Agenda Governing Body Board (Part 1) - Waltham Forest CCG · 26/10/2016 · Agenda Governing Body Board (Part 1) Date: 26 October 2016 Time: 12.00-14.00 ... Performance and Quality

Agenda Governing Body Board (Part 1) [26 October 2016]

Agenda Governing Body Board (Part 1) Date: 26 October 2016

Time: 12.00-14.00

Venue: Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP

Chair: Dr Anwar Khan

Topic Action

Required Clinical Lead/ Lead

Lead Officer(s)

Page No.

General Business

Apologies and announcements To discuss Dr Anwar Khan

Declarations of interest (register on public view)

To discuss ALL

Draft minutes from September’s Board To discuss

Matters Arising To note 1

Chair’s update including Chair’s action To note

Clinical Director update To note Dr Ken Aswani

Questions from Members and Public To note

2 Governance

No items

Topic Action Required

Clinical Lead/ Lead

Lead Officer(s)

Page No.

3 Performance and Quality

3.1a & b

Performance and Quality Reports For discussion Dr Dinesh Kapoor

Les Borrett & Helen Davenport

2 &

21

3.2 NELFT Response and Action Plan for CQC Inspection – 1-1.20pm

To note Jacqui Van Rossum & John Brouder

Helen Davenport

33

4 Finance and QIPP

4.1 Finance Report To approve - Les Borrett 39

5 Strategy and Planning

5.1 Commissioning Strategic Plan (CSP) 2016/17 to 2019/20

To approve - Jane Mehta 54

5.2 Organisational Development Report To note - Jane Mehta 57

6 For information

6.1 Minutes of Audit Committee (September 2016)

For info - Helen Davenport

72

6.2 Minutes of Performance and Quality Committee (September 2016)

For info Dr Dinesh Kapoor

Helen Davenport

78

6.3 Minutes of Medicines Optimisation Committee (September 2016)

For info Dr Ravi Gupta

Helen Davenport

94

6.4 Minutes of Planning and Innovation Committee (September 2016)

For info Richard Griffin

Jane Mehta 105

6.5a & b

Minutes of Reference Group (July and September 2016)

For info Richard Griffin

Helen Davenport

111 & 123

Topic Action Required

Clinical Lead/ Lead

Lead Officer(s)

Page No.

6.6 Minutes of Primary Care Development Committee (September 2016)

For info - Jane Mehta 129

6.7a & b

Minutes of Finance and QIPP Committee (June and September 2016)

For info - Les Borrett 136 & 139

6.8 Minutes of IT Committee (September 2016)

For info Dr Mayank Shah

Les Borrett 143

6.9 Actions from Leyton/Leytonstone, Chingford and Walthamstow Locality Meetings (September 2016)

For info

Dr Dinesh Kapoor, Dr Tonia Myers, & Dr Abdul Sheikh

Jane Mehta 152

7 AOB

8 Forward plan For discussion ALL 155

Next meeting

Date: 23 November 2016

Time: Formal Board 12.00-14.00 & 16.00-18.00

Venue: Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP

Page 1 Action Log Waltham Forest CCG Governing Body Part 1 on 28 September 2016 including earlier Brought Forward Items 26 October 2016

Action log Waltham Forest CCG Governing Body Part 1 on 28 September 2016 including earlier Brought Forward Items Date: 28 September 2016

Time: 12-2pm

Minute No.

Action Lead/ Owner

Due Date

Status Status Approval

Date Completed

048/16 The annual Health and Wellbeing Board report to be presented to our October Governing Body meeting.

TH October 2106

Open

Deferred to Nov 16

007/16 (i)

Present the Governing Body with detailsof the work being undertaken by the patient reference group.

RG October 2016

Open

Deferred to Nov 16

087/16 Raise the issue of equitability of staff distribution across the Trust sites at the next CQRM

HD October 2016

Closed October 2016

088 /16 (i)

Invite NELFT CEO to attend the Governing Body Meeting, 26 October 2016

HD October 2016

Closed October 2016 – invite accepted

088 /16 (ii)

Contact CQC to request sight CQC report for Barts Health

HD October 2016

Closed October 2016

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Item 3.1a

Title of report Performance and Quality Report (CCG Scorecard)

From Les Borrett, Director of Financial Strategy - WFCCG

Helen Davenport, Director of Nursing, Quality and Governance - WFCCG

Author Enrico Panizzo, Senior Commissioning Manager - WFCCG

Purpose of report The purpose of this report is to inform the CCG Governing Body of the CCG’s performance against the CCG Scorecard and other national performance and quality standards at the end of August 2016 (Month 5). Where updates are not available at the time of reporting a verbal update will be provided at the Committee. Three targets are currently considered high risk: Cervical Cancer Screening (6b) and A&E 4hr Performance at Whipps Cross (11a); and the Whipps Cross Family and Friends Test (13a). Eleven targets are considered at medium risk to delivery. The Ambulatory Care target and the Learning Disability Target have been moved from low to medium risk. The report outlines actions being taken for all medium and high risk indicators. A Deep Dive into medium and high risk targets was completed on 17 October 2016 and the actions agreed at this meeting are reflected in this report.

Changes/additions/amendments to paper as a result of discussions held at other committees

Not applicable.

Recommendations

The CCG Governing Body is asked to review the report and the identified areas of risk and make any recommendations for further investigation or assurance.

Impact on patients & carers The CCG is not meeting several performance targets, including the 4hr waiting time target for A&E at Whipps Cross Hospital. The report details the actions being taken by the CCG and by providers to address these and other areas of under-performance. The Scorecard is the principal tool for the CCG to ensure it is reporting on the impact of the CCG’s work programmes for 2016/17 in terms of improved patient care and outcomes. The report supports the delivery of improved care by providing a process for recording progress each month and highlighting any risks to delivery, so that these risks can be appropriately mitigated by the CCG.

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Performance and Quality Report (CCG Scorecard)

Risk implications Failure to ensure that there are improvements to the quality and performance of services commissioned may result in a failure to manage and mitigate risks with potential harm to patients and reputational damage to the CCG.

Financial implications Failure to meet NHS Constitution standards or CCG Local Priorities may affect the size of the Quality Premium, an additional incentive payment made to CCG to meet national quality targets.

Equality analysis The report has considered the CCG’s equality duty and where relevant has identified relevant actions which address any likely impact on equality and human rights.

Business Intelligence Source

The report contains data from a range of sources. The main sources of data are: Health Analytics (HA) for primary care data, Secondary Use Services (SUS) for acute data, Health and Social Care Information Centre (HSCIC) and NEL CSU for performance data. The report also refers to performance and quality reports received from Barts Health and North East London Foundation Trust.

Other committees/groups, including the CCG Reference Group and Rapid Feedback Group An earlier version of this report was presented to the Performance and Quality Committee.

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October 2016

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1. Scorecard Aims and Objectives NHS Waltham Forest Clinical Commissioning Group (WFCCG) has developed the Scorecard to report progress against key performance and quality targets in 2016/17.

The Scorecard has been designed around the CCG workstreams as identified in the CCG Business Grid (Appendix A). In order to create the Scorecard each CCG workstream lead was asked to develop a maximum of two indicators and targets that reflect the key goals for that programme. These goals have been developed in collaboration with the relevant Clinical Director and/or Clinical Leads. The Scorecard has also been signed-off by the Performance and Quality Committee (11 May 2016) and approved by the Governing Body (25 May 2016).

The intention of the Scorecard is to identify specific measurable indicators that can be used to demonstrate improvements in patient care and outcomes over the course of the year. Where it has not been possible to measure health outcomes on a regular basis, indicators have been chosen that most closely reflect the work being undertaken by the CCG workstreams to influence improvements in outcomes.

The Scorecard reflects Waltham Forest priorities and objectives and enables the CCG to measure the effectiveness of its work plan. Where appropriate, the Scorecard has used existing national indicators and targets. This is the case for the key national targets that CCG was not meeting at end of 2015/16. Local CCG plans should support national performance objectives. Where relevant the Scorecard targets have been aligned with the levels of ambition set out in the CCG Operating Plan and Quality Premium submissions to simplify reporting processes.

The CCG performance reporting process will focus on the latest performance information, progress made in the past month, the identification of any risks to delivery, and actions being taken to resolve underperformance or mitigate adverse impact. Whilst the reporting process will focus on performance of the Scorecard indicators, the intention is also to capture the key elements of the wider work being undertaken within each workstream, to the extent that this supports making a difference for the residents of Waltham Forest.

The monthly reporting process will also be used to report by exception on the CCG’s performance against national performance and quality targets not covered by the Scorecard so that the CCG is aware of any risks to the local population. This exception reporting includes the NHS Constitution standards and the CCG requirements outlined in the 2015/16 Operating Plan guidance.

2. Scorecard risk assessment Performance on the CCG Scorecard is RAG rated on the basis of the following thresholds:

Green: performance is meeting target level or is on trajectory to meet target level by expected date

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Amber: performance is below target/trajectory but has demonstrated improvement from baseline Red: performance has not improved from baseline

In addition to the RAG rating described above the forecast delivery of each target is risk assessed. This risk assessment considers any risks to delivery, under-performance to date and the scale of the required improvement trajectory.

3. 2016/17 CCG Scorecard Performance The main risks to the performance against targets are outlined below along with planned mitigations.

1a Emergency admissions for high risk cohort Risk: Low

The CCG achieved its target for reducing emergency admissions in 2015/16 with a total reduction of 829 admissions (19%) from the high risk cohort. The target for 2016/17 is to see a further reduction of 10%. In August there was a 8% reduction in emergency admissions from the high risk cohort. YTD there has been a reduction of 13% (323 emergency admissions) from this group. The reductions have been most significant in UTIs, CVD (heart failure), Falls and Convulsions/ Epilepsy. Figures for the Whipps Cross site show that total emergency admissions are down 6% in 2016/17.

1b Emergency admissions from care homes Risk: Medium

In 2015/16 the total number of ambulance conveyances from care homes increased by 7%. The 2016/17 target is for a reduction in emergency admissions for patients from a specific cohort of residential and nursing homes that has been identified for enhanced support from GP practices. As there are relatively small numbers of admissions this figure is expected to be reasonably volatile month on month. Procurement for the 12 month pilot has been completed and five GP practices, covering 11 homes, have mobilised the new service in July with ward rounds starting from 1 August. Initial feedback from patients and families has been positive. Training with care homes to support reduced admissions has been underway since January and pharmacist support with medication reviews commenced in April. In August there were 11 fewer emergency admissions from the targeted care homes (a 32% reduction compared to the previous year) and 54 fewer A&E attendances (64% reduction). YTD there have been 69 fewer emergency admissions.

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2a Improving Access to Psychological Therapies (IAPT) Recovery Rate Risk: Low

The target relates to the effectiveness of the IAPT service commissioned from NELFT and measures the proportion of patients that are considered to move into recovery. A person is considered to have moved into recovery if after treatment they score below the clinical threshold for depression and anxiety. Performance can be affected if the overall case-mix of patients entering treatment changes in severity. Performance in 2015/16 was 47.91% and the target for 2016/17 is 50%. Data for August 2016 shows the CCG’s performance for recovery is at 55% and has been above target since April. The IAPT access rate is on track. A task and finish group is in place with NELFT to oversee achievement of this target.

2b Early Intervention in Psychosis Risk: Low

This is a new national target for 2016/17. The target is for 50% patients experiencing their first episode of psychosis to access NICE concordant care within two weeks of referral. Performance for August was 82% and has been above target since April. The CCG expects to meet this target in 2016/17. In August performance for Waltham Forest was 82% against the target of 50%.

3 Dietetics Waiting Times Risk: Low

The CCG has invested in an expansion of the children’s dietetics service in 2016/17. This service sees children with swallowing difficulties, high level intolerances, home enteral feeding, and severe jaundice. The target is for urgent cases to be seen in two weeks and routine referrals to be seen in 18 weeks. The latest performance is at 80% and is expected to improve as recruitment is completed. No issues with staffing or delivery have been reported to-date. Performance for August was 88%. Overall activity was low for the month reflecting summer holidays. It is expected that the service will reach the 95% target by October 2016.

4 Early Antenatal Booking (Whipps Cross Hospital) Risk: Low

This target was achieved in 2015/16 and performance remains strong in April 2016. The target measures the proportion of women that are seen within 13 weeks of their pregnancy out of all women that are referred to Whipps Cross within 10 weeks of their pregnancy. The CCG is

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working with Barts Health to implement a comprehensive action plan to improve early booking for those not known to the service before 10 weeks. This programme includes: engagement with our Maternity Service Liaison Committee (MSLC) to help increase awareness about the importance of early booking, improving signposting, GP education, increasing options for self-referral, and working with Whipps Cross staff to increase access. The target continues to be met in M5 with performance of 98.44%.

5 Learning Disability Health Checks Risk: Medium

This is a new target for 2016/17. Performance as of July was 5.44% against a target of 45% by the end of the year. Performance is just above the trajectory to meet the target. This trajectory increases in rate later in the year. An action plan is in place with trajectory signed off by the Performance and Quality Committee. Actions include the Learning Disability service offering support to practices including training to raise awareness about the importance of annual learning disability health checks. Another area for improvement is consistency in coding of health checks so that accurate performance is measured. Actions are being targeted at practices with low reported uptake. Although reported performance figures are low they are above the levels for the same period last year and above the planned trajectory, which increases at the end of the year. The CCG has an action plan in place that has been agreed with all GP practices and will be undertaking targeted visits to GP practices with the Learning Disability Team to help improve performance. Work is also underway to ensure that activity is appropriately coded. The CCG is undertaking a re-design of the LD service which will come into effect from April 2017 and has agreed short term funding to pilot new working arrangements within the team in 2016/17. This will support a nurse to identify learning disability patients and work proactively with practices to initiate and support health checks.

6a CCG GP Referral to Treatment (62 Days) Performance Risk: Low

The target measures the proportion of people with cancer who start treatment within 62 days of their referral from GP. The CCG met this target for the final two months of 2015/16 and Barts Health saw improvement in this target over the course of the year. In August the CCG met seven out of eight cancer waiting time targets. The 31 day target for first treatment was 95.5% against a target of 96%. This was due to two urological breaches out of 12 patients on that pathway. Against the 62 days target there were four breaches, 2 in Breast, 1 in Gynaecological, 1 in Lower Gastrointestinal and one on the Sarcoma pathway. The CCG had two breaches over 100 days, one on the Breast and one on the Lower Gastrointestinal pathway. Root cause analysis is completed for all 62 day breaches. The CCG met the standard in June, July and August data shows the CCG meeting the standard with performance at 85.7%.

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6b Cervical Cancer Screening Risk: High

The risk assessment is considered high due to the large number of additional screens that need to be completed to meet the target (6,550). A workshop has been held with clinical lead and leads have been assigned to localities to help manage delivery. Performance is available at GP practice level and a tracker is being produced to monitor the impact of practice visits. The Waltham Forest GP Federation (FedNet) contract offers out-of-hour tests for women. The clinical leads have started visits to practices in July to address all screening performance and will specifically target the cervical screening performance. Individual practice level data has been provided to clinical leads. Work is also underway to understand discrepancies between data sources which largely relate to the reporting of patient “exceptions” (where patients do not respond to invitations to attend screening). A letter to all practices has been sent by the communication team outlining the importance of screening programme and targets. A Cancer Working Group has been established with fortnightly meetings. A communications plan is in development for a cervical screening campaign and initial meetings have been had with public health and the engagement team. M4 performance was 62.73% which is above the baseline, but below the target and considered high risk. Performance on cervical screening decreased in July and August, increasing the gap to target to just over 9500 patients requiring a smear test in order to reach 73.5%. This is likely to be partially due to seasonal factors, with patients called for screening in June/July more likely to be away on holiday and unable to attend an appointment. Recent activities on cervical screening include: 1) Continuation of practice visits by clinical leads; 2) Launch of the cervical screening patient survey; 3) Review of screening data to evaluate differences between scorecard data and QOF data used by practices. Work is targeted at GP practices to understand their performance and how they compare with other practices, including into how GP practices may exception report patients that do not attend appointments. The CCG is planning how understanding of the issues could be improved through a Board development session in November.

7a Diabetic Retinopathy Risk: Low

The target aims to increase the number of people with diabetes that has retinopathy screening within the year. There are approximately sixteen thousand people with diabetes in Waltham Forest. Work is focused on learning lessons from high performing practices. Diabetes UK have completed a report for the CCG and this is being used to support a peer-review process that is planned to start in July. Performance has been above trajectory from M2-M5 with almost 6000 Waltham Forest patients being screened so far this year.

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7b Renal – Reduced Outpatient Appointments Risk: Medium

The target is to reduce the number of renal outpatient appointments. The project is to introduce a collaborative virtual Chronic Kidney Disease (CKD) clinic & Referral Management System between Waltham Forest primary care and Bart’s Health NHS Trust, providing a more responsive service to CKD patients. Data sharing agreements have been agreed with practices. The project is due to start in October and reporting on this indicator will therefore start from December 2015.

7c COPD – Post Bronchodilator Spirometry Risk: Medium

The target is to increase the number of COPD patients that have confirmation of diagnosis through Bronchodilator Spirometry within twelve months of diagnosis. Improved diagnosis should support identifying patients for appropriate ongoing management. Performance for August was 36.4%, with only a slight improvement from the previous months. Performance is measured against the cohort of patients diagnosed with COPD in 2015/16 and is expected to improve over the course of the year towards the target. Performance at M5 is below plan and actions are being taken to improve performance with GP practices and to raise awareness, including awareness of appropriate coding of patients in GP records. The CCG has surveyed practices’ access to spirometry with responses from all apart from four practices. This has highlighted issues with the utilisation and calibration of spirometry machines that has been flagged with the primary care team. Discussions have been held at locality meetings and messages in the medicines management bulletin, GP practice bulletin and hosted on the practice portal for ease of access. A GP education and training forum was arranged on respiratory on 29 September 2016. A multidisciplinary meeting has been set up to address the issues with regards to spirometry comprising of Secondary Care and Respiratory lead from Primary Care and other relevant stakeholders. An additional 320 patients need to have spirometry in order to meet the target. The CCG has identified these patients and is working with practices, through prescribing leads, to ensure that they receive spirometry.

8 Patients on the Palliative Care Register Risk: Medium

The CCG ran an education session in May to encourage identification outside of cancer expecting this to increase the number of patients added. At the end of August the CCG was 3 below target. Performance is just above target in September at 444. M5 performance has

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increased slightly to 433. The CCG is developing an action plan to provide an updated plan to meet the 2016/17 target. The plan includes actions to ensure all CHC Fast Track patients are flagged to GP practices by NEL CSU as they are identified. Integrated Care, COPD and Heart Failure teams have also been asked to identify patients. An End of Life care template has been developed for clinical systems that should ensure patients are added to registers as they are identified. After death analysis is also to be piloted by the Clinical Lead to highlight examples for future learning. The recording of end of life patients should be supported by the programme of enhanced GP support to care homes.

9a Continuing Healthcare Eligibility Assessments (28 days) Risk: Medium

The proportion of people who completed a community CHC assessment in 28 days was 57% in July against a target of 80%. This is a deterioration from the previous month. Timely access to social worker and next of kin delays were reported as the reasons for the breaches. An escalation process between NELFT and LBWF is in place and this has been effective in improving performance. The CCG is working with LBWF to get a better understanding of the allocation of social workers to complete these assessments. The CCG is also working to reduce next of kin delays by ensuring that families are given clear guidance about the process. Performance for Month 5 was 57%. Although the escalation framework is having an impact the majority of delays relate to social worker cover and this issue and the next of kin delays are being followed up with NELFT and LBWF to better understand the root causes of the performance issues and how the CHC process could be better designed to minimise delays.

9b Personal Health Budgets Risk: Medium

There are currently 51 people receiving a Personal Health Budget in Waltham Forest. These are all continuing healthcare patients. The CCG is implementing a series of projects to expand this number. In July the CCG launched the offer of PHBs to pregnant women with high levels of anxiety or fear of giving birth (tokophobia). The next stage of the project will be targeting careers and cancer screening patients. Referrals have been low and this has impacted performance. The CCG has launched the tokophobia programme with Homerton and adjusted the eligibility criteria to increase the number of referrals. Performance is expected to improve in line with the roll-out of the programme and is in line with expected trajectory. The next programme to support carers to attend IAPT and cancer screening programmes is planned to start in November. In M5 the CCG is 14 short of plan to meet this target. New programmes are in development and the CCG is working with Homerton to

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increase referrals into existing schemes. Barts have also started to promote the programme with community midwives. The next PHB programme is targeting carers to support them undertake cancer screening.

10 RTT incomplete pathway performance Risk: Low

The CCG is currently meeting the national target. However the reported CCG performance does not include figures for Barts Health. Figures reported directly from the trust show that Whipps Cross underachieved against the incomplete target with 84.74% in July 2016. This was a deterioration on the previous month (86.82%). The number of patients waiting over 18 weeks was 2,822 at Whipps Cross which is a deterioration from the previous month (2,564). The deterioration in performance was an expected result of the move from retrospective to live validation. This will release valuable validation resource to focus on validation of the backlog and as well as the known new data errors that occur daily. It will also allow for real time training of the staff making the errors. The Trust is providing weekly report to CCGs showing validation progress and the PTL size. The Trust has advised that validation of 52+ patients will continue as previously. Performance remains most challenged in the surgical specialities including Trauma and Orthopaedics. The Trust has identified further options for the management of this data quality issue. This has affected the timeline for a return to reporting and the production of site and speciality level trajectories for the elimination of 52+ and 40+ waiters and the Trust has advised this work cannot be accurately completed until such time as the validation of these cohorts of patients is complete. There will also be a significant deterioration in the reported month end position for a period of time, until the benefits of this change are realised. The Access Policy has been further revised and has been shared with CCGs for comment. The Trust has advised that it is now outsourcing whole pathways, from referral onwards. In addition, internal capacity is being enhanced in all areas to reduce backlogs including through the Newham Gateway Centre. The first RTT deep dive took place in August 2016 (combined with the existing cancer deep dives), looking at 52+ waiters in T&O, Plastics, Urology and General Surgery/Colorectal. In M5 the CCG met the target on the nationally reported figures.

11a A&E 4hr all types performance at Whipps Cross Risk: High Whipps Cross have produced an updated improvement plan to support the trajectory to achieve 95% by end of March 2017. This focuses on strengthened clinical leadership, staffing, length of stay and the paediatric pathway. Performance has not met the trajectory for the last four weeks with performance of 85%, 85%, 84% and 83% (up to 9 October 2016. The trust has introduced a new internal structure for managing performance and the CCG attended the first meeting of the Emergency Pathway Improvement Board on 1 September 2016. This will focus on four workstreams: ED/Admission avoidance, Operations/Flow, Discharge and Paediatrics. The Trust has opened a new Paediatric Clinical

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Decision Unit (CDU) in October and this should reduce the number of paediatric breaches. Whipps has also been participating in daily ‘phone calls led by the CCG to ensure that the numbers of delayed transfers of care and medically optimised patients are minimised and these are at historically low numbers. However, bed occupancy remains very high and has led to increasing numbers of breaches related to bed management. The site is working with ECIP to introduce the SAFER discharge bundle to implement new rotas for medical and nursing staff that better match capacity and demand over the day. The CCG is implementing its plans for discharge to assess and out of hospital pathways together with Barts Health to reduce the numbers of medically fit patients at WX and is expanding the model of integrated care to the moderate risk cohort to reduce emergency admissions. The new provider for the Urgent Care Centre has been in place since 19 July. The transfer of providers has been achieved with little incident and in the first three months of the new service overall activity at the UCC increased by 11% compared to the previous year. The CCG is working to procure the Urgent Care Centre in line with guidance on integrated urgent care services and this is progressing alongside the procurement of NHS111 across the NEL CCGs. All types attendances at Whipps Cross show a small increase from the previous year (2%) but are lower than increases at The Royal London (5%) and Newham Hospital (10%). Emergency admissions are down 6% at Whipps Cross. Performance for the week ending 9 October was 83% against a trajectory of 88%. The trajectory assumes that Whipps Cross will meet the target by the end of March 2017. Barts Health did not meet the STP trajectory for Q1 or Q2. Current pressures relate to very high bed occupancy and lack of flow within the hospital.

11b Ambulatory Care Pathway Risk: Medium

This is a new target for 2016/17. A key part of the Transforming Care Together strategy is the formation of acute care hubs and ambulatory care is a key part of this model. Whipps has been developing their model over the last two years and this has resulted in a reduction in the number of short stay admissions. This should have a positive impact on patient care. In 2016/17 the CCG is supporting the expansion of ambulatory care through a CQUIN (Commissioning for Quality and Innovation) incentive payment. The numbers of patients being treated within ambulatory care has increased and met the target in May 2016. Performance has since deteriorated below target. The trust failed to meet the CQUIN target for Q1 and part of the payment will be withheld on this basis. Despite not meeting the target the ambulatory care service does appear to have had a significant impact on reducing emergency admissions with a length of stay less than one day; these have reduced by 30% in 2016/17. Figures for August are just below the 30 target at 28 but continue to show an increase on the previous year. Barts have appointed three new consultants that started in September. The Ambulatory Care Service has been short of staff and this has resulted in reduced operating hours. The CCG is working with Whipps to understand how activity can be increased in Q3 and Q4.

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12a Antibiotic prescribing in primary care Risk: Low

The aim of the target is to reduce the unnecessary prescribing of antibiotics. The rate of antibiotic prescribing reduced in 2015/16 and the CCG expects to see this trend extended into 2016/17. The 2016/17 Medicines Optimisation Scheme includes an audit of broad spectrum antibiotic in attempt to improve prescribing further. This has been launched and the majority of practices have been visited and signed-up. The CCG is also participating in the anti-microbial stewardship group covering NE London with participation from GPs, CCGs, Local Authorities and Public Health. This should help identify best practice and areas for further improvement. Performance in M4 was better than the target and an improvement from last year.

12b Prescribing of broad-spectrum antibiotics Risk: Low

The aim of the target is to reduce the use of broad spectrum antibiotics, including co-amoxiclav, cephalosporins, and quinolones. Performance at the end of July continues to improve. The expected challenge will be maintaining current performance over the winter period. Performance in M4 was just below the target but showed an improvement on last year.

13a Improvement in Whipps Cross FFT score Risk: High

The A&E, Maternity and Inpatients combined score for July was 93.1%, this is below the 16/17 target of 95%. Barts Health board reports states in June 90.7% of A&E respondents, 96.2% of Maternity and 94.3% of inpatients at Whipps Cross would recommend the service to friends and family. The response rate for inpatients at Whipps Cross has remained at 31.6% in June 2016 and continues to be the highest response rate across Barts Health. The A&E response rate for May 2016 is at 5.5% showing a slight increase from 5.3% in May 2016. Performance at July was 93.1%, which is below the previous year’s performance and the 2015/16 target. The CCG has focused on improving both the performance and the response rate to the FFT at Whipps Cross. A new patient experience manager is in post at Whipps Cross and the CCG is meeting with the Director of Nursing on a monthly basis. There has been some improvement in the Inpatient and Maternity scores and the CCG is still working to ensure improvement in 2016/17.

