL CCGs were: Croydon – 37% Kingston – 54% Merton - 49% Richmond – 59% Sutton – 77% We will speak to Sutton CCG colleagues to explore the reasons for their high response rate. The response rate in Wandsworth split by stakeholder group is on page 9 of the report. The response rate from GP member practices decreased from 74% in the previous year to 60% (i.e. from 31 practices to 25). The response rate from NHS providers was just 10% (1 response out of 10 invitations), compared with 40% (i.e. 4 responses) the previous year. The response rate from local authorities stayed at 40% (2 out of 5 responses).
The questions are divided into six sections. The summary of the results is on pages 4 and 5 of the Ipsos MORI report.
4. Part D: Board
What are the areas where improvement during 2015/16 is reflected in the results from the survey?
2. Part B: Decisions and 3. Part C: Management
ANALYSIS
1. Part A: Meeting Open
WANDSWORTH CCG
Overall Engagement The results were better this year for four of the six questions, with very positive responses on the questions about engagement and the overall working relationship.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
Commissioning Services The results were better this year for two of the five questions, involvement and engagement with the right individuals (which had declined last year) and that plans will deliver continuous improvements in quality within available resources.
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Overall Leadership of the CCG The results are encouraging, with improvements in three of the five questions with strong results in stakeholders confidence in the leadership of the CCG to deliver plans and priorities and also to deliver improved outcomes for patients.
Monitoring and Reviewing Services There was an improvement for two of the three questions. Plans and Priorities There was an increase in the results for all five questions. This area was identified last year as the one where we could make the most improvement, and this is encouraging.
What are the areas where results have either declined or where the results have remained lower than we would be satisfied with? Overall Engagement The results for the two questions on whether the CCG has listened to stakeholder views and taken on board their suggestions at 70% and 61% respectively are lower than for the other questions.
Overall Leadership of the CCG There was a small decline in the result for the question about the CCG leadership having the necessary blend of skills and experience, from 85% to 82%.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
Commissioning Services The results declined for one question – “I understand the reasons for the decisions that the CCG makes when commissioning services”, from 77% to 70%.
4. Part D: Board
Seven (28%) of the Member Practices responding felt that the arrangements for member participation in decision-making were not effective, which is of concern whilst also noting that 68% of respondents felt that they were either very of fairly effective. Similarly, 12 (48%) of Member Practices felt they were able to influence the CCG’s decision-making just a little.
2. Part B: Decisions and 3. Part C: Management
Clinical Leadership of the CCG There was an increase in the results for all three questions, with 91% having confidence in the clinical leadership of the CCG to deliver its plans and priorities, up from 87%
1. Part A: Meeting Open
WANDSWORTH CCG
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Clinical Leadership of the CCG N/A
Plans and Priorities Only 55% of respondents agreed that “When I have commented on the CCG’s plans and priorities I feel that my comments have been taken on board”. This is similar to last year (54%) and is clearly an area where greater focus ought to be directed.
Other Questions Only two respondents from local authority stakeholders responded to the question about how effective the CCG has been as part of the Local Safeguarding Children Board, but both responses were negative, i.e. that the CCG had not been effective.
What actions can we take in 2016/17 to address the areas where the scores are low or have declined?
Issue
Action
Arrangements for member participation in and influencing decisionmaking
Include an agenda item for Board and Management Team to take questions from Member Practices
Timescale
Circulate Management Team agenda to Localities
Locality Leads
July
Take issues to Members Fora before the Board discusses them, to inform papers before being finalised
Locality Leads
September
Ongoing from now
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
Responsible owner Business Manager
4. Part D: Board
An outline action plan will include the following:
2. Part B: Decisions and 3. Part C: Management
Monitoring and Reviewing Services There was a marked reduction for the second successive year to the question “I have confidence that the CCG effectively monitors the quality of services it commissions”, down to 68% (from 79% two years ago).
1. Part A: Meeting Open
WANDSWORTH CCG
70
Locality Leads (and Locality Managers)
September
Use the Locality Bulletin to ask specific questions from practices, and add link to Nicola’s blog.
Locality Leads (and Locality Managers)
July
Present information in a way that is accessible to GPs
All
July
Use of new Board templates will facilitate this
All
In place from April
Communicate through Nicola’s blog
Communications team to coordinate
July
Use the Locality Bulletin.
Locality Managers
July
The Quality Group is overseeing the Quality work plan, which already incorporates a number of relevant actions to enhance our oversight of the quality of commissioned services.
Quality Group
Ongoing 4. Part D: Board
Effective monitoring of the quality of services the CCG commissions
Use of survey monkey approach to set agenda items
A Framework to Assure Quality Deputy Director of Quality and will be developed. Lead Nurse
Strictly Confidential
Feedback on the results of contributions received will be given to all stakeholders (i.e. “You said ……, we did …….”)
November
All, but mostly the July Commissioning and Primary Care Development directorates, with Board Intelligence Hub template
5. Part E: Meeting Close
Ensuring that anyone who comments on CCG plans and priorities feels that their
2. Part B: Decisions and 3. Part C: Management
Communication of the reasons for the decisions that the CCG makes when commissioning services
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1. Part A: Meeting Open
WANDSWORTH CCG
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The Safeguarding Team action plan already incorporates the need for the CCG to further strengthen its input as both a supportive and a challenging partner within the Local Safeguarding Children Board, following the recommendations from the November 2015 Ofsted inspection. There is a parallel action with respect to the Local Safeguarding Adults Board.
support from the Communications team Board Registered Nurse and Deputy Director of Quality and Lead Nurse
Ongoing
CONCLUSION
Whilst the overall results are very positive there are some areas to focus on, particularly around communicating the reasons for our commissioning decisions and on the dynamic of engagement with stakeholders so that they feel they have been listened to and their views have been taken on board particularly with respect to member Practices.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
Many stakeholders understandably are concerned about the quality of services (presumably given the financial context of our main acute provider and the wider financial context in the NHS). We therefore need to engage more with stakeholders to ensure our approach to quality monitoring is understood and that we take on board any concerns and demonstrate that we are acting on them. The Quality work plan has been reviewed and updated and a new Framework for Quality Assurance is being developed.
4. Part D: Board
Following the Ofsted inspection the CCG is a member of a new Children’s Services Improvement Board with Wandsworth Borough Council and other partners from the Local Safeguarding Children Board and the CCG Safeguarding work plan incorporates the commitment to strengthen our input to the Board itself.
2. Part B: Decisions and 3. Part C: Management
comments have been taken on board Being an effective partner in the Safeguarding Children and Adults Boards respectively
PAGE 7 OF 8
1. Part A: Meeting Open
WANDSWORTH CCG
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PAGE 8 OF 8
For Reference Edit as appropriate: 1. The following were considered when preparing this report:
[Not applicable] [Not applicable] [Yes] [Yes] [Yes] [Not applicable] [Not applicable] [Yes]
Please explain your answers:
2. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities [Yes]
Make the best use of resources, continually improve performance and deliver statutory responsibilities [Yes]
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities [Yes]
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting [Yes]
Develop the CCG as a continuously improving and effective commissioning organisation [Yes]
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances Equality impact assessment Patient and public involvement
1. Part A: Meeting Open
WANDSWORTH CCG
Please explain your answers:
4. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does comply]
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
3. Executive Summaries should not exceed 1 page. [My paper does not comply]
73
The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2015 and 2014.
Overall Engagement Overall, to what extent, if at all, do you feel you have been engaged by the CCG over the past 12 months? And how satisfied or dissatisfied are you with the way in which the CCG has engaged with you over the past 12 months?*
To what extent do you agree or disagree that the CCG has taken on board your suggestions? Overall, how would you rate your working relationship with the CCG? And thinking back over the past 12 months, would you say your working relationship with the CCG has got better, got worse or has it stayed about the same?**
% very/ fairly satisfied % strongly/ tend to agree % strongly/ tend to agree % very/ fairly good % got much/ a little better
The CCG involves and engages with the right individuals and organisations when making commissioning decisions
% strongly/ tend to agree
I have confidence in the CCG to commission high quality services for the local population % strongly/ tend to agree % strongly/ tend to agree The CCG effectively communicates its commissioning decisions with me
The CCG’s plans will deliver continuous improvement in quality within the available resources
% strongly/ tend to agree % strongly/ tend to agree
*Base = all who feel they have some level of engagement with CCG (2016; 44, 2015; 52, 2014; 51) **Base = all who feel they have a working relationship with CCG (2016; 44, 2015; 52, 2014; 52)
Wandsworth CCG Fieldwork: 1 March - 4 April 2016
89%
81%
85%
86%
75%
80%
70%
75%
67%
61%
58%
-
91%
87%
87%
34%
35%
44%
2016
2015
2014
75%
69%
81%
84%
83%
88%
70%
77%
73%
68%
69%
63%
84%
71%
71%
5. Part E: Meeting Close
I understand the reasons for the decisions that the CCG makes when commissioning services
2014
4. Part D: Board Governance
Commissioning services
2015
3. Part C: Management Reports
And still thinking about the past 12 months, to what extent do you agree or disagree that the CCG has listened to your views where you have provided them?
% a great deal/ a fair amount
2016
2. Part B: Decisions and Discussions
Base = all stakeholders (2016; 44 , 2015; 52 , 2014; 52) unless otherwise stated
1. Part A: Meeting Open
Summary
74
2015
2014
The leadership of the CCG has the necessary blend of skills and experience
82%
85%
83%
91%
92%
83%
93%
85%
79%
82%
77%
75%
86%
81%
81%
2016
2015
2014
93%
92%
85%
91%
87%
88%
84%
81%
77%
2015
2014
There is clear and visible leadership of the CCG I have confidence in the leadership of the CCG to deliver its plans and priorities The leadership of the CCG is delivering continued quality improvements I have confidence in the leadership of the CCG to deliver improved outcomes for patients
Clinical leadership of the CCG There is clear and visible clinical leadership of the CCG I have confidence in the clinical leadership of the CCG to deliver its plans and priorities The clinical leadership of the CCG is delivering continued quality improvements
% strongly/ tend to agree % strongly/ tend to agree % strongly/ tend to agree % strongly/ tend to agree % strongly/ tend to agree
% strongly/ tend to agree % strongly/ tend to agree % strongly/ tend to agree
2016
Monitoring and reviewing services I have confidence that the CCG effectively monitors the quality of the services it commissions
I have confidence in the CCG to act on feedback it receives about the quality of services
Plans and priorities How much would you say you know about the CCG’s plans and priorities? I have been given the opportunity to influence the CCG’s plans and priorities
The CCG has effectively communicated its plans and priorities to me The CCG’s plans and priorities are the right ones
73%
79%
% strongly/ tend to agree
93%
92%
88%
84%
% strongly/ tend to agree
2016
% a great deal/fair amount % strongly/ tend to agree % strongly/ tend to agree
% strongly/ tend to agree % strongly/ tend to agree
81%
79%
2015
2014
89%
81%
77%
68%
65%
60%
55%
54%
50%
84%
77%
-
70%
67%
63%
5. Part E: Meeting Close
When I have commented on the CCG’s plans and priorities I feel that my comments have been taken on board
68%
4. Part D: Board Governance
If I had concerns about the quality of local services I would feel able to raise my concerns with the CCG
% strongly/ tend to agree
3. Part C: Management Reports
2016
2. Part B: Decisions and Discussions
Overall leadership of the CCG
1. Part A: Meeting Open
Summary cont.
