AGENDA · 2020-05-07 · Page 2 of 11 Minutes approved by the Chair : 1.5.2020 confirm attendance, raise any questions and also to advise when members leave the meeting. He advised

NHS BLACKBURN WITH DARWEN CCG NHS EAST LANCASHIRE CCG

COVID 19 Decision & Accountability Framework

Blackburn with Darwen Clinical Commissioning Group and East Lancashire Clinical Commissioning Group Governing Bodies

Meeting in Common

Virtual Meeting : Wednesday, 13 May 2020 1:00pm – 4:00pm

AGENDA

PART 1

ITEM LEAD ACTION FORMAT TIME

1 Welcome Dr R Robinson Chair

1:00pm

2 Minutes a. BwD CCG Draft Minutes 15.4.20 b. EL CCG Draft Minutes 15.4.20

2.1 Action Matrix

Chair

Chair

Approval Attached

COVID-19 Updates

3 Financial Update

Mr R Parr Mrs K Hollis

Receipt / Information

Attached 1:05pm

3.1 BwD CCG Finance Report 3.2 EL CCG Finance Report


Receipt Receipt

Attached Attached

4 Performance Update

Mr R Parr Receipt Presentation To follow

1:20pm

5 Summary of PL CCGs Incident Room Key Decisions


Receipt Attached 1:30pm

6 Urgent & Emergency Care Position Mr A Walker

Receipt Presentation 1:40pm

7 Testing for Coronavirus

Mrs K Lord Receipt Attached 1:50pm

Other Items

8 Joint Committee of CCGs - Workplan 2020/21

Dr J Higgins Approval Attached 2:10pm

9 2020/21 Uplift for L&SC Individual Placement Agreement (IPA) Providers

Mrs K Hollis Approval Attached 2:20pm

Any Other Business

10 Questions & Closing Remarks

Chair 2:30pm

11 Date & Time of Next Meeting Wednesday, 10 June 2020 at 1pm

Chair 2:35pm

Page 1 of 1

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

COVID-19 GOVERNING BODY : ACTION MATRIX v1

MIN REF

ACTION

OWNER

COMMENT

RAG

20:021 Finance Report Members to receive a revised Finance Report incorporating additional expenditure incurred during the COVID 19 pandemic.

RP/KH

Item included on 13 May Agenda

20:022 Staff Testing Staff testing to be included as a regular item on the agenda.

KL

Item included on 13 May Agenda.

20:025 Community DVT Service Redesign Procurement Communication to be issued on General Practice to ensure a clear message is conveyed regarding DDimer testing.

Guidance incorporated into the Medical Directors letter to General Practice.

20:027 Personal Protective Equipment A cost proposal to be developed for the purchase of PPE to support staff across Pennine Lancashire.

AW

Update included on the 13 May Agenda.

20:028 Risk Register Review of the Risk Register at the May GB meeting to highlight the areas that have been identified during the COVID 19 pandemic

Update incorporated into the Performance Report and included on the 13 May Agenda

20:029 Any Other Business Risk assessment of interventions/services that are

not currently being provided in primary care and ELHT due to the COVID 19 pandemic and any potential impact.

Current position regarding waiting lists and waiting times – are these still being monitored?

Current A&E position in terms of activity levels and waiting times

AW / RP

Performance Report to the 13 May meeting Urgent & Emergency Care Provision report to the 13

May GB responds to this action.

Page 1 of 11 Minutes approved by the Chair : 1.5.2020

NHS East Lancashire Clinical Commissioning Group NHS Blackburn with Darwen Clinical Commissioning Group

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Minutes of the Virtual Meeting held on Wednesday, 15 April 2020

Blackburn with Darwen CCG

Graham Burgess Dr Ridwaan Ahmed Dr Adam Black Professor Dominic Harrison Dr Julie Higgins Mr Paul Hinnigan Dr Nigel Horsfield Dr Qashuf Hussain Mrs Kathryn Lord Dr Mohammed Moosa Mr Roger Parr Dr Zaki Patel

CCG Chair Clinical Director of Quality & Primary Care GP Executive Director of Public Health & Wellbeing Joint Chief Officer Lay Member - Governance Lay Member - Clinical Advisor Executive GP & Clinical Lead Director of Quality & Chief Nurse Executive GP & Clinical Lead Chief Finance Officer Executive GP & Clinical Lead

East Lancashire CCG

Dr Richard Robinson Dr Santhosh Davis Dr Mark Dziobon Mrs Kirsty Hollis Dr Julie Higgins Mrs Kathryn Lord Mrs Michelle Pilling Dr Rakesh Sharma Mr David Swift Dr Paul Taylor Mr Alex Walker Dr David White

CCG Chair – Meeting Chair Clinical Advisor & GB Member Medical Director Chief Finance Officer Joint Chief Officer Director of Quality & Chief Nurse Lay Member - Quality & Patient Engagement Clinical Advisor & Governing Body Member Lay Member - Governance Secondary Care Doctor Director of Performance & Delivery Clinical Advisor & Governing Body Member

In Attendance

Mrs Debra Atkinson Mrs Anne Holden

Head of Corporate Business, EL CCG Corporate Administration Officer, EL CCG

Apologies:

EL CCG: Dr Tom Mackenzie

Clinical Advisor & Governing Body Member

BwD CCG: Mrs Claire Richardson Dr Geraint Jones

Director of Population Strategy and Transformation Lay Member - Secondary Care Doctor

Min Ref ITEM ACTION

20.018 Welcome and Apologies The Chair welcomed all members to the Governing Body meeting which was the first meeting held virtually through Microsoft Teams. He thanked members for persevering with a virtual meeting and asked that the chat facility be used to


confirm attendance, raise any questions and also to advise when members leave the meeting. He advised that Mr Hinnigan had submitted questions in advance and these would be covered as we move through the agenda. It was anticipated that papers had been read in advance and if there were any objections to the recommendations, Members were asked to raise these through the chat facility, otherwise the Chair would assume members support the decisions. Apologies were confirmed as outlined above and the meeting was quorate for both Governing Bodies. In terms of Conflict of Interest (CoI), Mr Hinnigan had raised concerns that GP Governing Body members had a CoI in the agenda item relating to Personal Protective Equipment (PPE). The Chair considered there would be no financial benefit to the individual GPs or their Practices as this was a wider issue affecting all front line staff in primary and community care. It was therefore the view that GPs should be included in the decision making. All members supported this approach. The Chair invited Dr Higgins, Joint Chief Officer to provide an overview of the work ongoing since the last meeting. Dr Higgins advised that during this unprecedented time, we are all working in a way that we would not have expected, with new modelling by NHS England and the lockdown measures put in place. A key concern has been the number of critical care facilities available, however Regional colleagues have confirmed we have the right number in place. We are starting to think about the higher rate of deaths in the NW due to a higher level of underlying conditions. A number of NHS services have been stood down due to COVID-19 and the general public are using facilities in a different way. The A&E and Ambulance position is also very different to this time last year. She advised that all strategic work in the CCG has been stepped down and staff are working to support the response to COVID-19. An Incident Command Centre (ICC) has been established, led by Mrs Hollis and Mr Parr as Incident Room Commanders and a seven day rota is in operation. Command and support cells have also been established to manage issues as they arise in primary, community and secondary care and the regulated care sector. She pointed out that EL CCG is privileged to have Dr Mark Dziobon as Medical Director. In view of the vacancy in BwD CCG, Dr Dziobon would also be formally acting as Medical Director for BwD CCG, supported by Dr Santhosh Davis and Dr Qashuf Hussain as Deputies. GP Executives are also involved in supporting the Incident Room. She highlighted the following areas of development:

Mr Walker is leading on issues relating to Personal Protective Equipment (PPE) on behalf of the CCGs.

A Tactical Group has also been established with partners, and leaders from the Partnership Leaders Forum are supporting the work of the Out of Hospital Cell, making some important and collective decisions.

Close working with Primary Care Network Clinical Directors, led by Mrs Walsh and Dr Dziobon, with a view to mobilising mutual aid to support practices and other providers where necessary.

A Primary Care Plan has been developed with primary care partners and the Local Medical Committee, led by Mr Walker in terms of community escalation to all practices.


In order to identify a different way of approaching our vulnerable patients so that community care can manage the COVID pandemic and palliative care at home, Mr Walker and colleagues are working closely with ELHT and Lancashire & South Cumbria NHS Foundation Trust to support this and Mrs Lord is leading on End of Life care. These are very specific pathways providing advice and guidance.

A plan for recovery beds is now in place to support the Regulated Care Sector, providing discharge facilities for infected patients in an out of hospital setting.

Personal Protective Equipment (PPE) has been a particular problem and staff testing is another issue we have had to respond to quickly, as national guidance has not been enough to support local need.

Members would receive further detailed information throughout the agenda and Dr Higgins paid tribute to staff for their hard work to support the COVID-19 pandemic.

20.019 Items for Approval from 18 March Virtual Meeting Following the announcement and advice regarding Covid-19, the decision was made to stand down the Governing Body Meeting in Common scheduled for Wednesday, 18 March 2020. A number of papers were presented for Assurance / Information, however the GB were asked to take a virtual decision on business critical items, as outlined below. The Chair referred to two papers that were presented to the March meeting of the Governing Body for approval. From the responses received, the decisions were not quorate and those members who had not responded were asked to support the following Business Cases:

Individual Patient Activity Business Case In his initial response, Mr Swift had asked if additional funding had been identified. Mrs Hollis confirmed that following a review of a number of individual packages of care, there was likely to be a reduction in expenditure.

Funding Allocations for the Child & Adolescent Mental Health Service (CAMHS)Transformation Schemes for 2020/21

RESOLVED: that Members supported the Individual Patient Activity Business Case and the Funding Allocations for the CAMHS Transformation Schemes for 2020/21.

20.020 Review of Governance In presenting the report Mrs Atkinson, Head of Corporate Business advised the report was based on the letter received from NHS England / NHS Improvement (NHSE/I)I dated 28 March 2020 providing guidance to support NHS Providers and Commissioners to free-up management capacity and resource to respond to the COVID-19 pandemic. The report set out the key actions that CCGs are asked to undertake and outlined the PL CCGs response to those areas and the steps being taken locally to strengthen the governance and decision making structure, together with a series of recommendations. In terms of process, it was agreed that members consider each of the


recommendations in turn. Dr Black requested clarity that these decisions can be made without going to the Membership. It was confirmed that the rationale for making these decisions was to ensure there are robust arrangements in place to ensure business continuity and critical timely decision making, should key staff become infected during this time and unable to be involved in decision making. Recommendations: 1. Members supported the arrangements put in place to enable the

Governing Body and Sub Committees to continue to take place where necessary and Quoracy was confirmed for the following Committees: Quoracy for the Audit Committees to remain as stated. Quoracy for the EL Remuneration Committee to be amended to two

members present. 2. Members delegated approval of the Annual Accounts for 2019/20 for EL

CCG to the EL Audit Committee. 3. Members delegated approval of the Annual Report 2019/20 for EL CCG

to the EL Audit Committee. 4. Decision Making – COVID 19 Incident Coordination Centre (ICC).

a. The Terms of Reference and function of the EL CCG Sustainability Committee & Blackburn with Darwen CCG Commissioning Business Group be delegated to the ICC Group whilst under COVID 19.

b. Primary Care Committees decisions to be delegated to the ICC group, subject to three members being party to a decision. In view of the potential conflicts of interest, members considered the recommendation be amended to three members being party to a decision, ensuring there is a non-clinical majority.

5. Members supported the deputy arrangements put in place for emergency

powers and urgent decisions, should key staff be unavailable. 6. Members supported the deputy arrangements put in place to ensure

there is sufficient provision for approval in terms of delegated financial limits, should key staff be unavailable.

It was confirmed that a summary of all key decisions will be logged and presented to Governing Bodies for assurance and any significant locally agreed decisions/actions will be presented to Governing Bodies for ratification. The remainder of the report outlined other areas highlighted in the letter and the work ongoing locally to support these. RESOLVED: that Members received assurance in terms of the work ongoing supported the recommendations as outlined.

20.021 Financial Considerations Mr Parr, Chief Finance Officer presented the report which outlined the decision making process in respect of a number of areas of activity during the COVID-19 pandemic. He described the process relating to COVID-19 expenditure, confirming this is captured on the general ledger and a monthly return is submitted to NHS England / NHS Improvement outlining all additional expenditure. Financial monitoring continues to take place and the monthly finance report to the


Governing Body would include details of additional expenditure, noting that additional costs are fully reimbursable. He advised that the Finance Team are currently working on the Annual Accounts for BwD CCG and he was pleased to confirm that good progress had been made and the year end position is as we expected it to be. Risks and mitigation continue to be managed through the Incident Control Centre and Cell Leads on a daily basis. Mrs Hollis, Chief Finance Officer was pleased to report that the financial position is as we anticipated it to be. The Finance Team was finalising the Annual Accounts process and aiming to complete the accounts by the original deadline, noting that the deadline for submission had been extended by three days in view of the current position. In terms of Financial Planning for 2020/21, this had been stood down nationally and organisations are being asked to monitor their accounts, particularly looking at any overspend on a monthly basis. Members would receive a detailed report on the current position in May. In response to Mr Hinnigan enquiry regarding COVID-19 expenditure, Mr Parr confirmed that a monthly return is submitted to NHS E/I and the Governing Body would receive a revised finance report at the next meeting incorporating the additional COVID-19 spend. Mrs Hollis advised that the level of detail being requested by the regulators on a daily basis is phenomenal, at a time when we are working to a very tight timescale for the submission of the Annual Accounts. Mr Parr and Mrs Hollis recognised the hard work of the staff within the Finance Teams and paid tribute to them for their efforts. RESOLVED: that Members received the report and supported the decisions made. ACTION: Members to receive a revised Finance Report incorporating additional expenditure incurred during the COVID 19 pandemic.