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13b Number of C. Diff cases due to a lapse of care Risk: Low

The new indicator for C. Diff in 2016/17 is to measure the number of lapses in care. A lapse in care is indicated by evidence that policies and procedures consistent with national guidance and standards were not followed by the relevant provider. In 2015/16 Whipps Cross recorded 3 lapses in care and the target for this year is zero. The Infection Prevention Control lead working within the CSU reviews all Root Cause Analysis monthly to establish themes and trends and is part of the group that determines whether there were lapses in care. For the year to date no lapses in care have been reported. The CCG’s target for total numbers of C. Diff cases for 2016/17 is 46. Whipps Cross reporting for June 2016 was12 cases, a total of 4 year to date. In M5 there have been no reported cases identified as due to a lapse in care.

14a General Practice FFT score Risk: Medium

The GP FFT for July was 84.3%, below the target of 85%. The CCG is working to promote FFT response rates, achievements and use for quality improvement through broader communications and via the locality meetings. FFT achievement is included as an indicator in the Primary Care Dashboard and practices are able to assess their achievements. As well as the wide ranging primary care, IT and estates work that is currently being implemented there is a planned primary care resilience and quality improvement programme being developed nationally and locally which should positively impact patient experience. Performance met the target in M2 and M3 but is considered medium risk due to the volatility in performance. The CCG is following up practices which appear not to have submitted FFT data to ensure that they are meeting reporting requirements.

Primary Care Quality and Performance

The quality metrics used within primary care indicate that there is variation in the quality of service provision across Waltham Forest, which in turn can affect service delivery. The Primary care dashboard will be used to support monitoring of quality and aims to drive improvements across the GP landscape. This will be shared with the board on an ongoing basis. Further work is being undertaken to look at how quality and performance can be improved working directly with practices to ensure resilience and sustainability. Work is also being undertaken to scope how quality improvement can be managed across a wider cross CCG footprint.

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Primary Care quality is also managed as part of the CCG’s delegated commissioning function, working alongside NHS England. The GP contracting issues are managed via the Primary Care Commissioning Committee in its decision making capacity and overall governance function.

The following primary care quality contracting issues that have been managed in this financial year include:

- One GP practice has been closed and the list has been dispersed in June, following quality concerns.

The Care Quality Commission (CQC) inspections together with analysis of quality metrics highlighted issues within the following domains in recent months:

- Safety- systems and processes not implemented in a way to keep patients safe

- Failing to be appropriately registered with the CQC

- Breach of the terms of the relevant insurance policies

- Clinical governance issues

- Safeguarding issues

The practices which receive an overall rating of ‘requires improvement’ have been assessed and appropriate contractual levers such as remedial and breach notices have been issued in alignment to the Standard Operating Procedure for managing CQC decisions. There have been 4 remedial breach notices issued to date within 2016/17 3 of which relate to CQC issues and one regarding an individual performer.

Officers are also working closely with practices to develop and manage action plans with key deliverables to address the quality improvement issues that have been highlighted in a timely manner.

16


Page 14

14b Utilisation of TQuest Risk: Low

The target is to increase the utilisation of TQuest for requesting pathology results. Data is monitored at the IT Committee and shared at GP Locality Commissioning Meetings. An IT trainer has been visiting practices with low utilisation in June and July to support improvement. The utilisation of TQuest has improved in M5 (48%) and is just below the target for the year (50%).

15a Delayed Transfers of Care Risk: Low

The target measures the number of patients that are classified as Delayed Transfers of Care (DTOC) at Whipps Cross as a proportion of their total bed base. The patient is classified as ready for transfer when a clinical decision has been made that the patient is ready, a multi-disciplinary team decision has been made and the patient is safe to transfer. Performance has remained within trajectory for the first four months. Part of this has been the result of daily system-wide ‘phone chaired by the CCG with Whipps Cross, the Integrated Discharge Team, the local authority and community provider to ensure that there are no unavoidable delays. These have reduced both DTOC and Medically optimised patients at the site and had an impact on bed occupancy. This progress has been monitored by NHSE in relation to the challenges at North Middlesex A&E and in preparation for planned junior doctor strike action. The CCG has agreed a CQUIN related to improving the number of DTOCs. Work is underway to improve the effectiveness of the Integrated Discharge Team. The CCG met this target for M5.

15b Medically Optimised

Risk: Medium

The target measures the number of medically optimised patients at Whipps Cross awaiting discharge. The figures are related to the DTOCs (above) but the classification is based on medical assessment. Whipps Cross was meeting this target at the end of May. The Out of Hospital Pathways programme of work will support a system approach to reducing the number of patients deemed medically optimised awaiting discharge on the Whipps Cross Hospital site. The programme will go live in September 2016 and will run for 6 months with a formal evaluation as to future commission of the pathways if successful. The CCG has met its improvement trajectory for M5.

17


Page 15

Performance Exception Reporting London Ambulance Service - Category A Response Times (8 min) August performance for Waltham Forest was 61.5% against a standard of 75%. This is an improvement from the previous month (56.2%). The London Ambulance Service (LAS) has made improvement in recruitment and the Newham Group, covering Waltham Forest, is currently at 94% staffing against a target of 95%. A revised trajectory for 2016/17 is being agreed but is unlikely to return performance to the 75% target. Current challenges centre on the training of the new workforce and achieving turnaround times. In Waltham Forest the LAS are considering piloting a “tethered” resource that would counter-act the exporting of vehicles over the course of the days due to patients being conveyed to Queens Hospital and the Royal London Hospital. Waltham Forest has relatively low levels of increase in demand, which have been high across London. Work on reducing demand on LAS includes supporting patients in care homes and reviewing “Frequent callers”.

18


Page 16

Appendices Appendix A Waltham Forest CCG Business Grid

19

# Description Lead CDR

E

D

A

M

B

E

R

T

A

R

G

E

T

Aim Trend Baseline Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17YTD or latest

performance

Assessed level of risk (high,

medium or low)

1a Emergency admissions for targeted cohort patients (Top 20%)5862 (489

per month)5862 - 5276

5276 (440

per month) 5862 (489 per

month)437 441 426 433 417 2154 Low Risk

1bReduced emergency admissions and A&E department attendances

for identified residential and nursing homes 1294 1294 - 971 971 1294 88 99 87 92 53 419 Medium Risk

IAPT recovery rate (NELFT returns) 47.28%47.28% -

49.99%50% 47.28% 60.45% 58.89% 50.72% 62.95% 54.69% 57.60% Low Risk

2b Early Intervention in Psychosis 49.99% N/A 50% 67.57% 66.67% 68.80% 66.67% 80.00% 81.82% 63.64% Low Risk

3 Childrens dietetics waiting time KH TM95% from

Q3 New 72.00% 59.00% 47.00% 50.00% 88.00% 88.00% Low Risk

4Early antenatal booking at Whipps Cross

(13 weeks)KH TM 85% 94.96% 97.93% 98.52% 99.02% 98.33% 98.44% 98.46% Low Risk

5Number of patients age 14+ on LD register who have had annual LD

health checkKH RG 41.00%

41% -

44.99%45% 41.00% 2.47% 3.75% 5.22% 5.86% 7.23% 7.23% Medium Risk

6a Cancer urgent GP referral to first treatment within 62 days 82.39%82.40% -

84.99%85% 82.39% 82.14% 74.19% 92.59% 85.19% 85.70% 85.70% Low Risk

6b Cervical cancer screening programme 64.41%64.41% -

73.49%73.50% 64.41% 65.96% 65.91% 65.79% 62.73% 63.17% 63.17% High Risk

7a Diabetic retinopathy (cumulative) LS 66.34%66.35% -

69.99%70% 66.34% 5.07% 11.67% 20.54% 28.90% 36.56% 36.56% Low Risk

7bRenal - first outpatient attendances at Barts nephrology

(Scheme starting October - No RAG rating til then)CE 552 551 - 470 469 552 52 47 46 47 78 270 Medium Risk

7c COPD - post bronchodilator spirometry AO 37.41%37.42% -

66.99%67% 50.42% 34.44% 34.83% 35.23% 35.92% 36.40% 36.40% Medium Risk

8 Patients registered as palliative care (cumulative) JR MS 411 412 - 472 473 411 414 417 429 429 433 444 444 Medium Risk

9a. CHC eligibility assessments within 28 days 47%47.01% -

79.99%80% 47% 100.00% 81.82% 37.50% 61.50% 57.14% 65.00% Medium Risk

9b. Personal Health Budgets (cumulative) 37Below

trajectory150 37 38 41 50 51 51 51 Medium Risk

10 RTT incomplete pathway performance LB DK 91.99% N/A 92% 94.10% 93.40% 93.29% 93.77% 94.06% 93.92% 93.69% Low Risk

11a A&E 4hr all types performance at Whipps Cross 84.39%84.4% -

94.99%95% 84.39% 81.8% 83.3% 83.5% 86.2% 87.7% 84.50% High Risk

11b Ambulatory care at Whipps Cross (average # patients seen per day) 25.99 26 - 29.99 30 25 29.65 31.61 28.9 26.9 28 29.01 Medium Risk

12a Antibiotic prescribing in primary care (items per STAR PU) 1.61 1.121 0.943 0.94 0.94 0.933 0.93 Low Risk

12b Use of broad spectrum anti-biotics 15.20%15.19% -

12.20%12.20% 15.20% 12.68% 12.53% 12.41% 12.31% 12.31% Low Risk

13aImprovement in Whipps Cross A&E, Maternity and Inpatient FFT

score93.75%

93.75% -

95%95.00% 93.75% 93.6% 92.2% 91.3% 93.1% 92.6% 93.1% High Risk

13b Number of C.Diff cases at Whipps Cross due to a lapse of care 4 N/A 3 3 0 0 0 0 0 0 Low Risk

14a General Practice FFT score 84.01%84.02% -

84.99%85% 84.01% 78.1% 86.1% 85.2% 84.3% 84.9% 83.1% Medium Risk

14b CCG technology uptake - tQuest MS 21.28%21.29% -

49.99%50% 21.28% 39.24% 40.76% 43.31% 46.44% 47.75% 43.44% Low Risk

15a DTOC as % of bed base (Whipps Cross) 5.13~%5.12% -

2.51%2.50% 5.13% 0.79% 0.81% 1.17% 2.18% 1.01% 1.01% Low Risk

15b Medically optimised (Whipps Cross) 45 44 - 26 25 45 38.11 37.04 34.37 36.59 25.74 26 Medium Risk

Integrated Care

Mental Health

Children

Maternity

Waltham Forest CCG - 2016/17 Performance & Quality Scorecard

GF

NA

KA

RG

2a

PL HD

Integrated commissioning

Planned care

Urgent care

Prescribing

Quality & Safety

EP

KH

Primary Care

Discharge efficiency

KA

RG

Learning disability

Cancer

Long term conditions

MSNA

SA

End of life care

HD

CE

AO

HDAW

20

Item 3.1b

Title of report Quality Dashboard and Exception Report

From Helen Davenport, Director Nursing Quality and Governance - WFCCG

Author Anne Walker, Deputy Nurse Director Quality and Clinical Governance - WFCCG

Purpose of report

The purpose of the report is to inform the Governing Body of the quality provided to the patients of Waltham Forest at its main Provider Organisations, indicating by exception where quality does not meet agreed targets.

Changes/additions/amendments to paper as a result of discussions held at Performance and Quality Committee

None

Recommendations

The Governing Body members are requested to:

1. Review the contents of the report. 2. Provide feedback on the content and lay out of document. 3. Agree where contract performance notices (CPNs) be served in view of non-compliance with

statutory/ contractual performance requisites.

Impact on patients & carers

With appropriate quality and governance in place patient safety and experience should be wholly assured. Failure to provide quality care leads to increased risk to patient safety and patient harm, poor patient experience and health outcomes.

Risk implications

Failure of all Waltham Forest CCG commissioned Providers to ensure the fundamental quality standards of clinical care across Waltham Forest health economy might lead to:

Patients not receiving expected quality of care which would lead to poor patient experience and in some cases patient harm.

Inhibit WFCCG from achieving its corporate objectives. Reputational risk.

Financial implications

Funding services that are not high quality do not meet the needs of the patient is poor value for money and may result in additional funding pressures.

21

Quality Dashboard and Exception Report

Equality analysis

The WFCCG is committed to fulfilling its obligations under the Equality Act 2010 and to ensure services commissioned by the WFCCG are non-discriminatory on the grounds of any protected characteristics.

The WFCCG will work with providers, service users and communities of interest to ensure that any issues relating to equality of service within this report are identified and addressed.


Barts Health Performance Dashboard

NELFT quality intelligence dashboard

CQC inspection website

Serious Incident Reports NELCSU – STEIS database

Other committees/groups, including the CCG Reference Group and Rapid Feedback Group

Performance and Quality Committee 12 October 2016.

22

Quality Report

Quality Dashboard and Exception Report

October 2016

23

Quality Dashboard Whipps Cross

October 2016Quality Report

2

24

Quality Dashboard – NELFT


3

25

Key Headlines

NELFT

• No overdue serious incident reports• Zero health acquired infections• Effective complaints management

Whipps Cross

• No lapses in care for cases of care for MRSA.• Inpatient Friends and Family test response rate

best performing site at Barts Health and exceeded compliance target for month.

• Reduction in number of falls. The trust presented at the last CQROA its falls prevention programme and the joint working with the community, CCG and local authority.

NELFT

• Compliance with Safeguarding training Adults (level 2) Children's level 1.

• Compliance with Basic Life Support Training.

Whipps Cross

• Complaints management- response rate at 47.30% An improvement compared to last month’s report rate 20% against target 80%.

• Duty of Candour compliance at 17% against target of 100% This is the lowest performance across the Bart's Health sites.

• Safeguarding children level 2 training below compliance levels.

• Overdue serious incidents were 24 this month same as last month.

• Basic life support training non compliant.• Friends and Family test response rate for A&E, slight

improvement in month but remains non compliant.• Emergency readmissions – rate has increased in

reporting month.


4

Areas for ImprovementAreas for Good Practice

26

Exception Report – Whipps CrossIndicator Perf Further Intelligence Action taken by CCG

Whipps CrossSerious Incidents overdue

24(Aug )

• Number of overdue incidents same as in July • Whipps Cross acknowledge capacity and

capability of governance team to deliver timely closure.

• Medical Director leading improvement plan.• Good Governance Institute working with

Whipps Cross to improve position.

• Concern raised formally at CQROA meetings July, August and September.

• Trajectory for compliance requested.• Workshop to be held jointly with BH and

CCG/CSU planned for Autumn.• Non compliance formally raised at the Quality

KPI meeting and for escalation as breach of contract.

Duty of Candour 17%(Aug )

Duty of Candour compliance target is 100%. Month on month deterioration in compliance.

July compliance was at 20% but shows a reduction to 17% this month.

Number of applicable cases is being questioned as appear low for the size of the organisation.

• Concern raised at CQROA meeting and action plan requested with trajectory for compliance.

• Associate Medical Director leading on back log of duty of candour cases.

• Formal monthly reporting by stage 1 and 2 requested by CCG.

• Deputy Nurse Director Quality and Clinical Governance WF CCG attending SIRMAP and compassionate care and patient experience meetings.

• Non compliance formally raised at the Quality KPI meeting and for escalation as breach of contract.

FFT Response Rate A&E

6.7%(Aug)

Response rate for A&E has not exceeded 7% for 16/17 against a target of 20%, although improvement has been seen from 3 to 6%.

Patient Experience Manager post currently vacant.

• Reviewed at CQROA meeting.• Deputy Nurse Director Quality and Clinical

Governance WF CCG attending SIRMAP and compassionate care and patient experience meetings.

• CCG support quality visits at Whipps Cross.• CCG Patient Experience Officer to undertake

FFT with patients in A&E from September.


5

27

Exception Report – Whipps Cross

Indicator Perf Further Intelligence Action taken by CCG/Trust

Whipps CrossComplaintsoverdue

47.3%(Aug)

Complaints responded to within 25 working days target of 80% has not been met in 16/17 with performance deteriorating from 48% in April to 12% in June 2016. Since June there has been improvement with July at 20.8% and August at 47.3%.

Governance team at Whipps Cross has capacity and capability concerns impacting on ability to facilitate timely complaints responses.

• Concern raised at CQROA and performance and actions reviewed monthly.

• Good Governance Institute supporting Whipps Cross in closing overdue complaints and serious incidents.

• Complaints performance and quality reviewed weekly at SIRMAP meeting.

• Non compliance formally raised at the Quality KPI meeting and for escalation as breach of contract.

VTE Risk assessment

89%(Aug)

The target set for Barts Health is 95% however this month the site only achieved 89% which is lower than last month.

• Issue to be raised at the Whipps CrossCQROA meeting November 2016.

Basic Life Support Training

79.7%(Aug )

Underutilisation of training sessions continues to be an issue across all sites, with only 50% of available capacity being utilised.

Support requested from site leadership operational model (LOM) senior management teams to address.

Use of enhanced advertising to improve attendance.

Drop in sessions being held to improve access.

Reviewed at CQROA meeting and assurance sought that no areas at risk due to low numbers of staff trained.

Deputy Nurse Director Quality and Clinical Governance WF CCG attending SIRMAP and compassionate care and patient experience meetings.


6

28

Exception Report – Whipps Cross


Whipps CrossMixed Sex Accommodation

1(Aug)

Barts Health reported 12 Mixed Sex Accommodation (MSA) breaches in July against a threshold of zero (down from 16 in June2016).

Breaches mostly occur at The Royal London, where the principal reason is delayed discharge from Adult Critical Care (ACCU) toward based care. Increased Critical Care Capacity.

Any breaches are reviewed with the Director of Nursing at Whipps Cross and areas of concern raised at the CQROA meeting.


7

29

Exception Report - NELFT


8


NELFTBasic Life Support Training

83.4%(Aug )

There has been a slight drop in performance from previous month of 84.3 to 83.4%.

Reviewed at CQROA meeting and assurance sought that no areas at risk due to low numbers of staff trained.

NELFT have put in place measures to address and this will be reviewed monthly till compliant.

Safeguarding Adults Level2

83.2%(Aug)

Second month of non compliance with 85% target.

Adult community health services are at 84.4% for safeguarding adults level 2 training.

Reviewed at September CQROA and NELFT provided assurance actions are in place to improve compliance.

Monitoring will continue to compliance is achieved.SafeguardingChildren Level 1

83.8% Second month of non compliance with 85% target.0.1% reduction from last month’s performance.

Reviewed at September CQROA and NELFT provided assurance actions are in place to improve compliance.

Monitoring will continue to compliance is achieved.

30

Quality Review Visits


9

Area Key Highlights

NELFT Ainslie Unit 20 September 2016 Visit undertaken on unannounced basis.Visit used pilot quality reporting template that mirrors the Care Quality Commission 5 key domains.Report not yet received and will be included in update for November 2016.

31

Care Homes

During July and August 2016 8 residential homes and 1 nursing home have been inspected. 4 reports have been published with 5 reports pending.


10

Nursing Home HighamsLodgeResidential MHChingford

Aspray House Nursing HomeLeyton

PeartreeHouse Care HomeResidential OP

Sable Care Limited Residential OPLeytonstone

Effective

Safe

Well-led

Caring

Responsive

Overall

The table demonstrates the CQC rating for each residential and nursing home against the 5 domains of care. Sable Care Limited’s report was published on 16 September 2016 and overall they have been rated inadequate.

KeyOutstanding

Good

Requires improvement

Inadequate

32

Item 3.2

Title of report North East London NHS Foundation Trust Care Quality Commission Report September 2016

From Helen Davenport, Director Nursing Quality and Governance - WFCCG

Author Anne Walker, Deputy Director Nursing Quality and Clinical Governance - WFCCG

Purpose of report

To inform the Governing Body of the findings contained in the report following the Care Quality Commission Inspection of North East London Foundation Trust.

NELFT was inspected in April 2016 as part of the CQC’s ongoing comprehensive mental health inspection programme. The announced visit took place between the 4-8 April 2016 with an unannounced inspection on 14 April 2016.

The overall rating for the Trust is requires improvement.

Changes/additions/amendments to paper as a result of discussions held at Performance and Quality Committee October 2016

None

Recommendations

The Governing Body are requested to:

1. Review the contents of the report. 2. Agree the recommendations.


With appropriate quality and governance in place patient safety and experience should be wholly assured. Failure to provide quality care leads to increased risk to patient safety and patient harm, poor patient experience and may impact on health outcomes.

Risk implications

Failure of North East London Foundation Trust to promote excellence and quality improvement will impact on the organisation’s ability to ensure the fundamental quality standards of clinical care are in place could mean that:

Some patients are not receiving the quality care WFCCG commissions and therefore have a poor experience and risk of harm.

33

North East London NHS Foundation Trust Care Quality Commission Report September 2016

Inhibit WFCCG from achieving its corporate objectives. Reputational risk.


Funding services that are not high quality do not meet the needs of the patient. Not ensuring care given is right first time represents poor value for money and may result in additional funding pressures.

Equality analysis

The WFCCG is committed to fulfilling its obligations under the Equality Act 2010 and to ensure services commissioned by the WFCCG are non-discriminatory on the grounds of any protected characteristics.

The WFCCG will work with providers, service users and communities of interest to ensure that any issues relating to equality of service within this report are identified and addressed.


Care Quality Commission Inspection Report NELFT – published 27/09/2016.


MDT – 10 October 2016

Performance and Quality – 12 October 2016

34

1

North East London NHS Foundation Trust Care Quality Commission Report September 2016

1.0 Introduction North East London NHS Foundation Trust (NELFT) provides community health and mental health services in Essex and across the North East London Boroughs of Barking and Dagenham, Havering, Redbridge and Waltham Forest. The trust provides care and treatment for a population of about 1.75 million and employs around 6,000 staff.

The trust provides the following 11 mental health core services:

1. Acute wards for adults of working age and psychiatric intensive care units (PICUs) 2. Child and adolescent mental health ward 3. Forensic inpatient/secure wards (low secure) 4. Long stay/rehabilitation mental health wards for working age adults 5. Wards for older people with mental health problems 6. Wards for people with a learning disability or autism 7. Mental health crisis and health-based places of safety 8. Community-based mental health services for adults of working age 9. Community-based mental health services for older adults 10. Community-based mental health services for people with a learning disability or autism 11. Specialist community mental health services for children and young people

It also provides five community health core services:

1. Community dental services 2. Community end of life care 3. Community health services for adults 4. Community health services for children, young people and families 5. Community inpatient services

NELFT became a Foundation Trust in 2008 and has 11 registered locations. The Care Quality Commission has inspected the Trust 17 times since registration and there have been 5 joint inspections with Ofsted. Between January 2015 and January 2016 four Mental Health Act review visits where 22 issues were identified, these included lack of involvement of patients in care planning, respect and restrictive practice.

NELFT was inspected in April 2016 as part of the CQC’s ongoing comprehensive mental health inspection programme. The announced visit took place between the 4 – 8 April 2016 with an unannounced inspection on the 14th April 2016.

35

North East London Foundation Trust Quality Commission Report Sept 2016

2

The inspection team was led by an Executive Nurse Director and the team comprised of four inspection managers, 16 inspectors with a range of expertise in the required areas.

The inspection:

Visited 62 wards, teams and clinics Spoke with 265 patients and people who use the services Reviewed the records of more than 258 patients Collected feedback from 339 patients, carers and staff Spoke with 32 ward and team managers Observed handovers and multi-disciplinary meetings Held 18 focus groups Interviewed the board members

The report was published 27th September 2016.

2.0 CQC Report Findings Below is a table indicating that report findings for all of the 5 domains of Care for the inspection undertaken 4 to 8 and 14 April 2016. The overall rating for the Trust is requires improvement.

14 services were inspected across the community and mental health services and of these 10 were rated as good. 3 areas were rated as requires improvement and 1 as inadequate and these can be seen in the table below.

Rating Service Inadequate Child and adolescent mental health wards Requires Improvement Community health services for adults

Community health services for children, young people and families Wards for older people with mental health problems.

36


3

The report identifies 57 areas that the provider must take to improve and 79 that should be improved. Where a registered person is in breach of a regulation or has poor ability to maintain compliance with regulations, but people using the service are not at immediate risk of harm, the CQC can serve a Requirement Notice on the provider. The provider is required to explain the actions that will be taken to comply with their legal obligations and improve care standards. Failure to provide an action plan to time is an offence and could lead to use of enforcement powers. The inspection and subsequent report highlighted 10 regulated activities where legal requirements were not being met and thus subject to requirement notice. 1. Regulation 5 HSCA (RA) Regulation 2014 Fit and proper persons; directors 2. Regulation 9 HSCA (RA) Regulation 2014 Person centred care 3. Regulation 10 HSCA (RA) Regulation 2014 Dignity and respect 4. Regulation 11 HSCA (RA) Regulation 2014 Need for consent 5. Regulation12 HSCA (RA) Regulation 2014 Safe care and treatment 6. Regulation 13 HSCA (RA) Regulation 2014 Safeguarding service users from abuse and improper

treatment 7. Regulation 14 HSCA (RA) Regulation 2014 Meeting nutritional and hydration needs 8. Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2010 Safety and suitability of premises. 9. Regulation 17 HSCA (RA) Regulation 2014 Good governance 10. Regulation 18 HSCA (RA) Regulation 2014 Staffing The CQC has the right to issue Warning Notices to a registered person where the quality of the care they are responsible for falls below what is legally required. Legal requirements can include the Health and Social Care Act 2008 (‘the Act’) and the regulations made under it, but also other legislation that registered persons are legally obliged to comply with in delivering the service.

NELFT and the Care Quality Commission held a Quality Summit on 14 October 2016 with all key stakeholders. The outline of the report was shared with stakeholders and the Chief Executive NELFT stated that whilst a number of key services were rated “good” work was required to ensure that all areas of improvement identified in the report were rectified. Work commenced on improvement actions as soon as the inspection completed. An action plan is being developed and following the summit will be finalised and shared with all commissioners.

The action plan will be monitored by the CQC who will revisit the areas of concern to ensure that actions have been completed. Currently there are no plans to re-inspect all NELFT services outside of the regular inspection regime, therefore the requires improvement status will remain ‘till the next inspection which will be within a 2 year time frame.

37


4

3.0 Recommendations WFCCG will arrange to discuss the report with the CQC lead inspector.

NELFT will be required to share with WFCCG the action plan developed to address the

regulation breaches.

WFCCG will review completion of action plan at the Clinical Quality Review Meeting monthly to

seek assurance that improvements are being progressed.

38

Item 4.1

Title of report Finance Report


Author Ian Clay, Deputy Director of Financial Strategy - WFCCG

Purpose of report

To provide an update to the Governing Body covering the financial position of the CCG as at the end of September 2016.

Changes/additions/amendments to paper as a result of discussions held at previous Committee

Not applicable.

Recommendations

The Governing Body is asked to approve this report.


None

Risk implications

There are some financial risks inherent within the CCG’s 2016/17 QIPP programme.


As a result of the information available to date the CCG is projected to achieve its planned surplus of £8.6 million for 2016/17 and to maintain its running costs within the cap set by the Department of Health.

Equality analysis

Not relevant for this report.


