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DUDLEY CLINICAL COMMISSIONING GROUP

PUBLIC AGENDA

Thursday 9 May 2019 1.00pm – 4.00pm

Boardroom, 3rd Floor, Brierley Hill Health & Social Care Centre, Venture Way, DY5 1RU

QUORACY Meetings of the governing body will be quorate when four elected GP clinical members and two other governing body members (one from the lay members or secondary care doctor and one from the Chief Executive Officer, Chief Operating and Finance Officer or Chief Nurse are present, (provided that if the Chair is not present, then either the Chief Executive Officer or Chief Operating and Finance Officer must be present).

Time Agenda Item Attachment Presented By

1.00pm 1. Apologies

1.00pm

2. Declarations of Interest 2.1 To request members to disclose any interest they have, direct or indirect, in any items to be

considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration for discussion or vote on any questions relating to that item. (Enclosed)

2.2 This meeting will be held in public and will be recorded purely as an aide memoir for the minute

taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed.

1.05pm 1.05pm 1.10pm 1.10pm

3. Minutes 3.1 Minutes from Board held on 14 March 2019 3.2 Matters Arising from Board held on 14 March 2019 3.3 Minutes from Extraordinary Board held on 28 March 2019 3.4 Matters Arising from Extraordinary Board held on 28 March 2019

Enclosed Enclosed Enclosed Enclosed

Dr D Hegarty Dr D Hegarty Dr D Hegarty Dr D Hegarty

1.15pm 1.25pm 1.35pm

4. Public Voice 4.1 Questions from the Public To respond to questions from members of the public received

prior to the Board, in writing, on the provision of health care to the population served by the CCG.

4.2 Feet on the Street: Primary Care 4.3 Public Update

Verbal Presentation Enclosed

Mrs H Mosley Mrs L Broster Mrs L Broster

1.45pm 5. Chairman & Chief Executive Officer Report Verbal Mr P Maubach 1.55pm

6. Strategy 6.1 Black Country Joint Commissioning Committee Assurance

Reports and Minutes

Enclosed

Mr P Maubach

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Time Agenda Item Attachment Presented By 2.05pm 2.15pm

7. Quality & Safety 7.1 Quality and Safety Committee Report 7.2 Capsticks Review for Dudley Group NHS Foundation Trust

Enclosed Verbal

Dr R Edwards Mrs C Brunt

2.25pm 2.35pm 2.45pm 2.55pm 3.05pm

8. Governance 8.1 Report from Audit & Governance Committee 8.2 Statement of Disclosure to Auditors 8.3 Board Assurance Framework and Risk Register 8.4 Report from Remuneration & HR Committee 8.5 Dudley CCG Staff Survey

Enclosed Enclosed Enclosed Enclosed Enclosed

Mr T Allen Mr M Hartland Mr T Allen Mr T Allen Mrs E-K Fletcher

3.15pm

9. Finance, Performance and Business Intelligence 9.1 Report from Finance, Performance & Business Intelligence

Committee

Enclosed

Dr R Tapparo

3.25pm 3.35pm

10. Acute & Community Commissioning 10.1 Commissioning Development Committee Report 10.2 Health and Wellbeing Board Report

Enclosed Enclosed

Dr J Darby Mr N Bucktin

3.45pm

11. Primary Care Commissioning 11.1 Report from Primary Care Commissioning Committee

Enclosed

Prof C Handy

3.55pm 12. Reflection Time

4.00pm

13. Exclusion of the Press and Public That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of

the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted.

14. Date and Time of Next Meeting

Thursday 11 July 2019 1pm – 4pm 3rd Floor Boardroom, Brierley Hill Health and Social Care Centre

A Glossary of terms is included at the end of the papers

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Title First Name Surname Job Title or Relationship with CCG Declared Interest

Mr Tony Allen Non-Executive Director Non-Executive Director - Shrewsbury & Telford NHS Trust Director - TNL Consulting Ltd

Mr Matthew Bowsher Chief Officer for Adult Social Care - Dudley MBC None

Mrs Laura Broster Director of Communications & Public Insight

Director of Shrops Hire Solutions Ltd Communications/Engagement Lead for BCWB STP

Mrs Caroline Brunt Chief Nurse None

Mr Neill Bucktin Director of Commissioning

Non-Executive governor and Chairman of the Corporation, Heart of Worcestershire College (A general further education college which provides services for young people with special educational needs and disabilities of the sort commissioned from time to time by the CCG.) Member of Managers in Partnership

Mrs Stephanie Cartwright

Director of Organisational Development, Transformation & Human Resources

In a personal relationship with Chief Executive Officer at Dudley CCG

Mrs Andrea Crew Chief Officer Healthwatch Dudley None

Dr Jonathan Darby Clinical Executive Acute & Community Commissioning

Salaried GP - St Margaret’s Well Surgery Medical Advisor for BBC Drama, Birmingham Director Manor Abbey Investments Ltd Non-Executive Director for the Royal Wolverhampton Hospitals NHS Trust

Dr Ruth Edwards

Board Member Kingswinford, Amblecote & Brierley Hill Locality / Clinical Executive for Quality & Safety

GP Partner - AW Surgeries Shareholder, Future Proof Health Limited (via practice shareholding)

Mrs Emma-Kate Fletcher Interim Director of HR & OD

Sister is a GP at Rosemary Street, Mansfield, Notts Friend (Margaret Gildea) is Senior Independent Director at Derbyshire Healthcare /NHS ft

Dr Richard Gee GP Engagement Lead Appointed member of Dudley Group Foundation Trust Council of Governors

Miss Kate Green Integrated Plus Manager None

Dr Purshotam Das Gupta Board Member Dudley &

Netherton Locality

GP Partner at Links Medical Practice Shareholder, Future Proof Health Limited (via practice shareholding)

Dr Christopher Handy Non Exec for Quality & Safety

Chief Executive, Accord Group Visiting Professor at Birmingham City University Board Member of: - Black Country LEP Board - Redditch Co-operative Homes - Black Country Consortium - Walsall Housing Regeneration Agency - Direct Health - Eurohnet

Ms Deborah Harkins Chief Officer for Health & Wellbeing (Director of Public Health)

Employed by Dudley Council Visiting Professor at University Central Lancs Member of council of Association of Directors of Public Health

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Title First Name Surname Job Title or Relationship with CCG Declared Interest

Mr Matthew Hartland Chief Operating & Finance Officer

Strategic Chief Finance Officer, Walsall CCG Strategic Chief Finance Officer, Wolverhampton CCG Director of Dudley Infracare Lift LTD Director of Infracare (Walsall and Wolverhampton) Limited Director of Whitbrook Management Company Member of Chartered Institute of Public Finance and Accountancy

Dr David Hegarty CCG Chair / Board Member Stourbridge, Wollescote & Lye Locality

GP Partner - Wychbury Medical Group Chairman of Black Country STP Clinical Leadership Group Partner is Director of Strategy at Worcestershire CCG Shareholder, Future Proof Health Limited (via practice shareholding) Shareholder with D C Corporation Ltd Council member- West Midlands Clinical Senate Member of LMC Member of BMA

Dr Tim Horsburgh Clinical Executive for Primary Care & LMC Representative

Salaried GP - Netherton Health Centre. Member of the Local Medical Committee Clinical Lead for SWITCH , CYP Drug Service GPSWI Clinical Lead CYP Commissioning Dudley CCG Designated Medical Officer Dudley CCG

Miss Karen Jackson Partner Agency ( Public Health) None

Mr Alan Johnson Secondary Care Clinician None

Dr Rebecca Lewis Board Member Halesowen & Quarry Bank Locality

GP Partner – Feldon Practice Surgery Shareholder, Future Proof Health Limited (via practice shareholding)

Dr Mohit Mandiratta GP Board Member Salaried GP at Feldon Road Practice GP Partner at Feldon Practice (with partner based shareholding in Futureproof)

Dr Stephen Mann Clinical Executive

GP Partner - Lion Health. Sister provides the Paediatric Triage Service Shareholder, Future Proof Health Limited (via practice shareholding)

Mr Paul Maubach Chief Executive Officer

Member of CIPFA Member of Managers in Partnership In a personal relationship with Director of HR & OD at Dudley CCG Chief Executive Officer, Walsall CCG

Mrs Helen Mosley Board Member Director, Wyre Community Trust

Dr Kiran Penumaka GP Board Member GP Partner at Quarry Bank Medical Practice

Dr Matthew Read Board Member Sedgley, Coseley & Gornal

GP Woodsetton Medical Practice Shareholder, Future Proof Health Limited (via practice shareholding)

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Title First Name Surname Job Title or Relationship with CCG Declared Interest

Dr Fiona Rose Elected CCG Board Member for SCG Locality GP Lead Quality and Safety

GP - Northway Medical Centre Providing Educational Support to Effective Consulting Ltd on a Consultancy basis Husband works for Bham City Council in IT Director of Rose Medical consultancy - providing locum GP support to Future Proof Health Ltd Sister - Practising GP (Solihull/Norfolk)

Mr Martin Samuels Strategic Director - People, Dudley MBC None

Dr Ruth Tapparo GP Board Member and Clinical Executive for Finance, Performance & Business Intelligence

GP Partner - Three Villages Medical Practice Shareholder, Future Proof Health Limited (via practice shareholding)

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES

MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 14 MARCH 2019

AT BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE

Members:

Dr D Hegarty Chair and GP Board Member – Dudley CCG Mr Tony Allen Lay Member for Governance – Dudley CCG ** Mrs C Brunt Chief Nurse – Dudley CCG Dr R Edwards Clinical Executive – Dudley CCG Mrs Emma-Kate Fletcher Interim Director of Organisational Development & Human Resources – Dudley CCG Dr P D Gupta GP Board Member – Dudley CCG Ms D Harkins Chief Officer, Health and Wellbeing (Director of Public Health) – Dudley MBC Mr M Hartland Chief Operating and Finance Officer – Dudley CCG Prof C Handy Lay Member for Quality and Safety – Dudley CCG Mr A Johnson Secondary Care Clinician – Dudley CCG Dr R Lewis GP Board Member – Dudley CCG Dr M Mandiratta GP Board Member – Dudley CCG Mr P Maubach Chief Executive Officer – Dudley CCG Mrs H Mosley Lay Member for Patient and Public Engagement – Dudley CCG Dr K Penumaka GP Board Member – Dudley CCG Dr M Read GP Board Member – Dudley CCG Dr F Rose GP Board Member – Dudley CCG Dr R Tapparo Clinical Executive – Dudley CCG Mr S Wellings Lay Member for Governance/Vice Chair – Dudley CCG (Vice Chair)

Non-Voting Members:

Mrs L Broster Director of Communications and Public Insight – Dudley CCG Mr N Bucktin Director of Commissioning – Dudley CCG

* Dr Horsburgh is also the LMC representative on the Board which is a non-voting role. ** Mr Allen was shadowing Mr Wellings as Lay Member for Governance until the end of the latter’s tenure and

as such was a non-voting member In Attendance:

Ms S Johnson Deputy Chief Finance Officer – Dudley CCG

Minute Taker:

Mrs S Kite PA to Chief Nurse – Dudley CCG

CCG024/2019 APOLOGIES

Apologies were received from:

Mrs A Crew Chief Officer – Healthwatch Dudley Dr J Darby Clinical Executive – Dudley CCG Dr R Gee GP Engagement Lead – Dudley CCG Dr T Horsburgh Clinical Executive – Dudley CCG (LMC Representative) * Dr S Mann Clinical Executive – Dudley CCG Mr M Samuels Strategic Director People – Dudley MBC

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CCG025/2018 DECLARATIONS OF INTEREST

Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. No declarations of interest were made at this point in the meeting. CCG026/2019 MINUTES FROM BOARD HELD ON 10 JANUARY 2019

The minutes of the Board meeting held on 10 January 2019 were accepted as a true and accurate record with the following exceptions: Page 2 – Mrs Mosley’s name was spelt incorrectly Page 9 – an action had been missed within the Quality and Safety Report in relation to infection prevention and control comparison trajectory. It was confirmed this would be covered within the Quality and Safety Committee paper later in the meeting. Resolved: 1) The Board accepted the minutes from the Board held on 10 January 2019 as a true and accurate record,

with the above exceptions

CCG027/2019 MATTERS ARISING CCG005/2019 Dr Horsburgh and Dr Mann had sent apologies so this action would be ongoing until the May

Governing Body. Board members were not aware of what arrangements were in place for patient involvement on the MCP Transition Board. Dr Hegarty had expressed his view that he thinks there should be patient representation.

CCG016/2019 Dr Hegarty had been unable to discuss the ongoing issues in relation to mortality, ophthalmology

RTT and MRI diagnostics with Jenni Ord and since the action was raised, she had resigned from her position. It was noted that NHSI would be appointing an interim Chair of the Acute Trust but no further information was available at that point.

The Board asked for assurance that the CCG does not lose sight of the appointment of the Interim Chair and their successor.

Resolved: 1) The Board noted the updates from matters arising

PUBLIC VOICE

CCG028/2019 QUESTIONS FROM THE PUBLIC

Mrs Mosley spoke to this item and advised that four questions had been received, which were:

Question asked: Has the CCG got a contingency plan given the range of services that Interserve offer if they go into administration? Response provided: As part of our business continuity planning the CCG regularly tests its reliance on major suppliers and develops plans to continue services in the event of major disruption or provider failure. We also work with the other health service providers in order to ensure that they have appropriate contingency arrangements. Interserve are a significant provider to the health sector with regards to estates and facilities. In Dudley we have been having discussions with them on a regular basis to understand any risk to services and to develop contingency plans. There had been articles in the press regarding Interserve’s financial position but the CCG had been informed that the company which provides the majority of the services management was in a good position.

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Question asked: We have been told that schools are having to pay £95 per person who attends mental health first aid training (for staff members). As this is so important for our younger population, shouldn’t health be funding this or working collaboratively with schools to ensure this happens with no cost? Response provided: Dudley Council have confirmed that they offer Mental Health First Aid (MHFA) for secondary schools. This forms part of a suite of training and awareness for education settings and all of the training programmes are provided free of charge. Where schools approach MHFA England or other providers directly they may be charged. We are unclear at this stage which school the POPs member is referring to, however we are in the process of contacting the POPs member to provide more information in order to resolve this issue. Mrs Mosley would follow this up with the person who raised the question.

Question asked: Can I ask whether the CCG has made/will be making a statement on the availability of drugs/prescriptions in the event of Brexit? Response provided: We have no plans to issue a statement at present. Should there be any national shortages of essential medicines a Supply Disruption Alert will be issued by the Department of Health, for which we have arrangements in place to deal with and respond to these immediately. As and when we receive any further information we will provide further advice. This was to be picked up as part of the Chair and Chief Executive briefing but the Board were informed that this was continually being discussed at Commissioning Development Committee and Primary Care Commissioning Committee. The official NHSE advice that had been given was that patients should not be stockpiling drugs for Brexit or for any other reason so there should not be a shift. Question asked: My local paper recently ran a front page article on Jenni Ord quitting the Trust. Whilst the article raised the issue, it did little more by way of informing the public. Surely no one can believe Ms Ord’s “to regain a better work-life balance” explanation. As I understand it, she was reappointed as Chair of the Trust only last autumn. According to the MPs, who played a key role in her decision to quit, the blame lies with management. James Morris “changes at the top are required”; Margot James: “the problems with the senior leadership team … do not begin and end with the Chair”. However, there could be other explanations, and these point the finger at governments and by extension, the MPs. It could be funding or it could be organisational structures which have been imposed by governments over many years. The newspaper article does not help here. In previous meetings of the Board, I have picked up comments which I have interpreted as concerns over the management of the Trust. Can I ask therefore, of the possible candidates for blame, which of the three mentioned above do you think has the major responsibility? Response provided: Thank you for taking the time to reflect your thoughts on the resignation of Jenni Ord from The Dudley Group Foundation Trust (DGFT). The CCG has received no additional information to that which is available and has been reported publically. It is not our place to comment on the media or MPs views on the contributing factors to the decision making by Ms Ord. Clearly the position of Chair requires significant commitment, we respect the decision made by Ms Ord and look forward to working with the new Chair once an appointment is made. No additional comments or questions were raised. Resolved: 1) The Board received questions from the public

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CCG029/2019 FEET ON THE STREET: LONG TERM PLAN Mrs Broster introduced Feet on the Street and as part of the publication of the NHS Long Term Plan, the Communications and Engagement Team went out to establish how much the local people understood. It was reassuring to hear that the public were in touch with the issues and the team felt there was an immense amount of pride with the NHS and the public and the services that are delivered locally. It was recognised that End of Life was a big issue for people and this would be explored more in ‘Dying Matters Week’ to obtain more stories and communicate some of the positives that are coming out of the work that is being undertaken in line with the End of Life Strategy. The Board were informed that Healthwatch Dudley had been selected by Healthwatch England as a Lead Partner for the Black Country STP to go out and have further conversations regarding the Long Term Plan. Mrs Broster would support Healthwatch to do this. There was an expectation that a significant amount of insight from the surveys they would produce and the scrutiny following this would be reported back at a future Board. One of the comments from Feet on the Street was in relation to scrutiny and Mr Allen requested more clarity on what was defined by scrutiny. It was explained that the context of the conversation was that more scrutiny was required and was referring to the negative news within the NHS and that there is more going on behind the scenes if it was looked at more closely. The Board commented on the diminishing monies within the NHS and it was felt important to continue going out to the public to talk about spend and the breakdown that is spent on individuals and on services. It was recommended recording this information within the public summary in the annual report to try and get key messages across. Resolved: 1) The Board received the Feet on the Street presentation

CCG030/2019 PUBLIC UPDATE

Mrs Broster spoke to this item to update Board Members with Communications and Engagement issues. Strategic Co-production Workshops were being held as a development opportunity aimed at patients and the public in strategic co-production. The workshop will be over two days and delivered with NHSE. Elements that were to be covered were discovering yourself; working with others; personalisation and strategic co-production. It was noted that the training had only been undertaken by Dudley CCG at the time of Board and there was a vast amount of willingness to be trained and coached in some of the areas. A further meeting was planned to take place in April to see what it might look and feel like for Dudley. Updates would be provided to Board as appropriate. Engagement on Learning Disabilities Facilities An engagement period was due to commence on 21 March 2019 for eight weeks. A Dudley public meeting was being held on 2 May 2019 at DY1 in Dudley in partnership with Dudley Voices. Future reports would be presented to Board, as it was recognised that a decision would be required on the Ridge Hill site. The scoring on the CQC Community Mental Health survey was commented on, noting that Dudley and Walsall Mental Health Trust had scored ‘better than most’ on three survey questions than other mental health trusts in England. Black Country Partnership NHS Trust had not scored as well in comparison. As a result, the Board recognised that there was a strategic plan for the merger of the two organisations and therefore it wanted to see the best possible outcomes as a result. It was recommended to have an assessment of the comparative strengths and weaknesses on the information available to the CCG, particularly from a patient perspective, to help inform discussions with both Trusts on what the priorities should be coming out of the merger. Mrs Broster agreed to follow this up at the Quality and Safety Committee and informed the Board that discussions had already been taking place with DWMHPT through their CQRM and also with BCPFT to gain more assurance from them on how they are obtaining the views and experiences of children who use the services. Resolved: 1) The Board received the report for assurance

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CHAIRMAN AND CHIEF EXECUTIVE OFFICER REPORT

CCG031/2019 REPORT

Mr Maubach spoke to the report, which was tabled. Notices and Acknowledgements Mr Steve Wellings was retiring on 31 March 2019 and Mr Maubach acknowledged Steve’s journey with Dudley CCG and the contribution he had made in making the CCG the successful organisation that it is. On behalf of the Board, Steve was thanked for his continued commitment and wished well for the future. Mr Tony Allen was introduced as the Non-Executive Director for Governance who would be replacing Steve. Tony was shadowing Steve until the end of March. Mrs Helen Mosley was also formally acknowledged as joining the Governing Body, although she had attended the last meeting shadowing Mrs Julie Jasper. A series of other recent senior leadership announcements were brought to the Board’s attention: Ms Jenni Ord had resigned as Chair of DGFT. The Trust would be encouraged to be as inclusive as possible in

seeking opinions on the future appointment Ms Deborah Rossi had been appointed as the CCG Transition Director. Deborah would support the work

towards a single commissioning voice in the Black Country Professor Steve Field had been appointed as Chair of Royal Wolverhampton Trust. The CCG would be looking

for increasing collaboration across the acute trust and the Black Country The MCP Transition Board were working to recruit to the MCP Chair position. Interviews would be held during

April 2019

Dudley MCP – Organisational Form A meeting was convened with Dudley CCG; the Local Authority; MCP Partnership; NHSE and NHSI to consider options for organisational form. The bidding partnership would carry out an options appraisal that would focus on the creation of an NHS organisation through either the separation of DGFT or the re-purposing of DWMHPT as a result of the merger of their business with BCPFT. A full business case would be required to set out the full details for the regulators to approve. Dudley MCP – Clinical Senate Review The Clinical Senate had held a two day review of the proposed MCP service model. A formal report was due to be received by the end of March and would feed into the Integrated Support and Assurance Process (ISAP). NHS Long Term Plan – Proposed Legislative Changes NHS England had published proposed changes to legislation to support the implementation of the NHS Long Term Plan. These took account of feedback made previously by the CCG and were largely positive. NHSE were carrying out a formal period of public consultation which Dudley were planning to give formal feedback to. A full report would be submitted to the next Board meeting. Winter Pressures Due to the significant problems around pressures in ED and the levels of escalation at DGFT, a joint review of the experiences and challenges faced over the winter is being held at the end of March. The outcome of the review would be reported at a future Board meeting. EU Exit The CCG had been working with partner organisations to ensure the NHS and social care system was prepared in the event of a no deal exit from the EU. All organisations had been working with NHSE to ensure supply routes were in place for essential clinical supplies and equipment, data security and to ensure there were no major workforce risks. There were two areas of concern raised, the first being the supply of drugs and although alternative arrangements had been put in place by the national government for the secure and supply of drugs from Europe into the UK, it was unknown how effective that would be. The second concern related to the social care market locally where there was a high proportion of the workforce who were EU nationals and although it was felt not to be an immediate problem, it was recognised that fewer EU nationals were seeking work in the UK, which could potentially create a problem in the future with regards to the capacity of care home providers being able to deliver services.

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NHS Parliamentary Awards Dudley CCG would be encouraging providers and submitting nominations to local MPs who will then choose who to officially nominate for a national NHS Parliamentary Award. This was a positive opportunity to celebrate some of the successes in Dudley at a national level. Dr Hegarty reiterated his thanks to Mr Wellings on behalf of the Board and welcomed Mr Allen and Mrs Mosley. With regards to the EU Exit, it was noted that a national briefing had been held and beyond medicines, there were contingencies in place for other areas of concern: these included the availability of vaccines; medical devices and non-clinical consumables. Work was also taking place across clinical trials and blood and transplant work. Dudley’s position in terms of risk assessment from a workforce aspect was mirrored nationally and a large amount of joined up working with the Local Authority was taking place in order to mitigate the risk. Mr Wellings commented on the CCG not being involved in the recruitment of the Chair at DGFT. He felt it was important to note that the hospital recognised what the CCG could offer in terms of the style and capability of the person to lead the hospital in future and as a local resident, he was disappointed that the CCG would not be involved in the process. Dr Hegarty reported that he had spoken to Ms Diane Wake and the CCG nominated member of the Board of Governors and had expressed the same view and that Dudley CCG would be prepared to assist in the process. Dr Hegarty had also made some recommendations on who he felt should be involved but had received no response from the Trust. Ms Harkins gave a local authority perspective on the EU nationals and reported that frequent monitoring of the situation was taking place and all independent and social care providers had been made aware of the EU Settlement Scheme and the support provided by the council for people to register and use for employees who it would have an impact on. Resolved: 1) The Board noted the report for assurance

STRATEGY

CCG032/2019 REPORT FROM PARTNERSHIP BOARD

Prof Handy spoke to this item and highlighted the key areas discussed at the Partnership Boards held on 23 January 2019 and 27 February 2019. Dudley Vision – CCG Contribution Further work was being carried out on the NHS Contribution to the Dudley Vision and trying to align what the CCG does against the Vision. A task and finish group was to be established to develop a local NHS ‘pathway into employment’ as it was recognised that this was required. Housing and Health Progress had been made on establishing a mechanism for NHS services to be routinely informed and consulted on housing developments. It was noted that there would be approximately 12,000 new homes being built in the Dudley borough over the next 10 years so it was inevitable that there would be an influx of new patients. There is a national MOU for housing developers so the Partnership Board would be considering that to ascertain whether it was something that Dudley could adapt and use. Young Health Champions Discussions were being held on how the funding could continue for the Young Health Champions to take the work forward in order that Dudley does not lose the benefit of the scheme. Perfect Fortnight The Partnership Board had received a report from DGFT on the ‘perfect fortnight’ and the learning from it. There was an issue around resource and flexible working, particularly with lead consultants. It appeared that discharge arrangements for patients also seemed to ease the flow during the fortnight. Resolved: 1) The Board noted the report for assurance

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CCG033/2019 BLACK COUNTRY JOINT COMMISSIONING COMMITTEE (JCC) ASSURANCE REPORTS AND MINUTES

Mr Maubach spoke to this item asking Board members to note the contents of the report for update on activity and assurance from the Black Country JCC meeting held on 14 February 2019, noting the ratified minutes for the meeting held on 10 January 2019. In addition to the report, one of the ongoing issues being overseen was the performance on the TCP and that collectively the Black Country was not hitting the target with regards to discharges into the community. It was reported that Dudley as a system had the lowest number of patients in inpatient care out of the four CCGs. This issue would remain on the risk register for some time until the situation made some improvement. The Board were informed that the JCC had reached the end of the 12 month rotation so the Chair of the Committee had moved from Dr Anand Rischie to Dr Salma Reehana. The Board asked for any update on the formal appraisal that Mr Andy Williams had requested for a move to a single CCG. It was reported that a CCG Transition Board had been established to work on the options appraisal of future CCGs, with the intention that a proposal would be presented to all four governing bodies in July 2019. Any Constitutional changes for Dudley would be made in the coming year, and the earliest the Constitutional changes would come into effect would be the subsequent year. It was felt important that Dudley continues to evolve and develop noting that Board and staff members should be sighted on progress. Mr Maubach advised he had been briefing the staff and had informed them that the first details about what the long term future might look like would not be available until the Board had considered this in July. It was acknowledged that there was a better relationship across the Black Country CCGs in terms of agreement and how the CCGs work together to move forward. There had been a lot of developmental work carried out to embed relationships and it was felt there was a better foundation to move forward. Resolved: 1) The Board noted the report for assurance QUALITY AND SAFETY

CCG034/2019 REPORT FROM QUALITY AND SAFETY COMMITTEE

Dr Edwards spoke to this item to advise the Board of key issues discussed at the Quality and Safety Committees held on 29 January 2019 and 26 February 2019. DUDLEY GROUP NHS FOUNDATION TRUST (DGFT) Further visits to DGFT had been carried out by the Care Quality Commission (CQC) in January 2019 to the ED Department, Diagnostics and Outpatients. The Trust’s view was positive in that the CQC had seen some improvements made within ED although no formal feedback had been received. The Trust had provided the CCG with a number of action plans which was progress. ED Weekly data continued to be monitored to determining if the Trust was achieving the Standard 31 targets. There was a general improvement but the Trust were not consistently achieving the targets every week. The increased number of trolley breaches had been discussed by the Committee and raised with the Medical Director at the CQRM. He advised that patients were being seen sooner in their patient journey by medical specialities but there was a problem with flow out of ED. The RCAs had been received for the breaches concerned for the CCG to review. Mortality Review DGFT have an action plan in place. A CCG Board Development Session had been planned for 11 April 2019 where external parties had been invited to attend. The Committee were briefed by the Business Intelligence team regarding the range of mortality indicators and the need to triangulate between them to gain a meaningful insight into mortality rates within DGFT. Assurance was given that the monthly figures from the SHMI were reducing.