RP/KH

20.022 Staff Testing Mrs Kathryn Lord, Director of Quality & Chief Nurse presented the report which outlined the national and local position regarding COVID-19 staff testing. She advised that progress had been made since the report was issued, confirming that EL and BwD CCGs have been allocated testing slots for key workers via the Lancashire & South Cumbria testing site based at Haydock Park and at the Royal Blackburn Hospital site. She confirmed that twelve requests for testing had been received to date, however a number of these did not meet the eligibility criteria for testing within the 72 hour window. Currently seven health care workers from primary care had been tested and would receive a negative result by text or a phone call from herself if their test is positive. She advised the position is changing and it was anticipated more staff would be able to be tested, particularly targeting Care Homes staff, to enable them to get them back to work after 14 days if they tested negative. Mrs Lord outlined the testing process, advising that the CCG is working with Occupational Health to direct staff to the right place. However national guidance is confusing and discussions are ongoing to try to streamline this locally. It was also reported that the main sites will not test those under 18 years and national guidance advised that parents will be supported by nursing


staff where a test is required on a child. Members discussed the process in terms of positive tests and if there will they be repeat swab in several days. Mrs Lord advised that some people are repeat tested if they continue to have symptoms after the initial test, however there are also a number of false negatives where people are feeling unwell. Professor Dominic Harrison, Director of Public Health & Wellbeing, provided feedback following discussions between the Directors of Public Health and the Chief Medical Officer. He referred to research at a London Ambulance Trust where some staff were self-isolating with symptoms, however on testing only 15% of self-isolating symptomatic staff tested positive. He advised the PCR test for the virus is only 70% accurate and Public Health England advice is to use only the recommended test. He considered there will be people self-isolating but 30% could have a false positive or false negative result. He felt there is a need to be cautious regarding the level of confidence. With regard to shielded patients, Dr Dziobon highlighted the need to consider where staff are deployed to ensure they are not at risk to the very vulnerable. Mrs Lord confirmed this is being addressed. She outlined the work ongoing to support the Regulated Care Sector, particularly targeting those care homes where there has been an outbreak, however there are constraints at the test centres due to the under 18 element in some cases. Safeguarding arrangements would continue to be put in place to ensure staff working in care homes are protected. Professor Harrison advised that up to 50% of people who are infected will have no symptoms and would not be tested. Discussion followed regarding testing protocols and he agreed to circulate information to members via email. In conclusion, it was agreed to continue to utilise the capacity we have in terms of staff testing that will have the most impact on the system. Further updates would be provided at the next meeting when there would be more knowledge about the position. RESOLVED: that Members were assured by the processes in place for staff testing and requested more detailed information at the next meeting. ACTION: Staff testing to be included as a regular item on the agenda.

KL

20.023 COVID-19 Recovery Centres Mr Alex Walker, Director of Performance & Delivery presented the report which described the work ongoing to scope the need and identify specific cohort sites in Pennine Lancashire where additional bed capacity can be created to provide support in an out of hospital setting, when critical care and overall hospital capacity within RBH is exceeded. He highlighted the vulnerability of the Care Sector in terms of COVID-19 and it was important to identify some alternative pathways for those who are COVID-19 positive, looking to step down into a residential care setting or a new placement in a care setting. A PL Transitional Care Cell has been established, led by Mr Walker with senior staff identified and deployed to the cell from partner organisations, to look at opportunities across the system. Potential areas included Rakehead at Burnley General Hospital, Dove Court Care Home, Gisburne Park Hospital and Pendleside Hospice. These facilities will provide 40 beds in a shielding capacity and an additional 20 beds to support the acute system through the period of the pandemic, with an opportunity to extend capacity depending on the situation at that time. Mr Walker confirmed


the pathways are available to both BwD and East Lancashire residents. Mr Hinnigan referred to the graph in Appendix A to the report which highlighted the Pennine Lancashire patient ‘hospitalisation’ numbers exceeding 1,000 in less than 2 weeks from now and over 6,000 in 6 weeks time, with over 1,500 critical care beds also needed by then and asked it these assumptions are correct? Mr Walker explained the position, pointing out the figures relate to the whole of the North West, not just Pennine Lancashire. This is the anticipated worst case scenario and work is now ongoing to understand the actual impact on the system. In terms of A&E attendance and hospitalisation, this shows a stable position currently and the curve on the worst case scenario has flattened. Professor Harrison shared information with members and outlined the NHS E model and the likely impact on the health care system. It was considered that further lockdown measures would significantly reduce the worst case scenario by two thirds. He referred to various insights on COVID-19 epidemiology and agreed to circulate information to members. He considered the best intelligence is what is happening in the hospital, pointing out that Royal Blackburn Hospital is the second most under pressure hospital in Lancashire, despite there being higher numbers of confirmed cases in Lancaster and Cumbria. Mr Hinnigan was pleased to understand the graph outlined the worst case scenario. In terms of planning, he asked what the peak position is likely to look like based on current assumptions and do we have enough beds available. Professor Harrison advised that NHS E data is not being shared with Public Health and there is a risk of overtopping demand in that more people need critical care beds that are COVID19 related. It was confirmed there are currently 153 critical care beds available across Pennine Lancashire. Dr Robinson provided feedback following a Regional discussion, when all CCG Chairs received assurance that there is sufficient hospital bed availability across the North West, supported by Nightingale hospitals. However national plans stop short at this point in forming local intermediate care arrangements which have to be considered locally, noting that Mr Walker has procured additional community bed capacity across Pennine Lancashire. In response to a query from Dr Davis, Mr Walker advised the additional beds would be used to step up from a care home setting in order to shield the system, but on the whole they would be used as a step down facility from the hospital. Dr Davis asked if there were any plans to open any more community step down beds in Pennine Lancashire considering the immense pressure likely in the hospital. Mr Walker confirmed that work is ongoing to ensure where we have the appropriate level of staffing to support this model. Dr Higgins pointed out that Mr Walker has anticipated the position and mobilised quickly to establish additional capacity across Pennine Lancashire and she thanked him for his work. The Out of Hospital Cell are working with Lancashire & South Cumbria NHS Trust to mobilise an additional 15 beds on the UCLAN site. She confirmed there are enough ventilated and critical care beds and there is a fine balance between getting enough up and running, including step down facilities. Some services have been turned off and work is now ongoing to review this and agree what can be brought back on line. The Medical Director and GP colleagues continue to review the position. Dr Robinson felt there is significant assurance that we are still delivering the


right services across the system and asked if ELHT are happy with the level of emergency services they can provide. Dr Dziobon provided feedback following the A&E Delivery Board, confirming that we are still delivering the right covid related services across the system. It was also agreed to include details in the routine communications to GPs to continue to refer patients to secondary care where necessary, using the usual pathways. If a referral is made using the two week rule, the GP should follow this up with the patient and encourage them to attend their appointment. RESOLVED: that Members support the approach taken to establish step up / discharge centres within Pennine Lancashire and paid tribute to Mr Walker for his work.

20.024 Waiving of Standing Financial Instructions (SFIs) for the Procurement of Essential Equipment / Enabling Tools Mrs Hollis, Chief Finance Officer advised that in response to the Reducing the Burden document, there may be a need to relax the Standing Financial Instructions (SFIs) and requirement to seek quotations or tenders and undertake single tender waivers in order to speed up the process of procurement for essential equipment or enabling tools on COVID-19 related expenditure. She had consulted the Audit Chairs for both CCGs and the Accountable Officer who were supportive of the proposed changes, which would be for an initial period of 12 weeks commencing on 6 April 2020. Mr Hinnigan confirmed he would support the relaxation of the existing procurement rules for an initial period of 12 weeks for Covid-19 expenditure, but only where no NHS procurement frameworks or contracts currently exist. Mrs Hollis confirmed this would apply where the CCG is unable to use suppliers on the national framework or where the supplier is unable to meet the requirements, it would be necessary to go off framework. RESOLVED: that Members supported the waiving of SFIs to speed up the process of procurement for essential equipment or enabling tools during the COVID 19 pandemic, for an initial period of 12 weeks commencing on 6 April.

20.025 Community DVT Service Redesign Procurement Mr Walker presented the report which had been considered by the Committees in Common and was due to be presented to the Governing Body for approval in March, however in view of the current circumstances around COVID-19 this was not considered. He outlined the position, confirming that the existing contracts for both East and Blackburn with Darwen CCGs are due to expire at the end of September 2020. He pointed out that to run a procurement during the current position was not realistic and in collaboration with procurement, a revised timetable had been drafted, with a request to extend the current contract for a period of 10 months to the end of July 2021. This would enable the CCGs to go out to procurement, allowing potential bidders to be engaged in the process and have time to submit a quality bid. Dr Sharma pointed out that the DVT service is requesting that a DDimer blood test is carried out before a referral is accepted and asked if this has been


agreed. Dr White referred to information on GP Teamnet which requested, where possible, that a DDimer test is helpful and valid in the first few days. He advised that the service change link on GP Teamnet had now been updated, confirming that a referral would not be rejected on the absence of a test and provided contact details for the GP to speak to the DVT service clinicians to discuss the circumstances and next steps. RESOLVED: that Members approved the longer extension of the existing EL and BwD CCGs contracts for a period of 10 months to the end of July 2021. ACTION: Communication to be issued on General Practice to ensure a clear message is conveyed regarding DDimer testing.

Comms Team

20.026 Incident Room Decisions Mrs Hollis presented the report which provided a record of how key decisions have been made within the PL CCGs Incident Room. She advised that decisions ranged from making changes to the way the CCGs are working and provided a record of how guidance has been interpreted and where resources have been committed. The Incident Control Centre (ICC) is operating as a major incident with Loggists in place to record all decisions and keep back up documentation. Part of the function of the ICC is to record and maintain records in terms of what is behind some of the decisions made. Mr Hinnigan referred to the decision to purchase new laptops for Primary Care Teams and asked a number of questions, given the significant sum involved. In response, Mrs Hollis confirmed that the laptops were purchased to allow the primary care workforce to work remotely, allowing them to continue to operate offsite. Equipment is being provided to General Practitioners, Practice Nurses and Receptionists who are currently working differently and remotely. An assessment of existing equipment was made and the laptops were ordered based on the GP IT Replenishment Programme which would have taken place in the new financial year. However this was brought forward due to the current position, providing 100 laptops for BwD CCG and 220 for EL CCG. A further supply of 281 laptops have been allocated from the central suppliers, providing a total of 601 new laptops to support primary care. The equipment was purchased via the existing NHS procurement framework and had to meet a specific standard, to include a smart card, camera, microphone and security systems. It was delivered quickly and is in the process of being configured and distributed to primary care staff. In terms of allocations, Mrs Lisa Cunliffe, Senior Transformation, Quality & Delivery Manager is working with colleagues to identify primary care requirements and need. One or two laptops would be allocated to each practice, however some of the smaller practices have their own and do not require any additional equipment. Dr Higgins paid tribute to Mrs Hollis and Mr Parr for taking forward the work in the Incident Command Centre in their exemplary Commander Roles, supported by the Senior Directors. RESOLVED: that Members receive the report and supported the key decisions made in the Pennine Lancashire CCGs Incident Room.


20.027 Personal Protective Equipment (PPE) Following a lengthy discussion, Members supported the work ongoing in relation to the supply of PPE equipment to primary and community care and the wider social care sector. In view of the difficulties experienced with the supply through the national system and the anxieties in general practice, a PPE Cell has been established, led by Mr Alex Walker. Members received a proposal for the PL CCGs to bolster PPE equipment to provide the appropriate level of protection for our staff. RESOLVED: that Members unanimously approved the investment for Personal Protective Equipment.

ACTION: A cost proposal to be developed for the purchase of PPE to support staff across Pennine Lancashire.

AW

20.028 Key Verbal Updates Mr Burgess highlighted the need to review the Risk Register in terms of interventions that are not currently being provided due to the COVID 19 pandemic and requested a review of the Risk Register at the May meeting. In response, Mrs Hollis confirmed that the ICC held a Risk Register which included anecdotal issues received through the various channels which is regularly reviewed. A number of areas highlighted issues whereby patients are not attending hospital appointments due to a fear of going into the hospital setting and the risk of infection. ACTION: Review of the Risk Register at the May GB meeting to highlight the areas that have been identified during the COVID 19 pandemic.

20.029 Any Other Business 20.029.1 Lay Member – Equality & Inclusion The Chair advised Members that due to a change in circumstances, Mrs Naz Zaman, Lay Member for Equality & Inclusion for EL CCG had taken the decision to step down from her role on the Governing Body. He was very grateful to her for her commitment and the time she put in to her role with the CCG. 20.09.2 May Governing Body Agenda Mr Hinnigan requested that the following areas be addressed at the next meeting of the Governing Body.

Services that are not currently being provided in primary care and at ELHT due to the COVID 19 pandemic and has the potential impact been risk-assessed?


Current A&E position in terms of activity levels and waiting times. 20.029.3 Closing Remarks Dr Robinson wished to give his personal thanks to Dr Julie Higgins for her work and excellent leadership of the Executive Team and thanked everyone for their work and approach throughout this time.


20.030 Next Meeting RESOLVED: that the next meeting of the Governing Body would be held virtually via Microsoft Teams on Wednesday, 13 May 2020 at 1pm.


