Meeting in Public of the Camden CCG Governing Body ... · James Wigg and Queens Crescent Practices Yes Yes No Direct GP Partner 15/11/2016 01/09/201512/06/2017 ... Care UK, HMP Pentonville

Meeting in Public of the Camden CCG Governing Body Wednesday 13 September 2017, 14:30 - 17:00 Committee Room 2, Civic Floor Camden Town Hall Judd Street WC1H 9JE

PART I AGENDA

Item Title Presenter Action Paper Time Page 1. Introduction 1.1 Apologies for Absence Dr Neel Gupta Note Verbal 14:30 -

1.2 Declarations of Interest Dr Neel Gupta Note 1.2 14:31 4

1.3 Declarations of Gifts and Hospitality Dr Neel Gupta Note 1.3 14:33 -

1.4 Minutes of the Previous Meeting Dr Neel Gupta Approve 1.4 14:35 7

1.5 Action Log

Dr Neel Gupta Note 1.5 14:40 19

2. Chair, Accountable Officer, Patient and Quality Reports 2.1 Chair’s Report Dr Neel Gupta Note 2.1 14:45 21

2.2 Accountable Officer’s Report Helen Pettersen

Note 2.2 14:50 25

2.3 The Patient Voice Report

Kathy Elliott Note 2.3 14:55 27

2.4 Quality and Clinical Effectiveness Report

Jane Davis Note 2.4 15:05 31

3. Strategy 3.1 System Intentions Paul Sinden Note 3.1 15:15 41

3.2 Primary Care Estates; Review and Refresh of Estates Strategy

Gordon Houliston

Note 3.2 15:25 51

4. Finance and Performance 4.1 Finance Report

Simon Goodwin

Note 4.1 15:40 59

4.2 Integrated Performance Report Charlotte Mullins

Note

4.2 15:50 69

5. Governance

5.1 Board Assurance Framework Ian Porter Note 5.1 16:00 95

5.2 Primary Care Co-Commissioning Paul Sinden Approve 5.2 16:10 105

5.3 Safeguarding Children’s Annual Report

Jackie Dyer Note 5.3 16:20 125

5.4 Health and Safety Annual Report Sarah Mansuralli

Note 5.4 16:30 159

6. Committee Reports – For Information

6.1 Finance and Performance Committee including Terms of Reference

Dr Birgit Curtis Approve/Note

6.1 16:35 163

6.2 Health and Wellbeing Board

173

6.3 Integrated Commissioning Committee

177

6.4 Localities Report

181

7. Any other Business 7.1 Draft Agenda November 2017 Meeting Dr Neel Gupta Note 7.1 16:45 184

8. Questions from the Public - Members of the public have the opportunity to ask questions relating to items that are on the agenda for this meeting.

9. Date of Future Meetings 8 November 2017 14:00 – 16:30pm

Register of Interests

A register of members’ interests is included with the papers and is available on the Camden CCG website:

http://www.camdenccg.nhs.uk

Definition of an Interest A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider

that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another

interest they hold”.

Managing conflicts of interests in the NHS: Guidance for staff and organisations 2017.

http://www.camdenccg.nhs.uk/

Trevor Myers Interim Director, Commissioning

& Contracting

Barry Moffatt Interim Deputy Chief

Finance Officer

Ian Porter Director Corporate

Services

Saloni Thakrar Healthwatch

Representative

Dr Martin Abbas GP Hilary Lance Patient Representative

Kathy Elliott Lay Member

Glenys Thornton Lay Member

Tyrieana Long Board Secretary

Jonathan Duffy Practice Manager

Dr Neel Gupta Chair

Dr Sarah Morgan GP

Helen Pettersen Accountable Officer

Dr Kevan Ritchie GP

Sarah Mansuralli Chief Operating Officer

Dr Philip Taylor GP

Simon Goodwin Chief Finance Officer

Jane Davis OBE Registered Nurse

Dr Birgit Curtis GP Dr Farah Jameel LMC Observer

Richard Lewin LA Representative

Simone Hensby Voluntary Action Camden

Cllr Richard Olszewski HWB Observer

Charlotte Mullins Director of Sustainable

Insights

Sally MacKinnon Transformation

Programme Director

Presenter

Table Plan - September 2017 Meeting

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Camden Clinical Commissioning Group Governing Body Members' Register of Interests 2017/18

Declared From Updated

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Non

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Prof

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Inte

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Non

-Fin

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Pers

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Inte

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Swiss Cottage Surgery Yes Yes No Direct Owner and GP Partner 16/12/2016 01/07/2007 13/6/2017Haverstock Healthcare Ltd Yes Yes No Direct Swiss Cottage Surgery is a shareholder 16/12/2016 01/07/2007 13/6/2017Swiss Cottage Private General Practice Yes Yes No Direct Owner and Shareholder 16/12/2016 01/01/2016 13/6/2017CHE Neighbourhood Yes Yes No Direct Swiss Cottage Surgery is affiliated to this neighbourhood 16/12/2016 01/08/2016 13/6/2017Cadence Minerals PLC Yes No No Direct Shareholder 16/12/2016 01/07/2014 13/6/2017Docmartin Residential Yes No No Direct Owner shareholder of property investment company 18/02/2017 13/6/2017Children's Trust Partnership No Yes No Indirect CCG Representative 16/12/2016 01/07/2014 13/6/2017North Camden Zone No Yes No Indirect CCG Representative 16/12/2016 01/07/2015 13/6/2017Camden Youth Foundation No Yes No Indirect CCG Representative 16/12/2016 01/08/2016 13/6/2017Central Health Evolution Limited Yes Yes No Direct Shareholder and Founding Member 22/03/2017 13/6/2017Hampstead Group Practice Yes Yes No Direct Nurse Practitioner 18/07/2017Haverstock Healthcare Limited Yes Yes No Direct Works at out of hours hub at weekend 18/07/2017Camden LMC No Yes No Direct Practice Nurse Representative, Not voting, observer role 18/07/2017Royal College of Nursing No Yes No Direct Member 18/07/2017West Hampstead Medical Centre Yes Yes No Direct GP Partner 14/12/2016 01/11/2012 05/07/2017Haverstock Healthcare Ltd Yes Yes No Direct West Hampstead Medical Centre is a shareholder 14/12/2016 01/11/2012 05/07/2017KCA Architects No No Yes Indirect Company Secretary and husband is a Director 14/12/2016 01/01/1998 05/07/2017Central Health Evolution Limited Yes Yes No Direct Shareholder 22/03/2017 05/07/2017Prince of Wales Group Practice Yes Yes No Direct Practice Manager 13/12/2016 12/06/2017SanKtus Welfare Project - Welfare Charity No No Yes Direct Treasurer 13/12/2016 12/06/2017

Dr Neel Gupta Elected GP and GB Chair The Keats Group Practice Yes Yes No Direct Salaried Employee 15/11/2016 01/08/2011 14/8/2017

James Wigg and Queens Crescent Practices Yes Yes No Direct GP Partner 15/11/2016 01/09/2015 12/06/2017Haverstock Healthcare Ltd Yes Yes No Direct Shareholder in GP Federation 15/11/2016 01/09/2015 12/06/2017Hampstead Group Partner Yes Yes No Direct Partner 29/11/2016 14/06/2017Haverstock Healthcare Ltd Yes Yes No Direct Shareholder in GP Federation 29/11/2016 14/06/2017CCAS Assessor Yes Yes No Direct GP Assessor 29/11/2016 14/06/2017Bloomsbury Surgery Yes Yes No Direct GP Partner 13/06/2017 13/06/2017Haverstock Healthcare Ltd Yes Yes No Direct GP Practice is a Member 13/06/2017 13/06/2017Central Health Evolution Limited Yes Yes No Direct GP Practice is a Member 13/06/2017 13/06/2017CCAS Assessor Yes Yes No Direct 2-4 sessions per month 13/06/2017 23/8/2017

Parliament Hill Medical Centre Yes Yes No DirectSalaried Employee. The partners at Parliament Hill Medical Centre are shareholders of Haverstock Health. 11/07/2017

Care UK, HMP Pentonville Yes Yes No Direct Salaried GP (1 day per week) 11/07/2017

Public Health England No No Yes IndirectPartner, Mr Peter Graham is a civil servant and works at Public Health England as a partnership marketing manager. 11/07/2017

Nature of InterestDeclared Interest- (Name of the organisation and nature of business)Name

Position (s) held- i.e. Governing Body, Member practice,

Employee or other

Date of InterestType of Interest

Is the interest direct or indirect?

Elected Voting Members

Jonathan Duffy Elected Practice Manager

Dr Jonathan Levy Elected GP Representative

Dr Sarah Morgan

Dr Kevan Ritchie Elected GP Representative

Dr Philip Taylor Elected GP Representative

Dr Martin Abbas Elected GP Representative

Dr Birgit Curtis Elected GP Representative

Elected GP Representative

Charlotte Cooley Elected Practice Nurse

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Director of Public Health Camden and IslingtonYes Yes No Direct Salaried Employee 15/11/2016 01/02/2013 12/06/2017Vice-chair of London Association of Directors of Public Health No Yes No Direct 15/11/2016 01/01/2014 12/06/2017Lewisham and Greenwich NHS Trust Yes Yes No Direct Paediatric Registrar 15/11/2016 01/03/2013 12/06/2017Welbodi Partnership - registered UK Charity No No Yes Direct Board Member 15/11/2016 08/08/2008 12/06/2017

Kings College London No No No Indirect

Wife is a research fellow which is funded by the NHS National Institute of Health Research and Tommy's Charitable Trust 15/11/2016 01/10/2014 12/06/2017

Nursing and Midwifery Council No Yes No Direct Registrant Panellist for the Conduct and Competence Panels 16/11/2016 01/02/2013 12/06/2017The Order of St John Priory Group for Greater London No No Yes Direct Member 29/03/2017 12/06/2017Caversham Group Practice No Yes No Direct Member of the Patient Participation Group 12/12/2016 13/06/2017Kaeconsulting - independent consultancy Yes No No Direct Owner/Director 12/12/2016 13/06/2017UK Public Health Register (UKPHR) No Yes No Direct Assessor and Chair of the Registration Panel 12/12/2016 13/06/2017Faculty of Public Health No Yes No Direct Member 12/12/2016 13/06/2017PHAST - public health consultancy No Yes No Direct Associate 12/12/2016 13/06/2017

Simon Goodwin Chief Finance Officer, NCL CCGs East London NHS Foundation Trust Yes No No Indirect Wife is a senior manager 14/06/2017 14/06/2017

Helen PettersenAccountable Officer, NCL CCGs and NCL STP Convenor No declared interests Nil return 05/04/2017

Richard Strang Lay Member Tavistock and Portman NHS Foundation TrustNo Yes Yes Direct Former Non-Executive Director 31/07/2017

Young Foundation Yes Yes No Direct Chief Executive Officer 09/08/2017Member of the House of Lords Yes Yes No Direct Baroness Thornton - Labour and Co-operative Member 09/08/2017 23/07/1998

London School of Economics No Yes Yes Direct Emeritus Governor 09/08/2017

Social Enterprise UK No Yes Yes Direct Patron 09/08/2017

Healthcare and Assistive Technology Society No Yes Yes Direct Chair of the Advisory Panel and Patron 09/08/2017

Camden LMC No Yes No Direct Chair 20/09/2016 18/06/2017

Camden, Barnet and Brent GP Practices Yes Yes No DirectLocum GP working across multiple GP practices and GP Appraiser (paid work) 18/01/2017 18/06/2017

Medical Women's Federation No Yes No Direct Trustee - unpaid 18/01/2017 18/06/2017UK General Practitioners Committee Yes Yes No Direct Elected Member - paid honoraria for attendance 18/01/2017 18/06/2017

NHS Digital Yes Yes No Indirect

Husband is a member of an advisory panel for e-Consult and is currently seconded to NHS Digital as a national medical director clinical fellow 18/01/2017 18/06/2017

Pulse Live Conferences Yes Yes No Direct Speaker - paid honoraria 18/01/2017 18/06/2017Medical Student OSCE examiner Yes Yes No Direct Paid for work completed 18/01/2017 18/06/2017

Simone Hensby Voluntary Sector Representative Voluntary Action Camden Yes Yes No Direct Executive Director 19/12/2016 18/06/2017

Camden Patient & Public Engagement Group No Yes Yes Direct Chair 16/08/2017 14/08/2017

Adelaide Medical Centre No Yes Yes Direct Chair of Patient Participation Group 16/08/2017London Borough of Camden Yes Yes No Direct Director of Integrated Commissioning 23/11/2016 13/06/2017Camden Schools Project Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017Camden BSF SPV Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017Camden SPV Holdings Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017Cabinet Member for Health and Adult Social Care Yes Yes No Direct Councillor, Camden Borough Council 22/11/2016The Altitude Consultancy Ltd Yes Yes No Direct Owner/Director - 50% shareholding 22/11/2016Royal Borough of Kensington and Chelsea Yes No No Indirect Partner is a Local Government Officer 22/11/2016

Lay Member

Jane Davis OBE Registered Nurse

Richard Lewin Local Authority Representative

Dr Farah Jameel LMC Observer

Glenys Thornton Lay Member

Hilary Lance Patient Representative

Richard Olszewski Health and Wellbeing Board Observer

Non-Voting Members

Appointed Voting Members

Julie Billett Public Health Representative

Dr Mathew Clark Secondary Care Doctor

Kathy Elliott

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Labour Party No Yes Yes Direct Member 22/11/2016Co-operative Party No Yes Yes Direct Member 22/11/2016Community Trade Union No Yes Yes Direct Member 22/11/2016West Hampstead Amenity & Transport Group No Yes Yes Direct Member 22/11/2016West Hampstead Community Centre No Yes Yes Direct Member 22/11/2016West Hampstead Branch Labour Party No Yes Yes Direct Treasurer 22/11/2016Fabian Society No Yes Yes Direct Member 22/11/2016Progress No Yes Yes Direct Member 22/11/2016Camden Healthwatch No Yes No Direct Chair 29/06/2017 12/07/2017Chomley Garden Surgery Practice No Yes No Direct Patient Participation Group Representative 06/01/2016 12/07/2017UK National Thalassemia and Sickle Cell Group (NHS England) No Yes No Direct Lay Member 06/01/2016 12/07/2017Ambassador Little Village Charity No No Yes Direct 12/07/2017 12/07/2017Camden Reach Pregnancy Project Yes Yes No Direct Project Coordinator 12/07/2017 12/07/2017London Antenatal Screening Programme No Yes No Direct Lay Member representative 12/07/2017 12/07/2017

Mike Cooke Chief Executive No interests declared Nil return 21/11/2016 28/06/2017Sally MacKinnon Transformation Programme DirectorChange the Record Management ConsultancyNo No Yes Indirect Executive Director. Company owned by husband David

MacKinnon 25/11/2016 01/10/2014 20/06/2017Sarah Mansuralli Chief Operating Officer No interests declared Nil return 12/06/2017 12/06/2017Barry Moffatt Interim Chief Finance Officer No interests declared Nil return 14/08/2017Charlotte Mullins Director of Sustainable Insights No interests declared Nil return 28/11/2016 13/06/2017Trevor Myers Interim Director of Commissioning

and ContractingGoosegate Consultancy Ltd Yes Yes No Direct Director

04/09/2017Ian Porter Director of Corporate Services No interests declared Nil return 14/11/2016 16/06/2017Neeshma Shah Director of Quality and Clinical

EffectivenessIndependent consultant Yes Yes No Direct Occasional ad hoc consultancy work on sole trader basis on

subject matter relating to medicine, the pharmacy profession and the health and social care landscape 25/11/2016 24/04/2013 18/06/2017

Saloni Thakrar Healthwatch Representative

Richard Olszewski Health and Wellbeing Board Observer

Attendees

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Agenda Item 1.4

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CAMDEN CLINICAL COMMISSIONING GROUP GOVERNING BODY

Minutes of the Part 1 Meeting held on Wednesday, 12 July 2017

The Wesley Hotel, 81-103 Euston Street, London, NW1 2EZ Present: Elected Voting Members: Dr Neel Gupta Chair Dr Martin Abbas Elected GP Representative Dr Birgit Curtis Elected GP Representative Dr Jonathan Duffy Elected Practice Manager Dr Jonathan Levy Elected GP Representative Dr Sarah Morgan Elected GP Representative Dr Kevan Ritchie Elected GP Representative Dr Philip Taylor Elected GP Representative Appointed Voting Members: Ms Julie Billett Director of Public Health, Camden and Islington Borough Councils Dr Matthew Clark Secondary Care Clinician Ms Kathy Elliott Lay Member Mr Simon Goodwin Chief Finance Officer, NCL CCGs Ms Judith Hunt OBE Lay Member and Acting Vice-Chair Ms Helen Pettersen Accountable Officer, NCL CCGs Mr Richard Strang Lay Member Non-Voting Members: Mr Leon Douglas Patient Representative Mr Richard Lewin Local Authority Representative, London Borough of Camden (LBC) Dr Farah Jameel LMC Observer Ms Saloni Thakrar Healthwatch Representative In Attendance: Ms Jo Courtenay Former Elected Practice Nurse (item 2.3) Ms Rachel De Souza Senior Communications and Engagement Manager Mr Emdad Haque Senior Equality and Diversity Inclusion Manager (item 5.4) Ms Lucy Flaws Strategic Commissioner, LBC (item 3.2) Mr Robert Hudson Interim Deputy Chief Finance Officer Ms Tyrieana Long Board Secretary, Camden CCG Ms Sally MacKinnon Transformation Programme Director, Camden CCG Ms Sarah Mansuralli Chief Operating Officer, Camden CCG Ms Charlotte Mullins Director of Sustainable Insights Partnerships, Camden CCG Mr Ian Porter Director of Corporate Services, Camden CCG Ms Neeshma Shah Director of Quality and Clinical Effectiveness, Camden CCG Mr Andrew Spicer Head of Governance and Risk, NCL CCGs (item 3.3)

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1. Introduction 1.1 Ratification of Terms of Office 1.1.1 Judith Hunt announced the results of the elections that had been held to select new

Governing Body members including the position of Chair. The elections had been conducted in accordance with the CCG’s constitution and to ensure transparency and fairness the ballot was administered and run by the Electoral Reform Society, an independent organisation specialising in public sector election.

1.1.2 The results of the election were:

Practice Nurse Representative Ms Charlotte Cooley GP Representatives Dr Martin Abbas Dr Neel Gupta Dr Jonathan Levy Dr Sarah Morgan Dr Kevan Ritchie Dr Philip Taylor Chair Dr Neel Gupta

1.1.3 The Governing Body agreed to ratify the election results and noted that the successful

candidates would hold office for a period of three years from 12 July 2017. 1.1.4 Chair’s Opening Remarks Dr Neel Gupta said that he was honoured to be the Chair of Camden CCG and it was a

somewhat daunting honour to follow on from Dr Caz Sayer who had been a tremendous ambassador for Camden and who was extremely well respected locally. He thanked Caz for the personal encouragement and support that she had provided in recent years.

1.1.5 The Chair also paid tribute to other outgoing colleagues, Jo Courtenay, Dr Ammara Hughes

and Dr Lance Saker who had served 6 years as Governing Body members and had made a major contribution to the development and success of the CCG.

1.1.6 The Chair drew attention to the CCG’s innovative and collaborative history which he hoped

would continue in spite of the challenging financial position. He said that there would be some difficult discussions ahead regarding service provision and the CCG would need to be judicious in its commissioning decisions. There were also opportunities and the Chair asked the Governing Body to work with him to achieve the best value for money.

1.2 Apologies 1.2.1 Apologies were received from Mike Cooke, Charlotte Cooley, Jane Davis and Simone

Hensby. 1.3 Declaration of Interests 1.3.1 There were no new declarations of interest. 1.4 Declarations of Gifts and Hospitality 1.4.1 There were no declarations of gifts or hospitality.

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1.5 Minutes of the Meeting held on 10 May 2017 1.5.1 The Governing Body considered the minutes of the meeting held on 10 May. It was noted that

Charlotte Mullins had also given apologies for the May meeting. 1.5.2 Subject to the above amendment the Governing Body agreed that the minutes of the

meeting held on 10 May 2017 were a true record. 1.6 Action Log 1.6.1 The Governing Body considered the updates on the actions arising from the previous

meeting. 1.6.2 With regard to the first action point, Neeshma Shah confirmed that follow up action had been

completed in respect of long waiting times for blood tests at South Camden Centre for Health and that the CQRG would continue to have oversight.

1.6.3 With regard to the second action point, Charlotte Mullins advised that the Commissioning

Support Unit had now been assured of the data quality submitted by the Royal Free London and the information breach had been stood down. In addition the necessary processes were in place to assure data at the Royal Free and Barnet hospitals.

1.6.4 The Governing Body noted the updates in respect of actions three and four. It was agreed

that the Integrated Commissioning Committee receive further update reports regarding Learning Disability patients.

1.6.5 The Governing Body agreed to note the Action Log. 2. Accountable Officer, Patient and Quality Reports 2.1 Accountable Officer’s Report 2.1.1 Helen Pettersen also paid tribute to the contributions made by the departing Governing Body

members and welcomed Simon Goodwin and Sarah Mansuralli who were both attending the meeting for the first time.

2.1.2 With the exception of Enfield CCG all of the Chief Operating Officer posts across NCL had

been filled substantively. 2.1.3 Helen Pettersen drew attention to the dedicated email address that had been established for

Camden general practices for questions or queries relating to residents affected by the evacuation from the Chalcots Estate.

2.1.4 Richard Lewin advised that a total of 641 households had been affected and he thanked the

CCG and clinical colleagues for their support at a very busy time for the Council. 2.1.5 The Governing Body agreed to note the Accountable Officer’s Report. 2.2 The Patient Voice Report 2.2.1 Kathy Elliott introduced the Patient Voice Report and highlighted:

a) The presentation delivered by Camden and Islington NHS Foundation Trust on patient experience and engagement.

b) Good attendance at the PPG Forum which had been established to share best practice, to celebrate success and to support dialogue between PPGs, CPPEG and the CCG.

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c) The agenda items at the PPG Forum which had been requested by PPG members, including GP Neighbourhood development, PPG success stories and the Camden Local Care Strategy.

2.2.2 Leon Douglas followed on with a patient story based on a real Camden experience set within

the context of helping the Governing Body design and commission safe services as part of the Local Care Strategy and within the geography of the Sustainability and Transformation Plan.

2.2.3 The patient is a gentleman in his 50’s who is on blooding thinning medication following

previous complications related to Pulmonary Emboli. He attended the Emergency Department of one of our local providers with a fracture and during the course of his treatment received pain relief consisting of aspirin which in his case was contraindicated given his regular medicines.

2.3.4 The information was available to clinicians to prevent this occurrence but the way the

processes and clinical care are currently designed meant that the incident still happened. The opportunity for this to happen in a potentially less information rich community setting, as the Local Care Strategy proposes, is high and the Governing Body was asked to consider the need to be especially vigilant in the design and implementation phases to ensure care is safe and effective and designs out these opportunities for error.

2.3.5 The Chair welcomed the patient story and having systems in place to provide the right care at

the point of care. 2.3.6 Dr Martin Abbas asked how CPPEG members had responded to the Finance and QIPP

update and how patients could support the CCG with efficiency savings. Kathy Elliott advised that CPPEG members were nervous about the financial climate and the potential impact on service provision. The presentation had lacked a clinical perspective and patients had struggled to grasp the financial details.

2.3.7 Helen Pettersen said that it was important that clinicians were present when communicating

to patients about clinical change and to focus on what the changes might mean for service users, which were not always negative in spite of the financial pressures. Clear and transparent communication was also emphasised.

2.3.8 Dr Kevan Ritchie highlighted the need to involve patients in the development of

Neighbourhoods, Care Closer to Home Integrated Networks (CHINs) and Quality Improvement Support Teams (QISTs). He asked that a structure was put in place to coordinate and facilitate engagement activities. The Chair endorsed CPPEG’s role to involve patients and capture feedback in relation to the primary care improvement work and asked that the engagement work was strengthened. Action 1: Ian Porter to follow up on involving patients in primary care developments.

2.3.9 The Governing Body agreed to note the Patient Voice Report. 2.4 Quality and Clinical Effectiveness Report 2.4.1 Jo Courtenay introduced the Quality and Safety Report and highlighted the reported

avoidable harm issues: University College London Hospitals NHS Foundation Trust (UCLH)

One case of MRSA bacteraemia reported in April. Learning points associated with the care and on-going management of vascular devices had been implemented.

Royal Free London Foundation Trust (RFL)

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The Trust reported one Never Event in April 2017. This incident occurred in October 2016, resulting from an unnecessary endoscopy procedure, due to an error on the booking list. Advice was sought from NHS England by the Trust and lead commissioner to ascertain if this incident met the SI criteria, hence the delay in reporting.

Commissioners were informed of thirteen Serious Incidents which occurred within the maternity division, arising from the admission of new born babies to the Neonatal Unit for cooling. An external review have been undertaken, which identified care and service delivery problems in three of the thirteen cases reviewed.

2.4.2 Jo Courtenay also drew attention to:

a) Concerns raised by local GPs regarding the alignment of UCLH’s Discharge Policy

with national guidance. The concerns had ben escalated and discussions were ongoing with the Trust to ensure adherence to national standards and relevant policies.

b) Camden and Islington Foundation Trust’s good progress against the CQC action plan, with evidence of assurance regarding the CQC domains of safety and being well led provided to the Clinical Quality Review Group in May 2017.

c) The Remedial Action Plan that had been developed by the Tavistock and Portman Foundation Trust in response to the Contract Performance Notice (CPN) that had been issued in April 2017 regarding two Serious Incidents that had not been reported to the patient safety team. It was anticipated that the CPN would now be closed.

d) Concerns about InHealth’s management of Serious Incidents and lack of engagement of their senior clinical and governance staff at commissioner review meetings.

e) The Looked After Children (LAC) annual report and strong performance by the LAC health team.

2.4.3 Helen Pettersen congratulated the Looked After Children health team for the excellent

performance that had been achieved in 2016/17. 2.4.4 Dr Matthew Clark asked about the serious incidents reported at Barnet Hospital. It was

confirmed that Barnet CCG had conducted an assurance visit to the Trust on 29 June and the outcome had been reported to Clinical Quality Review Group. Assurances had been provided regarding appropriate escalation and handling of the serious incidents that had occurred.

2.4.5 Saloni Thakrar asked for an update on the NHS England national review of medicines and the

safeguards in place to protect vulnerable groups. It was confirmed that the review had paused owing to the General Election but information about the scope of the review was in the public domain. Dr Farah Jameel advised that the review had been discussed by the national GP Committee.

2.4.6 The Governing Body agreed to note the Quality and Safety Report. 3. Strategy 3.1 North London Partners in Health Care Sustainability and Transformation Plan 3.1.1

Helen Pettersen introduced the latest version of the North London Partners in Health Care Sustainability and Transformation Plan (STP) which had been published in June 2017.

3.1.2 The updated plan confirms the vision submitted to NHS England in October 2016 and the

more granular details of the planning carried out in the last six months. Although a commitment was made to publish the STP in the interests of openness and transparency it was acknowledged that it was a technical planning document and not especially reader friendly. A public facing summary of the STP written in plain English was therefore being produced.

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3.1.3 Helen Pettersen advised that in line with other STPs the NCL STP had been renamed to reflect the partnership of health and care organisations.

3.1.4 With regard to the overall NHS financial position, CCGs and Trusts were being asked to work

together to balance the budget and deliver efficiency savings. The financial gap in North Central London (NCL) for commissioners and providers was £60m. The STP does not balance the finances in the coming financial year or by 2020/21 and NCL has been identified by NHS England and NHS Improvement as the area with the largest overspend.