Wandsworth CCG Fieldwork: 1 March - 4 April 2016
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PAGE 1 OF [X] PAGE 1 OF 2
Board Assurance Framework Author: Sandra Allingham
Sponsor: Sean Morgan
Date: 14th July 2016
Context The Board Assurance Framework (BAF) has been developed to report on the principal risks to the organisation’s corporate objectives, and is the main process through which the Board receives assurance on the management of risks.
Question(s) this paper addresses 1. Does the BAF include sufficient information on the controls and actions required to
mitigate the risks? 2. Does the BAF provide sufficient assurance against the achievement of each objective?
Conclusion 1. The report includes information on controls that have been put in place, and actions
identified, in order to manage and mitigate the risks. The detailed review and scrutiny of the BAF ensure that appropriate controls and assurances are in place to manage the mitigation of these risks.
involves the Risk Review Group, the Integrated Governance Committee, and the CCG Board. Risk scores are tracked during the year to enable monitoring of the effectiveness of the actions, controls and assurances.
4. Part D: Board
2. All risks and their actions are regularly reviewed and scrutinised. The scrutiny process
2. Part B: Decisions and 3. Part C: Management
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
Input Sought We would welcome the board’s input to:
Review the Board Assurance Framework as a whole and assess on whether the principal risks are accurately reflected. Consider whether any further actions or controls are required. Note the level of risk detailed in the report. Approve the report.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
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PAGE 2 OF 2
For Reference Edit as appropriate: 1. The following were considered when preparing this report:
[Yes] [Yes] [Yes] [Yes] [Yes] [Yes] [Not applicable] [Yes]
Please explain your answers:
2. This paper relates to the following corporate objectives:
Commission high quality services which improve outcomes and reduce inequalities [Yes]
Make the best use of resources, continually improve performance and deliver statutory responsibilities [Yes]
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities [Yes]
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting [Yes]
Develop the CCG as a continuously improving and effective commissioning organisation [Yes]
4. Part D: Board
2. Part B: Decisions and 3. Part C: Management
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances Equality impact assessment Patient and public involvement
1. Part A: Meeting Open
WANDSWORTH CCG
Please explain your answers:
4. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does not comply]
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
3. Executive Summaries should not exceed 1 page. [My paper does comply]
77
1. Part A: Meeting Open
Attach
INTRODUCTION
The Integrated Risk Management Framework was approved in June 2012 by the CCG Board and reviewed by the Integrated Governance Committee in July 2014. The Board Assurance Framework and Risk Management process were reviewed by Internal Audit in October 2014, with identified recommendations, which have been actioned.
The Board Assurance Framework has been developed from the organisation’s key objectives and principal risks to those objectives (identified by the Board). The Board Assurance Framework is the main process through which the Board receives assurance on the management of risks to the achievement of the strategic objectives.
The Board Assurance Framework outlines details of the principal risks as at June 2016 that may prevent the CCG from achieving its strategic objectives. Information included in the report identifies:
Controls that have been put in place to manage the risks; Assurances that have been received to demonstrate if the controls are having the desired impact; Performance against Key Performance Indicators; Details of any gaps in the assurance; and Comments and further actions required.
4. Part D: Board Governance 5. Part E: Meeting Close
Higher scoring operational risks are also reported and escalated within the wider system of risk across the organisation. This provides the Board with an overview of the totality of the high level risks which face the organisation together with the action plans to address them. The detailed review and scrutiny of the Board Assurance Framework ensures that appropriate controls and assurances are in place to manage the mitigation of these risks. Analysis identifies any objectives that are at a greater risk and provides opportunities for remedial action which will increase the level of assurance.
3. Part C: Management Reports
The risk process and framework is fully established across the CCG. Risks at all levels are identified, assessed, scored, reported, owned and recorded. Some risks will be identified by the Board; others will be raised by managers and staff as part of their day-to-day work. Each risk is assessed in terms of both its potential likelihood and impact. Those two dimensions are each given a score between 1 and 5 (in line with the National Patient Safety Agency’s Model 2 Risk Matrix) - the risk score is then calculated by multiplying those two numbers. Controls are put in place to reduce the likelihood or the impact of each risk.
2. Part B: Decisions and Discussions
BOARD ASSURANCE FRAMEWORK
Page 1 of 37
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All risks and their actions are regularly reviewed and scrutinised. The scrutiny process involves the Risk Review Group, the Integrated Governance Committee, and the CCG Board. Risk scores are tracked during the financial year, to enable monitoring of the effectiveness of the actions, controls and assurances. The following operational risks scoring twelve and above are being reported by exception: (R18) (R72) (R77) (R85) (R89) (R95)
IT provision – risk score 12 Failure to provide assurance that those most vulnerable in care homes and in the community are free from harm – risk score 12 Failure to reduce inequalities because of absence of specific focus – risk score 12 Failure of commissioning high quality services – risk score 12 Financial distress of main provider – risk score 16 1% Non-recurrent uncommitted reserve – risk score 12
3. Part C: Management Reports
2. Part B: Decisions and Discussions
There are currently eleven BAF risks, five rated very high (15-25), four rated as high (8-12), and two moderate (4-6). The highest level individual risks are: (R7) ‘Financial pressures across the health and social care economy’, (R9) ‘Failure to plan expenditure to reflect budget and maximise use of resources’, (R16) ‘Failure to receive the appropriate level of funding allocation’, (R29) ‘Failure to implement the Out of Hospital Strategy’, and (R68) ‘Failure to achieve performance ambitions set out in the 2015/16 Assurance Framework and the 2015/16 Operating Plan’, each with risk scores of 16.
1. Part A: Meeting Open
Attach
4. Part D: Board Governance 5. Part E: Meeting Close
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The dashboard below summarises the Corporate Objectives and lists the relevant principal risks. Potential Principal Risk
Objective 1: Commission high quality services which improve outcomes and reduce inequalities
Risk 16 – Failure to receive the appropriate level of funding allocation.
Risk 33 – Failure to have sufficient plans to cater for surges in activity and growth in population caused by local community developments.
Risk 50 – Failure to commission services in a way that delivers integrated and sustainable models of care. Risk 99 – Challenges facing main provider
Risk 7 – Financial pressures across the health and social care economy. Risk 9 – Failure to plan expenditure to reflect budget and maximise use of resources. Risk 68 – Failure to achieve performance ambitions set out in the 2015/16 Assurance Framework and the 2015/16 Operating Plan. Risk 75 – Sustainable health economy
Tolerance Score
Movement from previous review
Date of last Review
20 (5x4)
16 (4x4)
9 (3x3)
↔
14/07/16
9 (3x3)
9 (3x3)
6 (3x2)
↔
14/07/16
16 (4x4)
8 (4x2)
8 (4x2)
↔
01/07/16
16 (4x4)
6 (3x2)
8 (4x2)
↔
14/07/16
20 (5x4)
20 (5x4)
New
14/07/16
16 (4x4)
16 (4x4)
9 (3x3)
↔
14/07/16
16 (4x4)
16 (4x4)
6 (3x2)
↔
14/07/16
16 (4x4)
16 (4x4)
8 (4x2)
↔
01/07/16
16 (4x4)
12 (4x3)
9 (3x3)
↔
14/07/16
4. Part D: Board Governance 5. Part E: Meeting Close
Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
Current Score
3. Part C: Management Reports
Risk 47 – Failure to have a shared understanding with providers of what safe high quality care looks like and how to recognise failure of care in light of the Francis, Keogh and Berwick reviews.
Initial Score
2. Part B: Decisions and Discussions
Corporate Objective
1. Part A: Meeting Open
Attach
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Risk 97 – Primary Care Commissioning
Objective 4: Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting
Risk 29 – Failure to reshape the local out of hospital and urgent care services to respond to local system.
Objective 5: Develop the CCG as a continuously improving and effective commissioning organisation
Risk 65 – Failure to develop and improve the CCG as an organisation.
6 (3x2)
↔
14/07/16
20 (5x4)
16 (4x4)
6 (2x3)
↔
14/07/16
9 (3x3)
4 (2x2)
1 (1x1)
↔
01/07/16
3. Part C: Management Reports
No corporate risks currently highlighted
12 (4x3)
2. Part B: Decisions and Discussions
Objective 3: Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities
20 (5x4)
1. Part A: Meeting Open
Attach
4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
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High
Very High
1: Commission high quality services which improve outcomes and reduce inequalities
0
1
2
2
2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
0
0
2
3
3: Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities
0
0
0
0
0
0
0
1
5: Develop the CCG as a continuously improving and effective commissioning organisation
0
1
0
0
Moderate
High
Very High
1
Very High
4
Moderate
1
2
5
Very High
3
Low
1
1
High
Very High
2
Low
1
Moderate
High
High
1
Low
Low
Low
Moderate
Moderate
1
2
3 LIKELIHOOD
4
5
4. Part D: Board Governance 5. Part E: Meeting Close
4: Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting
5
3. Part C: Management Reports
Mod erate
2. Part B: Decisions and Discussions
Low
Objective
IMPACT
BAF Risk Profile Summary July 2016
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1. Part A: Meeting Open
Attach Objective 1: Commission high quality services which improve outcomes and reduce inequalities
Risk Rating: (consequence x likelihood)
Risk History
Director Lead: N McDowell Date last reviewed: 14/07/2016
Rationale for current score: NHS England set Business Rules for CCGs to operate within. The implication of the rules will impact the budgets after CCG allocations have been confirmed.
Initial: 5x4 Current: 4x4 Tolerance rating: 3 x 3
There are a number of variables which need to be confirmed in order to plan appropriately, such as the way primary care services are commissioned/ contracted for.
Internal Assurances Management Team Finance Resource Committee Audit Committee Board External Assurances: Internal Audit External Audit NHS England
Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Level of resources secured and plan for the year to be confirmed. 2. QIPP plan assurance. 3. Reserves analysis. 4. Reporting on primary care services financial position.
Further actions required: (What more should we do?) 1. Regular analysis of financial position at Finance Resource Committee (31/03/2017). 2. Quarterly review of progress of QIPP schemes (30/06/2016). 3. Monthly oversight at FRC of underlying recurrent financial position (31/03/2017).
Additional comments: (With these actions taken, how serious is the problem?) If CCG allocations change without sufficient risk management then plans and targets will not be met. In addition, assumptions made in the System Transformation Plan (STP) will be out of date and in need of refreshing which could increase the financial gap across SWL.
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Review of position and plans by monthly Finance Resource Committee. Management Team receive regular reports on the financial plan. NHS England Assurance meetings to review performance. Reserves in place if adverse impact on financial position. Continual review of the five-year plan and refresh where assumptions crystallise.
3. Part C: Management Reports
National tariff for 2017/18 and beyond has not been confirmed so if this is above current projections it will impact on plans in place.
2. Part B: Decisions and Discussions
Risk 16 (Finance) – If the Department of Health reduced the CCG’s allocation, this would impact on the ability to influence effective practice performance to ensure control
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1. Part A: Meeting Open
Attach
Objective 1: Commission high quality services which improve outcomes and reduce inequalities
Risk Rating: (consequence x likelihood)
Risk History
Director Lead: A McMylor Date last reviewed:
14/07/2016
Initial: 3x3 Current: 3x3 Tolerance rating: 3 x 2
This score remains the same as the CCG are planning a strategic response to the issues faced.