NHS East Lancashire Clinical Commissioning Group NHS Blackburn with Darwen Clinical Commissioning Group

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Minutes of the Virtual Meeting held on Wednesday, 15 April 2020

East Lancashire CCG

Dr Richard Robinson Dr Santhosh Davis Dr Mark Dziobon Mrs Kirsty Hollis Dr Julie Higgins Mrs Kathryn Lord Mrs Michelle Pilling Dr Rakesh Sharma Mr David Swift Dr Paul Taylor Mr Alex Walker Dr David White

CCG Chair – Meeting Chair Clinical Advisor & GB Member Medical Director Chief Finance Officer Joint Chief Officer Director of Quality & Chief Nurse Lay Member - Quality & Patient Engagement Clinical Advisor & Governing Body Member Lay Member - Governance Secondary Care Doctor Director of Performance & Delivery Clinical Advisor & Governing Body Member

Blackburn with Darwen CCG

Graham Burgess Dr Ridwaan Ahmed Dr Adam Black Professor Dominic Harrison Dr Julie Higgins Mr Paul Hinnigan Dr Nigel Horsfield Dr Qashuf Hussain Mrs Kathryn Lord Dr Mohammed Moosa Mr Roger Parr Dr Zaki Patel

CCG Chair Clinical Director of Quality & Primary Care GP Executive Director of Public Health & Wellbeing Joint Chief Officer Lay Member - Governance Lay Member - Clinical Advisor Executive GP & Clinical Lead Director of Quality & Chief Nurse Executive GP & Clinical Lead Chief Finance Officer Executive GP & Clinical Lead

In Attendance

Mrs Debra Atkinson Mrs Anne Holden

Head of Corporate Business, EL CCG Corporate Administration Officer, EL CCG

Apologies:

EL CCG: Dr Tom Mackenzie

Clinical Advisor & Governing Body Member

BwD CCG: Mrs Claire Richardson Dr Geraint Jones

Director of Population Strategy and Transformation Lay Member - Secondary Care Doctor

Min Ref ITEM ACTION

20.018 Welcome and Apologies The Chair welcomed all members to the Governing Body meeting which was the first meeting held virtually through Microsoft Teams. He thanked members for persevering with a virtual meeting and asked that the chat facility be used to


confirm attendance, raise any questions and also to advise when members leave the meeting. He advised that Mr Hinnigan had submitted questions in advance and these would be covered as we move through the agenda. It was anticipated that papers had been read in advance and if there were any objections to the recommendations, Members were asked to raise these through the chat facility, otherwise the Chair would assume members support the decisions. Apologies were confirmed as outlined above and the meeting was quorate for both Governing Bodies. In terms of Conflict of Interest (CoI), Mr Hinnigan had raised concerns that GP Governing Body members had a CoI in the agenda item relating to Personal Protective Equipment (PPE). The Chair considered there would be no financial benefit to the individual GPs or their Practices as this was a wider issue affecting all front line staff in primary and community care. It was therefore the view that GPs should be included in the decision making. All members supported this approach. The Chair invited Dr Higgins, Joint Chief Officer to provide an overview of the work ongoing since the last meeting. Dr Higgins advised that during this unprecedented time, we are all working in a way that we would not have expected, with new modelling by NHS England and the lockdown measures put in place. A key concern has been the number of critical care facilities available, however Regional colleagues have confirmed we have the right number in place. We are starting to think about the higher rate of deaths in the NW due to a higher level of underlying conditions. A number of NHS services have been stood down due to COVID-19 and the general public are using facilities in a different way. The A&E and Ambulance position is also very different to this time last year. She advised that all strategic work in the CCG has been stepped down and staff are working to support the response to COVID-19. An Incident Command Centre (ICC) has been established, led by Mrs Hollis and Mr Parr as Incident Room Commanders and a seven day rota is in operation. Command and support cells have also been established to manage issues as they arise in primary, community and secondary care and the regulated care sector. She pointed out that EL CCG is privileged to have Dr Mark Dziobon as Medical Director. In view of the vacancy in BwD CCG, Dr Dziobon would also be formally acting as Medical Director for BwD CCG, supported by Dr Santhosh Davis and Dr Qashuf Hussain as Deputies. GP Executives are also involved in supporting the Incident Room. She highlighted the following areas of development:

Mr Walker is leading on issues relating to Personal Protective Equipment (PPE) on behalf of the CCGs.

A Tactical Group has also been established with partners, and leaders from the Partnership Leaders Forum are supporting the work of the Out of Hospital Cell, making some important and collective decisions.

Close working with Primary Care Network Clinical Directors, led by Mrs Walsh and Dr Dziobon, with a view to mobilising mutual aid to support practices and other providers where necessary.

A Primary Care Plan has been developed with primary care partners and the Local Medical Committee, led by Mr Walker in terms of community escalation to all practices.


In order to identify a different way of approaching our vulnerable patients so that community care can manage the COVID pandemic and palliative care at home, Mr Walker and colleagues are working closely with ELHT and Lancashire & South Cumbria NHS Foundation Trust to support this and Mrs Lord is leading on End of Life care. These are very specific pathways providing advice and guidance.

A plan for recovery beds is now in place to support the Regulated Care Sector, providing discharge facilities for infected patients in an out of hospital setting.

Personal Protective Equipment (PPE) has been a particular problem and staff testing is another issue we have had to respond to quickly, as national guidance has not been enough to support local need.

Members would receive further detailed information throughout the agenda and Dr Higgins paid tribute to staff for their hard work to support the COVID-19 pandemic.

20.019 Items for Approval from 18 March Virtual Meeting Following the announcement and advice regarding Covid-19, the decision was made to stand down the Governing Body Meeting in Common scheduled for Wednesday, 18 March 2020. A number of papers were presented for Assurance / Information, however the GB were asked to take a virtual decision on business critical items, as outlined below. The Chair referred to two papers that were presented to the March meeting of the Governing Body for approval. From the responses received, the decisions were not quorate and those members who had not responded were asked to support the following Business Cases:

Individual Patient Activity Business Case In his initial response, Mr Swift had asked if additional funding had been identified. Mrs Hollis confirmed that following a review of a number of individual packages of care, there was likely to be a reduction in expenditure.

Funding Allocations for the Child & Adolescent Mental Health Service (CAMHS)Transformation Schemes for 2020/21

RESOLVED: that Members supported the Individual Patient Activity Business Case and the Funding Allocations for the CAMHS Transformation Schemes for 2020/21.

20.020 Review of Governance In presenting the report Mrs Atkinson, Head of Corporate Business advised the report was based on the letter received from NHS England / NHS Improvement (NHSE/I)I dated 28 March 2020 providing guidance to support NHS Providers and Commissioners to free-up management capacity and resource to respond to the COVID-19 pandemic. The report set out the key actions that CCGs are asked to undertake and outlined the PL CCGs response to those areas and the steps being taken locally to strengthen the governance and decision making structure, together with a series of recommendations. In terms of process, it was agreed that members consider each of the


recommendations in turn. Dr Black requested clarity that these decisions can be made without going to the Membership. It was confirmed that the rationale for making these decisions was to ensure there are robust arrangements in place to ensure business continuity and critical timely decision making, should key staff become infected during this time and unable to be involved in decision making. Recommendations: 1. Members supported the arrangements put in place to enable the

Governing Body and Sub Committees to continue to take place where necessary and Quoracy was confirmed for the following Committees: Quoracy for the Audit Committees to remain as stated. Quoracy for the EL Remuneration Committee to be amended to two

members present. 2. Members delegated approval of the Annual Accounts for 2019/20 for EL

CCG to the EL Audit Committee. 3. Members delegated approval of the Annual Report 2019/20 for EL CCG

to the EL Audit Committee. 4. Decision Making – COVID 19 Incident Coordination Centre (ICC).

a. The Terms of Reference and function of the EL CCG Sustainability Committee & Blackburn with Darwen CCG Commissioning Business Group be delegated to the ICC Group whilst under COVID 19.

b. Primary Care Committees decisions to be delegated to the ICC group, subject to three members being party to a decision. In view of the potential conflicts of interest, members considered the recommendation be amended to three members being party to a decision, ensuring there is a non-clinical majority.

5. Members supported the deputy arrangements put in place for emergency

powers and urgent decisions, should key staff be unavailable. 6. Members supported the deputy arrangements put in place to ensure

there is sufficient provision for approval in terms of delegated financial limits, should key staff be unavailable.

It was confirmed that a summary of all key decisions will be logged and presented to Governing Bodies for assurance and any significant locally agreed decisions/actions will be presented to Governing Bodies for ratification. The remainder of the report outlined other areas highlighted in the letter and the work ongoing locally to support these. RESOLVED: that Members received assurance in terms of the work ongoing supported the recommendations as outlined.

20.021 Financial Considerations Mr Parr, Chief Finance Officer presented the report which outlined the decision making process in respect of a number of areas of activity during the COVID-19 pandemic. He described the process relating to COVID-19 expenditure, confirming this is captured on the general ledger and a monthly return is submitted to NHS England / NHS Improvement outlining all additional expenditure. Financial monitoring continues to take place and the monthly finance report to the


Governing Body would include details of additional expenditure, noting that additional costs are fully reimbursable. He advised that the Finance Team are currently working on the Annual Accounts for BwD CCG and he was pleased to confirm that good progress had been made and the year end position is as we expected it to be. Risks and mitigation continue to be managed through the Incident Control Centre and Cell Leads on a daily basis. Mrs Hollis, Chief Finance Officer was pleased to report that the financial position is as we anticipated it to be. The Finance Team was finalising the Annual Accounts process and aiming to complete the accounts by the original deadline, noting that the deadline for submission had been extended by three days in view of the current position. In terms of Financial Planning for 2020/21, this had been stood down nationally and organisations are being asked to monitor their accounts, particularly looking at any overspend on a monthly basis. Members would receive a detailed report on the current position in May. In response to Mr Hinnigan enquiry regarding COVID-19 expenditure, Mr Parr confirmed that a monthly return is submitted to NHS E/I and the Governing Body would receive a revised finance report at the next meeting incorporating the additional COVID-19 spend. Mrs Hollis advised that the level of detail being requested by the regulators on a daily basis is phenomenal, at a time when we are working to a very tight timescale for the submission of the Annual Accounts. Mr Parr and Mrs Hollis recognised the hard work of the staff within the Finance Teams and paid tribute to them for their efforts. RESOLVED: that Members received the report and supported the decisions made. ACTION: Members to receive a revised Finance Report incorporating additional expenditure incurred during the COVID 19 pandemic.

RP/KH

20.022 Staff Testing Mrs Kathryn Lord, Director of Quality & Chief Nurse presented the report which outlined the national and local position regarding COVID-19 staff testing. She advised that progress had been made since the report was issued, confirming that EL and BwD CCGs have been allocated testing slots for key workers via the Lancashire & South Cumbria testing site based at Haydock Park and at the Royal Blackburn Hospital site. She confirmed that twelve requests for testing had been received to date, however a number of these did not meet the eligibility criteria for testing within the 72 hour window. Currently seven health care workers from primary care had been tested and would receive a negative result by text or a phone call from herself if their test is positive. She advised the position is changing and it was anticipated more staff would be able to be tested, particularly targeting Care Homes staff, to enable them to get them back to work after 14 days if they tested negative. Mrs Lord outlined the testing process, advising that the CCG is working with Occupational Health to direct staff to the right place. However national guidance is confusing and discussions are ongoing to try to streamline this locally. It was also reported that the main sites will not test those under 18 years and national guidance advised that parents will be supported by nursing


staff where a test is required on a child. Members discussed the process in terms of positive tests and if there will they be repeat swab in several days. Mrs Lord advised that some people are repeat tested if they continue to have symptoms after the initial test, however there are also a number of false negatives where people are feeling unwell. Professor Dominic Harrison, Director of Public Health & Wellbeing, provided feedback following discussions between the Directors of Public Health and the Chief Medical Officer. He referred to research at a London Ambulance Trust where some staff were self-isolating with symptoms, however on testing only 15% of self-isolating symptomatic staff tested positive. He advised the PCR test for the virus is only 70% accurate and Public Health England advice is to use only the recommended test. He considered there will be people self-isolating but 30% could have a false positive or false negative result. He felt there is a need to be cautious regarding the level of confidence. With regard to shielded patients, Dr Dziobon highlighted the need to consider where staff are deployed to ensure they are not at risk to the very vulnerable. Mrs Lord confirmed this is being addressed. She outlined the work ongoing to support the Regulated Care Sector, particularly targeting those care homes where there has been an outbreak, however there are constraints at the test centres due to the under 18 element in some cases. Safeguarding arrangements would continue to be put in place to ensure staff working in care homes are protected. Professor Harrison advised that up to 50% of people who are infected will have no symptoms and would not be tested. Discussion followed regarding testing protocols and he agreed to circulate information to members via email. In conclusion, it was agreed to continue to utilise the capacity we have in terms of staff testing that will have the most impact on the system. Further updates would be provided at the next meeting when there would be more knowledge about the position. RESOLVED: that Members were assured by the processes in place for staff testing and requested more detailed information at the next meeting. ACTION: Staff testing to be included as a regular item on the agenda.

KL

20.023 COVID-19 Recovery Centres Mr Alex Walker, Director of Performance & Delivery presented the report which described the work ongoing to scope the need and identify specific cohort sites in Pennine Lancashire where additional bed capacity can be created to provide support in an out of hospital setting, when critical care and overall hospital capacity within RBH is exceeded. He highlighted the vulnerability of the Care Sector in terms of COVID-19 and it was important to identify some alternative pathways for those who are COVID-19 positive, looking to step down into a residential care setting or a new placement in a care setting. A PL Transitional Care Cell has been established, led by Mr Walker with senior staff identified and deployed to the cell from partner organisations, to look at opportunities across the system. Potential areas included Rakehead at Burnley General Hospital, Dove Court Care Home, Gisburne Park Hospital and Pendleside Hospice. These facilities will provide 40 beds in a shielding capacity and an additional 20 beds to support the acute system through the period of the pandemic, with an opportunity to extend capacity depending on the situation at that time. Mr Walker confirmed


the pathways are available to both BwD and East Lancashire residents. Mr Hinnigan referred to the graph in Appendix A to the report which highlighted the Pennine Lancashire patient ‘hospitalisation’ numbers exceeding 1,000 in less than 2 weeks from now and over 6,000 in 6 weeks time, with over 1,500 critical care beds also needed by then and asked it these assumptions are correct? Mr Walker explained the position, pointing out the figures relate to the whole of the North West, not just Pennine Lancashire. This is the anticipated worst case scenario and work is now ongoing to understand the actual impact on the system. In terms of A&E attendance and hospitalisation, this shows a stable position currently and the curve on the worst case scenario has flattened. Professor Harrison shared information with members and outlined the NHS E model and the likely impact on the health care system. It was considered that further lockdown measures would significantly reduce the worst case scenario by two thirds. He referred to various insights on COVID-19 epidemiology and agreed to circulate information to members. He considered the best intelligence is what is happening in the hospital, pointing out that Royal Blackburn Hospital is the second most under pressure hospital in Lancashire, despite there being higher numbers of confirmed cases in Lancaster and Cumbria. Mr Hinnigan was pleased to understand the graph outlined the worst case scenario. In terms of planning, he asked what the peak position is likely to look like based on current assumptions and do we have enough beds available. Professor Harrison advised that NHS E data is not being shared with Public Health and there is a risk of overtopping demand in that more people need critical care beds that are COVID19 related. It was confirmed there are currently 153 critical care beds available across Pennine Lancashire. Dr Robinson provided feedback following a Regional discussion, when all CCG Chairs received assurance that there is sufficient hospital bed availability across the North West, supported by Nightingale hospitals. However national plans stop short at this point in forming local intermediate care arrangements which have to be considered locally, noting that Mr Walker has procured additional community bed capacity across Pennine Lancashire. In response to a query from Dr Davis, Mr Walker advised the additional beds would be used to step up from a care home setting in order to shield the system, but on the whole they would be used as a step down facility from the hospital. Dr Davis asked if there were any plans to open any more community step down beds in Pennine Lancashire considering the immense pressure likely in the hospital. Mr Walker confirmed that work is ongoing to ensure where we have the appropriate level of staffing to support this model. Dr Higgins pointed out that Mr Walker has anticipated the position and mobilised quickly to establish additional capacity across Pennine Lancashire and she thanked him for his work. The Out of Hospital Cell are working with Lancashire & South Cumbria NHS Trust to mobilise an additional 15 beds on the UCLAN site. She confirmed there are enough ventilated and critical care beds and there is a fine balance between getting enough up and running, including step down facilities. Some services have been turned off and work is now ongoing to review this and agree what can be brought back on line. The Medical Director and GP colleagues continue to review the position. Dr Robinson felt there is significant assurance that we are still delivering the


right services across the system and asked if ELHT are happy with the level of emergency services they can provide. Dr Dziobon provided feedback following the A&E Delivery Board, confirming that we are still delivering the right covid related services across the system. It was also agreed to include details in the routine communications to GPs to continue to refer patients to secondary care where necessary, using the usual pathways. If a referral is made using the two week rule, the GP should follow this up with the patient and encourage them to attend their appointment. RESOLVED: that Members support the approach taken to establish step up / discharge centres within Pennine Lancashire and paid tribute to Mr Walker for his work.