3.1.5 Helen Pettersen advised that there were significant pressures on budgets in 2017/18.

However analysis had shown that to bring the health system into balance was unachievable in one financial year and it would affect quality and access to services and also the range of services offered to patients. As a result no action will be taken in this financial year and the £60m gap, which was largely attributable to the providers, would remain. Commissioners and providers were being asked to focus on the delivery of existing QIPP plans.

3.1.6 The Chair invited questions on the STP. The Governing Body:

a) Welcomed the high level strategy b) Questioned whether the plan to bring together the funding currently used for Local

Commissioned Services (LCS) and the premium spent on Personal Medical Services to establish a single LCS contract framework for NCL had been agreed.

Action 2: Helen Pettersen to look into history to find out what had been discussed and agreed and by whom. c) Noted that NHS England had delegated the commissioning of the PMS premium to

CCGs. d) Noted that the Control Total gap for NCL was £61m and with around another £50m of

unidentified income/CIPs/QIPP, with high risk CIPs/QIPPs being in addition to these two numbers. NHS England (NHSE) and NHS Improvement (NHSI) seem to be accepting of current plans, but have not formally approved them. Discussions are ongoing with NHSE and NHSI with regard to 2017/18 and also taking into account what 2018/19 might look like.

e) Noted the arrangements in place to remove the potential for silo working in the programme management of the STP, with the mapping of interdependencies across workstreams and oversight by the NCL senior management team to remove duplication and share best practice from the CCGs.

f) Welcomed the sharing of good practice across the CCGs to save time and resources. g) Noted that each CCG had contributed £300k to the STP programme and the overall

programme management resource was relatively small. CCGs were involved on an equitable basis and “fastest first” models were in place to achieve value for money. The Chair requested a breakdown of how this money was being spent in order to evidence value for money along with a summary of the STP programme structures and teams in order to ensure that contribution from CCGs was equitable. Action 3: Helen Pettersen

h) Identified that the STP did not adequately convey the continuity in accessing services which was an important aspect for patients and especially in relation to the avoidance of hospital admissions.

i) Identified that sufficient funding was needed to implement the health and care closer to home model and to train the appropriate staff.

j) Noted the Integrated Personal Commissioning site initiative and concerns about the potential for silo working.

k) Noted the plans for access to diagnostics and improved cancer diagnoses. Caution was identified in relation to the delivery of associated QIPP savings.

l) Noted the lack of GPs was a key workforce risk and the difficulties in recruiting clinical staff which was a risk for the delivery of care in the community.

m) Noted that the STP was continuing to evolve and there was good communication and collaboration taking place locally.

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3.1.7 The Governing Body agreed to:

Note the reframing of the STP partnership of health & care organisations: North London Partners in Health & Care

Ratify the North London Partners in Health & Care Sustainability and Transformation Plan

Note the intention to produce a plain English public summary of the plan Note the commitment to continue to work with NHS England and NHS

Improvement to produce a set of achievable financial plans for 2017/18 as part of the Capped Expenditure Process

3.2 Camden Better Care Fund 2017-19 3.2.1 Richard Lewin introduced a report on the Better Care Fund (BCF) which had been considered

by the Integrated Commissioning Committee and had recommended approval of the proposed budget allocation of the 2017-19 BCF plan.

3.2.2 Following significant delay the national BCF guidance was published on 4 July and the final

narrative plan is due to be submitted to NHS England on 11 September 2017. The Local Government Association (LGA) had subsequently withdrawn its support for the guidance due to concerns about the targets for Delayed Transfers of Care and the potential impact of failing to meet these targets on future years funding for social care.

3.2.3 On the basis of the above and the fact that some key information was also still being

established, the Chair agreed with the Governing Body that this item would be for discussion only and no decisions would be made at this meeting including approval of the proposed budget allocation for 2017-19.

3.2.4 Richard Lewin explained the funding sources for the BCF which were:

the nationally mandated CCG minimum contribution of £18.371m the new recurring Improved Better Care Fund allocation of £0.778m a non-recurring £5.814m announced in the 2017 spring budget a Disabled Facilities Grant of £0.791m and capital and revenue reserves of £1.589m

The total for the BCF was £27.343m and the Governing Body was being asked to approve the proposed revenue investment plan and in line with the CCG’s governance arrangements to delegate approval for the signing of the final BCF narrative plan.

3.2.5 Historically the Camden Better Care Fund has changed over time to meet the requirements of

national policy and conditions set by NHS England. The original BCF allocations incorporated existing S256 pooled budgets (transferred funds from the CCG to Local Authority to enable the LA to perform functions on its behalf) and transferred funds from the Primary Care Trust, which otherwise didn’t meet the criteria of the BCF or relate to delivery against the national metrics. As such, it represents a mix of pre-existing and new integrated services.

3.2.6 The Integrated Commissioning Committee (ICC) recommended that all BCF schemes align

with the most recent national metrics and in response a rapid review of schemes using a range of available data has been undertaken by each of the programme leads to provide assurance and options to the ICC. The categories of schemes were highlighted in the report as well as those schemes where the fit to the national wasn’t as clear and more work was needed to understand outcomes for Camden residents from the social and health care budgets that had been allocated.

3.2.7 Richard Lewin advised that the additional funding of £6.5m in 2016/17 had been allocated to

local authorities to stabilise the local adult social care provider market, to reduce instances of delayed transfers and to support care for people to remain at home.

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Agenda Item 1.4

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3.2.8 The Governing Body

a) Welcomed the detailed report that had been provided and thorough discussions that had taken place at the ICC to understand all of the BCF schemes.

b) Emphasised the importance of evidence and involving Public Health in the understanding of data to examine impact of the BCF services.

c) Identified that the BCF was part of the wider health care system and could focus on prevention and self-care initiatives.

d) Noted that Safeguarding Training was not a good fit with the BCF and the funding could be reallocated to other areas but this was a mandatory CCG requirement that might need to be funded from elsewhere

e) Noted that historically it had been difficult to link individual initiatives with specific outcome metrics and there was evidence of some duplication of schemes, for example reablement.

f) Noted the ongoing work to review BCF schemes and to evidence activity and value for money.


Note the timeline of existing reviews set out in the report and Appendix B, Note that the Integrated Commissioning Committee (ICC) will consider and approve

options in regard to unallocated funds in year. The instigation of Chair’s Actions in line with the CCG’s Constitution to delegate

approval of: a) The final BCF narrative plan at the appropriate time in September. b) The budget allocation of the BCF plan 2017-19 , subject to further existing reviews or

new reviews where the ICC has agreed that schemes do not appear to provide value for money or align sufficiently to the four proposed national metrics

c) The proposed funding allocations of the Improved Better Care fund (iBCF) grant to local authorities to support social care sustainability.

To ensure robust decision making around these areas it was agreed that the NCL CFO, Simon Goodwin, and the Chair of the ICC Dr Matthew Clark, would also be part of these approval decisions.

3.3 North Central London Joint Commissioning Committee 3.3.1 The Governing Body received an update report on the NCL Joint Commissioning Committee

which had met for the first time on 6 July. Helen Petersen advised that the report recommended some minor changes to the Committee’s terms of reference and some recommendations around the role of the three independent clinical advisors.

3.3.2 Dr Farah Jameel noted that there was no LMC representation on the Committee and said that

it would be helpful to have representation from general practice. Helen Pettersen confirmed that the NCL Joint Commissioning Committee held meetings in public and the LMC were welcome to attend. She agreed to consider the request. Action 4: Helen Pettersen


Note the report Approve the amended Terms of Reference and Standing Orders and Approve the recommended changes to the nature and role of the three independent clinical

advisors.

4. Finance and Performance 4.1 Integrated Performance Report 4.1.1 Charlotte Mullins highlighted the key performance issues from the June 2017 Integrated

Performance Report (IPR). These were:

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Agenda Item 1.4

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a) Contract Performance Notices issued to UCLH for 62 day cancer waits and A&E 4

hour waits. Remedial Action Plans for 2017/18 had been agreed with the Trust and would be monitored by the Clinical Quality Review Group.

b) One incidence of a patient waiting for treatment over 52 weeks. Imperial Hospital had been alerted.

c) UCLH’s A&E performance which relatively good in comparison to other NCL providers but was below the national standard.

d) Camden CCG’s e-referral rate of 44% which was below expectations and was a reflection of the data quality issues at the Royal Free which had impacted on the performance standard.

4.1.2 In discussion the Governing Body:

a) Identified that the IPR could report on other waiting times such as access to community services and CAMHS waiting times. Action 5: Charlotte Mullins to add other relevant waiting time information to the IPR.

b) Noted the under performance in the IAPT recovery rate which was felt to relate to a national data reporting issue.

c) Noted that the good progress that had been made with the data quality issues at the Royal Free and that the Finance and Performance Committee continued to monitor the situation.

d) Welcomed the Value Chains that had been presented the report which could be shared more widely.

e) Welcomed the good working relationship which had been forged with UCLH and the ongoing open discussions regarding cancer waiting times and A&E performance.

4.1.3 The Governing Body agreed to note the contents of the Integrated Performance Report. 4.2 Finance and QIPP Report 4.2.1 Simon Goodwin introduced the above report and confirmed that the CCG was on track to

meet its control total at the end of the year, although it was early in the new financial year and the data was unreliable.

4.2.2 He acknowledged the large QIPP target for Camden CCG and advised there was an

additional cost pressure of £2m arising from the delegated primary care commissioning budget from NHS England. A paper would come to the Governing Body in due course with proposals to find a solution to the shortfall in funding.

4.2.3 Simon Goodwin also advised that the Governing Body would also be asked to consider a

resolution for a £2m shortfall at Enfield CCG and what NCL can do as a whole to balance the budget.

4.2.2 In response to a question from Dr Matthew Clark about activity levels, Simon Goodwin

advised that although the activity data was not sufficiently robust, the current overspend was not above the levels held in reserve.

4.2.3 The Governing Body agreed to note the Finance and QIPP Report.

5. Governance 5.1 Localities Report 5.1.1 Dr Birgit Curtis presented the Localities Report which was taken as read.

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5.1.2 A query was raised regarding the acute contract changes in connection with late cancer diagnosis in primary care. Dr Curtis agreed to follow-up with Dr Imogen Staveley for additional clarification and also to circulate the root cause analysis work. Action 6: Ian Porter

5.1.3 The Governing Body agreed to note the Localities Report. 5.2 Board Assurance Framework 5.2.1 Judith Hunt introduced the Board Assurance Framework (BAF) and advised that no new risks

had been added to the BAF since the last Governing Body meeting. 5.2.2 Further to the request at the last meeting risk 382 had been updated to reflect the impact of

the STP in the delivery of QIPP targets. A reduced risk level was reported in relation to the transition risk and new risk owners had been assigned following the changes at senior management level.

5.2.3 Neeshma Shah advised that further assurances had been provided in connection with the

Continuing Healthcare risk and in the light of work being undertaken at NCL level it was anticipated that the risk could be removed from the BAF.

5.2.4 Matthew Clark highlighted acute activity and its potential impact on the delivery of QIPP in the

event of over performance. He requested visibility and monitoring of this risk and it was agreed that it would be added to the BAF. Action 7: Ian Porter

5.2.5 Leon Douglas highlighted two potential areas of risk in relation to:

Objective E – The degree to which the relationship between the STP and Local Care Strategy would impact on the working jointly with the people and patients of Camden to shape commissioned services. Objective H – Vacancy rates and the use of interim staff and the risk of having the necessary capacity and staffing resource to deliver the organisation’s objectives. The Chair asked that the highlighted risks were reflected in the BAF. Action: 8 Ian Porter

5.2.6 The Governing Body agreed to note the Board Assurance Framework. 5.3 Emergency Preparedness and Business Continuity Report 2016/17 5.3.1 Ian Porter introduced the above report and confirmed that there had been no major incidents

during 2016/17. 5.3.2 The annual report confirmed the CCG’s compliance with the statutory emergency planning

and business continuity activities. The priority actions for the CCG in 2017/18 were highlighted.

5.3.3 The Governing Body agreed to note the Emergency Preparedness and Business

Continuity Report and thanked Ian Porter and the team for their work. 5.4 Equality Information Report 2016/17 5.3.1 Judith Hunt introduced the above report and advised that the CCG continued to pay

significant attention to equality issues. Under the provisions of the Equality Act 2010 the CCG is required to produce equality information to demonstrate how it is meeting the public sector equality duty.

5.3.2 Camden has a diverse population which transitions quickly. The report confirms the progress

made with regard to the Diversity and Inclusion Plan which is owned by the Executive Management Team. The CCG continues to advance equality for diverse groups and in particular significant improvement has been made in in recruiting BME employees in the last year.

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5.3.3 Judith Hunt thanked Emdad Haque, Martin Emery and Ian Porter for their equality work and

support. 5.3.4 Ian Porter drew attention to the progress that had been made in advancing the CCG’s

equality work and the focus on the Local Care Strategy. More work was planned to support GP practices and providers and to work collaboratively with partners.

5.3.5 Dr Jonathan Levy thanked Healthwatch for their engagement work with GP practices. Saloni

Thakrar welcomed the report and the inclusion of the information for disability groups. She advised that a new workforce disability equality standard would be introduced in 2018.

5.3.6 The Governing Body agreed to approve the 2016/17 Equality Information Report and its

publication in due course. 6. Committee Reports

6.1 Audit Committee Annual Report 6.1.1 The above report was taken as read. Judith Hunt paid tribute to the CCG’s and CSU’s

Finance Team for their continued hard work and positive Audit outcome during a challenging year of change. No red rated internal audit reports had been received during the year.

6.1.2 Judith Hunt welcomed Richard Strang as the new Audit Chair. 6.1.3 The Governing Body agreed to note the Audit Committee Annual Report. 6.2 Finance and Performance Committee Report and Terms of Reference 6.2.1 The Governing Body received proposed revisions to the terms of reference for the Finance

and Performance Committee. These were in relation to quorum requirements, membership and voting.

6.2.2 The Committee Report was taken as read. A request was made for a communication to be

made to GP practices regarding the reimbursement of quadrivalent flu vaccines as reported. Action 8: Ian Porter

6.3 Integrated Commissioning Committee Report 6.3.1 The above report was taken as read. Dr Mathew Clark was confirmed as the new Chair of the

Committee. 6.3.2 The Governing Body agreed to note the Integrated Commissioning Committee Report. 6.4 Procurement Committee Report 6.4.1 The above report was taken as read. 6.4.2 The Governing Body agreed to note the Procurement Committee Report.

7. Any Other Business 7.1 Draft September 2017 Meeting Agenda 7.1.1 The Governing Body agreed to note the planned agenda items for the September 2017

Governing Body meeting.

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7.1.2 Dr Farah Jameel advised that the General Practitioners Committee planned to ballot GPs on

collectively closing their lists which and there had discussed a national ballot of GPs. The Chair requested follow-up action with the NCL Primary Care Committee to prepare for potential list closures in Camden GP practices. Action 9: Ian Porter

8. Questions from the Public 8.1 There were no public questions. 8.2 Farewell 8.2.1 The Chair announced that it was the final Governing Body meeting for Judith Hunt who had

served as a Lay Member on the Governing Body since September 2013. In her time at Camden CCG Judith had served on a number of Committees, including being Chair of the Remuneration Committee and the Audit Committee and in the last year had been the Vice Chair. Judith had also led on public and patient engagement and the CCG’s equality work.

8.2.2 The Chair highlighted Judith’s knowledge of Camden and the public sector and local

government expertise she had brought to the role. He thanked Judith for the contribution she had made and said she would be missed.

8.2.3 Judith Hunt thanked Neel for his warm words and said that it had been an interesting and

pleasurable four years. It had been especially challenging in the last year with just two lay members and she thanked Kathy Elliott for her support. She encouraged the Governing Body to keep going forward and said that she too would miss everyone.

8.3 Meeting Close 8.3.1 There was no further business. The Chair closed the meeting at 15:20pm.

These minutes are agreed to be a correct record of the Part 1 meeting of Camden Clinical Commissioning Group held on 12 July 2017

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

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Agenda Item: 1.5

CAMDEN CLINICAL COMMISSIONING GROUP GOVERNING BODY 2017 ACTION LOG - PART 1

Meeting Date Action No.

Action Lead Deadline Update

12 July 1 Patient Voice Report Work with GP practices to facilitate patient engagement in the development of Neighbourhoods and Care Close to Home Integrated Networks (CHINs).

Ian Porter September 2017

A neighbourhoods discussion pack has been produced by the CCG to assist practices with patient engagement activity. The CCG is in discussion with neighbourhood leads to identify further support to involve patients in the development and delivery of initial services. The CCG is attending the September CPPEG meeting to discuss neighbourhood development and answer questions.

12 July 2 North London Partners in Health & Care STP Report back on the history to find out what had been discussed and agreed regarding the plan to bring together the funding currently used for Locally Commissioned Services (LCS) and the premium spent on Personal Medical Services to establish a single LCS contract for all of North London (p21 of STP).

Helen Pettersen

September 2017

A verbal update will be provided at the meeting.

12 July 3 North London Partners in Health & Care STP Provide a breakdown of STP programme spend in order to evidence value for money. Also provide a summary of the STP programme structures and teams to ensure contribution from CCGs is equitable.

Helen Pettersen

September 2017

A paper was circulated separately to all GB members on 6.9.2017.

12 July 4 NCL Joint Commissioning Committee Consider the inclusion of an LMC member on the NCL JCC to represent general practice.

Helen Pettersen

September 2017

A verbal update will be provided at the meeting.

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Agenda Item: 1.5 12 July 5

Integrated Performance Report Add additional performance measures to the IPR in respect of CAHMS waiting times and access to community services.

Charlotte Mullins

September 2017

Completed. The additional performance measures are now included within the IPR.

12 July 6 Localities Report Circulate the root cause analysis work regarding cancer diagnosis in primary care to GPs.


Completed. The information was circulated with the September Locality papers.

12 July 7 Risk Register Add acute over performance to the Risk Register.


The acute over performance risk has been reviewed and is being monitored by the Finance and Performance Committee.

12 July

8 Risk Register Ensure that the risks highlighted in respect of strategic objectives E and H are reflected in the BAF


The risks that were highlighted in relation to the STP and HR have been considered and are being monitored at directorate level.

12 July 9 Finance and Performance Committee Communicate information on flu vaccines to GP practices.


This is being actioned by the GP Web Team.

12 July

10 Primary Care National Ballot Liaise with the NCL Primary Care Committee about the planned national ballot of GPs and prepare for possible closure of lists in Camden.


Completed. This matter was raised with the Committee’s secretariat team.

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Camden Clinical Commissioning Group Governing Body Meeting 13 September 2017

Report Title Chair’s Report Agenda Item 2.1 Date 04/09/2017

Lead Director N/A Tel/Email Report Author Dr Neel Gupta, Chair Tel/Email [email protected] GB Sponsor(s) (where applicable)

Tel/Email

Report Summary

The purpose of this report is to highlight the Chair’s business activities and to provide an update on key areas of work.

Purpose (tick one box only)

Information

Approval To note

Decision

Recommendation The Governing Body is asked to note the contents of this report.

Strategic Objectives Links

The Chair’s business activities are linked to all of the CCG’s strategic objectives.

Identified Risks and Risk Management Actions

Where applicable any risks are identified within the report.

Conflicts of Interest

None

Resource Implications

Not applicable.

Engagement

Engagement activities are contained with the report.

Equality Impact Analysis

There are no equality impacts arising from this report.

Report History

The Chair’s Report is a standing item on the Governing Body agenda.

Next Steps

None

Appendices

None

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Chairs Report

July to September 2017

1. Introduction

This is my regular written report to the Governing Body, updating on the business that I undertake on behalf of the CCG and highlighting key areas of work.

2. Announcements

On behalf of the Governing Body I would like to thank Judith Hunt for the invaluable contribution she made to Camden CCG as a Lay Member and more recently as Vice Chair. Judith stepped down on 31 August and I wish to offer my very best wishes for the future.

I am pleased to welcome two new Lay Members to our Governing Body; Richard Strang and Glenys Thornton, who took up post in July. The process to appoint a new Vice Chair is underway.

I would also like to take this opportunity to offer my sincere thanks to Dr Imogen Staveley who has been the CCG’s Clinical Lead for Cancer. Her contribution and clinical leadership on cancer has been significant and achieved measurable impact both in terms of performance and patient outcomes. Imogen ceases her clinical lead role for Cancer on 20th September 2017.

Governing Body Induction

We have implemented a thorough Governing Body induction programme for both new and existing Governing Body members. Three sessions have been held to date:

14 June – Welcome meeting 19 July – Introduction to corporate governance 30 August – Governing Body Workshop

The workshop on 30th August focussed on a reflection of the 360 degree survey which is an annual assessment by the CCG’s stakeholders of our effectiveness as a commissioning organisation. This yielded positive discussions about strengths and areas for development going forward.

The workshop highlighted a number of areas that needed improvement as well as strengths to build on. This will be the basis of the CCG’s operational work plan and priorities going forward.

Two further events are being planned for the next quarter which will focus on:

20 September – Commissioning Cycle and Decision Making Date TBC – Stakeholder engagement and partnership working

3. Meetings and Visits

Since formally taking up post in July both Sarah Mansuralli, Chief Operating Officer and I have been undertaking introductory visits to providers and partners in the borough. To date we have held constructive meetings with the Chief Executive, Chief Finance Officer and Clinical Director of Camden and Islington Foundation Trust, the Chief Executive and Clinical Director of the Royal Free Hospital Hampstead Site and meetings with the Executive Director of Supporting People and Director of Adult Social Care at Camden Council.

During September, October and November, Sarah and I will be commencing a programme of member practice visits and continuing to meet senior leaders within provider and partner organisations.

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4. Health Overview and Scrutiny Committee, July 2017

The last Health Overview and Scrutiny Committee had a number of items related to mental health and the NCL Sustainability and Transformation Plan (STP). The Committee requested a further update on the CQC inspection findings for the Camden and Islington Foundation Trust in November. The Committee further heard about experiences of changes to mental health services at the Highgate Day Centre. With respect to the NCL STP, members recognised that for Camden this mirrored the Local Care Strategy and commented that it was helpful to see the work being done in mental health recognising that mental health is a high priority for Camden residents.

Overall, the initiatives in the STP were welcomed and it was helpful to see work that looked more holistically at the health system and explored the links between health and care. Members emphasised the need for engagement and co-production within individual initiatives.

5. Celebrating Success

University College London Hospitals Foundation Trust and Camden Clinical Commissioning Group have been shortlisted for a Health Service Journal award for their pilot initiative on Addressing Complex Persistent Pain which is now an NCL sector wide development being led by the Trust working with the NCL commissioning senior leadership team. The number of entries for this prestigious health industry award has been increasing year on year and 2017 heralded a significantly increased number of entries from all over the NHS and wider healthcare industry, so to be shortlisted is a fantastic achievement for both the Trust and CCG for this innovative work.

6. NHS England Assurance

The CCG had is quarterly assurance meeting with NHS England in July. The meeting focussed on the CCG’s performance against clinical priority areas; cancer, learning disabilities and mental health. There was also substantial discussion about QIPP and finance and this was particularly pertinent for Camden given the financial challenges both this year and next. NHSE concluded that due to the financial pressures within NCL, there would be further meetings to ensure that the CCG maintained ‘grip’ on performance, finance and QIPP deliverables.

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Report Title Accountable Officer’s Report

Agenda Item 2.2

Date 31/8/2017

Lead Director N/A

Tel/Email

Report Author Helen Pettersen, NCL Accountable Officer

Tel/Email [email protected]

GB Sponsor(s) (where applicable)

Tel/Email

Report Summary The Accountable Officer’s Report highlights key issues for the Governing

Body’s consideration that are not covered elsewhere on the agenda.

Purpose (tick one only)

Information Approval To note

Decision



The Accountable Officer highlights a variety of issues within the report and these may link with all strategic objectives.


Where applicable any risks are identified within the report.


There are no conflicts of interest arising from this report.


No direct implications, although each area described has resource implications for the CCG.

Engagement

Engagement activities are highlighted as appropriate.



Report History This report is a standing item on the Governing Body agenda.

Next Steps None

Appendices None

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mailto:[email protected]

1. Introduction This report provides an update on the key activities that the senior team and I have been involved in since the last Governing Body meeting.

2. Welcome A warm welcome to Mr Trevor Myers who joins the CCG as Interim Director of Commissioning and Contracting while a substantive appointment to the role is being progressed. Trevor will be supporting Sarah to develop Camden’s commissioning and contracting function and structure for the contract portfolio that sits outside the Integrated Commissioning arrangements with London Borough of Camden. Rebecca Booker joins the CCG as Deputy Chief Financial Officer. Rebecca formally takes up post on 25th September.

3. Joint Commissioning Committee We have now had two Joint Commissioning Committees meetings held in public – in June and July. The first JCC seminar is scheduled for 7th September. Members will recall that the CCGs agreed to try to recruit an Independent Chair for the Committee. We interviewed for this post in August but unfortunately were unable to make an appointment. The Committee will be discussing next steps at the Board seminar in September.

4. NCL Senior Management Team We have now made a substantive appointment to the COO role for Enfield. John Wardell who is currently leading Nene CCG will be joining us in November although we hope he will be able to come to key meetings before then. John is a Speech and Language Therapist by training and has a wealth of experience in health and social care.

5. Wider Leadership Team The second NCL Wider Leadership Team workshop was held on Tuesday 5th September. The agenda covered a range of updates on local , London wide and national issues as well as a discussion on how we can work together effectively across the 5 CCGs and STP. We also had a discussion about Accountable Care systems and how this could work for the benefit of patients and the population locally. As well as keeping colleagues updated on progress and key issues, the purpose of the workshops is to encourage networking, share learning and develop working across NCL.

6. Winter Planning As part of annual winter preparedness, the CCG has been working with UCLH NHS Trust and wider system partners to develop the winter plan for submission to NHS England by 8th September for assurance. The plan is focussed on ensuring there is enough capacity to meet the pressures of winter through: Reducing delayed transfers of care Reducing variation in best practice Primary care streaming Flu planning Helen Pettersen Accountable Officer

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Report Title The Patient Voice Report

Agenda Item 2.3 Date 13/09/2017

Lead Director Ian Porter,

Director of Corporate Services Tel/Email [email protected]

Report Author Martin Emery, Head of Engagement & Francesca McNeil, Head of Communications and Engagement

Tel/Email [email protected] [email protected]


Kathy Elliott, Lay Member Communications & Engagement


Report Summary

This paper provides a synopsis of the patient and public engagement activity undertaken since the previous Governing Body meeting.


Information

Approval To note

Decision

Recommendation The Governing Body is asked to note the content of the report.


Objective E: Work jointly with the people and patients of Camden to shape the services we commission


Not Applicable


Not Applicable


Not Applicable

Engagement

Engagement activities are documented in this report.


No equality impact assessment is required for this report.

Report History

The Lay Governing Body member responsible for Patient and Public Engagement presents a bi-monthly report to the Governing Body.

Next Steps None

Appendices

Not Applicable

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The Patient Voice Report (September 2017)

This paper covers work undertaken over the past two months, relating to Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission. 1. Camden Patient & Public Engagement Group (CPPEG) Since the last Governing Body meeting, the CCG has held one CPPEG operational meeting, one open public meeting and a bi-annual PPG forum meeting. Key themes and issues arising are described below. 1.1 CPPEG operational meeting (10/07/2017) At the July meeting the following were discussed (links to papers included below):

CCG Committee reports (here) Population Health Management tool (here) Quality, Innovation, Productivity and Prevention (QIPP) update (here) Camden GP Extended Access Service (here) Refreshed Communications and Engagement Plan (here)

You Said We Did Camden GP Extended Access Service: CPPEG members asked that representatives attend an future CPPEG open meeting

Camden CCG has: AT Medics presented at the CPPEG open meeting on Monday 14 August. Presentation also made available on CPPEG website.