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DUDLEY AND WALSALL MENTAL HEALTH TRUST (D&WMHT) CQC Inspection D&WMHT were inspected by the CQC in September 2018 with a formal rating of ‘Good overall’ being received. BLACK COUNTRY PARTNERSHIP NHS FOUNDATION TRUST (BCPFT) CQC Inspection BCPFT had been inspected by CQC during October 2018 and were revisited in January 2019 with the Trust being rated as ‘Requiring Improvement’ overall. SAFEGUARDING Changes to Safeguarding Local Safeguarding Children Boards (LSCB) were being replaced by Multi Agency Safeguarding Arrangements (MASA). The responsibility for Child Death Overview/Review Panels was transferring from LSCBs to the CCG and Local Authority. INFECTION PREVENTION AND CONTROL Dudley CCG would breach the C.Diff trajectory for 2018/19 with 86 cases, the target being 75. It was recognised there was an increase of cases within care homes which had been scrutinised by the public health team. Some residents had been identified as having a recurrence of infections and a joint action plan was developed to determine the lessons learnt and where the improvements could be made. The 15% vacancy rate at DGFT was highlighted and the question was asked of how many of the Trust’s employees were EU nationals and whether this should be included on the risk register. It was reported that the Trust were fully sighted on the staff that it would affect and it was felt it was not currently a significant issue. The highest risk was within the social care independent providers. It was also reported that the vacancy rate was comparable within other hospitals. With regards to treating sepsis with antibiotics, it was recognised that this would increase C.diff rates, therefore this needed to be managed appropriately. It was noted that the new Chair would need to address the deterioration in the staff survey from DGFT, but it was acknowledged it would be discussed at the Quality and Safety Committee. Resolved: 1) The Board received the report for assurance CCG035/2019 CHANGES TO CURRENT SAFEGUARDING CHILDREN ARRANGEMENTS

Mrs Brunt spoke to this item to update the Board on the significant changes to safeguarding children arrangements following the Wood Report (2016). A new statutory framework had been introduced, which set out clear requirements, but gave local partners the freedom to decide how they operate to improve outcomes for children. Statutory safeguarding partners moving forward would consist of the Local Authority, Police and the CCG. A paper outlining proposals was to be presented to the Department of Education by the end of June and fully implemented by the end of September. Mrs Brunt advised she was the Vice Chair of the Children’s Safeguarding Board and Chair of the Serious Case Review Group. The Chair of the Safeguarding Children’s Board had resigned and a replacement would be appointed but in the interim, Mrs Brunt had agreed to cover the role. There was not a requirement for the Chair to be independent but the Safeguarding Board had chosen to appoint an independent chair moving forward. It was noted that the last sentence of the report was missing and it should have read ‘however it was recognised that the MASA will need to be published and shared with the Department of Education for their approval’. Due to the change in arrangements, it was questioned whether there was sufficient capacity within the team. It was acknowledged that Sue Nicholls, Deputy Chief Nurse would be in post from 12 April 2019 however, the safeguarding team would require more capacity.

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Mrs Brunt had been in discussions regarding allocations in terms of finances and it was difficult to determine as the detail was not available on what it would look like or the costs associated with it. On a separate note, the number of child deaths was not specified within the report so Mrs Brunt agreed to bring the details to the next Board meeting. Resolved: 1) The Board received the report for assurance 2) The Board noted that Mrs Brunt had taken on the role of interim Chair of the Safeguarding Children’s

Board and, should more capacity be required, that the CCG supports the team in order to build more resilience

3) The Board requested a further update at the May Board GOVERNANCE

CCG036/2019 REPORT FROM AUDIT AND GOVERNANCE COMMITTEE

Mr Wellings spoke to this item, highlighting the decisions made under delegated authority at the Audit and Governance Committee held on 30 January 2019. Freedom of Information (FOI) The CCG had received 44 requests between 1 October 2018 – 31 December 2018. Annual Report and Accounts 2018/19 Update An update on the Annual Report and Accounts had been received by the Committee with a further update being presented to Committee at its next meeting on 28 March 2019. External Audit The Committee received the Audit Risk Assessment report for assurance and confirmed that management’s responses were consistent with their understanding. Internal Audit Dudley CCG had been given full assurance on its financial systems management. GDPR Assurance had been received from CSU that the CCG was on track with the expected actions in the specified timetable. The Committee were due to consider a further report at its next meeting with the expectation to recommend the CCG reduces the risk related to it on the risk register. Resolved: 1) The Board received the report for assurance 2) The Board were reminded that all Board members were required to complete the GDPR consent form

and should return it to Emma Smith at the earliest opportunity CCG037/2019 BOARD ASSURANCE FRAMEWORK AND RISK REGISTER

Mr Wellings spoke to this item, to update the Board on the combined Board Assurance Framework (BAF) and Risk Register as at 8 February 2019. Board members were asked to consider any changes to be made to those risks which were accountable to them. These were: Risk 13: Failure of the governing body to demonstrate appropriate leadership/clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities. Board members agreed the risk would remain unchanged. Risk 112: There is a risk that Governance arrangements between organisations (that are part to the STP) are either insufficient or inconsistent. This may lead to inadequate governance and insufficient transparency which could create unintended financial risk, inconsistent decision making or misalignment of strategic direction and implementation’. It was noted that there were inconsistent planning assumptions within the system with regards to the Midland Metropolitan Hospital therefore it was agreed the risk would remain unchanged.

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Risk 150 – ‘There is a risk that change of leadership in local system organisations will impact on system delivery, particularly in relation to loss of local knowledge’. The Board agreed the risk would remain unchanged however it was noted that moving forward with a STP and potentially one CCG, it was recognised this could have an impact and dilute the local knowledge. Risk 151 – ‘There is a risk that the CCG fails to meet its statutory duties in respect of the delivery of high quality care to the population of Dudley’. Board members agreed the risk would remain unchanged. Risk 152 – ‘There is a risk that the pace of change in the transformation of the system will not be aligned to the views of the public. This may result in the CCG moving too quickly to allow time for adequate involvement or not moving quickly enough to meet public expectations’. The Board felt this was still a significant risk in terms of needing more pace and the risk that the wider STP changes would ‘outstrip’ what was trying to be embedded in Dudley. In addition to this, it was felt more messages needed to be sent out to the public on the development of the MCP and a discussion needed to take place with the Transition Team on how to take this forward in order to provide some assurance to the public. The Board recommended that Prof. Handy and Mr Maubach raise this at the next meeting of the Transition Board to explore what their communications policy is to engage with the local population. There was also concern raised that there was a risk that the STP geography was getting distant from the public and they would not be able to contribute to it. Mrs Broster informed Board members that she was the Workstream Lead for Communications and Engagement for the STP and would be reviewing the Communications and Engagement Strategy at an STP level and organising a citizen’s panel that would have a representative voice for the Dudley people. Risk 156 – ‘There is a risk that Dudley CCG could be exposed to financial and reputational risk if it fails to comply with the requirements of the General Data Protection Regulation. The CCG could receive potential fines of up to €17m or 4% of annual turnover for failure to comply, or face other enforcement action from the ICO including warnings, enforcement notices, undertakings or audits.’ It was noted that the risk would be reviewed at Audit and Governance Committee and therefore would remain unchanged pending discussion at Committee. Risk 157 – ‘There is a financial risk that the CCG is unable to deliver a 20% reduction in CCG administration costs by 2020/21 in line with those made by NHS England and NHS Improvement through the joint working initiative that key business delivery and the future sustainability of the CCG may be adversely affected’. A paper was due to be presented to the Finance, Performance and Business Intelligence Committee, as part of the financial plan, so feedback would be provided at the next Board meeting. Resolved: 1) The Board received the report for assurance and approved the recommendations made by the Audit and Governance Committee to the governing body 2) The Board recommended Prof. Handy and Mr Maubach explored what the Transition Board’s communications policy is to engage with the local population CCG038/2019 REPORT FROM REMUNERATION AND HR COMMITTEE

Mr Wellings spoke to this item to provide assurance to the Board regarding key issues discussed and approved by the Remuneration and HR Committee held on 30 January 2019. Workforce Dashboard The sickness absence rate had slightly decreased to 0.38%. Mandatory training compliance was reported at 79% and work continued to make improvements. Personal Development Review compliance was reported at 74%. The CCG headcount was reported at 140. STP and Black Country and West Birmingham Joint Commissioning Committee Workforce Update The HR Directors and HR Leads had met with CCG Staff Side and Staff Council Chairs to reflect on the message that was sent to staff following the Accountable Officer and Chair development day to sense check how staff felt about the direction of travel and the mechanism used for updating staff. Staff felt it was a positive way of sharing the message and felt it continued to build trust in the leaders.

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Staff Engagement The Committee received an update with regards to engaging with staff who are aligned to the MCP. A series of FAQs had been developed. Staff who would remain at the CCG would also have the opportunity to engage with senior management about any changes to affect the CCG. Policies The Committee reviewed and updated the PDR Policy and Secondment Policy. Bullying and Harassment Development Session The Committee received an update about the bullying and harassment development session that would be taking place in May 2019 for all CCG staff. This was a result of the staff survey. Staff Survey The proposed questions for the staff survey were discussed by the Committee which was due to be conducted through Survey Monkey. The results would be analysed and shared with the Board and Remuneration & HR Committee. Office Holder Standing Operating Procedures It was agreed at Committee to develop a Standard Operating Procedure (SOP) to provide guidance to both the CCG and Office Holders. This would be developed by the HR function for approval by the Executive Team. The document would also form part of the induction process for new Governing Body members. HR Shared Function The Committee received a proposal for a shared HR function across the four Black Country CCGs. The Committee were provisionally in agreement with the proposal however, noted that more detailed costings were required. The Board welcomed the engagement with staff who would remain within the CCG as there appeared to be a focus on MCP aligned staff. With regards to the bullying and harassment session, a Board Development Session had been held and as a result more detail was requested in terms of the specific issues that had been raised. The Board asked whether this detail was available as it may be seen as a missed opportunity if not. It was also pointed out that the Board Development Session was considered as mandatory and all Board members should have attended. The attendance was not available at the time of Board but it was agreed to discuss this at the next Committee and report back to the next Board. Resolved: 1) The Board received the report for assurance including the decisions taken under delegated authority 2) The Board requested attendance at the Board Development Session, to be reported in the Committee

report at the May Board

FINANCE, PERFORMANCE & BUSINESS INTELLIGENCE

CCG039/2019 REPORT FROM FINANCE, PERFORMANCE & BUSINESS INTELLIGENCE COMMITTEE

Dr Tapparo spoke to this item summarising the key issues discussed by the Finance, Performance and Business Intelligence Committees held on 20 December 2018, 31 January 2019 and 28 February 2019. Statutory Financial Duties The CCG had an annual budget at January 2019 of £493.5m. As of January 2019, it was reported the CCG was underspent by £11.35m and was expected to achieve its revised year end control total of £13.6m as agreed with NHS England. NHS Constitution Standards/CCG Assurance Dudley CCG had met all of the NHS Constitution Standards in October with the exception of A&E waits and an under performance in ambulance handovers. A&E waits had failed to achieve the 95% national standard in January 2019, with 80.16% of patients admitted, transferred or discharged within 4 hours. The Committee were disappointment that despite CQC input, there was yet to see a sustained improvement.

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Key Indicators Other indicators reported on were the increase in cancelled operations, the underperformance against the national standard for IAPT access and a decline in the dementia diagnosis rate. Through performance benchmarking against neighbouring CCGs, out of 25 indicators, Dudley was ranked first in seven of the areas, but disappointingly ranked last in seven of the areas which related to ambulance handovers, IAPT and the MRSA/C.Diff indicators. The Committee reviewed the expenditure of Dudley CCG and noted the overspend within the Commissioning Development Committee. Although there was an overspend it did not breach the CCG financial duties. QIPP The QIPP target of £17m was forecast to be achieved in 2018/19 with a year to date achievement of £14.4m. Some of the plans had not delivered but were expected to deliver within the next financial year. An assurance call had taken place with NHS England in February to discuss the QIPP programme and a further update was scheduled for 15 March 2019 to discuss progress made. Combined Board Assurance Framework The risks assigned to the Committee were reviewed and accepted. Diagnostics The Committee received a report on the review of non-obstetric ultrasound activity at DGFT and noted that the MRI non-obstetric ultrasound performance had been variable against the national target. It also noted that the numbers waiting for non-obstetric ultrasounds at DGFT had increased and performance against the national target had deteriorated. The Committee had requested more in-depth detail and although the Trust were currently performing, the Committee would be reviewing the situation on a regular basis. Remedial Action Plans (RAPs) It was reported that there were 12 RAPs in place, 10 at DGFT and 2 at Dudley and Walsall Partnership NHS Trust. Draft Financial Plan Overview The Committee received a draft of the CCG’s Financial Plan overview for 2019/20 with a forecast spend of £504.6m. It was reported that Dudley’s spend was greater than the allocation so work was being carried out on the QIPP challenge to resolve this. Black Country Financial Flows within the STP The Committee received a report on the complex projected financial flows when place-based models were implemented within the STP. The majority of financial flows from commissioners to providers remained within the Black Country STP with the STP being a net receiver of income from external STPs. The Committee had recommended the model to be discussed at a future Board Development Session. Decisions taken under Delegated Powers The Committee endorsed and approved the investment prioritisation scoring matrix to score and prioritise investment proposals against the £1m investment reserve. The Board noted the progress the QIPP programme had made as a result of a lot of hard work. It was noted that due to poor performance at DGFT, Dudley was not achieving its quality targets, and it was felt that the Trust do not see the financial impact it has on the system when they are not achieving their targets. In relation to performance measures, particularly over 52 week waits, it was noted that the position had changed since the report was produced so clarification was requested to feed back the position at the end of Q3 at the next governing body. In addition, the information on patients who were at weeks 45-52 and were at risk of breach should also be reported at the next meeting. The 62 day cancer performance target was discussed and clarification was sought on the reasons why the target was not being met. The Board were advised that there were three contributing factors which were: the capacity of the Royal Wolverhampton Hospital to treat the total volume of referrals being sent to them; issues with regards to Dudley sending late referrals; and issues with the IT system.

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It was reported that late referrals were being discussed at CQRM and it had been noted there was a difference in timeframes for referrals between UHB and Wolverhampton. It was noted that Cancer waits was the biggest issue and the Remedial Action Plan had been reconsidered and not delivered. This had been escalated in the Trust in December. The Board requested Dr Edwards and Mrs Brunt to report to the next Governing Body meeting on the understanding of what the root cause was behind the issue and what actions were being taken to address it as the Board needed to be sighted on what the underlying problem was. Resolved: 1) The Board received the report for assurance 2) The Board noted the decisions taken under delegated authority 3) The Board requested clarification on performance measure, particularly in relation to over 52 weeks

and 45-52 weeks at the end of Q3, to be reported at the next governing body 4) Dr Edwards and Mrs Brunt to report to the May Board on the root cause of late referrals for Cancer

waits and what actions were being taken to address them

ACUTE AND COMMUNITY COMMISSIONING

CCG040/2019 REPORT FROM COMMISSIONING DEVELOPMENT COMMITTEE

Mr Bucktin spoke to this item asking Board members to note the matters considered by the Commissioning Development Committees held on 16 January 2019 and 27 February 2019. NHS Continuing Healthcare – Choice and Resource Allocation Policy The Committee noted advice from Counsel that the Equality and Human Rights Commission (EHRC)’s comments be adopted and the policy amended as it would not affect the underlying rationale of the policy and the 20% ‘cost ceiling’ would be retained. The Committee approved the revised policy, following advice from Counsel, which incorporated the comments of the EHRC. QIPP MSK is a vital part of QIPP and a further report on progress was received by the Committee. MSK has a number of dimensions and the Committee would be discussing these moving forward. Hospice at Home in Residential Care Homes for End of Life Care Patients The Committee received a Business Case for consideration of a new service to support end of life patients in residential care homes. The Committee approved the proposed service. Patient and Community Engagement Indicator – 2018/19 CCG Improvement and Assessment Framework (IAF) The Committee approved the submission of the evidence regarding compliance with the Patient and Community Engagement Indicator of the IAF to NHS England. Resolved: 1) The Board noted the matters considered by the Committee CCG041/2019 MCP PROCUREMENT PROJECT BOARD

Mr Bucktin spoke to this item to provide an update to the Board in relation to the procurement and mobilisation of the MCP. The Board were being asked to note the matters considered by the Procurement Project Board held on 11 February 2019 and 11 March 2019. Bidding Partnership – Progress Letters had been exchanged with the bidding partnership about progress on the implementation of the contract mobilisation and the Procurement Board considered their response to that. A further letter had been sent suggesting there were four main areas to focus on, these being; the production of the Strategic Outline Case that needed to be submitted to NHS Improvement; bringing the services together safely into single organisations to deliver integrated services; to continue developing a care model and the existing organisations to implement the service development agreed; and governance arrangements and how the organisation would be governed, and for some developmental work to be carried out. In addition to the report, Mr Bucktin advised that the Integrated Care Provider Contract that was required to implement the MCP was due to be published imminently.

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It was noted that the Clinical Senate Review had provided verbal feedback but written feedback was expected at the end of March 2019. Resolved: 1) The Board noted the matters considered by the MCP Procurement Project Board PRIMARY CARE COMMISSIONING

CCG042/2019 REPORT FROM PRIMARY CARE COMMISSIONING COMMITTEE (PCCC)

Mr Wellings spoke to this item summarising the key issues discussed at the meetings of the PCCC held on 18 January 2019 and 22 February 2019. The Board were asked to note the involvement of the sub-committees that supported PCCC. PRIMARY CARE OPERATIONAL GROUP (PCOG) GMS Contract Monitoring The Committee received an update from PCOG, which included GMS contract monitoring findings for 2018/19; it also noted the changes to primary medical services contracts as set out in the five year framework for GP Contract reform. A formal report was expected on the implications in April. The Committee also approved three contractual variations in respect of partnership changes, as recommended by PCOG. The Committee also discussed the GMS Contract monitoring process for the forthcoming year and whether practices required practice visits as a result. Primary Care Premises Statutory Compliance There had been some concern expressed in previous Committees that there were seven practices who did not meet the statutory premises compliance and therefore Mr Wellings, as Chair of the Committee, wrote to those practices giving seven days’ notice to comply. It was reported at the last Committee that all seven practices were now compliant. Three Villages Medical Practice – closure of the Wollaston Branch Surgery The Committee noted the closure date of Three Villages Medical Practice branch surgery which was Friday 12 April 2019. Special Allocation Scheme (SAS) – formerly known as the Violent or Excluded Patient Scheme It was reported that there were 24 patients on the scheme in Dudley which would be reviewed at the PCCC, with the intention to make recommendations to return them out of the scheme where possible. Minor Surgery PCOG had received a report detailing minor surgery provided in primary care delivered under the GMS Contract and Local Improvement Scheme (LIS). The Committee ratified the recommendation of PCOG to communicate with practices to clarify the commissioning arrangements for minor surgery under both the GMS Contract and the LIS. Dudley Quality Outcomes for Health (DQOFH) – Monitoring Process The Committee approved the DQOFH monitoring process and reporting mechanism for 2018/19 and 2019/20 contracts. GENERAL PRACTICE FORWARD VIEW (GPFV) STP – GPFV Planning Proposals The Committee approved the proposed governance arrangements of planning priorities to be undertaken at an STP level. Work was ongoing on how primary care contracts would be aligned across the STP. Primary Care Development Group and GPFV Workforce Sub-Group The Committee received assurance on the work that both sub-groups were undertaking. Subject to minor changes to the structure of reporting arrangements, amendments to the terms of reference for both groups were approved. QUALITY The Committee were assured by practices who had been re-inspected by CQC and were identified as ‘green’ on all the CQC ratings.

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FINANCE The financial position of the Committee was reported as a break-even position. RISK REGISTER PCOG discuss and review the Risk Register and make recommendations to the Committee. The Committee reviewed and updated the Risk Register. Mr Wellings’ was supported by the Board in reducing the numbers on the Special Allocation Scheme and assurance was sought on the appeals process for patients who were put on the scheme. It was the understanding that the CCG had more of a role in monitoring the process and the CCG would oversee the appeals process, but the question was asked whether this process had been put in place. A recommendation had been made to the Committee on the composition of the appeals panel and discussion had taken place to appoint a patient representative to be on the panel. A progress report was due to be sent to Committee at its next meeting. It was suggested that the appeals process is published on the CCG website for practices to understand the process clearly. It was recognised that there were conflicts of interest from a number of GP Board members which related to some of the items within the PCCC report. Dr Hegarty took the opportunity at this point in the meeting to discuss the governance arrangements in relation to the PCCC. A meeting had taken place with the Non-Executive Directors to discuss how the statutory Committees would be covered by the NEDs. This would be circulated amongst the NEDs for comments, which will then be discussed at Remuneration and HR Committee, before being reported back to Board. Resolved: 1) The Board received the report for assurance

CCG043/2019 LOCALITY FEEDBACK REPORT – JANUARY AND FEBRUARY 2019

Mrs Brunt spoke to this item to advise the Board of themes emerging from discussions held at Locality meetings in January and February 2019. The main focus for localities had been in relation to the formation and agreement of Primary Care Networks (PCNs). As part of the report, an update from the GP Engagement Lead is provided. The Board highlighted the childhood immunisation position and recognised the rates were falling within the Dudley Borough. Ms Harkins advised that an audit would be carried out by public health and GPs would be contacted for their support and a report taken to the Health Protection Group. This intelligence would be fed back to localities and if necessary, would report back through the Quality and Safety Committee. Resolved: 1) The Board received the report for assurance

CCG044/2018 REFLECTION TIME

Board members felt the meeting had been chaired very well. EXCLUSION OF THE PRESS AND PUBLIC

That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted.

DATE AND TIME OF NEXT MEETING

Thursday 28 March 2019 (Extraordinary Board) 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre

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Thursday 9 May 2019 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD

Name Title

Signed Date

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

MATTERS OUTSTANDING

PUBLIC BOARD MEETING – MAY 2019

ITEM NO AGENDA ITEM ACTION TO BE TAKEN ACTION FOR UPDATE COMPLETED

CCG135/2018 (November 2018)

Report from Audit and Governance Committee

The Audit and Governance Committee Terms of Reference to be adjusted to reflect who the Chair would be once Mrs Jasper and Mr Wellings leave the organisation and for other Committee members to be governing body members

Mr Hartland

This will be completed as part of a full review of TOR following the changes to the Governance Structure in April 2019

ONGOING

CCG135/2018 (November 2018)

Report from Audit and Governance Committee

All Committee Terms of Reference to be aligned to reflect the new constitution of what the new NED roles would include and present all to the Board for approval

Mr Hartland

This will be completed as part of a full review of TOR following the changes to the Governance Structure in April 2019

ONGOING

CCG0352019 (March 2019)

Changes to Current Safeguarding Children Arrangements

The Board requested an update at the May Board on the capacity of Safeguarding capacity within Dudley CCG

Mrs Brunt Private agenda item COMPLETE

CCG037/2019 (March 2019)

Board Assurance Framework and Risk Register

The Board recommended Prof. Handy and Mr Maubach to explore what the Transition Board’s Communication Policy was to engage with the local population

Prof. Handy Mr Maubach

CCG038/2019 (March 2019)

Remuneration and HR Committee Report

Further details to be provided as a result of a bullying and harassment Board Development Session that was held. Attendance details to also be included within the next Committee report to Board in May

Mrs E-K Fletcher Included within the Remuneration and HR Committee Report

COMPLETE

CCG039/2019 Finance, Performance and BI Committee Report

Clarification requested on performance measures, particularly in relation to over 52 weeks and 45-52 weeks at the end of Q3, to be reported at next Board

Mr Hartland

Included within the Finance, Performance and Business Intelligence Committee report

COMPLETE

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ITEM NO AGENDA ITEM ACTION TO BE TAKEN ACTION FOR UPDATE COMPLETED

CCG039/2019 Finance, Performance and BI Committee Report

Dr Edwards and Mrs Brunt to report on the root cause of late referrals for Cancer waits and the actions being taken to address them

Dr Edwards Mrs Brunt

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DUDLEY CLINICAL COMMISSIONING GROUP EXTRAORDINARY BOARD PUBLIC MINUTES

MINUTES OF THE EXTRAORDINARY BOARD MEETING HELD IN PUBLIC ON

THURSDAY 28 MARCH 2019 AT BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE

Members:

Dr D Hegarty Chair and GP Board Member – Dudley CCG Mr Tony Allen Lay Member for Governance – Dudley CCG ** Mrs C Brunt Chief Nurse – Dudley CCG Dr R Edwards Clinical Executive – Dudley CCG Mrs Emma-Kate Fletcher Interim Director of Organisational Development & Human Resources – Dudley CCG Dr P D Gupta GP Board Member – Dudley CCG Ms D Harkins Chief Officer, Health and Wellbeing (Director of Public Health) – Dudley MBC Mr M Hartland Chief Operating and Finance Officer – Dudley CCG (dialled in for Financial Plan) Dr T Horsburgh Clinical Executive – Dudley CCG (LMC Representative) * Dr R Lewis GP Board Member – Dudley CCG Dr M Mandiratta GP Board Member – Dudley CCG Mr P Maubach Chief Executive Officer – Dudley CCG Mrs H Mosley Lay Member for Patient and Public Engagement – Dudley CCG Dr M Read GP Board Member – Dudley CCG Dr F Rose GP Board Member – Dudley CCG Mr M Samuels Strategic Director People – Dudley MBC Dr R Tapparo Clinical Executive – Dudley CCG Mr S Wellings Lay Member for Governance/Vice Chair – Dudley CCG (Vice Chair)

Non-Voting Members:

Mrs L Broster Director of Communications and Public Insight – Dudley CCG Mr N Bucktin Director of Commissioning – Dudley CCG

* Dr Horsburgh is also the LMC representative on the Board which is a non-voting role. ** Mr Allen was shadowing Mr Wellings as Lay Member for Governance until the end of his tenure and as such

was a non-voting member In Attendance:

Dr R Gee GP Engagement Lead – Dudley CCG Ms S Johnson Deputy Chief Finance Officer – Dudley CCG

Minute Taker:

Mrs T Green Business Support Manager – Dudley CCG

Before the meeting commenced, the Board acknowledged it would be Mr Wellings’ final Board meeting as he was due to retire on 31 March 2019. Mr Wellings was thanked for his contribution to the Board and the CCG and wished him well in his retirement. CCG045/2019 APOLOGIES

Apologies were received from:

Mrs A Crew Chief Officer – Healthwatch Dudley Dr J Darby Clinical Executive – Dudley CCG Prof C Handy Lay Member for Quality and Safety – Dudley CCG Mr A Johnson Secondary Care Clinician – Dudley CCG Dr S Mann Clinical Executive – Dudley CCG Dr K Penumaka GP Board Member – Dudley CCG

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CCG046/2019 DECLARATIONS OF INTEREST

Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. It was acknowledged that the report on Constitutional Changes would impact the GP voting members of the Board and it was agreed that those members identified would not contribute to the discussion and the Chair role would be handed over to the Vice Chair for this item CCG047/2019 FINANCIAL PLAN

Mr Hartland spoke to this item, via telephone, to present the baseline budgets for the financial year 2019/20 and was asking the Board for approval. It was reported that the paper had been presented to the Finance, Performance and Business Intelligence Committee prior to being presented to the Board. Dudley CCG’s financial plan had been approved by NHS England and it met NHSE business rules, however there was further detail to be discussed prior to the Board considering sign off. Dudley CCG had received new five year allocations, the first two years being fixed, and receiving a growth of 5.3%. The budget had been constructed on the new allocations, the requirements in terms of the Long Term Plan, the Operational Plan, but also the business rules from NHSE. With regards to the 5.3% growth, this was good based on previous years however Dudley had received the lowest growth across the Black Country and was below the national average. Walsall CCG had received 5.6%, Wolverhampton CCG had received 6.1% and Sandwell and West Birmingham CCG had received 7.1%. The resource allocation for 2019/20 was £516.0m and it was planned to spend £504.3m which would leave a surplus of £11.7m. This was in line with the control total set by NHSE and would utilise £1.92m draw down of historic surpluses carried forward, which Dudley could use to spend on the MCP but would be a non-recurrent allocation. A budget of £262m had been established with acute providers, however, the main contract with DGFT had not yet been signed. The CCG had made an offer to DGFT which was higher than the national formula that the CCG believed was a fair offer, but it had been rejected by DGFT. An issue for DGFT was their control total set by NHSI which, at the time, they believed was unachievable and was preventing them from agreeing a contract. The Board noted that the budget being presented, was the CCG’s maximum budget. There was a Dudley escalation meeting with NHSE due to take place the following day where it was expected to be discussed. The Board were advised that there may be a risk that the CCG were mandated to increase the offer although this was not expected as the offer was fair and supported by NHSE. It was noted that the financial plan did not include any additional costs as a consequence of the ‘no deal’ from the EU and that the CCG had been told not to plan for it. In terms of running costs, there was an expectation in two years’ time to reduce the running costs by 20% and the budget book for next year would include a 10% reduction in the running cost budget. The allowance would remain the same but the CCG would budget for 10% less spend which would be targeted on non-direct staff elements. The plan for this would be discussed and monitored through the Finance, Performance and Business Intelligence Committee. With regards to primary care, Dudley CCG has a delegated budget which is ring-fenced and is defined in terms of what can be spent against it. With regard to GPs indemnity costs, CCGs were asked to plan for a 1% reduction in their allocated primary care budget but the reduction was in fact 4%. This was a cost pressure against the primary care delegated budget and would be challenged nationally by the STP planning leads. The Board were advised that the CCG would need to plan for the reduction, noting that additional saving plans would need to be constructed to fund the shortfall. As part of the financial framework and as a result of the restructure of the Committees, it was noted that Finance, Performance and Business Intelligence Committee would set and allocate budgets to the Committees, manage risk and provide assurance to the Governing Body. Each Committee would have more accountability of managing the budget they are delegated and being accountable to the Finance, Performance and Business Intelligence Committee and the Governing Body. The Scheme of Delegation would emphasise that Committees and