Income and expenditure is reported from Non ISFE (the CCG ledger) and activity from provider SLAM (Service Level Agreement monitoring) returns held on the NELIE (North East London Information Exchange) database.


The Finance and QIPP Committee receives a more detailed report covering financial performance.

39

Finance Report Update regarding the financial position of the CCG as at the end of

September 2016.

40

Finance Report

Page ii

Contents 1 Introduction 1

2 CCG summary income and expenditure position 1

2.1 Key headlines for M6 2

3 Commissioning expenditure 2

3.1 Barts Health contract 4

3.2 Associate acute contracts 6

3.3 Non Acute 6

3.4 Prescribing 7

4 Other financial risks and mitigations 7

5 QIPP 8

6 Balance sheet, cash management and PSPP 8

7 Conclusion and recommendation 9

Appendix A Detailed income and expenditure position 10

Appendix B Detailed QIPP performance 11

Appendix C Statement of financial position (balance sheet) 12

41

Finance Report

Page 1

1 Introduction The purpose of this report is to update the Governing Body on the financial position as at the end of September (month 6) and provide projections of income and expenditure to year end. The report goes on to describe any key variances to the commissioning budget and identifies financial risks and mitigating actions.

The Governing Body is asked to note that the CCG is forecasting that it will achieve the planned surplus of £8.6 million although there are risks to this position which will be outlined within the report.

2 CCG summary income and expenditure position A detailed budget position is attached at Appendix A and a summary position is shown in the following table:

Annual Budget

£’000

Year to Date

(surplus)deficit

£’000

Forecast Outturn M6

£’000

Barts Health 138,938 67 107

Other Acute 60,780 876 1,996

Mental Health 33,194 (9) (55)

Other Non-Acute 57,551 (250) (210)

Prescribing 35,113 (235) (471)

Delegated Primary Care 35,628 (33) (10)

Corporate 9,195 (46) (20)

Sub-Total 370,399 370 1,337

CCG Reserves 10,629 (370) (1,337)

TOTAL EXPENDITURE 381,028 0 0

TOTAL INCOME 389,628 - -

NET CCG POSITION 8,600 0 0

42

Finance Report

Page 2

2.1 Key Headlines for M6 to note are: The CCG is reporting a breakeven position against plan year to date (YTD) and is forecasting to

deliver a total surplus of £8.6 million at year end after the application of reserves. In line with revised planning guidance we are assuming that there will be no commitments made against the £3.8 million non-recurrent headroom reserve.

Barts have submitted SLAM data for M5 that if extrapolated results in a headline full year claim of £3.1 million above contract value after taking account of estimated readmissions, threshold and productivity metrics adjustments which have been calculated using precedent established during 2015/16. This headline claim reduces further as a result estimating the impact of coding and counting challenges and the rephrasing of the plan to reflect in year QIPP schemes and we are projecting a full year deficit of £0.1 million against the contract. The report includes detailed analysis showing our assessment of the risks associated with this contract.

Based on M5 SLAM claims submitted by other NHS and independent sector providers we are reporting a projected £2.0 million year end risk which reflects material variances at a number of Trusts. Further details are provided within the report.

We have reviewed our 2016/17 QIPP schemes and applied risk ratings which are detailed within Appendix B.

We have received actual prescribing data up to July 2016 and have used this to extrapolate 2016/17 costs up to M6 on the basis of the average daily prescribing costs over the last 6 months which results in a surplus of £0.5 million at year end against the QIPP adjusted plan.

Performance against the delegated primary care budget is shown separately at Appendix A. The budget includes a £0.5 million QIPP target and the majority of savings are expected to be delivered through a London wide review of business rates.

3 Commissioning expenditure At month 6 the CCG is reporting a £0.4 million deficit against commissioning budgets and a projected deficit of £1.3 million at year end. This deficit is covered by uncommitted reserves as detailed later in the report.

The following graphs show changes in activity over the period from April 2015 to August 2016 for accident and emergency attendances, outpatient first attendances and births broken down by activity at Barts and all other providers along with the total.

43

Finance Report

Page 3

0100020003000400050006000700080009000

FA Outpatient GP referral activity - Barts & Associates

Barts Grand total Associates

Linear (Barts) Linear (Grand total) Linear (Associates)

100020003000400050006000700080009000

10000

A&E Barts and Associates

Barts Grand total AssociatesLinear (Barts) Linear (Grand total) Linear (Associates)

050

100150200250300350400450

Deliveries

Barts Grand total AssociatesLinear (Barts) Linear (Grand total) Linear (Associates)

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This data indicates that births have been relatively stable over the 17 month period from April 2015 however we have seen a recent increase in activity at Barts offset by a reduction at other providers, particularly the Homerton. Activity across all providers was lower in August.

Attendances at accident and emergency departments have been reasonably steady over the same period but with a reduction in recorded attendances at Barts for August 2016.

Total outpatient first attendance data recorded on the SUS system can be used as a proxy for GP referrals and the graph shows a marginal upward trend across the 17 month period. Activity at Barts is shown as decreasing with an equivalent increase shown at other providers (including the independent sector), particularly since June 2016.

Key commissioning variances and projected risks are as follows:

3.1 Barts Health contract

The M5 SLAM claim submitted by the Trust indicates an extrapolated full year claim totalling £3.1 million above contract value after taking account of estimated readmissions, threshold and productivity metrics adjustments which have been calculated using precedent established during 2015/16. A summary showing all of the adjustments made to the headline M5 claim extrapolated for the full year is contained within the following table:

M6 Reporting Upside Base Case Downside M5 FOT

£'000 £'000 £'000 £'000

Extrapolated FOT from M5 SLAM 144,262 144,262 144,262 145,133

Readmissions penalty (2,958) (2,465) (1,972) (2,493)

Emergency Threshold (1,780) (1,483) (1,186) (1,779)

Impact of Productivity Metrics (901) (751) (601) (876)

Penalties Other (251) (209) (167) (156)

Critical Care Work In Progress 369 369 369 223

Unbundled Palliative Care (1,096) (913) (730) (807)

Impact of QIPP Phasing (1,125) (900) (675) (1,048)

Automated Claims (611) (509) (407) (1,007)

Other Challenges (948) (790) (478) (512)

Sub‐Total 134,962 136,611 138,414 136,678

CQUIN (base case assumes 85%) 2,405 2,434 2,466 2,436

Total Contract Claim 137,367 139,045 140,881 139,114

Source of Funds

Contract Value 138,938 138,938 138,938 138,938

Total Source of Funds 138,938 138,938 138,938 138,938

Total Forecast Risk (1,571) 107 1,943 176

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The table details the value of the adjustments which have been made reflecting a risk assessment of the challenges which have been made to the Trust. As can be seen from the table, there are both upside and downside risks associated with the above projection and the scale of the range at M6 is £3.5 million.

In addition, the M5 claim includes a number of significant variances against plan that when extrapolated forward result in the headline figure of £144.3 million shown in the table above. These are detailed below:

o £4.4 million headline claim relating to non-electives which represents a 13.8 percent projected variance against plan. As was reported previously a significant element of this relates to case mix or coding changes which are now subject to an activity query notice.

o £0.6 million relating to accident and emergency attendances which represents a 6.5 percent variance against plan. As illustrated within graph 2 below the weighted average tariff calculated from Barts SLAM data has been increasing. The weighted average tariff for 2016/17 is £145 compared with the 2015/16 average of £132 (an increase of 9.8 percent). In addition, there has been a 3.6 percent increase in attendances when comparing April to August 2016 with the same period in 2015. This level of growth does not align with data provided through performance reporting so further analysis is being undertaken to reconcile the 2 data sources.

Graph 1 Graph 2

o £2.2 million projected underspend against elective in patient and day case pathways. This

may be the result of patients choosing alternative providers or delays with the provider undertaking RTT clearance work in which case there is a risk that the trend seen over the first 5 months may not continue throughout the year. The following graph shows the number of elective episodes completed on a monthly basis since July 2015.

500052005400560058006000620064006600

Apr-1

5M

ay-1

5Ju

n-15

Jul-1

5Au

g-15

Sep-

15O

ct-1

5N

ov-1

5D

ec-1

5Ja

n-16

Feb-

16M

ar-1

6Ap

r-16

May

-16

Jun-

16Ju

l-16

Aug-

16

Waltham Forest CCG at Barts HealthA&E Activity

£110 £115 £120 £125 £130 £135 £140 £145 £150

Apr-1

5

May

-15

Jun-

15

Jul-1

5

Aug-

15

Sep-

15

Oct

-15

Nov

-15

Dec

-15

Jan-

16

Feb-

16

Mar

-16

Apr-1

6

May

-16

Jun-

16

Jul-1

6

Aug-

16

Waltham Forest CCG at Barts HealthWeighted Average Tariff

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The adjusted M6 position includes a £0.9 million adjustment reflecting re-phasing of the detailed plan to reflect that a number of the CCG’s QIPP schemes are planned to begin in October. The adjustments to the detailed activity plan reflected the part year nature of the schemes.

Negotiations with the Trust to settle Q1 have been progressing and agreement has now been reached on the majority of individual challenges. At present the contract risk across all CCGs at Q1 is estimated to be between £2.6 and £3.1 million based on challenges still to be finalised. The specific impact on WFCCG is broadly in line with the range shown within the table above to project year end risk on the contract.

3.2 Associate acute contracts Based on M5 SLAM data received from other providers we are projecting a full year risk of £2.0 million with material risks developing at the following Trusts:

£1.0 million risk projected against the £5.2 million North Middlesex University Hospital contract.

£0.6 million of this risk is a result of a significant rise in elective activity as outlined in previous reports. The remainder of the pressure relates predominantly to increased activity within outpatients. The market share graph from page 3 would indicate that this represents a change in referral patterns rather than an increase in overall referrals by GPs.

£0.6 million risk projected against the £1.6 million Royal Free contract. Referrals to the Trust have been increasing steadily as was outlined in previous reports resulting in a projected £0.2 million risk within outpatients. In addition, non-elective activity has increased over the same period.

£0.7 million risk projected against the £6.2 million UCLH contract. This is predominantly due to a £0.3 million projected risk on elective activity. As was reported previously, first outpatient attendances at the Trust have been increasing steadily since April 2015. The market share graph from page 3 would again indicate that this represents a change in referral patterns rather than an increase in overall referrals by GPs.

3.3 Non Acute We are reporting a projected £0.4 million overspend against the learning disabilities continuing

care and respite care budget associated with changes in package costs for a number of existing clients and new clients that have transitioned into adult CHC services. There are risks associated with the potential for further clients to transition during the remainder of 2016/17.

We are currently projecting a £0.5 million risk across our continuing care budgets. This projection includes the impact associated with the significant increase in the rate paid for Free Nursing Care (FNC) agreed nationally which has been estimated to have an impact of £0.2 million within Waltham Forest. In addition, we are reflecting £0.2 million associated with claims received for the retrospective reimbursement of privately funded care costs which have been successful at Independent Review and are the responsibility of the CCG to settle. There is a provision of £0.2 million within our projections to cover increases in the number of packages which may be agreed during the remainder of the financial year. Finally, we expect to recover costs of

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£0.1 million from other health and social care commissioners relating to patients that have been admitted into beds within a WFCCG funded block contract. The following graph shows the number of clients on a monthly basis funded by the CCG categorised by Adult CHC, Older Persons CHC and Fast Track. The graph indicates the total number of cases has been reducing slightly over this period and that the mix between categories has changed. Projections around financial risk are being refined in conjunction with the CHC contracting team.

We are projecting £0.5 million investment slippage across a number of community health services contracts, a £0.2 million under spend relating to the transfer of the paediatric eye service into the main Barts contract and underspend across a range of cost and volume contracts totalling £0.4 million.

3.4 Prescribing We are now projecting a £0.5 million surplus at M6 against the GP prescribing budget based on

extrapolating actual prescribing data covering the 6 month period from February 2016 to July 2016 for a full year and then adjusting for the delivery of phased QIPP savings of £1.0 million.

4 Other financial risks and mitigations Other financial risks faced by the CCG and mitigations are:

Work continues with the London Borough of Waltham Forest to understand further risks around the number of young learning disabilities adults who may become eligible for CHC.

The 2016/17 budget assumes successful delivery of the £9.5 million gross QIPP programme and the latest risk assessment of the overall programme will be provided later in the report.

CCGs have been asked to provide an additional £6 million to London Ambulance which is currently being disputed on the grounds that performance has not improved. The risk for WFCCG is £0.2 million.

0

50

100

150

200

250

300

Adults

Older People

Fast Track

Total

Linear (Total)

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The CCG has established a contingency reserve of £1.9 million within its 2016/17 plan and this has not been applied within our projected outturn at M6.

The CCG established non recurrent headroom of £3.8 million within the 2016/17 plan and in line with planning guidance no commitments are assumed against this reserve.

As at M6 the acute risk reserve totals £2.4 million and we have applied £1.0 million to offset risks within our commissioning budgets. Therefore £1.4 million remains uncommitted to help mitigate any further risks that emerge during the year.

5 QIPP Appendix B shows the latest detailed risk assessment of the CCG’s QIPP plan which underpins our 2016/17 budget along with a projection of the level of QIPP which will be achieved at year end. The risk rating is summarised in the following table. The appendix now includes details of QIPP investments for 2016/17 which result in a net QIPP plan of £7.3 million.

Current Value

Current Percentage

Previous Assessment

£m

Red 0.0 0% 0%

Amber 3.5 48% 48%

Green 3.8 52% 52%

Total 7.3 100% 100%

6 Balance sheet, cash management and performance against public sector payment policy (PSPP)

Details of the CCG’s closing statement of financial performance or balance sheet along with comparable figures at M6 are shown within Appendix C.

The CCG had drawn down cash totalling £174.2 million at the end of M6 from the government banking service and had cash holdings of £1.1 million as at the end of September which is approximately 3.8 percent of the cash drawn down in the month. Cash management rules require that we minimise the level of cash held at month end to at no more than 1.25 percent and we have therefore failed this measure for September.

The CCG, in common with all public sector bodies, is mandated to pay suppliers within 30 days from submission of a valid invoice and has a target of 95 percent achievement. As at the end of September the CCG’s cumulative performance was measured at 99.1 percent (based on the value of invoices paid) and 94.9 percent (based on volume of invoices paid).

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7 Conclusion and recommendation The Governing Body is asked to approve this report.

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Appendices A. Detailed income and expenditure position

Budget Actual Variance Budget Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000

Confirmed (192,798) (192,798) 0 (389,628) (389,628) 0

Acute SLA's 93,502 94,427 924 187,004 188,948 1,944

SLA Exclusions and Other Acute 6,418 6,436 18 12,714 12,873 159

Acute & Integrated Care Total 99,920 100,863 943 199,718 201,821 2,103

Mental Health 16,814 16,805 (9) 33,194 33,139 (55)

Learning Disabilities 2,625 2,837 212 5,280 5,663 383

Continuing Care 7,458 7,561 103 14,302 14,753 451

Community Services 16,342 16,001 (341) 32,721 31,938 (783)

Programme Spend on Additional Activities 1,181 1,043 (138) 2,330 2,118 (212)

CSS Services 1,119 1,034 (85) 2,918 2,869 (49)

Prescribing 17,557 17,321 (235) 35,113 34,643 (471)

Co‐Commissioning 18,213 18,180 (33) 35,628 35,618 (10)

Non Acute Total 81,308 80,783 (526) 161,486 160,740 (746)

Total Commissioning Expenditure 181,229 181,646 417 361,204 362,561 1,357

Running Costs ‐ Admin 3,117 3,090 (27) 6,235 6,224 (11)

Running Costs ‐ Programme 699 699 (0) 1,247 1,247 0

Operating Costs Total 3,816 3,789 (27) 7,482 7,471 (11)

GP IT 592 573 (19) 1,185 1,176 (9)

Programme Corporate Costs Total 592 573 (19) 1,185 1,176 (9)

Premises ‐ Void Costs 264 264 (0) 528 528 0

Estates Costs Total 264 264 (0) 528 528 0

Contingency (0.5%) 100 0 (100) 1,877 1,877 0

Headroom Reserve 0 0 0 3,454 3,454 0

Recurrent Investments 1,226 1,226 0 3,752 3,438 (314)

Other Reserves 1,271 1,001 (270) 1,545 522 (1,023)

Reserves and Contingencies Total 2,596 2,226 (370) 10,629 9,291 (1,337)

Total Expenditure 188,497 188,498 1 381,028 381,028 (0)

Unadjusted Surplus / (Deficit) 4,300 4,300 (1) 8,600 8,600 0

YTD Full YearSummary Position

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B. Detailed QIPP performance

Heading Proposed Project Planned Gross

Savings £M

Investment

£M

Planned Net

Savings £M

Forecast Gross

Savings £M

RISK

Assessmen

t

Integrated Care Phase 4

Self Care, Prevention & Early Intervention

Care Homes Support Programme

Falls and Bone Health Service

Maximising Utilisation of Beds

Ambulatory Care

Urgent Care Procurement

DVT Pathway

Continuing Health Care CHC Proposals £0.20 £0.20 £0.20

Primary Care Enhanced Services Contract Reviews £0.20 £0.20 £0.20

Primary Care MHS Pilot

Development of Primary Care Model by

NELFT

Reduction in Alcohol Related Admissions

MSK Pathway Procurement

Opthalmalogy Pathway Procurement

Renal Pathway Pilot

Gynaecology Pathway

Integrated Care co‐ordination

CHC for Children

Various pathway redesign

Medicines Management Medicines Management £1.00 £1.00 £1.00

All Acute Providers

NELFT

All other non acute providers

Delegated Primary Care £0.50 £0.50 £0.50

Corporate Reduce Property Voids £0.20 £0.20 £0.20

£9.50 £2.17 £7.33 £7.33 100.0%

£2.60 £2.60

£0.78

£0.70

£0.35

£0.70

£0.10

£0.78

£0.70

Productivity & Contract

Efficiencies

£0.70

£0.70

£0.70

£2.60Integrated care

Urgent and Amnulatory

Care

Mental Health

Planned Care

Women & Children £0.10

£1.82

£2.60

£0.35 £0.35

£0.70

£0.10

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C. Statement of financial position (balance sheet)

Statement of Financial PositionPosition as at 30 September 2016

£000 £000Mar 2016

Sep 2016

NON-CURRENT ASSETS

Property, Plant and Equipment - - TOTAL Non Current Assets - -

CURRENT ASSETSTrade and Other Receivables 5,913 4,650 Cash and Cash Equivalents 78 843

TOTAL Current Assets 5,991 5,493

TOTAL ASSETS 5,991 5,493

CURRENT LIABILITIESTrade and Other Payables (29,661) (26,672) Provisions - - Borrowings - - TOTAL Current Liabilites (29,661) (26,672)

NET CURRENT ASSETS/(LIABILITIES) (23,670) (21,178)

Trade and Other Payables - - Provisions - - Borrowings - - TOTAL Non-Current Liabilites - -

FINANCED BY:

General Fund (23,670) (21,178) Revaluation reserves - - TOTAL TAXPAYERS EQUITY (23,670) (21,178)

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Page 1

Item 5.1

Title of report Commissioning Strategic Plan 2016/17 – 2019/20 Refresh

From Jane Mehta, Director of Strategic Commissioning - WFCCG

Author Sharon Yepes-Mora, Associate Director of Strategic Planning - WFCCG

Purpose of report The Waltham Forest CSP 2014- 2017 has been updated to reflect the current national strategy and how the organisation is implementing the Five Year Forward View locally. The CCG’s first Commissioning Strategy Plan (CSP) was developed in 2013 setting out Waltham Forest’s priorities for healthcare for 2013-2014. The CSP was refreshed for 2014-2017. The CSP has now been refreshed for the period 2016/17-2019/20. The draft document attached in Appendix 1. Contextually the CSP’s relevance has decreased; it serves as the local strategy that is contained within a wider CCG strategic framework across North East London. It does however have purpose as a comprehensive internal planning document that clearly sets out the CCG’s vision, values and local plans for transformation. At its core the CSP is the narrative that describes the work programmes contained in the CCG’s Transformation Grid (Appendix 2). This is set within the context of developing a North East London Sustainability and Transformation Plan (STP) and the WEL Transforming Services Together (TST) delivery programme. The main changes in the refreshed strategy are highlighted below: 1. The updated CSP is reframed as TST Local which demonstrates that the CSP is the local delivery of

TST and maintains the same “brand” as TST. 2. It aligns the CCG specific work with the broader national and regional context. There is strong

alignment with the TST programme throughout as well as the Better Care Fund. 3. It updates the national and local strategic context with specific reference to the Five Year Forward

View ambition and the Strengthening Financial Performance and Accountability in 2016/17 (21 July 2016) sets out a series of actions designed to support the NHS to achieve financial sustainability and improve operational performance. The CSP contains the CCG’s local response to the national drivers and challenges.

4. The vision and values remain unchanged however the strategic objectives have been slightly changed to reflect system leadership and collaboration across NE London. This is described more fully in the attached transformation grid.

5. The structure has changed to focus on the priority work programmes and their plans over the next three years, as described in the transformation grid. The plans represent local delivery of the TST ambitions.

6. Each of the priority work programmes has a separate section describing ambitions and plans to deliver them over the next three years.

7. There is also a strengthened section outlining the enablers required for delivery including IMT, Workforce, Estates, Communication and Engagement and Organisational Development.

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Commissioning Strategic Plan 2016/17 – 2019/20 Refresh

8. The CSP can now be used as a compass as there are signposts throughout the document (links not yet activated) to other relevant documents as appropriate in order to reduce the level of detail.

9. There is a renewed commitment to the Asthma UK pledge. Also to the Chavasse Report guide to ensure better and greater continuity of care for those severely wounded in action, injured in training, or suffering debilitating musculoskeletal infirmity as a consequence of their military service.

Recommendations

The Governing Body is asked to:

1. Review the changes to the refreshed CSP 2. Approve and agree the content of the final draft CSP


The development and implementation of the Commissioning Strategic Plan will have a positive impact on patients and carers. The implementation of the clinical and strategic priorities will significantly enhance service quality and health outcomes and also promote equality of access and enable more patients to be treated closer to home. The CCG recognises the need to build on partnerships and structures and for the future ensure that new opportunities for involvement and engagement are realised, particularly around patient groups in practices and patient pathways. The CCG’s Community Participation Strategy 2013-2016 sets out how the CCG will involve the community in Waltham Forest in the commissioning decisions we take over the next three to five years. The CCG is currently seeking patient and stakeholder feedback on the CSP.

Risk implications

Financial risks and opportunities are an inherent part of any ambitious commissioning plan. However diligent planning and the availability of adequate resources will help ensure these organisational risks/opportunities are actively managed.


The CSP supports the organisation to manage some key financial and service delivery risks.

Equality analysis

The CCG has a responsibility not to discriminate and to promote equality of opportunity and pay particular attention to those group or sections of society with poorer health and life expectancy. The CCG is therefore committed to undertaking Equality Impact Assessments for any proposed tender in order to ensure that no groups are adversely affected by the process or potential result.


The September 2016 meeting of the Planning and Innovation Committee agreed the content of the draft CSP and requested that it is sent to the Patient Reference Group for information and to form part of the group’s welcome pack.

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Commissioning Strategic Plan 2016/17 – 2019/20 Refresh

Attachments:

Appendix 1 Commissioning Strategy Plan 2016/17 – 2019/20

Appendix 2 Transformation Grid

56

Item 5.2

Title of report Implementation of the Organisational Development Strategy - A Progress Update

From Jane Mehta, Director of Strategic Commissioning - WFCCG

Author Sharon Yepes-Mora, Associate Director Strategic Planning - WFCCG

Purpose of report

The overarching aim of the Organisational Development (OD) strategy 2015 and implementation plan is to support the delivery of corporate objectives and in particular the provision of consistent and high standards of quality, clinically driven care to the population of Waltham Forest.

An OD strategy was developed during 2015 with an associated action plan. This report provides the Governing Body with an update of progress made to date on implementing the strategy with a focus on the four main themes of the strategy:

1. Developing strong clinical leadership 2. Developing stronger collaborative relationships 3. Strengthening how we involve and engage patients and the public 4. Developing strong cohesive teams

Changes/additions/amendments to paper as a result of discussions held at Committee

Paper not presented at Committee level.

Recommendations

The Governing Body is requested to:

1. Review the progress report on the implementation of the Organisational Strategy 2015 and receive six month updates going forward.


The CCG has a firm commitment to achieving its clinical priorities, corporate objectives and ensuring patients are at the centre of what we do. The Organisation Development strategy and implementation plan is an enabler for this, setting how the CCG will develop its people, processes and organisation so that it can be a first class commissioner of healthcare for the residents of Waltham Forest.

Risk implications

Without strong OD systems and processes and robust succession planning there is a risk that the CCG will be unable to recruit and retain highly performing staff. Without developing emerging clinical leaders the CCG would be unable to fulfil its clinical commissioning function.

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Implementation of the Organisational Development Strategy - A Progress Update


The CCG needs to ensure that expenditure for officer and clinical development is in line with the available budget and training and development balanced across the organisation’s priority work programmes.

Equality analysis

The CCG has a responsibility not to discriminate and to promote equality of opportunity and pay particular attention to those group or sections of society with poorer health and life expectancy. The CCG is therefore committed to undertaking Equality Impact Assessments for any proposed tender in order to ensure that no groups are adversely affected by the process or potential result.


The NHS Leadership Academy resource has been utilised.


The Officer Organisation Development Working Group manages the OD implementation plan and monitors progress.

Attachments

Appendix 1 Organisational Development Working Group Terms of Reference

58

Implementation of the Organisational Development Strategy

A Progress Update October 2016

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Organisational Development Strategy 2016-17

Page ii

Contents 1 Introduction 1

2 Organisational Development Working Group 1

3 Implementation Update 1

3.1 Developing Strong Clinical Leadership 2

3.2 Develop Stronger Collaborative Relationships 2

3.3 Strengthening how we involve and engage patients and the public 2

3.4 Developing strong cohesive teams 3

4 Work in Progress – next steps 4

5 Recommendation 5

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1 Introduction Organisational Development (OD) is a planned, systematic approach to improving organisational effectiveness. It aligns strategy, people and processes to achieve delivery of strategic aims and objectives. This report presents the Governing Body with a progress report on the implementation of the Organisational Development (OD) strategy and its implementation plan. Regular six monthly updates will be presented to the Governing Body going forward. The 2015/16 Organisational Development Strategy was developed during 2015. The purpose of the strategy was to develop an engaged, motivated and skilled workforce, operating with the right culture of innovation, learning and teamwork and processes to lead first class delivery of transformation and maintaining the business programmes within available resources. There are four priority themes contained within the strategy and this report will focus on implementation made to date. Priorities were identified following feedback from staff, directors and the Governing Body through staff surveys, interviews and an away day discussion held in spring 2015. The overarching themes are: 1. Developing strong clinical leadership 2. Developing stronger collaborative relationships 3. Strengthening how we involve and engage patients and the public 4. Developing strong cohesive teams

2 Organisational Development Working Group An OD Working Group has been established to lead the implementation of the OD Strategy with particular reference to developing strong teams. The group takes a lead role in the OD and improvement agenda in areas such as behaviour and values, culture change, employee engagement, change management, leadership development and talent and succession planning. The group has developed and regularly maintains a monitoring framework for the OD implementation plan with a RAG rating to ensure that organisational development initiatives and activities are on track. There is representation at the group from across the organisation and all levels of staff. The group accounts into the monthly All Staff Meeting. The group is exploring having clinical lead representation as part of the membership. The current Terms of Reference are attached in Appendix 1. Quick wins for the group include to date: December 2015 - Delivering an improved Induction Pack and process for new staff December 2015 - Setting out an agreed Competency and Appraisal framework January 2016 - Improved staff engagement around HR (Human Resources) policies and processes

3 Implementation Update One of main themes in the OD strategy was that the organisation needed to focus on developing clinical leadership (including succession planning).