1.2 Bi-Annual PPG Forum Meeting (06/07/2017) CPPEG hosted the fourth bi-annual PPG reflecting with 55 PPG members in attendance. The agenda was developed based on input from PPG members, to include:

Patient Participation Group (PPG) success stories: General Practice Neighbourhoods (commissioning and provider perspective) How could GP Neighbourhoods work in practice? Improving care for frail people Improving Local Care for people with mental health problems and/or learning disabilities

Presentations can be viewed here. You Said We Did PPG Success Stories: Additional case studies should be collated over time General Practice Neighbourhoods: PPG members asked for an update at the next PPG forum

We will: Continue to work with PPG members and practice staff to build and share case studies of success stories across Camden. We will: Include a Neighbourhoods agenda item on neighbourhoods at the next Forum.

1.3 CPPEG open meeting (14/08/2017) CPPEG open meetings occur bi-monthly as an opportunity for the public to engage with the work of the CCG. At the August meeting 39 people attended and the following topics were discussed.

Camden GP Extended Access Service Care Integrated Digital Record (CIDR) update PPG forum update

You Said We Did Camden GP Extended Access Service: Attendees asked that AT Medics return to report progress in 2018-19

Camden CCG will: Invite AT Medics to a CPPEG operational and open meeting in the next financial year

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http://www.camdenccg.nhs.uk/publications/cppeg-operational-meeting-papers-10-july-2017/34928

http://www.camdenccg.nhs.uk/downloads/get-involved/cppeg/2017/170710/2-Population-Health-Using-evidence-to-drive-local-implementation.pdf

http://www.camdenccg.nhs.uk/downloads/get-involved/cppeg/2017/170710/2b-Finance-QIPP-update-Month-2-May-2017.pdf

http://www.camdenccg.nhs.uk/downloads/get-involved/cppeg/2017/170710/3-Camden-GP-Extended-access-update.pdf

http://www.camdenccg.nhs.uk/downloads/get-involved/cppeg/2017/170710/15-Communications-and-Engagement-plan-2017-2018.pdf

http://www.camdenccg.nhs.uk/ourwork/local-care.htm

http://www.camdenccg.nhs.uk/downloads/get-involved/PPG/2017/170706/NHS-Camden-CCG-CPPG-Forum-presentation-6-July-2017.pdf

1.4 CPPEG operational catch up meeting (14/08/2017) Hilary Lance has been appointed as CPPEG Chair and the appointment was ratified at the meeting. The CCG and CPPEG thanked Leon Douglas and Saloni Thakrar (in her absence) for their hard work and valuable contribution as CPPEG Chairs and wished them success for the future. The following items were discussed:

General Practice PMS review update GP Neighbourhoods

You Said We Did General Practice PMS review update Submitted questions on the different contracts, the plans to reinvest funding and impact for smaller practices General Practice PMS review update Submitted questions on the geography of neighbourhoods, development plans, patient engagement, commissioning structure and role of the Federation

Camden CCG will: The primary care team will attend the September CPPEG operational meeting to discuss Camden CCG will: The primary care team will attend the September CPPEG operational meeting to discuss

2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission A range of other engagement has been delivered over the last two months to support Objective E:

Re-procurement of termination of pregnancy service: The general practice and service user survey has been completed and the findings are currently being analysed and will be presented at a future CPPEG operational meeting.

Camden CCG participation in an NCL Admission Avoidance Citizen Reference Group, chaired by Healthwatch Camden, to support local roll out of engagement activity in STP planning

Camden Local Care Strategy (Citizens Panel Survey): a survey is underway asking the panel for views on current health services, health information and experiences of accessing and receiving support for managing their health and care issues. This will provide baseline data to assess the impact of Local Care Strategy transformation. Plans for sharing these results are in development.

Children’s Commissioning Team (Citizens Panel Focus Groups): a series of focus groups are being planned with parents to explore seeking healthcare support and advice for common healthcare conditions re: their children. The results will be made available following analysis.

Accessible Information Standard: The Communications and Engagement team are supporting the Clinical Lead for Learning Disabilities and Governing Body elected General Practice Manager with improving General Practice compliance with AIS requirements. A range of tools and templates are now available on the GP website for practices to use.

Equality Delivery System (EDS2): the CCG is ascertaining CPPEG members’ views (incl. stakeholder members) of how the CCG and local providers are performing.

3.0 Looking ahead (August/September/October) The range of patient and public engagement activity is planned, including:

A consultation workshop for the CCG governing body and executive team Camden Local Care Strategy presentation at the next Camden Carers Service meeting CCG Chair Question Time with the local Somali adolescents CPPEG operational meeting: GP Neighbourhoods, Universal Offer and Commission Intentions A second Deaf Awareness workshop for CCG and General Practice staff Staff Communications and Engagement Group to meet with CCG, Public Health and Council

members attending to discuss engagement and communication activity planned for Quarter 2. Dermatology planned care public focus group.

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Report title Quality and Clinical Effectiveness Report

Agenda item 2.4 Date 29 August 2017

CCG Clinical Lead

Charlotte Cooley Tel/Email [email protected]

Lead Director Neeshma Shah Tel/Email [email protected]

Report Author

Quality and Safety Team Tel/Email

Report Summary This report provides a summary of key quality, safety and clinical effectiveness

information for Camden CCG. Key points to note in relation to Acute, Mental Health and Community providers are highlighted within the main body of the report. Areas to highlight to the Governing Body are: UCLH

Trauma services were reviewed by the National Peer Review team in July 2016. The reviewers were complimentary regarding the provision of tracheostomy care, including provision of training. Concerns were identified regarding the numbers of nursing staff trained in line with Advanced Paediatric Life Support and Advanced Trauma Nursing as well as the numbers of trauma patients who receive a CT scan within one hour of presentation to ED. The Trust has an action plan for improvement

The Trust is performing well against the core standards in the Sentinel

Stroke National Audit Programme (SSNAP) which aims to improve the quality of stroke care by auditing stroke services against evidence based standards and national benchmarking.

RFL

The Trust retrospectively reported one Never Event in June 2017.

Assurances were provided to commissioners on actions resulting from an external review were regarding thirteen of Serious Incidents which occurred within the maternity division, resulting in the admission of new born babies to the Neonatal Unit for cooling.

Camden Medicines Management Committee To note the financial impact of NHS England’s announcement to retain centrally the category M savings resulting from the negotiation of the community pharmacy contractual framework funding.

Purpose


Decision

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Recommendation The Governing Body is asked to note the content of this report, and to read in conjunction with the CCG’s annual safeguarding children report.


The report on outputs from the CCG Quality and Safety Committee supports delivery of the following strategic organisational objectives: Objective A: Commission the delivery of NHS Constitutional rights and pledges Objective B: Improve the quality and safety of commissioned services by identifying gaps and concerns in service provision, and seeking assurance on quality and safety improvements related to these. Objective C: Improve health outcomes, address inequalities and achieve parity of esteem By seeking evidence from providers and partners relating to better outcomes for patients.


Provider management of quality and safety issues affecting patient care and experience. These are being managed through regular clinical quality review (CQR) meetings and regular liaison with respective provider leads. No reports have been received to date from NHS England on primary care contractors. The issue has been raised with NHSE.

Resource implications

None

Equality impact analysis

An equality impact assessment has not been conducted on this document as it is a summary report and record of the key outcomes of the Quality and Safety Committee meeting.

Report History This report is a summary report of the work of the Committee. Next steps None Glossary CAMHS Child and Adolescent Mental

Health Service CPN Contract Performance Notice CQC Care Quality Commission CHR Clinical Harm Review CQRG Clinical Quality Review Group CQR Clinical Quality Review C&I Camden and Islington NHS

Foundation Trust CNWL Central North West London NHS

Foundation Trust CSCB Camden Safeguarding Children’s

Board CTG Cardiotocography DNA Did not attend ED Emergency Department GOSH Great Ormond Street Hospital for

Children NHS Foundation Trust HH Haverstock Healthcare IPC Infection Prevention and Control

team IPU Integrated Practice Unit KPIs Key Performance Indicators LBC London Borough of Camden MCA Mental Capacity Act

NE Never Event NELETN North East London Essex

Trauma Network NNU Neonatal Unit NHSE NHS England NMTNG National Major Trauma Nursing

Group QAS Quality Alert System QI Quality Improvement QSC Quality and Safety Committee RCA Root Cause Analysis RFL Royal Free London Foundation

Trust RTT Referral to Treatment SI Serious incidents STEIS Strategic Executive Information

System SSKIN Surface Skin Keep Incontinence

Nutrition T&P Tavistock and Portman NHS

Foundation Trust UCLH University College London

Hospital NHS Foundation Trust VBC Value Based Commissioning

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Executive Summary The Quality and Safety Committee (QSC) were appraised of services provided by acute, community and mental health services, where Camden CCG is either lead or associate commissioner, from a quality, patient safety and clinical effectiveness perspective during the committee meetings in July and August 2017. The committee also received reports from Camden Integrated Musculoskeletal Services (CIMS), Q4 North Central London Infection Prevention & Control Report (IPC), Great Ormond Street Hospital (GOSH), Community Epilepsy Service, Camden Diabetes Integrated Practice Unit, Care Homes Continuing Health Care and Home Care, Hospices, GP Extended Access, Community Dermatology Service and Camden Medicines Management Committee. The Quality and Clinical Effectiveness Risk Register is reviewed monthly. Key points and actions from these reports and discussions are noted below. 1. University College Hospital London UCLH is one on eleven designated trauma units within North East London and Essex Trauma Network (NELETN). The National Peer Review programme reviewed all trauma services across the UK during 2016 and reviewed trauma services at UCLH during July 2016. Key messages:

The reviewers were complimentary regarding the provision of tracheostomy care, including provision of training.

The panel identified that there were insufficient members of the nursing team who were appropriately trained in line with Advanced Trauma Nursing Course/Advanced Paediatric Life Support (ATNC / APLS) or Level 2 of the National Major Trauma Nursing Group (NMTNG) guidance, both in adult and paediatric trauma.

It was also identified that patients who had suffered trauma were not receiving a Computed Tomography (CT), within one hour of arrival in the Emergency Department (ED).

A comprehensive action plan was developed in response to these findings, facilitating faster access to CT scans. UCLH have been successful in recruiting nurses of all grades to work in ED, these staff have been supported to achieve competency within ATNC and APLS, as set out in the NMTNG.

The Trust continues to progress its improvements against actions noted in their CQC visit plan. In line with the recommendations in the Lampard report the Trust has commenced DBS (Disclosure Barring Service) rechecks, aiming to complete 550 staff this year, starting with those working in paediatrics and key areas whose previous checks were pre-2009. Compliance has been sustained with the 31-day wait subsequent chemotherapy treatment and two week wait for all cancers. The Trust continues to be challenged in meeting the 62 day standard. Clinical Harm Reviews (CHR) are undertaken on all patients who have breached 62 days and who have waited over 100 days for treatment; to date no clinical harm has been identified within these patient groups. The Trust is performing well against the core standards in the Sentinel Stroke National Audit Programme (SSNAP) which aims to improve the quality of stroke care by auditing stroke services against evidence based standards and national benchmarking. The Trust provided assurances in relation to compliance with the National Safety Thermometer audits which incorporate pressure ulcers, falls with harm, catheter acquired urinary tract infections and venous thromboembolism. Assurance was provided in relation to the Trust’s response and actions following the stage 2 resources alert issued by NHS Improvement on the review of nasogastric tube safety critical requirements.

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The CCG continues to work with the Trust to address concerns of patients being discharged after one DNA. 2. Royal Free London The RFL reported the following incident resulting in avoidable harm: The Trust retrospectively reported one Never Event (NE) in June 2017, pertaining to the insertion of a temporary (covered) biliary stent in August 2016. This stent was inserted to treat clinical symptoms associated with cholestasis following abnormal liver function tests and itching. The patient attended the endoscopy department in March for planned removal of the stent. The procedure was unsuccessful as the stent was embedded, due to an over growth of tissue. A second attempt to remove the stent in April 2017 was also unsuccessful. A review of the endoscopy log was undertaken, as it is unusual to experience difficulties in removing temporary stents. The review indicated that the serial number for the stent inserted on 30th August 2016, corresponded to an uncovered (permanent) metal stent which is not intended for removal. This is incident meets the NE criteria and is currently being investigated in line with the Serious Incident Framework 2015. Assurances were provided to the CQRG on 26 July 2017, following the identification of twelve Serious Incidents (SIs) which have been reported across the maternity division since January 2017. These incidents related to the unexpected admission of new born babies to the Neonatal Unit (NNU) for therapeutic cooling, shortly after birth. A Quality Assurance visit undertaken by Barnet CCG on 29 June 2017 reaffirmed the findings of the external reviewers from UCLH. Key actions taken by the maternity division, following the findings of the external reviewers;

All staff (Obstetric and midwifery) involved in this cluster had their competence and training reviewed.

Staff were referred to their line manager or educational supervisor as appropriate, to reflect on these incidents.

All staff involved in this cluster of incidents were found to be competent in CTG interpretation, which is part of mandatory training.

As an additional measure, these staff were requested to complete their K2 CTG training and attend a Masterclass on 24 June 2017, on fetal heart monitoring. CTG Masterclasses are held every six months, attendance by Obstetric and midwifery is mandatory.

GPs within Camden and Barnet raised concerns regarding the 2 week Heart Failure and new diagnosis pathway offered by the RFL. Patients referred into the service by their GP using the electronic referral process are not receiving their appointment within two weeks. Barnet CCG met with the Consultant Cardiologist and Clinical Lead for Heart Failure at the RFL to discuss these concerns. There will be additional clinic slots added to the current clinic template from September to address this issue. RFL continue to sustain compliance against the 31-day wait subsequent chemotherapy treatment and two week wait for all cancers. Challenges remain with achieving the 62-day urgent GP referral standard. The Trust performed well in the SSNAP audit, implementing multidisciplinary team meetings leading to an improved assessment process and the implementation of group therapy sessions. Assurance was provided in relation to the Trust’s response and actions following the stage 2 resources alert issued by NHS Improvement on the review of nasogastric tube safety critical requirements. The Trust convened a multidisciplinary, cross-site specialist group to map safety-critical requirements to identify any gaps. The Trust is assessing if misplaced NGTs can be removed in radiology immediately after identification, and to review a model of care to train radiographers to interpret NGT x-rays.

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3. Camden and Islington Foundation Trust GPs in Camden have raised concerns using the Quality Alert System (QAS), in relation to the quality and content of information of discharge summaries, access to crisis services and monitoring of patients commenced on antipsychotic therapy. These concerns have been escalated to Islington CCG as lead commissioner. The Trust have committed to include themes and trends identified through QAS alerts within their monthly governance report, presented at CQRG. The CQC have formally advised the Trust that they will be undertaking an announced inspection, on the week commencing 04 December 2017. In preparation for this visit, the Trust have developed a project plan supporting their overarching CQC action plan:

Detailed project plan agreed and signed off by the Foundation Trust Executive (FTE). A CQC Preparation Programme Board has been developed, chaired by the Director of Nursing,

reporting into the FTE and Quality & Safety Committee. Each of the key work streams is overseen by an Executive Director, supported by a Non –

Executive Director. Communication of the forthcoming inspection has been cascaded to all staff.

The Trust continues to make progress against their CQC action plan. The actions are currently being reviewed at the Trust Executive Board every fortnight. The following 5 areas have been signed off by the Trust:

Addressing safety, dignity and well-led gaps concerning Health Based Places of Safety (HBoS) Repair cycle (premises) for clinical areas Guidance and governance processes around ligature management Medication management Core skills training and appraisal for staff.

The Trust continues to monitor and report the use of prone restraints on the wards and a decrease was noted in the first quarter. The Trust remains non-compliant with the Prevention Management of Violence and Aggression (PWVA) training, and is trying to address this gap in capacity. There are concerns over the Trust staff achieving compliance against mandatory training, with non-compliance with fire training, information governance and manual handling. The Trust remain non-compliant with their safeguarding adults and Prevent training, and presented a plan at CQRG to rectify this. The Trust has rolled out its Training Tracker and has reported 500 users thus far, acknowledging that there is much more to be done. In its Quality Account for 2016-17 the Trust had set out 12 priority areas – it achieved 5 fully, and partly achieved 7, many of the latter linked to some of the improvement areas in the CQC visit. NHS England have published their investigation into a mental health SI (Mr T), and the Trust is working with the Commissioners to ensure that the required evidence is presented as part of the action plan. Further meetings are taking place outside the CQRG. 4. Tavistock and Portman Foundation Trust The Trust were issued with a Contract Performance Notice (CPN), in 28 April 2017, following the Trusts failure to submit two outstanding SIs. The Trust have since submitted the outstanding SI reports and uploaded the learning and root causes onto the Strategic Executive Information System (StEIS). The Trust’s 2016 -17 Quality Account set out 11 priority areas; the Trust achieved the areas under patient safety indicators, patient involvement with physical healthcare, patient and public involvement and one element of CAMHS outcome monitoring programme and failed to achieve the other element; Trust also did not achieve the adult outcome monitoring programme.

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For 2017-18 the Trust has set our 4 key priorities within patient safety, clinical effectiveness and patient experience. 5. Central and North West London Foundation Trust The Trust are undertaking a Quality Improvement (QI) project to develop a multi-factorial falls risk assessment tool, for use within community and in-patient settings. The purpose of this is to integrate the falls assessment with the rehabilitation pathway. This pilot is overseen by the Trust’s Older People Network. The Trust’s monthly divisional risk management sessions are focusing on the promotion of patient safety and the reporting of incidents. The Pressure Ulcer Board presented a Deep Dive into the service to the CQRG on 14 June 2017, key messages include:

A Trust wide Pressure Board has been established, chaired by the Divisional Director of Nursing. All Root Cause Analysis (RCA), learning and implementation of action plans are monitored here.

The Surface Skin Keep Incontinence Nutrition (SSKIN) care bundle has been implemented across the Trust.

Adult Safeguarding PU protocol has been implemented across Camden Community Services.

The Trust’s infection prevention and control team have conducted a series of environmental audits with positive results across the majority of areas. The Community Health Annual Patient Survey had a response from 2613 patients equating to a response rate of 29%. Key findings were:

Improving the information to be provided to patients on how to give feedback To review the generic information for patients, i.e. details of how, when and who to contact within

services, informing patients that they may not always see the same staff member at each appointment.

To review the time slots to ensure that sufficient time has been allocated to discuss health needs with the healthcare professional

To review the availability of private spaces for those who wish to speak to a member of staff in confidence.

Themes from the complaints received in quarter 4 were related to communication and waiting times for appointments. The Trust have participated in a programme of internal peer review of services to facilitate the sharing of good practice and learning across the organisation. 6. Camden Integrated Musculoskeletal service (CIMS) In December 2016, UCLH was awarded a new Value Based Commissioning (VBC) contract to act as the Lead Provider for a new fully integrated pathway for musculoskeletal (MSK) in Camden from 1st April 2017 for the next five years. Currently, UCLH are not reporting on this contract from a quality and patient safety perspective, and has been escalated to the contract manager. The CCG s escalated this matter to UCLH, requesting that a response and resolution / remedial plan is agreed at the next monthly CIMS Contract Review Group (CRG) meeting. Failure of UCLH to report against the quality schedule will result in a Contract Performance Notice (CPN) being issued at the earliest opportunity.

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7. Great Ormond Street Hospital (GOSH) NHSE advised the CCG that due to the intense media attention surrounding Charlie Gard, a decision was taken to suspend formal CQRG meetings with the Trust. The Executive team at GOSH have been supporting staff, following the allegations and threats suffered by staff. A learning event will be held to reflect on the events surrounding the care and treatment provided to Charlie and his parents. This reflection will also focus on the support offered to Charlie’s parents and to staff. 8. Community Epilepsy Service The clinical lead and commissioning manager presented the Committee with plans related to the safe closure of this service, having received a notice from the Provider of stopping the service. A joint commissioner / provider meeting was held on 04 July 2017 to agree a formal closure plan for the service, ensuring the safe transition of patients on the current epilepsy case load into the care of their GP or neurology services within secondary care. The service has formally informed patients and their GPs of this planned closure. The Committee commended the clinical lead and manager of the excellent communication that had been prepared and sent. 9. Diabetes Integrated Practice Unit In 2015, the RFL was awarded a new Value Based Commissioning (VBC) contract to act as the lead provider for a new fully integrated pathway for diabetes provision in Camden from 01July 2015 – 31 March 2018. The RFL is not currently reporting on Quality & Safety aspects of this service as set out in Schedule 4 of the NHS Standard Contract. These concerns have been formally raised with the provider by the CCG as it considers the options for this VBC contract. A quality schedule and reporting timeframes are due to be agreed at the end of August and will be formally signed at the Contract Review Group in September. 10. Care Homes, Continuing Healthcare and Home Care Performance Assurances were provided on the performance of local care homes and those receiving care in their own home. Key messages:

The Integrated Adults Commissioning team and the CCG quality and safety team work collaboratively to optimise assurance and quality improvement in Care Providers.

All Care Homes in the borough have been rated as “Good” by the CQC, with the exception of Wellesley Road which “requires improvement”. A joint action plan was developed with Camden Local Authority and the care home, which is monitored regularly.

No Providers were under the establishment concerns process in LBC; four Care Homes were under enhanced monitoring

There are four local care homes providing nursing care where Camden has contracted beds for continuing health care (CHC) placements. Oversight is maintained with monitoring meetings to validate improvements and track new developments.

Regular reports are received from the Home Care Agencies on the Framework. Two of these received a rating of “requires improvement” from the CQC and LBC is working in partnership with LB of Barnet and Westminster respectively to validate the required improvements. Framework provider monitoring includes care plan reviews, telephone satisfaction checks, late / missed visits, safeguarding, client feedback, supervision and appraisal of staff, and mandatory training

11. Hospice Report Assurance was received relating to the Providers of hospice care in Camden – St John’s and Elizabeth Hospice, and Marie Curie Hospice.

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Quality and safety reporting includes reporting of incidents (including serious incidents), safe and secure handling of medicines, safeguarding, and patient feedback. The integrated commissioning manager and quality and safety team work collaboratively to gain these assurances from the Hospices, and provide effective constructive challenge. 12. Community Dermatology Service The current service provides a consultant led non-acute dermatology service within the community setting, provided by the RFL. The Trust have served notice on Camden CCG to cease provision of this service on 14 December 2017. Meetings are being established with the RFL to co-ordinate this closure and gain assurance that there is a clear plan from the Provider to ensure that patients currently receiving treatment are safely transitioned into an alternative service. The Committee were not assured that the relevant communication to patients and GPs was in place relating to this service closure, and the commissioning manager was asked to liaise with the CCG team implementing the closure of the community epilepsy service. 13. Quality and Clinical Effectiveness Risk Register

The Directorate added two new risks, assurance to be obtained from all member practices that they are meeting their statutory obligations for safeguarding adults and children. Newly delegated commissioning responsibilities, require assurance processes to be developed. The committee members agreed to the proposal to transfer the risk relating to Continuing Healthcare (CHC), to the Adults Integrated Commissions, as work regarding CHC and Simplified Discharge is now led by this team. 14. Camden Medicines Management Committee

The Committee was apprised of the communication from NHS England on their intention to retain the savings that would have resulted from the reduction in category M drug prices, which is linked to the community pharmacy contractual framework funding. These in year reductions are not planned into the budget setting process as they are not known at the time when the annual financial planning is undertaken; more importantly these savings mitigate against the unexpected in year rise in prices of certain medicines when ‘no cheaper stock’ is available. NHSE’s intention to retain these savings centrally to form part of the overall system risk reserve therefore places an unforeseen cost pressure on the CCG prescribing budget and QIPP plan. This has been flagged to the NCL Chief Financial Officer and Accountable Officer. The national consultation launched by NHS England on items that should not be routinely prescribed in primary care was brought to the attention of the Committee. Possible implication of a national decision was discussed and that advice would be sought on the requirement of local engagement and consultation when a national decision was implemented. Many of the medicines included in the proposal are those with unproven efficacy, and where more effective, safer and cost effective alternatives are available. Quarter 4 – 2016/17 data shows that Camden CCG has met both Antibiotic Quality Premium targets set for the year 2016/17 with further improvements seen in meeting the target for the reduction in the proportion of broad spectrum antibiotics prescribed (10% to 9.4% from quarters 1 to 4 respectively). The Committee congratulated the efforts made by Camden practices to achieve the targets.

A Multimorbidity and Polypharmacy Workbook Based Review for 2017/18 as a quality improvement indicator for GP Practices was assessed in terms of ensuring patients obtaining maximal gain and optimal outcomes for their prescribed medication, and reduction in medication-related harm. Problematic polypharmacy may be associated with increased adverse drug events, hospital admissions, increased healthcare costs, and non-adherence and this review should improve patient outcomes and associated QIPP efficiencies. The following guidelines were approved:

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Camden, Islington, and Haringey Responsible Respiratory Prescribing Group for the clinical management, diagnosis, and prescribing for adult patients presenting with chronic obstructive pulmonary disease were approved. The financial impact of the range of inhalers available was assessed for Camden CCG.

Guidelines for monitoring Disease Modifying Anti-Rheumatic Drugs (DMARDs) - the

commissioning implications of the recommendation for retinal assessments for patients on Hydroxychloroquine were discussed.

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Report Title System Intentions for 2018/19


Lead Director Paul Sinden

Director of Performance and Acute Commissioning


Report Author Paul Sinden Director of Performance and Acute Commissioning





Report Summary

This paper sets out the initial draft of system intentions for North Central London (NCL) CCGs for 2018/19. System intentions The draft is based on the following principles agreed at the North Central London (NCL) CCG Joint Commissioning Committee (JCC) on 6 July 2017:

Intentions should signal a clear change in the relationship between commissioners and providers compared to previous years through a move to system intentions from commissioning intentions. This is done in recognition of development of the Sustainability and Transformation Plan and the new commissioning arrangements for the five North Central London CCGs;

Intentions should be concise and present an aggregated position for the five CCGs, and reference how plans for 2018/19 will be formed on the basis of agreed areas of work between commissioners and providers including the Sustainability and Transformation Plan workstreams;

Whilst the focus is on aggregate intentions across the five CCGs there will be some scope for local CCG intentions to deliver CCG financial plans;

Intentions should reflect the priorities identified through engagement with patients and public;

We need to ensure that agreements for 2017/18 and 2018/19 in provider contracts signed in December 2016 are carried forward into 2018/19. This would include contract form;

Contracts signed in December 2016 indicated that contract values for 2018/19 will need to be determined and agreed during 2017/18, with an insert into the signed contracts indicating that 2018/19 contract values will be based on the agreed 2017/18 contract flexed for outturn adjustments for 2017/18, plus 2018/19 growth and less the impact of STP interventions in 2018/19;

Hospital contracts remain on a payment-by-results format in 2017/18 and 2018/19, albeit modified for marginal rates, and intentions would therefore need to cover changes to tariff, and rules on counting and coding.

The draft system intentions are also consistent with the NCL CCG Commissioning Strategy developed in 2016, as an enabler for delivery of the NCL Sustainability and Transformation Plan.

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Planning timetable for 2018/19 A detailed planning timetable for 2018/19 has been developed. The timetable assuming agreement of contract baselines with providers for 2018/19 and operating plans for 2018/19 being finalised by the end of December 2017. Both contract baselines and operating plans will include the impact of Sustainability and Transformation Plan interventions for 2018/19. The planning timetable has been shared with providers for consideration, and has been established in advance of any formal planning guidance from NHS England (NHSE) or NHS Improvement (NHSI). The Governing Body is asked to note and comment on the procurement principles that will underpin system intentions and delivery of the Sustainability and Transformation Plan.