20.024 Waiving of Standing Financial Instructions (SFIs) for the Procurement of Essential Equipment / Enabling Tools Mrs Hollis, Chief Finance Officer advised that in response to the Reducing the Burden document, there may be a need to relax the Standing Financial Instructions (SFIs) and requirement to seek quotations or tenders and undertake single tender waivers in order to speed up the process of procurement for essential equipment or enabling tools on COVID-19 related expenditure. She had consulted the Audit Chairs for both CCGs and the Accountable Officer who were supportive of the proposed changes, which would be for an initial period of 12 weeks commencing on 6 April 2020. Mr Hinnigan confirmed he would support the relaxation of the existing procurement rules for an initial period of 12 weeks for Covid-19 expenditure, but only where no NHS procurement frameworks or contracts currently exist. Mrs Hollis confirmed this would apply where the CCG is unable to use suppliers on the national framework or where the supplier is unable to meet the requirements, it would be necessary to go off framework. RESOLVED: that Members supported the waiving of SFIs to speed up the process of procurement for essential equipment or enabling tools during the COVID 19 pandemic, for an initial period of 12 weeks commencing on 6 April.

20.025 Community DVT Service Redesign Procurement Mr Walker presented the report which had been considered by the Committees in Common and was due to be presented to the Governing Body for approval in March, however in view of the current circumstances around COVID-19 this was not considered. He outlined the position, confirming that the existing contracts for both East and Blackburn with Darwen CCGs are due to expire at the end of September 2020. He pointed out that to run a procurement during the current position was not realistic and in collaboration with procurement, a revised timetable had been drafted, with a request to extend the current contract for a period of 10 months to the end of July 2021. This would enable the CCGs to go out to procurement, allowing potential bidders to be engaged in the process and have time to submit a quality bid. Dr Sharma pointed out that the DVT service is requesting that a DDimer blood test is carried out before a referral is accepted and asked if this has been


agreed. Dr White referred to information on GP Teamnet which requested, where possible, that a DDimer test is helpful and valid in the first few days. He advised that the service change link on GP Teamnet had now been updated, confirming that a referral would not be rejected on the absence of a test and provided contact details for the GP to speak to the DVT service clinicians to discuss the circumstances and next steps. RESOLVED: that Members approved the longer extension of the existing EL and BwD CCGs contracts for a period of 10 months to the end of July 2021. ACTION: Communication to be issued on General Practice to ensure a clear message is conveyed regarding DDimer testing.

Comms Team

20.026 Incident Room Decisions Mrs Hollis presented the report which provided a record of how key decisions have been made within the PL CCGs Incident Room. She advised that decisions ranged from making changes to the way the CCGs are working and provided a record of how guidance has been interpreted and where resources have been committed. The Incident Control Centre (ICC) is operating as a major incident with Loggists in place to record all decisions and keep back up documentation. Part of the function of the ICC is to record and maintain records in terms of what is behind some of the decisions made. Mr Hinnigan referred to the decision to purchase new laptops for Primary Care Teams and asked a number of questions, given the significant sum involved. In response, Mrs Hollis confirmed that the laptops were purchased to allow the primary care workforce to work remotely, allowing them to continue to operate offsite. Equipment is being provided to General Practitioners, Practice Nurses and Receptionists who are currently working differently and remotely. An assessment of existing equipment was made and the laptops were ordered based on the GP IT Replenishment Programme which would have taken place in the new financial year. However this was brought forward due to the current position, providing 100 laptops for BwD CCG and 220 for EL CCG. A further supply of 281 laptops have been allocated from the central suppliers, providing a total of 601 new laptops to support primary care. The equipment was purchased via the existing NHS procurement framework and had to meet a specific standard, to include a smart card, camera, microphone and security systems. It was delivered quickly and is in the process of being configured and distributed to primary care staff. In terms of allocations, Mrs Lisa Cunliffe, Senior Transformation, Quality & Delivery Manager is working with colleagues to identify primary care requirements and need. One or two laptops would be allocated to each practice, however some of the smaller practices have their own and do not require any additional equipment. Dr Higgins paid tribute to Mrs Hollis and Mr Parr for taking forward the work in the Incident Command Centre in their exemplary Commander Roles, supported by the Senior Directors. RESOLVED: that Members receive the report and supported the key decisions made in the Pennine Lancashire CCGs Incident Room.


20.027 Personal Protective Equipment (PPE) Following a lengthy discussion, Members supported the work ongoing in relation to the supply of PPE equipment to primary and community care and the wider social care sector. In view of the difficulties experienced with the supply through the national system and the anxieties in general practice, a PPE Cell has been established, led by Mr Alex Walker. Members received a proposal for the PL CCGs to bolster PPE equipment to provide the appropriate level of protection for our staff. RESOLVED: that Members unanimously approved the investment for Personal Protective Equipment.

ACTION: A cost proposal to be developed for the purchase of PPE to support staff across Pennine Lancashire.

AW

20.028 Key Verbal Updates Mr Burgess highlighted the need to review the Risk Register in terms of interventions that are not currently being provided due to the COVID 19 pandemic and requested a review of the Risk Register at the May meeting. In response, Mrs Hollis confirmed that the ICC held a Risk Register which included anecdotal issues received through the various channels which is regularly reviewed. A number of areas highlighted issues whereby patients are not attending hospital appointments due to a fear of going into the hospital setting and the risk of infection. ACTION: Review of the Risk Register at the May GB meeting to highlight the areas that have been identified during the COVID 19 pandemic.

20.029 Any Other Business 20.029.1 Lay Member – Equality & Inclusion The Chair advised Members that due to a change in circumstances, Mrs Naz Zaman, Lay Member for Equality & Inclusion for EL CCG had taken the decision to step down from her role on the Governing Body. He was very grateful to her for her commitment and the time she put in to her role with the CCG. 20.09.2 May Governing Body Agenda Mr Hinnigan requested that the following areas be addressed at the next meeting of the Governing Body.

Services that are not currently being provided in primary care and at ELHT due to the COVID 19 pandemic and has the potential impact been risk-assessed?


Current A&E position in terms of activity levels and waiting times. 20.029.3 Closing Remarks Dr Robinson wished to give his personal thanks to Dr Julie Higgins for her work and excellent leadership of the Executive Team and thanked everyone for their work and approach throughout this time.


20.030 Next Meeting RESOLVED: that the next meeting of the Governing Body would be held virtually via Microsoft Teams on Wednesday, 13 May 2020 at 1pm.

NHS Blackburn with Darwen CCG

Summary Governing Body Report - March 2020

Programme Costs

£000

Administration Costs

£000

Expenditure

£000

Revenue Resource Limit

Confirmed (279,289) (3,613) (282,902)

Total Revenue Resource Limit (279,289) (3,613) (282,902)

Expenditure

Commissioning (Page 2) 273,216 0 273,216

Corporate (Page 4) 3,539 0 3,539

Reserves (Page 4) 0 0 0

Healthcare Sub Total 276,755 0 276,755

Running Costs (Page 4) 0 3,447 3,447

Total Expenditure 276,755 3,447 280,202

Surplus/(Deficit) 2,534 166 2,700

Better Payment Practice Code YTD Value (%) YTD Volume (%) Target (%)

NHS99.9 99.7 95.0

Non NHS99.6 99.8 95.0

Cash £

Annual Cash Drawdown282,819,201

Actual Cash Drawdown277,194,752

Bank Account and Petty Cash Float Balance at

31st March 2017 192,865

APPENDIX A

Page 1

1

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP COVID-19 : Virtual Discussion

Blackburn with Darwen CCG Governing Body and East Lancashire CCG Governing Body Meeting in Common

Report Title: Chief Finance Officer Report Agenda No:

3.1

Meeting Date: 13 May 2020 – Virtual Discussion

Summary of Report: This report outlines the summary financial position for NHS Blackburn with Darwen CCG at March 2020

Report Recommendations: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of March 2020.

Financial Implications: None

Procurement Implications: None

Report Category:

Support and recommend/forward the report.

Tick

Approve the recommendations outlined in the report.

Debate the content of the report.

Receive the report for information. Y

Author:

Mrs Linda Ring, Finance Manager

Report supported & approved by your Senior Lead? Y

Presented By: Mr Roger Parr, Chief Finance Officer and Deputy Chief Officer

Other Committees Consulted: None

Privacy Impact Assessment (PIA)

Has a PIA been completed in respect of this report? N

If Yes, please attach If No, provide reason below.

Equality Impact Analysis (EIA)

Has an EIA been completed in respect of this report? N


Data Protection Impact Assessment

Is a Data Protection Impact Assessment Required? N

Risks: Have any risks been identified / assessed? Ref no: 2019/04 & 2019/05

Y

Conflict of Interest: Is there a conflict of interest associated with this report? N

Clinical Engagement: Has any clinical engagement/involvement taken place as part of the proposal being presented.

N

Patient Engagement: Have patients been involved in the drafting of this report? N

Privacy Status: Can the document be shared Y

CCG Corporate Objectives :

CO1 To commission the best quality and effective services to deliver optimal healthcare outcomes for our local population.

CO2 Ensure the balance of our health investment reflects our population’s needs and keeps the population well.

Y

CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management strategies.

CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the needs of our population.

CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above, the national average in the next 10 years.

2

Executive Financial Summary Month 12 – Period Ending 31

st March 2020

Actual

£000

Funds Available 282,902

Commissioning 217,181

Primary Care 56,035

Corporate 6,986

Reserves 0

Balance 2,700

Summary Financial Position – The CCG is reporting a year end surplus of £2,700k in line with the surplus agreed with NHS England. The figures remain provisional at this stage and will be confirmed following the completion of the external audit review. The draft Annual Accounts were submitted on 27th April 2020. The final accounts will be presented to the Audit Committee in May 2020 for final approval.

Financial Duties

The CCG has achieved its financial duties for the year i.e.

expenditure not to exceed income, and running costs to be

maintained within the amount specified.

The CCG received an allocation of £2,700k for digitisation of

primary care Lloyd George records which was not spent in

2019/20 and has therefore reported an in-year surplus. The CCG

will carry forward the allocation to 2020/21.

Key performance Indicators

During 2019/20, a maximum cash drawdown was set by NHS England as shown in Appendix A. At the 31

st March 2020, the

CCG had a cash balance of £193k.

Better Payment Practice Code – for both NHS and Non NHS invoices, the CCG has achieved its target of 95% for both number and value.

Risks

The year-end position includes a number of assumptions which have yet to be finalised and a small risk remains. The main area is prescribing costs where expenditure is based on actual expenditure to February with an estimate for March.

QIPP

The CCG achieved QIPP savings of £6,000k achieving its QIPP target for 2019/20.

Capital

A combined budget for hardware replacement of the GPIT estates, provision of infrastructure, mobility working and operating software was approved by NHS England on behalf of the CCG. Expenditure of £242k has been achieved in 2019/20.

Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the overall financial position of the CCG at the end of March 2020.

NHS East Lancashire CCG

Summary Governing Body Report - March 2020

Programme Costs

£000

Administration Costs

£000

Expenditure

£000

Revenue Resource Limit

Confirmed (655,052) (8,088) (663,140)

Total Revenue Resource Limit (655,052) (8,088) (663,140)

Expenditure

Commissioning (Page 2) 633,238 0 633,238

Corporate (Page 4) 1,505 0 1,505

Reserves (Page 4) 0 0 0

Healthcare Sub Total 634,744 0 634,744

Running Costs (Page 4) 7,181 7,181

Total Expenditure 634,744 7,181 641,925

Surplus/(Deficit) 20,308 907 21,215

Better Payment Practice Code YTD Value (%) YTD Volume (%) Target (%)

NHS99.5 97.5 95.0

Non NHS98.1 98.1 95.0

Cash £

Annual Cash Drawdown648,433,347

Actual Cash Drawdown645,800,104

Bank Account and Petty Cash Float Balance at

31st March 2020 188,303

APPENDIX A

Page 1

1



Report Title: Chief Finance Officer Report Agenda No:

3.2

Meeting Date: 13 May 2020 – Virtual Discussion

Summary of Report: This report outlines the summary financial position for NHS East Lancashire CCG at March 2020

Report Recommendations: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of March 2020.



Report Category:


Tick




Author:

Mrs Deidre Lewis, Deputy Chief Finance Officer


Presented By: Mrs Kirsty Hollis, Chief Finance Officer and Deputy Chief Officer










Risks: Have any risks been identified / assessed?

Y



N






Y



CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or about, the national average in the next 10 years.

2

Executive Financial Summary - Month 12 – Period Ending 31st

March 2020

Actual

£000

Funds Available 663,140

Commissioning 505,881

Primary Care 127,357

Corporate 8,687

Reserves 0

Balance 21,215

Summary Financial Position – The CCG is reporting a year end surplus of £21,215k in line with the surplus agreed with NHS England. The figures remain provisional at this stage and will be confirmed following the completion of the external audit review. The draft Annual Accounts were submitted on 27th April 2020. The final accounts will be presented to the Audit Committee in June 2020 for final approval.

Financial Duties

The CCG has achieved its financial duties for the year i.e.

expenditure not to exceed income, and running costs to be

maintained within the amount specified.

COVID 19

The CCG received funding from NHS England of £736k in

2019/20 for the purchase of laptops £310k and various items of

revenue expenditure of £426k.