Internal Assurances: Management Team Estates Steering Group External Assurances NEV Programme Board
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) An Estates Steering Group has been established, led by the CCG, bringing together partners from NHS England and NHS Property Services to maintain an overview of primary care estate within Wandsworth including opportunities for development. Scoping work to identify MCP (Multi-specialty Community Provider) hub locations in light of expected population changes is on-going via the Estates Strategy Steering Group. An Estates Strategic Framework has been developed and approved by Board in December, which detailed our broad approach to Estates Development in Wandsworth. Joint Strategic Needs Analysis in place and referenced as part of the Estates and service development work. A schedule of individual practice surveys is in place to identify any practice specific issues, including any void spaces that could be utilised in the future. Feasibility studies are also being undertaken on a number of sites across the borough to look at the options for utilising space and premises as part of our future developments.
3. Part C: Management Reports
Rationale for current score: The CCG’s current plans are based on a fundamental shift in setting of care (ie away from hospital) and there is a risk that these plans could be derailed if the increase in population, such as Nine Elms Vauxhall (NEV), or more patients being managed with a long-term condition are not able to access care in the appropriate out of hospital setting. This would drive up acute activity and spend.
2. Part B: Decisions and Discussions
Risk 33 (Planning) – Rising population growth coupled with the projected increase in patients with long-term conditions places significant pressure on estates with primary and community services. If there is no coherent estates strategy factoring in the different health needs across Wandsworth, the population could suffer through unmet need or areas of the borough not having sufficient access to services.
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Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. HUDU (Healthy Urban Development Unit) data available on population growth.
Estates and Technology Transformation Fund submission completed on 30th June; this includes bids that support the growth in West Wandsworth and other wards, as well as better use of Queen Mary’s Hospital (QMH).
4. Part D: Board Governance 5. Part E: Meeting Close
Follow-up Health Input Assessment for Nine Elms Vauxhall being developed to be reviewed at the Project Board.
3. Part C: Management Reports
Additional comments: (With these actions taken, how serious is the problem?) Monitoring arrangements are currently being put in place to work with Lambeth and Wandsworth Public Health departments to create a clear review process of the impact of the incoming population. The changes to the development will be reviewed either six monthly or annually as the development progresses. The on-going monitoring plans will directly involve LCCG and WCCG members of the Health Project Board.
2. Part B: Decisions and Discussions
Further actions required: (What more should we do?) 1. Establish monitoring arrangements within CCG to review project progression, changes to development timescales and population profile via the Estates Steering Group – HUDU providing population data (31/03/2017). 2. Continue to develop collaborative working to establish joint appointment to develop Section 106 submissions. Additional resource identified to support development of joint process and delivery of Section 106 (01/01/2017). 3. Further meetings with SGH, NHSPS and Damson Health re potential to establish a Multi-specialty Community Provider (MCP) hub at Doddington (01/12/2017). 4. Review practice surveys and identify any priority areas that will affect practice capacity and report back to the Estates Working Group (01/09/2016). 5. Review outcomes of ETTF bid once these become available (01/09/2016).
1. Part A: Meeting Open
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1. Part A: Meeting Open
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Objective 1: Commission high quality services which improve outcomes and reduce inequalities Director Lead: S Morgan Date last reviewed: Risk Rating: (consequence x likelihood)
Risk History
01/07/2016
Rationale for current score: The impact of failing to detect quality failures can be very severe both to patient safety and the reputation of the CCG/NHS. Learning from the Francis report shows that quality deterioration is more likely during periods of financial challenge. Although the CCG has monitoring systems and processes in place to triangulate hard and soft data, further developments can be made.
Initial: 4x4 Current: 4x2 Tolerance rating: 4 x 2
Internal Assurances: Integrated report to the Integrated Governance Committee. Board receives summary minutes from Integrated Governance Committee. Key indicators tracked through Quality Monitoring System. Quality Group monitors Serious Incidents. Safeguarding Committee monitors Safeguarding Key Performance Indicators. Pressure sore incidents monitored through Quality Group. Review of themes from complaints and patient feedback. External Assurances Quality Risk Summits. Healthwatch Reports. Provider Quality Accounts and quality / performance dashboards Clinical Quality Review meetings with providers. Clinical Senates / Networks. Monthly meeting of NHS England London Quality Surveillance Group. Friends and Family Test scores. Quarterly Assurance meetings with NHS England. Overview and Scrutiny Committee. Local Adults Safeguarding Board and the Local Safeguarding Children’s Board.
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) CCG representation at monthly Clinical Quality Review Groups (CQRGs) with the main providers, Quality Surveillance Group (QSG), and Professional Standards Board (Local Authority – Quality Surveillance). Board and Integrated Governance Committee receive copies of reports and high level summaries from all Quality meetings (including CQRGs, Quality Group, Safeguarding Committee and other Task and Finish groups). Programme of commissioner-led quality visits (quality walkabouts) at St George’s Hospital have been established to provide an opportunity to listen to patients, families, service users and staff during the visits. Quality alert systems in place (‘Make A Difference’ at practices for healthcare professionals to raise quality concerns; Care Connect at St George’s Hospital; Google alerts; Twitter). Monthly CCG Integrated Governance report details clinical quality concerns and actions to address highlighted issues. Quarterly Quality and Patient Safety Report provided to Integrated Governance Committee providing details of clinical quality concerns and mitigations with a monthly highlight exception summary report. Quality focused Board to Board meeting held with St George’s Hospital (January 2015). Revised Complaints policy approved by IGC (November 2015). Enhanced quality surveillance measures implemented for SGH during period of
3. Part C: Management Reports
Enhanced surveillance process established with St George’s Hospital as part of the lead commissioner role to monitor current financial and quality concerns.
2. Part B: Decisions and Discussions
Risk 47 (Quality) – Failure to develop effective early warning systems to monitor soft intelligence will hinder the early detection of poor, or potentially poor, quality of care within commissioned services.
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Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Data on quality comprises some hard data (e.g. on HCAIs) and also soft intelligence and is in disparate places and multiple formats, and collating a holistic view of quality across a provider is challenging, and assuring quality across a pathway across multiple providers is highly challenging. 2. The CCG commissions from a number of small providers including non-NHS providers, which do not have formal CQRG meetings.
Patient Experience reports (complaints, surveys, compliments). Care Quality Commission Reports.
Further actions required: (What more should we do?) 1. Use Quality Group to triangulate data and review processes (31/03/2017). 2. Develop Quality Surveillance process for contracts not served by CQRGs (30/06/2016). 3. Consider escalation of quality concerns through Management Team and Integrated Governance Committee (31/03/2017).
3. Part C: Management Reports
Additional comments: (With these actions taken, how serious is the problem?) There continues to be a balance between developing trusting relationships with our main providers and establishing systems of control. Whilst the controls in place provide good assurance, risks of quality failures are exacerbated by financial pressures and also challenges in recruiting permanent staff to some roles.
2. Part B: Decisions and Discussions
financial recovery. Quality Group established to undertake more in-depth analysis of systems including for small contracts. Clinical Reference Groups report quality issues to the Integrated Governance Committee. Clinical commissioning representation on SGH quality inspection visits.
1. Part A: Meeting Open
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4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 1: Commission high quality services which improve outcomes and reduce inequalities
Risk Rating: (consequence x likelihood)
Date last reviewed: 14/07/2016
Rationale for current score: Responsibility for health has been split between CCGs, Local Authorities (Public Health) and NHS England. The complexity of this arrangement has the potential to lead to fragmented pathways across the wider health and social care landscape if there is no effective engagement, or alignment of health priorities.
20 15 10 5 0
Risk
Tolerance
A Health and Social Care Integration Group has been established by the CCG and Wandsworth Borough Council to oversee delivery of integrated commissioning programmes for Older People, Mental Health, Learning Disabilities, Children and Public Health. WCCG is an integral partner of the South West London Five-Year Strategic Plan ensuring aligned CCG work plans and working within the SW London Sustainability and Transformation Planning Group. Internal Assurances: Management Team CCG Board Delivery Group External Assurances Health and Wellbeing Board. Overview by Joint Commissioning Executive, and Health and Wellbeing Board. Better Care Fund Working Group System Resilience Group
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Operating Plan sets out the CCG’s ambitions to commission services that will deliver integrated and sustainable models of care through joint programmes of work. Quarterly meetings in place with NHS England to work through commissioning gaps and areas of potential duplication, ensuring urgent clarification where required. Service specification joint commissioning boards in place e.g. Health Visiting. Cross CCG meetings established (Chief Officers, Finance, Commissioning) to take forward areas of shared interest. Monthly Joint Executive Committee established. Two-year plan for integrated services within Better Care Fund owned by Health and Wellbeing Board. WCCG is an integral partner of the South West London Five-Year Strategic Plan ensuring aligned CCG work plans and working within the SWL Sustainability and Transformation Planning (STP) Group. Health and Social Care Integration Steering Group established. Joint Commissioning Programmes agreed, with joint governance framework.
3. Part C: Management Reports
Initial Jun-13 Sep-13 Dec-13 Mar-14 Jun-14 Sep-14 Dec-14 Apr-15 Jun-15 Oct-15 Mar-16 Jul-16
Initial: 4x4 Current: 3x2 Tolerance rating: 4 x 2
Risk History
Director Lead: R Wellburn 2. Part B: Decisions and Discussions
Risk 50 (Commissioning) – If collaborative and partnership working with the Local Authority, NHS England and other CCGs does not secure the intended joined up approaches, this will impact on the CCG’s ability to achieve the transformational change necessary to improve the quality, value and viability of commissioned services.
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Gaps in Assurances and Controls: (What additional assurances should we seek?) None currently identified.
Further actions required: (What more should we do?) None currently identified.
2. Part B: Decisions and Discussions
Additional comments: (With these actions taken, how serious is the problem?) Effective joint working is likely to remain an area of significant risk, but shared governance arrangements and mutually agreed commissioning programmes will contribute to risk reduction during 2015/16.
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 1: Commission high quality services which improve outcomes and reduce inequalities
Risk Rating: (consequence x likelihood)
Risk History
Director Lead: S Morgan Date last reviewed: 01/07/2016
Initial: 5x4 Current: 5x4 Tolerance rating:
Any provider facing all of these challenges at the same time will be at greater risk of performance failures, and potentially of experiencing a delay in identifying significant performance or quality. Internal Assurances: Management Team Quality Group Integrated Report to Integrated Governance Committee External Assurances System Resilience Group Clinical Quality Review Group oversight of quality and review of Trust Cost Improvement Programmes CQC Inspection undertaken 15th June 2016 Joint governance structure with NHS Improvement and NHS England
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) CEO/CO regular meetings (as well as at executive level). Continued quality oversight through Clinical Quality Review Group and Integrated Governance Committee. Revised governance arrangements in place with the Trust and major associate commissioners, including with NHS Improvement and NHS England.