Information

Approval To note

Decision

Recommendation The Governing Body is asked to: NOTE and comment on the draft system intentions for 2018/19; NOTE and comment on the draft procurement principles included

within system intentions. Strategic Direction System intentions for 2018/19 will support delivery of:

The North Central London Sustainability and Transformation Plan; Local CCG priorities include joint commissioning priorities with Local

Authorities. System intentions will be determined by:

Local priorities to deliver the health and improvement priorities agreed through the Health and Wellbeing Board and informed by the Joint Strategic Needs Assessment;

The North Central London Sustainability and Transformation Plan; The carry forward of priorities from 2017/18 included in current two-year

contracts with providers for 2017/18 and 2018/19; National planning guidance including the refresh of The Five Year

Forward View.


The main risks to generating commissioning intentions for 2018/19 within CCG resource envelopes are:

Delivery of the targeted activity reductions and cost savings from STP interventions and local QIPP in 2017/18;

Developing further QIPP and STP interventions proposals for 2018/19; Triangulation of CCG and Trust views on 2017/18 forecast outturn and

the impact of 2018/19 Sustainability and Transformation Plan workstream interventions;

Ensuring agreements in two-year contracts for 2017/18 and 2018/19 signed in December 2016 are carried forward from 2017/18 into 2018/19.


Conflicts of interest are managed robustly as they arise and in accordance with the NCL Conflicts of Interest Policy.


Plans for 2018/19 will need to be developed within CCG resource envelopes and encompass run-rates from 2017/18 adjusted for demographic growth, the impact of Sustainability and Transformation Plan and local QIPP interventions, and the impact of national planning guidance.

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Engagement

Intentions should reflect the priorities identified through engagement with patients and public. Local CCG engagement timelines will be built into the process for generating system intentions, as well as being informed by on-going engagement structures.


This report was written in accordance with the provisions of the Equality Act 2010.

Report History

Development of system intentions for 2018/19 have been considered by: North Central London (NCL) Contract Delivery Group on 26 May 2017; The

Senior Management Team of the five North Central London CCGs on 6 and 20 June 2017;

The NCL CCG Joint Commissioning Committee on 6 July 2017 where the outline for system intentions was agreed.

Next Steps The next steps in the development of system intentions for 2018/19 will be to: Identify Sustainability and Transformation Plan (STP) workstream priorities,

and the associated finance and activity impact; Identify local CCG priorities over and above STP priorities, and align them

where possible to maximise system benefit; Enact local CCG engagement plans with stakeholders to ensure plans are

reflective of local priorities; Develop a set of outcome indicators used in the update to the Five Year

Forward View and the NCL Sustainability and Transformation Plan (STP) to underpin intentions for 2018/19;

Develop plans for 2018/19, including the negotiation of contract baselines with providers, by December 2017.

Appendices

None

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North Central London CCGs – System Intentions for 2018/19 1. Introduction This document sets out system intentions and actions we intend to take for 2018/19 that support the direction of travel in the North Central London Sustainability and Transformation Plan (STP) for the next five years.

2. System Intentions Intentions for 2018/19 build on the collaborative approach in developing the Sustainability and Transformation Plan (STP), and to the contract round for 2017/18 and 2018/19 facilitated through the STP. Continuation of this is collaborative approach is underpinned by a move from commissioning intentions in 2017/18 to system intentions in 2018/19.

The shift to system intentions will be underpinned by a set of principles by which we would like to work together: Partner organisations will work together for the benefit of local people; We will involve local people on our design, planning and decision-making; Partner organisations will find innovative ways to cede current powers and controls to explore new

ways of working together; We will be open, transparent and enabling in sharing data, information and intelligence in all areas

including finance, workforce and estates; Partner organisations will find ways to risk-share during transformational change; We will find ways to share joint incentives and rewards; Partner organisations will make improvements by striving to be the best together; We will be rigorous in ensuring value for money and financial sustainability.

Our system intentions for 2018/19 therefore describe the areas where joint working across CCGs and providers will ensure the best outcomes for patients by planning and commissioning at scale or across the whole health and care system, with acknowledgement that there will be local plans for each CCG for specific areas of delivery.

The Sustainability and Transformation Plan (STP) provides a detailed picture of the local health and care landscape; the population demographics; and acute, community, mental health, social care and primary care provision in the five boroughs. The STP also sets out the case for change and our ambition for an overarching model of care in North Central London (NCL). System intentions will not duplicate this information in detail and should be read in conjunction with the STP.

The rapidly changing health and social care landscape also requires us to begin to redefine our role as commissioners and our business as usual. Our system intentions therefore focus on things we need to do to ensure we continue to deliver value, reduce inequalities, as well as ensure the local system retains the capability to focus on delivering high quality care for our population.

3. Strategic challenges The local health system faces five main strategic challenges:

Prevention. Prevention and population health needs to be central to our plans to reduce the health and wellbeing gaps, care and quality gaps, and finance and efficiency gaps in North Central London (NCL). Improving health outcomes and delivering long-term benefits for the population as a whole will require delivery at scale, upfront investment, and close working with local authorities to address the wider determinants of health.

Financial challenge. Developing the STP has led to a common understanding that we operate as a system in deficit. We need to understand the cost of delivering services and change the way we work to align incentives, reduce duplication, and take cost out of the system.

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Delivery of the Sustainability and Transformation Plan. The Sustainability and Transformation Plan (STP) provides a plan for our system to work together to better meet the needs of the population, improving quality, and setting out how local services will evolve and become sustainable over the next five years. The STP workstreams, for both service models and enablers, set out ambitions for changes at scale that require us to work together in different ways. The priorities for these workstreams are central to our system intentions for 2018/19.

Continuing to deliver value and reduce variation in care. We know across the range of providers in North Central London (NCL) there are inequalities in outcomes, service quality, and unwarranted variations in cost. We want to work to ensure that care is always of the highest possible standard and that we reduce waste in the system. We are committed to addressing shortcomings in the quality of service delivery through delivery of the STP, service change, and also through use of the new commissioning arrangements for NCL CCGs introduced in 2017/18.

Redefining our business as usual. The five year forward view sets out new models of care many of which support delivery of our Sustainability and Transformation Plan (STP). New ways of working will require us to think differently about how we commission health and care services and how organisations work together to ensure we continue to deliver improvements in outcomes for our population.

4. Achievements in 2017/18 Intentions for 2018/19 build on the collaborative approach in developing the Sustainability and Transformation Plan (STP), and to the contract round for 2017/18 and 2018/19 facilitated through the STP. This approach has yielded A greater alignment of commissioner and provider plans through the Sustainability and Transformation

Plan (STP) including an agreed set of service improvement priorities; A common understanding of the underlying financial pressures across the NCL health and care

system; Contracts for 2017/18 and 2018/19 incorporating service improvement priorities in the STP, and

delivered to the national planning timetable; New commissioning arrangements for NCL CCGs providing impetus for greater alignment of

commissioning priorities and creating greater delivery capacity across commissioners and providers. 5. North Central London System Intentions Intentions for 2018/19 seek to address the areas of priority for joint commissioning across the five North Central London (NCL) CCGs, to further align intentions of the CCGs for the best system impact, the rationale for acting jointly across NCL, and to identify the levers and mechanisms that will ensure that the Sustainability and Transformation Plan (STP) is delivered across the health and care system.

5.1 Sustainability and Transformation Plan Priorities Pivotal to intentions for 2018/19 will be delivery of jointly agreed STP priorities signed off by Health and Care Cabinet incorporating both priorities from service workstreams (prevention, care closer to home, urgent and emergency care, planned care, and mental health) and support from enabling functions to deliver service priorities (finance, interoperability, estates, workforce, system incentives). 5.2 Priorities from local engagement with stakeholders Engagement with local people across North Central London CCGs has identified priorities for delivering health and care services: The need to invest in prevention and primary care; Better co-ordination of care for the individual supported by making general practice the centre of co-

ordinated care through health and care teams working around the practice; Co-production of care and helping people manage their own care; Improving the quality of, and reducing the variation of, primary care and secondary care services. National and local strategies have a strong alignment to how people tell us they would like to see services provided.

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This focus on promoting health and wellbeing, maintaining independence, and streamlining care leads us to consider: How we improve outcomes over the long-term for some of our vulnerable population groups; Models of care and payment mechanisms that promote and enable delivery of care more effectively

and efficiently. 5.3 Financial challenges Developing the STP has led to a common understanding that we operate as a system in deficit. Latest forecast for 2017/18 indicate a system deficit of £97m against CCG and Trust financial control totals. The normalised deficit for the year, after removing the benefit of non-recurrent support is £137m (source North Central London Finance and Activity Modelling (FAM) Group 21 July 2017). The system deficit is after delivery of significant provider cost improvement programmes (CIP) and CCG QIPP programmes of between 4% and 4.5% in 2017/18. In addition to STP workstream interventions, system intentions for 2018/19 will therefore focus on reducing the system financial deficit through: A greater understanding of provider cost profiles to better align cost improvement programmes (CIP)

and CCG QIPP plans to ensure that service improvements can be delivered at the same time as removing costs from the system and delivering financial sustainability;

Development of a financial strategy for North Central London (NCL) in recognition of the need to promote system sustainability as well as individual organisation sustainability. The NCL-wide financial strategy is required as: Individual CCGs are in different financial positions; If the wide disparity in CCG financial positions is not addressed implementation of Sustainability and

Transformation Plan initiatives could be put at risk; To provide resilience to all CCGs in the light of limited funding uplifts for the next two years and

service pressures; CCGs need to work with providers to best achieve the conditions for receipt of sustainability funds

by providers. 5.4 Local CCG intentions not covered by Sustainability and Transformation Plan Our system intentions for 2018/19 focus on joint working across CCGs and providers to deliver the best outcomes for patients by planning and commissioning at scale or across the whole health and care system. However, there will also be local plans for each CCG for specific areas of delivery that are the result of local engagement and/or required for CCGs to meet their financial duties. CCGs will also seek to align locally identified priorities to retain commissioning at scale. 5.5 Greater alignment with specialist commissioning Current arrangements for commissioning specialised services can create fragmented pathways that are suboptimal clinically. Better alignment of CCG and specialist commissioning locally will allow pathways to be aligned and perverse incentives to be removed. In 2018/19 CCGs will therefore work with the NHS England Specialist Commissioning Team to: Hold joint contract management meetings with providers; Establish lead commissioner arrangements with CCGs and Specialist Commissioning taking on

management of overall contracts where they are the predominant commissioner and currently manage the vast majority of the contract baseline;

Co-commission pathways that are fragmented across CCG and Specialist commissioned services. Across the footprint of North Central London we now have a chance to look at a range of specialised services that might benefit patients from being co-commissioned or being commissioned more locally. These pathways include: Critical care pathways including a focus on neuro-rehabilitation; Bariatric care (with weight management);

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Psychiatric Intensive Care Unity care with a particular focus on women’s care; Child and Adolescent Mental Health (CAMHs) Tier Four services; Forensic mental health and locked rehab; Eating disorders; HIV and sexual health services.

5.6 System incentives and contract form CCGs would like to continue to work with providers in 2018/19 to further develop system incentives and options for contract form that better support the new models of care in the Sustainability and Transformation Plan (STP) being established across North Central London (NCL). This work is being undertaken through the established acute contract modelling group, with membership from both providers and commissioners to ensure that options for the use of alternative contract forms are co-produced. CCGs believe that work on the realignment of system incentives and contact form are priorities for 2018/19 as: Commissioning and contract form do not yet reflect the progress being made locally in developing and

delivering new models of care in NCL; The need to achieve balanced budgets across the health and care system will be supported by a re-

design of system incentives, payment mechanisms, and contracting structures; In preparation for contracts for 2019/20 and onwards CCGs would therefore like to shadow-run alternative contract forms in 2018/19 to ensure that any changes support delivery of the STP and balance risk equitably across the system. 5.7 Contract requirements for 2018/19 Two-year contracts for 2017/18 and 2018/19 were signed in December 2016. Whilst there are no major national contract adjustments anticipated at this stage there are key contract terms that will require local negotiation and agreement to underpin the second year of the 2017/19 contract (2018/19). Contracts signed in December 2016 provided for negotiation and agreement of contract baselines for 2018/19 during 2017/18. This is built into the planning timetable for developing plans for 2018/19. Contract baselines for 2018/19 will be reflective of the run-rate (outturn) for 2017/18 adjusted for growth and the impact of Sustainability and Transformation Plan and QIPP interventions. It should also be noted that plans for 2018/19 will need to respond to any emerging national policy and associated planning guidance. Any updates to national technical guidance, including for tariff, will be dealt with separately to system intentions. 5.8 Working with local authorities on joint commissioning With both health and social care organisations facing financial and operating challenges, we need to develop closer working with local authorities. We need to develop ways of working that mean we can tackle broader determinants of health as part of our move to population based health models and new models of care. Closer working with local authorities also brings the opportunity to join up services and improve care for vulnerable people. In 2018/19 we will: Take forward work to transform care across the five boroughs, including a focus on services for people

with learning disabilities; Adopt a clear approach to integration with Councils beyond social care for broader determinants of

health – housing, employment, prevention alliances with the third sector; Develop joint commissioning plans with local authorities with a focus on transforming care for people

with learning disabilities and delivery of the Better Care Fund.

5.9 Procurement principles Through development of the Sustainability and Transformation Plan (STP) Trusts have asked CCGs to consider their approach to procurement in delivering service improvements. In response CCGs have developed the following procurement principles to support both delivery of the STP and decision-making on the best route to delivering service improvements:

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The priority is to commission high quality local services for the residents of North Central London; CCGs will therefore first work with existing providers to best ensure these high quality local services are

provided (only where local providers cannot provide services to the requisite quality and value or meet service gaps the CCGs will consider procurement to remedy this);

Services will be developed and procured in line with the Sustainability and Transformation Plan; The CCG will engage with all providers to communicate the priorities and commissioning intentions of

the CCG in order to ensure transparency; The CCG will involve the public, patients and carers in proposals to change services which affect them

and more generally in the different aspects of commissioning services such as, planning and design; A range of expertise from a variety of providers will be used to develop detailed service specifications

for new service models ensuring all providers are treated equally and the specification does not discriminate against providers;

All decisions to procure services will be evidenced based taking into account clinical effectiveness, patient safety, outcomes, quality improvement and value for money;

Procurement decisions will consider not only the whole life cost of the intended improvements but also how the procurement outcome will deliver social value to the local area;

The CCG will act with a view to securing the needs of the people who use the services, improve the quality of the services and improving efficiency in the provision of the services including through the services being provided in an integrated way (including with other health care services, health-related services or social care services);

All procurements will comply with the requirements of the CCGs’ standing financial orders and standing financial instructions.

All procurements will comply with the requirements of European Union procurement processes, where they apply and all procurements will comply with the principles-based approach set out in the NHS (Procurement, Patient Choice and Competition)(No.2) Regulations 2013;

Specialist procurement advice will be taken to ensure the best procurement decision and route is adopted.

The CCGs welcome feedback from Trusts and other stakeholders on these procurement principles.

6. National Context System intentions for North Central London in 2018/19 are consistent with: The joint NHS England / NHS Improvement NHS Operational Planning and Contracting Guidance for

2017-2019; Refresh of the Five Year Forward View published in 2017. NHS England / NHS Improvement NHS Operational Planning and Contracting Guidance for 2017-2019 The guidance sets out how the NHS operational and planning processes would support delivery of Sustainability and Transformation Plans and financial sustainability in the NHS. The guidance set out the financial and business rules for both 2017/18 and 2018/19. The guidance indicated that: There needed to be a radical change in the behavioural dynamics of planning and contracting towards

a more collaborative process; This would be underpinned by simplified approaches to contracting and flexibility in implementing

strategies; Partnership working would be incentivised by a number of funding streams available at a Sustainability

and Transformation Plan (STP) level; Local health economies with robust STPs could adopt system control totals for finance, providing

transparent opportunities for the sharing of risk. Work by commissioners and providers on the contract round for 2017/18 and 2018/19 made progress on the above, and system intentions for 2018/19 are designed to continue that process.

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Refresh of the Five Year Forward View The NHS Five Year Forward View set out how the NHS needed to change to meet the needs of the population and set out three improvement opportunities - a health gap, a quality gap, and a financial sustainability gap. These gaps were targeted to be closed by a better integration of primary and specialist hospital care, physical and mental health services, and of health and social care. Delivery of these improvement opportunities was to be supported by change within the NHS, well-functioning social care, extra capital investment, transformation funding, and a focus on prevention and public health. Priorities identified for 2017/18 are also framed within the constraints of the requirement to deliver financial balance across the NHS and therefore the main 2017/18 national service improvement priorities for the NHS are: Improving A&E performance including upgrading the wider urgent and emergency care system; Strengthening access to high quality GP services and primary care; Improvement in cancer services (including against waiting time standards) and mental health. Delivery of the national service improvement priorities and financial balance will be further supported by: Supporting service redesign through Sustainability and Transformation Plans; A focus on funding and efficiency through the NHS ten-point efficiency plan; Delivery on the enablers for service improvement including workforce, safer care, technology and

innovation. The link to the refresh of the Five Year Forward View is provided below: https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf Plans for 2018/19 will also need to respond to any emerging national policy and associated planning guidance.

7. Outcomes A section on outcomes will be included in the intentions for 2018/19 incorporating the outcomes used in the update to the Five Year Forward View and the NCL Sustainability and Transformation Plan (STP). This was not done for 2017/18.

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https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf

https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf

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Report Title Primary Care Estates; Review and Refresh of Estates Strategy


Lead Director Gordon Houliston Tel/Email [email protected] Report Author Matthew Black Tel/Email [email protected] GB Sponsor(s) (where applicable)

Dr Neel Gupta Tel/Email [email protected]

Report Summary

This report provides a brief update on Camden’s commissioned estate. With the transfer of primary care commissioning to the CCG along with budgetary constraints, Camden’s Estate’s Strategy will be refreshed to reflect these changes. This report suggests objectives and estates criteria for refreshing the strategy along with timescales for engagement. The report details the predicted population changes for the borough of Camden and highlights possible cost-pressures in relation to three schemes which were instigated prior to primary care commissioning transferring to the CCG and to expired or expiring leases.


Information

Approval To note

Decision

Recommendation The Governing Body is asked to:

Note the status of the CCG’s commissioned estate. Note the forthcoming refresh of the Estates Strategy. Comment on the estates criteria.


Commission the delivery of NHS Constitutional rights and pledges Improve the quality and safety of commissioned services


Key risks are highlighted within the report.




Actions identified in the paper are covered by the current management resource.

Engagement

Engagement activities are set out within the report.


Not carried out for this report.

Report History First presented to this meeting. Next Steps Taking into account comments from the Governing Body, the Estates Strategy

refresh and associated engagement will commence.

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[ 1 / 7 ]

Primary Care Estates; Review and Refresh of Estates Strategy

1 Summary

This paper gives a brief update on Camden’s commissioned estate.

A predicted increase in the Camden population of approximately six per cent over the next ten years is expected to increase the demand for local healthcare services. As primary care commissioning has been delegated to Camden Clinical Commissioning Group along with the responsibility for the primary care estate, Camden’s Estates Strategy should now be refreshed to reflect these changes as well as the CCG’s substantially changed operating environment.

Furthermore, the Estates Strategy should also ensure that it is aligned to the Local Care Strategy, which is the Camden component of the North Central London (NCL) Sustainability and Transformation Plan (STP). This paper proposes a number of objectives and ‘estates criteria’ which could enable this.

Prioritising the refresh of the CCG’s estates strategy and associated criteria is important due to the need to make future decisions about estates against a strategic framework that aligns to the CCG’s priorities and deliverables. Formal decisions regarding estates are pending the review and refresh of the Estates Strategy and will need to be made by November 2017

The Governing Body is asked to note the contents of this report, specifically:

The process and timescales for the refreshed estates strategy To comment on the proposed ‘estates criteria’ proposed as the framework for

the Estates Strategy refresh

2 Camden’s estate and population predictions

Camden’s existing healthcare estate comprises a multitude of providers over hundreds of sites in Camden delivering primary, secondary, community, dental, ophthalmic, etc. services. As Camden Clinical Commissioning Group (CCG) is responsible for the commissioning of primary care services as of 2017, this means that thirty-four GP practice premises are now under the CCG’s responsibility. These premises are generally in a ‘good’ or ‘reasonably good’ state of repair and are mainly leasehold (82%).

The CCG’s responsibilities with delegated commissioning of primary care are to ensure that the primary care services it commissions are provided in fit for purpose premises and which are prepared for future demand changes brought on by such things as population growth.

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[ 2 / 7 ]

There are significant population increases expected in the borough over the next decade. The Greater London Authority population projections1 give a net 6% increase in the overall population of Camden between 2018 and 2028, with particular emphasis on the wards of West Hampstead, St Pancras & Somers Town, Regent’s Park, Holborn and Covent Garden. These are detailed in the table below.

Table 1: Greater London Authority population projections

Population Prediction Camden Borough Ward 2018 2028 Change St. Pancras and Somers Town 12,821 14,536 13% Regent's Park 11,885 13,308 12% West Hampstead 14,500 16,111 11% Holborn and Covent Garden 11,792 12,583 7% Bloomsbury 12,350 13,050 6% Camden Town with Primrose Hill 11,333 11,958 6% Hampstead Town 4,700 4,960 6% Highgate 3,594 3,797 6% King's Cross 21,833 22,917 5% Haverstock 18,714 19,643 5% Kilburn 18,286 19,214 5% Gospel Oak 16,929 17,857 5% Belsize 16,438 17,250 5% Cantelowes 16,000 16,813 5% Kentish Town 14,300 15,000 5% Fortune Green 12,500 13,150 5% Swiss Cottage 10,500 11,039 5% Frognal and Fitzjohns 8,467 8,900 5% Total 236,941 252,085 6%

The increase in population will have a knock-on effect on demand for local services and amenities, and so it is incumbent upon the CCG to assure itself that adequate primary care provision is planned to meet future need. Overlaying these population predictions with known estate developments, such as new housing, demonstrates that there are four or five distinct ‘hotspots’ in the borough, as shown in the diagram below.

1 London Data Store (no date) Ward Atlas [online]. Available at http://londondatastore-upload.s3.amazonaws.com/instant-atlas/ward-atlas-html/atlas.html (Accessed 29 August 2017).

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Figure 1: Camden’s predicted population density in 2028, and identified ‘hotspots’

From this it can be seen that the west of the borough (roughly the CHE (W) neighbourhood) will be affected by the Belsize Priory, Abbey Estate and West End Lane developments. East of this and in the NW5 neighbourhood, the redevelopment of the Morrisons supermarket in Camden Town is expected to create a significant pressure on local services. Looking eastward again, both the NW5 and the whole of the CHE(S) neighbourhoods will be affected by the Kings Cross and other developments. In the north of the borough in the NW3 neighbourhood, two smaller developments are taking place which will have commensurate impact in that area.

3 Finance and Sustainability

Most healthcare services will require premises and generally these are paid for by the commissioner. This means that the CCG is now liable for the rent, rates and other associated costs of the premises which deliver primary care services. This further emphasises the need to review and refresh the CCG’s estates strategy to take into account these additional responsibilities.

Additionally, most of the primary care estate (82%) is leasehold which presents cost pressures associated with the extension of such leasehold arrangements. This is because the budgets for primary care commissioning have been delegated from NHS England to the CCG on an as is basis. Given the historical nature of current leasehold arrangements being substantially lower than current market value and/or

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[ 4 / 7 ]

leases being agreed at 'peppercorn’ (generally well below market value) values, renegotiation of leasehold arrangements are likely to be higher and trigger a rent and rate review. This is generally conducted by an impartial third-party, and for the NHS, this is the District Valuer2, a Governmental department.

In accordance with the general principle to achieve value for money, the CCG should also ensure its estate is well-utilised. In particular, the CCG should be mindful of keeping to a minimum ‘void costs’, i.e. paying for un-used space as this is not an effective use of the healthcare budget.

In July 2016, a utilisation study was conducted by Oakleaf Group on behalf of the CCG. Although it was only partially-completed (22 out of 34 practices, i.e. a 65% completion rate) a number of premises can be seen to be operating at a lower than optimal utilisation. For example, a rough standard is for rooms to be occupied 60% to 90% of the time they are available (i.e. in ‘working hours’). The utilisation study found that a number of premises were at less than 60% and one was at 48%.

Using the findings of the incomplete study, the potential liability of void costs can be estimated and shows that the CCG could be paying £756k for empty rooms each year. The study’s findings also present a potential opportunity as it identifies spaces which could be better utilised, such as through housing additional services, for example.

4 Estates Strategy

Camden CCG’s Estates Strategy was produced late-2015. As part of producing the strategy, a complete stocktake of the local estate was undertaken and partnerships were formed with local providers and other stakeholders to set up a Camden Premises Steering Group. This group has met a number of times since then and has acted as a forum for estates issues. It was chaired by the Chief Financial Officer of the CCG at that time.

With the delegation of primary care commissioning to the CCG it was deemed appropriate to re-invigorate the CCG’s estates programme and so a management post has been identified to lead the work on behalf of the CCG. In terms of a workplan for Camden’s estates, the Camden Local Care Strategy is being used to give a steer: The Strategy sets out a vision whereby Health and care services will work together with local people to provide coordinated, proactive, accessible, good quality care in order to improve the health and wellbeing of people in Camden. The strategy also identifies that more care will be delivered in the primary and community setting, including more specialist services as well as promoting the use of multi-disciplinary teams.

2 Cf. https://www.gov.uk/government/organisations/district-valuer-services-dvs/about (Accessed 29 August 2017).

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[ 5 / 7 ]

Taking this into account, five key objectives have been identified for the Estates Strategy:

Ensure that estates developments are commissioner-led Ensure spaces are fit for purpose Ensure spaces are well-used Ensure the system has capacity for the future Ensure spaces are flexible and appropriate for multi-disciplinary working

These objectives will be reflected in the refresh of the strategy and will form the basis of the estates strategy implementation plan.

As well as this, a key enabler for refreshing the strategy means identifying certain ‘estates criteria’ that will be used to appraise premises and to act as a framework for decision making and prioritising. The key elements to appraising the CCG’s estate are suggested below and the Governing Body is asked to comment upon them.

Table 2: Draft estates criteria for appraising primary care estate

Estates Criteria Rationale Does the occupying practice have a list size of less than 4,000?

Using NHS Digital data3, half of Camden practices have a list size less of than six thousand and a quarter have a list size of less than four thousand.

There is some evidence that larger practices are associated with better performance in terms of the Quality and Outcomes Framework (QOF), referral rates to secondary care, and admission rates for ambulatory care sensitive conditions4,5.

Is the occupying practice a ‘single-hander’?

There is some evidence that larger practices are associated with better performance in terms of QOF, referral rates to secondary care, and admission rates for ambulatory care sensitive conditions6.

Can change be made at net zero cost?

Owing to the financial savings challenge and other budget challenges, schemes or changes which will realise a cost-pressure cannot be funded. Instead, schemes or changes that can be achieved at nett zero cost should be prioritised.

3 http://content.digital.nhs.uk/article/2021/Website-Search?productid=25240&q=Number+of+Patients+Registered+at+a+GP+Practice&sort=Relevance&size=10&page=1&area=both#top 4 Kelly, E. & Stoye, G. (2014) Does GP Practice Size Matter? GP Practice Size and the Quality of Primary Care [online]. Available at https://www.ifs.org.uk/uploads/publications/comms/R101.pdf (Accessed 29 August 2017). 5 Care Quality Commission (2016) The state of health care and adult social care in England 2015/16 [online]. Available at http://www.cqc.org.uk/sites/default/files/20161019_stateofcare1516_web.pdf (Accessed 29 August 2017). 6 Kelly, E. & Stoye, G., op cit.