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importantly the Directors within them, would be responsible for the budgets they are set. The reporting mechanism would also be restructured to reflect this. In summary, the Board were asked to note that the CCG had received five year allocations, it had low growth, it had set the budget that meets statutory requirements and met what was required in terms of the Operational Plan. In addition, it was also noted that the recurrent underlying position was reduced down to 1% and were at the minimum of what the CCG needed to achieve the financial target. By managing the budget, meeting the QIPP target and managing risks, Dudley CCG should achieve the financial plan that was set. It was therefore proposed that the Governing Body accepted the financial plan as it was presented, noting the risks as described, noting a Quarter 1 review and noting the requirements of the Governing Body and whole CCG to ensure that the budget is adhered to in order to ensure the CCG meets its statutory financial duties. Dr Tapparo provided an update from the Finance, Performance and Business Intelligence Committee that met immediately prior to the Board. It was stated that the financial plan would be extremely challenging and they were disappointed that the CCG was unable to commit to all of the proposed investments. It was noted that the public perception was that there was £20bn being put into the NHS with the assumption that Dudley would have significant additional resource to spend. Overall, the Committee approved the financial plan. Concern was raised with regards to the increase to primary care which was 2.6% and was half of what the acute would receive. Although there would be other resources made available through grants, this didn’t triangulate with the aims of the Long Term Plan and it was felt there were some inconsistencies and inappropriate allocation of funding at a national level. The final point made by the Committee related to the future Midland Metropolitan Hospital and the potential risk to the Dudley system if Sandwell and West Birmingham NHS Trusts localisation plan was implemented as planned. With regards to the prescribing budget, the forecast PPA data at month 9 had been used as the basis for the 2019/20 baseline. Net inflation and ONS growth of 4.97% had been applied with a further £4.23m identified as a QIPP target but concern was raised that this would be a difficult challenge and there was uncertainty on whether those targets could be met. In response to the growth going to the acute provider compared to primary care, the Board were advised that the CCG had been given additional funding, as part of the 5.3% specifically to direct the funding straight to the provider sector. The benefit to the CCG being that if activity was prevented from going to the acute, the CCG would retain the funding therefore providing an incentive. It was asked whether the indemnity top slice would be a ‘one off’ or whether it would be a yearly assessment top slice. It was advised that this was not expected to increase year on year which is what the planning assumption was based on. Mr Samuels raised that there was an understanding from the Local Authority that the BCF had been agreed at a national level and that the CCG mandatory contribution would be increased, not by inflation, but by what the overall budget increase had been, which for Dudley was 5.3%. It was confirmed that at the time of the Board, BCF was not one of the mandated issues that had to be managed through the financial plan and the CCG had not been informed by NHSE to increase BCF by the 5.3%, so clarity would be sought on this particular issue. It was also clarified that no assumption was being made in 2019/20 or 2020/21 onwards that the CCG would pick up any contribution when the iBCF would reduce or disappeared which was flagged as a risk. Resolved: 1) The Board approved the budgets for the CCG for the 2019/20 financial year, acknowledging the

challenges and risks as discussed 2) The Board felt disappointed in terms of the allocation, supporting the challenge back to NHS England

on the allocation formula 3) The Board noted the ongoing risk on how the rules of the BCF might be applied

CCG048/2019 NHS LONG TERM PLAN – PROPOSED LEGISLATIVE CHANGES

Mr Bucktin spoke to this item to ask the Board to approve the CCG’s response to proposed legislative changes from NHS England and NHS Improvement in terms of the NHS Long Term Plan, in order to make a submission by the end of March 2019. As part of the ongoing work for the MCP, it had been reported previously that discussions were being held with NHSE and NHSI on potential primary legislation changes in order to overcome some of the issues encountered

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during the procurement. Within the Long Term Plan is a section that, in order to implement, legislative proposals would be published. The report being presented was a document which had been published where NHSE had conformed with a series of proposals to change legislation which had been designed to deal with issues identified within the Long Term Plan. The report had been set out in a way that identified the proposed change, the reasons for it and what the response might be. It was noted that the majority were positive and welcomed but there were some areas which were highlighted to the Board. Under the heading ‘Getting better value for the NHS’, the document proposed to remove the procurement requirements that had been placed over the public contract negotiations but should the legislation be approved, it proposed that those regulations would no longer apply. It also suggested having a best value test when commissioners are going through the process of creating an Integrated Care Provider however clarity was being sought from NHSE on what a best value test would look like and how it would be demonstrated as best value to the CCG and wider stakeholders. One of the other issues was under the heading ‘Integrated Care Provision’, and organisational form and that the only mechanism available to create a new NHS organisation under the existing legislation would have been through the separation of a Foundation Trust, however the Secretary of State did not have the power to create new NHS bodies. The proposal therefore was for the Secretary of State to have the power to create a new Integrated Care Provider where that was required by the system but the process behind this would need to be understood. Within the document itself, it talked about governance arrangements of those organisations and in the MCP prospectus it set out requirements on how the MCP would be expected to be governed, particularly the relationship it would have with the local community. If it were to go down a NHS Foundation Trust route, there was already a mechanism there to enable the local community involvement in the governance of a NHS Foundation Trust. The other area that was brought to the Board’s attention was under the heading ‘Planning our services together’ and one of the issues that was being looked at was how the CCG dealt with double delegation with regards to commissioning of primary care services. The document proposed that the CCG carried out delegated functions as if they were their own in order to move the double delegation barrier. This would be welcomed as it would allow the resources to be channelled which related to the commissioning of primary care, through the Integrated Care Provider in future. In addition a number of commissioning activities would be transferring from the CCG to the MCP and it would be helpful for the legislation to reflect that. The Commissioning Strategy Unit had produced a report on the problems experienced as part of the procurement as evidence to demonstrate why the changes were so important. It was recommended that the report should be sent along with the submission being made. It was recommended that the Board supported bringing NHSE and NHSI together in order to improve communication between the two of them as that was not currently the case. The Board were advised that in order to contract the MCP services a different form of contract was required which had been subject to a consultation process and judicial reviews. The Consultation had concluded and NHSE had published their response where Dudley was mentioned within it. Some changes were being made to the contract but would only be available in specific circumstances to organisations when they had gone through the ISAP process. NHSE had also approved the statutory regulations to allow primary care services to be commissioned through the contract which would support Dudley’s position. Resolved: 1) The Board approved the comments in response to the proposed legislative changes in terms of the

NHS Long Term Plan 2) The Board supported the recommendation to incorporate the report from the Commissioning Strategy

Unit, when the submission was made 3) The Board supported the bringing together of NHSE and NHSI CCG049/2019 OPERATIONAL PLAN 2019/20

Mr Bucktin spoke to this item and advised the Board that two sets of planning guidance had been received this year, the Long Term Plan guidance and also planning guidance for 2019/20. The CCG had two statutory duties to fulfil which were a duty to prepare a plan and to ensure it had taken into account the Joint Health and Wellbeing Strategy which had been agreed by the Health and Wellbeing Board.

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It was noted that the main area addressed within the plan was in relation to primary and community services and how Dudley intended to implement the MCP. The requirements set out in the plan had largely been met or would be fully met by the time the MCP was operational. The one area which required further work was in relation to 24 hour community based urgent care response. A draft had been taken to the Health and Wellbeing Board for them to consider whether the Joint Health and Wellbeing Strategy had been taken into account which they had endorsed. The latest draft was being presented to Board for consideration as it was noted that further work was required on the finalisation of the DGFT contract and to ensure the QIPP plan was described. The plan would be discussed at Finance, Performance and Business Intelligence Committee, to consider the financial implications, which would then be reported back to Board through the Committee report at a future Board. A comment was made with regards to the ambulance triage not being delivered and the fact that a survey had been completed on patients in beds at Russells Hall which identified that 30% die within 12 months of being in a bed when in the end stages of life. Other comments related to the Primary Care Network and Integrated Community Teams, where it states ‘They will led by an appointed GP Integration Lead’, this should be amended to read ‘PCNs will be led’. Also, within the urology section it states ‘We will seek to develop a community urology service however it was noted that there was a uro-gynae service therefore the document should be amended to reflect this. Ms Harkins reflected on the health inequalities and did not feel the plan specified what the NHS would be doing in terms of the delivery of services to deliver better outcomes for people in poverty, in deprived areas or from BME groups. She was encouraged by school readiness and advised that Dudley was the worst in the region for school readiness which is worse than where it should be for the deprivation. Dudley was also worse in comparative authorities and child poverty was a key part and therefore the wider contribution that could be made was felt critical in order to make a sustainable system. It was commented at the end of year assurance meeting with NHSE how refreshing child readiness was and how the approach had not been seen in any other CCG. With regards to next steps, the plan would be published on the CCG’s website and as a result of an audit report that was presented to the Commissioning Development Committee, quarterly reviews would be taking place on what was set out in the plan and the outcome of the reviews would be reported back to Board through the Committee report. A discussion took place with regards to exclusion from school and absenteeism. It was noted that Dudley had a school exclusion rate which was double the national rate with the majority of children having health issues which was contributing to this. It was felt this should be flagged as a key factor to build in for next year. Knife crime had also not been identified within the plan and it was noted that Dudley had significant knife crime within the borough. One of the issues that had been identified was the extent DGFT were reporting knife crime incidents to Public Health England. Diane Wake was now a member on the Health and Wellbeing Board but one of the issues is what the wider contribution is to solve this as a system, which would be picked up through the Health and Wellbeing Board. Mrs Brunt advised that she had met with Mary Sexton, Interim Chief Nurse at DGFT and one of the areas discussed where the Trust were not reporting on, beyond knife crime, was peer-on-peer assault amongst young people and children in playgrounds. A large amount of work was being carried out across the system that recognised issues that feed into child health and wellbeing, such as drug and alcohol misuse and domestic violence. The Safeguarding Board had oversight of this work and would report to Board as a standing item within the Quality and Safety Report whilst going through transition in terms of safeguarding. Resolved: 1) The Board requested alterations were made with regards to Urology and Primary Care Networks, as

discussed 2) The Board noted that further financial analysis would be presented through Finance, Performance and

Business Intelligence Committee, that would feed into the plan, with any financial implications being presented back to Board, if necessary

3) The Board recommended that once the financial analysis had been worked through, that the Plan would be published

4) The Board approved CCG’s Operational Plan for the period 2019/20 on this basis

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CCG050/2019 CONSTITUTIONAL CHANGES Mr Maubach spoke to this item to present a summary of proposed changes to Dudley CCG’s Constitution for approval prior to its submission to NHS England. The Board were advised there was an inaccuracy between the written paper and the proposal being submitted to NHSE. This related to the membership governance structure. The paper stated there would be up to five ‘elected’ GP Locality Representatives however, at the last Board, it was concluded that there would be five ‘appointed’ GP Locality Representatives. The proposal being submitted to NHSE was correct. A discussion had been held at the Members Event about there being a different number of Primary Care Networks (PCNs) to localities. It was recognised that the PCN geography needed to be understood as a starting point. One of the reasons for having fewer GP representatives was about managing the number of lead roles and making space for leadership roles within the PCNs and the MCP. It was noted that the aim was to have up to five GP Locality Representatives but the Board were asked if it would be reasonable to have one representative covering more than one PCN or should there be a locality structure that would be consistent with PCNs. There was a consensus to have up to six as it would provide some flexibility but noting that it could be changed on a monthly basis should there be a need to. With regards to the recruitment process, it was pointed out that an election process was clearer than an appointment process, and that the confidence of the membership and clinical input within the organisation needed to be maintained. It was recognised that the process protected the GP leadership contribution within the system whilst the rest of the capacity would be reduced. The question was asked whether Dudley was putting itself at risk by having a reduced number of clinical leadership roles considering the STP, but it was reported that even with the new arrangement in place Dudley would have at least the same if not more GPs than in the other Black Country CCGs. Going back to the point about the recruitment process, it was reported that there needed to be some detail behind the changes in terms of a HR process if the paper was approved and acknowledged that Dudley LMC was the statutory body who represented primary care and the process would involve the LMC. Discussions had been held at the Remuneration and HR Committee and the outcome from that was that if there had to be a HR process, it would have to be as open as possible and the Committee were given assurance that this would be the case. The Committee had also expressed its concern regarding the amount of work that exists in the CCG currently and in the future and whether there was enough clinical resource to cope with the demand, and the Committee were also assured that there would be. In terms of the number of elected locality representatives, it was pointed out that if the number was left at 10, this would provide flexibility. Recognising the conflicted position for GP elected members, those Board members were excluded from the involvement in taking a decision on the paper, and therefore Dr Hegarty handed the Chair to Mr Wellings. The remaining Board members who would make a decision were the voting Executives and the Non-Executive Directors, who were being asked to approve the paper, noting that the detail would be provided at a later date. It was clarified that the following Composition of the Governing Body which would be submitted to NHSE, and was within Appendix 1 of the paper would be: a) The chair; elected by the voting members of the Governing Body from the GP representatives b) The lay member vice chair (elected by the voting members of the Governing Body from the nominated lay members) c) Up to 10 (including the Chair) appointed GP representatives of member practices d) Up to five appointed Clinical Executives Resolved: 1) The Board members, excluding GP elected members, approved the proposed changes to the

Constitution noting the amendments within Appendix 1, as stated, for submission to NHSE Mr Wellings handed the Chair back to Dr Hegarty.

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CCG051/2019 CORPORATE OBJECTIVES 2019/20

Mr Maubach spoke to this item to present the headline Corporate Objectives for 2019/20 and asked the Board to approve the high level objectives with the exception that they would be used to form the objectives for all staff in the CCG. The objectives had set out additional detail on the areas of priority which the objective was intended to cover. This would assist with the PDR objective setting exercise throughout the CCG within quarter 1. Each corporate objective would be led by a Director and managed through a Committee which would provide a clear line of accountability, risk management and reporting arrangements. It was noted that workforce development did not appear under a separate heading however it was felt that it was an integral part of a number of workstreams. It was suggested therefore that a statement of intent should be included that would apply to all areas of transformation of change. A question was raised with regards to one of the objective deliverables which stated ‘improving collaboration between Dudley and Walsall CCGs’, and why it was only specific to Dudley and Walsall and not the other Black Country CCGs. The response was that staff within the two CCGs were being encouraged to cross cover in a move to the reduction of management costs and would be difficult to do across all four CCGs. It was suggested that under objective 6 ‘Work well with the Local Authority’, deliverable number two should be amended to read ‘the social economic environmental’ as this would cover a broader spectrum. Resolved: 1) The Board approved the high level corporate objectives with the expectation that they would be used

to form the objectives for all staff in the CCG 2) The Board agreed that workforce should be incorporated through a statement of intent 3) The Board agreed to the amendment of the social economic environmental rather than economic

regeneration 4) The Board recommended a paper be presented to the Board in terms of what Dudley’s current position

was with regards to workforce and how it translates for the various aspects with the intention of developing a Dudley wide workforce plan that would link in with the STP workforce plan

CCG052/2019 ITEMS OF URGENT ANY OTHER BUSINESS

Statutory and Mandatory Training Board members were advised that they needed to be compliant with their statutory and mandatory training and there were some members with training that was outstanding. Members were asked to complete their training and submit the evidence via email to sophie.sirrell@nhs.net by no later than 31 March 2019. Board Development Session – 11 April 2019 Board members were invited to send questions on the Bewick Report to tracey.green5@nhs.net by close of play on 29 March 2019 in order to share these with Prof Bewick to consider and address at the Board Development Session on 11 April 2019. Local Authority Decision Making Mr Samuels advised the Board that the Local Authority were in purdah and would not be taking any decisions, unless of a very urgent nature, until after the 16 May 2019, when the Cabinet members would be appointed. Sarah Norman Sarah Norman was leaving her post as Chief Executive at the Local Authority in June 2019 to take a post in Barnsley. The advert was live at the time of Board and Sarah’s successor would be announced at an extraordinary council meeting taking place on 30 April 2019. Resolved: 1) The Board noted the additional items of urgent any other business

DATE AND TIME OF NEXT MEETING

Thursday 9 May 2019 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre

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MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD

Name Title

Signed Date

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

MATTERS OUTSTANDING (EXTRAORDINARY BOARD)

PUBLIC BOARD MEETING – MAY 2019

ITEM NO AGENDA ITEM ACTION TO BE TAKEN ACTION FOR UPDATE COMPLETED

CCG051/2019 (March 2019)

Corporate Objectives 2019/20

A paper to be presented to the May Board in terms of what Dudley’s current workforce position was with the intention of developing a Dudley wide workforce plan that would link in with the STP workforce plan

Mrs E-K Fletcher Deferred to July Board meeting ONGOING

Introduction This report is presented with the aim of keeping Board Members up to date with communications and engagement items and ‘hot topics’. It is also produced with the specific aim of further strenghtening the patient voice at the meetings of our Governing Body, by including sections dedicated to feedback from our Patient Participation Groups, Patient Opportunity Panel (POPs) and Healthwatch. Specific feedback from public involvement activities is used to inform committee decisions and full details of all our involvement can be found in the ‘your voice’ section of our website www.dudleyccg.nhs.uk.

This month Feet on the Street went to explore people’s views on GP Primary Care to inform the developing Black Country Strategy. We wanted to hear people’s views first hand on the relationship they have with their local GP practice, particularly their thoughts and awareness of new access at weekends and evenings and alternatives to seeing a GP such as telephone advice, on- line consultation and visiting a neighboring practice.

Engagement on Learning Disabilities – The Black Country Transforming Care Programme (TCP) is about making sure that more people with Learning Disabilities (LD) are supported to have assessment and treatment in a community setting. It is also about making sure that people only go to hospital because their health needs cannot be met safely in the community at that time, with everybody making sure that hospital care is of high quality and for the shortest time possible.

The Black Country Transforming Care Programme has been working with people with LD, their families and carers to develop plans for a new community model of care that maintains their rights, respect and dignity. By investing more in appropriate, high quality community provision we aim to prevent inappropriate hospital admissions and reduce reliance on unnecessary hospital stays. However, people who require assessment and treatment in an inpatient setting will still have access to beds in the Black Country. The shift in this clinical model to predominantly community based assessment and treatment will provide the right treatment, at the right time, in the right place.

We are currently seeking the views of local people and stakeholders on the new clinical model and the future of assessment and treatment beds. We know that by treating more people with LD in the community we are reducing the need for inpatient beds but we will still need some. Clinicians at the service provider, Black Country Partnership

Public Update

NHS Foundation Trust, have evaluated existing facilities and believe the unit that can best provide a safe and effective service is at Penrose House, in West Bromwich, Sandwell. This site can treat men and women in separate facilities and has access to emergency services 24/7. The proposal which we are seeking views on is therefor for the accommodation at Ridge Hill in Dudley and Orchard Hills/Daisy Bank in Walsall to remain closed and for the service at Penrose House, in Sandwell to become the assessment and treatment center for the Black Country.

There will be a public meeting in Dudley on the 2nd May where commissioners, the service provider and advocacy support services will be explaining the proposals. The feedback we receive, building upon those already gathered, will inform the TCP Board recommendations which will be presented to the CCG Governing Body in July.

Further information can be found on the CCG website. http://www.dudleyccg.nhs.uk/tcp-dudley/

Patient Opportunity Panel (POP) Meeting – The group met in April and received a presentation from Dr Lucy Martin and colleagues on cancer screening. There was discussion around how PPGs could help promote the benefits of cancer screening and work collaboratively with practices. Dudley Borough Healthcare Forum (HCF) – The March HCF focused upon the national Long Term Plan (LTP) and provided an opportunity to meet the transition team involved in developing the MCP. The CCG also explained how Dudley has already taken steps to implement much of the LTP ambition for new care models.

People gave their thoughts on how the MCP should develop in Dudley, what might help reduce the pressure on hospitals and which health inequalities should we address.

The May Healthcare Forum will be dedicated to Dying Matters week and we have many people booked onto the session to see the theatre production of ‘The Birth of Death’.

Back Pain Workshop – in March we held a workshop with local people to understand their experiences of back pain. The workshop was led clinically by Dr Malik and the Commissioning Manager Mark Curran. Around 30 people attended and asked questions and shared their views on proposed changes to pathways.

Black Country Primary Care Strategy Development- Extensive engagement and consultation has taken place over the last few years to really understand patient and public perceptions and expectations around primary care services. This started with a formal consultation into the development of an MCP which demonstrated that access, continuity, co-ordination and communication were all key factors which people felt were most important. In addition there have been many discussions with patients and the public on the NHS Long Term Plan, The Five Year Forward View, The GP Five Year Forward View, extended hours, self-care, primary care hubs, workforce, population health, outcomes and much more. The CCG has regular forums, such as the Patient Opportunity Panel, which are involved in strategic direction which includes reviewing the GP survey.

In addition there have been several consultations over practice changes including branch closures, mergers and practice closures. These have all been highly emotive and contentious and have much public and wider stakeholder interest. This has highlighted that place based care and relationships hold resonance and importance to people. This has all helped us to build a really rich picture and narrative of what is important to Dudley people. We

are building on that as the Black Country and West Birmingham STP produces a Primary Care strategy, this includes a public event on the 23rd May to share the key strategy areas and seek local views.

Dying Matters Week- Dudley CCG is part of Dying Matters Dudley which is group which exists to lift the taboo around talking about death and acts as an information signpost for the Black Country in matters of life and death. We aim to do this through open conversations and community events designed to bring us together in a safe and open environment, in order to best prepare for end-of-life. During Dying Matters week 13th- 18th May we have a number of activities planned including a children’s art competition, death cafes, a theatre production and a camper van touring the borough. Governing Body members are encouraged to come along and take part in the sessions if they can.

Long Term Plan Engagement- we have been working with colleagues across the STP and our partners in Healthwatch to seek views on the Long Term Plan. The views of staff and the public will be used to inform a Black Country and West Birmingham Long Term Plan which needs to be developed by the autumn. There is a more detailed update on this work later in the report provided by Health watch Dudley who are coordinating this on behalf of the other Healthwatch organisations. We look forward to seeing the feedback from local staff and people in full over the next few months.

Online consultations- Following the launch of the ‘Ask NHS’ app, there are currently 2 practices live and 3 testing functionality of the app across the brough with 900 registered users.

Since launching the ‘Ask NHS’ app locally, NHS England have commenced the roll out of national programmes ‘111 Online’ and ‘The NHS App’ which provide the same functionality as our local version developed by Sensely.

Promotion of the the NHS App has already commenced in some areas and is due to increase across the Midlands from May 2019. To avoid any confusion in the messaging we are curently limiting the promtion of Ask NHS to the 5 practices live or testing the application.

Diabetes prevention week- the 1st – 7th April was Diabetes Prevention week and the CCG actively promoted the key messages of this campaign to help people identify the risks of diabetes and make positive lifestyle changes. Along with the nationally provided materials we produced a series of poscase videos with our local Health Coaches to give local people adbvice on healthy eating and excersise. The campaign reached over 40k people via social media.

Annual report production- We are in the production stage of the Annual Report for 2018/19. We invited members of the public to review the draft report and have incorperated feedback into the final draft. A full and summary version will be available for our Annual General Meeting which is to be held on Thursday 4 July 2019.

NHS Parliamentary Health Awards-The NHS Parliamentary Awards were launched by Dr Sarah Wollaston MP, Chair of the Commons Health Select Committee, in Parliament on March 5, 2019. This year we are once again assisting our local MPs to recognise the efforts of NHS staff and to encourage them to noininate individuals and teams for the Parlimentary Awards (closing date 26th April). We have engaged local service providers and provided local MPs with 6 award nominations for Dudley. We are aware that at least one MP has submitted nominations and we will know if any have been sucessful in July when the winners are selected.

Proactive and Reactive Media Activity - The Advertising Equivilant (AVE) has been calculated as £74,055 with an estimated reach of 2,518,418. The CCG has now secured an license with the Newspaper License Agency (NLA) for the next 2 years to receive media clippings and share content with a small number of people. Media Update- Communications and Engagement – Media Monitoring –March to April 2019

Title/web link Summary Release Date

Coverage (with links where available)

Message is to buy local for economy Media Story 03.032019 Express & Star

Integrated care systems - practical steps for primary care

Media Story 01.03.2019

NHS Networks (Web)

Dudley CCG Invites Public to attend Board Meeting

Press Release 04.03.2019

Learning Disabilities Rating by NHSE Media Enquiry 04.03.2019 PULSE - Valeria Fiore

Autism & ADHD Services Dudley Media Enquiry 04.03.2019 HSJ – Rebecca Thomas

MP calls to abolish asthma charges Media Story 07.03.2019 Express & Star

Ask NHS app goes live in Dudley Press Release 11.03.2019

http://www.dudleyccg.nhs.uk/ask-nhs-app-goes-live-in-dudley/

GP Practice staff pay 2018 Media Enquiry 12.03.2019 Pulse - Lea Legraien

Reaction piece: NHS England may scrap 4-hour A&E target

Media Enquiry 12.03.2019 Pulse – Valeria Fiore

Reshaping A&E waiting time: the sector reacts

Coverage of Media Enquiry

12.03.2019 The Commissioning Review (Web)

Children wait months for mental health treatment

Media Story 12.03.2019 Stourbridge, Worcester, Dudley, Halesowen News

Asthma prescription fees call Media Story 16.03.2019 Dudley & Stourbridge Chronicle

PDA TO ROLL OUT CLINIC PHARMACY PILOT IN DUDLEY

Media Story 19.03.2019 The Independent Community Pharmacist

Out of area placements (Mental Health)

Media Enquiry 19.03.2019 HSJ – Rebecca Thomas

Thousands of cataracts patients are missing out on vital surgery because of

NHS rationing

Media Story 20.03.2019 Mail Online

Involvement in primary care research: is your practice one of the 68not benefiting?

Media Story 21.03.2019 BJGP (British Journal of General Practice)

GP workforce schemes celebrated by local NHS

Press Release

STP

01.04.2019

Integrated care systems - practical steps for primary care

Media Story 04.04.2019 NHS Networks (Web)

The Integrator: Does anybody want the ICP contract?

Media Story 05.04.2019 HSJ

Dying Matters Dudley: creating conversations and death-friendly

communities

Media Story 06.04.2019 EHospice (Web)

Getting by with a little help from our friends

Press Release

STP

06.04.2019

Healthwatch Dudley

Update for Dudley CCG Board

April 2019

NHS Long Term Plan engagement #WhatWouldYouDo?

Across the country local Healthwatch are engaging the public in shaping delivery of the NHS Long Term Plan. Activity began in March and will continue until early May, following which a report outlining findings will be produced.

Healthwatch Dudley has taken a coordinating role and will compile a report on behalf of Healthwatch organisations from across the Black Country and West Birmingham STP region.

To ensure consistency of messaging, Healthwatch England has developed a campaign and key messages for each area to adapt locally, called #WhatWouldYouDo.

The campaign aims to raise awareness of changes that are taking place in the NHS and encourages members of the public to share their views with Healthwatch to help shape local plans.

Key themes include:

How can people be supported to live healthier lives?

What can services can do to provide better support - particularly for specific conditions, such as cancer, mental ill health, dementia, heart and lung conditions, learning disabilities and autism?

How can the NHS make it easier for people to have more control of their health and wellbeing?

How can the NHS make it easier for people to access support closer to home and via technology?

Engaging Dudley borough communities

The Healthwatch Dudley team is in the process of delivering a wide variety of engagement and promotional activities, to enable local people to share their views and ideas including.

Town Centre engagement in Dudley, Brierley Hill, Stourbridge, Halesowen, Coseley & Lye.

An information event at Russells Hall Hospital Health Hub.

Focus groups involving people with experiences of learning disability, autism and cancer.

Discussion sessions with health and social care students, young health champions and fibromyalgia and dementia support groups.

A People’s Network event at Brierley Hill Civic Hall.

Press coverage in Dudley, Stourbridge and Halesowen News printed and online editions.

A Black Country Radio interview with Healthwatch Dudley Chief Officer Andrea Crew.

Social media promotion via @HWDudley Twitter account and Healthwatch Dudley website.