3. Part C: Management Reports
Rationale for current score: The main provider for health services for Wandsworth residents is St George’s University Hospital NHS Foundation Trust which is facing a number of significant challenges currently, including a large number of changes to the Board and senior leadership team, a sizeable savings programme in 2016/17 to deliver its financial control total, ongoing performance and quality issues including estates issues, workforce recruitment and retention issues, particularly in community services, and data quality and reporting issues linked to IT implementation and staff training. The contract with the Trust is the largest the CCG holds, the Trust is by far the largest provider of acute care, and is the CCG’s main provider of community services.
2. Part B: Decisions and Discussions
Risk 99 (Delivery) – As lead commissioner the CCG has to give assurance to associate commissioners of services at St George’s Hospital about the management of risks relating to the significant challenges currently faced by the Trust.
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Additional comments: (With these actions taken, how serious is the problem?)
Further actions required: (What more should we do?) Improved performance monitoring to include bringing together quality, performance and finance information in a balanced scorecard approach to give a comprehensive overview of performance and track the potential for challenges in one respect to impact on others. (31/07/2016) Potential Board to Board, once new permanent Trust senior leadership team is in place. (30/09/2016)
2. Part B: Decisions and Discussions
Gaps in Assurances and Controls: (What additional assurances should we seek?) Significant leadership changes at the Trust, with high number of roles filled by Interims. This impacts on the extent of assurance that can be given by the Trust The normal contractual levers in the standard NHS Contract are not available in 2016/17 where providers are in receipt of Sustainability and Transformation Funding, which includes St George’s.
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities Director Lead: N McDowell Date last reviewed: Risk Rating: (consequence x likelihood)
Risk History
14/07/2016
Rationale for current score: Most of the acute providers in SWL are experiencing financial distress. For 2016/17 a number of CCGs in SWL are also reporting a deficit position.
Initial: 4x4 Current: 4x4 Tolerance rating: 3 x 3
WCCG’s main provider is experiencing significant financial pressure for 2016/17.
Internal Assurances: Management Team Finance Resource Committee Board
4. Part D: Board Governance 5. Part E: Meeting Close
External Assurances Internal Audit review that budgets have been set appropriately NHS England Assurance meetings. Finance Review Group
3. Part C: Management Reports
Main controls in place: (What are we currently doing about the risk?) Assurance meetings established with NHS England – triangulation of plans between providers and commissioners. Monthly South West London Chief Finance Officers’ meetings in place. Monthly Finance Review Group meetings set up across SWL to monitor the on-going position – reports provided to Finance Resource Committee. Regular finance reports to Management Team, Finance Resource Committee, and Board – reports detail risks and mitigating action, including utilisation of reserves. Trust and Commissioner Assurance Board (TCAB) in place with main provider to review financial position.
2. Part B: Decisions and Discussions
Risk 7 (Finance) – If one or more SWL CCGs experience financial and performance difficulties, this would impact on Wandsworth’s ability to deliver statutory functions and responsibilities.
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Further actions required: (What more should we do?) 1. To review South West London financial and performance issues in year (31/03/2017).
Additional comments: (With these actions taken, how serious is the problem?) Provider and CCG’s financial challenge could impact ability to meet clinical performance targets and general stability in the health economy.
2. Part B: Decisions and Discussions
Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Impact of in-year over performance on the STP. 2. Review main provider financial turnaround plan. 3. CCG plans to be shared and discussed through Finance Review Group.
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
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Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
Risk Rating: (consequence x likelihood)
Risk History
Director Lead: N McDowell Date last reviewed:
14/07/2016
Rationale for current score: CCG QIPP has areas which are high risk such as reduction in non-elective activity.
Initial: 4x4 Current: 4x4 Tolerance rating: 3 x 2
Historic performance has shown some schemes failed to deliver due to over optimistic savings and delays in delivery.
New schemes developed and implemented during the year. Internal Assurances: Delivery Group Management Team Finance Resource Committee Board External Assurances Internal Audit NHS England
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Business Intelligence Group (BIG) established, with weekly meetings reporting to the Delivery Group and Management Team, to review outlying areas of spend and performance, identify priorities for investment and recommend investment decisions. Monthly Delivery Group meetings to review progress of delivery against Quality, Innovation, Prevention and Performance (QIPP) schemes reporting to Management Team. All QIPP schemes have detailed plans, which where appropriate have been agreed with providers 2016/17 QIPP plan approved by the Board following Finance Resource Committee scrutiny. Performance reported in finance report to Management Team, Finance Resource Committee, and Board. NHS England assurance process monitors financial performance. Internal Audit planned on the overall QIPP process from planning to monitoring.
3. Part C: Management Reports
No significant new transformation programme implemented.
2. Part B: Decisions and Discussions
Risk 9 (Finance) – If the CCG does not deliver QIPP (Quality, Innovation, Productivity and Prevention) savings, this will jeopardise delivery of the financial control total, which would impact on the opportunity to improve quality and innovation
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Gaps in Assurances and Controls: (What additional assurances should we seek?) None currently identified.
Additional comments: (With these actions taken, how serious is the problem?) CCG holds a small contingency reserve but this might be utilised by other cost pressures emerging.
2. Part B: Decisions and Discussions
Further actions required: (What more should we do?) 1. QIPP plan for 16/17 to be monitored at least quarterly via the Finance Resource Committee (31/03/2017). 2. Continual development of schemes throughout the year – no investment released until risks are fully mitigated (31/03/2017).
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
Risk Rating: (consequence x likelihood) Initial: Current: Tolerance rating:
Risk History
Director Lead: S Morgan Date last reviewed:
01/07/2016
4x4 4x4 4x2
Internal Assurances: Integrated report to the Integrated Governance Committee (IGC). The Board receives copies of the minutes from IGC. Performance alerts and risks are reported to Management Team by exception. System Resilience Group (SRG) focus on A&E, Referral to Treatment (RTT) targets, Cancer access. Delivery Group gives detailed scrutiny of performance plans and 15/16 performance. Commissioning Reference Group and CQRG monitor and report Acute Provider performance to the CCG. External Assurances NHS England Assurance monitoring (face-to-face meetings/telephone calls). NHS England Performance Improvement Forum. Weekly reports received from NHS England. Tripartite arrangements for A&E, RTT and Cancer access. High level NHSE scrutiny of challenged targets. IST and external review of RTT at St George’s..
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Performance reporting mechanisms are in place for all the main providers and cover achievement against key performance measures as well as highlighting risks. Issues highlighted through Contract monitoring and CQRG meetings. Minutes of Clinical Quality Review Groups are reported to the Integrated Governance Committee. Dashboards for Clinical Reference Groups developed to enable progress to be tracked. Performance reporting is a standing item on the Board and Integrated Governance Committee agenda. Board receives regular updates on areas of under-performance. Assurance reviews with NHS England are scheduled to review current performance. New governance structure now in place on performance at St George’s with NHS Improvement and NHS England. Internal escalation process agreed and intensive support in place for high risk targets. Following the One Version of the Truth diagnostic review a Flow Programme is in place for the emergency and urgent care system. A remedial action plan is in place for Cancer access.
3. Part C: Management Reports
Rationale for current score: The CCG has faced a number of performance pressures over recent years. It has proved challenging to deliver some of the NHS Constitution standards, such as A&E four-hour maximum wait, RTT (Referral to Treatment) waits, cancer waits, and IAPT (Improving Access to Psychological Therapies). The standard on A&E four-hour maximum wait is unlikely to be achieved in 2016/17. Performance on the two-week urgent outpatient cancer wait, and sixty-two day maximum wait for treatment has been below the standard in 2015/16, but a recovery plan has been agreed with St George’s. There are significant issues with reporting of RTT performance at St George’s which require attention.
2. Part B: Decisions and Discussions
Risk 68 (Performance) – Failure to deliver performance improvements in commissioned services, resulting in non-delivery of the NHS Constitution Domains, core standards, targets, Quality Premium, or planned health outcomes.
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Further actions required: (What more should we do?) 1. Continued scrutiny from Delivery Group (31/03/2017). 2. Implementation of new governance framework with NHS England, NHS Improvement and St George’s (31/05/2016). 3. Given the extent of the RTT waiting time issues additional capacity is being sourced in other local providers, both NHS and independent sector.
Additional comments: (With these actions taken, how serious is the problem?) The CCG is commissioning providers to deliver the NHS Constitution standards, and is commissioning sufficient activity to do so. The CCG is performing a leadership role in improving patient pathways on a system-wide basis. However, performance is clearly not entirely within the influence of commissioner actions.
2. Part B: Decisions and Discussions
Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Recovery plan for RTT from St George’s will be dependent on issues with the quality of performance reporting being resolved, which is likely to take some time. 2. The normal contractual levers in the standard NHS Contract are not available in 2016/17, where providers are in receipt of Sustainability and Transformation Funding, which includes St George’s.
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
Internal Assurances: Delivery Group Finance Resource Committee Management Team Board External Assurances NHS England SWL Programme Board SWL Finance and Activity Committee
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) The STP has been developed to resolve the financial gap across the SWL economy. WCCG play a significant role in supporting the delivery of the programme and lead in a number of areas. WCCG has significant clinical and non-clinical input to ensure the priorities of the CCG are represented. All CCGs recognise the risk and contribute to the programme running costs, however, risk pool element is now captured with the 1% non-recurrent reserve. Investment fund created to implement changes required to transform services. Activity plans are monitored and reported monthly through Delivery Group. Financial performance is monitored through Finance Resource Committee, Management Team, and Board.
3. Part C: Management Reports
Financial position for providers is deteriorating faster than expected and the need for change is greater. CCG positions are also under significant pressure.
2. Part B: Decisions and Discussions
Risk 75 (Finance) – The SWL Collaborative Commissioning programme sets out the financial case for change as Director Lead: N McDowell well as the non-financial. If the programme does not deliver or proceed, there is a risk that the financial pressures set out would appear across the health economy. This would result in some providers not being Date last reviewed: 14/07/2016 financially viable as well as CCGs having a shortfall in delivery of shifts of care (impacts delivery of QIPP). Risk Rating: Risk History Rationale for current score: (consequence x likelihood) The System Transformation Plan (STP) has been developed by the CCGs and highlights the risks facing SWL if transformational change is not Initial: 4x4 undertaken. Current: 4x3 Tolerance rating: 3 x 3 The 5 year plan is driven by reductions in acute activity and more activity taking place in the community along with general efficiencies brought about by collaborative working. Therefore if the SWL plans do not deliver this will put the strategy at risk. Plans so far such as QIPP across SWL have not been fully delivered and as a result acute activity continues to grow.
1. Part A: Meeting Open
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Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Contingency plan 2. Understanding provider position on a regular basis.
2. Part B: Decisions and Discussions
Additional comments: (With these actions taken, how serious is the problem?) Risk is still high as programme develops.
Further actions required: (What more should we do?) 1. Review current budgets to identify if fully utilised (30/09/216)
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities Director Lead: A McMylor Date last reviewed: Risk Rating: (consequence x likelihood)
Risk History
14/07/2016
Rationale for current score: The CCG took on fully delegated Primary Care Commissioning functions from 1st April 2016. Since taking on these responsibilities, we are working closely with NHS England colleagues to understand the functions in more detail and work through the transition process.
Initial: 5x4 Current: 4x3 Tolerance rating: 3 x 2
Internal Assurances: Primary Care Committee CCG Board Primary Care Operational Group Finance Resources Committee Primary Care Quality Review Group External Assurances NHS England
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) A Primary Care Commissioning Committee has been established to oversee the management of the delegated functions. A Primary Care Operational Group has been established to support the day to day management and decision making process. A Primary Care Quality Review Group has been established.