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[ 6 / 7 ]

Estates Criteria Rationale It should be noted that there currently is no rolling

programme of repairs and as such, the primary care estate is functionally depreciating year on year. Premises and spaces will naturally degrade over time through natural wear and tear, and so this cost cannot be avoided long-term.

Is space utilisation greater than 90%?

Generally, spaces should be utilised 60% to 90% of the time, any more than this implies that the premises are either at full capacity or will have no future capacity.

Is space utilisation less than 60%?

Low-utilisation results in ‘void space’ costs which need to be minimised.

Spaces which are more flexible should mean that they are better able to be used more regularly, and so have higher utilisation rates.

How far away is the nearest neighbour?

Clusters of practices close together may mean an inefficient estate. For example, there are three practices within half a kilometre of each other in Camden. Reducing these premises to one or two sites could save between £20k and £50k a year. A review would need to confirm viability by taking into account the actual capacity of practices / services to collocate or merge.

How flexible is the space?

Moving away from fixed-use spaces into more flexible ones should greatly increase the utilisation rate of space.

Moving away from smaller units, possibly inadequate or poorly converted spaces, into more modern, flexible spaces should give capacity for the future.

5 Conclusion and Next Steps

The Governing Body is asked to note the contents of this report, specifically:

The process and timescales for the refreshed estates strategy To comment on the proposed ‘estates criteria’ proposed as the framework for

the Estates Strategy refresh

Having a strong set of criteria, agreed by all means that an objective strategy can be developed as the basis for ensuring the best utilisation of the existing estate and prepares the Camden healthcare system for the future.

Taking into account comments from the Governing Body, the estates strategy refresh will continue and the proposed stakeholder engagement and draft timelines are as follows.

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[ 7 / 7 ]

Table 3: Draft stakeholder engagement timelines

Date Activity September 2017 Estates Strategy refresh finalised by the CCG’s internal

working group. Executive Management Team review and comments

incorporated.

October 2017 Camden Premises Steering Group review and comment. Public engagement takes place through the

CitizenSpace portal. Camden Patient and Public Engagement Group review

and comment. Locality meetings review and comment. Taking into account feedback from patients, public,

member practices and other stakeholders, the Estates Strategy will be finalised.

November 2017 Final refreshed strategy sent to the Governing Body’s meeting on 8 November 2017.

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Report Title Finance and QIPP Update Report

Agenda Item 4.1

Date of Report 29 August 2017 Lead Director Simon Goodwin Tel/Email [email protected]

Report Author Barry Moffatt


Sponsor(s) (where applicable)

Simon Goodwin Chief Finance Officer


Report Summary This report sets out the CCG’s financial position at the end of month 4 and the

latest position with regard to QIPP.



Decision



Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for money services.


This report sets out the financial risks and opportunities for 2017/18.


This report sets out the CCG’s financial position at the end of July 2017, together with the forecast spend for the year.

Engagement

Not applicable for the purpose of this report.



Report History The Governing Body receives regular Finance and QIPP updates.

Next Steps Continued oversight by the Finance and Performance Committee.

Appendices Appendix 1 - Finance Report

Appendix 2 - QIPP Update

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Working with the people of Camden to achieve the best health for all

Camden CCG Finance Report Month 4 - July 2017 Appendix 1

Barry Moffatt

Interim Deputy CFO

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1. Business Headlines July 2017, Month 4 Summary

Table one set out the financial position for Camden CCG for Month 4 together with the projected year end positon. Table 1: Summary

Year to Date Full Year Forecast

Budget Actual

Variance Unfav/(Fav)

Budget Actual Variance

Unfav/(Fav)

£000's £000's £000's £000's £000's £000's

Revenue Resource Limit 138,401 138,401 0 406,725 406,725 0

Total Income 138,401 138,401 0 406,725 406,725 0

Acute Spend 67,908 68,219 311 196,492 200,976 4,484

Non Acute Spend 50,817 50,575 (242) 147,838 147,875 (946)

Primary Care Delegated Commissioning

12,756 12,755 (1) 38,270 38,270 0

Investment Spend 2,783 2,995 212 8,078 8,160 82

Running Costs 1,923 1,923 (0) 5,583 5,610 27

Overheads, Contingencies & QIPP

2,409 2,569 160 10,465 5,835 (3,647)

Total Expenditure 138,596 139,036 439 406,725 406,725 0

Surplus / (Deficit) (196) (635) (439) 0 0 0

Overall the CCG forecasts to achieve its control total at the end of the year. The Acute position has worsened in Month 4 by £4.439m predominately due to a budget adjustment made to Royal Free £4.0m and over performance at Royal Free in direct access (diagnostics) £0.339m where activity is up 21% YTD. This has been challenged by the CSU as it appears the variance may be a counting and coding issue relating to bundled and unbundled images where the provider is now using one system to count activity. Non-Acute is forecast to be £0.9m overspent primarily in Mental Health £0.2m and Children’s Services £0.5m. The forecasted overspend has been offset by the release of contingency and use of non-recurrent reserves. The Acute run rate needs to reduce by c£0.6m a month for the CCG to achieve the forecast. Further financial pressures and risks which need to be noted.

The CCG received the delegated primary commissioning budget from NHSE with a deficit of £2m. The CCG anticipates this will be funded through NCL.

QIPP under delivery YTD at month 4 is £0.411m compared to £0.9m at month 3. The full year risk that the QIPP will not be fully realised equates to £1.25m / 5.2% at month 4. £0.76m of this risk relates to STP Transformation schemes and £0.49m relates to local schemes.

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2. Acute Contract spend analysis Month 4 Acute Contracts are forecast to overspend by £4.4m at year end. The current year to date overspend is c£0.3m. Table 2 below shows the Acute spend per provider. Where appropriate the marginal rate on acute contracts has been applied. Table 2: Acute Expenditure

Provider Plan Year to

date

Spend Year to date

Variance Year to date

Unfav/(Fav)

Plan Full Year

Forecast Full Year

Forecast Variance Full Year

Unfav/(Fav)

£000 £000 £000 £000 £000 £000

UCLH 22,447 22,993 546 66,451 67,024 573

ROYAL Free 20,468 20,241 (227) 60,361 64,886 4,525

Imperial College 112 131 19 335 377 42

Moorfields Eye Hospital 950 902 (48) 2,850 2,849 (2)

Barts 858 851 (7) 2,512 2,624 112

Guy's and St Thomas 0 0 0 0 0 0

The Whittington 2,190 2,251 61 3,517 3,525 8

Other 20,884 20,850 (33) 60,466 59,691 (774)

Total 67,908 68,219 311 196,492 200,976 4,484

UCLH - the Trust are currently implementing a data warehouse improvement project which caused delays in the submission of reliable data. Break down of spend by POD will be provided Month 5. Royal Free - Over performance is evident at POD level in Diagnostic Imaging, Non electives, Outpatients, Electives and A&E. To note the Indicative Activity Plan has not yet been agreed. A deep dive into the provider’s activity has been requested to be performed with the CSU in weeks 2 and 3 in August. Imperial college - The large over performance relates to Critical Care and Non-Elective. The high level of over performance has been queried with the Trust to ensure that it is valid. Table 3: Acute Spend Run rate

April

May

June

July

Forecast average to year

end Total

Budget

Variance

Unfav/(Fav)

£000 £000 £000 £000 £000 £000 £000 £000

Royal Free NHS Foundation Trust 5,229 5,229 5,474 5,456 5,437 64,886 60,361 4,525

University College London Hospitals NHS Foundation Trust 5,384 5,384 6,555 5,669 5,504 67,024 66,451 573

Imperial College Healthcare NHS Trust 716 716 844 667 743 8,888 7,757 1,131

The Whittington Hospital NHS Trust 443 443 389 2,251 870 10,489 10,477 12

Moorfields Eye Hospital NHS Foundation Trust 228 228 207 240 243 2,849 2,850 (2)

Bart’s and The London NHS Trust 195 195 257 207 221 2,624 2,512 112

Guy's and St Thomas' NHS Foundation Trust 211 211 206 361 185 2,465 2,500 (35)

NCAS/OATS 210 210 250 134 199 2,397 2,397 0

Other acute 2,868 2,868 5,046 3,039 3,192 39,354 41,187 (1,833)

Total acute 15,484 15,484 19,227 18,024 16,595 200,976 196,492 4,484

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Table 3 above shows the actual expenditure for the months April to July as well as the average monthly expenditure for July 17 to March 18 (based on the contract values). The current monthly run rate for Acute is £16,595k, this needs to reduce to £16,034k to achieve the forecast. The table highlights that if the CCG continues to spend at the current rate acute contracts will be overspent by £4.5m. Compared to previous month the average run rate has improved by £0.8m. In part this is due to the reduced working days in July, an average of 19.5 days against 22 days in June. The Acute QIPP savings are profiled from month 4. It remains vital that the CCG achieves its QIPP target to meet the plan. Further work to asses over performance is work in progress being led by the Interim Director of Commissioning and Contracting, the Director of Sustainable Insights and the Deputy Chief Finance Officer.

3. Non Acute Expenditure Table 4: Non Acute Expenditure

Service

Plan Year to date

Actual Spend Year to

date

Actual Variance -

Year to date Unfav/(Fav)

Plan Full Year

Forecast Full Year

Forecast Variance Full Year

Unfav/(Fav)

£000 £000 £000 £000 £000 £000

Mental Health 17,909 17,996 87 53,037 53,266 228

Children's Services 3,425 3,599 174 9,776 10,231 455

Continuing Care 4,240 4,140 (100) 12,719 12,417 (302)

End of life 848 926 78 2,274 2,274 0

Better Care Fund 1,065 1,065 0 3,196 3,196 0

Community 11,101 10,791 (311) 30,707 30,551 (156)

Quality & Clinical Effectiveness

9,196 9,024 (172) 27,225 27,279 55

Primary Care (LCS) 1,202 1,099 (103) 3,411 3,031 (380)

Other 1,831 1,935 104 5,493 5,630 137

Total 50,817 50,575 (242) 147,838 147,875 37

Non –Acute contracts are based on Block contracts. The full year spend is expected to be £37k overspent. Children’s services are forecast to overspend by £0.5m due to an increase in personal health budgets, this reflects an increase compared to prior years. The Mental Health forecasted over spend, £0.2m is for a high cost placement in the independent sector. These are forecast to be offset by underspends in Continuing Care £0.3m, Community £0.2m and Primary Care LCS £0.4m.

4. Running costs Running costs are forecast to deliver within budget at year end. 5. Staffing Staff costs have reduced for both permanent and temp staff costs YTD compared to last year. Interim staff expenditure is £0.5m under budget, and permanent staff is under spent by £0.1m YTD.

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Graph 1: Staffing expenditure 2016/17 v 2017/8

6. Overheads & Sustainable Insights / GP IT Overheads and Sustainable Insights are forecast to deliver on budget.

7. QIPP QIPP under delivery YTD at month 4 is £0.411m compared to £0.9m at month 3. The full year risk that the QIPP will not be fully realised equates to £1.25m / 5.2% at month 4. £0.76m of this risk relates to STP Transformation schemes and £0.49m relates to local schemes. New schemes have been implemented to assist in bridging the gap. A deep dive is currently been undertaken to fully understand that the schemes listed are robust and will be achieved as currently forecast. Full details of the QIPP is reported on Agenda item 3.5.

8. Risks and mitigations Potentials risks for the CCG:-

The risk on the QIPP under delivering risk is £4.8m. £2m deficit for Delegated Primary Care commissioning.

These are mitigated by:-

£2m non recurrent reserves Support from other CCGs for the Primary care deficit

0

100

200

300

400

500

600

700

800

900

Payroll Payroll Contractor &Agency

Payroll Contractor &Agency

Payroll Contractor &Agency

Apr May Jun Jul

£'00

0

Staffing Actual Spend 2017/18 vs 2016/17

2017/18

2016/17

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Greater focus on QIPP programme management to ensure delivery

9. Summary The CCG has forecast to achieve its control total, however non-delivery of the QIPP will put significant pressure on this.

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1

Appendix 2

QIPP Update Report – Month 4 2017/18

The purpose of this paper is to provide the committee with an update of the QIPP plan at month 4 of 2017/18.

The CCG submitted is monthly position with an underachievement of £411k. The overall CCG rating within the finance templates reported to NHSE is amber based on a negative variance of £486k against 2017/18 forecast outturn (FOT). This is an improvement of £240k against the month 3 FOT position.

Although our current position is mainly positive the increase in underachievement at month 4 is highlighting the slippage of transformation projects in the first half of 2017/18. The improved FOT position is a result of this as the CCG has sought to identify alternative QIPP in July to offset this under performance with two new lines incorporated into the plan which equates to £902k.

Recognising the challenge in developing new models of care within timescales provided, the organisation has introduced a new process of monthly team reviews of QIPP to understand the current and forecast QIPP positions, with any mitigating actions agreed including additional QIPP identified where appropriate.

This exercise has demonstrated that 42% of the QIPP plan is delivered via mainly contract and budget savings at £7.63m, with a focus required on delivering the transformation element at £7.88m across 35 schemes. The CCG is currently working toward implementation for many of these QIPP projects by October 17 ahead of the winter period.

Split of QIPP FOT for 2017/18 by RAG status (£,000):

2136

5747

2086

7632

486

Red Amber Green Blue Under Delivery

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2

QIPP Position Month 4

Key Risks

The main risk to QIPP delivery remains the pace of change to develop and implement new models of care in-year for 17/18. Although the CCG is reporting 42% of its plan closed (blue), this is disproportionately related to contract efficiencies and budgets.

The majority of QIPP lines rated as Red or Amber are associated to transformation and STP work streams with start dates now adjusted for mid-year delivery of October. Teams are currently reviewing forecast savings and any mitigating/alternative QIPP projects to offset Q1/2 under delivery.

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68 of 191


Report Title Integrated Performance Report

Agenda Item

4.2

Date 01/09/2017

Lead Director Charlotte Mullins, Director

Sustainable Insights

Tel/ Email

[email protected]

Report Author Richard Cartwright Head of Performance

Tel/ Email

[email protected]


Dr Birgit Curtis Tel/ Email

[email protected]

Report Summary The Integrated Performance Report reports on provider performance against the

constitutional targets, financial performance, quality and outcomes. The report also highlights the performance management of CCGs using the CCG Improvement and Assessment Framework which provides a stronger focus on outcomes over acute provider access targets.



Decision

Recommendation The Governing Body is asked to note the contents of the Integrated Performance Report.


Commission the delivery of NHS Constitutional rights and pledges Improve the quality and safety of commissioned services


These are identified within the report.



Engagement




Report History This report is a standing item on the Governing Body agenda.

Next Steps None

Appendices None

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Integrated Performance ReportAugust 2017

70 of 191

Contents

DESCRIPTION PAGE

1 Access -

1.1 Operating Plan Targets 3

1.2 Provider Access Targets 4

1.3 Demand Management 5 - 6

1.4 Delayed Transfers of Care (DTOCs) 7 - 8

1.5 CAMHS and Community Access 9 - 10

2 Commissioned Services Register Monitoring 11

3 Quality -

3.1 Serious Incidents 12

3.2 Complaints and Friends & Family Test 13

4 Activity -

4.1 Performance against Operating Plan 14

4.2 QIPP Plan 2017/ 19 15 - 16

5 Finance 17

6 Improvement & Assessment Framework -

6.1 2016/17 Year End Rating & Clinical Priority Areas 18

6.2 Dashboard - Four Domains 19

7 2017/18 Quality Premium 20

8 Workforce 21 - 22

9 Glossary 23

10 Appendices A - Population HealthB - Commissioned Services Register

24 - 25Sep. Attachment71 of 191

Key messages:

• Cancer waiting times and A&E 4 hour waits remain the key areas of concern and focusfor the CCG.

• In June 2017 London was ranked 1st of the four regions at 91.4%, with 15 of 22 Trusts notachieving the 95% standard. A&E performance at both UCLH and Royal Free is reflectiveof the regional and national position.

• Camden performance for the 62 day cancer target continues to be driven by non-compliance at UCLH. Trust performance is managed in line with the CCG’s performancemanagement framework.

• The CCG narrowly missed the diagnostics standard for a second month. Royal Free, UCLHand Imperial had the highest numbers of Camden patients waiting over 6 weeks.

• The CCG is working with acute providers to ensure that sufficient capacity of e-referralslots are made available, and with primary care colleagues to ensure the system is beingutilised where appropriate.

• While national data continues to show Camden not meeting the IAPT target, local datashows the CCG achieving this at 52.65% (Jul 17). Data quality issues are being addressedwith NHSE.

1. Access 1.1 CCG Operating Plan Targets

Camden CCG 2017/18 Performance Scorecard

Target/

Threshold

RTT Incomplete Pathways within 18 Weeks 92% Jun-17 93.1% 92.9%

RTT 52+ week waiters 0 Jun-17 6 13

Diagnostics Diagnostics - 6+ week waiters 99% Jun-17 98.7% 98.9%

A&E 4 Hour Waits 95% Jul-17 89.0% 90.3%

Delayed Transfers of Care - Acute - Jun-17 397 1181

Delayed Transfers of Care - Non-Acute - Jun-17 150 384

Total delayed days per 100,000 18+ population - Jun-17 276 n/a

2 week wait 93% Jun-17 94.5% 94.1%

2 week wait breast symptomatic 93% Jun-17 92.5% 91.9%

31 day 1st definitive treatment 96% Jun-17 100.0% 98.8%

31 day 1st subsequent treatment - surg. 94% Jun-17 87.5% 90.7%

31 day 1st subsequent treatment - chemo. 98% Jun-17 100.0% 100.0%

31 day 1st subsequent treatment - radio. 94% Jun-17 100.0% 100.0%

62 day standard 85% Jun-17 75.0% 75.4%

62 day standard - screening 90% Jun-17 100.0% 100.0%

62 day standard - upgrade No Target Jun-17 100.0% 95.9%

Mixed Sex Mixed Sex Accommodation Breaches 0 Jun-17 4 8

MRSA Reported Cases (CCG Assigned) 0 Jun-17 0 1

C.Difficile Reported Cases Jun-17 8 13

Cat A (RED1): Response within 8 Min 75% Jun-17 74.2% 81.1%


Cat A: Response within 19 Min 95% Jun-17 93.6% 94.7%

Cat A (RED1) Trajectory - Jun-17 75% 75%



Cat A: Response within 19 Min 95% Jun-17 95.0% 95.3%

CPA Follow-ups 95% 2016/17 Q4 95.7% 95.5%

IAPT Access 4% 2016/17 Q4 4.4% 4.1%

IAPT Recovery Rates (NB national data presented) 50% 2016/17 Q4 44.0% 43.1%

6 Weeks IAPT Waiting Times 75% Apr-17 88.0% 85.1%

18 Weeks IAPT Waiting Times 95% Apr-17 98.0% 98.0%

Dementia Diagnosis Rate 67% Jun-17 87.6% 87.1%

Psychosis (EIP) - 2 Week Wait, NICE approved package 50% May-17 85.7% 77.9%

Eating Disorders Waiting Times (4Wk Routine) 95% 2016/17 Q4 80.0% 67.3%

Eating Disorders Waiting Times (1Wk Urgent) 95% 2016/17 Q4 No activity 100%

New children and young people receiving treatment

from NHS funded community services30% 2017/18 Q1 Await MHSDS

V2 data, tbc Await MHSDS V2 data, tbc

Individual children and young people receiving

treatment by NHS funded community services30% 2017/18 Q1 Await MHSDS

V2 data, tbc Await MHSDS V2 data, tbc

Utilisation of e-RS booking

50% (April 2017)

80% (Oct 2017)May-17 41.0% 43.0%

Wheelchair

ServiceRTT Childrens Wheelchairs within 18 Weeks 100% 2017/18 Q1 100.0% 100.0%

PHBs per 100,000 GP registered pop.11.23 (2017/18 Q1) 2016/17 Q2 13.3

n/a

Indicator Type

Camden DTOCs

(days)

Cancer - 2

week

Reporting Period

Annual

RTT

LAS

(Camden)

LAS

(London wide)

Mental Health

A&E

e-RS

Personal Health

Budgets

Cancer - 31 day

Cancer - 62 day

HCAI

Camden CCG - Current month Trend Camden CCG -

YTD Trend

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UCLH Key Messages:

The CCG re-issued UCLH with Contract Performance Notices for 2017/18 for 62day cancer and A&E. Remedial action plans were refreshed and continue to be themain mechanism to drive improvements in A&E and cancer performance.

A&E UCLH achieved performance of 90% in Q1, thereby achieving the 15%

performance element of the Sustainability & Transformation Fund. Following a positive Q1, unvalidated data suggests that performance in July had

dropped to 88.2%.

Cancer The 62 day standard continues to be impacted by late referrals from BHRUT

and some other local referring Trusts. Complex diagnostics and urologypathway issues which are addressed in the RAP also impacted Juneperformance.

All Root Cause Analyses of 100+ day breaches will be reviewed by CQRG for anyevidence of clinical harm or disease progression, on a monthly basis as per theguidance provided by NHSE.

Diagnostics UCLH failed to achieve the diagnostic target this month following seven

successive months of compliance. In June 90 patients waited over 6 weeks at UCLH, 10 more than would have

seen the Trust submit a compliant position. Non-compliant modalities in June were audiology, Peripheral Neurophysiology,

Urodynamics, Colonoscopy, Flexi Sigmoidoscopy and Gastroscopy. The Trust remains compliant year to date, however the Camden as lead

commissioner is monitoring UCLH diagnostics performance closely, and followsthe CCG’s performance management framework in managing the contract.

1. Access1.2 Provider Access Targets

UCLH and Royal Free 2017/18 Scorecard

Royal Free YTD

Target/

Threshold

Reporting

PeriodPerformance Trend Performance Trend Performance Trend Performance Trend

RTT Incomplete Pathways 92% Jun-17 92.9% 93.1% 92.2% 92.3%

RTT 52+ week waiters 0 Jun-17 0 2 3 8

Diagnostics Diagnostics - 6+ week waiters 99% Jun-17 98.9% 99.2% 99.5% 99.6%

A&E 4 Hour Waits 95% Jul-17 88.2% 89.7% 84.5% 85.2%

A&E 12 Hour Waits 0 Jul-17 0 0 0 0

Delayed Transfers of Care (days) - Trust level - Jun-17 663 2514 905 3319

Delayed days per occupied beds % 2.5% Jun-17 5.3% 6.3% 8.7% 8.9%

2 week wait 93% Jun-17 95.0% 94.4% 94.9% 93.8%

2 week wait breast symptomatic 93% Jun-17 91.2% 92.4% 91.7% 92.4%

31 day 1st definitive treatment 96% Jun-17 87.6% 91.3% 96.4% 97.3%

31 day 1st subsequent treatment - surg. 94% Jun-17 92.0% 90.7% 100.0% 98.9%

31 day 1st subsequent treatment - chemo 98% Jun-17 100.0% 100.0% 100.0% 100.0%

31 day 1st subsequent treatment - radio 94% Jun-17 100.0% 100.0% 100.0% 100.0%

62 day standard 85% Jun-17 62.9% 64.1% 81.4% 83.5%

62 day standard - screening 90% Jun-17 44.4% 58.9% 85.7% 90.0%

62 day standard - upgrade 90% (UCLH) Jun-17 70.6% 78.9% 82.5% 85.2%

Mixed Sex Mixed Sex Accommodation Breaches 0 Jun-17 21 40 40 85

Cancelled Ops for non-clinical reasons

rebooked >28 days100% 2017/18 Q1 92.1% 92.1% 93.7% 93.7%

Urgent operation cancelled for the 2nd time 0 Jun-17 0 0 0 0

MRSA Reported Cases (Trust assigned) 0 Jun-17 0 1 1 2

C.Difficile Reported Cases Jun-17 8 14 9 18

Handover time over 30min of arrival 0 Jun-17 169 558 196 557

Handover time over 60min of arrival 0 Jun-17 9 38 104 264

% of Data recorded electronically 90% Jun-17 94.7% 93.6% 86.0% 87.2%

VTE VTE Risk Assessed Admissions 95% Mar-17 96.2% 96.2% 96.9% 96.9%

SHMI Summary Level Hospital Mortality Indicator <100

Jan 2016 to Dec 2016 74.7 n/a 90.1 n/a

Cancelled Ops

HCAI-

Ambulance

Handover

A&E

DTOCs

Cancer - 2

week

Cancer - 62 day

Cancer - 31 day

RTT

UCLH UCLH YTD Royal Free

Indicator Type

NCL Sector A&E PerformanceA&E performance continues tochallenge across London, andnationally. In June 2017 London wasranked 1st of the four regions at 91.4%,with 15 of 22 Trusts not achieving the95% standard.*Moorfields data relates to Type 2 only.**Chase Farm data relates to Type 3 only.

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1. Access1.3 Demand Management

The following two pages focus on demand management in terms of admission avoidance. Further information on demand, including referrals can be found on page 14 of thisreport.

Extended Access Extended access in primary care (08:00 - 20:00, seven days a week) is in place in Camden. Primary care streaming continues at UCLH (12:00 - 18:00), and will extend to a 10:00 - 22:00 service from September 2017.

UtilisationComparative data suggests that Camden does not use extended access as extensively as other NCL CCGs. Utilisation rates have been discussed with Haverstock Health and various actions are underway to improve utilisation, including patient awareness of the service. The Integrated Care Team business case to redesign community services is due to be taken at the Integrated Commissioning Committee on 27/09/17.AT Medics will take over the full contract from 1st December 2017 and are in the process of mobilisation.

2016/17 The current provision of weekends across all hubs and weekdays at the

South hub was mobilised by Nov 16. Utilisation improved as the service became embedded.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North South West North South West North South West North South West North South West

Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Current EA Service: Utilisation 2016/17

YTD 2017/18 The West hub continues to have better utilisation than North or South In Jul 17, the South hub is at its second highest point since service

commencement (the South hub has been subcontracted since 1 Jul 17)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North South West North South West North South West North South West

Apr-17 May-17 Jun-17 Jul-17

Current EA Service: YTD

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1. Access1.3 Demand Management

Simplified Discharge - Discharge to Assess Progress This is part of the wider Supporting People Programme, building on

Camden’s integrated commissioning arrangements and includesadmissions avoidance as well as simplified discharge.

D2A Pathway 0 - agreement with Adult Social Care on hospital restart ofpre-existing care packages.

D2A Pathway 1 - is in place with UCLH as a Planned, Do, Study, Act(PDSA) pilot using real live cases - 30 to date - to help design the pathwaycollaboratively.

D2A pathway 2 & 3 - for patients unable to immediately return home. Muchof the system, such as rehabilitation beds and trusted assessorarrangements are in place. A review of the bed capacity is beingundertaken to support assessment at home as the preferred option.

D2A targets - reduced delayed transfers of care from 15 a day to 10.72,which will go towards achieving the £799k QIPP in 2018/19, facilitatingpatient flow out of the acute hospital.

RAPIDS The chart (right) shows admission avoidance from the Rapid Response

service plus the out of hours nursing service. Rapids accounts for approximately two-thirds of these admission avoidance

episodes per month. Implementation of the Rapid Response Admission Avoidance business case

has commenced and includes: - The development of a communication plan to promote the service in

Primary care - Re-provisioning of nursing resources into the Rapids service - Discussion with London Ambulance Service to re-direct potential Admission

Avoidance patients. 0

20

40

60

80

100

120

140

April 2016 May 2016 June 2016 July 2016 August 2016 September2016

October 2016 November2016

December2016

January 2017 February2017

March 2017 April 2017 May 2017 June 2017

RAPIDS activity

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1. Access1.4 Delayed Transfer Of Care (DTOCs)

The most recent benchmarking data available suggests thatCamden performs better than both England and London,however Q1 2017/18 has seen a pressure on DTOCperformance and this largely relates to the successfulcompletion of social care assessments.

The Integrated Commissioning Team have been workingclosely with the Adult Social Care Team to address thispressure and the improved position for June 2017 appears toreflect the impact of this work.