In addition to taking part in our focus groups and events, local people are also being encouraged to share their views (until the end of April) via two surveys which can be found at: https://www.healthwatch.co.uk/what-would-you-do

The Dudley CCG and Black Country and West Birmingham STP communications and engagement teams have supported this work.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Black Country Joint Commissioning Committee (BCJCC) Assurance Report

Agenda item No: 6.1

TITLE OF REPORT: Black Country Joint Commissioning Committee (BCJCC) Assurance Report

PURPOSE OF REPORT: This report provides a summary of business considered at the BCJCC meeting held on 14 March 2019

AUTHOR OF REPORT: Mr Alastair McIntyre, Interim STP Portfolio Director

MANAGEMENT LEAD: Mr Paul Maubach, Chief Executive Officer

CLINICAL LEAD: Dr Anand Rischie, Chair – Walsall CCG/Chair Black Country JCC

KEY POINTS: Minutes from the BCJCC meeting held on the 14 March 2019 for

assurance

RECOMMENDATION: 1) To note the ratified minutes from the meeting held on the 14 March 2019

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ANY CONFLICTS OF INTEREST DECLARED: None

ACTION REQUIRED: Decision Approval Assurance

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Black Country and West Birmingham Joint Commissioning Committee (JCC) Minutes of Meeting dated 14th March 2019 Members: Dr Salma Reehana – Chair, Wolverhampton CCG Dr Helen Hibbs – Accountable Officer, Wolverhampton CCG Paul Maubach – Accountable Officer, Dudley CCG & Walsall CCG Dr Anand Rischie – Chair, Walsall CCG Dr David Hegarty – Chair, Dudley CCG Matthew Hartland – Chief Finance and Operating Officer, Dudley CCG; Strategic Chief Finance Officer Walsall and Wolverhampton CCG’s James Green – Chief Finance Officer, Sandwell & West Birmingham CCG Laura Broster – Director of Communications and Public Insight Julie Jasper – Lay Member, Sandwell and West Birmingham CCG Alastair McIntyre – Portfolio Director, Black Country and West Birmingham STP In Attendance: Charlotte Harris – Note Taker, Black Country and West Birmingham STP Jonathan Fellows – Black Country and West Birmingham STP Mike Beak – Sandwell & West Birmingham CCG Peter McKenzie – Wolverhampton CCG Apologies: Andy Williams – Accountable Officer, Sandwell & West Birmingham CCG Prof Nick Harding – Chair, Sandwell & West Birmingham CCG Paula Furnival – Director of Adult Social Care, Walsall MBC Jim Oatridge – Lay Member, Wolverhampton CCG Mike Abel – Lay Member, Walsall CCG Peter Price – Lay Member, Wolverhampton CCG Simon Collings – Assistant Director of Specialised Commissioning, NHS England 1. INTRODUCTION 1.1 Welcome and introductions as above. 1.2 Apologies noted as above. 1.3 There were no declarations of Interest. 1.4 The minutes of the meeting held on the 14th February 2019 were agreed as an accurate record. 1.5 The action log was reviewed and actions confirmed as delivered or others taken within the

agenda. 1.6 Action 130 and 134 were discussed and agreed as closed with a new actions agreed.

Actions: CCGs to meet and discuss the models under consideration in the four places and look at how these build to a sustainable ICS and ensure sustainability when trying to establish acute collaboration. Alastair McIntyre to confirm the workshop with Toby Lewis for Senior Responsible Officers regarding Midland Metropolitan Hospital assumptions and activity flows.

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The Black Country and West Birmingham STP and Birmingham and Solihull STP Board to Board to be arranged regarding the Midland Metropolitan Hospital being financially and clinically sustainable.

1.8 Action 131 was closed. Dr Helen Hibbs and Alastair McIntyre met with the Association of

Black Country Authorities (ABCA) and it had been a positive meeting. Local Authority leaders asked to be kept informed of progress with the ICS with a six monthly update

1.9 Action 133, a draft paper was considered by the STP the Directors of Finance group with a

subsequent paper to be presented to the Health Partnership being held on 18 March 2019. 1.10 Action 135, it was agreed there will be a single paper for the JCC and the Governing Bodies. 1.11 Action 138, it was agreed the CCGs all purchase access to the “Quality Standards” and value

access to these. The CCGs are not in support of the pooling of the commissioned credits. It was agreed to leave the commissioning of credits to the individual CCGs for the 2019/20 cycle.

1.12 Action 139, noted as work in progress.

2. CCG TRANSITION BOARD 2.1 The Transition Director has been appointed to Deborah Rossi, who is starting on 20 March

2019. There will be an induction programme. The Transition Board are next meeting after the JCC.

3. CLINICAL LEADERSHIP GROUP UPDATE 3.1 There was no update given this month. The next meeting is being held on 21 March 2019. 4. UPDATE FROM STP 4.1 The group received an update on progress with the STP.

A discussion was held around the options appraisal currently being held by Sandwell and West

Birmingham CCG around their boundaries and the potential effect this might have in future on STP boundaries.

5. FORMALLY DELEGATED AREAS 5.1 Transforming Care Partnership 5.1.1 Dr Helen Hibbs updated the group on the Transformation Care Partnership (TCP). There had

been an escalation call with the national team. The national team recognised the actions that are in place and work is being done regarding increasing the planning around discharges is good. However the number of admissions remains high and there has been disappointing slippage of the numbers of patients being discharged in quarter 4. The programme will be continuing for another two years. There is a big challenge across the TCP and individual CCGs in meeting trajectories for 2019/20.

5.2 Mental Health 5.2.1 Dr Helen Hibbs presented on the update from the One Commissioner Programme. There

continues to be a big focus on improving Mental Health services. Regulators are challenging the system to bring programmes together for greater assurance. The Mental Health

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Investment standard is under scrutiny and will be reviewed at the Health Partnership on 18 March 2019.

5.3 CHC Care Home Procurement – Highly Complex Care – Proposal 5.3.1 This item was deferred until May. 5.4 Other Areas for Formal Delegation – Future Pipeline Discussion 5.4.1 The Accountable Officers were asked to consider areas to be brought forward for delegation

to the JCC. Specialised Commissioning to be invited to attend the JCC or Clinical Leadership Group (CLG) for discussion on specialised services

Actions:

Prof Nick Harding to discuss at the Clinical Leadership Group the delegation of Specialised Commissioning to the Joint Commissioning Committee. Accountable Officers to consider any other areas that they think could be formally delegated to the JCC and bring it to the board as a suggestion for further discussion.

6. RISK REGISTER 6.1 It was agreed there would be attendance from one of the governance leads at the JCC moving

forward. 7. MATTERS OF COMMON INTEREST 7.1 Place Based Update – Wolverhampton 7.1.1 Dr Helen Hibbs gave an update on the Wolverhampton Integrated Care Alliance. 7.2 Performance and Assurance Return 7.2.1 The performance and transformation report was noted. There are currently 88 transformation

assurance statements for 2019/20. There will need to be a sign off process for Senior Responsible Officers from April.

7.3 Primary Care Development Agenda 7.3.1 This item was deferred until July. 7.4 SCC Planning Commissioner Update 7.4.1 Mike Beak gave a presentation on the Strategic Capacity Cell (SCC) in WMAS that went live

on 27 February 2019. Action: Simon Brake to attend the JCC to give an update on the Strategic Capacity Cell. 8. FEEDBACK FROM GOVERNING BODIES 8.1 No comments were raised. 9. ITEMS FOR INFORMATION 9.1 No comments were raised.

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10. ANY OTHER BUSINESS 10.1 Dr David Hegarty informed there is a current process in Dudley CCG to identify the non-

executive representative to attend the JCC and Transition Board. 10.2 Alastair McIntyre noted that a Planned Care Workstream Lead was yet to be recruited and

asked Accountable Officers to consider a nomination before the Health Partners board on 18 March 2019.

11. DATE OF NEXT MEETING

Thursday 14 April, PD017, Wolverhampton Science Park, Glaisher Drive, Wolverhampton, WV10 9RU

JCC Action Log

No. Date Action Lead Deadline Status Update 133 10th

Jan 2019

A presentation of overall financial commitments for the JCC and STP to be delivered.

James Green

140 14th Mar 2019

CCGs to meet and discuss the models under consideration in the four places and look at how these build to a sustainable ICS and ensure sustainability when trying to establish acute collaboration.

Alastair McIntyre

Matthew Hartland

31st May

2019

141 14th Mar 2019

Alastair McIntyre to confirm the workshop with Toby Lewis for Senior Responsible Officers regarding Midland Metropolitan Hospital assumptions and activity flows.

Alastair McIntyre

31st May

2019

22/03/2019 – Availability has been requested

142 14th Mar 2019

The Black Country and West Birmingham STP and Birmingham and Solihull STP Board to Board to be arranged regarding the Midland Metropolitan Hospital being financially and clinically sustainable.

Dr Helen Hibbs

Jonathan Fellows

31st May

2019

143 14th Mar 2019

Prof Nick Harding to discuss at the Clinical Leadership Group the delegation of Specialised Commissioning to the Joint Commissioning Committee.

Prof Nick Harding

9th May 2019

144 14th Mar 2019

Accountable Officers to consider any other areas that they think could be formally delegated to the JCC and bring it to the board as a suggestion for further discussion.

Andy Williams Dr Helen

Hibbs Paul

Maubach

9th May 2019

02/04/2019 – In light of the wider work underway looking at transformation, this is not the right time to increase the scope of delegation

145 14th Mar 2019

Simon Brake to attend to give an update on the Strategic Capacity Cell.

Paul Maubach

9th May 2019

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Quality & Safety Committee Report

Agenda item No: 7.1

TITLE OF REPORT: Quality & Safety Committee Report

PURPOSE OF REPORT: To advise the Board of key Quality and Safety issues discussed at the Quality & Safety Committee 26 March 2019 and in other associated meetings

AUTHOR OF REPORT: Mrs Sue Nicholls, Deputy Chief Nurse

MANAGEMENT LEAD: Mrs Caroline Brunt, Chief Nurse

CLINICAL LEAD: Dr Ruth Edwards, Clinical Executive Lead for Quality KEY POINTS: Overview of:

Dudley Group NHS Foundation Trust (DGFT) Emergency Department System Oversight and Assurance Group DGFT Mortality Data Cancer waits Serious Incidents (SIs) management and Root Cause Analyses (RCAs) Dudley Walsall Mental HealthTrust (D&WMHT) Challenges with IAPT – 6 weeks RTT

Black Country Partnership Foundation Trust (BCPFT) CQC inspection rated Requires Improvement Action plan received at CQRM (March 2019)

Malling Health

Transforming Care Programme Safeguarding Safeguarding Capacity Review

Nursing and Care Homes Dudley CCG Primary Care Infection Prevention & Control (IPC) Risk Register

RECOMMENDATION: To accept this report recognising the limited assurance that is currently available regarding DGFT and that the CCG Quality & Safety Committee and associated work-streams continue to maintain oversight of all clinical quality standards in line with the CCG’s statutory duties

FINANCIAL IMPLICATIONS: None to report

WHAT ENGAGEMENT HAS TAKEN PLACE:

User experience is an essential component of quality assurance and surveillance and as such public views and feedback form part of the triangulation of hard and soft intelligence

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

None to report

ACTION REQUIRED: Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 QUALITY & SAFETY COMMITTEE REPORT 1.0 INTRODUCTION

The report summarises the key issues discussed by the Quality & Safety Committee at the meeting on

26 March 2019. The report details activity being carried out by the Quality and Safety team alongside relevant information acquired since the last committee meeting.

2.0 DUDLEY GROUP NHS FOUNDATION TRUST (DGFT)

The Quality & Safety Committee reviewed the CCGs developing quality dashboard for DGFT and the following areas were discussed; Emergency Department activity, performance and quality and safety concerns; including internal

escalation processes and flow throughout the hospital at times of peak demand and pressure Serious Incident (SI) investigations and quality of Root Cause Analysis Cancer waits Healthcare Acquired Infections

2.1 Emergency Department Background: As previously reported to Board, there have been further inspections of the ED department by the Care Quality Commission (CQC) on 13, 15, 29, and 30 January 2019. In addition the CQC undertook a Well Led assessment during 13-15 Feb 2019. The report(s) are awaited. The Oversight and Assurance meeting met in March 2019 with all relevant stakeholders represented; NHSI; NHSE; CQC and the CCG. Progress against the Trusts ED improvement plan was reviewed. The next Oversight and Assurance meeting is scheduled for 9th May 2019. It is expected that there will be a full discussion in relation to the inspections referenced above.

CCG actions and assurance: Ongoing detailed monitoring of ED performance and associated quality indicators including daily

operational calls and weekly monitoring of CQC Section 31 compliance information Discussion of ED improvement plans at CQRM and system wide Oversight and Assurance meetings

2.2 DGFT Mortality data

Committee were briefed by the Business Intelligence team regarding the range of mortality indicators and acknowledged the need to triangulate between each of them in order to gain meaningful insight into mortality rates within DGFT. To note, although the published national SHMI data remains above the national average, the latest monthly data shows a downward trend. SHMI data will be updated during April 2019. CCG actions and assurance: Ongoing CCG activities are embedded to include: Business Intelligence team monthly review of local and national mortality data Reviewing the Learning from Deaths reports provided by DGFT at the mortality meetings and CQRMs The CCG Clinical Lead for Quality and Safety attends the joint mortality review group.

2.3 Cancer Waits

Remedial action plans (RAP) remain in place for 62 day waits and tertiary referrals.

CCG actions and assurance: The RCA’s for patients that have breached the 104 day target were reviewed at the Cancer LIT

meeting and it was confirmed that patients have not been harmed as a result. RAPs remain in place and are being closely monitored by the contract team and via the CQRM.

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2.4 Serious Incident (SI) management and Root Cause Analyses (RCAs):

Following the significant work focussing on the management and quality of RCAs DGFT have achieved the KPIs during February and March 2019. The KPIs have been incorporated into the 2019/2020 contract with DGFT to ensure that focus remains. The quality of RCA reports have improved and as a result the CCG is able to close a greater number of RCAs upon first submission.

CCG actions and assurance:

The CCG Quality and Safety team continue to embed the changes to stream line internal processes and support the Trust in maintaining their improving position.

KPIs will be monitored via CQRM

3.0 DUDLEY & WALSALL MENTAL HEALTH TRUST (D&WMHT) It has been noted that the Trust has been challenged in meeting the Improving Access to Psychological

Therapies programme (IAPT) in 2 KPI areas; Referral to treatment within 6 weeks – the Trust has reported a quarter 3 actual (Oct, Nov, Dec 18)

of 54% against a national requirement of >75%. In comparison, quarter 2 (July, Aug, Sept 2018) reported 87.3%.

The delivery of this was discussed in detail and it was acknowledged that this is included within the Trusts risk register. This will continue to be monitored via CQRM.

CCG actions and assurance:

Assurance is now gained through a joint CQRM process with Walsall CCG. To review and monitor IAPT service delivery via CQRM

4.0 BLACK COUNTRY PARTNERSHIP NHS FOUNDATION TRUST (BCPFT)

As previously reported to Board, BCPFT were inspected by CQC during October 2018. The final report was published in January 2019 and rated the Trust as Requiring Improvement. Areas highlighted by the CQC included challenges to recruitment process, including processes for recruiting executive positions. The CQC also highlighted that governance systems from ward to board were not sufficiently strong. The CQC noted a lack of consistent challenge at the executive level before RCA reports were signed off. An action plan has been received at CQRM (1 March 2019) which indicates that a number of actions have been completed. The Trust has a fortnightly CQC oversight meeting with senior executive leadership. In addition to Dudley CCGs local arrangements with BCPFT which has a specific focus on children’s services there is a combined CQRM across the Black Country system. Wolverhampton CCG are now chairing this meeting and are leading a review of the meetings and processes to further strengthen the governance and assurance arrangements. CCG actions and assurance To receive and monitor the action plan through CQRM. To agree an assurance programme aligned to the CQC report and resulting action plan

5.0 MALLING HEALTH

Malling Health were inspected by the CQC 20/21 March 2019. The draft report is awaited however no enforcement action is expected. It has been identified that there are a low number of safeguarding referrals being made and that Malling Health no longer attending the CCGs Safeguarding Quality Review Meeting (SQRM). CCG actions and assurance The safeguarding team will undertake a review of Malling Health The CQCRM will receive and monitor the CQC report and action plan in due course.

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6.0 TRANSFORMING CARE PROGRAMME (TCP) UPDATE

The trajectory for the Black Country TCP continues to prove challenging. The Dudley CCG currently has 11 adult patients but no children or young people within the programme. There has been 2 recent admissions. An RCA is undertaken for each individual admission to consider whether the admission was preventable and whether lessons can be learnt. Dudley CCG is no longer subject to weekly escalation calls with NHSE however significant focus remains on the programme which has been extended for a further 2 years. The effective use of the dynamic risk register will form an essential tool to prevent admissions in the future for children, young people and adults. Work continues to populate the register with partner agencies. CCG actions and assurance: Escalation to Dudley Local Authority has taken place to ensure the programme remains high priority

and that sufficient resources are in place. There is evidence that additional social work resource has been put in place to support recommendations following multi-disciplinary team meetings

The CCG are actively involved in the weekly monitoring of TCP patient level data and participation in the TCP programme.

The CCG has enlisted the support of clinical experts to support discharge The CCG is increasing capacity through the appointment of a case-worker.

7.0 Safeguarding

In February 2019, the National Network of Designated Healthcare Professionals (NNDHP) wrote to all CCG Accountable Officers regarding the current designated professional’s capacity. Designated Safeguarding Nurses and Doctors are statutory roles as indicated in the Intercollegiate Document. The letter provided Accountable Officers with information to influence the effective implementation of recent legislation. New local child safeguarding arrangements give Accountable Officers and/or Chief Nurses new responsibilities. Dudley CCG have been actively involved in developing the local Multi Agency Safeguarding Arrangements and are preparing to publish the plan. Recently published statutory guidance specifies the ways in which designated professionals should be deployed. Amongst other things, it stipulates that: 1. They should “Be a member / or advisor of the Local Safeguarding Partnership (LSP)…” 2. They should “Serve, as appropriate, on the sub-committees of the LSP…” 3. “… designated professionals should also have regular, direct access to the CCG Accountable Officer

or Chief Nurse to provide expert advice and support for child safeguarding matters, and they should also be invited to all key safeguarding partnership meetings.”

4. Designated professionals for safeguarding children “…are dedicated posts and should not be combined with responsibilities for adult safeguarding or looked after children”.

Accountable Officers were asked to confirm that are compliant with the Intercollegiate Document with regard to designated professional capacity. The safeguarding team are reviewing the service in line with the aforementioned documents and statutory guidance. A response has been sent.

8.0 Nursing and Care Home update A number of homes were of concern to the CCG and the committee were briefed on the actions taken which include Medicines Management training, further review of Infection Prevention, joint visits with the local authority and where required a quality risk summit meeting with the home manager/owner to review the action plans in place. It has been identified that there are a number of homes which have not been inspected by the CQC since 2016 as the CQC prioritise homes that have had concerns raised against them. The CCG seeks to triangulate intelligence with the local authority and other partners to ensure the quality of services provided. CCG actions and assurance: Regular reporting of the CHC audits via Q&S Committee.

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Review and expansion of routine monitoring (including working jointly with the Local Authority) where appropriate alongside responsive inspections

Review and develop a quality monitoring framework for nursing and care homes 9.0 PRIMARY CARE

An update of CQC Primary Care inspections is provided in Appendix 1. There has been 3 further published reports. AW Surgeries (inspected in Jan 2019) have been rated as good overall. All domains were rated good

with the exception of responsive which was rated as requires improvement. The report was published 6 March 2019

Steppingstones Medical Practice (inspected in Feb 2019) have been rated as good overall. All domains were rated good with the exception of Well led which was rated as requires improvement. The report was published 12 April 2019

The Greens Health Centre have been rated as requires improvement overall. 2 domains were rated as good – caring and responsive. The report was published 16 April 2019.

There remains one Primary Care SI open, currently managed by NHSE as it relates to a cold chain incident. The CCG has liaised with NHSE in regards to progress.

CCG actions and assurance: The Quality and Safety team continue to work closely with primary care and public health colleagues

in relation to patient safety issues. The Q&S team are working closely with their Walsall CCG colleagues to develop the systems and

processes needed to establish the new governance structure.

10.0 INFECTION PREVENTION & CONTROL C.difficile

DGFT – a linear trajectory indicates that DGFT will end the year with 25 cases against an objective of <28 DCCG - the linear trajectory suggest that Dudley CCG will end with 86 C.Diff cases, breaching the target of 75 E.Coli A linear trajectory suggests that Dudley CCG will end the year with 236 breaching the target of 205 Primary care The Primary Care IPC audit schedule has been developed for 19/20. Immunisations Falling vaccination uptake rates continue to be a concern, particularly with regards to childhood immunisations. A Multi-agency Immunisation Group has been established by the CCG. This group works with all stakeholders in Dudley as well as NHSE/PHE to help identify and address any issues; a local improvement plan is currently being developed.

CCG actions and assurance: Bi-monthly HCAI partnership meetings take place with all main providers. Multiagency Immunisation group established by the CCG

11.0 RISK REGISTER

The risk register has been updated, with no new risks added.

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12.0 RECOMMENDATIONS The Board is asked to accept this report and the associated actions and assurance as a summary of the Quality and Safety Committee discussions providing oversight of clinical quality standards in line with the CCG’s statutory duties.

Sue Nicholls Deputy Chief Nurse 25 April 2019 Attachments: Appendix 1 – PCAT Tool CQC Rating

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Audit & Governance Committee Report

Agenda item No: 8.1

TITLE OF REPORT: Audit & Governance Committee Report

PURPOSE OF REPORT: To advise the Board of the key issues discussed and agreed at the Audit & Governance Committee meeting on 21 March 2019

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr R Tapparo, Clinical Executive Finance, Performance & Business Intelligence

KEY POINTS:

Items received for assurance or approved under delegated authority at meeting held on 21 March 2019: BAF & RR – Update presented under separate agenda item; no new

risks opened or closed. FOI – Freedom of Information (FOI) quarterly report received for

assurance. Annual Report and Accounts 18/19 update – Update regarding

submissions and next steps for assurance External Audit – External Audit Plan and Audit Risk Assessment

received for assurance. Internal Audit – Progress Report; Recommendation Tracking Report;

and Key Development Briefing received for assurance. Information Governance – Update in relation to the Toolkit

submission for assurance.

A number of other updates were received for information and assurance and these are detailed in the report.

RECOMMENDATION: 1) The Board is asked to receive this report for assurance and to note the decisions taken under delegated authority

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: Not applicable

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 AUDIT & GOVERNANCE COMMITTEE REPORT 1.0 INTRODUCTION

The report summarises the key issues discussed at the Audit & Governance Committee meeting on 21 March 2019.

2.0 KEY INDICATOR SUMMARY The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined in the CCG’s Constitution and the Committee’s Terms of Reference. Indicator Position RAG 1. Regulation and Control Good progress

CCG Governance Arrangements – Constitution Current proposed changes have been submitted to NHSE and comments have been received back. Further changes to be submitted in relation to boundary change.

Scheme of Delegation Revised Operational Scheme of Delegation approved 18 October 2018. Relevant updates to Constitution approved by NHSE 22 June 2018.

Compliance with Prime Financial Policies No issues Board & Committee Effectiveness Continued progress against

Governance Improvement Plan.

2. Annual Report and Accounts (ARA) 2018/19 First draft submitted to NHSE 17/04/2019 and no changes have been proposed

3. Operational & Risk Management Good Progress Anti-Fraud and Security Anti-Fraud and Local Security

Management Specialist Work-plans 2018/19 approved. Progress reports being received.

Risk Management Arrangements – Combined BAF & Risk Register in place; Chairs/Management Leads of committees attending & updating Audit & Governance Committee;

BAF & Risk Register updated monthly and actively managed. BAF & Risk Register critically reviewed and updated at Committee level.

Report newly commissioned services Procurement Strategy & reporting updated to reflect new managing conflicts of interest guidance.

External Audit Plan for year ended 31 March 2019 issued.

Internal Audit Audit Plan 2018/19 approved March 2018. Audits progressing.

Other Policies Polices reviewed and updated routinely.

Other Policies – Business Continuity Policy Service procured from Arden & GEM CSU to support the Business Continuity Management Process.

4. Information Governance CSU IG staff on-site regularly progressing IG Work-plan and supporting CCG officers.

Information Governance Group established IG Steering Group meetings scheduled throughout 2019/20

Compliance with Information Governance toolkit Toolkit 2018/2019 submitted with Standards Not Met – Action Plan.

Information Asset Management structure to be established with IAOs and IAAs identified from CCG staff

IG working with IAOs & IAAs to take forward information asset register update.

IG Policy Revised Policies approved Oct 2018. Freedom of Information requests (FOIs) All responded to within required

timescale

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3.0 ITEMS DISCUSSED 3.1 Board Assurance Framework & Risk Register

The Committee received the Board Assurance Framework & Risk Register as at 8 March 2019 for assurance. It noted no changes to the register in relation to scores and descriptions. Now that the corporate objectives have been agreed, the risks will be re-assed in line with the objectives.

3.2 Freedom of Information (FOI)

The Committee received the FOI quarterly activity report for the period 1 January to 11 March 2019 for assurance. The CCG had received 38 requests; there were zero breaches; all FOIs were acknowledged and responded to within 20 days, and the average number of days taken to respond was 9.2 days.

3.3 Annual Report and Accounts Production 2018/19 Update The Committee received an update on the Annual Report & Accounts for 2018/19 for information and assurance. The Board is asked to note that the first draft of the Annual Report and Accounts was submitted to NHS England for review on the 17 April 2019 and we are pleased to confirm that feedback has been that no amendments are required. The final version of the Annual Report is due to be submitted to NHSE on the 29 May 2019.

3.4 External Audit The Committee received the External Audit Progress Report for information and assurance and highlighted no issues or weaknesses. In respect of the value for money audit, the auditors had concluded there were no significant risks.

3.5 Internal Audit The Committee received updates on the recommendation tracking report for assurance. It also received the following internal Audit reports for assurance:

Financial Management and QIPP – Full/Significant Assurance Conflicts of Interest Management – Significant Assurance Financial Reporting and Performance Management – Significant Assurance

The Committee were also informed that the draft reports on IG and GDPR, and Partnership Working had just been published and would be presented to the next meeting. The Board can be assured that the IG and GDPR report was given significant assurance and the Partnership Working was given full assurance. The Committee received the Draft Annual Report and Head of Internal Audit Opinion for 2018/19 for assurance on the effectiveness of the system of internal control for the year ended 31 March 2019. This gave an overall opinion of significant assurance, noting that no significant internal control issues (as defined by HM Treasury) were required to be reported in the CCG’s Annual Governance Statement. The Committee received and approved the 3-year Internal Audit Strategy 2019-22 and it was noted that additional days may be required in years two and three because of the changing landscape in Dudley. This would be assessed annually. The Committee received and approved the Internal Audit Plan for 2019/20 and also received the Internal Audit Charter for information. The Committee received the NHS Key Developments Briefing Updates for January and February 2019 for information.

3.6 Information Governance

The recent focus of the IG Compliance Officer has mainly been on the work around the Data Security Protection Toolkit (DSPT). The Committee were informed that as at 14 March 2019, 54 out of 70

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mandatory evidence items had been provided. The majority of the evidence items were outstanding were from the CCG’s IT provider and the Committee noted that Mr Hartland had written to DGFT’s Chief Executive requesting a response by 29 March 2019 so that the remaining evidence could be uploaded. The Board should note that sufficient evidence was not received in time for the submission and the CCG had to submit a toolkit marked “Standards not Met” – Action Plan. This means that we have until the end of June 2019 to submit the remaining evidence so that our toolkit status can be changed to “Satisfactory” as expected. Evidence from the provider has now been received and is being reviewed in advance of the submission.

3.7 Other Issues The Audit & Governance Committee considered and received updates and assurance in respect of:

Counter-Fraud Progress report 2018/19 Counter-Fraud Awareness Staff Survey Results 2018/19 Monitoring Compliance with Prime Financial Policies Security Management Progress Report Data Quality Policy Annual Declarations of Interest – Board Members Register

3.8 DECISIONS TAKEN UNDER DELEGATED POWERS

Separate report to Board on BAF & Risk Register 4.0 DECISIONS REFERRED TO THE BOARD

None

5.0 RECOMMENDATIONS The Board is asked to:

1) Receive this report for assurance 2) Note the decisions taken under delegated authority

Mr M Hartland Chief Operating and Finance Officer April 2019

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Statement of Disclosure to Auditors

Agenda item No: 8.2

TITLE OF REPORT: Statement of Disclosure to Auditors

PURPOSE OF REPORT: To seek assurances from the Board to support the approval of the Annual Report & Accounts 2018/19

AUTHOR OF REPORT: Mr M Hartland, Chief Operating & Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating & Finance Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

Annual Report & Accounts 2018/19 approval process outlined

Assurances sort from the Board to allow the Audit & Governance Committee to approve the audited Annual Report & Accounts on Wednesday, 29 May 2019

RECOMMENDATION:

To recognise that authority to approve the Annual Report & Accounts is already delegated to the Audit & Governance Committee in the CCG’s Constitution

Confirm that so far as the members are aware, there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware

Confirm that the members have taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 STATEMENT OF DISCLOSURE TO AUDITORS 1.0 INTRODUCTION

1.1 The draft Annual Report & Accounts for 2018/19 were prepared and submitted to NHS England before

the national deadline of midday 18 April 2019 and are currently being audited by the CCG’s external auditors.

1.2 The Audit & Governance Committee meeting on 22 May 2019 will receive the auditor’s report and other supporting items in order for it to approve the final Annual Report & Accounts under its authority delegated by the CCG Board.

1.3 The approved Annual Report & Accounts will be submitted to NHS England on or before the national deadline of noon Wednesday, 29 May and will be formally presented at the CCG’s Annual General Meeting on Thursday 4 July 2019.

1.4 For the Audit & Governance Committee to fulfil its responsibilities, it requires a number of assurances from the Board as detailed in the next section.