3. Part C: Management Reports
A number of risks were identified as part of the due diligence exercise conducted prior to taking on delegated responsibilities, therefore, the CCG has already begun to implement a number of strategies to mitigate against those risks.
2. Part B: Decisions and Discussions
Risk 97 (Primary Care Development) – Risks associated with the transition of functions associated with taking on Delegated Commissioning responsibilities
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Gaps in Assurances and Controls: (What additional assurances should we seek?) A more detailed risk register to be developed for Primary Care Commissioning to include quality, finance and commissioning.
3. Part C: Management Reports
Additional comments: (With these actions taken, how serious is the problem?) We continue to work with NHS England colleagues to manage the day-to-day activities associated with Primary Care Commissioning, and as such are in a position to better understand the current risks associated with these new functions. These additional assurances now in place, including a robust governance structure, ensure that risks can be identified earlier and any mitigating controls/actions can be put in place.
2. Part B: Decisions and Discussions
Further actions required: (What more should we do?) Individual practice ‘deep dive’ visits to take place to identify any legacy issues and to identify any possible issues, concerns or achievements (31/07/2016). Finalise operating model which will detail the on-going processes and arrangements for the day to day management of the delegated functions (31/07/2016). On-going transition process in place with NHS England (31/03/2017). Weekly meetings taking place with NHS England colleagues to support the transfer and management of the delegated functions (31/03/2017). Primary Care Commissioning risk register to be developed (31/08/2016).
1. Part A: Meeting Open
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4. Part D: Board Governance 5. Part E: Meeting Close
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Attach Objective 4: Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting
Risk Rating: (consequence x likelihood) Initial: 5x4 Current: 4x4 Tolerance rating: 2 x 3
Risk History
Director Lead: R Wellburn Date last reviewed:
14/07/2016
Although we have robust plans in place for delivering the required shift to out of hospital care and are monitoring them closely, we are in the early stages of implementation and therefore are yet to see whether we will continue to deliver the reductions in activity expected in the longer term and therefore the risk score remains.
4. Part D: Board Governance 5. Part E: Meeting Close
The Planned Care Programme has been established and the Programme Lead appointed. The objective will be to focus on areas where the CCG can reduce outpatient attendances using the Right Care approach through better care pathways and alternatives to hospital attendance.
3. Part C: Management Reports
Rationale for current score: If the CCG does not engage with the South West London Collaborative case for change and the drive for integrated commissioning, or react to the call to action for transforming primary care and implement robust plans to address the change in financial allocations, this will put the CCG at financial risk, and impact on our ability to commission high quality services for patients in Wandsworth in the future.
2. Part B: Decisions and Discussions
Risk 29 (Planning) – If the CCG does not engage with the Collaborative Commissioning programme and the drive for integrated commissioning, or react to the call to action for transforming primary care and make robust plans in relation to the change in financial allocation, this will put the CCG at financial risk and impact on the ability to commission high quality services for patients in Wandsworth in the future.
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Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Further work required on the evaluation of the programme via the work commissioned from GE Finnamore. 2. Whilst activity for NELs has reduced, we have seen an increase in cost and the reasons for this need to be understood.
Further actions required: (What more should we do?) 1. Out of Hospital model evaluation in development and outputs will be regularly reviewed at Delivery Group (31/03/2017). 2. CCG to develop specification and procurement approach for the MCP (Multi-specialty Community Provider) as well as resources for management support going forward (01/01/2016).
External Assurances South West London Collaborative Out of Hospital Clinical Design Group.
4. Part D: Board Governance 5. Part E: Meeting Close
Additional comments: (With these actions taken, how serious is the problem?) Although a large number of out of hospital initiatives have already been developed and implemented, significant challenge remains, most notably around ensuring delivery of the ambitious targets identified for the remainder of year one and year two of implementation.
3. Part C: Management Reports
Internal Assurances: Out of Hospital Programme monitoring and evaluation overseen by the Delivery Group. Regular reports from the Delivery Group to Management Team Progress on out of hospital initiatives being monitored and evaluated by the Business Intelligence Team.
2. Part B: Decisions and Discussions
Main controls in place: (What are we currently doing about the risk?) Monthly reports to the Delivery Group on progress against overarching key performance indicators and secondary care activity trajectories. Significant two year non-recurrent funding invested in Out of Hospital initiatives, which are monitored and evaluated by the Business Intelligence Team to ensure they are delivering on the Key Performance Indicators set out in the original plan and in QIPP. Development of a Multi-specialty Community Provider (MCP) model for out of hospital care by April 2017 approved by Board in June 2015. A Primary Care Transformation Group has been established to oversee development of the Multi-specialty Community Provider (MCP) model and the wider primary care work programme. Funding has now been agreed to continue successful programmes into 2016/17.
1. Part A: Meeting Open
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Attach Objective 5: Develop the CCG as a continuously improving and effective commissioning organisation
Risk Rating: (consequence x likelihood)
Risk History
Director Lead: S Morgan Date last reviewed:
01/07/2016
Rationale for current score: The CCG continues to have a stable executive team with good clinical succession planning. The CCG continues to provide significant leadership to the SWL Collaborative Commissioning and across other London-wide programmes.
Initial: 3x3 Current: 2x2 Tolerance rating: 1 x 1
Internal Assurances: Annual Staff Survey results. Appraisal process and regular reviews of individual performance in place. External Assurances Annual 360o survey of key CCG stakeholders. CCG Assurance Framework.
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Structure and functions regularly reviewed by Executive Directors. Workforce Committee maintains an overview of workforce related issues. Aligned organisational objectives with team and individual objectives. Regular staff Away Day sessions (three per year) and bi-monthly Team Briefing sessions. Training sessions delivered as part of Board Seminar sessions. Flexible working arrangements available for staff. All staff have set work objectives and PDPs (personal development plans) which are reviewed regularly with their line manager to ascertain progress against the actions they have set themselves. Coaching sessions for all Board members are on-going. Workforce Committee agreed (1/9/15) the action plan to implement the staff survey results including further training on objective setting.
3. Part C: Management Reports
Although the risk is low, there are some challenges in management and clinical capacity.
2. Part B: Decisions and Discussions
Risk 65 (Organisation Development) – If there was not an effective workforce and strong leadership in place, it would be difficult for the CCG to be a high performing organisation, and undertake strategic plans to deliver on corporate objectives.
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Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Management and clinical capacity reviews needed.
2. Part B: Decisions and Discussions
Additional comments: (With these actions taken, how serious is the problem?) Reduction in management running costs may place additional pressures on workforce.
Further actions required: (What more should we do?) 1. Refresh of Organisation Development Plan (30/09/2016). 2. Central database recording completion of key milestones of the appraisal process across the organisation to be created and monitored (30/09/2016). 3. Review workforce needs by directorate and implement workforce changes (30/09/2016). 4. Further consideration of potential benefits of increased collaboration with other CCGs (30/09/2016).
1. Part A: Meeting Open
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3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach The following detailed Operational Risks are currently rated 12 or above and have been included for information: Objective 1: Commission high quality services which improve outcomes and reduce inequalities Director Lead: S Morgan Date last reviewed: Risk Rating: (consequence x likelihood)
Risk History
01/07/2016
Initial: 4x3 Current: 4x3 Tolerance rating: 4 x 2
Internal Assurances: Review of progress at Safeguarding Sub-committee (action plans, work plans in place and monitored). Oversight at Integrated Governance Committee through Integrated Report. Service Standards Board created to provide strategic direction to improving care home quality. Feedback from health professionals working in care homes (BACS and GPs). Quality Review Committee led by Local Authority in place with health involvement. External Assurances Local Adult Safeguarding Board (SAPB). Serious Incidents reported and reviewed. CQC and Healthwatch reports.
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Adult Safeguarding Nurse in place enabling close working relationship with the Continuing Health Care team. Executive Board lead for Safeguarding in post. Partnership working with Local Authority Safeguarding team and Local Adult Safeguarding Board membership. Liaison Nurse post appointed to support quality in care homes. Safeguarding Adults policy agreed. Quality Board with Wandsworth Healthwatch to focus on quality in care homes.
3. Part C: Management Reports
Rationale for current score: Care homes care for some of our most vulnerable groups of patients. There is limited capacity available with several homes having closed in Wandsworth over the last two years and some patients are placed out of area. Systems for monitoring the quality of care homes are not as well developed as for other sections. Further work with the Local Authority is on-going.
2. Part B: Decisions and Discussions
Risk 72 (Quality) – If the CCG is unable to provide appropriate oversight, scrutiny and assurance within the care home setting, this increases the risk of potential harm to vulnerable clients/service users.
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Additional comments: (With these actions taken, how serious is the problem?) Requires constant review and scrutiny to ensure service continues to meet requirements.
Further actions required: (What more should we do?) 1. Work closely with new Continuing Care supplier to quality assure placements and formal performance monitoring (31/03/2017). 2. Continue to share information with key partners (31/03/2017). 3. Develop frailty work stream to support better commissioning for vulnerable patients (31/03/2017).
2. Part B: Decisions and Discussions
Gaps in Assurances and Controls: (What additional assurances should we seek?) A number of issues with the database of the previous support supplier were identified, which are in the process of being rectified in the move to the new supplier. This has highlighted that we are not able to be assured at this time that all funded patients have received their six-monthly reviews and therefore their circumstances or needs may have changed and not been actioned.
1. Part A: Meeting Open
Attach
3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 1: Commission high quality services which improve outcomes and reduce inequalities Director Lead: G Mackenzie Date last reviewed: Risk Rating: (consequence x likelihood)
Risk History
14/07/2016
Rationale for current score: Health inequalities are increasing across most London Boroughs.
Initial: 4x5 Current: 4x3 Tolerance rating: 3 x 2
Analysis based on the Joint Strategic Needs Assessment (JSNA) defines the Wandsworth population and sets out the challenge. Differential health benefits across Wandsworth have been identified.
Internal Assurances: Management Team External Assurances Health and Wellbeing Board
4. Part D: Board Governance 5. Part E: Meeting Close
Main controls in place: (What are we currently doing about the risk?) Equality Impact Assessments when completed identify equalities impact used to measure outcomes. Joint Strategic Needs Assessment has identified some areas of inequalities. Corporate Objectives are monitored through the Board Assurance Framework (BAF). Annual Equalities training delivered to staff. Regular updates to Management Team. Actual measure of life expectancy across Wandsworth used as a control to monitor achievement.
3. Part C: Management Reports
Health and Wellbeing Board strategy in place.
2. Part B: Decisions and Discussions
Risk 77 (Quality) – If the CCG does not have robust data to guide understanding of health inequalities, or a strategy in place to address them, there is a risk that inequalities will continue or worsen.
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Additional comments: (With these actions taken, how serious is the problem?) Making a difference in health inequalities is a long term issue. Addressing health inequalities will require all partners to work together.
Further actions required: (What more should we do?) 1. Equality Impact Assessment process to be strengthened, with additional scrutiny by the Patient and Public Involvement (PPI) team to ensure that strategies and policies take into account CCG priorities for reducing inequalities. Part of Board reporting review (30/06/2016). 2. Health inequalities project worked through Thinking Partners Group (30/06/2016).