NHS England gives a list of 10 reasons for a DTOC.Nationally the fastest growing reason is ‘awaiting carepackage in own home’. In England in May 2017 there wereover three times as many delayed days due to patientsawaiting a care package in their own home compared to April2014, although significantly this does not appear to be anissue in Camden.

0

50

100

150

200

250

Camden Local Authority Delayed Discharge reasons (Number of delayed days)

A) COMPLETION OF ASSESSMENT B) PUBLIC FUNDING

C) WAITING FURTHER NHS NON-ACUTE CARE DI) AWAITING RESIDENTIAL HOME PLACEMENT OR AVAILABILITY

DII) AWAITING NURSING HOME PLACEMENT OR AVAILABILITY E) AWAITING CARE PACKAGE IN OWN HOME

F) AWAITING COMMUNITY EQUIPMENT AND ADAPTIONS G) PATIENT OR FAMILY CHOICE

H) DISPUTES I) HOUSING - PATIENTS NOT COVERED BY NHS AND COMMUNITY CARE ACT

- England

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1. Access1.4 Delayed Transfer Of Care (DTOCs)

0

200

400

600

800

1000

1200

UCLH

Acute

Non-Acute

0

200

400

600

800

1000

1200

1400

1600

Acute

Non-Acute

Royal Free

Camden CCG and UCLH continue to work closely on a daily basis to ensure numbers ofDTOC’s and MO’s are kept within acceptable limits.

A DTOC trajectory plan is currently being created and will be shared with NHSE inSeptember 2017.

Barnet CCG continue to lead on DTOC meetings for Royal Free, which are held twice eachday to expedite early discharges and free up bed capacity in acute setting.

The PMO structure is being established by Barnet CCG and the Recovery Action Plan hasbeen refreshed to help the trust meet the 4 hour A&E target.

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1. Access1.5 CNWL Access

CNWL community services access targets

The following additional performance measures are contained within the CNWL contract for Camden:

- Patients on incomplete non consultant led community pathways have been waiting no more than 6 weeks from referral to first appointment.- Referrals responded to within 48 hours. This will include non-face to face clinical appointments, but does not include phlebotomy only services.- Urgent referrals to out of hours (OOH) nursing responded to within 2 hours.

The latest available data shows that CNWL not meeting the new measured access targets for community services in 2017/18. Future reports will include a full narrative around the reasons for this.

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1. Access1.5 CAHMS and Community Access

The following additional performance measures are contained within contracts for Camden. Data, where available, and narrative around performance will be included in future reports.

MSKThe contract has the following performance measures:

- 95% of urgent and physiotherapy referrals to be seen within 10 working days of receipt of referral.- 90% of all routine referrals to be seen within 20 working days of receipt of referral.- 100% of patients referred on to appropriate services within 3 working days of completion of triage identified as out of scope of MSK

Long Term Condition ServicesWaiting times in community contracts are not currently routinely measured, however a number of LTC services are being reviewed at present with the expectation that in future such measures will be captured. Integrated Commissioning and IT colleagues are developing methods to address issues around current data (robustness, ownership, extraction, validation) with the provider (Royal Free). The Diabetes IPU is subject to nationally mandated waiting time targets plus patient outcomes and experience surveys.

CAMHS Camden uses a number of different providers for CAHHS services (health, mental health, social care and the voluntary sector). Tavistock and Portman are the largest of those

providers however key services are also provided by The Brandon Centre, The Anna Freud Centre, Camden & Islington Foundation Trust and Fitzrovia Youth in Action.

The CAMHS Local Transformation Plan is currently being refreshed for 2017/18, and it is expected that based on the Camden population, the potential cohort of children and young people aged 0-18 years with some type of mental disorder will be estimated at 5597.

A mid-year projection by Public Health in 2016/17 estimated that 2424 children and young people would have accessed services in that year, which is higher than the national target set at 30% of the potential cohort in 2016/17.

The next iteration of Camden’s CAMHS Transformation Plan is due for submission in October 2017. The Plan will include refreshed population statistics and an updated baseline position based on 2016/17 actual performance. Additional performance measures such as referral to treatment and access data across the full breadth of providers will also be referenced in the Transformation Plan. In addition, there will be a refocus on extracting and monitoring high quality outcome data to assess the impact of services in 2017/18.

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2. Commissioned Services Register Monitoring

Summary

The Commissioned Services Register is comprised of a list of contracts that Camden CCG wholly or partly funds. A copy of the Register is available as Appendix B to this report.

The Register provides monthly oversight of these contracts, broken down into spend and performance, for the purposes of contract monitoring and informed decision-makingregarding their future or maintenance.

This month (August 2017) the focus is on those contracts with a high attention level whose overall RAG status is Red or Amber.

Highlights

UCLH - Acute Hospital Services: There is an unfavourable variance of £452k, due to over performance in non-elective outpatients and maternity. This is offset by underperformance in elective and diagnostic imaging.

Royal Free - Acute Hospital Services: There is an over performance of £4.5m seen in diagnostic imaging, non-elective, outpatients, direct access and elective. Under performanceof £2.4m is reported in critical care, drugs and devices, maternity and other (attributed to the plan adjustment in Camden’s ledger position, - £3.9m).

Whittington Hospital - Acute Hospital Services: The contract is forecast to over perform by £193k - this does not include an adjustment for 50% marginal rate. Over performance isdriven by maternity whilst under performance is seen across majority of PODs, particularly non-elective, critical care and drugs & devices.

Whittington Health - Adult Community Services: Targets are on track although clarification needed if accurate and represent value for money. An additional report will be taken toAugust Integrated Commissioning Committee detailing the robust set of KPIs and options for longer term commissioning intentions including possible novation or procurement forwhole community contract, along with children’s services.

A data assurance workstream has been developed in partnership with the CSU to assure Camden of its acute position.

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3. Quality3.1 Serious Incidents (SIs)

UCLH

Assurances regarding organisational wide learning following SI investigations, wasreported to the Clinical Quality Review Group (CQRG) meeting on 1st August 2017.

RFH

Barnet CCG undertook a Quality Assurance visit on 29th June 2017, supported by theMaternity Specialist at NELCSU to review recent cluster of SIs within maternity services.Key messages: Clear leadership within maternity and obstetric teams. All staff (Obstetric and midwifery) involved in this cluster had their competence and

training in CTG reviewed. Staff who were directly involved in this cluster of incidents have been referred to their

line manager or educational supervisor as appropriate, to reflect of these SIs.

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3. Quality3.2 Complaints and Friends & Family Test

UCLH

Complaints: UCLH continue to make progress in responding to complaint, as reported toCQRG on 01 August 2017.

Friends and Family Test (FFT): In-patient FFT and response rates have been sustained.The patient experience team introduced SMS texting in May, in some areas to helpimprove response numbers.

RFH

Complaints: Clinical treatment and communication remain the primary focus ofcomplaints received by the Trust. The Patient Experience team are working withclinical teams to address these themes, as reported to CQRG on 26 July 2017.

Friends and Family Test: FFT reporting remains steady across the Trust.

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4. Activity4.1 Performance Against Operating Plan

Referrals – The MAR data which is used to monitor referrals is a significant part of the dataassurance deep dive. Camden CCG is working with Barnet CCG as lead commissioner tounderstand the changes within the RFH data collection and subsequently any changesneeded to plan. This exercise has also begun with ULCH. Camden CCG have informed NHSEthat there is likely to be a change required to plan but the changes required will be informedby the deep dive.

Follow Up Outpatient Attendances – Follow up outpatient attendances are below thecurrent plan. The deep dive will provide insight on whether this is driven by changes in dataflows or an actual reduction in activity.

Elective Admissions – The current position shows an over performance of 7.6%. This isdriven by UCLH submitting chemo activity as daycase rather than regular day attendanceswhich results in its inclusion in national monitoring data. UCLH have been asked to resubmitthe data with the correct coding.

A&E Attendances – Month 3 saw significant under reporting by the RFH. This informationhas been resubmitted. The actual performance showed 6% below plan for month 3. Work isbeing undertaken with the national NHSE team to ensure that overseas visitors are handledconsistently within monitoring data flows and plans.

The CCG is required to submit an Operating Plan to NHS England on an annual basis. The plan takes into account expected demographic and non-demographic growth along withany increases expected due to new guidance. The performance against Plan is monitored by NHS England throughout the year, historically via a monthly return from the CCG andthen additionally in 2017/18 via an NCL wide teleconference to review activity, performance and QIPP across the system. As of this month (August 2017) STPs have been asked tooversee the assessment of activity performance against plan and a new process is currently being implemented.

2016/17 saw unprecedented over performance on Royal Free and UCLH contracts, but not on the CCG’s Operating Plan. Although measured on different data sources (Contract =SLAM, Operating Plan = SUS SEM), the direction of travel should be similar in both. The CCG is currently undertaking a forensic deep dive of all data sources to ensure that activity isbeing reported accurately, and that data issues are not affecting the CCG’s financial position.

YTD Plan YTD Actual Variance % Variance

Referrals 27,483 25,906 (1,577) (5.74)

First Outpatient Attendances 29,051 29,574 523 1.80

Follow Up Outpatient Attendances 52,138 48,894 (3,244) (6.22)

Elective Admissions 6,053 6,513 460 7.60

Non Elective Admissions 4,779 4,778 (1) (0.02)

A&E Attendances 32,548 29,119 (3,429) (10.54)

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4. Activity4.2 QIPP Plan 2017/ 19 - Executive Summary

Overview & Progress

The CCG submitted its monthly position with an underachievement of £411k. The overallCCG rating within the finance templates reported to NHSE is amber based on a negativevariance of £486k against 17/18 FOT. This is an improvement of £240k against themonth 3 FOT position.

Although our current position is mainly positive the increase in underachievement atmonth 4 is highlighting the slippage of transformation projects in the first half of 17/18.The improved FOT position is a result of this as the CCG has sought to identifyalternative QIPP in July to offset this performance with two new lines incorporated intothe plan at a total of £902k.

Recognising the challenge in developing new models of care within the timescalesprovided, the organisation has introduced a new process of monthly team reviews ofQIPP to understand the current and forecast QIPP positions, with any mitigating actionsagreed including additional QIPP identified where appropriate.

This exercise has demonstrated that 42% of the QIPP plan is delivered mainly viacontract and budget savings at £7.63m, with a focus required on delivering thetransformation element at £7.88m across 35 schemes. The CCG is currently workingtoward implementation for many of these QIPP projects by October 2017 ahead of thewinter period.

2136

5747

2086

7632

486

Red Amber Green Blue Under Delivery

QIPP Position

Split of QIPP FOT for 17/18 by RAG status (£,000):

Key Risks

The main risk to QIPP delivery remains the pace of change to develop and implement newmodels of care in-year for 17/18. Although the CCG is reporting 42% of it’s plan closed(blue), this is disproportionately related to contract efficiencies and budgets. The majorityof QIPP lines rated as Red or Amber are associated to transformation and STP workstreams with start dates now adjusted for mid-year delivery of October. Teams are currentlyreviewing forecast savings and any mitigating/alternative QIPP projects to offset Q1/2under delivery.

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4. Activity4.2 QIPP Plan 2017/ 19 - Status

The QIPP programme is forecasting YTD underachievement of £411k at M4, with a negative variance of £486k against 17/18 FOT.

The variance against plan in month relates to adjustments to forecast positions based on reviews undertaken by each commissioning team.

Plan YTD

Actual YTD

VariancePlan FOT

Actual FOT

Variance

TRANSFORMATIONAL

1) Unplanned Care (285) (169) (116) (2,623) (2,475) (148)

2) Planned Care (418) (227) (191) (5,011) (4,570) (441)

3) Community Services 202 226 (24) 302 403 (101)

4) Primary Care (41) 0 (41) (493) (292) (201)

5) Children's Services (7) 0 (7) (85) (64) (21)

Sub-Total (549) (170) (379) (7,910) (6,998) (912)

TRANSACTIONAL

6) Mental Health (285) (360) 75 (855) (1,081) 226

7) Prescribing (121) (121) 0 (364) (364) 0

8) Primary Care (83) (83) 0 (250) (250) 0

9) Finance & Contract Efficiencies (2,768) (2,560) (207) (8,708) (8,006) (702)

Sub-Total (3,257) (3,125) (132) (10,177) (9,701) (476)

QIPP Plan Total (3,806) (3,295) (511) (18,087) (16,699) (1,388)

NEW ADDITIONAL QIPP

10) New QIPP Lines 0 (100) 100 0 (902) 902

Revised QIPP Total (3,806) (3,395) (411) (18,087) (17,601) (486)

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5. Finance

Overview

An acute FOT overspend of £4.4m, includeso £4.5m over at Royal Free for which further validation into activity data is being

undertaken.o £0.5m over on UCLH is also to be validated.

Risks

On a risk rated basis, £4.8m of the QIPP plan (£22.345m) is considered to be at risk down from £6.4m in month 3.

Mitigations

A deep dive into all QIPP schemes is to be undertaken to validate the overall position.

Increased rigour to QIPP PMO process and actions required to progress delivery. Refocus of CCG resources on delivery of QIPP.

Year to Date Full Year Forecast

Budget ActualVariance

Unfav/(Fav)Budget Actual

Variance

Unfav/(Fav)

£000's £000's £000's £000's £000's £000's

Revenue Resource

Limit138,401 138,401 0 406,725 406,725 0

Total Income 138,401 138,401 0 406,725 406,725 0

Acute Spend 67,908 68,219 311 196,492 200,976 4,484

Non Acute Spend 50,817 50,575 (242) 147,838 147,875 (946)

Primary Care Delegated

Commissioning12,756 12,755 (1) 38,270 38,270 0

Investment Spend 2,783 2,995 212 8,078 8,160 82

Running Costs 1,923 1,923 (0) 5,583 5,610 27

Overheads,

Contingencies & QIPP2,409 2,569 160 10,465 5,835 (3,647)

Total Expenditure 138,596 139,036 439 406,725 406,725 0

Surplus / (Deficit) (196) (635) (439) 0 0 0

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Jul 2016 Jan 2017

Camden EnglandBetter Care 122a Cancers diagnosed at early stage 45.8% 45.8% 54.2% 61/ 209 H

Better Care 122b People with urgent GP referral having first definitive treatment for cancer within 62 days of referral

67.1% 78.5% 82.2% 97/ 209 H

Better Care 122c One year survival from all cancers 72.0% 72.0% 71.1% 50/ 209 H

Better Care 122d Cancer patient experience 88.6% 8.8 8.8 41/ 209 H

Better Care 126a Estimated diagnosis rate for people with dementia

68.7% 73.0% 75.4% 43/ 209 H

Better Care 126b Dementia care planning and post-diagnostic support

79.4% 80.0% 80.0% 68/ 209 H

Better Health 103a Diabetes patients that have achieved all the NICE recommended treatment targets

43.5% 43.5% 42.4% 37/ 209 H

Better Health 103b People with diabetes diagnosed less than a year who attend a structured education course

14.3% 14.3% 19.1% 17/ 209 H

Better Care 124a Reliance on specialist inpatient care for people with learning disability and/or autism

67 59 59 112/ 209 L

Better Care 124b Proportion of people with a learning disability on the GP register receiving an annual health

54.0% 54.9% 54.9% 10/ 209 H

Better Care 125a Neonatal mortality and stillbirths 4.8 4.8 7.0 117/ 209 L

Better Care 125b Women's experience of maternity services 76.4 76.4 76.4 171/ 209 H

Better Care 125c Choices in maternity services 67.7 67.7 67.7 53/ 209 H

Better Health 101a Maternal smoking at delivery 2.8% 2.1% 3.6% 11/ 209 L

Better Care 123a Improving Access to Psychological Therapies recovery rate

40.8% 41.4% 46.4% 154/ 209 H

Better Care 123b People with first episode of psychosis starting treatment with a NICE recommended package of care treated within 2 weeks of referral

81.8% 86.2% 83.6% 52/ 209 H

MATERNITY TBC

MENTAL HEALTH Good

Better is

DIABETES TBC

LEARNING DISABILITIES TBC

CANCER Requires Improvement

DEMENTIA Outstanding

CLINICAL PRIORITY

2016/ 17 RATING

(JULY 2017)

Performing Well

Needs Improvement

Jul 2017INDICATOR

Camden

2015/ 16 RATING

(JUNE 2016)

Needs Improvement

Performing Well

Top Performing

Needs Improvement

DOMAIN Camden CCG’s headline rating has been

announced as Good for 2016/17.

NHSE have released ratings for three of thesix clinical priority areas for 2016/17 - Cancer,Dementia, Mental Health.

Ratings positively improved for Dementiaand Mental Health.

The rating for Cancer remained unchanged,and is reflective of the wider system issuesrelating to the 62 day cancer target. Thesignificant improvements to earlydiagnosis should be noted.

Ratings for Diabetes, Learning Disabilities andMaternity are expected to follow later in theyear, as is a refreshed 2017/18 IAFdashboard.

Further changes are expected to NHSE’sassurance processes going forward, with anincreased focus on monitoring and reportingvia the STP.

6. Improvement & Assessment Framework6.1 2016/ 17 Year End Rating & Clinical Priority Areas

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6. Improvement & Assessment Framework6.2 Dashboard - Four Domains

The IAF dashboard, published at the end of July2017, covers indicators located in four domains:Better Health, Better Care, Sustainability andLeadership.

Work has commenced to analyse the detail ofthe indicators within the dashboard, with relevantleads across the CCG to:- obtain assurance on Camden’s performance,

particularly for those indicators whereCamden is in the worst quartile orperformance has declined.

- to identify what is required to achieve‘outstanding’. The output of this work will bereported via the IPR.

Maternity- 125a, occurrences will fluctuate throughout a

given period (monthly/ quarterly), and onlybecome relevant if such changes aresustained.

- 125b and c a national survey has recentlybeen completed, the findings of which will beavailable later in the year. Much of NCL’sBetter Births work relates to choice andpersonalised care with the intention ofincreasing women’s experience of choice andcontinuity of care.

- 101a, noted that Trusts are now accuratelymeasuring CO levels and identifying morepregnant smokers.

Falls 104a, three pieces of work havecommenced to drive improved performance -prevention work initiated by Public Health,admissions avoidance post falls in thecommunity, and the care home LES.

NHS Camden CCGBetter Health Period CCG Peers England Trend Better Care Period CCG Peers England Trend

R 101a ✔ Maternal smoking at delivery 16-17 Q3 3.6% 2/11 11/209 R 121a n/a High quality care - acute 16-17 Q4 56 6/11 134/209

R 102a n/d % 10-11 classified overweight /obese12/13 to 14/15 35.0% 4/11 142/209 R 121b n/a High quality care - primary care16-17 Q4 64 4/11 116/209

R 103a n/d Patients who achieved NICE targets2015-16 42.4% 1/11 37/209 R 121c n/a High quality care - adult social care16-17 Q4 64 1/11 12/209

R 103b n/d Attendance of structured education course2014 19.1% 1/11 17/209 R 122a n/d Cancers diagnosed at early stage2015 54.2% 3/11 61/209

R 104a n/d Injuries from falls in people 65yrs +16-17 Q3 2,367 7/11 170/209 R 122b ✘ Cancer 62 days of referral to treatment16-17 Q4 82.2% 4/11 97/209

R 105a n/a Utilisation of the NHS e-referral2017 03 41.3% 6/11 #DIV/0! R 122c n/d One-year survival from all cancers2014 71.1% 4/11 50/209

R 105b n/a Personal health budgets 16-17 Q4 13 6/11 94/209 122d n/d Cancer patient experience 2015 8.8 3/11 41/209

R 105c n/a % of deaths in hospital 16-17 Q2 47.5% 8/11 109/209 R 123a n/d IAPT recovery rate 2017 01 46.4% 7/11 154/209

105d n/d LTC feeling supported 2016 03 62.4% 7/11 148/209 R 123b ✔ EIP 2 week referral 2017 03 83.6% 4/11 52/209

R 106a n/d Inequality Chronic - ACS 16-17 Q3 964 6/11 119/209 R 123c n/a MH - CYP mental health 16-17 Q4 95% 1/11 13/209

R 106b n/d Inequality - UCS 16-17 Q3 1,830 4/11 100/209 R 123d n/a MH - Crisis care and liaison 16-17 Q4 57.5% 9/11 155/209

R 107a ✘ AMR: appropriate prescribing 2017 02 0.62 1/11 1/209 R 123e n/a MH - OAP 16-17 Q4 75.0% 8/11 158/209

R 107b ✘ AMR: Broad spectrum prescribing2017 02 9.3% 5/11 120/209 R 124a n/d LD - reliance on specialist IP care16-17 Q4 59 9/11 112/209

108a n/a Quality of life of carers 2016 03 0.78 7/11 137/209 124b ✘ LD - annual health check 2015-16 54.9% 1/11 10/209

Sustainability Period CCG Peers England Trend R 125a n/d Neonatal mortality and stillbirths2015 7.0 6/11 117/209

R 141a n/a Financial plan 2016 Green 1/11 1/209 125b n/a Experience of maternity services2015 76.4 7/11 171/209

R 141b n/a In-year financial performance 16-17 Q4 Green 1/11 1/209 125c n/a Choices in maternity services 2015 67.7 4/11 53/209

R 142a n/a Improvement area: Outcomes 16-17 Q3 ########## 1/11 1/209 R 126a n/a Dementia diagnosis rate 2017 03 75.4% 5/11 43/209

R 142b n/a Improvement area: Expenditure16-17 Q3 ########## 1/11 1/209 126b n/d Dementia post diagnostic support2015-16 80.0% 5/11 68/209

R 143a n/a New models of care 16-17 Q4 N #VALUE! R 127a n/a Delivery of an integrated urgent care service2017 01 7 1/11 1/209

R 144a n/a Local digital roadmap in place 16-17 Q4 Y #VALUE! R 127b n/d Emergency admissions for UCS conditions16-17 Q3 2,250 5/11 88/209

R 144b n/a Digital interactions 16-17 Q4 54.7% 10/11 183/209 R 127c ✘ A&E admission, transfer, discharge within 4 hours2017 03 88.9% 7/11 111/209

R 145a n/a SEP in place 2016-17 Y ##### #VALUE! R 127e n/d Delayed transfers of care per 100,000 population2017 03 8.3 3/11 47/209

Well Led Period CCG Peers England Trend R 127f n/d Hospital bed use following emerg admission16-17 Q3 446.2 3/11 33/209

R 161a n/a STP 2016-17 Green 1/11 1/209 R 128a n/d Management of LTCs 16-17 Q3 872 6/11 99/209

R 162a n/a Probity and corporate governance16-17 Q4 Fully Compliant 1/11 1/209 R 128b n/d Patient experience of GP services2016 03 83.5% 7/11 149/209

R 163a n/a Staff engagement index 2016 3.83 4/11 48/209 R 128c n/a Primary care access 2017 03 80.0% 4/11 15/209

R 163b n/a Progress against WRES 2016 0.20 11/11 208/209 R 128d n/d Primary care workforce 2016 09 0.97 2/11 107/209

R 164a n/a Working relationship effectiveness16-17 59.80 11/11 188/209 R 129a ✔ 18 week RTT 2017 03 93.4% 3/11 44/209

R 165a n/a Quality of CCG leadership 16-17 Q4 Green 1/11 31/209 R 130a n/a 7 DS - achievement of standards2016-17 0.0% 1/11 #N/A

Key R 131a n/a People eligible for standard NHS CHC16-17 Q3 27.1 10/11 179/209

Worst quartile in England Best quartile in England

Interquartile range

Good

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7. 2017/ 18 Quality Premium (QP)

In January 2017 the CCG received £492k of theavailable QP for 2015/16. The CCG expects toreceive the 2016/17 monies in month 9 of 2017/18.

To gain access to Quality Premium funds, CCGsmust pass the following two gateways:1. Quality Gateway - no cases of serious quality

failures at a local provider where CCG is notconsidered to have made appropriate,proportionate response with its partners to resolvefailures. Payments will be discretionary andsubject to CCG assurance process criteria inrelation to quality failures where gateway is notachieved.

2. Financial Gateway - operate in a mannerconsistent with Managing Public Money; does notincur unplanned deficit in 2017/18, or requireunplanned support to avoid unplanned deficit; anddoes not incur a qualified audit report in respectof 2017/18.

Continuing Healthcare - the following actions arebeing taken to achieve the reduction required todeliver on <15% of CHC assessments:- bringing in house and redesigning the CHC

assessment team. The team is to be integratedwith the DTOC team and be locality focused. Thecombined resources will work closely with AdultSocial Care and other key community partners toundertake timely assessments and reviews.

- the reduction will also be supported through thedevelopment of the discharge to assess pathway1 and 3.

Measure Target Latest Data

Quality

Premium

allocation

Maximum

Available

Early Cancer Diagnosis 4% point improvement

OR

At least 60% diagnosed at stage 1 & 2

44.1% (2013)

45.8% (2014)

54.2% (2015)

17% £227,165

GP Access and Experience 85% of respondents who said they had a good experience of making an

appointment

OR

3 percentage point increase from July 2017

79.4% (2015)

83.0% (2016)

17% £227,165

Continuing Healthcare Part a) in more than 80% of cases with a positive NHS CHC Checklist,

the NHS CHC eligibility decision is made by the CCG within 28 days from

receipt of the Checklist

Part b) less than 15% of all full NHS CHC assessments take place in an

acute hospital setting.

Part a) 91%

(Q1 2017/18)

Part b) 68%

(Q1 2017/18)

17% £227,165

Mental Health Total number of bed days relating to out of area placements to have

reduced by 33%

17% £227,165

Bloodstream Infections 2017/18 Part a) 10% reduction (or greater) in all E coli BSI

Part b)

b1 - 10% reduction (or greater) in the Trimethoprim: Nitrofurantoin

prescribing ratio

b2 - 10% reduction (or greater) in the number of trimethoprim items

prescribed to patients aged 70 years or greater

Part c)

items per STAR-PU must be equal to or below 1.161 items per STAR-PU

Part a) 185

(Jan - Dec 2016)

Part b1) 0.954

(Jun 15-May 2016)

Part b2) 1936

(Jan - Dec 2016)

Part c) 0.61

(Mar 2017)

17% £227,165

Local indicator: The percentage of people waiting 6

or more weeks for a colonoscopy.

93.2% 98.1% (Apr 2017)

97.36% (Mar2017)

90.57% (Jun 2017)

15% £200,440

NHS Constitution requirement Target Latest Data WeightingWeight

ValueMaximum 18 weeks from referral to treatment –

incomplete standard.

STF/ Op Plans for Q4 17/18 - 92% 92.9%

(Jun 2017 YTD)

25% £334,066

Maximum four hour waits in A&E departments -

standard.

STF/ Op Plans for Q4 17/18 - 95% 90.3%

(Jun 2017 YTD)

25% £334,066

Maximum two month (62-day) wait from urgent GP

referral to first definitive treatment for cancer.

STF/ Op Plans for Q4 17/18 - 85% 75.4%

(Jun 2017 YTD)

25% £334,066

Maximum 8 minute response for Category A (Red 1)

ambulance calls.

STF/ Op Plans for Q4 17/18 - 75% 81.1%

(Jun 2017 YTD)

25% £334,066

Ach

ieve

men

t in

dic

ato

rsP

enal

ty in

dic

ato

rs

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8. Workforce

HR Data Table

* Head count at 30 June 2017** The sickness absence rate is based on the FTE (Full Time Equivalent) hours lost each month and has been

averaged for the reporting period*** Number of vacancies over the quarter

As 24/07/17, we have 21 interims in the following Directorates. All IR35 have beenreceived and on file.