2.0 ANNUAL REPORT & ACCOUNTS APPROVAL-ASSURANCES 2.1 In order that the Audit & Governance Committee can approve the audited Annual Report & Accounts

on 22 May, the Board is requested to provide the following assurances: 1. To formally confirm and minute that authority to approve the Annual Report & Accounts is already

delegated to the Audit Committee in the CCG’s Constitution (Appendix D, Scheme of Delegation). 2. The Members Report section of the Corporate Governance Report within the Annual Report

includes the following statement: Statement of Disclosure to Auditors “At the time this Annual Report was approved, each Governing Body member declared the following: • so far as they were aware, there was no relevant audit information of which the CCG’s auditor was unaware that would be relevant for the purposes of their audit report, and • they had taken all the steps that they ought to have taken as a member in order to make

themselves aware of any relevant audit information and to establish that the CCG’s auditor was aware of that information.”

Each member of the CCG Board (Governing Body) is requested to confirm that this statement is accurate and applies to them. In addition, should a member of the Board become aware of any relevant matters up until the signing off of the Annual Report & Accounts on 22 May, they should make the CCG’s auditors aware of this.

3.0 RATIONALE 3.1 The reasons for such a statement in the accounts/annual report are various, but include:

It is the role of external auditors to audit the accounts presented to them With a budget of £516 million, no-one in the organisation, including the Chief Operating & Finance

Officer, will know every transaction that has occurred during the year that has contributed to the overall values included in the accounts in arriving at the year-end values

The auditors will therefore review the financial system, and many working papers provided to

them for general and particular items (where requested) and test the financial transactions and assumptions made in the presentation of the figures. The auditors have the ability and authority to review every detail of the accounts and have free will to question the finance team on everything in the accounts.

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Ultimately, responsibility for the accuracy of the accounts sits with the Chief Operating & Finance

Officer as this is a statutory duty of that role. In addition, Paul Maubach has responsibility as Accountable Officer.

In addition, this is a way auditors protect themselves against any liability relating to the accounts.

3.2 However, as Board members in an NHS organisation (as in a private company), all Board members

also have a responsibility in relation to the accounts. This relates mainly to the confidence and assurance that you have regarding the financial management and associated systems/assurance processes of the CCG.

3.3 In deciding whether you have such assurance, you could ask yourself the following questions:

Do you believe the Finance Department fulfil their duty in producing robust finance statements? Do you believe the Chief Operating & Finance Officer and Chief Accountable Officer fulfil their

duties in terms of managing the finances of the CCG? Do you believe the Clinical Executive for Finance, Performance & Business Intelligence fulfils

their duty in terms of managing the finances of the CCG? Do you believe the Finance, Performance & Business Intelligence Committee adequately

challenges and manages the finances of the CCG? Do you believe the Audit & Governance Committee (including all lay members) holds the Chief

Operating & Finance Officer to account for financial issues within the CCG and ensures that all relevant systems and processes are adequate and robust?

Do you believe as a Board member you receive adequate assurance from the Finance, Performance & Business Intelligence Committee and Audit & Governance Committee regarding the management of finance in the CCG?

3.4 Other items of assurance you could take are:

We have received full assurance regarding our financial management and significant assurance regarding our financial systems and QIPP from our internal auditors

We have received assurance from NHS England that the CCG has excellent financial management

Audit & Governance Committee (including External and Internal Audit) have approved our Annual Governance Statement

We have a counter fraud officer that supports the CCG 3.5 The reason for the statement in the Members statement discussed at Board is for the External Auditors

to assure themselves and question, once taking all of the above into account – i.e. accurate set of accounts, full assurance from internal audit in terms of processes, no material issues found – is there anything that Board members are aware of that should change External Audit’s opinion of approving the accounts?

4.0 RECOMMENDATIONS 4.1 The Board is asked to:

To recognise that authority to approve the Annual Report & Accounts is already delegated to the Audit & Governance Committee in the CCG’s Constitution

Confirm that so far as the members are aware, there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware

Confirm that the members have taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information

M Hartland Chief Operating & Finance Officer - May 2019

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Combined Board Assurance Framework and Risk Register

Agenda item No: 8.3

TITLE OF REPORT: Combined Board Assurance Framework and Risk Register

PURPOSE OF REPORT: To update the Board on the combined Board Assurance Framework (BAF) and Risk Register and present it as at 10 April 2019

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

Update on the combined BAF & Risk Register as at the 10 April 2019: Whilst there have not been any changes proposed by Committees to

the risks for last month, the Board is still required to consider Risks 13, 112, 150, 151, 152 and 156 as a standing item

RECOMMENDATION: 1) The Board is asked to receive the report for assurance and approve

any recommendations made by the Audit & Governance Committee 2) The Board is asked to consider whether any updates to risks 13,

112, 150, 151, 152 and 156 are required

FINANCIAL IMPLICATIONS: None direct. Potential consequence if risks materialise

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) AND RISK REGISTER 1.0 INTRODUCTION

In accordance with the CCG’s Risk Management Strategy, an extract of the combined BAF and Risk Register for those risks scored 16 and over (which comprise the Board Assurance Framework) plus any risks less than 16 assigned to the Board is presented to the CCG Board. This is based on the position as at 10 April 2019.

2.0 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) & RISK REGISTER Those risks with an initial or residual score (after actions having been taken and controls implemented) of 16 or higher and any others assigned directly to the Board are presented in detail at Appendix 1. These risks are also summarised in the table below:

Risks 16 or higher (plus risks assigned to Governing Body) as at the 10 April 2019

Initial Risk

Residual Risk

Accountable Committee

10. There is a risk that the health and social care economy will fail to engage and work together to implement required service changes

16 12 Commissioning Development

13. Failure of the governing body to demonstrate appropriate leadership/ clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities.

12 8 Governing Body

36. There is a risk that key performance indicator will not be met resulting in the loss of the Quality Premium.

16 12 Commissioning Development

77. There is a risk of failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented.

16 9 Commissioning Development

84. There is a risk that failure to control costs and deliver significant QIPP savings will put the future sustainability of the CCG at risk.

16 12

Finance, Performance & Business Intelligence

98. Future shape of the CCG and consequential impact on staff and delivery. 16 12 Remuneration &

HR

104. There is a risk that there will be a lack of suitable bidders to enter into a contract for the MCP 16 4

Commissioning Development

112. There is a risk that Governance arrangements between organisations (that are party to the STP) are either insufficient or inconsistent. This may lead to inadequate governance and insufficient transparency which could create unintended financial risk, inconsistent decision making or misalignment of strategic direction and implementation.

16 16 Governing Body

116. There is potential to destabilise the health system both clinically and financially as a result of MCP implementation

16 12 Commissioning Development

129. Lack of effective management of waiting list within the ophthalmology department which results in poor patient outcome. Lack of follow up appointment due to process failure.

16 8 Quality & Safety

136. There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce

16 12 Primary Care Commissioning

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Risks 16 or higher (plus risks assigned to Governing Body) as at the 10 April 2019

Initial Risk

Residual Risk

Accountable Committee

148. There is a risk that the financial pressure on local providers will put pressure on the CCG in delivering its financial & performance targets.

20 12

Finance, Performance &

Business Intelligence

150. There is a risk that change of leadership in local system organisations will impact on system delivery, particularly in relation to loss of local knowledge

8 8 Governing Body

151. There is a risk that the CCG fails to meet its statutory duties in respect of the delivery of high quality care to the population of Dudley.

15 12 Governing Body

152. There is a risk that the pace of change in the transformation of the system will not be aligned to the views of the public. This may result in the CCG moving too quickly to allow time for adequate involvement or not moving quickly enough to meet public expectations.

12 8 Governing Body

153. There is a risk that there are failures of clinical care in the DGFT emergency department (ED) and this will impact on the quality and safety of patient care.

Specific issues highlighted by the CQC from

December 2017 include: failure to manage the deteriorating patient and sepsis pathways; paediatric care including safeguarding appropriately; timely and appropriate triage and assessment.

25 25 Quality& Safety Committee

156. There is a risk that Dudley CCG could be exposed to financial and reputational risk if it fails to comply with the requirements of the General Data Protection Regulation. The CCG could receive potential fines of up to €17m or 4% of annual turnover for failure to comply, or face other enforcement action from the ICO including warnings, enforcement notices, undertakings or audits.

12 4 Governing Body

157. There is a financial risk that the CCG is unable deliver a 20% reduction in CCG administration costs by 2020/21 in line with those made by NHS England and NHS Improvement through the joint working initiative that key business delivery and the future sustainability of the CCG may be adversely affected.

16 12

Finance, Performance &

Business Intelligence

3.0 RECENT AMENDMENTS TO THE BAF AND RISK REGISTER

The following amendments to risks 16 and over have been made since the Board received the BAF and Risk Register as at 8 February 2019 at its meeting of the 14 March 2019. Review & Updates – Updates were received from the leads for the Primary Care Commissioning Committee; Quality & Safety Committee; Commissioning Development Committee; Finance, Performance & Business Intelligence Committee and Remuneration & HR Committee. The Board is requested to review Risks 13, 112, 150, 151, 152 and 156 for which it is directly responsible and update as appropriate.

3.1 Risk Description, related controls, assurances, actions and comments None

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3.2 Changes to the Residual Risk Scores Risk 156: The Audit & Governance Committee reviewed this risk at its last meeting on the 14 March and was sufficiently assured that the GDPR action plan was progressing and were fully assured. It was proposed that the residual risk score be decreased to 4 from 8 (1x4). The Audit and Governance Committee recommends that the Board decrease the residual risk score.

3.3 New Risks

None

3.4 Risks Proposed for Closure (Requiring Board approval) No risks are proposed for closure

4.0 RECOMMENDATIONS

1) The Board is asked to receive the report for assurance and approve any recommendations made by the Audit & Governance Committee

2) The Board is asked to consider whether any updates to risks 13, 112, 150, 151, 152 and 156 are required

5.0 APPENDICES

Appendix 1 – Combined BAF & Risk Register as at 10 April 2019 (risks 16 and over & Risks 13, 112, 150, 151, 152 and 156)

M Hartland Chief Operating and Finance Officer April 2019

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2018/1910-Apr-19 MASTER Document capturing changes to risks, agreed by Committee, for the month of March 2019

ID Original Date Last Review

(Committee Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)Risk Description Accountable

Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk

Score (PxI)Score

before any controls are in

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery of principal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

10 01/05/2013 20/03/2019 17/10/2018 2

There is a risk that the health and social care economy will fail to engage and work together to implement required service changes

CDC Dr J Darby Neill Bucktin 4 4 16

QIPP plan and implementation. Joint approach to QIPP development with Dudley Group. Service Improvement Delivery Plans in place with providers. Collaborative Leadership Teams - DGFT and DWMHPT Health and Social Care Leadership Group (A&E Delivery Board). BCF Section 75 Agreement.

Development of Commissioning Plan subject to endorsement by Health and Wellbeing Board. Series of joint strategies beneath JSNA overseen by Partnership Bodies/Boards BCF Section 75 Agreement.

Memorandum of Understanding with Public Health, membership of H&W Board, contribution to JSNA

Commissioning intentions, Change Meetings with providers

None

QIPP reporting to CDC and governing body.

Report to Board on CCG contribution to HWB activity. CCG compliance with JHWS

Internal and external audit reviews

Review of Performance with Health and Wellbeing Board, Internal Audit review

Regular updates to CCG governing body on wider stakeholder engagement as appropriate

4 3 12 =

1.Develop and implement service improvement development plans with JHWS External peer plans with all providers.2. Health and Social Care Leadership Group to be responsible for major system change: - Urgent Care- Service Integration3. Reporting mechanism on Better Care Fund implementation to be agreed.4. Reports to be made to CDC along with Outcome Ambitions and Better Care Fund.5. Establishment of Partnership Board to oversee system and new care model development. 6. Additional spending DMBC to report ot Board

To be reviewed monthly

Mar-19

13 01/05/2013 14/03/2019 14/03/2019 2

Failure of the governing body to demonstrate appropriate leadership/ clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities

GOVERNING BODY Dr David Hegarty Paul Maubach 3 4 12 Organisational Development plan. Governing body development events

Clinical leadership structure is being reviewed None OD plan delivery is not being

reported upon yet 2 4 8 = Implement OD plan delivery reporting to Remuneration Committee May-19

36 16/05/2013 20/03/2019 17/10/2018 3There is a risk that key performance indicators will not be met resulting in the loss of the Quality Premium

CDC Dr J Darby Neill Bucktin 4 4 16

Plans for local targets mostly in place and on track, but still significant risk of not achieving national domains 1 and 5 (PYLL and HCAI)

Successful plans for domain 1 and 5 need to be put in place

Quality Premier achievement reporting to CDC and governing body None None 3 4 12 =

Regular report on actions and performance to CDC linked to Outcome Ambitions and Better Care Fund.Review monthly

Dec-19 2017/18 position awaited

77 22/07/2015 20/03/2019 12/12/2018 1, 2, 3, 4

There is a risk of failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented.

CDC Dr J Darby Neil Bucktin 4 4 16Accountability framework including its Terms of Reference agreed by Partnership Board

None Reports to Board Performance Monitoring NCM Team Confirmation of external performance management arrangements 3 3 9 = Approval of the economic case across

the Local Health EconomyMar-19 Transformation Plan awaited from

bidder

84 07/12/2015 28/03/2019 28/03/2019 3

There is a risk that failure to control costs and deliver significant QIPP savings will put the future sustainability of the CCG at risk

F&P Dr Ruth TapparoMatt Hartland 4 4 16

The QIPP challenge process is robust and the CCG has a history of delivery.

Internal audit recommendations have been reflected in the processes and QIPP challenge days focus on the entire commissioner portfolio which includes both financial and performance elements.

Joint ownership of QIPP Scheme/PID between commissioner and provider.

Greater accountability is placed on the commissioner to ensure delivery following the new financial framework.

Meeting actions are fully minuted and are attended by the head of financial management – commissioning and head of commissioning and representation from the provider.

Business Case/PID - Check MG

Failure to critically assess the viability of a scheme

Clearer exit strategies when schemes do not deliver

Inconsistency in following the appropriate process and challenging the Business Case/PID

Failure to monitor plans and take timely action

Development of future year schemes

Monthly QIPP challenge process. Challenge meetings with commissioners actions are logged.

Monthly reporting to FP&BI committee

CDC oversight of QIPP delivery, and is a standing item of the CDC agenda

QIPP day to focus on the savings for the programme have taken place.

Initial PID documents for 2018/19 2019/20 have been completed by commissioners.

2 year QIPP programme has been developed from reviewing NHSE Menu of Opportunities and Right Care Packs.

The QIPP programme is being managed by a senior programme manager.

Routine position updates are provided to FP&BI including recurrent status of schemes over 2 years.

19/20 QIPP Programme has been presented to FP&BI Committee.

Business Case Reiew Group has been established to ensure cases are robust and corporate sign off process is improved.

Plan and monthly reporting to NHS England.

Forms part of annual internal audit review

Commissioner accountability

Inadequate contingency plans for additional schemes

3 4 12 =

PID Documents and project plans to be commenced in line with key dates to ensure delivery.

Business cases to be completed and approval sort from the relevant committee

Commissioners to be held to account.

Scoping of 2019/20 programme to be undertaken and paper to be presented to FP&BI committee

QIPP Programme to be reviewed on an ongoing basis and form part of the quarter 1 financial review process

Jul-19

Residual risk reduced due to the year to date overachievement of the 2018/19 QIPP target with an increased confidence of achieving the full year QIPP target 18/19 QIPP Programme achieved.

19/20 schemes to be monitored through established QIPP challenge process and reviewed as part of quarter 1 financial review.

98 12/07/2016 27/03/2019 04/04/2018NEW 4 - Develop the CCG

Future shape of the CCG and consequential impact on staff and delivery.

REM Steve Wellings Stephanie Cartwright 4 4 16

Focus of Executive and Senior Management Team. Active involvement in the development of the STP and implementation of the MCP.Regular item on Remuneration Committee agenda.

Risk is currently being managed as one of the objectives for the Director of Organisational Development and HR.

Assurance gained from intensive support from the National New Business Models team and leadership in the development of the STP.

National drivers may be out of control of local management. 4 3 12 =

Regular item on Remuneration Committee.Focus of quarterly reflection by the Executive Team.Establishment of a task and finish group to oversee the future shape of the CCG

Aug-18

Conversations have been held with current provider of primary care interventions to review plans to register patients virtually in a separate primary care setting. RISK TO BE REWORDED FROM JANUARY MEETING

104 08/06/2016 20/03/2019 17/10/2018 4AThere is a risk that there will be a lack of suitable bidders to enter into a contract for the MCP

CDC Dr J Darby Neill Bucktin 4 4 16Early publication of Prior Information Notice (PIN) to stimulate market and engage with prospective providers

None MCP Procurement Project Board None 2 2 4 = Market engagement event Mar-19Preferred bidder identified. Contract mobilisation to commence.

112 08/06/2016 14/03/2019 14/03/2019 4C

There is a risk that Governance arrangements between organisations (that are party to the STP) are either insufficient or inconsistent. This may lead to inadequate governance and insufficient transparency which could create unintended financial risk, inconsistent decision making or misalignment of strategic direction and implementation.

GOVERNING BODY Dr David Hegarty Paul Maubach 4 4 16

CCG membership of STP sponsor group and Dudley CCG leadership of place based component of the STP model

JCC Committee in place to support joint working across

CCG is a member of Stakeholder Group to assess scope and consequence of SWB CCG consultation exercise

STP is a partnership of 18 organisations, both provider and commissioner and there isn't a collective commissioning perspective on the STP. 4 CCGs need to agree a common process

Routine updates from senior managers on capacity of teams to be presented to operations meeting.

Senior Managers have received 1:1 PDR's with managers within the CCG during December 16 to understand capacity. Paul Maubach will followed up in January with additional 1:1's

Senior Manager meetings held monthly

Feedback from AO and Chair from SWB Stakeholder Group

N/A None identified to date 4 4 16 =

To actively contribute to SWB Stakeholder Group

To seek clarity and consistency of partner governance arrangements on all areas where we need collective arrangements (both STP and JCC)

To ensure due diligence of any shared governance or planning arrangements (both financial, clinical and overall governance arrangements)

Aug-19

Inconsistent planning assumptions within the system with regards to the Midland Metropolitan Hospital therefore it was agreed the risk would remain unchanged

116 08/06/2016 20/03/2019 16/01/2019 4C

There is potential to destabilise the health system both clinically and financially as a result of MCP implementation

CDC Dr J Darby Neill Bucktin 4 4 16Internal assessments and Integrated Support and Assurance Process (ISAP)

None Reports to Procurement Project Board and CCG Board at each stage of the process ISAP None 4 3 12 = Enter ISAP Checkpoint 2 Mar-19

Date to commence ISAP Checkpoint 2 Awaited from NHSE/I

129 21/03/2017 25/03/2019 25/03/2019 3

Lack of effective management of waiting list within the ophthalmology department which results in poor patient outcome. Lack of follow up appointment due to process failure.

Q&S Dr Ruth Edwards Caroline Brunt 4 4 16

DGFT are aware of the root cause of these incidents and has put in place a parallel waiting list to support a prioritisation exercise.Lack of process when ophthalmology moved to the partial booking model. DGFT have since put in place extra follow up clinics, developed a process to record when a patient is required to attend a follow up clinic. Recovery Action Plan now agreed with improved performance trajectory.

Red Amber Green flag system in place, however this system does not alert DGFT to all patients within the system who may have been subject to delayed follow up

Reporting of serious incidents to Quality and Safety committee.Incident s reviewed at Weekly Team meetings. Actions resulting from RCA investigations have been reviewed.

WMQRS carried out an audit of the service. Quality and Safety team is kept updated.

Marginal failure to deliver against agreed performance trajectory.Lack of follow up appointment information to provide early warning indicators.

2 4 8 =

Evidence of learning following serious incidents being shared across the ophthalmology directorate.

Audit of waiting list to be completed.

Develop integrated risk regarding waiting list management - to be discussed at the February Q&S Committee

Carry out assurance visit

May-19 Assurance visit planned to follow-up on actions from SIs

ID Original Date Last Review

(Committee Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)Risk Description Accountable

Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk

Score (PxI)Score

before any controls are in

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery of principal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

136 21/07/2017 16/03/2019 16/03/2019 4B

There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce

PCC Alan Johnson Caroline Brunt 4 4 16

Annual Workforce Audit for clinical and non-clinical staff carried out

Recruitment Fayres/ Joint working and raising profiles in Primary Care

Training needs and skills set assessment

Primary Care Team visits with practice to obtain soft intelligence

Engagement with NHS England, Health Education England and Local Workforce Advisory Board committed to training and professional development.

Joint working with local Community Provider Education Network (CPEN) to maximise opportunities for Primary Care Workforce development

Productive General Practice Quick Start programme

GPFV Workforce sub group established

Workforce plan to be developed

No current model of care available to address the workforce gaps

Report to PCCC regarding training needs and workforce analysis

Feedback from individual practices is reported through PCOG

Report to PCC regarding EPIC Programme progress

Gaps in reporting to Committee needs to be clarified as some of the soft intelligence is not suitable for a public meeting.

CCG do not currently receive notification from NHSE in respect of outstanding appraisals

4 3 12 =

1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the clinical and non clinical workforce

2) Develop a joint action plan with external partners (e.g.. HEE) to establish future workforce needs moving into an MCP provider - including the production of workforce development plans at a primary care network level.

3) Participating in the STP Intensive Support Programme for GP recruitment and retention - including leading on a GP mentorship scheme on behalf of the STP Move to Key Control

4) Implementing the CCG GP Forward Plan and investing in the MCP model of care in advance of MCP "go live"

5) PCOG has sight of practices impacted by workforce challenges and recruitment issues and offers support through National schemes (GP resilience) and locally through support agreed through PCOG and PCCC

1) April 20202) April 2019

June 20193) April 2019

4) Quarterly review throughout 2019/20

Operational lead - D King

148 02/11/2017 28/03/2019 28/02/2019

There is a risk that the financial pressure on local providers will put pressure on the CCG in delivering its financial & performance targets

F&P Dr Ruth Tapparo Matt Hartland 5 4 20

Robust contract management via contract review meetings, performance management, joint strategic planning. Financial Plan and contracts agreed with providers. Financial Assurance KPIs reported to Board. Joint monthly payment reconciliation process including validation of activity.

Triangulation report submitted to NHSE for assurance

Lack of transparency and understanding of pressures on local providers.

Reports to F&P & Q&S, Board reportsMinutes of CRM and QRM meetings. Performance report across a range of KPIs. Regular meetings between CCG and DG FT & DWMH Senior Manager Teams now being held. Board to Board meetings take placeMonthly finance meetings with NHS Providers.Partnership Board established Control total was accepted by DGFT and contract has been agreed

Financial Pressures on DGFT was raised at the Board to Board meeting the CCG had with the trust on 13th December

To address local transparency issues a workshop has been arranged for 19th December with local Providers on system wide pressures

A further Dudley Health System workshop was held on 23rd January following impact of the "NHS Long Term Plan".

NHS Improvement Reports

CQC Reports

Deloittes - deep dive report

Transparency between local organisations. 3 4 12 =

As a Dudley Health Economy prioritise how best to utilise its limited resources that enables the best outcome for the Dudley population and agree areas to focus investment for best outcomes as a system

Mar-19System priority workshops are taking place during Jan 19 to Mar-19

150 09/11/2017 14/03/2019 14/03/2019

There is a risk that change of leadership in local system organisations will impact on system delivery, particularly in relation to loss of local knowledge.

GOVERNING BODY Dr David Hegarty Paul Maubach 4 2 8

Strategic CLT meetings held with provider organisations on a monthly basisSenior managers in constant conversation and regular meetings held with provider leadership teams

The CCG clinical and management team are aware of the gap of knowledge and are managing it effectively through building new relationships and sharing intelligence.

The mitigation of this is risk is that the CCG will lead on developing new relationships with new leadership that is in place

Regular discussion with partner organisations concerned.

Obtaining regular assurance from providers that leadership is stable within organisation

4 2 8 =From January 2018 quarterly meetings between the leadership organisations (MCP, TCT and STP) will be implemented to encourage the development of relationships.

May-19

The Board agreed the risk would remain unchanged however it was noted that moving forward with a STP and potentially one CCG, it was recognised this could have an impact and dilute the local knowledge.

151 08/02/2018 14/03/2019 14/03/2019

There is a risk that the CCG fails to meet its statutory duties in respect of the delivery of high quality care to the population of Dudley.

GOVERNING BODY Dr David Hegarty Paul Maubach 5 3 15

Statutory duties are managed through the scheme of delegation which is allocated to each of the CCG’s committees (FP&BI, CDC, REM, PCCC, Q&S and AG)

Regular Board Development sessions are in place to ensure the Board is up to date with the challenges and duties of the GB

TOR for Committees are regularly reviewed to ensure in line with current legislation

Board Member inductions need to be strengthened to ensure that new members are familiar with the issues the CCG faces

Capacity to deliver the statutory requirements of the organisation need to be understood further

Work Plans and Committee Annual Reports provide assurance that the committee is meeting its duties.

Regulatory inspections

NHS England outcomes framework

Health & Wellbeing Board

Overview & Scrutiny Committee

Formal reporting on plans and performance no comprehensive 4 3 12 =

1) Board member inductions to be formalised

2) Review of workforce to be carried outMay-19 Risk to remain unchanged

152 14/03/2018 14/03/2019 14/03/2019 2

There is a risk that the pace of change in the transformation of the system will not be aligned to the views of the public. This may result in the CCG moving too quickly to allow time for adequate involvement or not moving quickly enough to meet public expectations.

GOVERNING BODY Dr David Hegarty Laura Broster 3 4 12

• Comms and Eng Strategy• Approach to engagement set out in constitution• Director of Comms signs off each business case• Good relationships with Health and Adult Social Care Scrutiny Committee• Significant assurance in recent internal audit• Goods rating in this domain from NHSE

External factors impacting on timeliness of decision making and availability of adequate information

need to increase officer awareness of patient and public engagement requirements when i.e., commissioning services

Internal Audit Reports have been Full Assurance

Director and Lay Member in place responsible for Patient and Public Insight IAF - NHS England rated Green

The CCG has limited ability to influence external bodies in decisions that could impact on our ability to engage in a timely way.

2 4 8 =

The CCG should seek opportunities to influence and raise awareness of Dudley dependencies on policy decisions

CH & PM to raise at the next Transition Board to explore what the communication policy is to engage with the local population

Communications & Engagement Strategy is being reviewed for the STP

May-19

The Board felt this was still a significant risk in terms of needing more pace and the risk that the wider STP changes would ‘outstrip’ what was trying to be embedded in Dudley. Actions outlined.

153 31/07/2018 25/03/2019 25/03/2019 3

There is a risk that there are failures of clinical care in the DGFT emergency department (ED) and this will impact on the quality and safety of patient care.

Specific issues highlighted by the CQC from December 2017 include: failure to manage the deteriorating patient and sepsis pathways; paediatric care including safeguarding appropriately; timely and appropriate triage and assessment.

Q&S Dr Ruth Edwards Caroline Brunt 5 5 25

Daily assurance calls with providers and regulators to check quality & safety of care on that day;Weekly assurance submissions of quality & safety metrics;Monthly oversight and assurance meetings to share and triangulate systems intelligence and monitor provider reports;Significant bespoke support from NHSI and ECIST to improve clinical pathways within the ED;

Lack of assurance in respect of ED clinical based on CQC findings

Leadership of system processes to gain assurance

Leadership and ongoing involvement in system work to gain assurance

Evidence of false positive assurance and inability of DGFT to self assess the internal organisational levels of assurance. Lack of provider analysis of information provided to CCG and associated failures to identify trends and themes and therefore to take appropriate actions to mitigate risks

5 5 25 =System response to offer provider to provider support from Royal Wolverhampton Trust alongside ongoing CCG and regulator actions to gain assurance

Feb-19Team discussion to ensure all relevant issues and actions captured

ID Original Date Last Review

(Committee Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)Risk Description Accountable

Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk

Score (PxI)Score

before any controls are in

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery of principal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

156 13/09/2018 14/03/2019 14/03/2019

There is a risk that Dudley CCG could be exposed to financial and reputational risk if it fails to comply with the requirements of the General Data Protection Regulation. The CCG could receive potential fines of up to €17m or 4% of annual turnover for failure to comply, or face other enforcement action from the ICO including warnings, enforcement notices, undertakings or audits.