2. Part B: Decisions and Discussions
Gaps in Assurances and Controls: (What additional assurances should we seek?) 1. Differential commissioning. 2. Joint approach with Local Authority (H&WB) 3. Regular updates to Board.
1. Part A: Meeting Open
Attach
3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 1: Commission high quality services which improve outcomes and reduce inequalities
Risk Rating: (consequence x likelihood) Initial: Current: Tolerance rating:
Risk History
Director Lead: S Morgan Date last reviewed:
01/07/2016
Rationale for current score: A high number of Serious Incidents reflect actual and potential serious harm which is likely to continue if not addressed. There is a time lag between the missed diagnosis occurring and the incident coming to light, therefore it is difficult to effectively measure improvement and progress.
4x5 4x3 2x2
External Assurances SGH Clinical Quality Review Group Trust Acting on Test Results group.
4. Part D: Board Governance 5. Part E: Meeting Close
Internal Assurances: Integrated Governance Committee Management Team Quality Group
3. Part C: Management Reports
Main controls in place: (What are we currently doing about the risk?) All Serious Incidents are reviewed via the action tracker at the monthly CQRG meetings between Wandsworth CCG and the provider. CCG attendance at the provider’s Patient Safety Committee. Thematic concerns result in quarterly summits between Wandsworth CCG and the provider to ensure that appropriate actions are taken as necessary with CCG oversight. Focus Improvement Group in place with CCG attendance. High level meetings are in place to seek appropriate solutions to the systems failure. There are regular meetings between the CCG and the provider including attendance at high level meetings, the Minutes of which are available to the CQRG. These will be monitored on an on-going basis. Board to Board meeting held with St George’s Hospital with a focus on quality (January 2015).
2. Part B: Decisions and Discussions
Risk 85 (Quality) – Wandsworth CCG has identified a theme from St George’s Healthcare NHS Trust Serious Incidents. The concern relates to a failure to act on test results due to a communication/systems failure. In some cases this has led to delayed treatment or diagnosis.
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Gaps in Assurances and Controls: (What additional assurances should we seek?) None currently identified.
Additional comments: (With these actions taken, how serious is the problem?) Identified as high priority for action by the Trust and there is good engagement with the CCG.
2. Part B: Decisions and Discussions
Further actions required: (What more should we do?) 1. CCG to continue to oversee action plan via Clinical Quality Review Group, and Task and Finish Group chaired by St George’s Hospital Medical Director (31/03/2017). 2. Integrated Governance Committee to provide high level assurance and monitoring to ensure appropriate action is taken (31/03/2017).
1. Part A: Meeting Open
Attach
3. Part C: Management Reports 4. Part D: Board Governance 5. Part E: Meeting Close
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1. Part A: Meeting Open
Attach Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
Risk Rating: (consequence x likelihood)
Risk History
Director Lead: S Morgan Date last reviewed:
01/07/2016
Rationale for current score: There have been a number of issues with IT support that have either impacted on CCG operational delivery (such as a service outage in April 2015), or which have reduced the confidence of the CCG in the capability of the supplier to provide high quality services (including the quality of the root cause analysis into the outage).
Initial: 4x3 Current: 4x3 Tolerance rating: TBC
Gaps in Assurances and Controls: (What additional assurances should we seek?) We are seeking assurance from the IT supplier that sufficient resource is being supplied to agreed projects, which will be maintained through the procurement process.
Further actions required: (What more should we do?) Implementation of transition to new provider (31/12/2016).
External Assurances: Weekly performance and projects meeting with the IT supplier. Monthly KPI report. IT support is a regular item at monthly performance meetings with SECSU.
Additional comments: (With these actions taken, how serious is the problem?) If the procurement were to result in a new supplier being chosen, a comprehensive transition plan will be required and a new risk will be raised.
4. Part D: Board Governance 5. Part E: Meeting Close
Internal Assurances: Periodic reports to Management Team
3. Part C: Management Reports
Main controls in place: (What are we currently doing about the risk?) CSU offer reviewed in light of new IT Operating Framework to ensure service is appropriate (June 2014). Issues with IT provision escalated to CSU MD. IT SLA agreed (November 2014). Regular review meetings held and systematic log maintained for key projects. CSU monitoring quality of service as part of SLA. Escalation process established. Additional Help Desk resources in place. Re-procurement of CCG IT service, with a revised specification, is underway.
2. Part B: Decisions and Discussions
Risk 18 (Corporate Affairs) – Risk that inadequate IT support will impact on ability to deliver organisation objectives. Disruption to network services and poor helpdesk service provision impacting on day-to-day work of the organisation. Lack of support for critical IT projects.
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Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities
Internal Assurances: Finance Resource Committee Quality Group Integrated Governance Committee
Further actions required: (What more should we do?) 1. Review by external assessors – Finance Resource Committee to assess impact (31/03/2016).
Additional comments: (With these actions taken, how serious is the problem?) Financial challenges faced by SGUFT will see the Trust providing a different range of services which will impact CCG’s commissioning priorities.
4. Part D: Board Governance 5. Part E: Meeting Close
External Assurances: Tripartite meetings – Monitor, NHS England, Wandsworth CCG
3. Part C: Management Reports
Main controls in place: (What are we currently doing about the risk?) Enhanced quality surveillance in place to include increased walk rounds, close monitoring of Cost Improvement Programmes, encouragement of further GP alerts, and dedicated Director role. Chief Executive Officer/Chief Officer regular meetings (as well as at executive level). Monitoring performance against existing quality indicators and dashboards. Continued quality oversight through Clinical Quality Review Groups and Integrated Governance Committee. Tripartite analysis and meetings – regulatory bodies exchanging views. Gaps in Assurances and Controls: (What additional assurances should we seek?) Turnaround plan. Meetings with Regulator.
2. Part B: Decisions and Discussions
Risk 89 (Quality) – The main provider for health services for Wandsworth residents is St George’s Hospital Director Lead: N McDowell Foundation Trust who are reporting a significant financial deficit for the year 2015/16. There are a number of risks which impact the CCG as a result of the financial position, such as quality, workforce levels, capacity, focus Date last reviewed: 14/07/2016 on delivery, waiting times etc. Risk Rating: Risk History Rationale for current score: (consequence x likelihood) Trust under review with turnaround plan in place. Large deficit forecast for 16/17. Initial: 5x4 Performance targets proving to be challenging. Current: 4x4 Staffing gaps appearing. Tolerance rating: TBC
1. Part A: Meeting Open
Attach
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1. Part A: Meeting Open
Attach Objective 2: Make the best use of resources, continually improve performance and deliver statutory responsibilities Director Lead: N McDowell Date last reviewed: Risk Rating: (consequence x likelihood)
Risk History
14/07/2016
Rationale for current score: Currently, the CCG has to report the reserve as uncommitted but has to assume for reporting purposes it is available to the wider NHS system.
Initial: 4x4 Current: 3x4 Tolerance rating: TBC
Internal Assurances: Finance Resource Committee Management Team Board
Gaps in Assurances and Controls: (What additional assurances should we seek?) Can we make a case for this funding to be retained by commissioners either locally or across SWL?
Additional comments: (With these actions taken, how serious is the problem?) No additional comments at this time.
Further actions required: (What more should we do?) Review outcome of contract negotiations (30/06/2016). On-going review to identify any in-year slippage (30/09/2016) Review of all recurrent budgets (30/06/2016).
4. Part D: Board Governance 5. Part E: Meeting Close
External Assurances: NHS England
3. Part C: Management Reports
Main controls in place: (What are we currently doing about the risk?) Delivery of 0.5% surplus instead of 1% surplus was agreed by the Board. Reduced level of planned investments. No contribution to SWL risk pool agreed by the Board.
2. Part B: Decisions and Discussions
Risk 95 (Finance) – The impact of central policy restricts CCG decisions regarding application of the 1% NR reserve, which reduces the potential for investment in services.
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Page
115
3.1. C01 Executive Report
116
3.2. C02 Finance Report
121
2. Part B: Decisions and
3. Part C: Management Reports
1. Part A: Meeting Open
Part C: Management Reports
3. Part C: Management 4. Part D: Board 5. Part E: Meeting Close 115
Executive Report Sandra Allingham
Nicola Jones / Graham Mackenzie 10/07/2016
PAGE 1 OF [X] PAGE 1 OF 5
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
0
Context The report provides information on the following items for information: Management Team Summary Sustainability and Transformation Plan Primary Care Committee Personal Health Budgets Transforming Care Group St George’s University Hospitals NHS Foundation Trust Health and Wellbeing Board
Input Sought The Board is asked to note the content of the report.
3. Part C: Management
2. Part B: Decisions and
Executive Summary
4. Part D: Board 5. Part E: Meeting Close 116
PAGE 2 OF 5
The Report Management Team Summary A summary of the main issues discussed by the Management Team in the period following the previous Board meeting is outlined below:
Sustainability and Transformation Plan The draft Sustainability and Transformation Plan (STP) for south west London has been submitted to NHS England. The document remains a draft until it has been through the national assurance process. This process is designed to ensure that the various plans align and meet the objectives set out for STPs. Once the draft has been finalised, we will publish it and discuss the contents further with local people and stakeholders in the months ahead. A final STP will then need to be submitted to NHS England in October.
The PCC received a variety of reports covering;
The CCG will be arranging future meetings to commence at 10am to enable more members of the public to attend. The next meeting in public is on Tuesday September 6th and the agenda and papers will be published on the CCGs website the week before.
5. Part E: Meeting Close
- the primary care transformation agenda - CCGs approach to quality surveillance - an update of key actions taken outside the PCC but covering those areas where clear policies exist, e.g. new partners joining a practice - update on the CCG Estates, Technology and Transformation Fund submission. - budget update
4. Part D: Board
Primary Care Committee The first PCC was held in public on 5th July, post the CCG taking delegated commissioning responsibilities from NHSE for general practice on April 1st.
3. Part C: Management
System Resilience Performance Serious Incidents and ‘Make A Difference’ Alerts St George’s University Hospital Foundation Trust Procurement Updates on services Quality and safety issues Estates Policies Investments Urgent and Emergency Care
2. Part B: Decisions and
1. Part A: Meeting Open
WANDSWORTH CCG
117
PAGE 3 OF 5
5. Part E: Meeting Close
Health and Wellbeing Board The joint Health and Wellbeing Board took place on Tuesday 28th June and received papers on the performance of the Better Care Fund in 2015/16, the Better Care Fund proposals for 2016/17 and the progress in Transforming Care for people with learning disabilities in Wandsworth. There was a part two seminar session considering the challenges facing South West London through the Sustainability and Transformation Plan (STP).
4. Part D: Board
St George’s University Hospitals NHS Foundation Trust As the lead commissioner for St George’s University Hospitals NHS Foundation Trust (SGH), WCCG has been working with the trust and regulators to ensure there is an enhanced system of assurance in place around SGH, which is facing significant challenge on a number of fronts. The Tripartite and Quality Oversight Group meet alternate fortnights to assure commissioners and regulators about plans in place and improvements in: Finance – the trust has a challenging programme of cost improvement to achieve an agreed control total with regulators Performance – the trust is not meeting core constitutional standards and programmes are in place around cancer, RTT and ED standards to improve services to patients Quality – the CQC inspected the site in June and have given their initial findings to the trust and commissioners. Estate – the trust has identified urgent work on estates to take place from the summer
3. Part C: Management
Transforming Care Group The CCG, Local Authority and providers meet on a weekly basis (by phone conference) and monthly in person to review the discharge arrangements for patients with a learning disability in a hospital setting of care, and those on an enhanced care register to support those at risk of admission. The final ‘long stay’ patient was discharged in June, with three patients currently in inpatient units and one being supported at risk of admission.