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3.1 Developing Strong Clinical Leadership Considerable progress has been made in developing strong clinical leadership which involves building clinical leadership capacity and capability, engaging the wider clinical membership to build a cohort of potential leaders and strengthening the role that Clinical Leads and Clinical Directors play within the work of the CCG.

The CCG has established a programme of development sessions aimed at Governing Body members which have covered a range of topical areas such as finances, estates and scaling up integrated care.

Clinical Directors and Leads have agreed work plans which contain corporate and work programme objectives. There has been a strong drive to hold regular meetings with programme leads and joint meetings with both Clinical Leads and Clinical Directors. These meetings were pivotal in developing the individual work programmes

A succession planning strategy for clinical leadership was developed and approved at the Governing Body January 2016 meeting which set out the approach to the development of clinical leaders.

A review process has been established to review roles at the end of the clinical lead contract, evaluate the purpose of the role and whether it is required going forward or if the terms should be changed or if the role is no longer required. There have been several opportunities to apply for clinical lead roles over the past year for example in mental health.

The CCG continues to review how the organisation engages with the membership. The locality meetings remain the main opportunity to engage with practices and these have been reviewed recently.

A Clinical Lead Network has been set up in response to suggestions at a development Away Day session. The ambition is to hold four meetings per year and the concept has been developed over time and will have an action learning set approach led by the Clinical Lead for education and development.

The CCG Chair is the lead clinician for OD and this supports/facilitates close working with the CEPN, (Community Education Provider Network) and integrated OD for clinicians.

3.2 Develop Stronger Collaborative Relationships The CCG has articulated a clear aspiration and intent to further build collaborative arrangements with Newham and Tower Hamlet CCGs. The organisational strategic objectives have been refreshed to reinforce collaboration with a specific objective to:

“Strengthen collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS”

The strong collaborative approach has enabled the CCG to be well positioned within the North East London STP (Sustainability and Transformation Plan) footprint and build upon established relationships including the local authority.

3.3 Strengthening how we involve and engage patients and the public This theme focuses in particular on how the organisation better utilises social media and strengthens the CCG’s digital presence as well as strengthening the role of the existing Patient and Public Reference Group (PPRG) and embedding engagement and involvement into business as usual.

The CCG successfully made an application for a Civil Service Fast Streamer placement. The placement started at the beginning of October 2016 for a six month period to work with the Communications team to develop and implement a comprehensive Social Media Implementation

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Plan for the CCG and lead the engagement with staff on a marketing plan to include main social media outlets such as Facebook, Twitter, YouTube and LinkedIn.

A further member of the Communications team has been recruited with a specific focus on patient and public engagement.

The CCG has carried out a range of engagement activities most notably the engagement with community group, wider public and clinicians in meeting the future challenges of primary care through the estates strategy.

At the September Annual General Meeting the efforts to involve and engage patients and the public was endorsed by the high turnout.

3.4 Developing strong cohesive teams This theme centres on valuing staff and developing skills and capability.

Valuing Staff Regular temperature checks are undertaken to gain insight into staff views across a range of areas including understanding of the organisation’s objectives, communication and suggested areas for change plus a deep dive into the PDP and appraisals process.

Surveys have so far pinpointed staff priorities that align with OD strategy but also picked up on areas that have not been looked at e.g. the need for the CCG to have more detailed guidance for all staff specifying how appraisals should be done. This has now been addressed.

The outcome of the surveys have been presented to the All Staff monthly meeting and the presentations of the three surveys undertaken to date are available upon request.

There is also a Suggestion Box in place and suggestions are reviewed and actioned and the outcomes fed back to all staff for example Dress Down Friday.

The CCG has signed up to the national NHS staff survey with the Picker Institute which is underway at present. The survey is administered annually so staff views can be monitored over time. It also allows the CCG to compare the experiences of staff in similar CCG organisations, and compare trends and experiences of CCG staff nationally.

The CCG participated in the Healthy Living Week Pilot at the end of September 2016 run by Healthy London Partnership (HLP) and invited the HLP team to attend and showcase the CCG on social media. The CCG is currently exploring the invitation to be a case study for the pilot. The diary of events included Workout at Work, a Tai Chi and Hula Hoop taster sessions, Fruit Box deliveries, Mindfulness exercises and table tennis. Participation saw over fifty members of staff take part in various work based activities encouraging fitness and mental wellbeing.

The CCG has signed up to Healthy Workplace Charter and are undertaking the self-assessment to achieve accredited status and the Healthy Living Week pilot will strengthen our application as well as mainstream some activities such as table tennis on a regular basis.

Developing skills and capability In addition to activities relating to valuing staff there has been intense activity to develop skills and capacity which are highlighted below:

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A Training and Development Policy has been developed as a framework to ensure that the limited training budget is allocated effectively. There has been a strong focus on leadership and supporting individual offers to undertake senior leadership training such as Elizabeth Garrett Anderson programmes. Alongside this the CCG has implemented an effective Appraisal and Personal Development Plan (PDP) process whereby staff have both a mid-year and an annual appraisal based upon start date.

The PDP process has been enhanced by the Maximising Potential Conversations initiative. This is an exercise currently underway where open and constructive conversations are taking place looking at individual potential; where they are now, where they want to be, and how they can be supported to get there. Maximising potential consists of talent and career development and is necessary for the retention of all employees and this exercise will support leadership development and succession planning across the organisation.

The outcome of the conversations will be used to shape a core curriculum of commissioning skills training and bespoke packages such as exploring opportunities for shadowing and secondment with neighbouring CCGs’ partners to develop greater depth of skills and experience.

The OD Strategy supports an integrated project team approach and fostering matrix working by establishing project teams to undertake specific pieces of work. As the CCG matures there has been an increasing shift towards working in a matrix management style especially associated with highly collaborative and complex projects; specific business objectives and targets become easier to achieve when there is good structured collaboration between the functional experts and programme leads.

A matrix working / inter-team map has been created which demonstrates that there is a strong matrix style of management with a significant number of staff with dual accounting for their work areas. This approach supports a collaborative style of working intended to support the staff to have a varied role and gain experience and expertise in different projects. It also serves that CCG as an enabler to rapidly activate skilled project teams and act responsively to demands placed on the organisation.

The monthly “Lunch and Learn” meeting is a new scheme where all staff are invited to attend an event to gain insight and learn about a particular topic such as the NHS Contract and Developing Business Cases and Primary Care Contracting. Attendance has been high with positive feedback.

Staff monthly meetings continue regularly and are hosted by the Accountable Officer and acts as an information exchange, a forum to showcase pieces of work and share successes.

The CCG has commissioned The Performance Coach (TPC) to run three coaching taster sessions from August to November 2016, to introduce staff to the concept of coaching as a leadership style. This is on the premise which is now supported by widespread experience, is that effective coaching can raise awareness and significantly increase levels of responsibility, understanding and ownership and so improving relationships and encouraging engagement, innovation and efficiency gains. Invitations have been issued to all officers, clinical leads and clinical directors and attendance across all three groups has been achieved.

4 Work in Progress – next steps 1. Complete the Maximising Staff Potential Conversations during November and complete a full review

in December 2016 2. Complete a training needs analysis for staff during January 2017 3. Identify health & wellbeing champions by end December 2016 4. Finalise the development of the staff intranet by end March 2017

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5. Develop a CCG Social Media strategy, policy and Twitter account by January 2017 6. Continue the Lunch & Learn Sessions for all staff on a monthly basis 7. Reframe the Clinical Lead Network as an action learning set, led and chaired by the GP lead for

education and training by end December 2016 8. Enhance the GP Education sessions to strategically align them to CCG priorities and extend them to

the wider MDT (Multi-Disciplinary Team) staff groups by end December 2016 9. Provide six monthly progress reports to the Governing Body, the next progress report due April 2017

5 Recommendation The Governing Body is requested to:

1. Review the progress report on the implementation of the Organisational Strategy 2015 and receive six month updates going forward.

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Organisational Development Working Group Terms of Reference

December 2nd 2015 Draft 0.2

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Document revision history

Date Version Revision Comment Author/Editor

09.11.2015 1.0 Author Toyin Ajidele

24.11.2015 0.1 SYM

02.12.2015 0.2 Updated post working group meeting 2.12.15

SYM

Document approval

Date Version Revision Role of approver Approver

Acknowledgements:

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Table of Contents

1 Purpose .......................................................................................................................................... 1

2 Key Responsibilities ..................................................................................................................... 1

3 Members ........................................................................................................................................ 2

4 Frequency of Attendance ................................................................. Error! Bookmark not defined.

5 Responsibility of Working Group Members and Attendees ....................................................... 2

6 Administrative Arrangements ...................................................................................................... 3

7 Accountability and Reporting arrangements .............................................................................. 3

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1 Purpose

The Organisational Development Group has been established (initially for a period of 12 months with a

self-assessment review at 6 months) to lead the development and implementation of the CCG’s

Organisational Development Strategy through a structured implementation plan that addresses all staff

groups.

The group will ensure that is a systematic approach with structures, processes, and systems in place to

ensure an effective capable workforce to meet the CCG’s current and future needs.

2 Key Responsibilities

The Working Group has the following responsibilities:

2.1 Implementation

1. Oversee the development and implementation of an effective OD strategy for CCG staff and clinical

leadership which supports the CCG’s business and transformational plans

2. Take a lead role in the CCG’s Organisational Development and improvement agenda in areas such

as behaviour and values, culture change, employee engagement, change management, leadership

development and talent/succession planning

3. Develop and maintain the monitoring framework for the OD implementation plan with a RAG rating to

ensure that organisational development initiatives and activities are on track

2.2 People Development

1. Support the development of HR processes, policies and procedures maintaining an effective system

of Human Resources, Workforce Planning and Learning and Development across the whole of the

organisation’s activities (both clinical and non-clinical) that supports the achievement of the

organisation’s strategic and operational objectives

2. Develop a talent management strategy to attract and retain a world class workforce

3. Develop an approach to succession planning, including the development of clinical leaders, to

ensure that all types of staff are developed for new challenges and to improve the retention of

talented key staff

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2.3 Leadership Design, develop and implement a CCG wide Leadership Development Programme for all categories of staff

2.4 Staff Surveys

1. Lead the staff satisfactions surveys (including the National Staff Surveys) ensuring the CCG gains

maximum benefits from these

2. Take responsibility for progressing actions arising from survey responses

3 Members

Working Group members include: 1. Director of Strategic Commissioning

2. Head of Primary Care

3. Associate Director, Strategic Planning

4. OD Manager

5. Head of Medicines Management

6. HR Manager

7. Finance Manager

8. Communications Lead

9. Executive Assistant

10. Business Manager

There is no named chair and the group will act as a collaborative with all members having an equal and

shared responsibility for the business of the group. Other attendees will be invited to attend meetings as

required.

4 Responsibility of Working Group Members and Attendees Members of the Committee have a responsibility to:

Attend meetings, having read all papers beforehand.

Act as ‘champions’, disseminating information and good practice as appropriate.

Identify agenda items to the OD Manager at least seven working days before the meeting.

Submit papers at least five working days before the meeting.

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Make open and honest declarations of their interests at the commencement of each meeting of

any actual, potential or perceived conflict in advance of the meeting.

5 Administrative Arrangements

The Working Group will be supported by the OD Manager who will be responsible for the management of the Committee’s business and will ensure:

An Action Log is produced within three working days of the meeting taking place and any outstanding

actions are carried forward until complete.

The agenda and accompanying papers are distributed to members five working days in advance of

the meeting date.

6 Accountability and Reporting arrangements Reporting Cycle & expectations

The Working Group will account into the monthly All Staff meeting

The Working Group will report to the Board twice a year on its work in implementing the OD strategy.

Final Version

2 December 2015

71

Highlights [Audit Committee] [September 2016]

Item 6.1

Committee Minutes

Audit Committee Meeting - September 2016

From Vineeta Manchanda, Deputy Chair, Audit Committee - WFCCG

Key highlights

The CCG Chair, Dr Anwar Khan, attended the meeting

Usual discussions in respect to directorate risk registers, noting that future reports would provide more detail in respect to those risks that had been retired from the risk register

Review and scrutiny of BAF ahead of Governing Body meeting

Update on progress against the CCG’s 2016/17 Information Governance Tool kit submission, noting that at the time of the report there were no known issues that would prevent the required level 2 status being achieved

Review of progress against mandatory training requirements noting that whilst the current level of compliance was below the trajectory it was not untypical for training statistics to improve in the 2nd half of the year

Presentation of the Internal Audit Report summarising progress against the CCG’s 2016/17 internal audit plan, drawing attention to the good progress made against reported actions

Presentation of the External Audit Report and Annual Audit Letter, 2015/16

Presentation by KPMG of a risk management benchmarking report. Subsequent deep dive into the CCG’s risk management and BAF reporting processes, chaired by the Deputy Audit Chair, took place 5 October 2016

Agreement to proposed amendments to the CCG’s scheme of delegation following issuing of guidance to the NHS that is intended to control the use of high cost interim staff.

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Audit Minutes September 2016 Page 1 of 5

Minutes of the Waltham Forest Clinical Commissioning Group Audit Committee (Part 1)

Date: Wednesday 7 September 2016

Time: 10am –12 noon Venue: Kirkdale House

Members Present Vineeta Manchanda (VM) - Chair Lay Member Audit Committee Dr. Rizwan Hassan (RH) Secondary Care Consultant In Attendance CCG Officers: Dr. Anwar Khan (AK) CCG Chair Les Borrett (LB) Director of Financial Strategy David Pearce (DP) Head of GovernanceAuditors: John Elbake (JE) Internal Auditor (RSM) Neil Hewitson (NH) External Auditor (KPMG) Ali Azam (AA) External Auditor (KPMG) Other: Zeb Alam (ZA) Information Governance, CCG Lead, NELCSU

Item

Action

Apologies for absence None Declarations of Interest There were no declarations of interest Minutes of the meeting held on 1 June 2016 Minutes of the meeting held 1 June 2016 were approved. VM

Matters Arising There were no outstanding Matters Arising

1 /16 Risk Management (1) Directorate Risk Registers:

DP presented the risk management report. DP advised that there were a total of 62 risks recorded across the CCG’s 3 directorates of which 6 risks had been identified for escalation to the Board Assurance Framework. RH enquired as to the details in respect to the new risk relating to Accountable Care System (ACS) which was a new risk added to the Strategic Commissioning Directorate risk register. LB advised the workings of the ACS whilst AK clarified that discussions with individual providers were continuing. AK further advised that there had been a Governing Body (GB) development session specifically relating to ACS. LB advised that he would circulate the relevant slides from the GB development session to the Audit Committee members. VM noted the references to those risks that had been retired from the individual directorate risk registers and requested that further details relating to this category of risk be included in future risk reports to the Audit Committee. The Audit Committee noted the report

LB DP

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2 /16 Risk Management (2)

Board Assurance Framework (BAF): DP presented a draft version of the BAF, advising that there was a likelihood that some of the details within the 6 risks reported through the BAF would be updated prior to the next meeting of the Governing Body. RH drew attention to Risk I (RTT) and noted the impact of the junior doctors industrial action. RH advised that although the planned industrial action had not taken place there remained an overall negative impact to the CCG’s performance target given that procedures had already been cancelled as part of the actions in place to respond to the industrial action. LB concurred with RH and further advised that future industrial action would continue to have further negative impacts on the performance target. VM noted the risk rating profile of Risk 2, (A&E target) and enquired as to whether the industrial actions were / would impact on the performance of this target. LB advised that was not the case and indeed performance tended to improve given the shift to senior consultant interventions during the industrial action period. LB further advised that the Trust continued to work on a range of issues, for example work force issues, in order to improve performance. VM drew attention to Risk 5 (Primary Care Commissioning) and enquired as to its impact on patients. LB clarified the process and advised that the expected outcome was improved patient care. Whilst there were some remaining issues with GPs, patient care would not be compromised. LB further advised that the London LMC had objected to the NHS England offer and that a revision was now due for consideration. AK further noted that the delays in the process was preventing some GP practices from finalising their related planning activities. The Audit Committee noted the report

3 /16 Information Governance ZA presented an update against the requirements and risks associated with

the 2016/17 Information Governance Toolkit (IGT) submission for 2016/17. ZA advised that a detailed work plan had been produced and that this was reviewed regularly with the CCG’s Senior Information Risk Officer (SIRO). ZA further advised that there were no significant changes in the requirements of the IGT submitted for 2015/16 and that the main risks to be managed included mandatory training and data flow mapping, including utilisation of NHS numbers. JE confirmed that the CCG’s IGT scores and ratings were subject to independent audit in order to validate the level and detail of the evidence submitted. LB further confirmed that at this point in time there were no known significant issues identified that would negatively impact on the CCG’s tool kit submission and prevent the achievement of the required Level 2 standard. The Audit Committee noted the report

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4 /16 Mandatory Training Report DP presented an update on the current status of the CCG’s mandatory

training status at August 2016. DP advised that the training statistics were produced through the CSU and that current compliance level was recorded at 38% across all mandatory training areas. DP further advised that whilst the current level of compliance was below the trajectory it was not untypically for training statistics to improve in the 2nd half of the year. AK noted that there were some concerns in respect to accessibility to a number of training modules for some staff. The Audit Committee noted the report

5 /16 CCG Policies Tracker

DP presented an update on the status of the CCG’s policies at August 2016. DP advised that a number of policies had been approved since the last report to the Audit Committee. DP further advised that in recognition of the effectiveness of the established process that the review period for policies had, in general, been extended to 2 years. DP further advised that the following policies were behind their current review schedule but that work was nearing completion on:

Safeguarding Children policy Safeguarding Children through Commissioning policy Standards of Business Conduct and the Management of Conflicts of

Interest policy (this policy is subject to approval following amendments to the statutory guidance on the management of conflicts of interest in CCGs)

Local Counter Fraud and Human Resources policy VM requested that clarification on the status of the ‘overdue for review’ policies be presented to the next Audit Committee meeting (2 November 2016). JE confirmed the robustness of the CCG’s proactive management of its policy approval process and advised that it fared well against other CCGs. The Audit Committee noted the report

DP

6 /16 Internal Audit

JE presented the internal Audit Report summarising progress against the CCG’s 2016/17 internal audit plan, drawing attention to the good progress made against reported actions. JE advised the status and target report publication dates to the Audit Committee against the remaining 6 planned internal audit areas. JE presented the audit findings, against the Quality and Risk Management (Whipps Cross Hospital) internal audit. JE advised that the report had been issued with Substantial Assurance. AK noted the assurance level and advised that the CQRM process monitored performance at Whipps Cross and whilst good progress was being made there remained much still to be done.

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JE further presented the CSU Quality Assurance Progress Report summarising the work undertaken against the 2016/17 Quality Assurance Plan, noting the 3 audits currently in progress including the audit work relating to cyber security and business continuity. JE described the quality assurance arrangements with the CSU. JE further clarified the main areas of focus given the assurance arrangements through Deloitte’s as the NHS England’s appointed auditors for CSUs. LB confirmed that the assignment areas relating to the CSU had been agreed with the CSU. The Audit Committee noted the individual reports

7/16 External Audit

NH presented an update on the external audit work programme: Progress Report: details of work undertaken since the last report to the Audit Committee (23 May 2016) along with technical updates. Annual Audit Letter, 2015/16: Key messages from the work conducted during 2015/16 resulting in the conclusion that the CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Risk Management Benchmarking Report: AA presented an independent report highlighting the top strategic and emerging risks being managed across their client base with WFCCG bench marked alongside all these. The Audit Committee approved the Annual Audit Letter and noted the progress report and the risk management bench marking report.

8 /16 Amendment to the CCG Scheme of Delegation

LB presented an amendment to the CCG’s Scheme of Delegation. LB advised that subsequent to the last review of delegated limits, guidance had been issued to the NHS that is intended to control the use of high cost interim staff. As such, with effect from 1st August 2016 the CCG must seek formal NHS England approval if it wishes to enter into a contract for the provision of interim staff with a daily rate of £600 or above (excluding VAT). LB further advised that the CCG will continue to operate using the scheme of delegation as previously approved by the Audit Committee but will incorporate the need to seek external approval if procuring high cost interim staff. LB presented a revised scheme of delegation noting the additional point in respect to Interim Staff. The Audit Committee approved the amendment to the CCG’s Scheme of Delegation.

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9 /16 Forward Plan

VM confirmed that the Deep Dive, scheduled 5 October 2016, would focus on the CCG’s Board Assurance Framework. VM further advised that the bench marking report presented by the external auditor’s would provide a basis for discussion.

VM

10/16 AOB N/A

11 /16 Private discussion between Audit Committee and Auditors

There was no business to discuss on this occasion.

12/16 Next Meeting

1 November, 2016 Venue Kirkdale House. (Please note that on this occasion the meeting is on Tuesday (1st) and not Wednesday (2nd) as was originally scheduled) .

Signed …………………………………………… Date ………………………….

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Highlights [Performance & Quality Committee] [September 2016]

1

Item 6.2

Committee Minutes

Performance and Quality Committee - September 2016

From Dr Dinesh Kapoor, Clinical Director Quality and Performance -WFCCG

Key highlights Chair’s Report

The Chair specifically highlighted cervical cytology and requested support from the Clinical Directors.

The Chair confirmed attendance at the clinical harm review meeting. The terms of reference for the Whipps Cross Clinical Forum need to be revised to

include the external clinical harm review around the Waltham Forest issues, this will be discussed at the forum and Performance and Quality meetings.

Cancer Services

Performance indicated that in June, 6 out of the 8 national standards were met and July, 7 out of 8 standards were met.

A deep dive session on cancer is planned for 4 November 2016. Internal cancer commissioning group established June 2016 and provides an

arena to discuss local approaches to cancer commissioning and end of life (EOL). Cervical screening programme target to achieve 73.5%, current performance at

65.79%. Barts Health Trust wide Paediatric oncology peer review undertaken in July 2016.

Concerns and risks were identified there being one action for Whipps Cross and another action relevant to all 3 sites. Barts has provided a response to the actions and have added the issues raised to the Trust risk register and governance is in place for follow up and review of actions.

The group requested an update on chemotherapy for certain cancers to be done at Whipps Cross, as this had been previously paused and not recommenced. Update for next meeting.

The group requested information relating to progress on 2 week wait under “unknown primaries”, as there is no form for unknown primaries and the pathway is unclear. Update for next meeting.

Public Health

No report in this month. Patient Experience

Whipps Cross Friends and Family Test is meeting the 80% target for patients who would recommend the service.

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2

Response rate for maternity and inpatients met targets in June although A&E rate remains significantly low at 3.7% in June (target 20%).

Whipps Cross complaints responded to within agreed timeframe target of 80% not achieved at 12% in June. The Good Governance Institute has been working with WX on serious incidents and complaints.

NELFT Friends and Family test percentage of patients who would recommend the service remains high at 85%.

NELFT complaints responded to within agreed timeframe was 66.7% in June against target of 80%.

GP Friends and Family test reported there were less than 40 responses received in June but still achieving the 85% target.

GP alerts – 6 alerts were received in July, 4 of which have been responded to. The usage is low compared to Tower Hamlets and Newham CCGs and the Chair has requested that GPs are asked to use the system to improve patient care and experience.

2015 Inpatient Survey Analysis – 83,000 patients were surveyed, with a 47% response rate in July 2015, (higher than 2014). Overall patient experience for Barts Health A&E was 7.6 out of 10. This is an average score.

Healthwatch – are carrying out service user representation training. Next one is on 18th September.

Performance The report highlighted the indicators with medium to high risk for the end of July:

1. Reduced emergency and A&E attendances for residential and nursing homes - medium risk.

2. Learning Disability health checks is amber rated due to low percentage, an action plan is in place. Clinical leads requested to contact the practice not signed up to the plan - medium risk.

3. Cancer urgent GP referral to first treatment within 62 days – medium risk. 4. Cervical cancer screening programme – high risk. 5. Renal - first outpatient attendances at Barts nephrology (Scheme starting October

- No RAG rating till then) – medium risk. 6. Chronic Obstructive Pulmonary Disease post bronchodilator spirometry – medium

risk. 7. Patients registered as palliative care - medium risk. 8. Continuing Health Care assessments within 28 days – medium risk. 9. A&E 4hr all types’ performance at Whipps Cross – high risk. 10. Improvement in Whipps Cross A&E, Maternity and Inpatient FFT score – medium

risk. 11. General Practice Friends and Family Test – medium risk. 12. DTOC as % of bed base (Whipps Cross) – medium risk. 13. Medically optimised (Whipps Cross) – medium risk.

Self-assessment of NHSE improvement and assessment framework overview provided to the committee. There are 60 indicators in the improvement and assessment framework which was released in June/July. These have been RAG rated according to whether the CCG is currently monitoring them. The committee agreed the 6 priority areas should come to this meeting and utilise the P&Q committee for assurance to Governing Body. BAF to be updated to reflect which committee will manage the risks.

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3

Quality Complaints Report WF CCG received 9 complaints in 2015/16 across 3 categories: 1. Funding decisions, 2. Service administration, 3. Continuing Healthcare (CHC).

Of the 9 complaints, 8 complaints were closed (5 upheld, 2 not upheld, 1 partially upheld) and one complaint is still under investigation.

Lessons learned were around – CHC, re-authorisation funding of medication and quality assurance of complaint responses.

Heathlands In response to a whistleblowing report made to CQC, the CCG and local authority carried out a visit of Heathlands and were satisfied with the standard and quality of care. There were areas that require improvement but nothing significant and an action plan is in place. CQC update

Whipps Cross and NELFT CQC reports have been sent out for factual accuracies checks, so not published as yet.

Whipps Cross enforcement notices have now expired and a current position on the notices to be discussed with the CQC next week.

NELFT reported there were no immediate issues/concerns raised by CQC. Bloomfield Court Report The committee received assurance that Bloomfield/Sequence Care Home are improving the quality of care at the requisite pace. Quality Dashboard

The committee were presented with a new style quality report, which was devised following feedback from auditors. The report includes;

Quality dashboards which include KPIs reviewed on a monthly basis Key headlines – what’s going well and areas for improvement Exception report – by indicator, with the headings performance, further intelligence

and action taken by CCG. Quality review visits – provides key highlights. Care homes

Quarterly 1 Quality and Governance report The committee were presented a new quarterly report on quality, safety, patient experience and governance. The committee approved the report and confirmed its presentation quarterly. Head of Maternity Commissioning annual report The annual report was presented to provide a broader understanding of maternity across North East London maternity network, CCG’s and providers. Transforming Services Together (TST) has progressed well with a strategy in place, with a desired shift in activity with more births taking place outside obstetric units. Medicines Optimisation

The committee received the presentation of the Quality Improvement dashboard with the aim to achieve £1million saving.