Governing Body Matt Hartland David Hegarty 3 4 12

• External support is commissioned from Arden & GEM CSU to support the CCG in fulfilling the requirements of GDPR, ensuring actions are documented and completed• There is a GDPR work plan in place, managed through the IG Steering Group and Audit & Governance Committee• GDPR Awareness communications have been circulated to staff on a weekly basis via all staff email • Information Governance Policies and Procedures have been reviewed in line with changes to UK Data Protection laws • A Data Protection Officer has been appointed • All staff are required to completed mandatory Data Security Awareness Level 1 training on an annual basis. Face to face training is also delivered when a need is identified

Full security review required to address any gaps in local security, data and IG compliance

• GDPR Work plan has been approved and reviewed by the Information Governance Steering Group and Audit and Governance Committee • An Information Governance report detailing DPIA completions, SAR requests received, compliance with the DSP Toolkit and data breaches is submitted to the IGSG and A+G Committee on a quarterly basis

ICO Guidance None 1 4 4

• Security Review taking place• Completion of the GDPR Work plan and assurance provided to IGSG and A+G

May-19

Based on the workplan presented to the Committee on the 14 March 2019 by the IG Compliance Officer and the signifcant assurance received that in relation to GDPR the CCG has taken all actions the Audit & Gov Committee - propose to Board to reduce to 1 x 4 = 4.

To be amended following approval by the CCG Board at its meeting on the 9 May

157 29/11/2018 28/03/2019 28/02/2019 2c

There is a financial risk that the CCG is unable deliver a 20% reduction in CCG administration costs by 2020/21 in line with those made by NHS England and NHS Improvement through the joint working initiative that key business delivery and the future sustainability of the CCG may be adversely affected.

F&P Dr Ruth Tapparo Matt Hartland 4 4 16

Monthly staffing reports are disseminated to budget holders, running costs forecasts are maintained on a monthly basis and the QIPP programme for 19/20 includes a proportion of the savings to be made with monthly QIPP challenge meetings arranged to monitor progress of achievement.

Monthly staffing reports are disseminated to budget holders, running costs forecasts are maintained on a monthly basis and the QIPP programme for 19/20 includes a proportion of the savings to be made with monthly QIPP challenge meetings arranged to monitor progress of achievement.

Monthly Finance budget reports are disseminated to Budget HoldersRunning Costs forecasts are prepared and monitored Reports are presented monthly to FP&BI committee outlining key variances across spend areas (Programme / Running Costs and Primary Care Co-Commissioning)

Planning guidance has been reviewed and draft plans have been constructed that includes a 10% running cost reduction in 2019/20 representing half of the saving required by 2021.

Yearly Internal Audit of financial management processes and reporting is carried outNHS England assurance returns completed.

3 4 12 =

Upon receipt of planning guidance understand the requirements to achieve the 20% reduction. Understand what impact the future MCP contract will have in relation to 20% reduction requirements.Running cost schedule to be updated and presented to SMT to formulate action plan to prioritise resources against future CCG objectives.Identify any shared resource opportunities with other CCG’s / CSU’s

Mar 19 – Produce Running Cost Schedule to be presented to SMT Mar 18 - Review schedule and formulate action plan to deliver the required reduction by 2020/21

Reassessed probability and increased accordingly

1 | P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Meeting: 9 May 2019 Report: Remuneration and HR Committee

Agenda item No: 8.4

TITLE OF REPORT: Remuneration and HR Committee Report

PURPOSE OF REPORT: To provide assurance to the Board regarding key issues discussed and approved by the Remuneration and HR Committee held on 27 March 2019

AUTHOR OF REPORT: Mrs Emma-Kate Fletcher, Interim Director of Organisational Development and Human Resources

MANAGEMENT LEAD: Mrs Emma-Kate Fletcher, Interim Director of Organisational Development and Human Resources

CLINICAL LEAD: Dr David Hegarty, Chair

KEY POINTS:

Workforce Dashboard reviewed noting an increased sickness rate of 2.21%, mandatory training compliance of 90%, and Personal Development Review compliance of 74% and a headcount of 142

The Committee discussed a new risk for the Risk Register The Committee received an update on the STP and Black County

and West Birmingham Joint Commissioning Committee Workforce Update

The Committee received an update on Staff Engagement for staff identified as moving to CCG or MCP in the future

The Committee received an update on the PDR Policy The Committee received an update on a proposed Bullying and

Harassment session for staff The Committee received an update about the Staff Survey 2018

results The Committee received an update on 2019 Staff Awards The Committee received an update in relation to Office Holders

Standing Operating procedures The Committee received an update on a Shared HR Function across

the Black Country CCGs The Committee received an update on VSM Performance Related

Pay Policy

RECOMMENDATION: The Board to receive the report for assurance, note the decisions taken under delegated powers and note the pay award recommendation that has been escalated to the CCG Board for decision.

FINANCIAL IMPLICATIONS: Within financial plan

WHAT ENGAGEMENT HAS TAKEN PLACE: n/a

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

ACTION REQUIRED: Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 REMUNERATION AND HR COMMITTEE REPORT 1.0 INTRODUCTION 1.1 This report provides assurance to the Board with regard to key issues discussed and approved by the

Remuneration and HR Committee on the 27 March 2019. The following items are a description of current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of reference.

1.2 Due to the nature of the Committee, there are no set key indicators to report to the Board. 2.0 REPORT 2.1 Risk Register The Committee reviewed the revised Risk Register noting the new risk which was added to reflect the

reduction in CCG Admin Costs by 20%. 2.2 STP and Black Country and West Birmingham, Joint Commissioning Committee Workforce

Update The Committee received a verbal report. On 1st March 2019 the JCC met and discussed a Training Passport to be used across the four Black Country CCGs. The Committee were informed of the appointment of a Transition Director who would be completing an options appraisal with regard to the possibility of bringing the Four Black Country CCGs together. From a STP perspective all the STP post have now been recruited and in post with one year appointments. There needed to be a common language and consistency when communicating to staff and Alan Duffell (Royal Wolverhampton) has been appointed as the HR Lead as Alice McGee has stepped down.

2.3 MCP Staff Engagement Update The Committee received a verbal update in relation to the engagement with staff who are earmarked to move to the MCP. There have been a couple of meetings with staff and a series of FAQs have been developed. Staff are awaiting the appointment of a new Transition Director and DGOH are leading on this recruitment.

2.4 Workforce Dashboard The Committee receives regular updates on HR and workforce metrics applicable to the CCG. This

includes analysis of vacancies, banding/skill-mix ratios, sickness, Personal Development Review completion and mandatory training compliance.

The Committee noted that sickness absence rate had increased to 2.21% and noted that sickness

increase was due to a couple of long term cases that had since returned to work, however, this remains below the CCG target of 3%. The Committee was assured that absence was being managed appropriately in line with CCG policy.

The Committee reviewed mandatory training and PDR compliance. Mandatory training was reported at 90%. PDR compliance was reported as 74%.

2.5 Staff Survey Results 2018

A verbal report was reported to the Committee in relation to the 2018 Staff Survey. It was agreed that these needed to be discussed in more detail before going to Board. It was therefore agreed that an extraordinary meeting would be set up to discuss further. This took place on 25th April 2019, where the action plan was discussed and amendments agreed.

3 | P a g e

2.6 Staff Awards 2019 The Committee received a verbal update in that a task and finish group has been set up to plan and organise the 2019 Staff Awards. The venue has been agreed as the Black Country Living Museum. The awards categories were being reviewed and consideration to the timing of the event to include primary care colleagues. Nominations were to be made via Survey Monkey only and further updates would be given as appropriate.

2.7 PDR Policy and National Progression System

The Committee received a verbal update about the PDR Policy and Pay progression. The Committee were advised that national guidance on pay progression was received and this related to new starters from April 2019 onwards. It was therefore recommended that current staff in post prior to 1 April 2019 would remain on the current system until 2021. Communication to staff will be provided.

2.8 Elected Members and Office Holders

The Committee received a written report about a new policy covering the contractual arrangements for GP Board Members, Clinical Executives, Lay Members and any ad hoc clinical appointments. The policy covers payments, work plans, reporting lines and any absence arrangements. This was agreed and signed off.

2.9 Clinical Change process

The proposed clinical change process for the HR aspects of the constitutional changes was presented to Committee having already been presented at Clinical Forum and GP Membership meetings. The process was debated, and approved.

2.10 HR Shared Function

There was a verbal update on the services provided by the CSU, which currently includes recruitment and ESR services. Following financial analysis, it would be more expensive to provide these services within the CCG, and so it was agreed that the HR shared function would not be progressed at the current time.

2.11 VSM Policy

A verbal update was given on the VSM Policy, and Committee agreed that as there had been no national guidance issued that there was no need to update the policy.

2.12 Bullying and Harassment

The Committee had a discussion about bullying and harassment, and highlighted that all future colleague training and development sessions should also be mandatory for Board Members to attend. The Committee was informed that sessions were planned and Board Members would be asked to attend.

3.0 RECOMMENDATION 3.1 The Board is asked to receive the update from the Remuneration and HR Committee for assurance

noting the decisions taken under delegated authority. Emma-Kate Fletcher Interim Director of OD and HR April 2019

1 | P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Dudley CCG 2018 Staff Survey Results

Agenda item No: 8.5

TITLE OF REPORT: Dudley CCG 2018 Staff Survey Results

PURPOSE OF REPORT: To provide Board with the results of the Dudley CCG Staff Survey undertaken in January 2019 and a summary of the proposed actions to be taken forward

AUTHOR OF REPORT: Mrs Emma-Kate Fletcher Interim Director of Organisational Development and Human Resources

MANAGEMENT LEAD: Mrs Emma-Kate Fletcher Interim Director of Organisational Development and Human Resources

CLINICAL LEAD: Dr David Hegarty, Chair

KEY POINTS: The questions used were similar to those in the 2017 Survey. This

helps with the comparison between the years Report details highlight areas and areas of concern Action Plan to address key areas of concern for the CCG

RECOMMENDATION: 1) To receive the results of the 2018 staff survey 2) To approve the recommended action plan

FINANCIAL IMPLICATIONS: n/a

WHAT ENGAGEMENT HAS TAKEN PLACE:

Staff Forum were asked to contribute any questions they may want included in the survey

Our CCG Staff Side representative was involved in the drafting and signing off of the staff survey questions

Remuneration and HR Committee were asked to input into the questions

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

ACTION REQUIRED: Decision Approval Assurance

2 | P a g e

DUDLEY CLINICAL COMMISSIONING GROUP PUBLIC BOARD – 9 MAY 2019 RESULTS OF THE 2018 STAFF SURVEY 1.0 INTRODUCTION 1.1 The 2018 staff survey was launched on 30 January 2019 and was closed on 8 March 2019. This

was slightly later than previous years and went into the next calendar year. 1.2 The questions were ratified by Remuneration and HR Committee in January 2019 following

consultation and engagement with the CCGs Staff Side Lead. Regular reminders were sent to staff reminding them of the importance to complete the survey and to prompt their response. The staff survey was completed and recorded using Survey Monkey software.

1.3 When reading the results, it is important to remind ourselves of why we undertake the staff survey

each year. The staff survey gives us a unique insight into what if feels like to work for this organisation and provides us with an opportunity to learn what we are doing well as an employer and what we need to improve on.

2.0 RESULTS 2.1 The staff survey was completed by 90 members of staff out of a possible 142. This equates to

approximately 63% which is 17% lower than the previous year. This is disappointing in comparison to the previous year, although this percentage is much higher than other NHS employers. A copy of the report is attached as Appendix 1 to this report and a summary of the results is shown below.

2.2 Highlights:

The highlights of the survey are as follows:

2018 2017 Difference (+/-) from

previous year 83% of respondents understand the CCG priorities

80% of respondents understand our CCG priorities +3%

87% of respondents understand what our CCG values mean

95% of respondents understand what our CCG values mean -7%

87% of respondents believe that our NEDs authentically demonstrate and consistently apply the CCG values

88% of respondents believe that our NEDs authentically demonstrate and consistently apply the CCG values

-1%

74% of staff believe that our Senior Management Team authentically and consistently demonstrate our values

75% of staff believe that our Senior Management Team authentically demonstrate our values

-1%

86% of staff believe that our Non-Executive Directors add value to the organisation

87% of staff believe that our Non-Executive Directors add value to the organisation

-1%

86% of respondents understand what is expected of them at work

88% of respondents understand what is expected of them at work -2%

90% of respondents have the skills needed to do their job effectively

90% of staff have the skills needed to do their job effectively 0%

74% of respondents feel they have the have the resources to do their job effectively

60% of respondents feel they have the have the resources to do their job effectively

+14%

3 | P a g e

2018 2017 Difference (+/-) from

previous year 74% of respondents staff feel that the organisation takes their feedback seriously

83% of respondents feel that the organisation takes their feedback seriously

-9%

81% of respondents think the organisation respects and values its employees

91% of respondents think the organisation respects and values its employees

-10%

91% of respondents feel proud to tell people that they work for Dudley CCG

91% of respondents feel proud to tell people that they work for Dudley CCG 0%

83% of respondents would recommend Dudley CCG as a place to work

90% of respondents would recommend Dudley CCG as a place to work

-7%

Areas of potential concern:

2018 2017 Difference +/-

46% of respondents can honestly recall all 6 of the CCG values

61% of respondents can honestly recall all 6 of the CCG values -15%

62% of respondents believe that Clinical Leadership authentically demonstrate and consistently apply the CCG values

75% of respondents believe that Clinical Leadership authentically demonstrate and consistently apply the CCG values

-13%

48% of respondents feel valued at work

51% of respondents feel valued at work -3%

49% of respondents are able to meet all of the conflicting demands on their time at work

45% of respondents are able to meet all of the conflicting demands on their time at work

30% of respondents felt pressure to work when they have felt unwell

21% of respondents felt pressure to work when they have felt unwell +9%

36% of respondents have witnessed bullying or harassment at work in the last 12 months

19% of respondents have witnessed bullying or harassment at work in the last 12 months

+17%

39% of respondents feel that poor performance is dealt with by the organisation

50% of respondents feel that poor performance is dealt with by the organisation

-11%

52% of respondents feel that staff forum benefits them

68% of respondents feel that staff forum benefits them -14%

2.3 Feedback on Black Country Commissioning Development and MCP

72% of respondents feel that the CCG is engaging with staff on the Black Country and West Birmingham collaborative commissioning proposals

81% of respondents feel the CCG is engaging effectively with staff on the development of the MCP

4 | P a g e

3.0 ACTION PLAN 3.1 Taking account of all of the feedback summarised above, the following actions are recommended:

Action Timescale Present highlights and areas of concerns with percentage results at Public Board meeting and share full report for discussion in Private Board meeting May 2019

Share report percentages with Staff Forum and review with the staff forum members around any areas for improvement May 2019

Full report to be shared with Senior Managers in advance of an in-depth review around areas for improvement particularly focussed on bullying and harassment, performance management and improvements that can be made on working better together across the organisation

May 2019

Arrange further training for all staff on bullying and harassment including how it can be perceived and reiterating the CCG policy and reporting procedure May 2019

Prepare further presentation to be shared with all staff May 2019

SMT to discuss continued comments and concerns around behaviours and bullying and harassment concerns. Undertake further work e.g. focus groups by an external party to explore concerns of bullying and harassment

June 2019

Work with staff side colleagues to address comments on Staff Forum June 2019

Provide clarity to colleagues on GP/Lay member roles and responsibilities in line with the constitution changes July 2019

Improve the understanding of the CCG values for new and existing staff. Review Values Based Recruitment and induction process for new starters. On-going

Continue with Staff engagement plan on supporting staff on Black Country commissioning developments and MCP changes (board development, senior management focus etc) and engage staff on CCG/MCP developments.

Ongoing

Work with Black Country HR and communications colleagues on improving staff engagement across the Black Country CCG organisations Ongoing

Plan for annual staff surveys moving forward to measure success of changes and highlight any additional issues Annually

4.0 RECOMMENDATION

1) That the Board receive the results of the 2018 Staff Survey for assurance 2) That the Board approve the recommended action plan

Staff Survey 2018 SurveyMonkey

RESPONSES

83.33% 75

3.33% 3

13.33% 12

90

Q1 Do you understand what the CCG priorities are? Answered: 90 Skipped: 0

Yes

No

Some

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Some

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

45.56% 41

8.89% 8

45.56% 41

90

Q2 Could you honestly recall all 6 of the CCG values? Answered: 90 Skipped: 0

Yes

No

Some

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Some

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

86.67% 78

1.11% 1

12.22% 11

90

Q3 Do you understand what the CCG values mean? Answered: 90 Skipped: 0

Yes

No

Some

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Some

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

62.07% 54

37.93% 33

87

Q4 Do you believe that our Clinical Leadership (Chair, Clinical Executives, Clinical Leads and Elected members) authentically

demonstrate and consistently apply the CCG values? Answered: 87 Skipped: 3

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

87.36% 76

12.64% 11

87

Q5 Do you believe that our Non-Executive Directors authentically demonstrate and consistently apply the CCG values?

Answered: 87 Skipped: 3

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

74.16% 66

25.84% 23

89

Q6 Do you believe the Senior Management Team (Accountable Officer, Chief Operating and Finance Officer, Chief Quality and Nursing Officer and Directors) authentically demonstrate and consistently

apply the CCG values? Answered: 89 Skipped: 1

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

72.22% 65

27.78% 25

90

Q7 Do you believe that other staff in the CCG demonstrate the CCG values?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

71.11% 64

28.89% 26

90

Q8 Do you know who our Non-Executive Directors are and what they do?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

85.56% 77

14.44% 13

90

Q9 Do you believe the Non-Executive Directors add value to the organisation? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

47.78% 43

6.67% 6

45.56% 41

90

Q10 Do you feel valued at work? Answered: 90 Skipped: 0

Yes

No

Sometimes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Sometimes

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

68.89% 62

3.33% 3

27.78% 25

90

Q11 Do you feel your role contributes to the success of the CCG? Answered: 90 Skipped: 0

Yes

No

Sometimes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Sometimes

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

61.11% 55

4.44% 4

34.44% 31

90

Q12 Do you feel you are given the opportunity to contribute to decisions that affect you where appropriate?

Answered: 90 Skipped: 0

Yes

No

Sometimes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Sometimes

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

61.11% 55

38.89% 35

90

Q13 Do you think the different teams in Dudley CCG work effectively together?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

85.56% 77

1.11% 1

13.33% 12

90

Q14 Do you know what is expected of you at work? Answered: 90 Skipped: 0

Yes

No

Sometimes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Sometimes

TOTAL

Staff Survey 2018 SurveyMonkey

Q15 When you do good work do you regularly receive recognition or praise?

Answered: 90 Skipped: 0

Always

Most of the time

Some of the time

None of the time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Always

Most of the time

Some of the time

None of the time

21.11% 19

31.11% 28

42.22% 38

5.56% 5

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q16 Are you given constructive feedback on where you can improve? Answered: 90 Skipped: 0

Always

Most of the time

Some of the time

None of the time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Always

Most of the time

Some of the time

None of the time

18.89% 17

33.33% 30

37.78% 34

10.00% 9

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q17 Are you held accountable for achieving your actions and meeting expectations? Answered: 90 Skipped: 0

Always

Most of the time

Some of the time

None of the time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Always

Most of the time

Some of the time

None of the time

60.00% 54

27.78% 25

10.00% 9

2.22% 2

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q18 Do your ideas and opinions seem to count? Answered: 90 Skipped: 0

Always

Most of the time

Some of the time

None of the time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Always

Most of the time

Some of the time

None of the time

25.56% 23

37.78% 34

30.00% 27

6.67% 6

TOTAL 90

Staff Survey 2018 SurveyMonkey

RESPONSES

48.89% 44

20.00% 18

31.11% 28

90

Q19 Are you able to meet all of the conflicting demands on your time at work?

Answered: 90 Skipped: 0

Yes

No

Sometimes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Sometimes

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

90.00% 81

1.11% 1

8.89% 8

90

Q20 Do you have the skills needed to do your job effectively? Answered: 90 Skipped: 0

Yes

No

Sometimes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Sometimes

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

74.44% 67

8.89% 8

16.67% 15

90

Q21 Do you have the resources needed to do your job effectively? Answered: 90 Skipped: 0

Yes

No

Some

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Some

TOTAL

Staff Survey 2018 SurveyMonkey

Q22 Does your line manager/supervisor support a balance between work and personal life for you?

Answered: 90 Skipped: 0

Always

Most of the time

Some of the time

None of the time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Always

Most of the time

Some of the time

None of the time

64.44% 58

16.67% 15

14.44% 13

4.44% 4

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q23 Does the organisation support the balance between work and personal life for you?

Answered: 90 Skipped: 0

Always

Most of the time

Some of the time

None of the time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Always

Most of the time

Some of the time

None of the time

41.11% 37

32.22% 29

21.11% 19

5.56% 5

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q24 Do you work extra hours on a regular basis to complete your work?

Answered: 90 Skipped: 0

Yes

No

Sometimes

If yes, why and how often?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

Sometimes

If yes, why and how often?

11.11% 10

21.11% 19

25.56% 23

42.22% 38

TOTAL 90

Staff Survey 2018 SurveyMonkey

RESPONSES

83.33% 75

16.67% 15

90

Q25 If you work extra hours, is it your own choice, or do you feel pressured by anyone or circumstances?

Answered: 90 Skipped: 0

My own choice

I feel pressured to...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

My own choice

I feel pressured to do so

TOTAL

Staff Survey 2018 SurveyMonkey

Q26 Can you tell us a little more about why you felt pressured or what the circumstances were?

Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

Q27 Have you felt pressure to work when you have felt unwell? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

30.00% 27

70.00% 63

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q28 If yes, can you tell us a little more about why you felt pressured or what the circumstances were?

Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

Q29 On a scale of 1-10 how do you rate your work life balance? 1=unhealthy 10=healthy

Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

Q30 If you have witnessed a health and safety near miss or incident, did you report it? If not, why not?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

15.56% 14

84.44% 76

TOTAL 90

Staff Survey 2018 SurveyMonkey

Q31 Did you share your concerns with your manager? Answered: 53 Skipped: 37

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

26.42% 14

73.58% 39

TOTAL 53

Staff Survey 2018 SurveyMonkey

Q32 If you reported it to your Manager, can you tell us what the outcome was? Answered: 35 Skipped: 55

Staff Survey 2018 SurveyMonkey

Q33 If you didn't report it to your Manager, can you explain why? Answered: 35 Skipped: 55

1415

Staff Survey 2018 SurveyMonkey

Q34 Have you experienced bullying or harassment at work in the last 12 months?

Answered: 90 Skipped: 0

Yes

No

If yes, was it direct or...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

If yes, was it direct or indirect? Examples of direct bullying could be confrontational, verbal or physical. Examples of indirect bullying could mean lies or rumours being spread, comments being made

Total Respondents: 90

20.00% 18

80.00% 72

21.11% 19

Staff Survey 2018 SurveyMonkey

Q35 Did the bullying or harassment involve: Answered: 24 Skipped: 66

Clinical Leadership (...

Senior Management (...

Line Manager

Any other Manager

Non-Executive Directors

Other

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Clinical Leadership (as described in question 4)

Senior Management (as described in question 6)

Line Manager

Any other Manager

Non-Executive Directors

Other

Total Respondents: 24

25.00% 6

12.50% 3

12.50% 3

12.50% 3

0.00% 0

45.83% 11

Staff Survey 2018 SurveyMonkey

Q36 Did you report it or share your concerns? Answered: 36 Skipped: 54

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

41.67% 15

58.33% 21

TOTAL 36

Staff Survey 2018 SurveyMonkey

RESPONSES

86.67% 78

13.33% 12

Q37 Do you know the procedure for reporting bullying and harassment? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

Total Respondents: 90

Staff Survey 2018 SurveyMonkey

Q38 If you reported it, can you tell us the outcome? Answered: 28 Skipped: 62

Staff Survey 2018 SurveyMonkey

Q39 If you didn't report it, can you explain why? Answered: 31 Skipped: 59

Staff Survey 2018 SurveyMonkey

Q40 Have you witnessed bullying/harassment at work in the last 12 months?

Answered: 90 Skipped: 0

Yes

No

If yes, was it direct or...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

If yes, was it direct or indirect? Examples of direct bullying could be confrontational, verbal or physical. Examples of indirect bullying could mean lies or rumours being spread, comments being made

Total Respondents: 90

35.56% 32

63.33% 57

34.44% 31

Staff Survey 2018 SurveyMonkey

Q41 Did you report it or share your concerns? Answered: 46 Skipped: 44

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

32.61% 15

67.39% 31

TOTAL 46

Staff Survey 2018 SurveyMonkey

Q42 If you reported it, can you tell us what was the outcome? Answered: 34 Skipped: 56

Staff Survey 2018 SurveyMonkey

Q43 If you didn't report it, can you explain why? Answered: 33 Skipped: 57

Staff Survey 2018 SurveyMonkey

RESPONSES

66.67% 60

33.33% 30

90

Q44 Do you feel Dudley CCG is offering appropriate support during the current periods of change?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

67.78% 61

32.22% 29

90

Q45 Do you think there is variation in performance across the CCG teams?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

68.89% 62

31.11% 28

90

Q46 Do you feel that poor performance is dealt with by your line manager?

Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

Q47 Do you feel that poor performance is dealt with by the organisation? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES RESPONSES

Yes

No

38.89% 35

61.11% 55

TOTAL 90

Staff Survey 2018 SurveyMonkey

RESPONSES

74.44% 67

25.56% 23

90

Q48 Does the organisation take your feedback seriously? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

81.11% 73

18.89% 17

90

Q49 Do you think the organisation respects and values its employees? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

Q50 Please could you use three words to describe the culture of our CCG?

Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

Q51 Do you have any suggestions as to how Staff Forum and staff engagement can be improved? If so, please comment

Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

RESPONSES

52.22% 47

47.78% 43

90

Q52 Do you feel that the Staff Forum benefits you? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

91.11% 82

8.89% 8

90

Q53 Do you feel proud to tell people that you work for Dudley CCG? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

Q54 On a scale of 1-10 how happy are you at work? 1=unhappy 10=very happy (please provide some additional information to explain

your score) Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

RESPONSES

83.33% 75

16.67% 15

90

Q55 Would you recommend Dudley CCG as a place to work? Answered: 90 Skipped: 0

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

Q56 Please feel free to add any comments about what it feels like to work for Dudley CCG. Your comments are incredibly valuable in

helping Dudley CCG become a better organisation to work for Answered: 90 Skipped: 0

Staff Survey 2018 SurveyMonkey

RESPONSES

72.09% 62

27.91% 24

86

Q57 Do you feel the CCG is engaging effectively with staff on the Black Country and West Birmingham/STP arrangements?

Answered: 86 Skipped: 4

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

80.90% 72

19.10% 17

89

Q58 Do you feel the CCG is engaging effectively with staff on the development of the MCP?

Answered: 89 Skipped: 1

Yes

No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

TOTAL

Staff Survey 2018 SurveyMonkey

RESPONSES

11.24% 10

57.30% 51

31.46% 28

89

Q59 Do you feel there is more the CCG could do to ensure that staff understand and feel engaged with the proposals?

Answered: 89 Skipped: 1

Yes

No

If YES, please make...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ANSWER CHOICES

Yes

No

If YES, please make suggestions

TOTAL

Staff Survey 2018 SurveyMonkey

Q60 Please suggest how would you like the CCG to engage with staff about future plans?

Answered: 90 Skipped: 0

1 | P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Finance, Performance and Business Intelligence Committee Report

Agenda item No: 9.1

TITLE OF REPORT: Finance, Performance and Business Intelligence Committee Report

PURPOSE OF REPORT:

To advise the Board of key issues discussed at the Finance, Performance and Business Intelligence Committees on 28th March 2019

AUTHOR(s) OF REPORT:

Mr M Hartland, Chief Finance and Operating Officer Mr J Smith, Head of Financial Management - Corporate

MANAGEMENT LEAD: Mr M Hartland, Chief Finance and Operating Officer

CLINICAL LEAD: Dr R Tapparo, Clinical Executive for Finance, Performance and BI

KEY POINTS:

The CCG expects to meet all financial duties in 2018/19. The CCG is reporting a year to date underspend of £12,494,425 for February 2019

and expects to achieve its revised year end control total of £13,611,000 as agreed with NHS England.

The CCG has failed to meet a number of NHS Constitution standards including A&E, Diagnostics and Cancer 62 day. There are performance exceptions to note in relation to Ambulance Handovers, IAPT Access and Dementia.

The Commissioning Development Committee (CDC) is forecast to overspend significantly against its delegated budget by £7.7m.

Committee received updates on the Board Assurance Framework & Risk Register. The Committee was presented with and approved the Financial Plan 2019/20. Reports from the IT Strategy Group and Estates Strategy Group were received. Under delegated powers the Committee endorsed and approved the Financial

Plan 2019/20; approved the roll out of the GP IT refresh by TeraFirma; supported the recommendation to decommission the MI-Experience app and endorsed the recommendation to achieve Cyber Essentials accreditation.

Note: Following the Committee meeting of 28 March reflected in this report, the CCG has submitted its draft annual accounts confirming that the CCG achieved its 2018/19 financial control total, further detail will be provided to the next Governing Body meeting when the accounts have been audited.

RECOMMENDATION: The Board is asked to: receive the report for assurance note the decisions taken under delegated authority

FINANCIAL IMPLICATION: As outlined in report and key points above

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ANY CONFLICTS OF INTEREST: None

ACTION REQUIRED: Decision Approval Assurance

2 | P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 FINANCE, PERFORMANCE AND BUSINESS INTELLIGENCE COMMITTEE REPORT 1.0 INTRODUCTION

The report summarises the key issues discussed by the Finance, Performance and Business Intelligence Committees at its meeting on 28th March 2019.