2. Part B: Decisions and
Personal Health Budgets The PHB Steering Group met to review progress in the development of the local PHB offer and increase in PHBs to the Wandsworth population. It was reported that: The needs assessment and resource allocation tools were in the process of being embedded across services The CCG currently had offered PHBs to 7% of the eligible population. Work was in train to offer a further 9 PHBs to children with complex needs (equal to 75% of that eligible population), with pilots in train for learning disability and mental health services It was agreed that the review of CHC cases in transfer to the new provider would be completed before an expansion of the PHB offer was made to existing and new CHC patients. This should be complete and PHBs available from October 2017.
1. Part A: Meeting Open
WANDSWORTH CCG
118
Use of the Seal Use of the corporate seal has not been required since the previous report.
Conclusion
2. Part B: Decisions and
The Board is asked to note the information on the items above.
PAGE 4 OF 5
1. Part A: Meeting Open
WANDSWORTH CCG
3. Part C: Management 4. Part D: Board 5. Part E: Meeting Close 119
PAGE 5 OF 5
For Reference Edit as appropriate: 1. The following were considered when preparing this report:
[Not applicable] [Not applicable] [Not applicable] [Not applicable] [Not applicable] [Not applicable] [Not applicable] [Not applicable]
Please explain your answers:
2. Part B: Decisions and
The long-term implications The risks Impact on our reputation Impact on our patients Impact on our providers Impact on our finances Equality impact assessment Patient and public involvement
1. Part A: Meeting Open
WANDSWORTH CCG
The content included in the report relates to items for information only.
Commission high quality services which improve outcomes and reduce inequalities [Not applicable]
Make the best use of resources, continually improve performance and deliver statutory responsibilities [Not applicable]
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities [Not applicable]
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting [Not applicable]
Develop the CCG as a continuously improving and effective commissioning organisation [Not applicable]
4. Part D: Board
3. Part C: Management
1. This paper relates to the following corporate objectives:
Please explain your answers:
The content included in the report relates to items for information only.
3. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does comply]
5. Part E: Meeting Close
2. Executive Summaries should not exceed 1 page. [My paper does comply]
120
PAGE 1 OF [X] PAGE 1 OF 6
Finance Report Author: Peter Ifold, Deputy CFO
Sponsor: Neil McDowell, Acting CFO
Date: 06/2016
Context The Finance Team is responsible for reporting the financial position for the CCG each month. This paper provides information on the month 2 financial position, highlighting key issues and the forecast outturn.
1. What is the CCG’s year to date financial performance against the approved budget? 2. Is the CCG on target to meet the planned 0.5% financial surplus at year end? 3. Implications around financial governance, strategy, performance and risk. 4. Can we keep running costs within the target set?
Conclusion
3. Part C: Management
Questions addressed in this report
2. Part B: Decisions and
Executive Summary
1. Part A: Meeting Open
WANDSWORTH CCG WANDSWORTH CCG
1. The CCG is on course to meet its target surplus of £2.08m.
4. Part D: Board
2. We expect to meet the running cost target.
Input Sought The decision we would like from the Board is: To note the contents of the report
This paper has been reviewed by the Finance & Resources Committee in June 2016.
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
Input Received
121
PAGE 2 OF 6
The Report [Consider each question with reference to:
(1) Strategy: progress towards our long-term goals (2) Performance: delivery of this year’s results (3) Governance: whether we are working in the ‘right way’]
WHAT HAS GONE WELL?
The CCG is on course to achieve a balanced Financial Position and achieve the planned 0.5% financial surplus at year end.
We are on course to meet the running cost target.
2. Part B: Decisions and
Looking Back
1. Part A: Meeting Open
WANDSWORTH CCG
WHAT HAS NOT GONE WELL?
At this early stage of the financial year there is very limited information available to review the financial position. More information will be available to review the financial position in future months. The Primary Care co-commissioning budget detail received from NHSE indicates a £172k shortfall in addition to a £233k This shortfall will be funded from the over performance reserve
Looking Ahead
Investment in non-acute services that started in 2015/16 By investing in out of hospital services this should help manage demand and costs around acute and other high cost services.
4. Part D: Board
OPPORTUNITIES?
3. Part C: Management
RISKS OR CONCERNS?
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
Managing acute performance If we don’t manage performance, then this will limit our ability to manage within the resource limit in 16/17 and meet the business rules set. Managing the financial impact if Continuing Healthcare growth continues. If we don’t manage the financial impact of growth in Continuing Healthcare this will limit our ability to manage within the resource limit in 16/17 and meet the business rules set. Non delivery QIPP This is essential for the future financial health of the CCG
122
PAGE 3 OF 6
In Conclusion CONFIDENCE?
The CCG is on course to achieve a balanced Financial Position and achieve the planned 0.5% financial surplus at year end.
2. Part B: Decisions and
I am confident that the financial position outlined in this paper is accurate based on available information and reflects the risks moving forward.
IMPLICATIONS?
1. Part A: Meeting Open
WANDSWORTH CCG
3. Part C: Management 4. Part D: Board
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
123
PAGE 4 OF 6
Data Dashboard See following PowerPoint slide pack.
1. Part A: Meeting Open
WANDSWORTH CCG
2. Part B: Decisions and 3. Part C: Management 4. Part D: Board
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
124
PAGE 5 OF 6
For Reference Edit as appropriate: 1. The following were considered when preparing this report:
The risks Yes Mitigations against a number of risks have been considered and implemented where appropriate Impact on our reputation Yes By not achieving the targets set would have an adverse impact on our Organisational reputation.
Impact on our providers Yes Prompt payment, accurate reflection of activity and finance Impact on our finances Throughout the report
Yes
Equality impact assessment Patient and public involvement
Not applicable Not applicable
Please explain your answers:
Commission high quality services which improve outcomes and reduce inequalities Yes
Make the best use of resources, continually improve performance and deliver statutory responsibilities Yes
Continually improve delivery by listening to and collaborating with our patients, members, stakeholders and communities Not applicable
Transform models of care to improve access, ensuring that the right model of care is delivered in the right setting Yes
Develop the CCG as a continuously improving and effective commissioning organisation Yes
Strictly Confidential
Board Intelligence Hub template
5. Part E: Meeting Close
4. Part D: Board
2. This paper relates to the following corporate objectives:
3. Part C: Management
Impact on our patients Yes Insufficient funding or poor planning would impact on our ability to commission services in an efficient way.
2. Part B: Decisions and
The long-term implications Yes Ensuring that we understand cost drivers that will impact on future years
1. Part A: Meeting Open
WANDSWORTH CCG
125
PAGE 6 OF 6
Please explain your answers:
1. Part A: Meeting Open
WANDSWORTH CCG
3. Executive Summaries should not exceed 1 page. [My paper does comply]
[My paper does not comply]
2. Part B: Decisions and
4. Papers should not ordinarily exceed 10 pages including appendices.
3. Part C: Management 4. Part D: Board
Board Intelligence Hub template
5. Part E: Meeting Close
Strictly Confidential
126
1. Part A: Meeting Open
To the end of May 2016
3. Part C: Management
July 2016
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group
4. Part D: Board Governance
Presented by Finance –
2. Part B: Decisions and Discussions
Finance Report –
127
1. Part A: Meeting Open
Contents 2. Balance Sheet
3. Part C: Management
3. Recommendations
2. Part B: Decisions and Discussions
1. Month 2 Financial Position
4. Part D: Board Governance
2
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group Board July 2016
128
• Plan to achieve the target surplus of £2.08m (0.5%)
Financial Governance
Financial Risk
• Annual internal audit plan is in place.
• Financial ledger system has limited capability to do detailed analysis
• Board Assurance Framework has been updated
• Contract values agreed with all main providers • Plan for QIPP has been agreed and expect to meet running cost target • Action is being taken to manage Continuing Health Care costs following concerns raised • Overall there is no variance from plan at month 2
• Year end accruals may not be sufficient to cover expenditure particularly relating to continuing healthcare and secondary care.
• Finance Committee have reviewed QIPP plan for 16/17 and agreed quarterly deep dive to review progress
• 2016/17 QIPP delivery represents our biggest risk due to size of the programme and the level of reserves held to mitigate against performance.
Wandsworth Clinical Commissioning Group 3
5. Part E: Meeting Close
• Financial control environment assessment has been submitted with action plan in place
4. Part D: Board Governance
• SWL Collaborative Commissioning programme work is ongoing to deliver system transformation plan. • Planning guidance has been issued which will help shape the financial strategy for 5 years from 2016/17 • Allocations have been published for the next 5 years with the first 3 years confirmed (hard) and the following 2 years indicative (soft) • 1% non recurrent reserve cannot be committed at 1 April 2016
3. Part C: Management
Financial Performance
2. Part B: Decisions and Discussions
Financial Strategy
1. Part A: Meeting Open
Finance Scorecard up to May 2016
Board July 2016
129
• Forecasting based on this data is difficult, but we still expect to achieve the target surplus set (£2.08m)
• We expect to meet running cost and QIPP targets
4
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group
4. Part D: Board Governance
• Assessment of any slippage on the agreed investments is currently being undertaken
3. Part C: Management
• There is a potential risk of over performance against accrued expenditure from the previous year for those providers where we have not agreed a year end settlement. Once month 12 is frozen we will assess this impact (planned for month 4 reporting)
2. Part B: Decisions and Discussions
• Early time of the year means that activity reporting is limited
1. Part A: Meeting Open
Month 2 – WCCG Key Messages
Board July 2016
130
1. Part A: Meeting Open
Month 2 – Revenue Resource Limit
2. Part B: Decisions and Discussions 3. Part C: Management 4. Part D: Board Governance
CCG (admin).
Wandsworth Clinical Commissioning Group 5
5. Part E: Meeting Close
The Resource Limit reflects the amount of money the CCG has available to commission services (programme) and to run the
Board July 2016
131
2. Part B: Decisions and Discussions
3. Part C: Management
4. Part D: Board Governance
Board July 2016 6
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group
1. Part A: Meeting Open
Month 2 Financial Position
132
•
A £50k favourable variance has been identified against Other Acute non-sla services reflecting a 15/16 pre-payment against the Cancer Resource Centre.
•
Primary care budgets are forecast to break even, though the co-commissioning budget detail received from NHSE indicates a £172k shortfall in addition to a £233k QIPP and this shortfall will be funded from the over performance reserve, to be actioned in Month 3.
3. Part C: Management
Overall budgets are forecast to breakeven as very limited information is available at this stage of the financial year. For Acute services Month 1 SLAM reports have been received but there is insufficient information to draw any conclusions.