Key performance Indicators

During 2019/20, a maximum cash drawdown was set by NHS

England as shown in Appendix A. At the 31st March 2020, the

CCG had a cash balance of £188k.

Better Payment Practice Code – for both NHS and Non NHS invoices, the CCG has achieved its target of 95% for both number and value.

Risks

The year-end position includes a number of assumptions which have yet to be finalised and a small risk remains. The main area is prescribing costs where expenditure is based on actual expenditure to February with an estimate for March.

QIPP

The CCG delivered QIPP savings of £12,720k for 2019/20 via a number of both recurrent and non recurrent schemes and other mitigations.

Capital

A combined budget for hardware replacement of the GPIT estates, provision of infrastructure, mobility working and operating software was approved by NHS England on behalf of the CCG. Expenditure of £1,560k has been achieved in 2019/20.

Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the overall financial position of the CCG at the end of March 2020.


COVID 19

Decision and Accountability Framework


Report Title: Coronavirus Cost Reimbursement Agenda No:

3

Meeting Date: 13 May 2020 – Virtual Consideration

Summary of Report: This report outlines the principles and process for reclaiming Covid-19 costs incurred by the CCGs

Report Recommendations: Note the content of the report Accept an update at a future meeting should the reimbursement regime be amended by NHSEI



Report Category:


Tick




Author:

Mrs Jill Marr, Deputy Chief finance Officer


Presented By: Mr Roger Parr, Chief Finance Officer and Deputy Chief Officer





Equality Impact Analysis (EIA) Has an EIA been completed in respect of this report?

N If Yes, please attach If No, provide reason below.



Risks: Have any risks been identified / assessed? Ref no: 2019/04 & 2019/05

Y



N






Y






13 MAY 2020

Coronavirus Cost Reimbursement 1. Introduction

1.1 The Government have announced additional measures to seek to reduce the spread

of coronavirus across the country with the NHS expected to come under intense pressure. NHS England and NHS Improvement (NHSEI) have set out the cost reimbursement arrangements and amended financial arrangements for the NHS for the period between 18th March and 31st July

1.2 All NHS providers and commissioners must carefully record the costs incurred in

responding to the outbreak and will be required to report actual costs incurred on a monthly basis. Accurate record keeping during this time is crucial and must meet the requirements of external audit, and public and Parliamentary scrutiny

2. Governance

2.1 Approvals and recording of expenditure:

2.1.1 The CCG’s Senior Directors via the Incident Control Centre are responsible for approving all covid-19 specific expenditure requests. Requests and supporting documentation is filed to support the decisions. The GB received a summary of the decisions made on the 15th April.

2.1.2 All expenditure is allocated to a unique Covid-19 financial code within the Integrated Single Financial Environment (ISFE) payments system, to ensure all costs can be identified and reclaimed.

3. Expenditure incurred up to 31st March 2020

3.1 Revenue Costs:

3.1.1 Costs such as patient facing services, consumables, Personal Protective Equipment (PPE) and other low cost equipment are classed as revenue costs.

3.1.2 CCG revenue costs are funded by a Revenue Resource Limit which can be increased by NHSEI to take into account new costs and services.

3.1.3 The CCGs were required to submit claim forms to NHSEI using a template with predetermined categorisation to allow consistent national data to be collected.

3.1.4 The data collection exercise for March 2020 was completed and submitted on the 8th April for both BwD and EL CCG. The costs submitted were £107k for BwD and £427k for EL CCG. Although costs were incurred and charged to the two individual CCGs, most of the new equipment and services related to the whole of Pennine Lancashire. Details can be seen at appendix 1

3.1.5 Both CCGs received additional Revenue Resource Limit (RRL) on the 17th April which fully reimbursed the above costs. The CCG’s final accounts reflect the above costs and the additional RRL.

3.2 Capital Costs – Primary Care IT:

3.2.1 Both BwD and EL CCGs agreed to purchase additional IT equipment for Primary Care to facilitate none face-to-face consultations. The equipment

included Laptops and Webcams. The cost of this equipment is classed as capital under financial rules.

3.2.2 The data collection exercise for March 2020 was completed and submitted on

the 8th April for both BwD and EL CCG. The costs submitted were £130k for BwD and £310k for EL CCG.

3.2.3 The ownership of Primary Care IT ultimately resides with NHSEI, therefore

the cost of this equipment was recharged to NHSEI via debtor invoices and netted off to zero in the CCG accounts. This is consistent with the treatment of the usual GP IT capital expenditure.

4. Expenditure 1st April to 31st July 2020

4.1 Costs are approved by the Senior Directors following the governance process in section 2 above. 4.1.1 Guidance is expected on the 5th May 2020 setting out the reimbursement

regime and timetable for 2020/21.

4.1.2 Indications are that the CCGs will be expected to report the April costs to NHSEI on the 15th May 2020, using a similar predetermined template to that used for March 2020 expenditure. The provisional reimbursable expenditure for April is shown at appendix 2.

4.1.3 The funding mechanism for revenue costs will be an increased Revenue Resource Limit.

4.1.4 Should the CCG need to purchase additional capital equipment after the 1st April, a bid will have to be submitted to NHSEI for approval, prior to any purchases being made.

4.2 Contractual payments and provider reimbursement

4.2.1 NHS providers will be provided with a guaranteed minimum level of income reflecting the cost base at the end of 2019/20 as calculated by NHSEI. Commissioners will agree block contracts with NHS providers with whom they have a contract to cover period 1 April to 31 July. The block contracts mandated by NHSEI include NHS Acute, Community and Mental Health Providers.

4.2.2 Other providers, non-NHS community and Primary Care will be paid as per

the contracts already in place, if they have continued to provide services. All Independent Sector acute activity has been contracted by NHSEI and will be paid by them for the period 23rd March to 31st July.

4.2.3 Payment of April to July block contracts will be paid in in 4 equal payments in

advance. 1st April, 15th April, 15th May and 15th June. Payments should not be revised to reflect any short falls in normal contractual performance during this period.

4.2.4 Trusts will suspend invoicing for non-contracted activity for the period 1 April

to 31 July.

4.2.5 2020/21 planning was suspended following submission of the draft operating plan and therefore does not reflect the cost of the block payments as described above. CCGs will set budgets based on the draft operating plan, for monitoring purposes and await guidance from NHSEI on the reimbursement regime to cover any variances.

4.2.6 NHSEI are also currently considering how the NHS moves back to “business as usual” and how the cost of transacting this activity, with covid-19 still prevalent, will be funded through CCGs to Providers.

5. Recommendations

The Governing Bodies are requested to:

Note the content of the report and process being followed.

Accept an update at a future meeting when the reimbursement regime for 2020/21 has been clarified by NHSEI

Roger Parr Deputy Chief Officer/Chief Finance Officer 1st May 2020

Appendix 1

Costs reimbursed in March 2020

Appendix 2

Provisional estimate of costs reimbursable in April 2020

Service PL Cost Bwd EL Reimbursed

£000's £000's £000's

REVENUE

PPE for Air Liquide 1.1 0.3 0.8 Mar-20

Easter cover in PC 72.0 6.0 66.0 Mar-20

EOL drugs in Pharmacies 3.2 3.2 Mar-20

Hospital Discharge Programme 44.0 16.0 28.0 Mar-20

Iplato addil SMS messages 18.6 9.3 9.3 Mar-20

Pulse Oximeters 2.4 2.4 Mar-20

CCG IT 29.0 29.0 Mar-20

Spider Phone 0.6 0.6 Mar-20

PPE in practices sourced through ELMS 80.0 24.0 56.0 Mar-20

Social Care review 18.0 18.0 Mar-20

Additional VPNs 27.0 27.0 Mar-20

Room hire 0.3 0.3 Mar-20

Telemedicine 238.0 238.0 Mar-20

534.2 107.1 427.1

CAPITAL

Primary Care IT/Webcams/EMIS etc 440.0 130.0 310.0 Mar-20

974.2 237.1 737.1

Service PL Cost Bwd EL Reimbursable

£000's £000's £000's

REVENUE

Hospital Discharge Programme 24.6 24.6 Apr-20

Additional DVT Services 1.3 1.3 Apr-20

Primary Care sustainability funding 605.9 178.3 427.6 Apr-20

Dual Registered Care Homes - Community Nursing 21.0 21.0 Apr-20

652.8 225.2 427.6

NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP NHS EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Page 1 of 3

COVID-19

Report to Governing Bodies : Wednesday, 13 May 2020

Pennine CCG Incident Room Decisions - Governing Body Update

Agenda Item: 5

Decision Ref.

Brief Description What the decision is? Financial Value (£s)

Overseeing Forum

216

Sustaining IHA and Section 47 Medicals

To ensure sustainability over the acute and longer term impact of COVID-19 (20/21) for all IHA’s and Section 47 medicals SDs supported the proposal.

£131,888 Senior Directors Command Cell (3:30pm 14/04)

253

Increase to Kooth contract SDs agreed the uplift for the Kooth contract for a 6 month period to address the increase in demand for provision


268

Homely Remedies Policy SDs agreed to adopt the Homely Remedies Policy SDs approved the costings for the policy

£2,000

Senior Directors Command Cell (3:30pm 15/04) Senior Directors Command Cell (11 am 22/04)

177

End of Life Drugs OOH SDs did not approve proposal to commission ELMS to deliver service for 12 weeks at a cost of circa £200k (based on worst case scenario). Paper to be reviewed.

£200,000 Rejected Senior Directors Command Cell (11 am 16/04)

274

Mental Health Support to Recovery Pathway

SDs agreed to support a proposed to commission a Mental Health Nurse directly from LSCFT. The individual will support all elements of the bedded recovery pathway (D2A beds, peripheral hospital sites, Gisburne Park, Pendleside Hospice and Dove Court) and will be linked closely with the Integrated Discharge Service at ELHT for period 20/04/20-20/07/20.


282

Increase to on call Psychiatric cover

SDs agreed a proposal to increase Psychiatric on call cover for a period of 12 weeks, with a 3 week review, at a cost of £56,000.

£56,000 Senior Directors Command Cell (11 am 22/04)


Page 2 of 3

295 Homeless Model SDs approved Option 3 of the Police Covid-19 Rough Sleeping Protocol for Lancashire for further development

Senior Directors Command Cell (3.30 pm 1/5)

297

Homely Remedies

Costs for the implementation of the Homely Remedies Policy supported by SDs.

Up to £2,000 Senior Directors Command Cell (11 am 22/4)

309 PPE and Care Homes Support

SDs approved proposal for Telemedicine for Care Homes and PPE disposable gowns Cost for Telemedicine £15.50 & VAT per unit Cost for gowns £2.45 each

£2,325 £12,250


311/322 Care Home Failure Plan Produced by Lancashire County Council (Log 311 superseded by Log 322)

313 Care Home Proxy Access Protocols for proxy access for online ordering of medicines supported by SDs

Senior Directors Command Cell (11 am 29/4)

317 Primary Care Cover for Bank Holiday 8/5/20

SDs agreed process for Primary Care cover for Bank Holiday 8/5/20

Senior Directors Command Cell (11 am 27/4)

177 OOH EOL medication storage and supply

SDs agreed to support the proposal to support second-on call when activated in relation to COVID activity and delegate decision re reasonable set-up costs incurred by ELMS to Kirsty Hollis.

TBC

320 Increased funding for ADHD/ASD

SDs supported request for uplift of funding of £34,315 for both organisations to meet demand and continue their offer of support for families, children and young people at this very challenging time.

£34,252 Senior Directors Command Cell (11 am 29/4)

E833 Recovery beds at Pendleside

SDs approved service specification and amended costs for Pendleside beds; including PPE. SDs previously agreed funding of £273,676 for the procurement of recovery beds on 2/4/20.

£180,924


E967 Funding request for POC machines

SDs did not approve request for use of POC machines in Pendle West and Ribblesdale PCNs over the next few months and thus request funding for 4 machines (approximately 10K-12K depending on type of machine available).

Approx £10,000-£12,000

Rejected Senior Directors Command Cell (11am 2/5)

Weekly H&WB survey Offer from HR at CSU to undertake a weekly H&WB survey with results published and additional support signposted where necessary supported by SDs.

Senior Directors Command Cell (11am 4/5)


Page 3 of 3

CDs PCN work

SDs supported that the sum of £37,500 for EL and £16,000 for BwD, which equates to 2 sessions per CD for six weeks be paid to CDs for onward disbursement. It was noted that this will test working arrangements of CDs. It was also recognised that any future work be planned, including a specification and remuneration.

£37,000 £16,000

Senior Directors Command Cell (11am 4/5)

E975 PPE Request for nitrile gloves – 900k pairs Cost £254,700 & VAT. Supported by SDs.

£305,640 Senior Directors Command Cell (11.45 am 2/5)

Personal broadband Some broadband suppliers have offered to make charges exempt for key workers for a period of 3 months. They require employers to sign this off. We therefore need an internal process. SDs agreed for DA to sign off eligibility for Primary Care colleagues.

NIL Senior Directors Command Cell (3.30 pm 4/5)

RECOMMENDATION : Members are asked to support the decisions made and receive the report for assurance.

Mr Roger Parr

Deputy Chief Officer / Chief Finance Officer

Mrs Kirsty Hollis

Deputy Chief Officer / Chief Finance Officer

Achieving and Sustaining Performance

against the Pennine Lancashire

4 Hour Performance Trajectory

Agenda Item: 6

COVID-19

Report to Governing Bodies : Wednesday, 13 May 2020

Current and potential future standards Current standard:

The clock starts from the time that the patient

arrives in A&E and stops when the patient leaves

the department on admission, transfer from the

hospital or discharge.

Pilot standards:

1. Time to initial clinical assessment in

Emergency Departments and Urgent

Treatment Centres (type 1 and 3 A&E

departments).

2. Time to emergency treatment for critically ill

and injured patients.

3. Time in A&E (all A&E departments and

mental health equivalents).

4. Utilisation of Same Day Emergency Care.

Why does it matter?