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The medicines optimisation related concerns raised during a quality assurance visit has been discussed with Barts Health who will respond formally and reported to the next meeting.

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Performance and Quality Committee Meeting

Date: Wednesday 14th September 2016

Time: 10.00am – 12.00pm

Venue: Boardroom, Kirkdale House, Leytonstone

Chair: Helen Davenport (HD)

Attendees: Dr Ken Aswani (KA) Les Borrett (LB) Kate Brintworth (item 9.7 only) (KB) Isabelle Davies-Tutt (IDT) Carl Edmonds (CE) Stephanie Good (SG) Kelvin Hankins (KH)

Paul Larrisey (PL) Rosie Martin (RM) Dr Tonia Myers (TM) Enrico Panizzo (EP) Anne Walker (AW) Kay Saini (item 10.1 only) (KS)

Apologies: Dr Dinesh Kapoor (DK) Joe McDonnell (JMcD)

Dr Munish Mistry (MM)

Minutes 1. Welcome and apologies HD

HD welcomed all and apologies were received from DK.

2. Declaration of interest register HD

There were no declarations of interest raised at the meeting.

3. Minutes of last meeting

Minutes of 6 July 2016 accepted as accurate.

Actions outstanding from previous meeting / Matters Arising Action

Actions completed were closed. Outstanding actions are updated on action log. The following actions were discussed. 5.0 TM to provide an update on clinical quality safety risk concerning smear testing at September meeting. 14.09.16 – minutes were amended as follows - TM highlighted a risk that smears are being reported as “Human Papilloma Virus (HPV) testing may be inaccurate” and then given a positive or negative result and being recalled on that basis. – TM escalated to the cytology department and ensured the confusing statement was removed. Action closed.

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Meeting minutes Performance and Quality Committee 14 September 2016

Page 2 of 12

6.1 Tier 2 Obesity Management update to be provided to September meeting by JMcD - JMcD did not attend the meeting and provided the following statement – “Given the pressures to make over £2million in public health savings over the next three years, it is now extremely unlikely that funding for any new services, such as those planned for addressing obesity, will be approved by the council’s internal governance. Smoking in pregnancy - given the current intention of LBWF to decommission the smoking cessation service in its entirety, consideration must now be given to alternative sources of support for pregnant women to quit smoking, including signposting to digital support. Once the future of smoking cessation in Waltham Forest is clarified, Public Health LBWF will be very happy to develop an action plan for this with maternity services and the CCG.” KH added that the Public Health cuts for this year is £1.6million and £2million next year, which has resulted in Public Health not extending the smoking cessation service and not planning to invest in Tier 2 Obesity services. KH and JMcD will be carrying out a mapping exercise of the Public Health initiatives, including obesity, smoking, cancer and mental health, to identify existing services and match them to priorities and identify where existing resources can be used to support priorities. They will also look at areas where a little investment in training and development of frontline staff can improve outcomes and how CCG resources can support the Public Health agenda where they match CCG, for example, mental health wellbeing. A paper will go to JCB in November. KH will talk to Lynn Snowden about investment into Tier 3 obesity, because if there is not going to be a Tier 2 obesity service, CCG will have to re-consider the model. HD raised concern about the lack of investment in obesity, given diabetes in children and would like to see a risk assessment for not investing. TM queried what children’s hubs are doing for obese children. KH will pick up in mapping. HD requested that obesity is put on the agenda for the next meeting when JMcD is present, to have a formal discussion about it. HD relayed that at a locality meeting yesterday, a review and external consultation regarding sexual health services was discussed and HD was not aware of this prior to the meeting. CE confirmed he was aware. TM asked where we scrutinise the local authority. HD suggested meeting with JMcD outside the P&Q meeting. KH explained that the sexual health service was discussed at length at the JCB yesterday and that Terry Huff has asked to see the risk assessment and quality impact assessment. HD would like the paper and feedback from the next JCB to be presented at the next P&Q. Action 3.1 Obesity to be put on the agenda for the next meeting, for a formal discussion, when JMcD is in attendance. Action 3.2 JMcD to provide paper (risk assessment and quality impact assessment) and feedback from the JCB meeting regarding sexual health services re-configuration. 8.2 and 8.3 Access policy has been circulated and discussed. However, it was felt that there had been a missed opportunity to take the policy to the Governing Body. The policy has now been signed off. DK shared the policy with LMC. CE confirmed John Peters (Barts Health Consultant) was scheduled to present to LMC and was on the agenda. However, JP did not attend the meeting. The administrator of the LMC will be following up with JP to find out what discussions he has had with LMC and whether they have supported or fed back at all. A lesson learned in what needs to be shared

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with the Governing Body in the future. TM clarified that she will relay at the locality meeting that the access policy has been shared with the LMC. Action 3.3 CE to follow up with Joanie Wilson (LMC administrator) re discussions and feedback received from LMC, regarding the Access Policy. Action 3.4 Mental health update to be added to October’s agenda. KH to present. 4. Chair’s Report Briefing – WX Clinical Forum Minutes Chair

HD provided a summary update from DK: - DK has sent the Clinical Directors update to the September LCMs and

has specifically highlighted cervical cytology, asking for support. - There have been helpful conversations at locality meetings regarding

FFT and MRI. Open MRI to be discussed under AOB. - DK has attended the clinical harm review meeting. - The terms of reference for the WX Clinical Forum need to be revised and

to include the external clinical harm review around the WF issues to be discussed there and at the P&Q meetings.

5. Cancer Services Update SG

- Performance – in June, 6 out of the 8 national standards were met. In July, 7 out of 8 standards were met.

- Action being taken by CSU service development and improvement plan carries any actions from remedial action plan from 2015/16. This is monitored at the national standards group meeting which LB attends.

- 4th Nov – is the next deep dive session on cancer. SG to ensure colleagues from WF CCG attend.

- Engaging in various forums and meetings. CSU report back any issues updates to CCG.

- Internal cancer commissioning group was set up in June which meets fortnightly and is chaired by Mayank and other Clinical Lead, where they discuss local approach to cancer commissioning and end of life (EOL), attended by CCG, CSU and Cancer Research UK facilitator.

- Focus is on cervical screening programme, which is on the scorecard to increase screening to 73.5%. It is currently 65.79%. Actions include clinical leads visiting practices to identify issues with improving uptake and looking at best practice.

- Developing communications plan for better engagement with residents and there will be a cancer stand at the AGM on 22nd September.

- Looking at how to engage better with the East London Cancer Group and looking at who should attend which groups to ensure CCG is represented at meetings.

- CCG had a meeting with Public Health on how best to work together on public awareness and engagement activities, in particular the Cancer Research UK roadshow and linking in with public health community health champions.

- Link with Barts Health via their site based Clinical Cancer Board – NA, SG and Mayank will attend.

- SG informed all about the data discrepancy between CCG and practices – EP asked how large the gap is between data. SG explained that Health Analytics is assisting with figures for the scorecard and measures the percentage of those screening in a) 3 years for 25 – 49 year olds and

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b) 5 years for over 50. The practices are using Open Exeter over 5 years for all ages. Discrepancy is where 25 – 49 year olds had a screening over 4 years ago are seen as up to date by practices, whereas Health Analytics would say they are not. Matt Henry is looking into whether we can use figures over 5 years and whether they are similar. Exception reporting by practices is also an issue.

- Looking at what processes can be put in place to improve communications around screening, for example texting to remind patients to respond to screening letters.

- 2 week wait referral forms – further communications will be sent this week as some practices are still using the old forms and faxing, rather than emailing.

- External engagement – improve links with Public Health, commission a joint strategy needs assessment (JSNA) for cancer, communications with BH has been challenging due to management changes. A survey will be sent out this week, for a month and use the results in focus groups end of Oct/early Nov. SG to ensure IDT – lead for patient experience is involved with engagement work.

Paediatric oncology peer review In July 2016, NHS England Quality Surveillance Team carried out a peer review of paediatric oncology services across the Barts Health Trust. Concerns and risks were identified. There was one action for Whipps Cross and another action relevant to all 3 sites. Barts has provided a response to the actions and have added the issues raised to the Trust risk register. NHS England will monitor the action plan and CSU will keep the CCG updated. SG addressed the 2 action points outstanding on the action log: Action 3.7 – The cancer services provided by Whipps Cross are oncology outpatient clinics, surgery, chemotherapy and radiotherapy. Action 3.8 - SG needed clarity on the action. HD clarified the action was trying to identify the pathway on what the commissioner can expect in terms of tertiary service and Whipps Cross for children and what the pathway is for shared care. HD acknowledged the very comprehensive report and good level of assurance provided by SG. HD acknowledged that although specialist commissioning have an overview for the Paediatric Oncology action plan, HD would like to pick it up at the WX CQRM, to ensure Whipps Cross is working on and that assurance is given, so that we can report it to the Governing Body and keep P&Q updated. HD reminded all that if they have a query about P&Q, to raise it outside the meeting and not wait for the next meeting. KA acknowledged the CCG is meeting national performance targets and commented:

1) End of life care (EOLC) – patients get preferred place of death and go through complex case management with integrated care. KA felt this should be monitored, as it is a priority. AW attends the cancer meeting and confirmed EOLC is a standing item on the agenda.

2) Urgent care – cancer patients should be given a point of contact and be clear on pathway, so that they are not admitted to urgent care.

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3) Specialist commissioning – Munish Mistry attended a workshop and KA suggested CCG link in with them to keep updated on their work such as cancer screening.

4) Public health – raise public awareness on areas of weakness, for example people presenting late, screening uptake and issues around delayed referrals.

TM found the paper helpful and asked for an update on chemotherapy for certain cancers to be done at Whipps Cross, as this had been previously paused. The service was promised and has not been delivered. SG to follow up with CSU and provide update at next P&Q. TM queried whether there was any progress on 2 week wait under “unknown primaries”, as there is no form for unknown primaries and the pathway is unclear. SG will find out. TM would like to see cervical screening included in the paper. Other boroughs have help at home for EOL. Paediatric oncology at Level 2 at WX, aware of a move to centralise and TM is keen Whipps Cross stays at level 2. May be part of TST programme. HD stated that every agenda item for P&Q should relate to CCG objectives, with a specific focus on the risks to the CCG and confirmed a monthly cancer update is required. Action 5.1 SG to ensure BH and CCG attend cancer deep dive Action 5.2 HD to include an update on Paediatric Oncology action plan on WX CQRM agenda, asking 1) how WX is managing risk of staffing and training, 2) electronic prescribing will be delivered in 2017 – what is the risk to the patient. Action: 5.3 SG to provide an update from CSU regarding chemotherapy for certain cancers to be carried out at Whipps Cross. Action: 5.4 SG to provide an update on 2 week wait under unknown primaries, as there is no form and pathway is unclear. Action: 5.5 SG to provide an update on the implementation of the national review of Paediatric Oncology, (level 2 at Whipps Cross).

6. Public Health

Not present.

7. Patient Experience IDT

IDT provided a summary of the patient experience report. Whipps Cross WX FFT – meeting 80% target for patients who would recommend the service. Response rate – maternity and inpatients met targets in June. A&E remains significantly low at 3.7% in June. Target is 20%. KH suggested the low response rate could be attributed to patients being confused about the difference between A&E and Urgent Care Centre. AW confirmed this was escalated from the KPI meeting and will go to CRG.

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WX complaints – target for number of complaints responded to within agreed timeframe was not achieved at 12% in June. Target is 80%. It has been a downward trajectory since March 2016. Good Governance Institute has been working with WX on serious incidents and complaints. NELFT NELFT FFT – percentage of patients who would recommend the service remains high at 85%. NELFT complaints – target for number of complaints responded to within agreed timeframe was 66.7% in June, a 33.3% decrease since April 2016, when it was 100%. Target is 80%. GP GP FFT – there were 40 less responses received in June but still achieving the 85% target. GP alerts – 6 alerts were received in July, 4 of which have been responded to. Other WX complaints – one complaint was received in July regarding a patient who attended a clinic, which had been moved. The patient was not informed of the change and is concerned about how they will attend the new site, as they have limited mobility. WX Intensive Care Unit patient diary - WX published the learning from the diaries. 2015 Inpatient Survey Analysis - 83K patients were surveyed, with a 47% response rate in July 2015, (higher than 2014). Overall patient experience for Barts Health A&E was 7.6 out of 10. This is an average score. AW suggested asking Barts Health how they are going to incorporate the findings into their patient experience strategy. Healthwatch – are carrying out service user representation training. Next one is on 18th September. There was a discussion about GP alerts, which remain low, compared to Tower Hamlets and Newham CCGs. To increase alerts, the form has been simplified, IDT attends the locality meetings, has phoned practices and has offered to complete the form on GPs behalf. KH suggested combining contract alerts and GP alerts. 5 possible alerts were raised at a locality meeting yesterday. The issue is with GPs not raising alerts. GPs will be asked at locality meetings and forums, to feedback on how CCG can help and support them and be more responsive to their issues. HD felt this issue has been discussed on many occasions. August figure was very low at 5. There are various issues at WX, for example, backlogs with SIs, complaints, Duty of Candour is non-compliant, failure to meet A&E target, issues with RTT and HD concluded that there must be issues for patients that GPs can raise. TM relayed a complaint by a partner and was asked to forward to IDT to turn into GP alert. KA raised the outcomes of GP alerts and commented it is an opportunity to make easier for future, so that the issue isn’t continuously raised. HD asked IDT to share on the GP website when there has been a definitive decision made or clarity given in response to an alert and to include a synopsis and outcome.

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CE suggested adding a bar chart to show how many GP alerts were resolved. HD asked committee to transfer any conversations with patients, relatives regarding their care, experience and complaints to HD’s team. Action 7.1: AW to ask Barts Health a) how they are going to incorporate the findings of the 2015 Inpatient Survey Analysis into their patient experience strategy, b) ask Whipps Cross management team how they are breaking it down and what they are doing for Whipps Cross (at CQRM), and c) IDT to contact the patient experience lead at Barts Health and discuss with them.

8. Performance EP

8.1

Scorecard EP highlighted the indicators with medium to high risk for the end of July: 1b – Reduced emergency and A&E attendances for residential and nursing homes – there were 80 attendances in July, which is a reduction from June which had 86 attendances. 5 GP practices are carrying out rounds in 11 care homes, project started in July 2016. A medium risk. 5 LD health checks – is amber rated due to low percentage, although numbers usually increase in quarter 4. An action plan is in place and have been signed off by all practices, except 1 practice, which does health checks. Lindy Shufflebotham has been to see the practice. HD asked the team, Clinical Lead and Director to contact and attend the one practice not signed up to the action plan. LD service has identified 2 nurses to work with practices to facilitate health checks. Have robust plan in place. Action to be copied and pasted in an email for immediate action. 7b Renal – scheme starts in October 2016. 7c COPD – KS is confident they will meet the target by the end of the year. As the year progresses, the results will improve with the new cohort of patients from April 2016. 8 Palliative care – issue is when person dies, they are removed from the list and you need to identify new people to add to the list. Clinical lead has been visiting practices to encourage them to add people to the list. Remains a high risk area. GF has been asked by Jane Mehta to provide an action plan. 9a CHC assessments – missed targets in June and July, although there was an improvement in July. Issues have been with local authority resourcing social workers. This has improved and should be back on target in September. Family engagement to meet 28 days. NELFT will now provide a covering letter with the completed DST, with a cut off period. Risk is families could challenge. 9b Personal Health Budgets – lower referrals than expected received. A new PHB scheme is launched every quarter. Latest scheme was for pregnant women with a fear of giving birth (tokophobia). Barts Health have made no referrals. Homerton is keen to refer and hope to be back on course. Low risk.

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8.2

Urgent care – moved from red to amber. WX had good performance in July and August and meet trajectory so at 91% but not met target of 95%. This could be because summer is usually good, due to low demand and will monitor to see if this is sustained. Work around DToC and low bed occupancy has also improved, under 90%. 13a FFT – AW confirmed the national target is 95% and CCG baseline is 93.75. Therefore, the national target is not unreasonable to achieve. 15a, b DToC – is within national target. There is a DToC out of hospital programme going live in September. The target was set by NHS England in July/August and have been taking diverts from North Middlesex since July. An action plan is in place, daily calls, been real focus and push. Other areas have improved as a result, i.e. length of stay and bed occupancy. Last week Whipps Cross had plus 19 beds for a few days. Looking to get Whipps Cross to give a time stamp to DToC and medically optimised daily reporting. EP is reliant on the daily calls. PL is working with Integrated Discharge Team on a system approach to support all areas. RTT - RM informed all the recent patient contact exercise has finished and considering when a return to reporting can start. There was a data comparison between 2 software products, identified more patients to be validated. The number was Frozen at 1st August and there are 69831 patients to be validated. RM clarified that they will identify those possibly waiting for treatment and will put them on patient tracking list, to be managed. Timeframe is dependent on option selected. LB clarified it is not about those not getting treatment but clarification of patient status. Trust has stopped retrospective validation to live/proactive validation to ensure patient pathway is clean. RM is expecting a deterioration in the month end position (not reported nationally). This frees up validation staff to deal with the 69831 patients. The Trust has provided 3 options for this work:

1) To be completed March 2017 – the cost will be in excess of £1million 2) To be completed later in 2017 3) With no extra validation staff, completion will be October 2017

Decision has not been made yet. NHS Improvement is looking at finances. HD requested a breakdown of Waltham Forest patients and provide communications on what it means to CCGs to Primary Care, at the next meeting and to be reflected in BAF. This may be raised at the AGM on 22nd Sept. RM will be leaving CSU will hand over to Alison. Action 8.3: The team, Clinical Lead and Director to contact and attend the one practice not signed up to the LD health checks action plan. Action 8.4: RM or colleague from LBWF to provide a breakdown of WF patients on validation list and provide an update at the next meeting. Action 8.5: RM to provide a communications paper to what the validation means for CCG and Primary Care and to be reflected in BAF. Self-assessment of NHSE improvement and assessment framework There are 60 indicators in the improvement and assessment framework. . Released in June/July. EP has RAG rated the 60 indicators, according to whether the CCG is already monitoring them. EP asked the committee to look at % of deaths in hospital, cancer patient experience, neonatal stillbirth, others will

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go to Primary Care or other dashboard. NHS England has published a summary of the framework and highlights 6 clinical priority area Cancer, Dementia, Diabetes, Learning Disabilities, Maternity and Mental Health and has assessment the CCG against them. Cancer is in the “Greatest need for improvement”. Decision – the committee agreed the 6 priority areas should come to this meeting and utilise the P&Q committee for assurance to Governing Body and include the primary care element, i.e. the primary care dashboard. BAF to be updated to reflect which committee will manage the risks.

9. Quality AW

9.1

Complaints Report WF CCG received 9 complaints in 2015/16 across 3 categories –

1. Funding decisions 2. Service administration 3. Continuing Healthcare (CHC).

Of the 9 complaints, 8 complaints were closed (5 upheld, 2 not upheld, 1 partially upheld) and one complaint is still under investigation. Lessons learned were around – CHC, re-authorisation funding of medication and quality assurance of complaint responses.

AW

9.2

Heathlands In response to a whistleblowing report made to CQC, HD, Sasha Wallace and the local authority carried out a visit of Heathlands and were satisfied with the standard and quality of care. There were areas that require improvement but nothing significant. HD has fed back to Heathlands verbally and a formal report will be sent to Heathlands. Heathlands has devised an action plan to address the areas of concern highlighted.

HD

9.3 CQC update

Whipps Cross and NELFT CQC reports have been sent out for factual accuracies checks, so not published as yet.

Whipps Cross enforcement notices have now expired. HD is meeting with CQC next week and has queried what their position is on the notices.

NELFT reported there were no immediate issues/concerns raised by CQC. CQC recognised Whipps Cross is a different organisation, improved staff

morale. There has been significant improvement at Whipps Cross but CCG

continues to seek assurances and work closely with them. CCG is keen for WF residents to know what has happened with the

enforcement notices.

AW

9.4 Bloomfield Court Report

PL is now assured that Bloomfield/Sequence Care Home are improving quality of care at the requisite pace. This has been evidenced in the work undertaken – both with local authority in Greenwich and Greenwich CCG.

Quality summit was undertaken in August, led by NHS England.

PL

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Bloomfield had a CQC re-inspection at the end of August. Report will be published at the end of September. CQC verbally informed Bloomfield there have been improvements.

CCG and local authority will carry out a visit at Bloomfield after the CQC report has been published.

PL is feeling confident that Bloomfield can provide the care to support the patient CCG is funding there.

The patient had their life review meeting at the end of August and will have their care and treatment review on 19th September, and on 29th September, the CCG will look at the discharge plan.

9.5 Monthly quality dashboard and exception report

AW presented a new style quality report, which was devised following feedback from auditors. Content includes:

Quality dashboards for WX and NELFT which include KPIs reviewed on a monthly basis

Key headlines – what’s going well and areas for improvement

Exception report – by indicator, with the headings performance, further

intelligence and action taken by CCG.

Quality review visits – provides key highlights.

Care homes AW would like a discussion on including primary care quality indicators. AW asked for feedback on the layout and content of the report. HD added that the Governing Body has requested the report. KA asked for consistency and context. General consensus was that the layout of the report is good. KH suggested adding the integrated dashboard of the registered care market would fit in under “Care homes”. KH suggested adding other providers CCG has large contracts with such as SEPT and MSI.

AW

9.6 Quarterly 1 Quality and Governance report AW informed all most healthcare organisations provide a quarterly report on quality, safety, patient experience and governance and presented the quarterly quality and governance report for feedback. AW proposed to look at the report on a quarterly basis at P&Q and look at expanding it to include safeguarding, primary care, quality and safety from medicines optimisation. AW requested the committee to review the report and provide feedback and to also consider whether P&Q would like to have the report presented on a quarterly basis.

AW

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Action 9.8: Feedback on both the Monthly quality dashboard and exception report and the Quality and Governance report to reach AW by the end of September Action 9.9 AW to send out Word versions of both the Monthly quality dashboard and exception report and the Quality and Governance report, to allow for amendments/comment/track changes

9.7 Head of Maternity Commissioning annual report KB presented the annual report and highlighted:

The report gives a broader understanding of maternity. There was a successful re-launch of the North East London (NEL)

maternity network with all the CCGs and providers. There is a defined work plan in place and already seeing outcomes,

despite being launched in January 2016. There is an agreement reporting on pan London dashboard and they are

about to agree NEL parameters, which will enable for the first time comparison like for like between providers.

Transforming Services Together (TST) has progressed well. There is a strategy in place. Although the implementation plan has slowed due to resource implications, there has been a desired shift in activity - more births are taking place outside obstetric unit.

Overall, the biggest change has been the coming together of all involved in maternity and look at maternity as a system wide issue.

HD thanked KB for her support, report and update.

KB

10. Medicines Optimisation AO

10.1 Medicines Optimisation scheme dashboard KS presented the dashboard to achieve the £1million QIPP saving. KS highlighted that there is a standard operating procedure in place to support practices and work is in progress to improve the red RAG ratings. KS presented another dashboard, taken from the NHS England medicines optimisation dashboard. It shows the practices which have access to the Pincer tool. Pincer is a prescribing tool which helps with safety. The tool used to be free but practices are now being charged for it. A lot of WF practices have not taken up the tool. CCG will be looking to NHS England for funding, if unsuccessful, KS submit a business case to CCG. KS was unsure of the cost. KS raised the quality assurance visit undertaken at Whipps Cross by AW. Barts Health will respond formally and KS will present the report at the next P&Q. Going forward, the pharmacist will carry out monthly visits on the wards and will report on a quarterly basis at the Medicines Optimisation Committee and P&Q. Action 10.2: KS to confirm the cost of Pincer tool for practices by Thursday 29th September with HD, for the assurance meeting.

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11 Forward Planner

Not discussed due to time constraint.

12 AOB All

1. Open MRI – HD asked who the application is made to and what the process is. KH confirmed CCG does not have a contract for this. It was identified that there is no risk regarding this.

2. Sharps bins – KS informed all that at the Diabetes Strategy Group, it was identified that patients discharged from Whipps Cross are not being issued with sharps bins for needles. AW will take forward as a GP alert.

Action 12.1: AW to raise the issue of insulin dependent diabetic patients not being issued with sharps bins, as a GP alert.

Details of next meeting:

Date: Wednesday 12 October Time: 10.00am – 12.00pm Venue: Boardroom Kirkdale House

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Highlights [Medicines Optimisation Committee] [September 2016]

Item 6.3

Committee Minutes

Medicines Optimisation Committee Minutes - September 2016

From Dr Ravi Gupta – Clinical Director for Medicines Optimisation - WFCCG

Key highlights

SPIROMETRY The spirometry audit has now been completed. A small number of practices did not complete the response to the questionnaire. It was identified that even though some practices do have a spirometer, some machines are being regularly calibrated and patients are still being referred elsewhere for spirometry. This questionnaire has highlighted the need for further work to determine whether the spirometers are being used and maintained correctly and whether practitioners are competent in using the machines. Medicines Optimisation Team (MOT) are looking into whether the Health Education England training course available for practitioners on the use of spirometers can be provided locally.

MEDICINES OPTIMISATION SCHEME 2017/18

The Committee discussed the feedback given at the locality meetings to identify how to develop and implement the scheme and look at possible areas of review for 2017-18. The Committee agreed to continue the current scheme set up. The outline of the proposed scheme was presented to the Committee and it was decided that the scheme should continue to focus around Medicines Optimisation and specifically look at addressing issues around polypharmacy, medicines reconciliation and waste.

NELMMN HOSPITAL ONLY PRESCRIBING LIST The Committee discussed the management of the NELMMN Hospital Only Prescribing list. NELMMN has disbanded and has not been replaced by another organisation. The Committee approved that the list will be reviewed by the WEL Medicines Optimisation and Commissioning Committee (WEL MOCC) and the MOT will reissue the updated list once it becomes available. In the meantime, the submissions requested as a part of Medicines Optimisation Scheme 2016-17 will be put on hold until the WEL MOCC list becomes available.

The summary of queries can be found in the locality pack (Please click here for link page 116)

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Minutes

Meeting Medicines Optimisation Committee

Date and Time: Wednesday 14 September 2016, 2:00pm-4:00pm

Venue: Boardrooms B&C, Kirkdale House, 7 Kirkdale Road, E11 1HP

Chair: Dr. Ravi Gupta

Attendees: Name Title

Dr. Ravi Gupta RG Waltham Forest CCG GP Clinical Director Ada Onyeagwara AO Associate Director, Assistant Director, Medicines Optimisation Team Dr. Imran Kazi IK GP Prescribing Lead for Chingford Dr.Thaven Chetty TC GP Prescribing Lead for Leyton/Leytonstone Dr. Rishav Dhital RD GP Prescribing Lead for Walthamstow Natalie McCallam Thomas

NMT Project Support Officer, Waltham Forest Medicines Optimisation Team

Hassan Serghini HS Senior Prescribing Advisor, Waltham Forest Medicines Optimisation Team Kay Saini KS Senior Prescribing Advisor, Waltham Forest Medicines Management Team Isaac Otomewo IO Senior Prescribing Advisor, Waltham Forest Medicines Optimisation Team Helen Davenport HD Director of Nursing, Quality and Governance Mayur Patel MP Local Pharmaceutical Committee representative for Waltham Forest Dr Hisham Swedan

HSW Local Medical Committee representative for Waltham Forest

Apologies Name Title

Kamaljit Takhar KT Deputy Chief Pharmacist, NELFT CSS Services Mohammed (Zahir) Rashid

MZR Clinical Commissioning Pharmacist Barts Health NHS Trust (Newham University Hospital)

Lynn Snowden LS Senior Commissioning Manager, Waltham Forest Anisha Sharma AS Prescribing Advisor, Waltham Forest Medicines Optimisation Team

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16/09/01 Welcome and apologies Apologies were received as above. It was also noted that RG, KS, HS and HSW would

arrive late to the meeting, due to other meeting commitments. In the absence of RG, IK acted as Chair and welcomed members to the meeting. Apologies were received as above.