Sickness AbsenceThe following graph shows the overall monthly sickness absence rates for the period 01June 2016 to 31 May 2017 (sickness data is reported 6 weeks in arrears):

The overall short term sickness absence has reduced over the past 12 months from 2.30%in June 2016 to 1.31% May 2017. Compared to Q4 there has been a slight increase inlong term during March 2017 of 0.98%. Over the past 12 months, sickness absence hascost the CCG an estimated £85,680 (based on the FTE lost over 12 months due tosickness).

The following table shows the average Directorate sickness absence rate for the period01/06/2016 - 31/05/2017. The arrows show the movement from the previous quarter’s data:

Q1 2016/17

Q2 016/2017

Q3 2016/17

Q4 2016/17

Q1 2017/18

Headcount 114 110* 104* 111* 110* Starters 13 6 10 12 11 Leavers 7 15 6 12 8 % Sickness 2.34%* 1.96%** 1.47% 1.14%* 1.58% Interims 27 26 27 22 21 Live vacancies 1 3 18 17 14***

Directorate Interims in Post (No.)

Transformation 0 Corporate Services 3 Finance 4 Quality & Clinical Effectiveness 0 Sustainable Insights 6

Other Primary Care 0 Acute 5 CCAS 3

CCG Directorate Q4 2016-17 Sickness

Absence Rate Q1 2017-18 Sickness

Absence Rate1 Commissioning 0.84% 1.36% Corporate Services 3.58% 3.24% Finance 11.73% 2.61% Quality & Clinical Effectiveness 1.90% 0.78% Sustainable Insights P/ships 2.37% 1.19% Transformation 0.15% 0.29%

1 The sickness absence rate is based on the FTE (Full Time Equivalent) days lost over the reporting period.

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8. Workforce

Occupational Health & Employee Assistance ProgrammeAXA, the CCG’s occupational health provider has reported the following occupationalhealth and employee assistance programme usage for the period 01/04/2016 - 31/03/2017.

Employee Relations CasesThere have been the following formal employee relations cases for the period 01/07/16 -30/06/17:

Whistle BlowingNo reported incidents.

AppraisalsThe CCG rolled out a new Appraisal Policy and Procedure in May 2017. All managers andstaff were given a deadline to complete review meetings (for the 2016/2017 period) and setobjectives for 2017/2018 by mid July 2017. This deadline has been extended to August2017, as a number of appraisals had not taken place. Following the revised deadline,another audit will take place to confirm the compliance rate across the CCG.

Mandatory TrainingThe following table highlights the mandatory training compliance by Camden CCGemployees (based on the total number of employees at 21/04/17 – 112): the previousquarter’s figure is in brackets ().

There were reported technical issues with the safeguarding modules during the periodwhich have now been resolved. The overall statutory training compliance for the CCG is80%.

Directorate breakdown (date as at 21/07/17):

Statutory & Mandatory training is undertaken and monitored via the NHS Online LearningManagement (OLM) system. The HR team have been and will continue to liaise withDirectors and managers to ensure all employees are undertaking their statutory training.The OLM lead will be providing regular drop in sessions at Stephenson House to supportwith any technical/ login support.

AXA OH Service Number of Employees utilising the service

Q3 Q4 Q1 Occupational Health 7 3 5

Employee Assistance Programme

7 5 3

Employee Relations Matter

Number of cases Q3 Q4 Q1

Change Management 1 - - Concerns during Probation Period

1 2 1

Long Term Sickness Absence

1 - 1

Mandatory Training Compliance Equality, Diversity and Human Rights - 3 Years 85% (83%) Fire Safety - 1 Year 78% (78% ) Health, Safety and Welfare - 3 Years 85% (79%) Information Governance - 1 Year 75% (79%) Safeguarding Adults - Level 1 - 3 Years 75% (84%) Safeguarding Children - Level 1 - 3 Years 79% (84%)

Directorate Statutory Compliance Commissioning Directorate 75% Corporate Services Directorate 90% Finance Directorate 83% Sustainable Insights Partnerships Directorate 81% Transformation Directorate 93% Quality & Clinical Effectiveness Directorate 76%

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9. Glossary

Abbreviation Full Term Description

2WW Two Week Wait cancer standard Cancer waiting times standard

A&E Accident and Emergency Hospital emergency department

CCAS Camden Clinical Assessment Service CCG referral management service

CSU Commissioning Support Unit Provides commissioning support functions to CCGs

CWT Cancer Waiting Times Set of indicators measuring cancer performance

DTOC Delayed Transfer of Care When an adult inpatient is ready to be discharged from hospital but this is delayed

EIP Early Intervention in Psychosis Access standard - 50% of patients should be treated within 2 weeks of referral

IAF Improvement and Assessment Framework Set of indicators on which CCG performance is assessed

IAPT Improving Access to Psychological Therapies Programme for treating people with depression and anxiety disorders.

MAR Monthly Activity Return Central activity data return

QIPP Quality, Innovation, Productivity and Prevention Programme to improve quality of care while making efficiency savings

RAG Red, Amber Green Colour coded rating based on performance

RAP Remedial Action Plan Recovery plan to bring performance back to compliance

RTT Referral to Treatment target NHS constitution target to start consultant-led non-emergency treatment within 18 weeks of referral

SI Serious Incident A serious event that warrants using additional resources to mount a comprehensive response

STF Sustainability and Transformation Fund Funding to acute trusts based on delivery of quarterly milestones

SUS Secondary Uses Service Repository for healthcare data

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The population health tool segments the Camden population using utilisation as aproxy for need.

The complexity of the people within the segments increase from left to right.

The latest information shows that 1.36% of the Camden population fall within the mostcomplex segment. Although a small proportion of the population, they account for19% of the CCGs total spend on acute.

Whilst shaping solutions to improve the outcomes for patients and reducing spend onthe most complex, there remains significant spend on the people falling withinhealthier segments. This spend is driven by high volume rather than high cost.

Insights from this tool is being shared with neighbourhoods to understand whichareas, population groups and geography should be targeted for the greatest impact.

The tool now includes community data which allows the CCG to understand whetherthe right services within CNWL are being accessed to add value to the patientpathway.

The following slide shows an example of how the population health tool helpsunderstand the different solutions required for different populations for ambulatorycare conditions.

The CCG has received CNWL and CIFT data and will be refreshing the segmentsbased on a whole system view (conversations have also begun with social care).

10. AppendicesA. Population Health

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Ambulatory Care Sensitive Conditions are often considered as a single problem to solve, however looking at ACSsthrough a population health lens it shows different needs driving the issue and therefore multiple responses are required.

People admitted for ACS conditions fall within 3 population health segments.

Main SegmentPopulation

in this

segment

Number of

patients who

had at least

one

emergency

admission to

ACS

Number of

Emergency

admissions

to ACS

conditions

Total Cost of

Emergency ACS

Conditions

Admissions

per patient

Cost ACS

admissions

per person in

the segment

Acute/Maternity patients

without LTCs with limited

potential to use secondary care

50,903 7,545 13,339 35,862,151£ 1.8 705£

LTC patients who need regular

management and /or

monitoring

4,609 1,256 1,504 2,036,278£ 1.2 442£

Patients with LTCs and have high

potential to use secondary care

3,001 2,233 6,013 17,395,263£ 2.7 5,796£

High volume – low complexity & cost

Response: • GP at the front door• Extended hours • 8-8 Saturday Service

Low volume – high complexity & cost

Response: • Reablement, rehabilitation and recovery• MDT

Low volume –growing complexity

Response: Universal Offer

Achieving the most effective healthcare outcomes for each segment requires tailored approaches

10. AppendicesA. Population Health

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Report Title Board Assurance Framework

Agenda Item 5.1 Date of Report 30 August 2017

Lead Director Ian Porter, Director of

Corporate Services


Report Author Brenda Thomas, Governance Lead (Interim)



Richard Strang, Lay Member Tel/Email [email protected]

Report Summary The Board Assurance Framework (‘BAF’) captures the most serious risks

identified as threatening the achievement of the CCG’s eight strategic objectives. Number of risks There are 8 risks on the BAF. Since the BAF was presented to the Governing Body at the 12th July 2017 meeting one risk has been de-escalated, one risk was closed and there are four new risks. The new risks are escalated from the NCL Joint Commissioning Committee risk register. Key Updates Risk 242 - Poor performance against constitutional targets (Threat): Monthly Contract Review Group meetings are now being held. This will become a standing item on the Performance Meeting agenda to review and track progress against the list on a regular basis. Camden CCG have requested for University College London Hospital (UCLH) to share with commissioners its Patient Transfer List broken down by specialty to understand the impact on Referral To Treatment (RTT). Risk 362- System Resilience (Threat): Full Community Bed review is underway and is scheduled to be completed by end September 2017. The ambition of this review is to identify further resources required to support Winter Resilience. Weekend Hub Access is currently in place and reprovision exercise has been completed to enhance utilisation. Extended hours access is also in place and reprovision exercise has been completed to enhance utilisation. Risk 363 - PMS Review (Threat): Local Project Plan for developing local proposals and managing contract transition has been agreed and a Proposal Prioritisation Workshop date agreed. Concerns around lack of financial baseline information and financial support from the Commissioning Support Unit (CSU) has been raised with Director of Primary Care at NHS England (London). Risk 382 - Failure to produce a deliverable and robust QIPP Plan for 2017/18 (Threat): The QIPP Challenge Panel has been established to oversee operational delivery of QIPP. The QIPP programme has now identified £22.4m of schemes, on a risk rated basis there is £4.8m considered at risk of being delivered. A deep dive into all QIPP schemes is to be undertaken in late August to identify and quantify the risks to the QIPP programme. The outcome of the review will inform the revision of the risk score.

95 of 191

mailto:ian.porter3@nhs.



NCL Joint Commissioning Committee Risks- New JCC 1 - Delivery of Cancer 62-day waiting time standard (Threat): There is

a risk that the system may be unable to cope with the level of demand and has limited resilience to unexpected events, due to insufficient capacity within the system, and inefficiencies along pathways in particular for inter-provider transfers.

JCC 2 - Delivery of four-hour waiting time standard for A&E (Threat): There may be insufficient capacity across hospital and community services to meet peaks in emergency care demand. There is a risk that people will spend more than four hours within emergency departments before receiving definitive treatment or be located in the wrong part of the system due to pressures along the emergency care pathway.

JCC 10 - Mobilisation of STP and QIPP plans (Threat): There is a risk that contracts will not be delivered within resource envelopes for 2017/18 if it is not ensured that STP and QIPP plans are delivered in accordance with planning assumptions.

JCC 11 - Managing acute contracts within contract baselines (Threat): There is a risk that CCGs will not meet their financial duties and/or investment is withheld to support delivery of the STP if expenditure on acute contracts exceeds planned contract baselines.

Closed/ Deescalated Risks Risk 74 – Continuing Healthcare (CHC) failing to deliver assurance that they

are delivering a safe and effective service to Camden patients (Threat). The Governing Body was informed at its meeting in July that further assurances had been provided in connection with the CHC risk and in the light of work being undertaken at NCL level it was anticipated that the risk could be removed from the BAF. The Quality and Safety Committee at its meeting on 16 August 2017 agreed to close this risk from the CCG risk register and transfer to the integrated adults commissioning team at the Local Authority, where accountability will now sit, as the CHC nurse provision has been transferred to this team for more oversight and scrutiny of the service. The Quality and Safety team has received assurance on the concerns that were raised on clinical assessors not assessing correctly and in a timely manner.

Risk 413 - Failure to ensure effective local commissioning and leadership at

this time of system wide change (Threat). With the appointment of the NCL Head of Governance & Risk and the Local Executive Director, this risk has been mitigated against to a large extent, with the following steps taken: Formal shadowing sessions for new Governing Body members were held

between May - July 2017; All Governing Body members are in post, including three lay members; Issues with NCL Joint Committee, acute commissioning and relationship

with local commissioning continue to be worked through; NCL Joint Committee organisational development workshop held in May; Transition risks continue to be managed through Executive Team

meetings; Handover discussion held with the Local Executive Director.

The risk rating has therefore been reduced from 15 to 9 and does not meet the threshold to remain on the BAF. This risk will be monitored at Committee/ Directorate level. Risk Ownership The following risks on the BAF have been reassigned to reflect new ownership: Risks 242- reassigned from Paul Sinden, NCL Director of Performance and Acute Commissioning to Sarah Mansuralli, Local Executive Director/ Chief Operating Officer.

96 of 191

Risk 362- reassigned from Simon Goodwin, NCL Chief Finance Officer, Sarah Mansuralli, Local Executive Director/ Chief Operating Officer. Risk 363 – reassigned from Sally MacKinnon, Director of Transformation to Sarah Mansuralli, Local Executive Director/ Chief Operating Officer.

Purpose Information Approval To note

Decision

Recommendation The Governing Body is asked to review the risks and provide feedback on the updated BAF.


The BAF focuses on risks relating to the strategic objectives of the CCG: A. Commission the delivery of NHS constitutional rights and pledges B. Improve the quality and safety of commissioned services C. Improve health outcomes, address inequalities and achieve parity of esteem D. Integrate and enable local services to deliver the right care in the right setting

at the right time E. Work jointly with the people and patients of Camden to shape the services we

commission F. Involve member practices and commissioning partners in key commissioning

decisions G. Maintain financial stability and ensure sustainability through robust planning

and commissioning of value-for- money services H. Build a high performing organisation that attracts, develops and retains a

skilled and motivated workforce.


The BAF is a risk management document which is presented at every Governing Body report. It is available to members of the public on the CCG’s website.


Updating of the BAF is the responsibility of each risk owner and their respective directorates. The Governance Team helps to support this by providing monitoring, guidance and advice.

Engagement



This report was written in accordance with the provisions of the Equality Act 2010.

Report History The BAF was last reviewed by the Governing Body on 12 July 2017 and by the Executive Team on 31 August 2017. Risks are continually kept under review by Governing Body committees and by the Executive Team.

Next Steps To continue to manage risk across the organisation in a robust way.

Appendices

The following is attached: 1. BAF; 2. BAF Heat Map; 3. Risk Scoring Key.

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Board Assurance Framework - September 2017

ID Director Objectives Description Controls Evidence of ControlsOverall Effectiveness of

Controls

Co

nse

qu

en

ce

(cu

rre

nt)

Like

lih

oo

d

(cu

rre

nt)

Rat

ing

(cu

rre

nt)

Ris

k le

vel

(cu

rre

nt)

Actions Update on Actions Action Competion Date

Co

nse

qu

en

ce

(Tar

get)

Like

lih

oo

d

(Tar

get)

Rat

ing

(Tar

get)

Ris

k le

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Targ

et)

362 Sarah Mansuralli, Local

Executive Director/ Chief

Operating Officer

Commission the delivery of

NHS Constitutional rights

and pledges

TITLE: System Resilience (Threat)

CAUSE: There may be insufficient

capacity within the system

EFFECT: Which may lead to the risk

that the system may be unable to

cope with changes and increases of

activity at times of high demand, such

as the winter time.

IMPACT: This may lead to

performance issues in A&E (UCLH),

referral to treatment targets, and

elective care which may impact on

patient care.

C1. An A&E delivery board has been established which has

executive level representation from key providers in the

system, eg UCLH, CIFT CNWL LAS and RFL.

C2. A&E Delivery Board has developed a 'Heat Map' dashboard

which monitors key parts of the system to highlight any issues

in terms of capacity and/or performance.

C3. With key providers, and using funding available to the A&E

Delivery Board, agreed which parts of the system would benefit

from increased capacity or efficiency changes.

C4. Continued monitoring of the plan (i.e. initiatives) against

agreed outcome measures.

C5. Funding is targeted to support the remedial action

plans(RAPs) agreed with UCLH.

C6. A North Central London ('NCL') wide review of how winter

went across NCL took place on 6th April 2017 to share lessons

learned.

C1. A&E Delivery Board papers (meets

monthly)

C2. Heat Map discussed at each A&E

Delivery Board meeting

C3. Bids submitted and considered at the

A&E Delivery Board

C4. Initiatives monitored through the

monthly impact report

C5. RAPs have been agreed with UCLH

C5. Bid received from UCLH for GPs at

the front door service

C6. Notes from the workshop.

AVERAGE: The controls

have a 61 – 79% chance of

successfully controlling the

risk

4 4 16H

igh

A1. Community Bed Review.

A2. Have in place Weekend Hub

Access.

A3. Access to Extended Hours

service.

A1. Full Community Bed review

is underway and is scheduled to

be completed by the end of

September 2017. The ambition

of this review is to identify

further resources required to

support Winter Resillience

A2. Currently in place,

reprovision exercise has been

completed to enhance

utilisation.

A3.Currently in place,

reprovision exercise has been

completed to enhance

utilisation.

A1. 30.09.2017 4 2 8

Mo

derate

A1. 05.05.2017

A2. 04.05.2017

A3. 31.08.2017

A4. 23.08.2017

A5. 23.08.2017

A6. 18.08.2017

2 2 4

Low

3 12

Mo

derate

363

Sarah Mansuralli, Local


Operating Officer

Improve health outcomes,

address inequalities and

achieve parity of esteem

TITLE: PMS Review (Threat)

CAUSE: If Camden CCG fails to

successfully complete the PMS

Review.

EFFECT: There is a risk that the

funding required to deliver an

equitable offer in general practice will

not be available.

IMPACT: This may result in the CCG

being unable to deliver the Primary

Care Mandate commitment - a

consistent offer for patients in general

practice in Camden.

C1. On-going communication with PMS Negotiating Team

C2. On-going communication with NHS England

C3. On-going communication with LMC

C4. GP Forward View returns to NHS England

C5. Local PMS Review Group established

C6. Governing Body Paper outlining approach for reinvestment

plans

C7. Final submission to NHS England of local PMS reinvestment

plans

C8. Financial position for 2017-18 received from NHS England

and information has been distributed to practices to support

baseline modelling.

C9. External review information from 2015-16 held.

C10. Local Reinvestment Forum established and running.

C11. Local Project Plan outlining approach to developing

reinvestment proposals and contract process in plan

C12. Regular meetings of NCL Reinvestment Group

C1. Email communication documenting

meetings with PMS Negotiating Team.

C2. Formal minutes of communication

between NCL CCG's and NHS England.

C3. Formal minutes of communication

between Camden CCG and London wide

LMC

C4. Completed Forward View template.

C5. PMS Review Group documentation.

C6. Copy of the Governing Body paper

outlining approach to reinvestment plans.

C7. Copy of final NHS England submission.

C8. Spreadsheets and e-mails.

C9. Spreadsheet.

C10. Minutes/ notes of meetings.

C11. Copy of Project Plan

C12. Minutes/ notes of meetings.




risk

4 5 20

High

A1. Letter to practices to confirm

outcome of dialogue around

transition.

A2. First local reinvestment

meeting held.

A3. Shaping local service

specification with support from

Sustainable Insights.

A4. Local Project Plan for

developing local proposals and

managing contract transition agreed

A5. Proposal prioritisation

workshop date agreed.

A6. Concerns around lack of

financial baseline information and

financial support from CSU raised

with NHSE Director of Primary Care.

A1. Letter to practices sent.

A2. Meeting on PMS review

held on 4.05.2017.

A3. Currently being shaped.

A4. Discussed at local group

A5. Discussed and agreed at

local group

A6. Emailed to NHSE Director of

Primary Care

242 Sarah Mansuralli, Local


Operating Officer


NHS Constitutional rights

and pledges

TITLE: Poor performance against

constitutional targets (Threat)

CAUSE: If there is poor performance

against contractual standards by

Camden CCG providers

EFFECT: There is a risk that the CCG's

commissioned services do not meet

constitutional targets

IMPACT: This may have a negative

impact on patients care, outcomes

and experience

C1. Regular performance meetings with providers and

strengthened CCG performance management process in place.

C2. Monthly escalation meetings with NHSE & UCLH

C3. Use of contractual leavers

C4. UCLH & CCG joint review of performance

C5. Commissioned services register included in Integrated

Performance Report.

C6. RAPs being implemented and monitored.

C7. Updated RAPs refreshed and agreed for 2017/18.

C1. Contract Review Group - monthly

meeting and Camden Performance

Operational Group monthly meetings.

C1. Key Lines of Enquiry sent to Trust

prior to new integrated performance

meeting. Performance management

framework formally adopted. New

performance governance structure

implemented.

C2. Escalation meetings with NHSE &

UCLH- monthly

C3. Serving Contract Performance

Notices to UCLH

C4. UCLH & CCG joint review of

performance completed and

recommendations put into RAPs

(recovery action plans).

C5. Integrated Performance report

C6. Monthly RAP monitoring templates

completed.

C7. Updated RAPs.




risk

4 4 16

High

A1. Hold monthly Contract Review

Group meetings. This will now

become a standing item on the

Performance Meeting which will

review and track progress against

the list on a regular basis

A2. Camden CCG have requested

for UCLH to share with

commissioners its Patient Transfer

List broken down by specialty to

understand the impact on Referral

to Treatment (RTT).

A1. Meetings have been

organised on a monthly basis.

A2. Meetings have been

organised on a monthly basis.

This will now become a

standing item on the

Performance Meeting which

will review and track progress

against the list on a regular

basis

A1. 31.07.2017

A2. 30.09.20174

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JCC 1 Paul Sinden


NHS constitutional rights

and pledges

TITLE: Delivery of Cancer 62-day

waiting time standard (Threat)

Cause: There may be insufficient

capacity within the system, and

inefficiencies along pathways in

particular for inter-provider transfers.

Effect: There is a risk that the system

may be unable to cope with the level

of demand and has limited resilience

to unexpected events.

Impact: This may result in people not

receiving treatment within 62 days

with potential adverse impact on their

health outcome.

C1. North Central London ('NCL') cancer governance

arrangements established to cover both performance and

transformation.

C2. Improvement trajectory agreed with NHS England and NHS

Improvement.

C3. Remedial Action Plans in place with providers that are not

meeting the 62 day standard.

C4. 38 day transfer protocol in place for inter-provider

transfers from district general hospitals to tertiary services with

the 38 day standard compatible with treatment commencing

within 62 days.

C1. Meeting papers and notes.

C2. Plans and trajectories in place with

each provider to allow NCL to meet the

standard overall.

C3. Plans.

C4. transfer protocol document.

Weak 4 4 16

High

A1. Continue to work with

providers on delivering the

trajectories.

A2. Continue to work with

providers to ensure sustainable

delivery and includes work through

the cancer vanguard.

A3. NCL recovery of the 62 day

standard by end of September

2017.

A4. UCLH recovery of the 62 day

standard by end of March 2018 and

is consistent with system recovery

by end of September 2017.

A1. Meeting with providers on

a monthly basis and ensuring

their plans are consistent with

agreed trajectories.

A2. Meeting with providers on

a monthly basis.

A3. Currently on track for

delivery.

A4. Currently on track for

delivery.

A1. 31.07.2017

A2. 31.07.2017

A3. 30.09.2017

A4. 31.03.2018

3 4 12

Mo

derate

JCC 2 Paul Sinden


NHS constitutional rights

and pledges

TITLE: Delivery of four-hour waiting

time standard for A&E (Threat)

Cause: There may be insufficient

capacity across hospital and

community services to meet peaks in

emergency care demand.

Effect: There is a risk that people will

spend more than four hours within

emergency departments before

receiving definitive treatment or be

located in the wrong part of the

system due to pressures along the

emergency care pathway.

Impact: This may result in people

experiencing delays in treatment,

admission to a hospital bed and/or

discharge back into the community.

C1. A&E Delivery Boards established and meet monthly which

have executive level representation from key providers and

commissioners in the system

C2. A&E Delivery Boards are informed by dashboards that

monitor key parts of the system to highlight any issues in terms

of capacity and/or performance.

C3. With key providers, and using resilience funding available

A&E Delivery Boards have agreed which parts of the system

would benefit from increased capacity or efficiency changes.

C4. Continued monitoring of the plan (i.e. initiatives) against

agreed outcome measures by A&E Delivery Boards.

C5. Funding is targeted to support the remedial action plans

(RAPs) agreed with UCLH.

C6. A North Central London (NCL) wide review of how winter

went across NCL took place on 6th April 2017 to share lessons

learnt.

C7. All A&E Delivery Boards submitted plans to NHS England for

winter 2017/18 based on experiences and pressures in 2016/17

C1. Meeting papers and notes.

C2. Meeting papers and dashboards.

C3. Remedial Action Plans, meeting

papers and notes.

C4. Meeting papers, notes and

dashboards.

C5. Plans to utilise winter resilience

monies.

C6. Report.

C7. Plans

Weak 4 4 16

High

A1 . Develop a demand and capacity

plan for both hospital and

community services.

A2. Implement STP initiatives.

A1. A&E Delivery Boards are

developing system wide

demand and capacity plans.

A2. STP initiatives are being

implemented in accordance

with individual plans. Progress

on implementation is reviewed

in CCGs and STP workstreams

monthly.

A1. 30.08.2017

A2. 31.07.20173 4 12

Mo

derate

15/09/201716

High44

High

A1. Develop PIDs/Project plans for

all QIPP schemes in line with NCL

STP plans and continue to

participate in the Capped

Expenditure Process.

A1. Finance plans were revised

in May 2017 in accordance with

NHS England's requirements

and to recognise the

devolvement of primary care

commissioning to CCGs. The

unidentified QIPP in the most

recent plan was reduced down

to zero, leaving a £22.4m gross

QIPP savings required for 2017-

18. A NCL wide capped

expenditure process summit

was held on 24th April 2017 to

identify opportunities for

additional savings through

difficult decisions. Both

commissioners and providers

are seeking to identify the

locality solutions jointly.

The QIPP programme has now

identified £22.4m of schemes,

on a risk rated basis there is

£4.8m considered at risk of

being delivered. A deep dive

into all QIPP schemes is to be

undertaken in late August to

identify and quantify the risks

to the QIPP programme.

C1. Minutes and papers of the QIPP

cabinet;

C2. Minutes and papers of the Finance

and Performance Committee;

C3. Minutes and papers of the QIPP

Cabinet and Finance and Performance

Committee.

C4. Contract of Service.

C5. Minutes of meetings and meeting

reports.

C6. Governing Body forum note.

C7. Updated financial assessment.

C8. Deloitte feedback.

C9. PMO reports.

C10. Minutes of workshop.

C11. Contracts with acute providers.

C12. QIPP register

C13. Meeting notes and papers.

C14. A NCL STP Finance and Activity

Modelling meeting occurs every two

weeks to ensure NCL remains on track

with QIPP delivery.




risk

5 4 20382Sarah Mansuralli - Local

Executive Director

Maintain financial stability

and ensure sustainability

through robust planning

and commissioning of value

for money services

TITLE: Failure to produce a

deliverable and robust QIPP plan for

2017/18 (Threat)

CAUSE: If the CCG fails to produce

and deliver a robust QIPP plan for

2017/18 that meets NHS mandated

control totals.

EFFECT: There is a risk that the CCG

will not have a balanced budget for

2017-18 and not meet NHS England

control totals.

IMPACT: This may result in the CCCG

being placed into Directions/special

measures by NHS England,

destabilisation of the CCG,

destabilisation of local providers, a

wider negative impact on the NCL

health economy and loss of influence

of quality of patient care.

C1. QIPP cabinet is overseeing the development of the 2017/18

QIPP plan.

C2. Finance and Performance Committee reviews and

approves the overall financial plan including QIPP.

C3 Currently going through a review of avoidable spend,

assigning priorities to spend areas with a view to reducing or

ceasing low priority spend.

C4. QIPP Manager to support the QIPP Programme is in role.

C5. QIPP Planning started in September 2016.

C6. Obtained from Governing Body direction on lower priority

spend areas for savings.

C7. Root and branch review of all spend across the

organisation completed.

C8. Deloitte review of QIPP completed.

C9. PMO taking a strengthened role in QIPP.

C10. Governing Body direction on lower priority spend areas

obtained.

C11. Contractual arrangements with acute providers in place.

C12. Clinical and manager leads in place for each area of QIPP.