Patient safety and outcomes (type 1)

Constitutional standard

Patient Experience System measure

4 hour A&E standard

Monthly Attendances – 31st March 2020

Dec Jan Feb Mar

Dec19-

Mar20 Type 1 64.15% 71.21% 70.19% 76.42%

Dec19-

Mar20 Type 3 96.77% 98.54% 98.85% 97.26%

Performance Weekly Rank (all types)

Week ending National Region %

15th March 2020 57/123 22/44 82.33%

22nd March 2020 28/123 11/44 90.98%

29th March 2020 47/123 17/44 87.27%

5th April 2020 60/123 25/44 85.13%

12th April 2020 66/123 26/44 87.61%

19th April 2020

61/123 24/44 91.80%

26th April 2020 29/123 9/44 95.43%

3rd May 2020 94/123 39/44 90.52%

Ambulance Handover trend

Handover HAS

• In January 2020, Royal Blackburn Hospital received a total of 3870 ambulances.

• Average ambulance turnaround time for January 2020 was 30 minutes. This is a substantial improvement when

compared to January 2019.

Graph to show monthly DTOC position

Reducing longer LOS trajectory and

action plan

• ELHT’s LLOS position is now significantly under the set requirement

and this position has sustained for the last 6 weeks.

• The position is as a result of the current situation, reduction in hospital

attends and ELHT’s sustained reduced bed occupancy with a specific

focus on planning for discharge from admission.

Mental Health Dashboard

Winter 2019/20 – What we have done. A robust Pennine Lancashire winter plan and mobilisation of the following

winter schemes: Area Scheme

Escalation & Capacity Management System

Seasonal Flu Vaccination

Primary Care Resilience & Walk-In Demand:

Increase extended access capacity

Hot Spot Day analysis across Pennine Lancashire services

Reactive Sub-Acute Response:

Increase IHSS capacity in BwD

Falls Response Service (L&SC development)

Weekend MEC Mulit-Disciplinary Teams (Monday Surge)

Clinical Site Management 24/7 7 days per week

Ward 19

Implement revised Emergency Surgical model to release 18 Fastflow Medical Beds (B20)

SAS/MEC Overnight Combined Ambulatory Unit

Additional Patient Services support

Speech & Language & Dietetics

Pharmacy in Reach in to ED

Paediatric In Reach into ED

Radiology Scanning & Reporting

Additional Dr Shifts in UCC

Point of Care - FLU

Perfect week w/c 4th November 2019 and 13th January 2020

Ambulance Liaison Officer role

Phlebotomy early morning service

Dedicated LLOS team

Increase ED majors cubicles by 7 to support reduction in corridor care

In-Hospital Flow PTSPatient Transport Services

Out of Hospital

Complete

Live

Live (2nd Dec 19)

Live (18th Nov 19)

Live (18th Nov 19)

Live (18th Nov 19)

Live (16th Dec 19)

Live (Jan 20)

In-Hospital Flow

ELHT Schemes

On track, go live 24th

Feb 2020

On Track -

Go live 20th Nov 2019

Complete

Live (2nd Dec 19)

Live (28th Dec 19)

Live (2nd Dec 19)

Live

Live

Live

Live

Live

Live (30th Nov 19)

RAG Rating

System live, data feeds

in

Live

Live (2nd Dec 19)

Live (2nd Dec 19)

National challenge

• Demand: – complexity and acuity has increased,

leading to more investigations and treatments in A&E departments

– relatively small demand growth but sensitive to these changes

• Supply: – inpatient bed occupancy levels risen

– staffing not kept pace with casemix changes

• Practice factors: – more tests and investigations

– threshold for admission has increased leading to more complex patients being discharged from A&E

• Emergent factors: – less resilient… days to recover not

hours

Link between type 1 performance and bed occupancy

Bed Occupancy

ACCESSING THE SYSTEM URGENT, EMERGENCY & ACUTE CARE IN-HOSPITAL FLOW HOSPITAL TO HOME WINTER PLANNING AND ESCALATION

SRO: Elizabeth Fleming

Deputy SRO: Stuart Hayton

SRO: Sharon Gilligan

Deputy SRO: Jillian Wild

SRO: Sharon Gilligan

Deputy SRO: Jillian Wild

SRO: Alex Walker /Tony McDonald

SRO: Tony McDonald

Deputy SRO: Elizabeth Fleming

Drivers

NHS Long-Term Plan:

- By 2023, CAS will typically act as the single point of

access for patients, carers and health professionals for

integrated urgent care and discharge from hospital care.

Drivers

NHS Long-Term Plan:

- Provide SDEC services at least 12 hours a day, 7 days a week by the end of 2019/20

- Provide an acute frailty service for at least 70 hours a week. They will work towards

achieving clinical frailty assessment within 30 minutes of arrival

- Aim to record 100% of patient activity in A&E, UTCs and SDEC via ECDS by March 2020

- Test and begin implementing the new emergency and urgent care standards arising from

the Clinical Standards Review, by October 2019

Drivers

NHS Long-Term Plan:

- The goal over the next two years is to achieve and maintain an average

DTOC figure of 4,000 or fewer delays and over the next five years to

reduce them further

- As well as the enhanced primary and community services response , we

will achieve this through measures such as placing therapy and social work

teams at the beginning of the acute hospital pathway, setting an

expectation that patients will have an agreed clinical care plan within 14

hours of admission which includes an expected date of discharge

- Implementation of the SAFER patient flow bundle and multidisciplinary

team reviews on all hospital wards every morning.

Drivers

NHS Long-Term Plan:

- The NHS and social care will continue to improve performance at getting people home

without unnecessary delay when they are ready to leave hospital

- The goal over the next two years is to achieve and maintain an average Delayed Transfer

of Care (DTOC) figure of 4,000 or fewer delays and over the next five years to reduce

them further

- Increase the capacity and responsiveness of community and intermediate care services

- Urgent response and recovery support will be delivered by flexible teams working across

primary care and local hospitals, developed to meet local needs

Drivers

Organisational and system pressures

Correspondence from National Director of Urgent & Emergency Care

re: Winter Planning

Delivered so far 2019/20:

Establishment of ‘on scene’ referral pathway for paramedics to be able to pass patients to IHSS across Pennine Lancashire as an alternative to hospital

Develop a draft Pennine Lancashire long-term model for ‘Same Day Primary Care’ (the scope potentially includes UTC’s, OOHs, CAS, AVS and Primary Care extended access)

UTC working group now established to support operational and estates delivery

plan (Sept 2019)

Implementation of Falls Pick Up service across ICS footprint to allow 24/7/365

rapid response to fallers who have rung 999 (Oct 2019)

AEDB Ambulance & Walk-In Demand Workshop held July 2019.

AEDB Safely Reducing Avoidable Ambulance Conveyance Workshop held

October 2019.

Complete a stocktake of conveyance avoidance schemes and scope

opportunities for the future. See workshop write up. (Nov 2019)

Implement plan to support resilience of Primary Care across winter 2019/20.

See schemes on Winter Plan Exception report. (Nov 2019)


Maximise Same Day Emergency Care via participation in the national Ambulatory Emergency Care Accelerator

Programme and evaluations of component parts:

RAU (Jun 2019)

AEC Network site visit held 2nd October to undertake initial review.

Low risk chest pain direct to AECU pathway commenced (Jul 2019)

Engaged and completed Ambulance Turnaround Programme (Apr 2019)

Re-embed previous minors SOP (Aug 2019)

Fortnightly report to Operational Executive meeting in relation to 4 hour performance and breach themes. (Sept

2019)

ED/UCC rotas re-profiled and updated to link with demand. Implemented new trainee rotas in Aug 2019,

complete implementation for substantive staff (Sept 2019)

GIRFT visit for Emergency Medicine on 17th October. Awaiting report (Oct 2019)

Project Manager and project structure in place to deliver Acute Medical model of care for Phase 6 (Nov 2019)

In-house Ambulance Liaison Officers to commence in post (Nov 2019)

Working with external recruitment support to enhance ED Consultant recruitment. (Nov 2019)


Commission Patient Transport Services resource from April 2019.

Value Stream Analysis (VSA) completed for the Clinical Flow function (Jun 2019)

Effective Flow Board now established and meeting fortnightly from August 2019.

Weekly Improvement Dashboard in place (Aug 2019)

27% increase in activity through the Discharge Lounge in the last 2 months. Work continues to

maintain and further improve utilisation. (Sept 2019)

OPRA Improvement Event held 25th September, outputs to be reported. (Oct 19)

OPRA assessment area opened creating 9 assessment spaces operating from 07:30-18:30 7

days a week. (7th Oct 2019)

Perfect Week held 4th – 8th November 2019.

Additional PTS winter support (Dec 2019)

Patient Transport Services – Review resources ahead of winter via Lancashire & South Cumbria

Task and Finish Group (Dec 2019)

Perfect week held 13th – 17th January (Jan 2020)


Reviews of the following service components to report to Intermediate Care Programme Board:

Discharge to Assess (May 2019)

Care Home Select (March 2019)

AGE UK Hospital Aftercare (March 2019)

Peripheral Site Review (May 2019)

Continue to work with voluntary and community sector services to more closely embed them within the Home

First pathway (Jan 2019)

Weekly LLOS reviews commenced (Oct 2019)

Perfect Week held 4th – 8th November 2019.

LCC Intermediate Care Review completed, awaiting refinements - ICS Workshop to be held 29/11/2019 (Nov

2019)

Develop longer term model for Discharge and Recovery, which is aligned with the development of

neighbourhood models of care, with an associated phased delivery plan. (Nov 2019)

Integrated Community Care Programme Board established overseeing out of hospital model (Dec 2019)

85% of CHC assessments will be completed outside of a hospital setting:

CHC VSA completed (Nov 2019)

Project groups established for Residential D2A pathway and D2A enhanced

pathway (Dec 2019)

Ongoing work around Fast Track Pathway (Jan 2020)

Project groups established as part of Intermediate Tier Work stream (Jan 2020):

Integration of non-bed based Intermediate Tier Services

Redefine bed-based Intermediate Tier Services

Develop a single Pennine Lancashire Intermediate Tier function overseeing access

and navigation


The following winter schemes are now live:

˗ Hot Spot Day analysis across PL

˗ Perfect week w/c 4th November

˗ Ward 19

˗ Falls Lifting Service

˗ Escalation & Capacity Management System

(EMS+)

˗ Seasonal Flu Vaccination Programme

˗ Increase PC Extended Access Capacity

˗ Speech & Language & Dietetics additional

recruitment

˗ Pharmacy in Reach in to ED

˗ Paediatric in Reach in to ED

˗ Point of Care FLU in ED

˗ Ambulance Liaison Officer Role

˗ Additional Dr Shifts in UCC

˗ Commission additional Patient Transport Services

(PTS)

˗ Weekend MEC MDTs (Weekend Surge)

˗ Increase IHSS capacity in BwD

˗ Clinical Site Management 24/7 7 days per week

˗ Additional Patient Services support

˗ Radiology Scanning & Reporting

˗ SAS/MEC Overnight Combined Ambulatory Care

˗ Patient Services coordinator to be based in

Clinical Flow Hub

˗ Implement revised Emergency Surgical Model

(28th Dec 19)

˗ Phlebotomy early morning service (16th Dec 19)

˗ Dedicated LLOS team (Jan 20)

˗ B20 Fast Flow Acute Medicine 18 bedded ward

(28th Dec 19)

To be delivered 2019/20:

1. Engage with system partners on the draft Same Day

Primary Care model and phased delivery plan. (Mar 2020)

2. Draft and engage on proposed UTC model for BGH site

(Mar 2020)

3. Establish AVS in East Lancashire (April 2020)

Note that there is a programme of work being developed through ICCPB

which has a key interdependency.


1. Maximise Same Day Emergency Care via participation in the national Ambulatory

Emergency Care (AEC) Accelerator 6 month Programme which commenced on 1st

October and will evaluate the following component parts:

o AECU

o OPRA

o SAECU

Work has now commenced on the chosen project which is linked to GP pathways.

1. Development of an MOU to support Internal Professional Standard – work is continuing

across specialities to establish streaming pathways (ongoing)

2. Commence the development of the Acute Medical and Medical Speciality model and

commence a workforce review (Dec 2020) – Project group is now underway; work is

progressing and reporting in to ELHT Operational Delivery Board.

3. Scoping work with Veredus to support Emergency Medicine Specialist recruitment now

complete. Work commencing to engage with potential candidates. (ongoing)

4. Funding secured from NHSE/I to support reduction in corridor care in ED. Project to

increase majors cubicles by 7, completion 21st Feb 2020, operational 24th Feb 2020.

Project plan and mobilisation group in place.

5. Planning underway for a Mental Health workshop which will include the MH model across

the emergency pathway. (Apr 2020)

6. Scoping work underway to bring forward the 111 Direct Booking in to Blackburn and

Burnley UTCs. (Apr/May 2020)


Value Stream Analysis (VSA) of Clinical Flow function with the following output work streams:

Live Sitrep prototype delivered and testing is still underway.

Programme of work with ward teams to encourage appropriate transport bookings

made earlier in the day (Ongoing)

Three further Perfect week exercises planned across 2020/21:

o March 20

o October 20

o January 21


Reduce the number of long and longer length of stay patients as a percentage of occupied beds (as per

trajectory).

Achieve the 123 patients by March 2020 and sustain the position for all of March.

Intermediate Tier Strategy paper to be shared through all governing bodies / executive boards etc. for

agreement and sign off (Nov 2019 – Mar 2020)

Increased utilisation of Home First (target of 100 patients per week):

Complete a robust review of the Home First pathway across Pennine

Lancashire (Feb 2020)

Consider patients who could be pulled to Home First / Intensive Home Support Service (IHSS) (ongoing)

Develop and commence delivery of project plans for the agreed constituent projects of Intermediate Tier work stream. (Mar 2020)


˗ Ongoing oversight of system escalation

processes

˗ Fortnightly Winter Delivery group underway to

review and refine 2019/20 winter schemes.

˗ Planning commencing for schemes across

2020/21 (ongoing)

˗ Hot Spot Day analysis commenced for Easter

2020/21.

Associated Measures / Indicators:

Attendance rates via ambulance, walk-in and telephone (including OOHs)

Pathfinder switch-offs

NWAS ‘see and treat’ / ‘hear and treat’ rates


˗ Admitted and non-admitted breaches

˗ Same Day Emergency Care activity

Ambulance turnaround times


˗ Bed occupancy (linked to reducing longer length of stay patients and

maximising assessment areas)

˗ Discharges before 1pm

˗ Weekend discharges


˗ 3.5% DTOC target

˗ Longer length of stay national trajectory


˗ All associated measures / indicators apply across

winter

PL Plan on a Page

Key Components

DEMAND HOSPITAL

FRONT END

• Walk-In

• Ambulance

• Staffing

• Estates

FLOW/

DISCHARGE

What have we delivered so far?