16/09/02 Declarations of Interest and Register of Committee Interest There were no declared interests.

16/09/03 Minutes and matters arising Review of August 2016 Minutes

The MOC minutes were approved by the Committee as accurate.

Review of Action Tracker MOC 228- To date, the Medicines Optimisation Team have received no written information of the self-care pharmacies in Waltham Forest from the LPC. This is of concern to the CCG, as the competencies of the pharmacists commissioned to provide the service is not clear. A verbal update has been given, but for assurance purposes, this must also be submitted in writing. If this information is not received by Friday 16 September 2016, this matter will be added to the MOC risk register. ACTION: MP to follow up the issue of the outstanding self-care information with the LPC. MOC 227- It was confirmed that the winter resilience fund cannot be used to support the development of leaflets and promotional material for minor ailments, so these will be funded by the CCG. The WEL MOCC will also be discussing WEL communications in its entirety. MOC 226- The Strategic Commissioning Team have confirmed that individual practices will need to give permission before their by-pass numbers can be circulated to the LPC. This permission is currently being sought. MOC 223- A covert administration policy template for residential homes has been developed, and is currently being reviewed. The policy template will be presented at a future MOC meeting. MOC 220- As there is evidence that only some practices have included a section on what to do if a prescription is not collected, the MOT has drafted information regarding uncollected prescriptions for inclusion in their repeat prescribing policies. As this is an action following a serious case review, all practices will be obliged to include this wording. The Committee agreed the use of the wording. MOC 219- The LPC are required to organise a meeting with the Heads of Medicines Management/Optimisation in Waltham Forest, Tower Hamlets and Newham CCGs, to discuss the policy for pharmacy requesting repeat prescriptions for patients from a GP currently being developed before the approval of this policy. This action is pending. ACTION: MP to follow up the issue of the outstanding meeting with the LPC.

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MOC 217- The Committee were informed that Dr Prakash Kawar has stepped down as the LMC representative, and that Dr Hisham Swedan (HSW) will now attend the MOC meetings. The LMC have also confirmed that any information contained in their minutes that is relevant to the MOC, will be circulated to the MOT generic inbox. ACTION: RG and AO to arrange a meeting with HSW, to discuss MOC attendance. MOC 216- The LPC representative confirmed that 30 pharmacies out of 59 in Waltham Forest are part of the new pharmacist federation. This action is now closed. MOC 213 and MOC 212- Both of these actions relate to the low engagement of the prescribing incentive scheme and will be discussed on the agenda under item 16/09/04. These actions have now been closed. MOC 211- The MOT have provided the Head of Governance with all the information required regarding the management of declarations of interest. The Head of Governance has produced a staff briefing for the CCG on declarations and conflicts of interest to provide clarity on the process. Following the update to the management of declarations, the CCG’s constitution will need to be changed, so a report is being taken to the next Governing Body meeting. This action is now closed. MOC 210- The private policy patient information leaflet is currently being reviewed by the Communications Team. MOC 209- The issue of uncollected prescriptions is being looked into by the LPC and will be raised at their next meeting. ACTION: MOT to draft a request to NHS England on behalf of the LPC, in relation to uncollected prescriptions and will pick up any outstanding issues with them. MOC205- This action regarding the pharmacy federation and self-care training has already been covered in MOC 228 and MOC 216. This action is now closed.

16/09/04 Quality, Performance and Governance

Risk Register R09- SPIROMETRY The spirometry audit has now been completed, but a small number of practices have not responded to the questionnaire despite numerous notifications from the MOT. It was noted that whilst some practices do have a spirometer, they still refer patients to other services and some practices, do not calibrate the machines. Based on this, further work will need to be carried out to establish whether the spirometers are being used and maintained correctly and whether practitioners know how to use the machines. Health Education England provide a training course to practitioners on the use of spirometers, so the MOT are looking into whether this training can be provided locally. ACTION: HD and AO will draft a letter on behalf of the Chair to the practices who have not responded to the spirometry questionnaire, highlighting the risk, the expectation of response and the action that will be taken if a response is not received. RAG Rating remains the same as last month: 9 (AMBER) - (3 for Likelihood and 3 for consequence)

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R11- ADMINISTRATION OF MEDICINES IN CARE HOMES All medicines policies (excluding one) for the nursing homes have been submitted and reviewed by the MOT. It was noted that whilst the policies were adequate, the main omission was around medication reviews and the management of medicines reconciliation. It was suggested that it would be useful for the nursing homes to review their policies in light of the NICE guidelines for care homes, released in 2015. The Quality and Governance Team will be carrying out a number of Quality Assurance visits, and will test out the medicines policies and action plans. A checklist has also been produced for the Prescribing Support Pharmacists to use in residential homes. RAG Rating remains the same as last month: 9 (AMBER) - (3 for Likelihood and 3 for consequence) R12- ACUTE PRESCRIBING BUDGET This risk is being reviewed by the MOC, as there is a need to identify what aspect of the risk should be included on the risk register. The Committee have not RAG rated this risk. R14- DIABETES This risk has discussed outside of the MOC meeting, where it was agreed that it must be made clear whether this is an MOC risk and what can be done to mitigate it, or whether it is a risk for another directorate in the CCG. The Committee agreed to focus on the management of diabetes prescribing and the implementation of NICE guidance. As the guidance is unclear and not very specific, this will need to be reviewed, with additional guidance provided. The financial element of this risk will be looked at outside of the MOC meeting. RAG Rating: 6 (YELLOW) - (3 for Likelihood and 2 for consequence) R15- COMMUNICATION WITH COMMUNITY PHARMACIES It has not always been clear in the past whether community pharmacists are aware of the work being carried out by the MOT. As a way to improve engagement and communication links, two community pharmacy events are being held in November 2016 with Waltham Forest, Tower Hamlets and Newham CCGs. The LPC and MOT have been working together, and engagement has also improved. This risk has now been retired. R16- DETECTION AND MANAGEMENT OF HYPERTENSION Whilst there are elements of this risk that relate directly to prescribing, it was agreed that further work is required to establish what the risk is against the CCG’s objectives. The Committee have not RAG rated this risk.

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COPD Indicator The Committee was updated on the Spirometry (COPD) indicator, which is a part of the Performance and Quality Scorecard for 2016-17. The spirometry (COPD) audit has now been completed, and further work is being carried out to address the practices that are still to respond. The MOT are confident that the indicator will be met as the cohort of patients being reviewed runs from April 2015 – March 2016, so improvement should be seen. To support this indicator, the MOT are also providing educational events and engaging with practice nurses.

Antimicrobial Stewardship update An update was provided to the Committee on Antimicrobial Stewardship in Waltham Forest for 16/17. There has been a steady decline in the overall prescribing of broad spectrum and antibacterial items, which has been due to the work being carried out by practices. The antibiotic audit carried out as part of the prescribing incentive scheme has also been a useful tool in assisting with the decline of prescribing. The CCG is currently within target for antibacterial items (CCG 0.934 – target 1.161), but further work is required on the broad spectrum target (CCG 12.50 – target 12.20). A number of practices are above the QP target, however the high prescribing practices will be monitored throughout the year in line with NICE guidance. At the recent NEL Antimicrobial Resistance Strategy Group, the implementation action plan was discussed, priorities were set and sepsis awareness was looked at. The group also discussed a smartphone app mainly used by hospital trusts to access formularies. The MOC agreed that this app was not required in primary care, as there are a number of other portals where formularies can be accessed. ACTION: MOT to highlight the practices that are performing well in relation antimicrobial stewardship in the MOT bulletin, as examples of good practice.

Medicines Optimisation 2017/18 The Committee was given feedback from the locality meetings, where the prescribing incentive scheme and low engagement by practices was discussed. Points raised included:

Larger practices have a number of locums, which makes it difficult to engage Some practices felt that the money received did not justify the amount of work

required Other practices felt the scheme was very valuable and the money received was an

important source of income, so the scheme should continue. One suggestion included hiring clerical assistants associated with the scheme

rather than using a pharmacists. Following discussion of the comments received, the Committee agreed:

The £175,000 budget will be divided between practices as previously. Support will be provided by two pharmacists in Primary Care

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Failing practices will be prioritised (as agreed by the Committee). It was noted that the top 5 poorest performing practices will not be focused on this time, as they have received additional support in the past, with little change in outcomes. The focus will therefore be on the 6th – 10th poorest performing practices, who may benefit from additional pharmacist support. In turn, engagement with the scheme may also improve.

An outline of the proposed Medicines Optimisation Scheme for 17/18 was provided to the Committee. For the forthcoming year, the MOT want to continue with the medicines optimising theme, improving outcomes for patients, ensuring medicines are taken correctly and reducing waste. The proposed areas of focus include:

Polypharmacy - A continuation of last year’s audit, using the ScriptSwitch® STOPP/START tool

Diabetes – Reviewing patients in line with current guidelines, encouraging a holistic approach in the management of diabetes and improving outcomes.

Respiratory – Practices to undertake a review of high risk asthma patients, implement key recommendations and undertake a patient satisfaction survey.

Hypercholesterolemia – Optimising Lipid Modification for primary and secondary prevention of Cardiovascular Disease (CVD)

Atrial Fibrillation – Practices using the GRASP AF tool to identify untreated patients and refer them to a local anticoagulation service for consideration

Medicines reconciliation – Practices providing evidence of a robust process for medicine reconciliation for patients discharged from hospital

Medicines waste – Reduce medicines waste through a campaign promotion in conjunction with local community pharmacist.

Following discussion on the proposals, including looking at the pros and cons, the Committee agreed that the Medicines Optimisation Scheme for 17/18 will focus on:

Polypharmacy (10 medications or more) Medicines Reconciliation Medicines Waste

The title of the scheme should include the words Optimising, Quality and Safety Audits will be called projects

The MOT will also work with the wider CCG to look at Diabetes in general.

LPP paediatric feeds The Committee were presented with three documents, produced by the London Procurement Partnership (LPP) for adoption. The first document contained a guide to initiating formulae used in cow’s milk protein allergy in children. The guidance provides information on how to appropriately treat, which formulas are available and also gives recommendations on what to prescribe along with quantities. The second document was a general guide on infant milks and formula feeding produced by the first steps nutrition steps which has been adopted by the LPP. The third document was a GP guide to reviewing formula in pre-term infants that contains information on various products as with the first document.

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It was noted that whilst the guidelines provided a lot of information, it did not provide any detail on diagnosis of allergies, which could create a clinical risk. Further information on diagnosis will need to be sourced from elsewhere by the MOT. A point was also raised that caution should to be taken when naming infant formulas on the formulary, and should be in line with advice from the World Health Organisation. Clarity is also required regarding the pathway for babies following discharge from the acute sector. It was highlighted that there is a need for a wider work plan to address all aspects of the pathway and management of managing Cow’s Milk Allergy Protein which include clarity around whether specific formulas can be recommended. ACTION: As part of the implementation plan, MOT to hold a GP forum covering paediatric feeds, diagnosis and treatment of allergies. The Committee did not approve the document, as further work is required.

End of life service specification and plan At the August 2016 MOC the Committee were asked to review and approve a document which summarises information for clinicians who may need to either provide advice or access the End of Life service. After review, the Committee requested that further information be included on prescribing, education and training for prescribers around controlled drugs. This information has now been included in the document. The Committee approved the document.

Regional Medicines Optimisation Committee (NHSE) This NHSE document has been circulated to the MOC, and looks at how drugs that have not received NICE approval will be managed. The four RMOCs will review these drugs and make a decision, which will only be advisory to the local APCs (Area Prescribing Committee). The document contains a series of questions that require answers by the MOC by 19/09/16. ACTION: The Committee were reminded to submit their answers for the RMOC questionnaire to the MOT by 16/09/16. It was confirmed that the WEL MOCC will be one of the Area Prescribing Committees in North East London (there will be 2-3 in total). A member of the WEL MOCC will also sit on one of the RMOCs.

NELMMN Hospital only list review A Waltham Forest GP raised an issue regarding the recent NELMMN hospital only submissions required as part of the prescribing incentive scheme. It was noted the hospital only list is not up to date, so it was not clear what was required from the practice and may create duplicate work. The matter was brought to MOC for discussion.

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As the NELMMN has disbanded and hasn’t been replaced by another organisation, the hospital only list will need to be reviewed and updated by the WEL MOCC. The MOT will reissue the updated list to practices in due course, but may need to amend the NELMM submission element of the prescribing incentive scheme. ACTION: MOT to review the NELMMN list and re-issue to practices

Malaria leaflet Barts Health have made a request for Waltham Forest CCG to host their patient information leaflet on Malaria on the practice portal. The leaflet provides information on Malaria, who is at risk, how it can be prevented and useful online resources. The Committee agreed that the information can be hosted on the practice portal. ACTION: MOT to host the malaria leaflet on the practice portal

Self-care resources The CCG currently hosts information on the website regarding medicines use in self-care. The Committee discussed whether further work was required to encourage patients to manage their own health, and where appropriate seek guidance from a community pharmacist rather than their GP. It was agreed that further work was needed, as this process will involve a whole culture change for many. An example of a Medicines for self-care patient leaflet was presented to the Committee to help promote this. This leaflet can be hosted on the CCG website and copies sent to GP practices, community pharmacists etc. Additional work can be done with Public Health and local supermarkets. Self-care is also an STP (Sustainability & Transformation Plan) workstream, which will review and recommend medicines that will not be prescribed by GPs across the health economy. The legality issues will also be discussed. The Committee approved the Medicines for self-care patient leaflet.

16/09/05

Finance and QIPP

16/17 Q1 Budget position The prescribing budget position was presented to the MOC for information.

It was highlighted that in quarter 1 there a significant forecast underspend, which could be

from the impact of the Category M list. However, this list is being revised in October 2016,

which may have an effect on the budget.

Dashboard

A dashboard update was presented to the MOC for information.

CSS Prescribing report An update on the prescribing costs by the CSS was presented to the MOC for information.

Scriptswitch ® An update on the use of ScriptSwitch ® by practices was presented to the MOC for information.

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MEETINGS UPDATE 16/09/06 Drugs and Therapeutic Committee (DTC) (formerly known as JPG) The Committee was given an update on the following points from DTC held in September

2016: Several drugs were reviewed at the last DTC. Some were not NICE approved and one was an unlicensed drug. The CCGs requested that Barts Health develop a process for managing such requests, and where funding was to be sought from commissioners then this should be discussed at a separate meeting.

16/09/07 WEL Medicines Optimisation and Commissioning Committee (WEL MOCC) Minutes of the meeting were provided for information.

16/09/08 NELFT Update The CCG had raised with NELFT the cost pressure associated with prescribing of doxepin,

following the recent significant price increase. NELFT DTC were unclear what the CCG required from committee as prescribing was undertaken in primary care. It was agreed that an email will be sent to the Chief Pharmacist at NELFT requesting clinical guidance for GPs to consider an alternative medication when reviewing a patient currently prescribed doxepin. ACTION: MOT to contact NELFT DTC for further support on more cost effective alternatives to doxepin.

16/09/10 Queries Query Log (August 2016)

A summary of queries received by the MOT were presented to the MOC for information.

Frequently asked questions (FAQs) A list of questions frequently asked by practices to the MOT was presented to the MOC. The questions, which will be hosted on the practice portal and updated on a quarterly basis, are divided into the following categories:

Prescribing queries Medicines Optimisation Scheme queries Community Pharmacy ScriptSwitch ® Other

For assurance purposes, a Standard Operating Procedure for frequently asked questions has also been produced. The Committee approved the FAQ document, which will be uploaded to the practice portal. ACTION: MOT to host the FAQ document on the practice portal.

16/09/11 NICE Update A review of the recently issued NICE guidance relevant to primary care was presented to

the Committee.

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16/09/12 LPC Update A list of pharmacies who provide the Minor Ailments Scheme in Waltham Forest has been

complied by AS. It notes the contact details and times the scheme is available at each pharmacy. This document will be updated when and as required. ACTION: MOT to ask the Communications Team to host the Minor Ailments Scheme pharmacy list on the public facing internet.

16/09/13 LMC Update The MOC will formally write to the LMC, thanking Dr Prakash Kawar for his time working

with the Committee. Dr Swedan was also welcomed to the Committee.

16/09/14 AOB There were no items discussed.

Wednesday 12 October 2016 2:00pm - 4:00pm Boardrooms B & C, Kirkdale House, 7 Kirkdale Road, Leytonstone, E11 1HP

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Highlights [Planning and Innovation Committee] [September 2016]

Item 6.4

Committee Minutes

Planning and Innovation Committee – September 2016

From Richard Griffin, Chair of the Committee - WFCCG

Key highlights Highlights of the September 2016 meeting are summarised below: 1. Strategic Commissioning Plan 2016/17-2019/20

The refreshed NHS Waltham Forest CCG Commissioning Strategic Three Year Plan for 2016/17-2019/20 was presented. It was agreed the main changes in the refreshed strategy would be taken to the Governing Body members at their Board Meeting (Part 1) in October and will be shared for information with the members of the Patient Reference Group members at their meeting in October.

2. Phlebotomy Update An overview of the phlebotomy update was presented. The existing contract with Barts Health will end on 31 March 2017. It was agreed to consider a review with Barts to reconsider a possible different route of negotiations and how to secure the services and talk to all potential providers about how to deliver the spec within the financial envelope.

3. Anticoagulation Update An update on the review of the FedNet anticoagulation pilot was provided for the Committee. The proposed review of the service delivery model will include reviewing the existing budget and assessing the level of investment required to deliver the desired clinical model.

4. End of Life Care –Improving Specialist Palliative Care Support Staffing at the Margaret Centre was explained, and packages of support for patients. Issues around urgent care were discussed at length, and it was agreed the specification would be finalised at MDT and Cancer Board, then back to the Committee in October.

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PLANNING AND INNOVATION COMMITTEE

Minutes of Meeting held on 14 September 2016 Boardrooms B&C

Chair:

Richard Griffin (RG)

Attendees:

Ken Aswani (KA) Ravi Gupta (RG) Gail Foord (GF) Abdul Sheikh (AS) Tonia Myers (TM)

Jane Mehta (JM) Mayank Shah (MS) Kelvin Hankins (KH) Anne Walker (AW) Ian Clay (IC) Sharon Yepes-Mora (SYM)

In Attendance:

Apologies:

Anwar Khan (AK) Dinesh Kapoor (DK) Julia Walsh (JW) Syed Ali (SA)

Item Action

1 Apologies Apologies were noted as above.

2 Declarations of Interest None

3 Minutes of the last meeting / Matters Arising The minutes of the last meeting were agreed as accurate.

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4. Strategic Commissioning Plan 2016/17-2019/20 SYM

SYM presented the committee with the refreshed NHS Waltham Forest CCG Commissioning Strategic Three year Plan for 2016/17-2019/20.

The Waltham Forest CSP 2014- 2017 had been updated to reflect the current national strategy.

JM requested most recent data for all sections, as the data captured was from October 2015 and this would need to be from August 2016.

AS had advised that the plan would need to include collaborative working.

It had been agreed at the committee that the main changes in the refreshed strategy would need to be brought to the attention of the Governing Body members at their Board Meeting (Part 1) on 26th October 2016 and to share for information with the members of the Patient Reference Group members at their meeting on 12th October 2016.

5. Phlebotomy Update

SG

SG gave an overview of the phlebotomy update from the approved proposed papers in May 2016 improving patient waiting times. Barts Health have been unable to implement proposed service improvements due to the financial position the trust. SG advised the committee, that the existing contract with Barts Health will end on 31st March 2017. Barts Health have informed the CCG that the running of this service had incurred them in losses with existing services and losing money. Barts Health had contacted the CCG to propose the withdrawal of the phlebotomy clinic located at Oliver Road so that the phlebotomist could be moved to another clinic. The reason for this is that the clinic, which is only accessible via booked appointments for patients of the two practices based at Oliver Road, is under-utilised, with a high DNA rate. Barts Health have therefore proposed that the four hours per week, of phlebotomist time be removed from Oliver Road and relocated to a busier site with higher demand levels.

The committee expressed their concern over the withdrawal of the service, the committee suggested that Oliver Road could provide a drop in /pre booked clinic for this service. Further discussion would need to go through an engagement and consultation period lead by communications and to liaise with Save our NHS. There had been further discussions around a possible new location for the phlebotomy clinic at the Langthorne Medical Centre, which currently has capacity issues for phlebotomists, also the Triangle Medical Centre had been considered an option for a phlebotomy clinic, as they have shown interest in holding this service, it had been explained that we would then need to withdraw from another site.

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AW explained to the committee that Barts Health may not be meeting the requirements on privacy and dignity due to not implementing agreed changes, and AW would seek advice from the CQRM. JM explained to the committee that there needs to be alternative ways of working, i.e. a courier service, onsite lab at clinics and suggested a possible trial, this would to be advertised once a preferable relocation has been agreed. JM will speak to Save our NHS at the Governing Body meeting about the concern over Barts Health withdrawing the service. The contract from 1 April 2017 onwards is out to procurement till 19 September 2016 to submit bids. Risk that no viable bids will be received, review this on 19 September 2016 then directly approach bidders to negotiate. One bidder on 26th August expressed concern about the financial envelope we might not get any liable bids, three of the potential bidders are domiciliary providers. Consider a review with Barts to look at and change model, specification to reconsider, a possible different route of negotiations and how to secure the services. Talk to all potential providers about how to deliver the spec within the financial envelope.

6 Anticoagulation Update

SG

SG updated the committee on the review of the FedNet anticoagulation pilot. The proposed review of the service delivery model will include reviewing the existing budget and assessing the level of investment required to deliver the desired clinical model.

Patients have been impacted by the existing service as a result of the provider being unable to deliver the service as commissioned. The proposed approach would continue the service delivery as it currently is until the model has been reviewed and advice will be sought on engagement with patients/carers as part of this work. The outcome of this discussion will be fed back to MDT on 26th September 2016.

JM had requested that KH prepare the commissioning intentions letter to FedNet to extend the contract and continue to have a service by March 2017. KH confirmed commissioning intentions was drafted proposing a contract agreement.

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FedNet had confirmed that they will extend their nursing contracts and review home visits to ensure continued service delivery. TST outpatient work stream looking at anticoagulation may be able to develop model across WEL. Changing CSP anticoagulation TST may help to support launch. Data Quality- activity and completion inaccurate dates, awaiting data submission for waiting times, quality of the service delivered metrics.

7 End of Life Care –Improving Specialist Palliative Care Support

GF

GB explained that in Waltham Forest there are currently community specialist palliative care support workers, currently six clinical nurse specialists, working as five whole time equivalents, this current service is staffed in the Margaret Centre at Whipps Cross Hospital.

GB discussed the responsive times based on predicted life expectancies and what packages of support were available to patients and families.

The committee raised issues around the Urgent Care aspect and support for key night services.

Further discussion regarding this service would require:

Bereavement support for adults and children Decisions about EOL care shifts- (very late) Hospice support Out Of Hours service with NELFT Link in with Rapid Response 24/7-Palliative Care service by phone Package style available Bypass A&E Fast track A&E Margaret Centre at night sitting service Marie Curie advice and care

centre at night Specialist palliative care and palliative care support, CHC and fast track

process End of life steering group workforce and OD with TST Currently two palliative care nurses in Chingford have resigned /retired Re write EOL papers for cancer committee- Gail October Unlock TST business case side Timeframe Locality as soon as possible Re-written TST or WF costing Psychology emotional support Post bereavement support

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Timescale Bereavement for children Unpick TST Business Case Studies- new business case link between

proposed model and TST business case. Action: Spec to be finalised at MDT and Cancer Board, back to P&I in October.

7 AOB

All

None Date of next meeting: 12 October 2016 4pm – 6pm

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Highlights [Patient Reference Group] [July 2016]

Item 6.5a

Committee Minutes

Patient Reference Group Minutes – July 2016

From Richard Griffin, Chair of the Group - WFCCG

Key highlights How do we increase the uptake of cancer screening tests? Dr Mayank Shah and Nuzhat Anjum explained challenges faced by the CCG to increase uptake of cancer screening programmes and are looking for guidance from PRG on how CCG can improve cancer screening uptakes.

Discussion:

Not enough information on risk factors that would make people realise that may include themselves

Not enough information on environmental factors for WF residents to know they are at risk

Why there were not more promotional materials about how to attend screening How will the CCG educate community leaders and at risk groups to then pass on

information to communities? Using digital communications and reminders. Look at Blood Service as an example. Group discussed opening hours and out of borough locations for working people

Agreed next steps

Share good practices and get other practices on board Patient involvement – take today’s ideas and develop Produce posters Look into developing text messaging service Bring promotional material back to PRG for feedback

End of Life Care leaflet review Janice Richards presented a draft copy of the End of Life Care (EoLC) leaflet targeting family members and requested feedback.

Discussion:

Found the leaflet very informative. Would like to add EoLC onto a PRG event in the future so we can discuss

programme in detail Is there going to be EoLC material for children and Easy Read?

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Highlights [Patient Reference Group] [July 2016]

Other supporting organisations such as Macmillan need to be added onto the leaflet. Good idea behind leaflet but too many words, maybe use diagrams, and the “don’t

panic” bullet point should be taken out Leaflet describes the biological aspects of dying, but needs to include the emotional

side. Needs some practical advice e.g. bed hygiene Cancer patients have good end of life package compared to non-cancer patients.

Some hospices don’t take on non-cancer patients. Aim to distribute leaflets online, GP practices, pharmacy, home care teams,

community nurses and as part of home care packages. Suggested getting in touch with insurance policy companies and including it in their

packages. What mental health provision is available to bereaved families?

CCG's AGM, Patient Reference Group and public involvement AGM is an important engagement event for public. Asked members to think about what they want on the stalls at the AGM, how to make it engaging for the public. Invited all the PRG to come along and take part on the stall and share ideas on how we can be more interactive.

Discussions:

Recruitment to PRG: We will have expression of interest form at AGM, and ask people to complete it there and then and then take it from there. Need to explain structure.

Promote how to sign up to PPG. Need to be prepared on how to respond to people who have trouble joining their PPG.

Review of Oliver Road Poster and Barts and Baby Movement Matters leaflet Members gave brief comments that were taken forward by Fatima Karim. AOB Bowel cancer material given out for people to take and distribute.