2.0 KEY INDICATOR SUMMARY

The table below identifies the CCG’s latest performance against key financial and performance indicators for 2018/19. This represents January performance information and February financial information. It is followed by exception reporting and an explanation of key issues where required.

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Indicator Frequency

Target/

Threshold

Latest

Period

Direction YTD FOT

Maximum two-week wait for first outpatient appointment for patients

referred urgently with suspected cancer by a GPM >93% 96.88% 94.76% 94.55%

Maximum two-week wait for first outpatient appointment for patients

referred urgently with breast symptoms (where cancer was not initially

suspected)

M >93% 94.74% 95.35% 97.40%

Maximum one month (31-day) wait from diagnosis to first definitive

treatment for all cancersM >96% 97.50% 98.32% 98.08%

Maximum 31-day wait for subsequent treatment where that treatment

is surgeryM >94% 100% 100% 98.90%

Maximum 31-day wait for subsequent treatment where that treatment

is a anti-cancer drug regimenM >98% 100% 100% 100.00%

Maximum two months (62-day) wait from urgent GP referral to first

definitive treatment for cancerM >85% 78.23% 81.82% 82.32%

Maximum 62-day wait from referral from an NHS screening service to

first definitive treatment for all cancersM >90% 100% 97.82% 98.04%

Maximum 62-day wait for first definitive treatment following a

consultant's decision to upgrade the priority of the patient M

No

Target92.00% 91.23% 91.35%

Change in national reporting from Sept-17 - Red ambulance calls

resulting in an emergency response must have a mean average <7 minsM <7mins 5mins 54s 5mins 58s 7mins

Ambulance Handovers: Breaches over 45 mins and less than 60 mins M 0 111 1,020 1,113

Ambulance Handovers: Breaches over 60 mins M 0 105 903 985

Cancer Waits (62 Days)

Ambulance

Cancer Waits (2 Weeks)

Cancer Waits (31 Days)

Oth

er K

ey F

inan

ce &

Per

form

ance

Ind

icat

ors

N

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Co

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Quality Premium 2018/19 Frequency

Potential

Value

Eligible

Quality

Premium Status

%

Adjustment

Final Quality

Premium

Part A - Type 1 A&E attendances

Part A: Non elective admissions with zero length of stay: 50 %

Part B - Non elective admissions with length of stay of 1 day or more:

50%M £582,516 £582,516 Pending

No

Adjustment£582,516

Total - Emergency Demand Management Indicators £1,165,032 £582,516 PendingNo

Adjustment£582,516

1 - Early Cancer Diagnosis: 17% of QI (Await 2017 baseline) Q £64,270 £0 Pending 0% £0

2 - GP Access & Experience: 17% of QI (Data due July 2019) A £64,270 £0 Pending 0% £0

3A - CHC 28 day eligibility decision: 8.5% of QI Q £32,135 £32,135 Pending 0% £0

3B - CHC assessments in hospital setting: 8.5% of QI Q £32,135 £32,135 Pending 0% £0

4 - Children and Young person to receive treatment in NHS funded

community services: 17% of QI (Awaiting Data)Q £64,270 £0 Pending 0% £0

5Ai - E coli infections: 17% of QP: 5.1% Q £19,281 £0 Pending 0% £0

5Aii - Collection and reporting E coli data: 2.55% Q £9,640 £0 Pending 0% £0

5B - Reduction of trimethoprim items prescribed to over 70s: 3.4% Q £12,854 £0 Pending 0% £0

5Ci - Sustained reduction of inappropriate antibiotic prescribing: 1.7% Q £6,427 £6,427 Pending 0% £0

5Cii - Additional reduction of inappropriate antibiotic prescribing: 4.3% Q £16,067 £0 Pending 0% £0

Local Priority (RightCare - Coronary Heart Disease): 15% of QP M £56,709 £0 Pending 0% £0

Total Quality Indicators £378,058 £70,697 Pending 0% £0

Total Quality Indicators + Emergency Demand Management Indicators M £1,543,090 £653,213 Pending - £582,516

Emergency Demand Management Indicators

The above Quality Indicators are reduced depending on the CCGs performance against NHS Constitution requirement (RTT incomplete and Cancer 62

day waits). For 2018/19 Dudley CCG is currently not achieving any of the constitution requirement resulting in the CCG not receiving any of the

above Quality Indicators awards. Please note the Emergency Demand Management Indicators are not affected.

Quality Indicators (QI)

M £582,516 £0 PendingNo

Adjustment£0Lo

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Performance CriteriaTarget/

ThresholdPeriod Dudley CCG

Black Country

CCG Rank

Sandwell & W.

B'Ham CCG

Walsall

CCG

W'Hampton

CCG

RTT Incompletes <18 week waits >92% Jan-19 92.11% 1 91.36% 89.96% 91.49%

RTT 52+ week waits 0 Jan-19 2 2 3 0 2

Diagnostics >6 week waits <1% Jan-19 2.93% 2 1.13% 0.68% 1.76%

A&E <4 hour waits >95% Feb-19 80.09% 2 82.25% 78.48% 88.43%

A&E >12 hour trolley waits 0 Feb-19 16 3 0 0 0

Cancer: 2 Week Wait >93% Jan-19 96.50% 2 95.28% 89.59% 86.06%

Cancer: Breast Symptoms 2 week wait >93% Jan-19 95.09% 1 93.71% 69.39% 44.16%

Cancer: 31 day first definitive treatment >96% Jan-19 95.54% 3 97.13% 94.36% 92.16%

Cancer: 31 day sub treatment - surgery >94% Jan-19 85.71% 2 95.83% 89.47% 76.47%

Cancer: 31 day sub treatment - drug >98% Jan-19 100% 1 100% 100% 95.46%

Cancer: 31 day sub treatment - radiotherapy >94% Jan-19 89.36% 2 98.28% 86.96% 87.81%

Cancer: 62 day standard >85% Jan-19 74.29% 3 81.58% 78.57% 65.12%

Cancer: 62 day screening >90% Jan-19 100% 3 88.89% 81.82% 85.71%

Cancer: 62 day upgrade N/A Jan-19 89.23% 1 85.71% 84.62% 68.18%

Ambulance Handovers between 45 & 60 mins 0 Feb-19 111 4 14 43 24

Ambulance Handovers over 60 mins 0 Feb-19 105 4 7 56 44

Mixed Sex Accommodation Breaches 0 Jan-19 23 4 847 13 4

DTOCs as a % of occupied beds <3.5% Jan-19 2.10% 1 2.84% 2.69% 2.96%

E-Referrals utilisation >80% Dec-18 87.06% 1 52.82% 67.47% 83.40%

Dementia Diagnosis >66.7% Feb-18 63.14% 3 62.45% 65.41% 71.10%

IAPT Access >4.2% 18/19 Q3 3.50% 4 5.25% 3.66% 4.48%

IAPT Recovery >50% 18/19 Q3 52.11% 4 60.00% 42.62% 51.67%

Early Intervention in Psychosis <2 week waits >50% Dec-18 100% 1 0% 100% 0%

MRSA 0 Jan-19 0 4 1 0 0

C. Difficile Varies per CCG Jan-19 7 4 11 3 1

Ambulance

MSA

DTOCs

HCAI

Mental Health

E-Referrals

Cancer - 62 day

RTT

Diagnostics

A&E

Cancer - 2 week

Cancer - 31 day

Better Health Period CCG Peers England Trend Better Care Period CCG Peers England Trend

102a % 10-11 classified overweight /obese2014-15 to 2016-17 38.6% 11/11 173/195 R R 121a High quality care - acute 18-19 Q1 58 9/11 141/195

103a Diabetes patients who achieved NICE targets2016-17 42.0% 6/11 49/195 B R 121b High quality care - primary care18-19 Q1 66 7/11 96/195

103b Attendance of structured education course2016-17 (2015 cohort) 5.7% 8/11 104/195 B R 121c High quality care - adult social care18-19 Q1 60 9/11 146/195

104a Injuries from falls in people 65yrs +17-18 Q3 2,342 6/11 148/195 G 122a Cancers diagnosed at early stage2016 54.0% 5/11 68/195

R 105b Personal health budgets 18-19 Q1 11.28 9/11 124/195 R R 122b Cancer 62 days of referral to treatment18-19 Q1 79.3% 8/11 127/195

106a Inequality Chronic - ACS & UCSCs17-18 Q3 2,509 7/11 142/195 G 122c One-year survival from all cancers2015 69.8% 11/11 166/195

R 107a AMR: appropriate prescribing2018 07 1.076 1/11 120/195 R R 122d Cancer patient experience 2017 8.6 11/11 179/195

R 107b AMR: Broad spectrum prescribing2018 07 5.8% 3/11 15/195 R R 123a IAPT recovery rate 18-19 Q1 38.0% 10/11 190/195

R 108a Quality of l ife of carers 2018 0.61 6/11 64/195 G R 123b IAPT Access 18-19 Q1 3.6% 10/11 162/195

G R 123c EIP 2 week referral 2018 09 91.1% 2/11 30/195

Sustainability Period CCG Peers England Trend 123dMH - CYP mental health (not available)

R 141b In-year financial performance18-19 Q1 Green 123f MH - OAP (not available)

R 144a Utilisation of the NHS e-referral service2018 07 77.0% 8/11 85/195 123e MH - Crisis care and liaison (not available)

R 145a Expenditure in areas with identified scope for improvement18-19 Q1 Green 123g MH - health checks (not available)

123h MH - cardio metabolic assessments (not available)

Leadership Period CCG Peers England Trend ¢ n/appR 123i MH - investment standard Compliant

R 162a Probity and corporate governance18-19 Q1 Fully compliant 123j MH - DQMI (not available)

163a Staff engagement index 2017 3.79 3/11 66/195 G R 124a LD - reliance on specialist IP care18-19 Q1 74 9/11 163/195

163b Progress against WRES 2017 0.10 4/11 60/195 ¢ 124b LD - annual health check 2016-17 #N/A #N/A #N/A

164a Working relationship effectiveness2017-18 80.56 2/11 10/195 ¢ n/app124c Completeness of the GP learning disability register2016-17 0.52% 6/11 66/195

166a CCG compliance with standards of public and patient participation2017 Green G R 125d Maternal smoking at delivery 18-19 Q1 13.9% 6/11 137/195

R 165a Quality of CCG leadership 18-19 Q1 Green G 125a Neonatal mortality and stil lbirths2016 5.3 10/11 137/195

¢ n/app125b Experience of maternity services2017 90.4 1/11 4/195

Key ¢ n/app125c Choices in maternity services 2017 60.4 3/11 109/195

Worst quartile in England G R 126a Dementia diagnosis rate 2018 08 63.3% 11/11 157/195

Best quartile in England R 126b Dementia post diagnostic support2016-17 68.4% 11/11 193/195

Interquartile range G 127b Emergency admissions for UCS conditions17-18 Q3 3,038 7/11 164/195

G R 127c A&E admission, transfer, discharge within 4 hours2018 10 87.8% 8/11 105/195

G R 127e Delayed transfers of care per 100,000 population2018 09 4.6 1/11 22/195

G 127f Hospital bed use following emerg admission17-18 Q3 441.9 2/11 44/195

G 105c % of deaths with 3+ emergency admissions in last three months of l ife2017 6.65% 5/11 157/195

¢ n/appR 128b Patient experience of GP services2018 84.2% 7/11 92/195

B R 128c Primary care access 2018 08 100.0%

G R 128d Primary care workforce 2018 03 1.01 3/11 69/195

¢ n/appR 128e Primary care transformation investment18-19 Q1 Green 1/11 1/195

R R 129a 18 week RTT 2018 09 92.5% 5/11 24/195

¢ n/app130a 7 DS - achievement of standards2016-17 2

G R 131a % NHS CHC assesments taking place in acute hospital setting18-19 Q1 9.6% 8/11 110/195

¢ n/app132a Sepsis awareness 2017 Green

G R 133a 6 week diagnostics 2018 09 1.3% 8/11 100/195

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3.0 STATUTORY FINANCIAL DUTIES

The Committee was advised that the CCG had an annual budget at February 2019 of £494.2m. This reflected the notified allocation from NHS England and CCG anticipated allocations. At this point in time, the CCG was underspent by £12.5m and is forecast to achieve a surplus on its Revenue Resource Limit of £13.6m meeting the increased revised control total agreed with NHS England. This reflects the increase of £960,000 for the deferment of the surplus drawdown to 2019/20.

Capital budgets, cash limits and the CCG’s programme and administration expenditure targets are all expected to be achieved.

At a summary level there are three distinct areas of expenditure within the CCG, for which budget responsibility has been delegated to appropriate Committees. These are commissioning expenditure (Commissioning Development Committee - CDC), running/staffing costs and reserves (Finance, Performance and Business Intelligence Committee) and primary care commissioning/membership development (Primary Care Commissioning Committee). Whilst the Finance, Performance and Business Intelligence Committee retains oversight of the financial position of the organisation and advises the Board regarding any mitigating actions that may need to be taken, the clinical and management leads of appropriate Committees are responsible and accountable for financial performance of their delegated portfolio. The table below identifies the financial position to date by Committee; Annual

Budget £m

Year to date

Budget £m

Year to date

Actual £m

Year to date

Variance £m

Forecast Variance

£m

Commissioning Development Committee 416.3m 380.8m 387.8m 7.0m 7.7m Finance, Performance & BI Committee 18.7m 15.9m 8.9m (7.0m) (7.7m) Primary Care Commissioning Committee 45.6m 41.8m 41.8m - - Surplus 13.6m 12.5m - (12.5m) (13.6m) Total 494.2m 451.0m 438.5m (12.5m) (13.6m)

Based on month 11, the Commissioning Development Committee (CDC) is forecast to overspend its delegated budget by £7.7m. The table below illustrates the main areas contributing to the forecast overspend being reported against CDC.

Annual Budget

£m

Year to date

Budget £m

Year to date

Actual £m

Year to date

Variance £m

Forecast Variance

£m

Non-Electives 72.8m 66.7m 69.2m 2.5m 2.7m Electives 43.8m 40.2m 40.2m 0.0m 0.0m Outpatients 45.6m 41.8m 42.8m 1.0m 1.1m Continuing Healthcare (CHC) 19.0m 17.4m 17.9m 0.5m 0.6m Learning Disabilities (LD), Adult Mental Health (MH) 9.9m 8.5m 9.0m 0.5m 0.5m Funded Nursing Care (FNC) 4.5m 4.1m 3.6m (0.5m) (0.6m) Other, including Prescribing 220.7m 202.1m 205.1m 3.0m 3.4m Total 416.3m 380.8m 387.8m 7.0m 7.7m

The latest position has been discussed at the Commissioning Development Committee and Finance, Performance and Business Intelligence Committee and rectification plans are being monitored and reviewed for each of the overspending items above.

The forecast overspending described above at this point does not result in a breach of the CCG’s financial duties. To mitigate the over-performance the CCG is required to utilise its reserves. It is vital that spending is robustly managed during the final month of the year in order to meet the CCGs duty to achieve the control total set by NHS England.

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4.0 NHS CONSTITUTION STANDARDS/CCG ASSURANCE The CCG has failed to meet a number of NHS Constitution standards including A&E, Diagnostics and Cancer 62 day.

4.1 A&E 4 Hour Waits

A&E waits failed to achieve the 95% national standard in February 2019, with 80.09% of patients admitted, transferred or discharged within 4 hours. Most of the four hour breaches occur between 00:00 and 09:00 due to lack of capacity at the Trust caused by discharges occurring late in the day due to continued pressure on TTOs and Consultant reviews. A number of actions are taking place within the trust to address these issues and the CCG is working with the trust to implement actions identified as part of the CQC inspections.

4.2 Cancer Waits (62 Days)

DGFT failed to meet the national 85% standard in January 2019 with a performance of 78.23%. There continues to be challenges at tertiary centres with local IT systems not configured to flag patients on the 38 day pathway. The CCG is withholding funds from the trust until a revised remedial action plan is agreed.

4.3 Diagnostics DGFT have failed to meet the 1% standard with 3.4% of patients waiting more than 6 weeks for a diagnostic test in January 2019. The challenges in performance were mainly due to flooding within the MRI department which limited the number of MRIs that could take place during the period. The trust have informed the CCG that performance for February has recovered.

5.0 PERFORMANCE EXCEPTION REPORTING 5.1 Ambulance Handovers

Both 45 and 60 minute handover breaches deteriorated in January to 111 and 105 respectively. Ambulance handovers form part of the system wide Urgent Care Action plan, which is overseen by the A&E Delivery Board.

5.2 IAPT Access IAPT Access continues to underperform against the national standard, challenged further by the

increase from 16.8% to 19% of estimated prevalence (equivalent to 6,468 people accessing the service throughout the year). The December position has been confirmed as 475 against a trajectory of 539 (an access rate of 3.5% against the national ambition of 4.75% for the latest rolling quarter).

Local data shared from the Trust in January/Feb 2019 demonstrates a significant improvement in performance with the access standard being constantly met.

In relation to the other key IAPT measure for Recovery; this was confirmed as 52.63% in December, meeting the 50% national standard.

5.3 52 Week Waits

The reported position for 52 week waits at the end of Q3 was 1 patient waiting treatment from the Royal Orthopaedic hospital. At the end of Q3 there were 4 45-52 week waiters at the following providers; 3 in T&O - 1 at West Midlands Hospital & 2 at The Royal Orthopaedic 1 in ENT at The Royal Wolverhampton The latest position for February 2019 shows 3 52 week breaches at the following providers; 1 in T&O at The Royal Orthopaedic 1 in Ophthalmology at Aspen health Midland Eye 1 in Neurosurgery at UHB The ROH have reported that all 52 week waits have been treated with the latest breach reported in February being treated on the 20th March.

The CCG is currently waiting on further detail for the two other 52 week breaches in February.

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5.4 Dementia Diagnosis

The dementia diagnosis rate increased slightly to 63.14% in February compared to 62.39% in January, equivalent to 2,682 people on the Dementia register. There was an increase of 28 people on the register and the prevalence figure decreased to 4,247.9 compared to 4,253.9 in January.

Based on the latest position the CCG doesn’t have confidence in meeting the March recovery standard. A paper is going to internal committees Wednesday 20th detailing how the CCG plans on meeting the standard in the next financial year

The target is to achieve 66.7% of the prevalence recorded on the Dementia register.

6.0 QIPP The QIPP target of £17m was forecast to be achieved in 2018/19 with a year to date achievement of £15.7m. There are currently 5 red rated schemes which are now expected to deliver savings next year and feature in the 2019/20 QIPP plan. The focus is now on the delivery of next year’s programme which has a target of £16.78m and equates to 3.3% of the total commissioning resource. The main QIPP schemes in 2019/20 are emergency admissions from care homes, inpatient rehabilitation, prescribing and activities to be delivered through the RightCare programme such as MSK.

7.0 LOCAL INDICATORS 7.1 Better Care Fund (BCF)

There are a number of conditions the health economy must meet to achieve performance within the Better Care Fund (BCF) plan. The BCF plan is managed on a quarterly basis, with the CCG reporting on non-elective admissions and Delayed transfers of care. Both of these areas are performing under plan and meeting the target with performance for January continuing to show a strong position.

8.0 OTHER ITEMS DISCUSSED 8.1 Combined Board Assurance Framework and Risk Register

The risks assigned to the Committee were reviewed and accepted. 8.2 Financial Plan 2019/20

The Committee agreed the CCG’s Financial Budgets 2019/20, which were subsequently approved by the Board on 28 March 2019. Total funding delegated to the CCG to be spent in 2019/20 is £516m. In addition, a notional allocation of £86.4m has been identified for Dudley for specialised services commissioning. The budgets identified a balanced financial position. However, planned spend was currently in excess of the allocation and therefore the achievement of the QIPP target (£16.78m) was necessary to meet the financial plan requirements and create recurrent headroom to fund future growth in activity and investment in new services. Plans reported are set to achieve the reduced surplus of £11.691m in line with the control total set by NHS England; £1.92m of the historic surplus would be available to the CCG next year, and financial risk of up to £6.08m across CCG managed budgets for which mitigations have been identified. The Committee approved the Financial Plan 2019/20, with the caveat that the outcome of the finalised contract negotiations with DGFT could impact on the assumptions within the plan.

9.0 REPORTS FROM GROUPS ACCOUNTABLE TO THE COMMITTEE 9.1 IT Strategy Sub-Committee

The Committee received an update on the issues discussed by the IT Strategy Group and noted good progress on implementing projects within the strategy. The main issues for the Board to note were the Committee supported the roll out of GP IT refresh by Terafirma as the current provider; good progress on the roll out of on-line consultations; updates on GP operating model addendum; and a potential issue regarding national promotion of the NHS app which appears to duplicate the local Dudley offer. A small group had been established to look at this issue.

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The Committee received a separate update report on the HSCN Network migration project and potential risks to the programme. Committee supported the recommendation to escalate.

9.2 Estates Strategy/Operational Group

The Committee received an update on the issues discussed by the Estates Operational Group and discussed a number of items in relation to the current year work programme as part of the Health Infrastructure Strategy. The main issues for the Board to note are that work on both Kingswinford and Lye premises developments have recommenced, with a process in place to confirm MCP space requirements for the buildings by the end of June; agreement in principle has been reached to formalise a remunerated lead tenant role in multi-occupier NHSPS/CHP health centres without on-site health centre management. A new structure for health economy estates groups has also been developed, with the current group split into separate operational and strategic groups.

10.0 DECISIONS TAKEN UNDER DELEGATED POWERS

Under delegated powers the Committee endorsed and approved the following:- 1. The Committee approved the Financial Plan 2019/20 2. The Committee endorsed the roll out of the GP IT refresh by TeraFirma. 3. The Committee endorsed the recommendation to achieve Cyber Essentials accreditation

11.0 RECOMMENDATION

The Board is asked to receive the report for assurance and asked to note the decisions taken under delegated powers.

Mr M Hartland Chief Finance and Operating and Officer May 2019

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Commissioning Development Committee

Agenda item No: 10.1

TITLE OF REPORT: Commissioning Development Committee Report

PURPOSE OF REPORT:

1. To note matters considered by the Commissioning Development Committee. 2. To recommend the commissioning of the Memory and Dementia

Assessment Service from MPNHSFT. 3. To recommend the permanent commissioning of the Enhanced Care Home

Team, subject to termination of the contract if evaluation indicates no impact.

AUTHOR OF REPORT: Mr H Bucktin – Graduate Assistant

MANAGEMENT LEAD: Mr N Bucktin – Director of Commissioning

CLINICAL LEAD: Dr J Darby – Clinical Executive

KEY POINTS:

1. Budget overspend £7.67m and achievement of QIPP target noted. 2. Non-emergency patient transport contract to be extended and re-procured. 3. Revised financial processes for Personal Health Budgets approved. 4. Memory and Dementia Assessment Service commissioning from Midland

Partnership NHS Foundation Trust (MPNHSFT) approved. 5. Enhanced Care Home Team (ECHT) permanent commissioning approved,

subject to future evaluation. 6. MOU for continuing Black Country demonstrator site for personalized care

into 2019/20 approved. 7. External audit of RTT management, systems and processes agreed. 8. 2017-19 Operational Plan has been delivered. 9. Revised/renamed EBI Policy and continued use of EMIS Templates

approved. 10. CCG Policy Review Group to be established. 11. Four STP mental health service specifications approved in principle. 12. ME Festival’s continuation approved; over 70 engagement activities noted.

RECOMMENDATION:

1. That matters considered by the Committee be noted. 2. That the Memory and Dementia Assessment Service be commissioned from

MPNHSFT. 3. That the ECHT be commissioned permanently, subject to termination of the

contract if evaluation indicates no impact. FINANCIAL IMPLICATIONS:

Memory and Dementia Assessment Service – £305,564 ECHT – £186,214

WHAT ENGAGEMENT HAS TAKEN PLACE:

None directly for this report.

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

None

ACTION REQUIRED: Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 COMMISSIONING DEVELOPMENT COMMITTEE REPORT 1.0 PURPOSE OF REPORT 1.1 To note matters considered by the Commissioning Development Committee at its meetings on 20 March

and 17 April 2019. 2.0 FINANCIAL PERFORMANCE 2.1 The Committee received the finance report for assurance and noted a forecast year-end overspend of

£7.67m for 2018/19 with significant overspend on Acute, Community and Learning Disability/Mental Health Services.

2.2 Dudley Group NHS Foundation Trust (DGFT) reported a forecast year-end overspend of £6.4m against

the Acute element of the contract. Ramsay Healthcare reported a £1.374m under-spend. 2.3 The Committee noted that the forecast position for learning disabilities and NHS Continuing Healthcare

had improved since February. 3.0 QUALITY, INNOVATION, PRODUCTIVITY AND PREVENTION (QIPP) PROGRAMME 3.1 The CCG had a QIPP target of £16.987m for 2018/19 plus a stretch saving target of £3.089m. . 3.2 The Committee was assured that over 2018/19 savings completed from the contract negotiations were

complete at full-year effect, that the CCG had delivered the QIPP target in the Financial Plan and the stretch target agreed in April 2019, and that additional recurrent savings from the 2018/19 programme had been included in the 2019/20 delivery programme.

4.0 CONTRACT POSITION FOR NON-EMERGENCY PATIENT TRANSPORT 4.1 At its extraordinary meeting in March 2019, the CCG Governing Body approved the procurement of a

new non-emergency patient transport service from 9 October and an intervening extension of the existing contract, following a recommendation from the Committee.

5.0 MEMORY AND DEMENTIA ASSESSMENT SERVICE FOR 2019/20 5.1 The Committee noted issues relating to the development of a new model of care for the Memory and

Dementia Assessment Service, following the business case approved in October 2018. 5.2 The original business case had involved transferring staff from the current Memory Assessment Service

at Midland Partnership NHS Foundation Trust (MPNHSFT), to Dudley and Walsall Mental Health Partnership NHS Trust (DWMHPT). Ongoing discussions regarding concerns from DWMHPT about workforce being able to meet demand and prescribing management, resulted in no service being ready to commence on 1 April 2019.

5.3 Given the concerns regarding DWMHPT’s ability to provide the service, the Committee recommended

that the CCG Governing Body commission the entire service from MPNHSFT at a cost of £305,564 as agreed in the original business case.

6.0 ENHANCED CARE HOME TEAM – PROGRESS 6.1 The Committee noted that the one-year probationary Enhanced Care Home Team (ECHT) had

implemented several initiatives and that there was evidence that these were starting to reduce the numbers of non-elective hospital conveyances and admissions.

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6.2 The Committee recommended that the CCG Governing Body commission the ECHT permanently at a cost of £186,214 (as agreed in the original business case) with the proviso that, if further evaluation reports indicate that this is having no impact, notice of termination will be given to the provider.

7.0 PERSONAL HEALTH BUDGETS (PHBs) – FINANCIAL PROCESSES 7.1 Following a recent internal audit, revised financial processes for PHBs have been developed. The

Committee approved the revised processes, subject to the auditors agreeing that they meet the report’s recommendations.

8.0 PERSONALIZED CARE AND SUPPORT PLANS – MEMORANDUM OF UNDERSTANDING 8.1 The Committee received a MOU for the continuation of the Black Country demonstrator site for

Personalized Care into 2019/20. The CCG, as part of the Black Country STP, is a demonstrator site and therefore required to sign-up to the 2019/20 MOU. Personalized care is one of the five major, practical changes in the NHS Long Term Plan that will happen over the next five years.

8.2 The Committee approved the MOU, acknowledging its requirements for local implementation. The

Committee also recognized the importance of personalized care and support planning when commissioning new services, in order to maximize the potential impact of this programme.

9.0 CCG OPERATIONAL PLAN 2017-19 REVIEW OF NATIONAL PRIORITIES 9.1 The Committee was assured of the delivery of the CCG’s 2017-19 Operational Plan, noting that it had

not received an overarching assurance report and therefore agreed to receive quarterly assurance updates for the 2019/20 Operational Plan.

10.0 NHS ENGLAND EBI GUIDANCE – IMPLICATIONS FOR CCG POLICIES 10.1 The Committee reviewed elements of the CCG’s Procedures of Limited Clinical Priority and Aesthetic

Surgery policies in line with new NHS England EBI (evidence-based interventions) Guidance. 10.2 The Committee approved a revised and renamed Evidence Based Interventions Policy to come into

effect from 1 April 2019, to be included in contracts with all secondary care providers. 10.3 The continued use of EMIS Templates in primary and secondary care was also approved by the

Committee. 10.4 The Committee agreed to establish a CCG Policy Review Group to advise the Committee about future

policy changes. 11.0 STP MENTAL HEALTH SERVICE SPECIFICATIONS 11.1 The Committee approved, in principle, service specifications developed across the Black Country and

West Birmingham STP for Dementia Diagnosis, “Core 24” Crisis Care, Early Intervention in Psychosis, and an Adult Neuro Developmental Service. Further consideration will be given to the financial implications.