• Establishment of IHSS referral pathway for paramedics

• Implementation of Falls Pick Up Service across the ICS

• Recruitment of In house Ambulance Liaison Officers

• Participation in NWAS Super 6 Programme

• 7 new majors cubicles operational from 24th Feb 2020 to support reduction in corridor care

• 111 online commenced

• Roll out of extended access across Pennine Lancashire

• Development of draft PL long term model for Same Day Primary Care

• Establishment of Acute Visiting Service in East Lancashire

What is yet to be delivered?

• Engage on proposed UTC model for BGH site

• Mental Health workshop scheduled to look at MH model

across the Emergency Pathway

• 111 Direct Booking in Blackburn and Burnley UTCs

• Engage with System Partners on draft Same Day Primary Care

model

DEMAND

• Walk-In

• Ambulance


• Mobilisation of the follow assessment areas: – Respiratory Assessment Unit (RAU)

– Older Persons Rapid Assessment Unit (OPRA)

– Ambulatory Emergency Care Unit (AECU)

– Surgical Ambulatory Emergency Care Unit (SAECU)

– Emergency Surgical Unit (ESU)

• Fast Flow Acute Medicine 18 bedded ward operational

from December 2019

• 7 new majors cubicles operational from 24th Feb 2020

to support reduction in corridor care

• Re-profiled ED/UCC rotas to link with demand


• Phase 6 Acute Medical Model of Care

• Mental Health Pod

• Live Sit Rep

HOSPITAL

FRONT END

• Staffing

• Estates


• Additional PTS resource

• Perfect week sessions held Nov 2019 and January 2020

• Integrated Community Care Programme Board established

• Increased utilisation of Home First

• Recruitment of dedicated Long Length of Stay team and Recovery Manager

• Achievement of 3.5% DTOC target since Nov 2019

• Project groups established as part of Intermediate Tier Work Steam

• Improved LLOS position


• Sustain LLOS position

• Delivery of project plans for the Intermediate Tier work

Stream:

– Integration of non-bed based Intermediate Tier Services

– Redefine bed-based Intermediate Tier Services

– Develop a single Pennine Lancashire Intermediate Term function overseeing

access and navigation

• Further perfect week exercises planned for 2020/21

FLOW/

DISCHARGE

What next? • Regulator scrutiny

• Robust planning for 2020/21

• Demand management:

– Development of Mental Health pod

– Phase 6 – Acute Medical Unit

– 111 Direct booking in to UTC’s

– Live Sitrep

– AECU accelerator programme focussing on primary care

streaming pathways

Risk s for the System

• Staffing

• Demand

• Funding

• Estates

Questions??

1

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP COVID-19 : Virtual Discussion

Blackburn with Darwen CCG Governing Body and

East Lancashire CCG Governing Body Meeting in Common

Report Title: Pennine Lancashire CCGs COVID19 Swabbing Update

Agenda No:

7

Meeting Date: Wednesday 13th May 2020

Summary of Report: This report outlines the current COVID19 swabbing offer for Pennine Lancashire CCG keyworkers and the population.

Report Recommendations: Note the updates to the swabbing offers across Pennine Lancashire.

Financial Implications: N/A

Procurement Implications: N/A

Report Category:


Tick

√



Receive the report for information. √

Author:

Kim Ciraolo, Quality & Performance Manager, MLCSU


Presented By: Kathyrn Lord, Director of Quality & Chief Nurse, Pennine Lancs CCGs

Other Committees Consulted:

N/A









Risks: Have any risks been identified / assessed? Y



Y









2


Agenda Item No: 7

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body

Meeting in Common

Wednesday 13th May 2020

Pennine Lancashire CCGs COVID19 Swabbing Offer Update

1. Introduction 1.1 This report aims to provide Governing Body members with an update on the current

COVID19 swabbing offer and processes that are in place for key workers, patients and regulated care sector residents across Pennine Lancashire.

2. Purpose / Background 2.1 Keyworker Swabbing

A process is in place 7 days per week for symptomatic health and social care key worker groups and/or symptomatic household members (appendix 1). Eligible key workers are in line with current government guidelines below (as of 5th May 2020): all essential workers including NHS and social care workers with symptoms (see the

full list of essential workers) anyone over 65 with symptoms anyone with symptoms whose work cannot be done from home (for example,

construction workers, shop workers, emergency plumbers and delivery drivers) anyone who has symptoms of coronavirus and lives with any of those identified

above.

The CCGs keyworker swabbing process has been disseminated to key worker colleagues in Health and Social Care, with a template for completion and submission to the CCGs Swabbing Cell for triage and referral to a swabbing site.

2.2 Key Worker Swabbing Sites

2.2.1 NHS Provider Labs

Staff and patients are swabbed and analysed within the acute hospital laboratory.

2.2.2 Regional testing centres

Preston College

Haydock Park

2.2.3 Satellite Hubs

Old Bank Lane Car Park, Blackburn

2.2.4 Mobile Hubs

Turf Moor, Burnley – 1st – 3rd May 2020. These sites are temporary ‘pop-up’ sites and are directly bookable via the Gov.uk website.

2.2.5 Non drivers/Home testing

Home testing kits now available via Gov.uk

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

3

Military Mobile Testing Team – will operate on a single day if there is a cluster of people who do not drive. ‘Pop-up’ sites for additional provision in other areas across the county.

2.3 Patient/Resident Swabbing There are multiple pathways (appendix 2) both active and in development to provide patient/resident swabbing. These consist of locally developed plans and county wide/regionally developed plans, and representatives from the CCG, local authorities and community services are continuing discussions regarding this provision. At the time of writing (5th May 2020) the current swabbing offer is as follows:

2.3.1 Hospital inpatients

All inpatients with suspected COVID

Inpatients prior to discharge to Regulated Care Sector/Hospice Care

All non-elective admissions (incl. asymptomatic)

All elective admissions – further guidance and roll out expected w/c 4th May 2020

2.3.2 Regulated Care

PHE testing pathway (appendix 3) – updated to include individual cases and outbreaks

ELHT District Nurses (East Lancashire residents)

LSCFT swabbing team (Blackburn with Darwen residents)

2.4 Outstanding/Gaps in provision

2.4.1 Domiciliary Care/Supported Living

LSCFT may be able to provide support (Blackburn with Darwen only) dependant on capacity and demand.

Gap for East Lancashire

3. Next steps 3.1 Discussions are ongoing with colleagues across the Pennine Lancashire footprint to

address the areas where provision is outstanding:

Source/provide swabbing training to LCC swabbing team to support optimum sampling with PHE courier kits for Care Homes.

Continue discussions regarding testing provision for Domiciliary Care

Plan for roll out to asymptomatic key workers pending release of updated guidance/criteria.

4. Recommendations 4.1 Members are requested to:

Note the report

Kim Ciraolo Quality & Performance Manager

4

Appendix 1 – Keyworker Testing

5

Appendix 2 – Regulated Care Pathways

KEY

LSCFT Community Swabbing Team

(BwD)

8am – 5pm, 7 days a week

PHE Courier Kits

(self-swab and courier return to

MRI)

ELHT District Nursing Team (EL)

7 days a week

Current gap in provision

Potential to be undertaken by

LSCFT dependant on capacity and

demand

Sy

mp

tom

ati

c In

div

idu

al

req

ue

stin

g s

wa

b f

or

CO

VID

-19

Blackburn with Darwen (BwD)

Domiciliary Care

Supported Living

Nursing Home Resident

Care/Residential Home Resident

Crisis/Step Up

Hospice

East Lancashire (EL)

Domiciliary Care

Supported Living

Nursing Home Resident

Care/Residential Home Resident

Crisis/Step Up

Hospice

6

Appendix 3 – Public Health England Regulated Care Process

7

Acute trust 3

Deputy Head of Safeguarding 1

Service Lead 1

HCA 1

Refuse collection 2

Bin wagon driver 1

Team Leader 1

CCG 1

CCG Staff 1

Agency 1

HCA 1

School Nursing 1

Support Worker 1

Financial Services 1

Financial Services 1

Fire & Rescue 1

Firefighter 1

Out of hours 1

GP 1

Key worker job role Count

Household member requests received

71

Household member requests Count

Social care 23

Primary care 20

Regulated care 12

Education 5

Local Authority 2

CCG 2

Fire & Rescue 2

Hospice 1

MH Trust 1

Voluntary Sector 1

Refuse collection 1

Pharmacy 1

No. positive*

5

*test results are currently only

received from tests

undertaken by ELHT

No. people sent for

testing

157

81

Haydock 8

Testing sites

ELHT

Preston

No. requests sent to specific sites

ELHT Preston Haydock

No. household members currently inside 14 day isolation

No. key workers currently inside 7 day isolation

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 7+

Co

un

t

No. days

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 14+

Co

un

t

No. days

Key worker job role Count

Regulated care 149

Care Assistant 84

Domestic 11

Care home manager 11

Senior Care assistant 7

Unknown 6

Care Home Cook 6

Nursing Assistant 5

Registered Nurse 4

Deputy care home manager 4

Support Worker 3

Administrator 1

Regional Manager 1

Social care worker 1

Carer 1

Health and Social Care Assistant 1

Kitchen Assistant 1

HCA 1

Team Leader 1

Primary care 54

GP 12

Receptionist 12

Primary care staff 9

Practice Nurse 6

Practice Manager 4

Practice paramedic 2

HCA 2

Administrator 2

Medical Secretary 2

Pharmacy Technician 1

Advanced Nurse Practitioner 1

Locum GP 1

Social care 33

Support Worker 16

Unknown 10

Adults Senior Carer 2

Community Occupational Therapist 2

Care Co-ordinator 1

Reablement Support Worker 1

Rehabilitaiton Support 1

Education 6

Teaching assistant 5

Early Years Worker 1

Local Authority 3

Permit Inspector 1

Plumber 1

Service Lead 1

Hospice 3

Hospice staff 2

Palliative Care Support Worker 1

Pharmacy 3

Community Pharmacist 1

Pharmacy Manager 1

Dispensing Assistant 1

Key worker requests received

274W/c

06-Apr

13-Apr

20-Apr

27-Apr

04-May

11-May

18-May

25-May

169

74

56

4

3

4

3

3

1

1

1

3

5

12

1

1

1

Agency

Service requests received from

MH Trust

% eligible for testing

73%

Regulated care

Primary care

Social care

Pharmacy

Acute trust

Hospice

CCG

Fire & Rescue

Out of hours

0

0

0

0

0

0

29

0

41 32

136

114 74

0

0

2

36

105105

Total requests

received

Total requests

sent for testing

2

36

Total eligible

2

49

Financial services

74

342 249 246

School Nursing

Voluntary sector

Refuse collection

Local Authority

Education

0

20

40

60

80

100

120

140

160

06-Apr 13-Apr 20-Apr 27-Apr 04-May 11-May 18-May 25-May

Coun

t

Week commencing

Requests received Eligible Sent for testing

Regulated care Primary care

Social care Pharmacy

Acute trust Hospice

CCG Fire & Rescue

Out of hours MH Trust

Agency Refuse collection

Local Authority Education

School Nursing

Appendix 4 – Pennine Lancashire Key Worker COVID19 Testing Dashboard – as of 12pm on 06/05/20 * 3 eligible staff missed the submission deadline and will be processed in the next referral run

N.B. Data only includes swabbing requests that have been made via the CCG process. We do not have access to data via any other referral routes.

1

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP COVID-19 Decision & Accountability Framework



Report Title: Lancashire & South Cumbria Joint Committee of CCGs – 2020/21 Work Plan

Agenda No:

8

Meeting Date: 13 May 2020 – Virtual Consideration

Summary of Report: The attached generic Board paper has been received from the Lancashire & South Cumbria Integrated Care System and sets out the proposed work plan for the Joint Committee of CCGs for 2020/21 and is designed to address specific issues requiring collective decision making by the eight CCGs in Lancashire and South Cumbria. The ICS have requested that the work programme is still considered as this authorises the Joint Committee to operate once we return to a more regular pattern of meetings. It is recognised the timetable for specific decisions will have to be updated and this will be undertaken as the situation becomes clearer.

Report Recommendations: Governing Body members are asked to endorse the CCG taking decisions on this proposed work plan through the Joint Committee of CCGs.



Report Category:


Tick

Approve the recommendations outlined in the report. √


Receive the report for information.

Author:

Lancashire & South Cumbria ICS


Presented By: Dr Julie Higgins, Joint Chief Officer


The report is being presented to all Lancashire & South Cumbria CCG Governing Bodies.









Risks: Have any risks been identified / assessed? N

2

Agenda ITEM: 8

Lancashire & South Cumbria

Joint Committee of Clinical Commissioning Groups 2020/21 Work Plan

Introduction This paper sets out the proposed work plan for the Joint Committee of CCGs for 2020/21. The work plan is designed to address specific issues requiring collective decision making by the eight CCGs in Lancashire and South Cumbria. These commissioning decisions arise from several of the existing workstreams operating under the partnership of organisations known as the Lancashire and South Cumbria Integrated Care System. The work programme, attached at Appendix 1, has been developed by commissioning and other workstream leads in recent weeks and was presented in draft to the Joint Committee at its meeting in March 2020. Each workstream has been asked to be as specific as possible at this stage in the year as to the nature of the decision being requested. The Governing Body is asked to endorse the CCG taking decisions on this proposed work plan through the Joint Committee of CCGs. Context 1. The Joint Committee of CCGs was established in 2016/17 to enable the eight CCGs in

Lancashire and South Cumbria to exercise jointly an agreed number of commissioning functions in line with current legislation. The primary purpose of the Joint Committee is to take decisions on commissioning issues which are pertinent to the whole of Lancashire and South Cumbria and which arise from the Healthier Lancashire and South Cumbria (ICS) programmes of work.

2. The Pennine Lancashire CCGs are represented on the Joint Committee by Dr Richard Robinson, Chair – East Lancashire CCG, Mr Graham Burgess, Chair - Blackburn with Darwen CCG and Dr Julie Higgins, Joint Chief Officer. The Joint Committee continues to operate with an independent Chair and for 2020/21 will be holding its meetings in public on a bi-monthly basis.

3. The work programme has been developed by commissioning and other workstream leads in recent weeks. Each workstream has been asked to be as specific as possible at this stage in the year as to the nature of the decision being requested for collective decision making. Members will note therefore that the Joint Committee will be asked to review for example: clinical models, business cases, cases for change and option appraisals leading towards public consultation where plans for significant service change are proposed.