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Patient Reference Group (PRG) minutes

Date and time:

Wednesday 13 July 2016 6-8pm

Venue: Boardroom B&C, 7 Kirkdale House, Leytonstone E11 1HP Chair: Richard Griffin (Lay Member for Community Participation)

Attending CCG/Healthwatch attendees

Guest speakers:

Dr Mayank Shah - CCG Clinical Director (MS) Janice Richards - Senior Commissioning Manager (JR) Nuzhat Anjum – Associate Director Strategic Commissioning (NA)

Guest Observer: Mark Bielby (MB)

CCG/Healthwatch standing attendees: Richard Griffin, CCG Lay Member for Community Participation (RG) Julia Walsh, CCG Head of Communications and Community Participation (JW) Fatima Karim, CCG Communications and Engagement Officer (FK) Isabelle Davies-Tutt, CCG Patient Experience & GP Alert Officer (ID) Rebecca Waters, Healthwatch Waltham Forest (RW)

Patient Reference Group members: Alex Kafetz (AK) Joan Fratter (JF) Sylvia Debreczeny (SD) Gen Ford (GF) Adrian Dodd (AD)

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Known Apologies:

Ana Da Cunha Lewin Caroline Rouse Caroline White Dada Imarogbe Neil Collins Ousmane Diop

Patient Reference Group (PRG) minutes

Item Topic Summary Actions 1 Welcome

Apologies Declaration of conflicts of interest

All members were welcomed and the apologies were noted as indicated above. There were no conflicts of interests raised at the meeting.

No actions

2 How do we increase the uptake of cancer screening tests?

MS and NA explained challenges faced by the CCG to increase uptake of cancer screening programmes and are looking for guidance from PRG on how CCG can improve cancer screening uptakes. MS informed:

Cancer screening programmes are free of charge, yet patients miss out

Nationally the rate of screening uptake is around 71% but locally, its 66% - far below what the CCG would like it to be

JW to circulate information regarding GF’s event on 25 June 2016.

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Nationally bowel screening uptake is around 60%, whilst Waltham Forest (WF) has an uptake of 48%, even though screening kits are sent directly to the patients house, uptake is low.

Breast screening target is around 80% but WF is currently achieving 67%.

There are various factors that contribute to low uptake. WF has diverse community, and so a generic message does

not apply to everyone. Patients don’t even attend screening appointments even

when a letter is posted out to them.

NA suggested: We engage with patients directly to find out the barriers Try and understand how we raise awareness in the

community to encourage early identification of cancer symptoms via their GPs and educate the community better on signs and symptoms.

GF commented – “I don’t go for screening, I have zero instance of cancer in family, don’t have any risk factors therefore I don’t go. I think a lot of people think this way. If I am told I have more risk factors I might be inclined to go. I think a lot of people think they won’t get cancer as they don’t have the risk factors and so wont turn up.” JF commented – “I don’t think there is enough information on the environmental contributions to cancer, more information needed. I went to a lecture about cancer, where they were saying both genetic and lifestyle choices can equate to 50% chance of having

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cancer, and the remaining 50% is environmental. More information is needed on the environmental aspects. So we need to look at how we educate everyone on environmental factors.” RW asked “What feedback have you had so far on cancer? What have you done? What barriers do you know of? NA responded

We know there are barriers in accessing services to accommodate working individuals, eg. We are looking at GP opening hours for cervical screening tests to accommodate working individuals

We know there are cultural barriers as some ethnic minorities who are not sexually active or have just been with one partner think they do not need to have the screening test done and it does not apply to them.

RW suggested producing more leaflets for the community to educate people on screening. NA informed the CCG is currently looking at producing more promotional materials and looking at broadcasting messages on display screens at GP practices. MS asked: “we have a diverse range of communities in borough. Sometimes male figures in certain ethnic groups play a big role in accessing services. How do you think we can educate them?

Approaching organisations individually like mosques/churches. Approach them and see if they can give a presentation on these issues. Some people cannot read,

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so listening to presentations in their own community group might be more effective – AD

Fund community groups to run educational sessions for their community, this is what Healthwatch did.

Sending people letters to attend screening is very easy but it is not that effective - GF

Look into sending out emails, it doesn’t cost anything and are communicating to patients directly and target specific groups by informing them of their risk factors - GF

Although technology is expensive, it’s very effective. I had a blood test recently and I constantly had reminders via text messages up to my appointment date. It was very easy for me to make changes to my apt if I had to - RW

Can screening be done across the region, so you don’t have to stick to the borough you live in to accommodate working people – RW

Go to practices and target people in waiting room to tell them about screenings and book them in there and then – RW

RG asked “what are the next steps for the CCGs?”

Share good practices and get other practices on board Patient involvement – take today’s ideas and develop Produce posters Look into developing text messaging service Bring promotional material back to PRG for feedback

RW to provide MS contact details of different community groups that they used

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3 End of Life Care leaflet review JR presented PRG with a draft copy of the End of Life Care (EoLC) leaflet targeting family members and requested feedback. Feedback and changes to the leaflet included:

Found the leaflet very informative. Would like to add EoLC onto a PRG event in the future so we can discuss programme in detail – RG

Is there going to be EoLC material for children? – JF. JR commented that she leads on adults EoLC but is not excluding children. Children’s EoLC is already at a good stage, the service already flows well but will take into account when looking to produce more material.

Other supporting organisations such as Macmillan need to be added onto the leaflet.

Good idea behind leaflet but too many words, maybe use diagrams, and the “don’t panic” bullet point should be taken out – GF

Swap the picture on the back to the front and take the front picture out, allows more room for contact details at the back – RW

Is there going to be an accessible standards version, easy read version after the production of the regular version? RW

Leaflet describes the biological aspects of dying, but needs to include the emotional side. Needs realism, should include some practical points – AK

Other comments:

Cancer patients have good end of life package compared to non-cancer patients. We should be looking at those with respiratory problems as they need more support. Some hospices don’t take on non-cancer patients. – MB

FK to make the changes raised by PRG on leaflet

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Aim to distribute leaflets online, GP practices, pharmacy, home care teams, community nurses and as part of home care packages. AD suggested getting in touch with insurance policy companies and including it in their packages.

AD said all people usually need support with stress management more than anything.

4 How can we use the CCG's AGM to showcase and develop the Patient Reference Group and public involvement in general

RG explained the AGM is an important engagement event for public. Asked members to think about what they want on the stalls at the AGM, how to make it engaging for the public. JW said there is a large section for the public involvement stall. Invited all the PRG to come along and take part on the stall and share ideas on how we can be more interactive. Comments raised:

At the previous AGM, there was 50 people interested in joining PRG, we interviewed 50 and 20 were selected. Are we going to be recruiting new members? - JF JW: we will have expression of interest form at AGM, and ask people to complete it there and then and then take it from there.

The way to get people interested in PRG is via the practice patient group - SD

Information from PPG should feed up and down to PRG. People should join local PPG in order to feedback to PRG – GF

Would be good to have a contact for each PPG – SD Produce triangle or diagram that shows public who and how

the PPG/PRG works

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RW said some patients finding it difficult to contact their PPG, these concerns are raised with Francis from Patient Association. JW advised that the communications team is copied into these emails.

Concerns raised that CCG website says no more recruitment for PRG, but we have two new members as observers - RW

Questions raised:

How many of the practices have PPGs with an identified patient chair contact? If they practice cannot supply this info, what will be done as they are in breach of their contract? – AK

Comms team to produce

RG to showcase

stats on PPG at AGM

FK to look at

the wording on the PRG page on website.

JW to ask Carl

– ask steering group to provide us with a list of all the PPG patient chairs.

5 Notes/Actions from last meeting

ID to make changes to item 1, to add SD’s conflicts of interests (Trustee for National Association of PPGs, Lay member for royal college of radiology, Lay member local faculty royal college of GPS)

RG didn’t circulate phlebotomy feedback review JF commented why the phlebotomy review didn’t have a lot

of engagement around it and asked “who is the decision maker on engagement?” JW explained commissioners lead on engagement. Reason behind the estates strategy getting a lot of engagement is

ID to action minutes from June

RG to circulate feedback review

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because the CCG had communications support in place, but it didn’t for the phlebotomy service. RW suggested comms produce a flowchart explaining the process. JW commented that the CCG now has a communications support process in place for future engagement.

6 Governing Body updates Highlights from the GB are:

CQC visiting Whipps Cross Hospital on 26th CCG making £8.6m surplus, less than previous years. Sustainability and transformation – draft submissions will be

coming out end of this month, not in public domain.

Comments JF raised concerns on the reduction of emergency surgery proposals in TST and how that is going to have implications on A&E and maternity services.

RW to provide presentation on TST/STP to Comms

JW to pass on comments to CSU

7 Review of Oliver Road Poster and Barts – Baby Movement Matters leaflet

Oliver Road Poster: There is a 111 signing website - BSL interpreters pop up on

the screen, add this information after NHS 111. Add “call” before NHS 111 number

Baby Movement Matters Poster:

Does the advice ‘drink something cold and lie down’ still apply, if so good to add it in.

FK to make changes on poster

FK to pass

comments on

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8 Review of this meeting and suggestions of items for the next PRG agenda AOB

JW shared left over promotional bowel cancer material for people to take and distribute. Comments:

It’s been interesting and thought provoking. Meeting had knock on effect on ideas which is good – AD

Always worry if there’s too much on the agenda, but today we had a good balance and we got through a lot. It’s been a worthwhile meeting – JW

Having too many people at a meeting like this is tricky as you never get anything done. What you covered tonight is incredible - MB

Suggestions for the next agenda:

BTC presentation, there were some good diagrams, can we look at these and understand them as a group - RW

STP, BTC and TST to get it on the September agenda Healthwatch to cover CQC inspection JR to return with EoLC but not necessarily for the next PRG

meeting.

JW to invite

relevant teams.

Date of next meeting: Wednesday 14 September 2016

Time: 6-8pm

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Highlights [Patient Reference Group] [September 2016]

Item 6.5b

Committee Minutes

Patient Reference Group (PRG) – September 2016

From Richard Griffin, Chair of the Group - WFCCG

Key highlights Community Health Services NELFT have introduced a single phone number to access community nurses 8am to 7pm. Out of hours calls will be redirected to a nurses mobile phone. There is also a triage nurse 9-5 to ensure emails and calls are dealt with in a timely manner. Community teams now have mobile devices to allow them to have all of the patient’s details when visiting to assist seamless care.

Patients will still need to be referred by a GP for their first assessment to the service. If a patient is known to NELFT they will give them the access number. Also carers, social workers and GPs can use the access number.

CCG have commissioned Age UK to work with NELFT to evaluate the service.

Out of Hospital leaflet Members were asked to discuss a draft leaflet for elderly people who attend Whipps Cross Hospital and are medically fit to leave hospital but they cannot go home as their home needs to be adapted for their new needs. Members gave feedback that was passed on to the CCG designer. Gail Foord explained that they are hoping to go live with the pathways within 2 weeks. Annual General Meeting (AGM) 190 people have RSVP’d. There will be 27 stands at the AGM. Development of PPGs will be discussed and a video will be shown. Richard Griffin will represent the PRG and will talk through how WF CCG are trying to develop a wider patient network in WF. Any Other Business (AOB)

Healthwatch Waltham Forest’s annual report and leaflets about their annual conference 5 October distributed.

Open day at Whipps Cross Hospital - 17 September. Healthy London Partnership is seeking to recruit two patient representatives. NHS England would like input into training for patient representatives.

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Page 1

Meeting CCG Patient Reference Group (PRG) minutes

Date and time Wednesday 14 September 2016, 6-8pm

Venue Boardroom B&C, 7 Kirkdale House, Leytonstone E11 1HP

Chair Richard Griffin (Lay Member for Community Participation)

Attendees Guest speakers: • Gail Foord, Head of Integrated Care (GF) • Philomena Arthur, Assistant Director Adults CHS Waltham Forest, NELFT (PA) • Sudeep Dhillon, Project Manager NELFT (SuD) • Deborah Dennis, Contracts Coordinator (DD) • Kelvin Hankins, Assistant Director of Contracting (KH) CCG/Healthwatch standing attendees: • Richard Griffin, CCG Lay Member for Community Participation (RG) • Julia Walsh, CCG Head of Communications and Community Participation (JW) • Isabelle Davies-Tutt, CCG Patient Experience & GP Alert Officer (ID) • Rebecca Waters, Healthwatch Waltham Forest (RW) Patient Reference Group members: • Joan Fratter (JF) • Sylvia Debreczeny (SD) • Caroline White (CW)

Apologies Adrian Dodd (AD)

Agenda items

1 Welcome / Apologies / Declaration of conflicts of interest

1.1

1.2

All members were welcomed and the apologies were noted as indicated above.

There were no conflicts of interests raised at the meeting.

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Actions - None

2 Community Health Services

2.1

2.2

2.3

2.4

2.5

2.6

2.7

PA explained that there has previously been a workshop where a community nurse’s strategy was devised and the feedback from patients was that the system is disjointed. PA explained that they now have a single point of access which is a number or an email address and this has been put into place to try to improve the service. There is also a triage nurse 9-5 to ensure emails and calls are dealt with in a timely manner. PA also explained changes that have taken place such as all staff have been supplied with mobile working devices to allow them to have all of the patient’s details when visiting to assist seamless care.

JF queried “Does this mean that it is no longer necessary for the patient to contact the GP to see an occupation therapist?”

PA explained that a GP will have to make the referral to the service but the referral to the occupational therapist will go straight to that team through a single point of access. GF said that from a GP’s perspective they will decide if you need occupational therapy, physiotherapy or district nursing. The GP will now only have to complete one referral form instead of different forms for a different service. Also every patient will now have a care coordinator.

SD “when would a patient use the access number?”

PA explained that if a patient is known to NELFT they will give them the access number. Also carers, social workers and GPs can use the access number. GF explained that the reason for this is if you are new to the system you will still need to have your initial assessment.

SD queried “What happens if someone calls at 10 past 5? What happens then?”

PA explained that there are people Monday to Friday answering the phone from 8am to 7pm and out of hours calls are sent through to a mobile phone which an on duty nurse will have.

SD asked “Are you going to evaluate this?”

PA answered “Yes we are evaluating this, the CCG have commissioned Age UK and every month they call people and see them and ask questions and send the information to NELFT with the patients consent. Also NELFT will randomly call patients who have used the service”.

SD “When do you report back to the CCG?”

PA “I write an outcome report every month for the CCG”.

JF queried around information that is being shared as there has been a lot of discussion around the information being shared i.e. will patients GP records be shared?

PA clarified that the patient information that the nurses will have access to is NELFT’s own electronic patient record not the GP’s record. But when we see the patient on the first visit we ask for consent if they would mind a healthcare professional seeing their information. If the patient says no then a note is made.

JF said “2 years ago at this group it was raised that NELFT will not take back equipment”

PA explained NELFT is part of ISES contract and it was LBWF’s policy to not take back equipment. NELFT have re-commissioned the service and believe that this will include returning and cleaning equipment.

Actions - None

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3 Out of Hospital leaflet

3.2

3.3

3.4

3.5

GF explained that what she is bringing to the PRG is a leaflet that is in very early stages for a service that WF CCG are working with NELFT to pilot. The pilot is to support people after discharge from hospital. The need for this is because some elderly people who attend Whipps Cross Hospital and are medically fit to leave hospital but they cannot go home as their home needs to be adapted for their new needs.

What we want to do is set up a range of support packages so when people are fit and no longer need a hospital bed that we can offer an alternative. GF explained the three pathways that would be available.

There has been a leaflet drafted to explain the three pathways when patients are admitted to the hospital. GF asked members to read the leaflet and give feedback.

GF asked if patients would want information of the three pathways when they are admitted to hospital and some of the information may not be relevant to them. If so would it be better as 3 leaflets rather than one?

RG asked members if there are any issues with the language or clarity of the leaflet. JW suggested that members write on their leaflet and hand them in. The Communication Team will then ensure these amendments are made. Members raised the following questions and gave the following feedback:

a) JF “Option 3 is for people who no longer have a medical need that means they need an acute bed but they will need long term care. Where will this assessment take place?”

b) JF “CHC sounds as if someone has health needs but some people are in care homes with care needs which is financially difficult”

c) RW “Healthwatch has suggested including an advice line on the leaflet which will explain this to patients”

d) JF “for example patients with Alzheimer’s that have families that are involved in the thinking and it might be helpful for them to see all the pathways so they can discuss these with medical staff and decide the best option”

e) SD “for relatives it would be useful to have one leaflet with all of the pathways, also if you email it I can share with my PPG members.”

f) SD “give patients the pathway that applies to them as I have seen leaflets before that give too much information and it can be unnerving.”

g) JW and RW suggested having all of the pathways on one leaflet but have an area that can indicate which pathway is relative to the patient.

GF explained that they are hoping to go live with the pathways within 2 weeks. JW said she is meeting with John Burchill on Monday to discuss this leaflet.

Actions

3.6 Communications Team to ensure member’s amendments are made.

3.7 Members to feedback by Monday 19 September 2016.

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4 Notes/Minutes from last meeting

4.1 JF queried “why BCT and system transformation is said to be on the agenda in the minutes but is not.” JW explained “this was moved to accommodate the Elective services re-procurement agenda item.”

Actions

4.2 Minutes were agreed as an accurate record of the previous meeting.

5 Annual General Meeting (AGM)

5.1

5.2

5.3

5.4

JW explained that the invites have gone out and that over 190 people have RSVP’d. She also explained that there will be 27 stands that will be at the AGM. She also explained that the development of PPGs will be discussed and a video will be shown. RG will talk through how WF CCG are trying to develop a wider patient network in WF. JW also explained the layout of the AGM.

RW asked if patients that are from a specific area will be seated with the Clinical Director for that locality.

JF said “that she knows that WF CCG have talked about recruiting people to the PRG. But what is the recruitment process?” RG responded that “this will be discussed at the next meeting and how we can raise awareness of the group as well.” JF “I am concerned that it has been a year since we discussed the recruitment process and we still are unsure of the process.”

RG explained that when he came into post that he contacted people on the PRG list to identify who are active members and if they were no longer attending the PRG they asked why. Some of the feedback was that their feedback is not being taken into account.

JW said “at the October meeting we could discuss the AGM and the outcome to the Patients Association Project meeting and PRG recruitment”.

Actions - None

6 Any Other Business (AOB)

6.1

6.2

6.3

RW handed out copies of Healthwatch Waltham Forest’s annual report and leaflets with information around the Healthwatch Waltham Forest’s conference 5 October. She also explained the format and speakers at the conference.

RW told members that this Saturday there is an open day at Whipps Cross Hospital.

JW explained that Healthy London Partnership is seeking to recruit two patient representatives and gave the information to members. She also explained to members that if they are successful to please let the CCG know so that the network can be used.

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6.4

NHS England have commissioned some training for patient representatives in November 2016 and they would like any CCG lay representatives and PRG members to attend the focus group to assist with designing the training. If members are interested please email JW and she will then send them the information.

Actions - None

Next meeting 12 October, 6-8pm, Boardroom B&C, Kirkdale House, Leytonstone, E11 1HP

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Highlights [Primary Care Development Committee][September 2016]

Item 6.6

Committee Minutes

Primary Care Development Committee – September 2016

From Dr Abdul Sheikh, Chair of the Committee - WFCCG

Key highlights

Primary Care Governance- Revised governance structure, which will mean that the Primary Care Development committee will be disbanded and replaced with a Primary Care Advisory Committee (PCAC) which will report directly to the Primary Care Commissioning Committee (PCCC).

The GPFV is a five year package for transformation and aims to deliver a package of

investment to primary care, which will support practices to increase capacity, work at scale, increase and upskill workforce, develop IT interoperability, support mental health of GPs, indemnity etc. There are 82 schemes in development with the objective to make practices sustainable for the future. CCGs are required to submit a GPFV plan to NHS England by 23 December 2016.

Medicines Optimisation support practices via incentivised schemes to improve prescribing and make it more safe and cost effective, across the health economy. The works aligns to the NHSE Medicines Optimisation dashboard. The team provide practical advice & carry out practice visits to enable improvements in prescribing.

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Highlights [Primary Care Development Committee][September 2016]

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Primary Care Development Committee

Date and time 21st September 2016

Venue Room D, Kirkdale House 7 Kirkdale Road, London E11 1HP

Chair Dr. A Sheikh

Present Organisation

Lorna Hutchinson NHSE Representative

Aysha Patel (AP) Senior Commissioning Manager - WFCCG

Emily Grundy Public Health Strategist

Rebecca Waters (RW) Healthwatch Waltham Forest

Anne Walker Deputy Director of Quality - WFCCG

Sultana Rahman (SR) Associate Director of Strategic Commissioning - WFCCG

Carl Edmonds (CE) Deputy Director of Strategic Commissioning - WFCCG

Hassan Serghini (HS) Senior Prescribing Advisor - WFCCG

Nyasha Mapuranga Head of Quality (Interim) - WFCCG

Apologies Organisation

Dr Anwar Khan (AnK) Clinical Director Chingford

Dr Dinesh Kapoor (DK) Clinical Director L/L

Jane Mehta (JM) Director of Strategic Commissioning - WFCCG

Joe McDonnell (JMc) Public Health

Hemant Patel (BP) Pharmacy Rep

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Agenda items 1. Welcome and apologies AS

1.1 Members were welcomed to the meeting and apologies received.

Actions: Deadline Owner

None

2 Minutes of the last meeting and matters arising

2. The minutes of 18th May 2016 were checked for accuracy and were approved with no amendments.


3. TOR Committee structure: New Governance arrangements

AS

3.1 Following the Baker Tilly Audit undertaken in 2015, and the Conflicts of Interest guidance released by NHS England in July 2016 a revised framework for governance of delegated primary care commissioning governance has been agreed by the board. This means that from January 2017 the Primary Care Development Committee will be disbanded and replace with a Primary Care Advisory Committee (PCAC), which reports directly to the Primary Care Commissioning Committee.

The PCAC will function as an action orientated body to complement the decision making function of the PCCC by focusing on discussing and reviewing current or potential future work streams, ensuring effective management and progress of work stream activity through agreed cases for change and resources available.

The meetings will be held monthly on the same day, with a break in between for networking and lunch. The membership of the committees will remain as they are apart from the fact that the Chair of PCCC will attend PCAC, there will also be an aim to include a practice manager representative. The Chairs of both Committees will meet on a regular basis to make the meetings effective.

Members agreed that going forward a specific topic should be discussed at PCAC to give focussed support via a multi-disciplinary approach. A forward planner to be developed and sent to group for input.

Actions: A forward planner to be developed in relation to future topics for the agenda and sent to group for input.

Deadline Owner

AP

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4. Practice Resilience & Quality Improvement SR

4.1 SR presented information regarding the General Practice Forward View (GPFV) which was published in April 2016 to deal with the issues that are faced by primary care including the increased demand, the limited workforce, people living longer with more complex health needs etc. The GPFV is a five year package for transformation and aims to deliver a package of investment to primary care, which will support practices to increase capacity, work at scale, increase and upskill workforce, develop IT interoperability, support mental health of GPs, indemnity etc. There are 82 schemes in development with the objective to make practices sustainable for the future.

CCGs are required to submit a GPFV plan to NHS England by 23 December 2016. Plans, as a minimum, must set out:

How access to general practice will be improved How funds for Practice Transformational Support (as set out in the GPFV) will be created

and deployed to support general practice How ring-fenced funding being devolved to CCGs to support the training of care

navigators and medical assistants, and stimulate the use of online consultations, will be deployed.

SR informed members that one Waltham Forest practice has been selected to participate in a national scheme in relation to GP recruitment.

A workshop will be held at the December GP Education forum to make practices more aware of the GPFV to ensure opportunities for funding are not missed.

Actions: None Deadline Owner

5 Medicines Optimisation HS

5.1 HS presented key work streams for the medicines optimisation team, the role is to support practices via incentivised schemes to improve prescribing and make it more safe and cost effective, across the health economy. The work aligns to the NHSE Medicines Optimisation dashboard. The team provide practical advice and carry out practice visits to enable improvements in prescribing.

Various elements are supported, which include prescribing for care home patients, undertaking prescribing audits, ensuring policies and government initiatives are adhered to.

There is a proposal for a multidisciplinary approach for policy development which will support engagement with schools and adult social care for key schemes including the Healthy start scheme. HS will link in with JM to discuss this further and develop communications and a joint strategy.

Quality improvement and Health Watch work will also be linked in and appropriate Health Watch reports can be shared with the group.

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Actions:

Deadline Owner

HS to work with JM to develop communication with patients/ joint strategy

HS

6. NHSE Update LH

6.1 LH informed members of the recent change of location for NHSE London area teams, further organisational changes are expected to take place early 2017 with SPG collaboration. It is expected NHSE will move to a permanent location next year. No specific programme of work at present, however area teams are currently linking in with local collaborative work.


None

7. Items for PCCC LH

7.1 - Practice Resilience & Quality Improvement- GP five year forward view - Child Obesity


Item to be discussed at PCCC AS


8 AOB

Child obesity – a discussion took place on the impact and current situation. Members agreed that this issue is very important, however it is currently being addressed by the Performance and Quality (P&Q) Committee and actions will be picked up by the Joint Commissioning Board (JCB) and via the Joint Strategic Needs Assessment (JSNA). Health promotion – AS informed members about a collaborative working scheme proposed for Waltham Forest, which was discussed at the last Primary Care Commissioning Committee. The proposal is have a single point of access for patients and a centrally managed Hub with triage. The aim will be to reduce/prevent A & E attendance, share resources and skills.

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None: CE to feedback regarding Obesity discussion at P&Q

Date of next meeting:

16th November 2016, 11:00 to 12:30 in 3rd Floor meeting room, Kirkdale House, London E11 1HP

135

Highlights [Finance & QIPP Committee] [June 2016]

Item 6.7a

Committee Minutes

Finance and QIPP Committee – June 2016


Key highlights The Committee received the month 2 (May) Finance report and noted that the CCG is projecting to deliver the 2016/17 planning surplus of £8.6 million and to maintain its corporate running costs to within the mandated “cap”.

The Committee reviewed the QIPP performance report reflecting M1 SLAM data.

The Committee received an update regarding 2016/17 contractual negotiations around the Whipps Cross Urgent Care Centre and local Out of Hours services.

The Committee received a report outlining progress in relation to the procurement of the community phlebotomy service. It was agreed price information would be circulated and Chair’s action taken on maximum financial envelope for the procurement.

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1

Meeting Finance and QIPP Committee

Date and time 15 June 2016

Board Room, Kirkdale House

12.30-2.00pm

Chair Alan Wells (AW)

Attendees: Apologies:

Les Borrett (LB),Kelvin Hankins (KH), Dr. Abdul Sheikh (AS), Enrico Panizzo (EP), Sharon Yepes-Mora (SYM), Dr. Syed Ali (SA), Vineeta Manchanda (VM), Ian Clay (IC), Carl Edmonds (CE), Diane Clements (DC) Jane Mehta (JM)

Agenda Items and Summary 1&2 Notes of last meeting The minutes of the last meeting were agreed. Two outstanding actions have been closed. 3.0 Matters Arising There were no matters arising. 4.0 Finance Report month LB presented the Month 2 Report to the Committee. This is the first report for this year’s budget. Barts Health data for April is subject to change. A small over performance was noted for out patients and under performance relating to drugs prescribing. LB advised the Committee at this stage we are due to hit our target. The Committee noted the Report.