12.0 DGFT UROLOGY REFERRAL TO TREATMENT TIMES (RTT) 12.1 Following the Committee previously noting the deterioration of the DGFT urology RTT, the Committee

considered a report comparing this with the 10 top national performers and noted that there is no appreciable difference with DGFT across several benchmarked parameters.

12.2 The Committee agreed to commence an external audit of RTT management, systems and processes at

DGFT, due to the report showing that 50% of activity referred to DGFT was by GPs, which may not have been included in the RTT statistics.

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13.0 ACUTE SERVICES COMMISSIONING ENGAGEMENT 13.1 The Committee noted feedback from local people at a public meeting in December around expectations

of acute services and future commissioning arrangements, which, although interesting, was from a small statistical sample.

14.0 ME FESTIVAL 14.1 On the basis of positive feedback, the Committee agreed to continue the ME Festival (due to take place

next at Himley Hall on 21 November 2019) while agreeing to explore different ways to organize the day. 15.0 ENGAGEMENT ANNUAL REPORT 15.1 The Committee received the Annual Report from the Engagement Team. It was noted that there have

been more than 70 opportunities for people to engage and that the ‘Duty to Report’ is no longer required. 16.0 RISK REGISTER – QUALITY PREMIUM 16.1 The Committee reviewed the Risk Register and agreed that a report be submitted to the DGFT Governors

regarding their poor performance against the Quality Premium targets. 17.0 RECOMMENDATION 17.1 That matters considered by the Commissioning Development Committee be noted. 17.2 That the Memory and Dementia Assessment Service be commissioned from MPNHSFT. 17.3 That the ECHT be commissioned permanently, subject to termination of the contract if evaluation

indicates no impact. Mr N Bucktin Director of Commissioning March 2019

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w

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Health and Wellbeing Board

Agenda item No: 10.2

TITLE OF REPORT: Report of the Health and Wellbeing Board

PURPOSE OF REPORT: To note matters considered by the Health and Wellbeing Board

AUTHOR OF REPORT: Mr H Bucktin – Graduate Assistant

MANAGEMENT LEAD: Mr N Bucktin – Director of Commissioning

CLINICAL LEAD: Dr D Hegarty – Chair

KEY POINTS:

1. The Health and Wellbeing Board’s membership has been amended 2. Dudley CCG’s Draft Operational Plan has been considered to have

taken proper account of the Joint Health and Wellbeing Strategy 3. Assurance has been provided on the Better Care Fund and

Transforming Care Partnership 4. The Alliance Boards have provided updates on successes, areas of

major concern/risk and areas for which support is required 5. Priorities have been identified by Safe & Sound’s draft Strategic

Assessment and through public surveys and consideration given as to how the Health and Wellbeing Board could support these as part of a ‘system’

RECOMMENDATION: That the matters considered by the Health and Wellbeing Board be noted

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE:

None

ACTION REQUIRED: Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 HEALTH AND WELLBEING BOARD REPORT (HWB) 1.0 PURPOSE OF REPORT 1.1 To note matters considered by the Health and Wellbeing Board (HWB) at its meeting on 21 March 2019. 2.0 AMENDMENT TO HWB MEMBERSHIP 2.1 The HWB agreed to an amendment to its membership and the relevant terms of reference following the

recent Council Cabinet portfolio changes:

Cabinet Member for Health & Adult Social Care Councillor C Bayton Cabinet Member for Children & Young People Councillor S Ridney Cabinet Member for Communities Councillor G Partridge Opposition nomination Councillor R Buttery

3.0 NHS LONG-TERM PLAN AND CCG DRAFT OPERATIONAL PLAN 3.1 The HWB considered the CCG’s Draft Operational Plan for 2019/20, which has been written to reflect

the NHS’s Operational Planning Guidance for 2019/20 and the main features of the NHS Long Term Plan:

i. A new service model for the 21st century ii. More NHS action on prevention and health inequalities iii. Further progress on care quality and outcomes iv. NHS staff receiving the backing they need v. Digitally-enabled care going mainstream across the NHS vi. Taxpayers’ investment being used to maximum effect

3.2 The Draft Operational Plan is supposed to take account of the Joint Health and Wellbeing Strategy’s four

priorities – a new relationship with communities, a shift to prevention, a stronger focus on joining up health and care services, and a stronger focus on what the strategy has achieved.

3.3 The HWB considered that the Draft Operational Plan has taken proper account of the Joint Health and

Wellbeing Strategy. 4.0 BETTER CARE FUND AND TRANSFORMING CARE PARTNERSHIP 4.1 The HWB considered the Joint Report of the Chief Officer (Adult Social Care, Dudley MBC) and Director

of Commissioning (Dudley CCG) on the Better Care Fund and Transforming Care Partnership. 4.2 Performance data has been received since December, demonstrating that the key areas of focus for the

Better Care Fund are being delivered. There have been significant reductions in emergency admissions to hospital, the reduction in delayed transfers of care for those who are admitted has been maintained, and permanent admissions to nursing homes have reduced significantly between April and December 2018 – reflecting the increasing effectiveness of reablement services.

4.3 The HWB noted the report and the assurance it provided. 5.0 BOARD ALLIANCE UPDATES 5.1 The Board received updates from the Children and Young People’s (CYP) Alliance Board, the Adults

Alliance Board, Safe and Sound (Dudley’s Community Safety Partnership), and the Adults and Children Safeguarding Boards. As well as noting a number of facts to ‘celebrate/share’, the Board was informed

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on the ‘top actions to do next’ for each Alliance Board, items for which the Alliance Boards require support from the Health & Wellbeing Board (HWB) and issues of major concern or risk.

5.2 The CYP Alliance Board requires support from the HWB in its commitment to prioritize investment in

financial and human resources to ensure the involvement of CYP in all that they do. There are major concerns that too many children are not school-ready and that too many CYP are being excluded from school.

5.3 The Adults Alliance Board requires support from the HWB it its commitment to continue to support co-

production as a key tool in achieving the goals in the HWB strategy. There are major concerns that organizational development will not happen fast enough to upskill staff in co-production.

5.4 Safe & Sound requires support from the HWB for:

Completion and submission of Injury Surveillance Data by Dudley Group NHS Foundation Trust (DGFT) on a regular basis

Serious Organized Crime and Organized Crime Groups – using an ‘Active Citizen’ approach/empowering communities to recognize ‘issues’ and report

Implementing the ‘real living wage’ for the workforce, providers, contractors and sub-contractors Ongoing work in Dudley to end ‘period poverty’

There are major concerns about the increase in violent crime (particularly weapon-related), the increase in crimes that target the elderly, and time-limited funding for projects.

5.5 The Adults and Children Safeguarding Boards require support from the HWB for how the HWB can

champion the Friends Against Scams campaign and to agree future governance of child death review arrangements. There are major concerns for the implementation of new safeguarding arrangements, the requirement of ongoing assurance from DGFT in respect of child and adult safeguarding activity in community and acute settings, and for the delay in processing cases that may meet the threshold for Safeguarding Adult Reviews.

6.0 COMMUNITY SAFETY PRIORITIES 6.1 The HWB considered a report from the Head of Community Safety on behalf of Safe & Sound to inform

the Board of Dudley’s Community Safety Partnership priorities. 6.2 To date, priorities identified for 2019/20 as part of Safe & Sound’s draft Strategic Assessment include:

Violent crime Organized car crime Burglaries Reducing re-offending Reducing victimization Reducing vulnerability

6.3 Priorities identified through public surveys include:

Violent crime Anti-social behaviour Burglary Drug misuse Mental ill health Theft

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6.4 The HWB noted Safe & Sound’s priorities, gave consideration as to how the HWB can support these priorities and as to how as a ‘system’ they could work together to prevent and reduce violent crime and its drivers.

7.0 RECOMMENDATION 7.1 That the matters considered by the Health and Wellbeing Board be noted. Mr N Bucktin Director of Commissioning May 2019

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 9 May 2019 Report: Report from the Primary Care Commissioning Committee

Agenda Item No: 11.1

TITLE OF REPORT: Report from the Primary Care Commissioning Committee

PURPOSE OF REPORT: To advise the Board on key issues discussed and the decisions taken at the meetings of the Primary Care Commissioning Committee on 15 March 2019 and 26 April 2019

AUTHOR(s) OF REPORT: Mrs J Robinson, Primary Care Contracts Manager Mr D King, Head of Membership Development and Primary Care Mrs J Taylor, Primary Care Commissioning Manager

MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse

CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

The Committee: Received an update from the Primary Care Operational Group

(PCOG) and was assured by: o A report regarding assessing compliance against Dudley

Quality Outcomes for Health (DQOFH) o A report regarding assessing compliance relating to extended

access provided in 2018/19 Received a presentation regarding the five year framework for GP

contract reform to implement The NHS Long Term Plan over the next five years to 2023/24

Noted the significant changes to the GP Contract and subsequent implementation of Primary Care Networks (PCN)

Received details of the Primary Care Network Directed Enhanced Service, the registration process and likely PCN configurations

Noted that locality meetings in April and May had been given over for practices to discuss PCN configuration

Noted that Robert Varnam, Head of General Practice Development, NHS England had attended members meeting in April to discuss PCN functions within Integrated Care Systems

Approved the revised indicators, thresholds and associated finances for the DQOFH contract for 2019/20

Approved the primary care extended access and Bank Holiday extended access schemes for 2019/20

Received the quality and safety matters that are set out in the quality and safety report

Received and discussed the full Primary Care Analysis Tool (PCAT) data set in private

Approved the baseline budgets for the financial year 2019/20 and noted that further work required to ensure that the residual cost improvement target of £158,000 is achieved

Reviewed and updated the current risk register Noted that The Black Country and West Birmingham Sustainability

and Transformation Partnership (STP) will be producing a Primary

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Care Strategy for submission to NHS England by 28 June and that the risks around consultation and engagement will be managed

Received in private session a financial analysis assessing the request from a GP Practice for financial assistance and agreed the steps that should be taken to safeguard the future of the surgery

RECOMMENDATIONS:

The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary Care Commissioning Committee

The Board is asked to delegate authority to the Primary Care Commissioning Committee to approve the STP Primary Care Strategy for submission to NHS England on 28 June

FINANCIAL IMPLICATIONS: Budgets delegated to the Committee for the financial year 2019/20 total £47.8m

WHAT ENGAGEMENT HAS TAKEN PLACE:

NHS England CQC Member practices Local Medical Committee

ANY CONFLICTS OF INTEREST IDENTIFIED IN ADVANCE

No conflicts of interest identified in advance

ACTION REQUIRED: Assurance Decision

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 9 MAY 2019 REPORT FROM THE PRIMARY CARE COMMISSIONING COMMITTEE 1.0 INTRODUCTION

1.1 This report summarises the key issues discussed and the decisions taken at the Primary Care

Commissioning Committees held on 15 March 2019 and 26 April 2019.

1.2 PRIMARY CARE CONTRACTING

GP Contract Changes and Primary Care Operational Plan

1.3 Committee received a full review regarding the implications of the contractual changes following the publication by NHS England and the BMA General Practitioners Committee of a five-year framework for GP Contract reform to implement The NHS Long Term Plan.

1.4 Committee noted the significance of the changes set out in the GMS contract for 2019/20 and joint proposals for reform for the four subsequent years and will receive regular reports regarding implementation.

Primary Care Networks (PCNs) 1.5 Committee received an update on the requirements of the PCN Directed Enhanced Service (DES) and

the process by which PCN registration will be agreed. 1.6 All locality meetings in April and May were given over to member practices to discuss and agree:

- PCN configuration - The nominated payee practice - Clinical Director

1.7 The members meeting in April was given over to a discussion on the role and function of the PCNs –

attended by Robert Varnam, Head of General Practice Development at NHS England. 1.8 Committee received assurance that the Primary Care team had provided the time and facilitation to

ensure that practices understood the implications of the PCN DES and the relationship between the PCNs and the MCP.

1.9 PCNs are required to submit their registration documents to the CCG by 15 May. The registration

documents will be considered by the Primary Care Operational Group on 22 May with a recommendation for approval of the Committee on 31 May.

1.10 Committee noted that the STP has also agreed a process for approving PCN registrations. The

Committee will essentially make a recommendation to the STP that provides assurance the registration process has been followed.

1.11 In the event that a practice chooses not to participate in the DES the PCCC will allocate the practice

population to a PCN (as this is a requirement on the CCG). 1.12 Committee expects that registration of all practices to a PCN will be achieved (as is a requirement of

the DES).

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2.0 PRIMARY CARE COMMISSIONING Dudley Quality Outcomes for Health (DQOFH) 2.1 Committee received a revised version of the indicators, thresholds and associated finances for the

DQOFH contract 2019/20 which had been reviewed and updated to reflect any changes in the National guidance and release of the new GP contract.

2.2 A statistical analysis has been undertaken as with previous years to derive the upper and lower

thresholds which has been applied to all indicators except those which are the same as the National contract (QoF), require a National target to be met or are new indicators.

2.3 The additional funding from the PMS review has been incorporated to fund the new indicators for

Asthma, COPD and Frailty and the prescribing incentive scheme has been integrated to fund a Quality Improvement module for Prescribing Safety in line with the National contract.

2.4 Committee approved the revised indicators, thresholds and associated finances for 2019/20.

Compliance of DQOFH (January 2019)

2.5 Committee was assured by an update received from PCOG regarding compliance against DQOFH.

Compliance of extended access provided in 2018/19

2.6 Committee was assured by an update received from PCOG regarding compliance of extended access provided in 2018/19.

Extended access and Bank Holiday extended access schemes for 2019/20 2.7 Committee approved the revised specifications for the Primary Care Extended Access and Bank

Holiday Extended Access Schemes. 3.0 QUALITY

3.1 The Quality and Safety report to the Board will set out in more detail those areas pertinent to primary

care. There were no issues in the report that required contractual actions to be taken against any practice.

3.2 Committee noted that there are currently 18 patients on the Special Allocation Scheme following 6

patients recently being successfully removed from the scheme and that all patients on the scheme are now held on a registered list.

3.3 The full Primary Care Analysis Tool (PCAT) data set was discussed in private and Committee was

assured by the level of monitoring being undertaken.

4.0 FINANCE 4.1 Committee received the budget, totalling £47.8m, delegated to Committee by the CCG Board for the

financial year 2019/20, and approved the financial plan, which due to a late reduction in the CCGs allocation as a result of the central funding of GP indemnity schemes included a cost pressure of £158,000.

4.2 Committee noted that the reduction meant the CCG received allocation growth that was below the level required to fund the commitments within the GP contract settlement, creating a cost pressure of £463,000 in the financial plan previously submitted to Board.

4.3 A subsequent budget review has reduced this pressure to £158,000 and further work will be undertaken over the next two months to identify QIPP schemes to bridge this gap between allocation and

5 | P a g e

expenditure. A report on short and long-term financial pressures, along with QIPP actions to ensure the committee achieves break-even, will be presented to committee in June.

4.4 It was also noted that the budget review had reduced budgets in a number of specific programme areas and that the residual risk in those areas was also increased from previous financial years. Strong financial management would be required to ensure committee achieved its responsibility to break even against budgets delegated to it.

4.5 Committee discussed in private session a financial analysis report produced in respect of a practice that has reported being in financial difficulty. Committee discussed the report and was in favour of a proposal that CCG support be provided to restructure the practice’s operating model onto a more sustainable footing. Actions in respect of this will be undertaken using delegated budget holder powers.

5.0 BLACK COUNTRY AND WEST BIRMINGHAM SUSTAINABILITY AND TRANSFORMATION

PARTNERSHIP (STP) PRIMARY CARE STRATEGY 5.1 The NHS Long Term Plan requires the STP to produce a Primary Care Strategy that articulates the

vision and key priorities for the STP by 28 June 2019. 5.2 The STP will be co-ordinating the production of the strategy with input from each CCG. The final

strategy needs to be submitted to NHS England by 28 June. 5.3 Committee discussed the risks related to engagement and consultation given the timescales for

producing the STP strategy. The risks will be mitigated as much a possible by the Primary Care and Communication and Engagement teams. A Dudley event for the public is planned for the 23 May at Bank Street Methodist Church.

5.4 Committee expressed their concerns about the short timescale involved in producing an STP strategy

and the need of having such a strategy at an STP level. 5.5 As the Board does not meet again until July Committee requests delegated authority from the Board to

approve the final STP strategy at its meeting on 28 June.

6.0 RISK REGISTER 6.1 Risks assigned to Committee were reviewed and updated. 7.0 RECOMMENDATIONS 7.1 The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary

Care Commissioning Committee on 15 March 2019 and 26 April 2019. 7.2 The Board is asked to delegate authority to the Primary Care Commissioning Committee to approve

the STP Primary Care Strategy for submission to NHS England on 28 June.

Dudley Clinical Commisioning GroupGLOSSARY - NOVEMBER 2018

Abbreviation Meaning#NOF Fractured Neck of Femur

£K £1,000 equivalentA&E Accident and EmergencyACO Accountable Care OrganisationACS Ambulatory Care Sensitive ConditionsACS Acute Coronary SyndromeACSs Accountable Care SystemsAD Assistant DirectorAfC Agenda for ChangeAGM Annual General MeetingAHSN Academic Health Science NetworksALE Auditors Local Evaluation

ALOS Average Length of Stay (in hospital)AMI Acute Myocardial Infarction

AMMC Area Medicines Management CommitteeAMR Antimicrobial resistance

Anti-D An antibody occurring in pregnancyAnti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease

AQP Any Qualified ProviderARIF Aggressive Research Intelligence FacilityASAP As soon as possibleAVE Advertising Value equivalent

BACs Bank Automated CreditBAF Board Assurance FrameworkBCC Black Country ClusterBCF Better Care Fund

BCPFT Black Country Partnership NHS Foundation TrustBFT Behavioural Family TherapyBMA British Medical AssociationBME Black Minority EthnicBMJ British Medical Journal

BPAS British Pregnancy Advisory BoardBSCCP British Society of Colposcopy and Cervical Pathology

CAB Citizens Advise BureauCAMHS Children and Adolescent Mental Health Service

CAO Chief Accountable OfficerCASH Contraception and Sexual Health

CCBT (CBT) Computerised Cognitive Behavioural TherapyCCG Clinical Commissioning Group

CCRN Comprehensive Clinical Research NetworksCDC Commissioning Development CommitteeCDiff Clostridium difficileCEO Chief Executive OfficerCETV Cash Equivalent Transfer ValueCFO Chief Finance Officer

CHADD The Churches Housing Association of Dudley & District LtdCHC Continuing HealthcareCHD Coronary Heart DiseaseCIP Cost Improvement PlanCLT Collaborative Leadership Team

CMO Chief Medical OfficerCNST Clinical Negligence Scheme for TrustsCNT Community Nursing Team

COPD Chronic Obstructive Pulmonary Disease

COSHH Control of Substances Hazardous to Health Regulations 2002CPA Care Programme ApproachCPN Community Psychiatric NurseCPR Cardiopulmonary ResuscitationCQC Care Quality Commission

CQNO Chief Quality and Nursing OfficerCQRM Clinical Quality Review MeetingCQUIN Commissioning for Quality and InnovationCRL Capital Resource LimitCRRT Community Rapid Response TeamCSG Clinical Strategic GroupCSU Commissioning Support Unit

CT scan Computer TopographyCVD Cardio Vascular DiseaseD&N Dudley and Netherton (Locality)

DACHS Directorate of Adult Children and Housing ServicesDCS Dudley Community Services

DCVS Dudley Community Voluntary ServiceDES Directed Enhanced ServiceDfES Department for Education and SkillsDGFT Dudley Group Foundation TrustDHR Domestic Homicide ReviewDMO Designated Medical OfficerDNA Did not attendDoH Department of HealthDoLS Deprivation of Liberty SafeguardsDoS Directory of Service

DPMA Dudley Practice Managers AllianceDPO Data Protection Officer

DQOFH Dudley Quality Outcomes for HealthDSCB Dudley Safeguarding Children’s BoardDTC Diagnostic and Treatment CentreDToC Delayed Transfer of Care

DWMHPT Dudley and Walsall Mental Health Partnership TrustDXA Dual X-ray Absorptiometry (measures bone density)E&D Equality and DiversityEAU Emergency Assessment UnitECA Extra Care AreaECM Every Child MattersECT Electroconvulsive TherapyED Emergency DepartmentEI Early ImplementerEI Early InterventionEIP Early intervention in PsychosisEMI Elderly Mentally IllEMIS Education Management Information SystemEoL End of LifeEPC Empowering People and CommunitiesEPIC Enabling Practices to Improve and ChangeEPP Expert Patients ProgrammeEPR Electronic Patient RecordEPRR Emergency, Preparedness, Resilence, ResponseERT Enzyme Replacement TherapyESR Electronic Staff RecordFCEs Finished Consultant EpisodesFED Forum for Education and DevelopmentFFT Friends and Family TestFHS Family Health ServicesFMC Facility Management CentreFOI Freedom of InformationFTE Full Time Equivalent

FYE Full Year EffectFYFV Five Year Forward ViewGDPR General Data Protection RegulationsGGI Good Governance Institute

GMS General Medical ServicesGOWM Government Office for the West Midlands

GP General PractitionerGPAQ General Practice Assessment of QualityGPFV GP Forward View

GPwSI GP with Special InterestGU Genito-urinary

GUM Genito-urinary MedicineH&QB Halesowen and Quarry Bank (Locality)HCAI Healthcare Associated InfectionsHCF Healthcare ForumHEE Health Education England

HENIG Health Economy NICE Implementation GroupHF Heart Failure

HFMA Healthcare Financial Management AssociationHIAO Head of Interal Audit OpinionHIC Health Improvement CentreHIS Health Infrastructure StrategyHIV Human Immunodeficiency VirusHPA Health Protection Agency

HPS/S Health Promoting Schools / ServiceHPU Health Protection UnitHR Human ResourcesHSC Health and Safety Commission

HSCQC Health and Social Care Quality CentreHSE Health and Safety Executive

HSMC Health Services Management CentreHT Home TreatmentHV Health Visitor

HWBB Health and Well-being BoardIAF Improvement Assessment Framework

IAPT Improved Access to Psychological TherapiesIC Infection Control

ICAS Independent Complaints Advocacy ServiceICE Integrated Commissioning Executive

ICNA Infection Control Nurses AssociationICO Integrated Care OrganisationICP Integrated Care ProviderIFR Individual Funding RequestIG Information Governance

IOSH Institute of Occupational Safety and HealthISAP Integrated Support Assurance Process

IT Information TechnologyIUCD Intrauterine Contraceptive DeviceJCAB Joint Clinical Advisory BoardJCC Joint Commissioning CommitteeJD Job Description

JSNA Joint Strategic Needs AssessmentKAB Kingswinford, Amblecote and Brierley Hill (Locality)

KLOE Key Lines of EnquiryKPI Key Performance Indicators

LAA Local Area AgreementLAC Looked After Children

LACYP Looked After Children and Young PeopleLAT Local Area TeamLD Learning Disability

LDP Local Delivery Plan

LDR Local Digital RoadmapLEA Local Education Authority

LeDeR Learning Disabilities Mortality ReviewLIFT Local Improvement Finance TrustLIG Local Implementation GroupLIS Local Improvement SchemeLIT Local Implementation Team

LMC Local Medical CommitteeLNG Local Negotiating CommitteeLPS Local Pharmaceutical SchemeLRF Local Resilience ForumLSCB Local Safeguarding Children’s BoardLTC Long Term ConditionsLVD Left Ventricular Dysfunction

LVSD Left Ventricular Systolic DysfunctionMAPA Management of Actual and Potential AggressionMASH Multi-Agency Safeguarding HubMAU Medical Assessment UnitMBC Metropolitan Borough CouncilMCP Multi-speciality Community ProviderMDT Multi Disciplinary TeamMIAA Mersey Internal Audit AuthorityMIMT Major Incident Management TeamMIRE Major Incident Response Executive

MLSOs Medical Laboratory Scientific OfficersMOU Memorandum of Understanding

MPAG Maternity Performance Assurance GroupMRSA Methicillin Resistant Staphylococcus AureusMSS Medium Secure ServiceNCA Non contract activityNCB National Commissioning BoardNCM New Care Model

NCRS National Care Record SystemNELHI National Electronic Library for Health Information

NFI National Fraud InitiativeNGMS New General Medical ServicesNHS National Health Service

NHSCPT NHS Community Practice TeacherNHSCSP NHS Cancer Screening Programme

NHSE NHS EnglandNHSI NHS Improvement

NHSP National Healthy Schools ProgrammeNHSR NHS ResolutionNICE National Institute for Clinical ExcellenceNMC New Model of Care/Nursing and Midwifery CouncilNOF New Opportunities FundNPfIT National Programme for ITNPSA National Patient Safety AgencyNRF Neighbourhood Renewal Fund

NRLS National Reporting and Learning SystemNSF National Service FrameworkOAT Out of Area TreatmentOBD Occupied Bed DayOD Organisational Development

ODM Oesophageal Doppler MonitoringOJEU Official Journal of the European UnionOOH Out of HoursOPH Office of Public HealthOSC Overview and Scrutiny CommitteeOT Occupational Therapist

PACS Primary and Acute Care Systems

PAF Positive Assurance FrameworkPALS Patient Advice and Liaison ServicePAM Patient Activation MeasuresPAS Patient Administration SystemPAU Paediatric Assessment UnitPBP Practice Based Pharamcists PbR Payment by ResultsPC Personal Computer

PCCC Primary Care Commissioning CommitteePCDSG Primary Care Development Steering GroupPCOG Primary Care Operational GroupPCSP Personalised Care & Support PlanPDF Portable Document FormatPDR Personal Development ReviewPDS Personal Dental Services

PDSA Plan, Do, Study, ActPDU Professional Development UnitPE Pulmonary Embolism

PEAK Database holding the main registered details of patients and associated referral, contact, caseload, outpatient, inpatient, MH Act and clinic information.

PEAT Patient Environment Action TeamPEPP Pooled Budget External Placement Panel

PFI Private Finance InitiativePGD Patient Group DirectivesPHB Personal Health BudgetPHE Public Health England

PHSO Parliamentary and Health Service OmbudsmanPICU Psychiatric Intensive Care UnitPID Project Initiation DocumentPIN Prior Information Notice

PMLD Profound and Multiple Learning DifficultiesPMS Primary Medical ServicesPNA Pharmaceutical Needs AssessmentPOD Prescription Ordering DirectPOPs Patient Opportunity PanelsPPA Prescription Pricing AuthorityPPG Patient Participation GroupPQQ Pre-Qualification QuestionsPSA Public Service Agreement

PSHE Personal and Social Health EducationPSIAMS Personal Social Impact Action Measurement SystemPTCA Percutaneous Transluminary Coronary AngioplastyPWB Personal Wheelchair BudgetQ&A Questions and AnswersQ&S Quality & SafetyQA Quality AssuranceQIB Quality Improvement Board

QIPP Quality, Innovation, Productivity and Prevention QMAS Quality Management and Analysis SystemQOF Quality and Outcome Framework

QPDT Quality and Practice Development TeamsRACPC Rapid Access Chest Pain Clinic

RAG Red, Amber Green (rating)RAS Respiratory Assessment ServiceRCA Root Cause AnalysisRCGP Royal College of General PractitionersRES Race Equality SchemeRHH Russells Hall Hospital

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences RegulationsRMO Responsible Medical OfficerRRL Revenue Resource Limit

RTT Referral to TreatmentSAP Single Assessment ProcessSAR Safeguarding Adult ReviewsSAR Subject Access RequestSCG Sedgley, Coseley and Gornal (Locality)SCIE Social Care Institute for ExcellenceSCR Serious Case Review

SDMP Sustainable Development Management PlanSDU Sustainable Development Unit

SEPIA Mental health computer systemSFBH Standards for Better Health

SFI Standing Financial InstructionsSI Serious Incident

SIC Statement of Internal ControlSLA Service Level AgreementSoMe Social MediaSPA Single Point of Access

SQPR Service Quality Performance Review SQRM Safeguarding Quality Review MeetingSRE Sex and Relationship EducationSRG System Resilience GroupSSD Social Services Department

SSDP Strategic Services Development PlanSTI Sexually Transmitted DiseaseSTP Sustainability and Transformation Plan

STRW Support, Time & Recovery WorkerSWL Stourbridge, Wollescote and Lye (Locality)

SWOT Strength, Weakness, Opportunity and ThreatTB TuberculosisTCT Transforming Care TogetherTIA Transient Ischaemic AttackTP Teenage Pregnancy

TPT Teenage Pregnancy TeamTTO To Take OutUCC Urgent Care Centre

UCSCs Urgent Care Sensitive ConditionsUHBT University Hospital Birmingham Trust

Vaccs & Imms Vaccinations and ImmunisationsVSM Very Senior ManagerWAN Wide Area NetworkWCC World Class CommissioningWIC Walk in Centre

WMAS West Midlands Ambulance ServiceWMCA West Midlands Combined Authority

WMHTAC West Midlands Health Technology Advisory CommitteeWMSCG West Midlands Strategic Commissioning GroupWMSSA West Midlands Specialised Services Agency

WTE Whole Time EquivalentYHC Young Health Champion