2. Part B: Decisions and Discussions
•
1. Part A: Meeting Open
Month 2 – Commentary
4. Part D: Board Governance
7
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group Board July 2016
133
2. Part B: Decisions and Discussions
3. Part C: Management
4. Part D: Board Governance
Board July 2016 8
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group
1. Part A: Meeting Open
Month 2 Acute Analysis
134
Includes contingency
3. Part C: Management
4. Part D: Board Governance
5. Part E: Meeting Close
Board July 2016 9
2. Part B: Decisions and Discussions
Wandsworth Clinical Commissioning Group
1. Part A: Meeting Open
Running Costs at Month 2
135
2. Part B: Decisions and Discussions
3. Part C: Management
4. Part D: Board Governance
5. Part E: Meeting Close
136
Wandsworth Clinical Commissioning Group 10
1. Part A: Meeting Open
QIPP Performance Year to date and Outturn
1. Part A: Meeting Open
QIPP Exception Reporting
However we do have a contingency plan to introduce pipeline schemes and extend or stretch existing schemes.
3. Part C: Management
We are already developing schemes for 17/18 using Right Care and see if these can be brought forward into 16/17. We are working across the STP to try and identify further opportunities.
4. Part D: Board Governance
Month 2 data is available but the quality of coding is poor and therefore we have no confidence in the benefits monitoring until this has been rectified. This also applies to general activity monitoring which differs from our SLAM reports.
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group 11
2. Part B: Decisions and Discussions
There are schemes which at this early stage of the year are amber rated with one red rated.
137
1. Part A: Meeting Open
Financial Risks
Over spend on acute and non acute areas. Continuing Healthcare growth continues.
Sufficient reserves Risk sharing arrangements. Growth of 4% in the budget for CHC
Level of investment
Significant investment in Out of Hospital Strategy
Investments will be monitored through the Delivery Group.
Failure to achieve required activity shifts as set out within the QIPP programme
Expected activity shifts to support Out of Hospital and BCF transformation – recurring impact
Sufficient reserves Risk sharing arrangements
Agreeing contracts
Contracts agreed above plan
Sufficient reserves
Specialised Commissioning
Services are transferred to CCG without sufficient resource
Negotiate realistic transfer of resource. Sufficient reserves
External financial processes
Primary Care Co-Commissioning / Estates / SWL providers in financial distress / etc.
SWL Risk Pool / collaborative working / working closely with main provider
Wandsworth Clinical Commissioning Group 12
5. Part E: Meeting Close
Level of spend
4. Part D: Board Governance
Mitigating Action
3. Part C: Management
Detail
2. Part B: Decisions and Discussions
Risk
Board July 2016
138
1. Part A: Meeting Open
Contents 2. Balance Sheet
3. Part C: Management
3. Recommendations
2. Part B: Decisions and Discussions
1. Month 2 Financial Position
4. Part D: Board Governance
13
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group Board July 2016
139
1. Part A: Meeting Open
Statement of Financial Position at Month 2
2. Part B: Decisions and Discussions 3. Part C: Management 4. Part D: Board Governance
Wandsworth Clinical Commissioning Group 14
5. Part E: Meeting Close
• This balance sheet snapshot reflected payments to be made on 1st June (in month 3). Therefore cash position above is not correct. Real cash position is a surplus of £57k as per Cash Drawdown slide
Board July 2016
140
2. Part B: Decisions and Discussions
3. Part C: Management
4. Part D: Board Governance
Board July 2016 15
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group
1. Part A: Meeting Open
Cash flow Statement at Month 2
141
2. Part B: Decisions and Discussions
3. Part C: Management
4. Part D: Board Governance
Board July 2016 16
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group
1. Part A: Meeting Open
Cash Drawdown to Month 2
142
1. Part A: Meeting Open
Contents 2. Balance Sheet
3. Part C: Management
3. Recommendations
2. Part B: Decisions and Discussions
1. Month 2 Financial Position
4. Part D: Board Governance
17
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group Board July 2016
143
2. Part B: Decisions and Discussions 3. Part C: Management
• The Board is asked to note the report taking account of the early stage of the year and the limited data available particularly around acute contracts to inform forecasts.
1. Part A: Meeting Open
Recommendations
4. Part D: Board Governance
18
5. Part E: Meeting Close
Wandsworth Clinical Commissioning Group Board July 2016
144
Page
4. Part D: Board Governance 4.1. D01 Summary Minutes:
145 146 146
4.1.2. Finance Resource Committee
148
4.3. D03 Open Space 4.3.1. Members of the public present are invited to ask questions of the Board relating to the business being conducted. Priority will be given to written questions that have been received in advance of the meeting.
2. Part B: Decisions and
4.1.1. Integrated Governance Committee 4.2. D02 AOB and Other Matters to Note
1. Part A: Meeting Open
Part D: Board Governance
3. Part C: Management 4. Part D: Board 5. Part E: Meeting Close 145
Meeting date:
19th April 2016
Main items discussed:
Decisions:
Safeguarding Committee Terms of Reference – Changes had been made to reflect the new guidance. The Committee agreed the proposed changes.
Particular points to note:
Safeguarding Adults Policy – The policy had been updated to reflect new national guidance and the London policies. Some changes had been made to the team structure. Some comments on the policy were noted, which would be taken through the Safeguarding Committee.
Safeguarding Adults Policy Safeguarding Committee Terms of Reference Conflicts of Interest draft guidance St George’s Hospital Clinical Quality Review Group Update Integrated Report Children’s Services Ofsted Report
Conflicts of Interest draft guidance – The Committee reviewed the draft guidance recently issued for consultation by NHS England, following a national review. A number of comments were noted, which would be fed back as part of the consultation response.
Integrated Report – The report provided an update on performance with particular focus on the following areas: risks, Information Governance, finance, QIPP, A&E, Referral to Treatment, Cancer, and Diagnostic Waits.
5. Part E: Meeting Close
Children’s Services Ofsted Report – The report outlined the key messages from the recent Ofsted review. No immediate actions were identified for the CCG, but the opportunity to strengthen partnership working with the Local Authority would be taken forward. As a member of the partnership, the CCG has a responsibility to challenge, which would be strengthened. The CCG would continue to work with the LA to provide support.
4. Part D: Board
St George’s Hospital Clinical Quality Review Group Update – The Committee received an update on the work of the CQRG. The report focused on the particular areas of concern for review by the CQRG, Serious Incidents, and other issues. It was noted that the Trust was fully engaged in the process of keeping patients safe. The next CQC (Care Quality Commission) visit was scheduled for June 2016, and the CQRG had been asked, with NHS Improvement, to monitor the process.
3. Part C: Management
Integrated Governance Committee
2. Part B: Decisions and
Committee:
1. Part A: Meeting Open
COMMITTEE FEEDBACK FORM
146
COMMITTEE FEEDBACK FORM
Meeting date:
17th May 2016
Main items discussed:
Decisions:
Child Safeguarding Policy – The Committee was asked to approve the revised policy, which had been amended to reflect revised guidance in the Pan London Child Protection Procedures and national guidance. Some further changes were highlighted during the discussion, which would be incorporated into the final version.
Learning Disability Update Child Safeguarding Policy Integrated Report Terms of Reference Review
Terms of Reference Review – The proposed amendments to the Terms of Reference were agreed. Some additional changes were proposed for inclusion. The Committee agreed the revised Terms of Reference. Particular points to note:
Integrated Report – The report provided an update on performance with particular focus on the following areas: risks, Information Governance, finance, QIPP, A&E, Ambulance Response Times.
4. Part D: Board
Learning Disability Update – The Committee received a programme update, noting that significant progress continues to be made across the work streams. There has been good progress in the commissioning of responsive services to ensure people with a Learning Disability can be supported in their homes, or as close to home, wherever possible. Systems and processes are being developed to provide assurance around the appropriateness of an admission to a community or hospital placement, referral to and management of that admissions, and safe and supported discharge back into the community.
3. Part C: Management
Integrated Governance Committee
2. Part B: Decisions and
Committee:
1. Part A: Meeting Open
Attach X
5. Part E: Meeting Close 147
Meeting date:
21st April 2016
Main items discussed:
Decisions:
No decisions were required.
Particular points to note:
16/17 Budget Setting – The report highlighted the main elements of the 2016/17 draft plan, including acute and non-acute services, Parity of Esteem, Primary Care, Reserves and QIPP. 2.61% growth had been applied to the allocation. The CCG was required to retain 1% nonrecurrent uncommitted reserve. The surplus has been set at 0.5% as previously agreed. The 2016/17 budgets would be presented to the Board at the Extra-Ordinary meeting on 25th May, following which budgets would be issued.
16/17 Budget Setting Draft Annual Report and Annual Accounts 15/16 Year End Position and 16/17 Planning St George’s Position
Draft Annual Report and Annual Accounts – An extract of the draft accounts was presented. Final submission of the accounts was due on 27th May. The External Auditors would be working in the CCG for two weeks from 9th May. Key points from the extract were noted.
St George’s Position – The Trust was working hard to improve on the current reported deficit at month eleven of £56.1m. The 16/17 financial plan was to achieve £17.2m deficit.
4. Part D: Board
15/16 Year End Position and 16/17 Planning – The Committee noted that the surplus, running costs, and QIPP targets had been achieved. A further increase to the Continuing Health Care budget had been made – the overspend had been managed through the reserves.
3. Part C: Management
Finance Resource Committee
2. Part B: Decisions and
Committee:
1. Part A: Meeting Open
COMMITTEE FEEDBACK FORM
5. Part E: Meeting Close 148
COMMITTEE FEEDBACK FORM
Meeting date:
17th May 2016
Main items discussed:
Decisions:
16/17 Budgets – The Committee received the revised budgets for 16/17, with changes from the previous version outlined. It was noted that the previous gap of £2.8m had now been bridged – this remained a significant area of risk. An on-going review of budgets had been put in place. Currently there was not a level of risk highlighted around primary care commissioning. Following the discussion, the Committee agreed that the 16/17 budgets should be recommended to the CCG Board.
Particular points to note:
Sustainability and Transformation Plan – An update on the Sustainability and Transformation Plan (STP) was received. Financial diagnostic work had been done across the SWL health economy, including a reconciliation exercise between provider and commissioner positions for the 15/16 forecast outturn. It was noted that changes to the plan would continue. The final STP was due for submission on 30th June.
16/17 Budgets Sustainability and Transformation Plan South West London Collaborative Budgets St George’s Position
4. Part D: Board
St George’s Position – An update was received by the Committee. It was reported at the Trust’s Board meeting in May that £55m was achieved against the £56m target. The 16/17 budget reflected £17.5m deficit.
3. Part C: Management
Finance Resource Committee
2. Part B: Decisions and
Committee:
1. Part A: Meeting Open
Attach X
5. Part E: Meeting Close 149
Page
5. Part E: Meeting Close
150
1. Part A: Meeting Open
Part E: Meeting Close
5.1. E01 Clinical Chair's Closing Remarks
5.3. E03 Part II Agenda items: 5.3.1. SWL Collaboration 5.3.2. Assurance 15/16 5.3.3. Remuneration Committee recommendations
2. Part B: Decisions and
5.2. E02 To resolve that the public now be excluded from the meeting because publicity would be prejudicial to the public interest by reason of the commercially sensitive or confidential nature of the business to be conducted in the second part of the agenda.
3. Part C: Management 4. Part D: Board 5. Part E: Meeting Close 150