5.0 QIPP Month 12 report EP took the Committee through the main points of the Report. Full year forecast savings are £9.5m. M1 YTD savings are £493,270 against an estimated £622,000. Mental Health is showing savings at this stage. The care home project is tracking just below following on from Month 1. AW asked whether being below estimate at Month 1 was likely to impact on the end of year outturn. LB assured him that this was often the pattern early in the financial year and was unlikely to have a negative impact. EP explained the potential risks as shown in his Report to the Committee. 6. PELC Update EP provided the Committee with a verbal update on the situation with PELC. It was agreed at the last meeting and Governing Body for a three month extension with PELC.

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PELC will run most of the OOH’s service but with no OOH’s being carried out at Whipps Cross. EP informed the Committee that progress has been made and it is possible the contract will be signed today. The key risks have been overcome, where employee liability information was unlocked last week. This will have no impact on patients. The contract has not been ‘closed’ with the Step in Provider. Having a new provider for nine months will allow the CCG to strengthen management and look at wider risks and on-going risks with PELC. Agency staff are frequently used by PELC, although over the next nine months it was hoped that this potential risk would reduce. This is a major issue with UCCG, with high use of agency staff. At present there is a possible overspend of £50k depending on when UCCG decrease the number of agency staff. However, this was not thought to be material. EP advised the Committee the cost model was only available this week and active discussions are still taking place, ToR have been completed and the contract is hoping to be signed this week. This will be taken to the Governing Body on 22 June 2016. Action KH : Verbal update to be provided in 3 months to the Committee. 7.0 Community and Domiciliary Phlebotomy Service CE presented the Report to the Committee. AS said that he didn’t favour Option C as recommended in the Report but preferred Option B. He felt that the current unit cost represented good value and said it was unlikely that a service could be procured for a lower cost. There was considerable discussion and some confusion about whether the decision had already been taken outside of the Committee to adopt Option C – procure a new service. AW, as Chair, made the point forcibly that papers should not be tabled for the Committee if a decision had already been taken and that, to do so, wasted the time of Committee Members. Moreover, it was for the Finance and QIPP Committee to decide on Options relating to possible procurement not the Executive in advance of meetings of the Committee. The point was made that Option B: renegotiating the Barts contract, would be open to legal challenge. Thus, it was agreed that Option B wasn’t actually a viable option and should not have been included in the paper. It was agreed that any procurement needed to cap the potential unit costs and that, before proceeding to procurement, information should be sought on what our neighbouring CCGs were paying for this service. It was further agreed that if no bids came in within the cap, we would be free to discuss extending the existing service, with improvements, with Barts. Action CE: What are associated providers paying so a maximum price can be agreed? This information to be shared with AW and AS for Chair’s Action to be taken. 8. A.O.B DK to be removed from distribution list. Dr Ken Aswani and Dr Ravi Gupta to be added to distribution list.

Next meeting: 20 July 2016

138

Highlights [Finance & QIPP Committee] [September 2016]

Item 6.7b

Committee Minutes

Finance and QIPP Committee – September 2016


Key highlights The Committee received the month 5 (August) Finance report and noted that the CCG is projecting to deliver the 2016/17 planning surplus of £8.6 million and to maintain its corporate running costs to within the mandated cap.

The Committee reviewed the QIPP performance report reflecting M4 SLAM data.

The Committee received and approved operational resilience proposals for 2016/17 subject to final ratification by the Urgent Care Working Group.

139

1

Meeting Finance and QIPP Committee

Date and time 21st September 2016

Board Room, Kirkdale House

12.30-2.00pm

Chair Vineeta Manchanda (VM)

Attendees: Apologies:

Les Borrett (LB), Dr. Abdul Sheikh (AS), Enrico Panizzo (EP), Sharon Yepes-Mora (SYM), Dr. Syed Ali (SA), Ian Clay (IC), Kelvin Hankins (KH) Carl Edmonds (CE), Nicola Pearce-McGinn (NP-M) Jane Mehta (JM)

Agenda Items and Summary 1&2 Notes of last meeting The minutes of the last meeting were agreed.

3.0 Matters Arising There were no matters arising. 4.0 Finance Report month LB presented the Month 4 Report to the Committee. It was reported that there had been no significant change at the end of July. Key Headlines for M5

It was noted that we are projecting a £0.3m overspend at year end on the Barts contract with a non-elective overspend of £4.7m, LB added that they were working with the CSU, to understand this in the light of overall year on year reduction in admissions.

Barts have submitted SLAM data for M4 that if extrapolated results in a headline full year claim of £3.5 million above contract value after taking account of estimated readmissions, threshold and productivity metrics adjustments which have been calculated using precedent established during 2015/16. LB identified a number of specific areas where the claim from Barts had increased significantly year on year and which were subject to formal challenge with the provider.

Non Acute We are reporting a projected £0.3 million overspend against the learning disabilities continuing care budget associated with changes in package costs for a number of existing clients and new clients that have transitioned into adult CHC services. There are risks associated with the potential for further clients to transition during the remainder of 2016/17. Positive news on prescribing we are now projecting a £0.4 million surplus at M5 against the GP prescribing budget based on extrapolating actual prescribing date covering the 6 month period from

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2

January 2016 to June 2016 for a full year and then adjusting for the delivery of phased QIPP savings of £1.0 million.

5.0 QIPP Month 4 report EP took the Committee through the main points of the Report. He reported on the Key messages:

Full year gross forecast savings are £9.5m against plan (100%). M4 YTD savings are £2,595,409 against an estimated plan of £2,582,000.

IC, Phase 4: M4 SUS data shows a reduction in emergency admissions of 290YTD, savings of £625k. Reductions in XBD Cost has not been included.

IC, Falls: M4 SUS data indicates with a decrease in related activity of 44 YTD, which can be attributed to the savings. Referrals doubled in May following Locality meeting attendance, and an education session.

IC, Care Homes: M4 SUS data indicates that there have been savings identified through a reduction of 58 non elective admissions, £271k savings YTD. Significant 7 training has been provided to all 12 homes, pharmacy intervention has started in a number of homes. GP enhanced support commenced from 1st August.

Ambulatory care savings figures have been calculated on the basis of reductions in zero-day length of stay emergency admissions at Whipps Cross. In M3 and M4 there were 205 fewer zero day emergency admissions at Whipps Cross for WFCCG.

Wellness Pilot: An action plan is in place, fortnightly meetings take place to ensure the ongoing development of the service, interviews to take place to appoint a service manager/CPN.

Medicines Optimisation: There has been an increase in the QIPP savings related to prescribing for Month 3, these savings are as a result of an improvement in the prescribing areas outlined in the QIPP incentive scheme. We have also seen a reduction in the prescribing of over the counter medications as part of the self-care indicator and are starting to see an impact on the prescribing of drugs with limited clinical value.

Savings from transactional costs are £825k in M3. This is a combination of; Acute Providers, NELFT, PMS Review, Non Acute Providers, List Maintenance and Delegated Primary Care along with reduced property voids.

All reported savings are based on M4 Flex SUS data (from acute trusts) and subject to changes as the end of the month.

AS asked for clarification around the decision making process for agreeing the new clinical model for MSK and the subsequent procurement. Action: KH to share MSK letter and new contract with AS. 6. Operational resilience EP took the Committee through the report. The purpose of the report is to sign-off the finances for the Operational Resilience (OR) programme for WFCCG for winter 2016/17. The group were advised that this would be going to the Urgent Care Working Group that afternoon for sign off. Added that all projects will have KPIs attached to them, and will track the progress otherwise the funding will be taken away. The committee to approve the funding outlined within the proposal.

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Action: CE to check with the Primary Care team on the input of the flu jabs. AOB None Next meeting 19th October 2016

142

Highlights [IT Committee][September 2016]

Item 6.8

Committee Minutes

IT Committee Minutes - September 2016

From Dr Mayank Shah, Chair of the Committee - WFCCG

Key highlights

Primary Care Technology Funds Bids now known as ETTF / Capital Bids

Bids are now being prioritised at STP Level Still awaiting final decisions ETTF fund was 400% over subscribed and it is still not clear how much money is

available in that pot. This particularly affects the diagnostics workstream as without ETTF there is no funding available to develop the diagnostic tool without this

The committee were advised that they would receive regular feedback, at a WEL level and on the WF bids. Refreshed IT Strategy

HN produced a draft high level implementation plan. HN went through the plan with the following highlights: uld need to be completed.

• HN has received indicative costs for 111 Adastra to EMIS appointment booking API. • Generic mailbox created – responses from practices poor. • Locality meetings attended to reiterated that they needed to be monitored. • Safeguarding and NELFT services to start using generic mailboxes.

HN stated that he would be working on a detailed a project plan that would be sent at a later date. This is in draft form only, he added that he welcomed any feedback BI report HN presented the BI Business Case. He stated that Health Analytics would need to stay as a main tool, and a presentation layer tool added which will enable commissioners to produce ad hoc reporting. The proposal is to extend the HA contract with a presentation layer for reports.

143


HN went through the following options: • Option 0 – Do Nothing (Status Quo) • Option 1 – Enhanced Provision - Maintaining Health Analytics with 3rd Party Data

Processing Product • Option 2 – Aligning clinical advice/enhanced service support with WEL • Option 3 – The Discovery Project • Option 4 – NEL / CSU Information Exchange • Option 5 – Develop in-house BI capability The recommendation was based on the following:

It satisfies the short to mid-term requirements of the WFCCG until the Discovery Project is live. If there is any risk of the Discovery Project being delayed, this option has the flexibility to mitigate that risk.

The 3rd party data processing product will support seamless integration with Health Analytics and with full access to the database this increases the reporting capability for WFCCG.

Using 3rd party data processing supports the use of and reporting on a variety of data sources. Apart from supporting existing reporting streams there is the potential capability to view patient activity starting with aggregate numbers and drilling down to individual pseudonomised patients. It will also support linking between datasets and with extracts/reference material for medicines optimisation.

Once the Discovery Project is in place, the 3rd party data processing product will seamlessly integrate and with other WFCCG departmental reporting requirements via industry standard accessibility methods.

Procurement timescales can be reduced using providers on a framework. This solution gives WFCCG predictive data analytics with the ability to view data at a granular level. It also means the WFCCG carries out analysis itself without relying heavily on the CSU, a recommendation of the review that was undertaken. Approval given by IT Committee to be presented at Finance & QIPP Committee with full costings.

IT implementation progress report HN gave an update on progress: Successful Migrations in the following practices:

LL Medical The Firs Queen’s Road Waltham Forest Community & Family Health – booked for 6 Oct 2016

EMIS Community

Project Steering group has been created initial kick off meeting held Project implementation group to be created Action agreed as follows: Review current Business Case & High level Target Operating Model Process Map ‘As Is’ and ‘To Be’ to assist in decision making of service team to roll

out

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Interconnectivity Phases Timescales Phase 1 – Internal UI / UX build - RIO to Orion Phase 2 – External UI / UX build estimated start Q4 – Orion to HIE (eLPR)

TQuest / Cyberlabs TQuest

o Tquest – figures up from last month 48% - o Usage improving though still some very low users o Clinical Directors to visit and encourage usage

Cyberlab o Upgrade Cyberlabs to 9.5 still outstanding - awaiting new upgrade date o API for SystmOne users now in operation o Discussions taken place on discontinuous of Cyberlab due to results now

available on HIE (eLPR) HIE

HIE programme to now be known as eLPR – East London Patient Record to shift the name away from a commercial product to a solution that we own

Funding for the eLPR Funding has been agreed for the 3 CCGs for this year for £150k each. Funding does need to be agreed recurrently to take the programme through the cycle of the LDR up to 2020

eLPR Link between Homerton and Barts has gone live eLPR Link between ELFT and Barts has gone live with a pilot number of

clinicians and a subset of the ELFT data A preliminary date has been set for the ELFT data and Homerton data to be

opened up to GP practices Pathology and Radiology now fully live in the eLPR Usage increasing to around 2500 hits a week in GP Practices and around 2000

hits a week in Barts iPlato (SMS)

IPlato (MyGP – part of GPSoc 1) app originally agreed to trial in 2 GP surgeries but will be expanded to 4-6 practices in order to get better validate functionalities & savings

145

IT Committee

Date: Wednesday 21st September 2016

Time: 15:00 – 17:00

Venue: Boardroom B/C, Kirkdale House, Leytonstone

Chair: Dr Mayank Shah (MS)

Attendees: Les Borrett (LB) Dr Thaven Chetty (TC) Joan Fratter (JF) Ed Keating (EK) Phil Koczan (PK) Luke Readman (LR) Ngozi Nbakogu (NN) Harry Nyantakyi (HN) Carl Edmonds (CE),

Apologies:

Richard Griffin (RG), Julia Walsh (JW), Dr Dinesh Kapoor (DK)

Agenda items 1. Welcome and apologies MS

The chair welcomed attendees and apologies noted.

2. Updated declaration of interest forms MS

No changes advised.

3. Notes from last IT committee & Matters Arising MS

Minutes from the July meeting were agreed and action log was updated.

4. ETTF - Feedback HN

HN updated the group with regards to the bids. Stated that there had been a meeting on Monday with Homerton and Barking and Redbridge. 7 bids had been submitted and the aim had been to prioritise them. There would be a follow up meeting with NHS England to share the information and to see if there is any money in the ETTF pot. Committee were advised that Patient on line were on top.

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Page 2 of 6

HN had not had fed back what WF priorities were. Advised committee that on the 27th September a decision will be made, for October or November.

Actions Deadline Owner

Action: BJ to share list with committee. October BJ/ALL

5. Refreshed IT Strategy – Action Plan/ HN

HN went through the paper with the following highlights:

HN has received indicative costs for 111 Adastra to EMIS appointment booking API

Generic mailbox created – responses from practices poor Locality meetings attended to reiterated that they needed to be monitored Safeguarding and NELFT services to start using generic mailboxes.

HN stated that he would be working on a detailed project plan that would be sent at a later date. This is in draft form only, he added that he welcomed any feedback.


Action: HN to meet with EK to discuss comms and the message to GPs.

Action: HN to monitor and ensure the practices are using the generic mail box.

Action: HN to clarify booking from the 111 direct to EMIS/EMIS clinical. Actions: HN to investigate the termination of faxes Action: HN to monitor the generic mailbox Action: HN to send out Fax guidelines to PK and for him to engage with the Practice Managers (PM) forum. Action: HN to liaise with JP on the next PM forum.

October Ongoing November Dec Ongoing Oct

HN/EK HN HN/CE HN HN HN/JP

6. BI report HN/NM

HN thanks NM for all her hard work on the document. HN goes through the document with the committee. He stated that Health Analytics would need to stay as a main tool, and a presentation layer tool added which will enable commissioners to produce adhoc reporting. There would be 2 layers, with a central pool where reports could be pulled off.

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Page 3 of 6

The proposal is to extend the HA contract with a presentation layer for reports. HN goes through the following options:

Option 0 – Do Nothing (Status Quo) Option 1 – Enhanced Provision - Maintaining Health Analytics with 3rd Party

Data Processing Product Option 2 – Aligning clinical advice/enhanced service support with WEL Option 3 – The Discovery Project Option 4 – NEL / CSU Information Exchange Option 5 – Develop in-house BI capability HN stated that he had reviewed all the options in detail, therefore the recommendation is Option 1 - Enhanced Provision - Maintaining Health Analytics with 3rd Party Data Processing Product. This is had been based on the following: It satisfies the short to mid-term requirements of the WFCCG until the

Discovery Project is live. If there is any risk of the Discovery Project being delayed, this option has the flexibility to mitigate that risk.

The 3rd party data processing product will support seamless integration with Health Analytics and with full access to the database this increases the reporting capability for WFCCG.

Using 3rd party data processing supports the use of and reporting on a variety of data sources. Apart from supporting existing reporting streams there is the potential capability to view patient activity starting with aggregate numbers and drilling down to individual pseudonomised patients. It will also support linking between datasets and with extracts/reference material for medicines optimisation.

Once the Discovery Project is in place, the 3rd party data processing product will seamlessly integrate and with other WFCCG departmental reporting requirements via industry standard accessibility methods.

Procurement timescales can be reduced using providers on a framework. This solution gives WFCCG predictive data analytics with the ability to view data at a granular level. It also means the WFCCG carries out analysis itself without relying heavily on the CSU, a recommendation of the review that was undertaken Approval given by IT Committee to be presented at Finance & QIPP Committee with full costings.


Action: HN to present a paper to F&Q committee. October HN

7. Generic Mailbox HN

Please see item 5

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8. HIE/Cyberlabs BJ

BJ gave the following updates: Progress

HIE programme to now be known as eLPR – East London Patient Record to shift the name away from a commercial product to a solution that we own

Funding for the eLPR Funding has been agreed for the 3 CCGs for this year for £150k each. Funding does need to be agreed recurrently to take the programme through the cycle of the LDR up to 2020

eLPR Link between Homerton and Barts has gone live eLPR Link between ELFT and Barts has gone live with a pilot number of

clinicians and a subset of the ELFT data A preliminary date has been set for the ELFT data and Homerton data to be

opened up to GP practices Pathology and Radiology now fully live in the eLPR Usage increasing to around 2500 hits a week in GP Practices and around 2000

hits a week in Barts Funding for the Discovery Project has been approved by the 4 CCGs in WELC

and EMIS data from Tower Hamlets CCG (to begin with) is expected to begin flowing into the Data Service in October.

Diagnostics funding has been applied for through the ETTF process. Prioritisation on ETTF is to take place by the LDR Leads by end of September. This is to change the test ordering system so that it will push clinicians into looking for previous tests in eLPR to avoid duplication of testing and also allow for more trend analysis

Next 6 weeks Need to seek assurances from the WEL CCGs for recurrent funding for the eLPR

project to give Barts (who are hosting the development team) assurances around recruitment and retention of staff.

ELFT data to increase in scope (more data items flowing) and in numbers of users. Newham Council to begin testing with HIE link to add into the eLPR. WEL IG Committee has been founded to improve the governance and decision

making around data sharing and other related issues. Committee has agreed to have one sharing agreement to cover all aspects of sharing and to pull together a Fair Processing plan to tell patients how we are going to share their data for what purposes and with whom.

Deliver new sharing agreement to support the opening up of ELFT and Homerton data to GP Practices through eLPR.

Challenges

ETTF fund was 400% over subscribed and it is still not clear how much money is available in that pot. This particularly affects the diagnostics workstream as without ETTF there is no funding available to develop the diagnostic tool without this

The programme is weak on developing links into Urgent Care (particularly around Adastra). Money has been applied for through a capital bid process but again this is not a guaranteed income stream

Patient online use of services is weak. All services are active but behavioural change in practice processes (set up of their clinical processes and promotion of these services) and in patients (signing up to and using the tools) is a concern. Resource has been applied for in ETTF.

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E-referrals usage is low across the borough. A major part of this is lack of resource in WEL to fix the existing Directory of Service (DoS) so it meets requirements and to add in services that are not yet on the DoS. The service is also affected by capacity issues at Barts which force the patient pathway outside of e-referrals to a more manual process. ETTF funding has been applied for but again this is not guaranteed.

For escalation

The IT programme needs other funding resource to ensure that it is not reliant on ETTF or Capital bids for pots of funds that it may not receive


Action: HN to liaise with DK as lead to take forward. Oct HN 9. IT & Digital Implementation progress report

HN gave an update on progress: Successfully Migrations in the following practices: • LL Medical • The Firs • Queen’s Road • Waltham Forest Community & Family Health – booked for 6th Oct 2016 EMIS Community

Project Steering group has been created initial kick off meeting held Project implementation group to be created Action agreed as follows:

o Review current Business Case & High level Target Operating Model o Process Map ‘As Is’ and ‘To Be’ to assist in decision making of service

team to roll out Interconnectivity Phases Timescales

o Phase 1 – Internal UI / UX build - RIO to Orion o Phase 2 – External UI / UX build estimated start Q4 – Orion to HIE

(eLPR) TQuest / Cyberlabs • Tquest – figures up from last month 48% - o Usage improving though still some very low users o Clinical Directors to visit and encourage usage • Cyberlab o Upgrade Cyberlabs to 9.5 still outstanding - awaiting new upgrade date o API for SystmOne users now in operation o Discussions taken place on discontinuous of Cyberlab due to results now

available on HIE (eLPR) HIE

Homerton info now available to BARTS – Data Sharing Agreements with GP Surgeries required to allow GP views

All results available on HIE (eLPR) – feedback required and process agreed in principle in the phasing out of ‘Copy to GP’ and other systems providing view of results

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Issue identified whereby some patient results are not being displayed BARTS collating affected patients NHS Number – escalated to EMIS. Investigations ongoing

Video Consultation

HN investigating other options (e.g. Egton integrated Solution with EMIS) Visit to Egton Lab to see Vidyo option arranging dates

Website pilot

Ongoing – Approach discussed at Patient online Task Group – JW /HN to draft Wireframes

iPlato (SMS)

IPlato (MyGP – part of GPSoc 1) app originally agreed to trial in 2 GP surgeries but will be expanded to 4-6 practices in order to get better validate functionalities & savings


Action: NP-M to link the patient on line and tquest usage figures on a spread sheet. Action: Clinical Directors/Leads to visit the practices and tackle.

October October

NP-M PK/MS/DK

10 Agree outstanding message and target audience, in line with Communications Strategy

EK

None


9. AOB

A 2nd patient rep will join the IT Committee from October. It was confirmed that his name is Adrian Dodd (AD). Committee thanked JF for all her continued contributions and stated that her efforts are valued.


Action: JF to give NP-M AD’s details. Action: NP-M to add AD to distribution list

ASAP ASAP

NP-M NP-M

Next meeting: 19th October 2016 - 3pm – 5pm Board room B&C Kirkdale House

151

Action Logs [Leyton/Leytonstone, Chingford and Walthamstow Localities] [September 2016]

Item 6.9

Committee Minutes

Locality Meetings – Leyton/Leytonstone, Chingford and Walthamstow – September 2016

From Shahnaz Begum, Miren Querejeta-Lopez and Linda Fontaine – Commissioning Managers - WFCCG

Key highlights Please find attached the signed action log from Leyton/Leytonstone, Chingford and Walthamstow locality meetings- September 2016

ACTION LOG: Leyton/Leytonstone (Shahnaz) – Dr Dinesh Kapoor (Chair)

Agenda Item Action Owner Due Date Status

Actions from 7th September Meeting

4.1 Emis practices having difficulty switching on data sharing agreement within the clinical system, instructions provided by CEG is not very clear. SB to liaise with CEG

September SB/CEG completed

4.2 Whipps Cross has stopped sending sample bottle, practices are not aware and not sure where to buy the correct bottles from. RA to raise GP alert

September RA …………..

7.2 Send updated Sexual Health presentation to members with minutes

Next meeting

SB completed

11.1 SB to obtain written information on the new direct access to the Cardiology service and share with members

Next meeting

SB In progress

11.2 All practices to return the Barts Health data

sharing agreements to Miren.Querejeta‐

[email protected] asap

Aug SB/MQL In progress

11.4 Members would like to have instructions on accessing / using generic mailbox.

Next meeting

SB/HN In progress

152


Chingford Locality Meeting Action Log (Miren) 13th July – Chair Dr Tonia Myers Actions Log

Agenda Item

Actions from 14th September Meeting Target Date Owner Status

3.2 Ambulatory Care – concerns were raised as no one

answers the telephone.

A meeting was held with clinicians last week.

Dr Anwar Khan provide feedback for next meeting.

October AK Open

4.5 2 Macmillan nurses at BARTS are retiring and SL

raised concerns about the level of service after they

are gone.

CE will update the group in relation to the Macmillan

nurses at the next meeting.

October CE Open

7.2

7.3

MQL to send out revised presentation to members with minutes.

YE will send details about the pharmacies that

provide sexual health services in the borough to

MQL to be circulated to the group.

September September

MQL YE

Completed

10.1 Members to send comments about Estate Strategy

to SK.

September ALL Completed

11.1

11.2

Reference levels for cholesterol are still not showing.

BS will take this back to Dr Ruth Ayling and provide

an update for the next meeting.

MQL to send weblink to GP portal to all members where email addresses for the support service for each specialty at Whipps Cross can be found.

October September

BS MQL

Open

Completed

153


Walthamstow Locality Meeting Action Log (Linda) 13th September 2016 – Chair Dr Sheikh Actions Log

Agenda Item

Action carried forward from July 2016 Meeting

Deadline Owner Status

GPs raised issues around sending emails from

EMIS –HN to investigate and feedback to GPs

GPs receiving tests results …. Update: Action:

HN advised that this issue will be discussed at

the next IT committee

By next meeting

By next meeting

HN

HN

Agenda

Item

Actions from 12th July 2016 Meeting Deadline Owner Status

6.1 Public Health updated presentation. LF to

forward with minutes

With minutes

LF Complete

8.2 AP to send IDT GP Alert in relation to BCG

vaccination for children

GPs to send a minimum of 1 FFT per month as

part of their contractual obligations

ASAP Per month

AP GPs

Complete

Complete

11.2 MRI Guidelines – LF to forward with minutes With minutes

LF Complete

11.3 Difficult/unacceptable behaviours by patients By next meeting

SR Complete

11.4 Children Stitch Removal for children under 12, this is not undertaken by PELC. Response ‐ Wound care ‐ no service for u12s. These patients should be seen by practices nurses. Most are doing this. The Community Service is only for 18 years and over as this was only commissioned from the adult community nursing team.

By next

meeting

CE Complete

154

Item 8

PART 126/10/2016 23/11/2016 25/01/2017 22/02/2017 22/03/2017 24/05/2017 28/06/2017 26/07/2016

GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESSChair's update Chair's update Chair's update Chair's update Chair's update Chair's update Chair's update Chair's update

Clinical Director update - Dr KA

Clinical Director update - Dr RG Director update - AW

Clinical Director update - RH

Clinical Director update - AS

Clinical Director update - tbc



Questions from Members and Public








GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCEBAF BAF BAF BAF BAF

HWBB annual report

PERFORMANCE AND QUALITY








P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report P&Q ReportLAS Progress Report

NELFT Response and Action Plan for CQC

Inspection RTT

Social PrescribingPatient Reference Group

work

FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPPFinance Report Finance Report Finance Report Finance Report Finance Report Finance Report Finance Report Finance Report

STRATEGY AND PLANNING








CSP 2016/17-2019/20 TST Business StrategyOrganisational

Development ReportWX SOC (Strategic Outline

Business Case)Organisational

Development Report

London Devolution

INFO INFO INFO INFO INFO INFO INFO INFO

155

Item 8

Reports from Safety Net Reports from Safety Net

Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports

PART 2

Primary Care Dashboard

21 October NEL STP Submission - Draft for Review and Comment

Procurement update Procurement update

156

Documents

Agenda Governing Body Board (Part 1) - Waltham Forest CCG · 26/10/2016 · Agenda Governing Body Board (Part 1) Date: 26 October 2016 Time: 12.00-14.00 ... Performance and Quality