4. The work programme has also been developed in the light of the Joint Committee’s review of Terms of Reference which took place during 2019/20. This identified two levels of decision-making as follows:

a. Level 1 – where decision making authority is within the delegated authority of the Joint Committee as outlined within its Terms of Reference and where a decision(s) undertaken by the Joint Committee will be final and binding on all member CCGs.

b. Level 2 – where health and social care commissioning areas and operational functions affect/impact on the population of Lancashire and South Cumbria (or wider)

3

are considered by the Committee and any decision(s) undertaken by the Committee form the basis of endorsements and recommendations to the Governing Bodies of each member CCG and other decision making bodies.

5. It is vital to emphasise that prior to any decisions coming to the Joint Committee, clinical, commissioning, finance and other colleagues from the CCG will have been involved by each workstream in the necessary development work. The Joint Committee has already discussed a clearer process of decision-making using gateways at a number of key stages to oversee these collective programmes of work. Each programme also has an agreed programme governance structure through which the ICS’s partners can review progress.

6. A more detailed timetable is now being developed for the Joint Committee to indicate when decisions on this work programme are anticipated during 2020/21. This will enable local Governing Bodies and CCG executive teams to plan more clearly for involvement on the issues under review.

7. Given the breadth of the agenda for commissioners in Lancashire and South Cumbria, it is possible that the work programme may need to be updated later in 2020. This will obviously be undertaken in line with expected governance arrangements involving CCG Governing Bodies.

Recommendation The Governing Body is asked to endorse the CCG taking decisions on this proposed work plan through the Joint Committee of CCGs DR JULIE HIGGINS Joint Chief Officer

4

Appendix 1

________________________________________________________________________________________________________________________________

Joint Committee of the Lancashire & South Cumbria Clinical Commissioning Groups

2020/21 Work Programme

5

Area 1: Committee Administration & Operation Service/ Subject Executive

Sponsor

Description Key Output Level of Decision

making

Committee

Administration

Andrew Bennett Holding of Committee meetings

Committee Agendas and papers

Committee minutes

Publication of notice of meetings

Approval and publication of Committee Agendas and papers

Approval of Committee minutes and ensure publication of minutes

on each CCG website

Approval of progress against Workplan and ensure publication

within each CCG annual report of progress

Approval of Quarterly and Annual Committee Reports to each CCG

Governing Body

Review of self-assessment.

Review of progress against Annual Workplan

Committee Self-assessment.

Delivery of the statutory

role, responsibilities and

Accountabilities as set-out in

the TOR’s.

Annual Committee report to

CCG Governing Bodies

Level 1

Committee

Administration

Andrew Bennett Review annual work plan and submit amendment recommendations

for adoption to each CCG Governing Body / GP memberships

Review Committee TOR and submit amendment recommendations

for adoption to each CCG Governing Body / GP Memberships.

Annual Committee Work

plan

Committee TOR

Level 2

Decision making authority level definition:

Level 1: where decision making authority is within the delegated authority of the Joint Committee as outlined within its Terms of Reference and where a decision(s)

undertaken by the Joint Committee will be final and binding on all member CCGs

Level 2: where health and social care commissioning areas and operational functions affect / impact on the population of Lancashire & South Cumbria(or wider) are

considered by the Committee and any decision(s) undertaken by the Committee form the basis of endorsements and recommendations to the Governing Bodies of each

member CCG, and other decision making bodies.

6

Area 2: Commissioning Policies and Standards across Lancashire & South Cumbria Service/ Subject Executive

Sponsor

Description Key Output Level of Decision

making

Commissioning

Policies

Andrew Bennett Agree updated commissioning policies developed collectively for all

CCGs

Policy Documents Level 1

Medicines

Management Policies

Andy Curran Agree updated medicines management policies developed

collectively for all CCGs

Commissioning Policies

Commissioning Pathways

Ratification of NICE

Technology Appraisals

Level 1

Commissioning

Standards

Sponsors of

specific

workstreams

recommending

standards

Agree key clinical standards to be consistently met across Lancashire

& South Cumbria, so that all people receive the highest possible care

and best outcomes.

Standards Documentation Level 1







7

Area 3: Lancashire & South Cumbria ICS Priority Programmes of work Service/ Subject Executive

Sponsor

Description Key Output Level of Decision making

SEND Julie Higgins Agree partnership improvement programmes linked to SEND

inspections.

This may involve collaborative work between CCGs and local

authorities, including specific delivery of a commissioning plan,

evaluation and monitoring system, implementation of the neuro

developmental pathway, therapy service review and transition to

adult services.

2020/21 Lancashire

SEND partnership

improvement

programmes

Level 2

Advancing Integration Julie Higgins Collaborative work between CCGs and Local Authorities in

Lancashire and South Cumbria to agree a commissioning strategy

and financial strategy for Intermediate Care Services.

Commissioning

strategy

Finance strategy

Level 2

Stroke Aaron Cummins/

Talib Yaseen

Commissioner

sponsor TBA

Review and approve Outline Business Case for the optimum

configuration of Hyperacute Stroke Units (HASUs)

Review and approve Pre-consultation Business Case (PCBC)

Decide on requirement and readiness to consult with the public on

options for HASU configuration

Review outcomes of HASU public consultation (if required)

Approve full business case

Approve commissioning approach and delivery plan

Outline Business Case

Pre-Consultation

Business Case

Full Business Case

Delivery Plan

Level 1

Vascular Karen Partington/

Talib Yaseen

Review and approve Pre-consultation Business Case.


options for operating model.

Review outcome of public consultation (if required)

Pre-Consultation

Business Case

Level 1

8

Commissioner

sponsor TBA


Approve commissioning approach and delivery plan.

Full Business Case

Delivery Plan

Head & Neck/Oral

Maxillo-facial services

Aaron Cummins /

Talib Yaseem

Review and approve Pre-consultation Business Case (PCBC)


options for operating model.


Approve commissioning approach and delivery plan

Pre-Consultation

Business Case

Full business case

Delivery Plan

Level 1

Diagnostics –

Interventional

Radiology, Endoscopy

and Endoscopic

Ultrasound

Kevin McGee/

Talib Yaseen

Approve case for change to the operating model for interventional

radiology services across Lancashire and South Cumbria

Review options appraisal for the operating model for interventional

radiology services across Lancashire and South Cumbria

Approve case for change to the operating model for endoscopic

ultrasound (EUS) services across Lancashire and South Cumbria

Review options appraisal for the operating model for endoscopic

ultrasound (EUS) services across Lancashire and South Cumbria

Approve case for change to the operating model for endoscopy

services across Lancashire and South Cumbria

Review options appraisal for the operating model for endoscopy

services across Lancashire and South Cumbria

Case for Change

Options appraisal

Case for Change

Options appraisal

Case for change

Options appraisal

Level 1

Adult Mental Health Peter Tinson Responsibility for all commissioning functions in accordance with the

agreed operating model and financial framework. Model and

framework to be agreed in March 2020 for implementation from

April 2020. Model will describe governance arrangements, including

JCCCG responsibilities.

Operating Model and

Financial Framework

Level 1

9

Responsibility for agreement of annual operational plan (including

finance), typically in January/February each year as part of a wider

collaborative commissioning planning process.

Operational Plan

Children’s Mental Health

Peter Tinson Responsibility for all commissioning functions in accordance with the


framework to be agreed in April 2020 for implementation from May

2020. Model will describe governance arrangements, including

JCCCG responsibilities.




Approve the annual refresh of the CYPEWMH Local Transformation

Plan

Approve the end of year position for 2019/20 and the financial

allocations for 2020/21 as detailed within the annual CYPEWMH

Business Plan

Approve the Clinical model for CYP Mental Health services across

Lancashire and South Cumbria

Approve transition and implementation plan for the Clinical model

for CYP Mental Health services across Lancashire and South Cumbria

Approve the Financial Modelling Template to underpin the Clinical

model for CYP Mental Health services across Lancashire and South

Cumbria.

Operating Model and

Financial Framework

Operational Plan

Transformation Plan

2020/21

Business Plan 2020/21

Clinical Model

Transition and

Implementation Plan

Financial Modelling

Template

Level 1

Learning Disabilities

and Autism

Peter Tinson Responsibility for all commissioning functions in accordance with the


framework to be agreed in May 2020 for implementation from June

2020. Model will describe governance arrangements, including

Operating Model and

Financial Framework

Level 1

10

JCCCG commissioning.




Operational Plan

Ambulance

Commissioning –

Paramedic emergency

service ( PES). NHS

111 and Patent

Transport Services (

PTS)

David Bonson Responsibility for all commissioning functions in accordance with the

agreed North West Collaborative Governance Arrangements.

Approve integrated future operating model across 999, NHS 111 and

PTS services which will include a collective financial and contractual

framework for Lancashire and South Cumbria (to be mobilised by

April 2021)

Agree strategic direction for Patient Transport Services across

Lancashire and South Cumbria

Operating Model,

Finance and

Contractual

Framework

Strategic Plan

Procurement Plan

Level 1

Cancer Denis Gizzi Agree recommendations for commissioners which arise from the

Cancer Transformation Programme.

Report and

Recommendations

Level 1

Planned Care Andrew Harrison Agree prioritised list of pathways and timeline for development of

outcome based consistent clinical pathways across Lancashire &

South Cumbria

Clinical Pathways Level 1

Falls Lifting Service Louise Taylor

(Executive

Director – LCC)

Receive recommendations for further opportunities for joint

commissioning of this service.

Report and

Recommendations

Level 2

Telecare Louise Taylor

(Executive

Director – LCC)

Review recommendations for further opportunities for joint

commissioning of these services.

Report and

Recommendations

Level 2

Health Infrastructure

Plan

Talib Yaseen Receive reports and recommendations for commissioners arising

from the planning process to respond to this national initiative

Report and

Recommendations

Level 2

Digital Health Gary Raphael Recommendations which support:

a) the commissioning of services from providers who are willing to

Report and

Recommendations

Level 2

11

collaborate towards a single electronic patient record across

Lancashire and South Cumbria.

b) The commissioning of services from providers who adopt a

“digital first” approach to service design and delivery







12

Area 4: Commissioning Leadership in developing new ways of working as set-out in the NHS Plan Service/ Subject Executive

Sponsor

Description Key Output Level of Decision making

Commissioning

reform

Andrew Bennett Oversight of Commissioning reform process based on agreed

roadmap (via Commissioning Reform Group)

Progress reports

Proposed CCG

constitution

Level 2

Commissioning

reform

Andrew Bennett Following engagement process with member practices and partner

organisations, progress proposals to establish a single CCG and five

locality commissioning teams across LSC. This is subject to a vote of

member practices to take place in May 2020.

CCG merger

submission to NHS

England/Improvement

Due Diligence Plans

required by NHS

England and CCGs as

part of an agreed

transition process.

Level 1

Transformation

Funding

Gary Raphael Opportunity to develop proposals for risk/gain share arrangements

for the use of local transformation funding as part of financial

strategy development.

Risk/gain share

proposals

Level 2







1


COVID-19 Virtual Discussion



Report Title: 2020/21 Uplift for Lancashire and South Cumbria Individual Placement Agreement (IPA) Providers

Agenda No:

9

Meeting Date: 13 May 2020 : Virtual Discussion

Summary of Report: The report provides details of the proposed uplift for Lancashire & South Cumbria Individual Placement Agreement (IPA) Providers

Report Recommendations: Members are asked to support the uplift proposals as outlined.

Financial Implications: As outlined in para 2.1 of the report.


Report Category:


Tick

Approve the recommendations outlined in the report. √


Receive the report for information.

Author:


Presented By: Mrs Kirsty Hollis, Chief Finance Officer


The paper is being presented to all CCG Governing Bodies in Lancashire & South Cumbria.









Risks: Have any risks been identified / assessed? Y/N

2


Agenda Item No: 9

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body

Meeting in Common

13 May 2020

2020/21 Uplift for Lancashire & South Cumbria Individual Placement Agreement (IPA) Providers

1. Introduction

1.1 Discussions on the uplift for Individual Placement Agreement (IPA) service providers

have reached a point where L&SC Chief Finance Officers (CFOs) have provisionally

agreed an inflationary increase for 2020/21 – this being 3.9% for Care Homes and

4.3% for Domiciliary Care providers.

1.2 The proposed uplift is however subject to CFOs taking it through the respective

governance processes for their CCGs. To facilitate and inform discussions it was

requested that the cost of the proposal be calculated.

1.3 It should be noted that the Fylde Coast CCGs have already agreed to this uplift (which

mirrors the Blackpool Council figure) so a decision is now required from the remaining

six L&SC CCGs.

2. Financial Considerations

2.1 MLCSU have calculated the cost of the proposed uplift (based on current numbers and

costs of packages) to be as follows:

CCG £000

Blackburn with Darwen 757

Chorley & South Ribble 904

East Lancashire 1,607

Fylde & Wyre 709

Greater Preston 847

Morecambe Bay 1,533

West Lancashire 448

Total 6,806

(Even though Fylde & Wyre CCG position is confirmed, their costs are included for

information; Blackpool CCG not shown as their package data not held by MLCSU).

2.2 For comparative purposes a strict implementation of the 1.4% NHS tariff uplift would cost

the seven CCGs £2.377m. The proposed uplift is slightly lower than the one adopted by

Lancashire County Council (4.54% for Nursing Homes, 4.81% for Domiciliary Care) –

the equivalent cost for the seven CCGs would be £8.637m.

3

3. Other Considerations

3.1 It is acknowledged that the uplift is a short term measure and does not address some of

the longer term structural issues in the market such as disparities in weekly rates and

fragmentation in the sector. These issues are being taken forward by the L&SC Provider

Market Management group – a case for change has already been developed, although

work is currently paused as the Covid-19 response takes priority. Increased liaison with

stakeholders should form part of this process.

3.2 It must be stressed that this uplift relates to ‘business as usual’ inflationary pressures such as increases to the National Living Wage. It does not address Covid-19 related

cost pressures - discussions are ongoing regarding potential reimbursement to

providers of additional costs incurred.

4. Recommendation

4.1 CCG’s are requested to formally agree (or otherwise) to the above uplift proposal.

The outcome of decisions be communicated to Paul Jones, Head of Finance, West

Lancashire CCG.

KIRSTY HOLLIS Deputy Chief Officer / Chief Finance Officer