C13. QIPP Challenge Panel established to oversee operational

delivery of QIPP.

C14. Camden CCG is part of the NCL STP which has shared

responsibility to ensure financial stability. This includes

commissioners and providers.

99 of 191

JCC 10

Paul Sinden, Director of

Performance and Acute

Commissioning




and commissioning of value-

for- money services

TITLE: Mobilisation of STP and QIPP

plans (Threat)

Cause: if we do not ensure that STP

and QIPP plans are delivered in

accordance with planning

assumptions

Effect: There is a risk that contracts

will not be delivered within resource

envelopes for 2017/18

Impact: This may result in delays to

service changes, higher contract

baselines for 2018/19 than anticipated

in financial plans for CCGs, and a

wider system financial gap.

C1. Signed contracts in place for 2017/18 and 2018/19

C2. Contract frameworks in place with each provider including

Local Delivery Teams to support the STP

C3. In-year contract variances subject to marginal rates rather

than full tariff adjustments

C4. Collaborative arrangements in place through Finance and

Activity Modelling (FAM) Group as part of STP governance

framework

C5. Sustainability and Transformation Plan governance and

supporting workstreams with commissioner and provider

membership in place

C1. Signed contracts

C2. Meeting minutes and papers



C5. Meeting papers

Average

4 4 16

High

A1. Finalise proposals to increase

support for STP workstreams

A2. Progress the work of the acute

contract modelling group to

consider alternative contract forms

A1. To discuss the approach to

this at SMT.

A2. To include the ambition to

change system incentives in

system intentions

A1. 31.07.2017.

A2. 30.09.2017

4 3 12

Mo

derate

JCC 11

Paul Sinden, Director of

Performance and Acute

Commissioning




and commissioning of value-

for- money services

TITLE: Managing acute contracts

within contract baselines (Threat)

Cause: if expenditure on acute

contracts exceeds planned contract

baselines

Effect: There is a risk that CCGs will

not meet their financial duties and/or

investment is withheld to support

delivery of the Sustainability and

Transformation Plan

Impact: This may result in delays to

investing in primary care and

community capacity and perpetuate

the risk over performance on acute

hospital contracts

C1. Signed contracts in place for 2017/18 and 2018/19

C2. Contracts include marginal rate payments/deductions for

variances from plan and 3% growth (higher than historic

growth trends)

C3. Contract management framework in place with providers

C4. Issue of contract notices in line with contact provisions

C5.. Mobilisation of STP and QIPP plans (see JCC10)

C6. North Central London Finance and Activity Modelling (FAM)

Group, with commissioner and provider membership. that

oversees system financial position

C7. Work on alternative contract forms to support the

Sustainability and Transformation Plan (STP) through the Acute

Contract Modelling Group (with commissioner and provider

membership)




C4. Contract documentation and

correspondence including remedial

action plans

C5. See JCC10


C7. Meeting minutes and papersAverage 4 4 16

High

A1. Develop and sign-off system

intentions for 2018/19

A2. Develop, in co-production, with

providers, proposals for alternative

contract forms for hospital

providers

A1. First draft to be considered

at Joint Commissioning

Committee on 3 August 2017

A2. Consideration of models

used elsewhere - Aligned

Incentive Contract in Bolton;

Accountable Care models

A1. 30.09.2017

A2. 31.10.20174 3 12

Mo

derate

100 of 191

BAF Risk Heat Map

2 3 4 5

3

4

5

Consequence

Likelihood

2

1

1

242

Item

5.1

Ap

pe

nd

ix 2

242

382

Current Risk Score: Target Risk Score:x x

382

363

363362362

JCC 1

JCC 1

JCC 2

JCC 2

JCC 3

JCC 3

101 of 191

Risk Scoring Key This document sets out the key scoring methodology for risks and risk management.

1. Overall Strength of Controls in Place There are four levels of effectiveness: Level Criteria Zero The controls have no effect on controlling the risk. Weak The controls have a 1- 60% chance of successfully controlling the risk. Average The controls have a 61 – 79% chance of successfully controlling the risk Strong The controls have a 80%+ chance or higher of successfully controlling the risk

2. Risk Scoring

This is separated into Consequence and Likelihood. Consequence Scale: Level of Impact on the Objective

Descriptor of Level of Impact on the Objective

Consequence for the Objective

Consequence Score

0 - 5% Very low impact Very Low 1 6 - 25% Low impact Low 2 26-50% Moderate impact Medium 3 51 – 75% High impact High 4 76%+ Very high impact Very High 5

Likelihood Scale: Level of Likelihood the Risk will Occur

Descriptor of Level of Likelihood the Risk will Occur

Likelihood the Risk will Occur

Likelihood Score

0 - 5% Highly unlikely to occur

Very Low 1

6 - 25% Unlikely to occur Low 2 26-50% Fairly likely to occur Medium 3 51 – 75% More likely to occur

than not High 4

76%+ Almost certainly will occur

Very High 5

102 of 191

3. Level of Risk and Priority Chart

This chart shows the level of risk a risk represents and sets out the priority which should be given to each risk:

LIKELIHOOD

CONSEQUENCE

Very Low (1)

Low (2)

Medium (3)

High (4)

Very High (5)

Very Low (1)

1 2 3 4 5

Low (2)

2 4 6 8 10

Medium (3)

3 6 9 12 15

High (4)

4 8 12 16 20

Very High (5)

5 10 15 20 25

1-3

Low Priority

4-6

Moderate Priority

8-10

High Priority

15-25

Very High Priority

103 of 191

104 of 191


Report Title Primary Care Co-Commissioning - Revisions to Governance

Agenda Item 5.2 Date 7th August

2017

Lead Director Paul Sinden, NCL Director of

Performance and Acute Commissioning Email [email protected]

Report Author Andrew Spicer, NCL Head of Governance and Risk; Frazer Tams, Interim Corporate Affairs Manager, Islington CCG; Alan Keane, Assistant Head of Primary Care- NCL, NHS England.

Email [email protected] [email protected] [email protected]



Email [email protected]

Report Summary

This report sets out proposed revisions to the governance arrangements for primary care co-commissioning across North Central London.


Information

Approval

To note Decision

Recommendation The Governing Body is asked to: Note the report; Approve the amendments to the Terms of Reference for the Primary Care

Co-Commissioning Committee in Common (‘Committee’); Approve the processes for making decisions outside of Committee meetings

and for professional central administration of this process.


This paper links to the following strategic objectives: Commission the delivery of NHS constitutional rights and pledges; Improve the quality and safety of commissioned services; Improve health outcomes, address inequalities and achieve parity of esteem; Integrate and enable local services to deliver the right care in the right

setting at the right time; Involve member practices and commissioning partners in key commissioning

decisions; Maintain financial stability and ensure sustainability through robust planning

and commissioning of value for money services. Identified Risks and Risk Management Actions

This report helps to maximise the opportunities for effective decision-making for primary care medical budgets delegated to the CCGs from NHS England in April 2017.


Conflicts of interest are dealt with robustly and in accordance with the NCL Conflicts of Interest Policy.

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This report helps to increase the efficient use of resources by streamlining decision making in a proportionate and appropriate way.

Engagement

This report was considered by the members of the NCL Primary Care Co-Commissioning Committee in Common which includes elected clinicians, lay members and officers from each of the five NCL CCGs.


This report was drafted in accordance with the provisions of the Equality Act 2010.

Report History

The Terms of Reference for the Primary Care Co-Commissioning Committee in Common were approved by Barnet, Enfield, Haringey and Islington CCG Governing Bodies in November 2016 and by Camden CCG Governing Body in January 2017.

Next Steps None.

Appendices

Appendix 1: Primary Care Co-Commissioning Committee in Common Terms of Reference with proposed amendments; Appendix 2: Process Flowchart.

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Primary Care Co-Commissioning Revisions to Governance

Introduction Between November 2016 and February 2017 the five North Central London (‘NCL’) Clinical Commissioning Groups (‘CCGs’) agreed to take on fully delegated primary care co-commissioning from NHS England. The five NCL CCGs are:

NHS Barnet Clinical Commissioning Group (‘Barnet CCG’); NHS Camden Clinical Commissioning Group (‘Camden CCG’); NHS Enfield Clinical Commissioning Group (‘Enfield CCG’); NHS Haringey Clinical Commissioning Group (‘Haringey CCG’); NHS Islington Clinical Commissioning Group (‘Islington CCG’).

To support decision making for fully delegated primary care commissioning the NCL CCGs agreed to robust governance arrangements. This included establishing the NCL Primary Care Co-Commissioning Committee in Common (‘Committee’). The Committee’s Terms of Reference were approved by each of the five NCL CCGs’ Governing Bodies with Committee meetings being held bi-monthly. To ensure time critical decisions can be made effectively and in a timely way the Terms of Reference contain a clear and robust process by which any urgent and immediate decisions could be made outside of Committee meetings. ‘Urgent’ decisions are defined as those that need to be made within twenty-four hours. ‘Immediate’ decisions are defined as those that need to be made within two weeks. The Terms of Reference set out that the following people are the decision makers for these urgent and immediate decisions:

The relevant Chair of the CCG; The relevant CCG Accountable Officer; The relevant CCG lay representative.

Issues Since the governance arrangements and Terms of Reference were approved there have been three significant issues which have affected the smooth operation of decision making. These are: 1. The shift in management model for the five NCL CCGs; 2. The need to better understand the number of items requiring decision-making outside of

Committee meetings; 3. The need to formally agree a process for decision making outside of Committee meeting

and to have professional administration of this process. Issue 1: The shift in management model for the five NCL CCGs When the Terms of Reference were drafted there were five CCG Chief Officers across NCL with one Chief Officer per CCG. However, from April 2017 there has been a shift in the management model with one single Accountable Officer across the five NCL CCGs with a Chief Operating Officer/Local Executive Director in each CCG. This shift has not been reflected in the Terms of Reference and has placed a significant and unnecessary burden on the time and capacity on the single NCL CCG Accountable Officer.

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As an interim measure the NCL CCG Accountable Officer has delegated decision making authority to the relevant Chief Operating Officer/Local Executive Director. This is in accordance with the provisions of the Terms of Reference. These people are:

Barnet CCG- Kay Matthews; Camden CCG- Sarah Mansuralli; Enfield CCG- Noreen Dowd; Haringey and Islington CCGs- Tony Hoolaghan.

These delegated arrangements are working well and as a long term solution the proposal is to formalise these arrangements by amending the Committee’s Terms of Reference and directly delegating authority to these people. Issue 2: The number of decisions needing to be made outside of Committee meetings being better understood When NCL CCGs took on full delegated of primary care commissioning it was expected that all decisions would be made at Committee meetings, with decisions being made outside of these being rare and only by exception for emergency or time critical items. However, since taking on full delegation it has become clear that there are a high number of decisions that need to be made outside of the scheduled Committee meetings. This is to ensure the smooth operation of primary care services and preserve continuity of care for patients. Many of these decisions are low level, non-contentious and low risk. CCGs currently have no way of easily making these low level decisions outside of Committee meetings and have been dealing with them through the urgent and emergency decision making processes set out in the Committee’s Terms of Reference. However, this is time consuming, an inefficient use of expensive resources and a misappropriation of the urgent and immediate decision making process. NHS England’s decision making arrangements for these low level decisions prior to the delegation of primary care commissioning to CCGs was dealt with through a panel held each week. Proposed solution The proposed solution is to amend the Committee’s Terms of Reference so that the following non-contentious, low risk, decisions can be made by a panel consisting of the NCL Director of Performance and Acute Commissioning and a Committee lay representative operating in a similar way to the previous NHS England panel: Type of Decision Contentious or Non-

Contentious Level of Risk

Requests to add or remove a partner

Non-contentious Low

Retirement of a partner and adding of a new partner

Non-contentious Low

Partnership changes- 24 hour retirement

Non-contentious Low

Opening of a patient list Non-contentious Low Increases in practice boundaries

Non-contentious Low

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The decisions once made would be reported to the following Committee meeting for noting. All other decisions will continue to be made at Committee meetings or through the ‘urgent’ and ‘immediate’ decision making processes as appropriate. The benefits of this approach are: The NCL Director of Performance and Acute Commissioning has operational oversight of

all acute and primary care commissioning across the five NCL CCGs so is well placed to make decisions on behalf of the five NCL CCGs;

The lay representative(s) add independent oversight and assurance to decision making; The lay representative is well placed to act impartially; It is an efficient and effective use of valuable resources; Frees up valuable committee time to concentrate on more strategic issues; Helps to safeguard smooth operation of primary care services and continuity of patient care; If the NCL Director of Performance and Acute Commissioning and lay member cannot jointly

agree after constructive challenge it implies that the decision is contentious and therefore would not be suitable for this process;

Establishes an effective process which is proportionate to the level of decision making and risk;

Ensures that the level of service and decision making provided to GP practices is no less than that previously provided by NHS England;

The approach is highly flexible and these type of decisions can be made in a timely way. The potential disadvantages of this approach are: It adds additional responsibilities onto the NCL Director of Performance and Acute

Commissioning and lay representative(s); It requires an agreed process for making decisions outside of Committee meetings and

professional administration of the process. Terms of Reference To give effect to the above proposed changes the following changes to the Committee’s Terms of Reference are recommended: Section Change 11.3 and 11.7 Renumbered to account for the other amendments 11.4 ‘Accountable Officer’ replaced with ‘Chief Operating

Officer/Local Executive Director’ for urgent decisions. 11.5 ‘Accountable Officer’ replaced with ‘Chief Operating

Officer/Local Executive Director’ for immediate decisions. 11.6 A new section has been added to enable the Chair and

NCL Director of Performance and Acute Commissioning to make the listed low to zero risk non-contentious decisions.

Amendments to the Terms of Reference are highlighted as tracked changes in appendix 1. Issue 3: The need to formally agree a standardised process for decision making outside of Committee meeting and to have professional central administration of this process Given the high number of decisions which need to be made outside of Committee meetings there is a need to ensure that there is a standardised process for dealing with these and that the process is centrally co-ordinated and professionally administered. This helps to ensure: The process is followed correctly; Papers are to a high standard and quality;

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Decisions are accurately and properly reported to the Committee; Decision-makers work within the authorities delegated to them. Process The proposed process for making decisions outside of Committee meetings is contained in appendix 2. The process considers: The urgency of the decision required; Whether the decision is either contentious or of a strategic nature; The timeliness of the next Primary Care Committee-in-Common To determine whether a decision on primary care medical contracts can be considered through: The routine decision making process for non-contentious and low risk items; The urgent decision-making process for items requiring a quick turnaround in advance of

a scheduled Primary Care Committee-in-Common - . ‘Urgent’ decisions are defined as those that need to be made within twenty-four hours. ‘Immediate’ decisions are defined as those that need to be made within two weeks;

The Primary Care Committee-in-Common for contentious and/or strategic items, and where timing of the Committee allows for consideration of urgent items.

The process also sets out where the Primary Care Committee-in-Common will consider a paper in Part Two (in private) rather than Part One (a meeting in public). Use of Part Two is restricted to: Commercially sensitive information; Contains patient data; Confidential data part of ongoing review/investigation; Potential for interruption, disruption or disturbance. Recommendations The Governing Body is asked to agree the following recommendations: To approve the amendments to the Committee’s Terms of Reference; To approve the processes for making decisions outside of Committee meetings and for

professional central administration of this process.

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NCL Primary Care Co-Commissioning Committee in Common

Terms of Reference

1. Introduction and Background

1.1 Simon Stevens, the Chief Executive of NHS England, announced on 1st May 2014 that NHS England was inviting Clinical Commissioning Groups to expand their role in primary care commissioning. Each Clinical Commissioning Group (‘CCG’) was invited to submit an expression of interest setting out its preference for how it would like to exercise expanded primary medical care commissioning functions.

1.2 One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to individual CCGs. Accordingly, in October 2016 each of the five CCGs in North Central London (‘NCL’) submitted separate applications to NHS England to exercise these commissioning functions for each of their own geographical areas.

1.3 The five North Central London CCGs (‘NCL CCGs’) are NHS Barnet CCG, NHS Camden CCG, NHS Enfield CCG, NHS Haringey CCG and NHS Islington CCG.

1.4 In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended) (‘NHS Act 2006’), NHS England subsequently delegated the exercise of the functions specified in section 4 below to each of the NCL CCGs for their own geographical areas.

1.5 Each CCG has established its own individual Primary Care Commissioning Committee as a committee of its Governing Body. The purpose of each committee is to be a corporate decision making body for the management of the delegated functions and the exercise of the delegated powers.

1.6 To promote cross NCL understanding, collaborative and integrated working, information sharing, benchmarking, greater transparency, openness and help manage conflicts of interest each of the NCL CCGs have agreed to hold their Primary Care Commissioning Committee meetings in the same time, in the same place, as a committee in common with a common Terms of Reference. This committee in common is known as the NCL Primary Care Commissioning Committee (‘Committee’).

1.7 These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee.

2. Committees in Common

2.1 The following committees form the Committee: NHS Barnet CCG Primary Care Commissioning Committee; NHS Camden CCG Primary Care Commissioning Committee; NHS Enfield CCG Primary Care Commissioning Committee; NHS Haringey CCG Primary Care Commissioning Committee; NHS Islington CCG Primary Care Commissioning Committee.

3. Statutory Framework

3.1 NHS England has delegated to each of the NCL CCGs the authority to exercise the primary

care commissioning functions set out in section 4 below for their own geographical areas in accordance with section 13Z of the NHS Act 2006.

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3.2 Arrangements made under section 13Z of the NHS Act 2006 may be on such terms and

conditions (including terms as to payment) as may be agreed between NHS England and each CCG.

3.3 Arrangements made under section 13Z of the NHS Act 2006 do not affect the liability of NHS England for the exercise of its functions. However, each CCG acknowledges that in exercising its functions (including those delegated to it) it must comply with the statutory duties set out in Chapter A2 of the NHS Act 2006 and including: No. Statutory Duty Section of NHS Act 2006 1. Management of Conflicts of Interest 14O 2. Duty to promote the NHS Constitution 14P 3. Duty to exercise its functions effectively, efficiently

and economically 14Q

4. Duty as to improvement in quality of services 14R 5. Duty in relation to quality of primary medical

services 14S

6. Duties as to reducing inequalities 14T 7. Duty to promote the involvement of each patients 14U 8. Duty as to patient choice 14V 9. Duty as to promoting integration 14Z1 10. Public involvement and consultation 14Z2

3.4 In respect of the delegated functions from NHS England the CCG will need to exercise those

functions in accordance with the relevant provisions of section 13 of the NHS Act 2006 including:

No. Statutory Duty Section of NHS Act 2006 1. Duty to have regard to impact on services in certain

areas 13O

2. Duty as respects variation in provision of health services

13P

3.5 Each of the individual Primary Care Commissioning Committees which form the Committee is

established by their respective Governing Bodies in accordance with Schedule 1A of the NHS Act 2006.

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

4. Role of the Committee 4.1 The role of the Committee is to carry out the function relating to the commissioning of primary

medical services under section 83 of the NHS Act 2006. This includes the following: Decisions in relation to the commissioning, procurement and management of Primary

Medical Services Contracts, including but not limited to the following activities: o Decisions in relation to Enhanced Services; o Decisions in relation to Local Incentive Schemes (including the design of such

schemes) o Decisions in relation to the establishment of new GP practices (including branch

surgeries) and closure of GP practices; o Decisions about ‘discretionary’ payments;

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o Decisions about commissioning urgent care (including home visits as required) for out of area registered patients;

o The approval of practice mergers; o Planning primary medical care services in the area, including carrying out needs

assessments; o Undertaking reviews of primary medical care services; o Decisions in relation to the management of poorly performing GP practices and

including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list);

o Management of delegated funds; o Premises costs directions functions; o Co-ordinating a common approach to the commissioning of primary care services

with other commissioners in NCL where appropriate; and o Such other ancillary activities that are necessary in order to exercise the Delegated

Functions.

4.2 In performing its role the Committee will exercise its management of the functions in accordance with the Delegation and the Delegation Agreement that each CCG entered into with NHS England. The Delegation and the Delegation Agreement sit alongside these Terms of Reference. The Delegation is contained in Schedule 2.

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

4.4 The Committee will have due regard to any relevant Quality and Safety issues which may

arise as agreed by Committee members. 4.5 In performing its role each Primary Care Commissioning Committee will act within the powers

delegated to it by NHS England. 4.6 Decisions made by each individual Primary Care Commissioning Committee will be binding

on NHS England as long as decisions are made within the scope of the powers delegated to it.

4.7 In performing its role Committee members will act in good faith towards each other, work

collaboratively, review evidence, share information, provide objective expert input and endeavour to reach a consensus and collective view.

5. Geographical Coverage 5.1 Each individual CCG has responsibility for carrying out the functions for their own geographical

areas as set out below:

Committee Geographical Area NHS Barnet CCG Primary Care Commissioning Committee

London Borough of Barnet

NHS Camden CCG Primary Care Commissioning Committee

London Borough of Camden

NHS Enfield CCG Primary Care Commissioning Committee

London Borough of Enfield

NHS Haringey CCG Primary Care Commissioning Committee

London Borough of Haringey

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NHS Islington CCG Primary Care Commissioning Committee

London Borough of Islington

6. No Double Delegation 6.1 The Committee operates under the principle of no double delegation. This means that each

CCG may only carry out the functions and make decisions for its own geographical area. No CCG has the power or authority to carry out the functions or make decisions for other any other CCG or its geographical area.

7. Pooling Budgets 7.1 The individual CCG Primary Care Commissioning Committees comprising the Committee

have no authority to pool budgets with each other. 7.2 Each individual CCG Primary Care Commissioning Committee is responsible for the

delegated funds in their respective geographical areas.

8. Membership 8.1 The membership of each of the individual Primary Care Commissioning Committees will meet

the requirement of their respective Constitutions. 8.2 The Committee and each of the individual Primary Care Commissioning Committees shall

have a lay and executive majority. 8.3 The Committee shall have the following non-voting attendees who will sit at non-voting

attendees in common across all five NCL Primary Care Commissioning Committees: A Practice Nurse representative; NHS England representative(s); Health and Wellbeing Board representative(s); Healthwatch Representative(s); LMC Representative(s); Non-conflicted external clinicians.

8.4 The list of members and non-voting attendees is set out in Schedule 1. 8.5 Committee members may nominate deputies to represent them in their absence and make

decisions on their behalf. Non-voting attendees may nominate deputies to represent them in their absence.

8.6 The Committee may call additional experts to attend meetings on a case by case basis to

inform discussion. 8.7 The Committee may invite or allow additional people to attend meetings as attendees.

Attendees may present at Committee meetings and contribute to the relevant Committee discussions but are not allowed to participate in any formal vote.

8.8 The Committee may invite or allow people to attend meetings as observers. Observers may

not present at Committee meetings, contribute to any Committee discussion or participate in any formal vote.

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9. Chair and Vice Chair of the Committee 9.1 The Chair of the Committee shall be a Lay Member from an NCL CCG. The Committee Chair

shall not be the Chair of an NCL CCG Audit Committee nor a Conflict of Interest Guardian. 9.2 The Vice Chair of the Committee shall be a Lay Member from an NCL CCG. The Committee

Vice Chair shall not be the Chair of an NCL CCG Audit Committee nor a Conflict of Interest Guardian.

10. Voting 10.1 Each individual Primary Care Commissioning Committee shall vote and make decisions for

their own geographical area only. A vote of one Primary Care Commissioning Committee will not be binding on any other Primary Care Commissioning Committee.

10.2 Each voting member of each Primary Care Commissioning Committee shall have one vote

with resolutions passing by simple majority.

10.3 Each Primary Care Commissioning Committee shall nominate a Lay Member from its own CCG to have the casting vote.

10.4 The Chair of the Committee may not vote on any resolution other than on those resolutions from his or her own CCG’s geographical area.

10.5 The Vice Chair of the Committee may not vote on any resolution other than on those resolutions from his or her own CCG’s geographical area.

10.6 Where there is a pan NCL resolution each of the five NCL Primary Care Commissioning Committees must vote in favour of the resolution for it to pass.

10.7 Each Primary Care Commissioning Committee can only invest their own delegated funds in their own geographic area. However, where there are new or additional funds available that are not delegated funds such as new transformation monies all decisions on how such money is invested will be treated as a pan NCL resolution.

11. Decisions 11.1 The Committee and each individual NCL Primary Care Commissioning Committee will make

decisions within the bounds of their remit. 11.2 Decisions of the Committee and each individual Primary Care Commissioning Committee will

be binding on NHS England. 11.3 Due to the nature of primary care commissioning the Committee recognises that some urgent

and immediate decisions may need to be made outside of Committee meetings. Each individual NCL Primary Care Commissioning Committee may therefore delegate urgent and immediate decisions that need to be made outside of Committee timescales in accordance with clauses 11.4 – 11.56 and 11.7 below.

11.4 Urgent decisions requiring a response within 24 hours will be made by the following people or

their nominated deputies: The relevant Chair of the CCG: ;

The relevant CCG Accountable Officer Chief Operating Officer/Local Executive Director; The relevant CCG lay representative.

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11.5 Immediate decisions requiring a response within 2 weeks will be made at a Committee

meeting where practicable. Where this is not practicable the following people or their nominated deputies will make the decision: The relevant Chair of the CCG; The relevant CCG Accountable Officer Chief Operating Officer/Local Executive Director; The relevant CCG lay representative.

11.6 Due to the nature of primary care commissioning the Committee recognises that the following non-contentious, low risk, decisions may be made outside of Committee meetings by a Committee lay representative and the NCL Director of Performance and Acute Commissioning acting together:

Requests to add or remove a partner; Retirement of a partner and adding of a new partner; Partnership changes- 24 hour retirement; Opening of a patient list; Increases in practice boundaries.

11.76 Decisions made outside of Committee meetings will be reported to the Committee at the next

Committee meeting. This may be in a public or private part of the meeting depending on the nature of the business and the decision(s) made.

12. Quorum 12.1 Each individual Primary Care Commissioning Committee must have a lay and executive

majority to be quorate. The following members must also be present: One lay representative; One officer representative; One clinical representative.

12.2 If the clinical representative referred to in clause 12.1 above is conflicted on a particular item

of business they will not count towards the quorum for that item of business and a non-conflicted clinician will be appointed or co-opted in their place.

12.3 If any representative is conflicted on a particular item of business they will not count towards

the quorum for that item of business. If this renders a meeting or part of a meeting inquorate a non-conflicted person may be temporarily appointed or co-opted to satisfy the quorum requirements.

12.4 For the Committee to be quorate all five NCL Primary Care Commissioning Committees must be quorate. If a Committee meeting is not quorate the Chair may permit the appointment or co-option of additional members if necessary.

12.5 In some very rare circumstances all clinicians may be conflicted and therefore it may not be

possible to co-opt or appoint a non-conflicted clinician to satisfy the quorum requirements. In this case the Chair may dis-apply the requirement to have a clinical representative present in clause 12.1 above and deem the meeting quorate upon the agreement of all of the lay representatives on the Committee.

13. Secretariat 13.1 The Secretariat to the Committee shall be provided by Islington CCG.

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14. Frequency of Meetings 14.1 The Committee shall meet bimonthly or as otherwise agreed by the Committee. 15. Notice of Meetings 15.1 Notice of a Committee meeting shall be sent to all Committee members no less than 7 days

in advance of the meeting. 15.2 The meeting shall contain the date, time and location of the meeting. 15.3 Where Committee meetings are to be held in public the date, times and location of the

meetings will be published on each CCG’s website. 16. Agendas and Circulation of Papers 16.1 Before each Committee meeting an agenda setting out the business of the meeting will be

sent to every Committee member no less than 7 days in advance of the meeting. 16.2 Before each Committee meeting the papers of the meeting will be sent to every Committee

member no less than 7 days in advance of the meeting. 16.3 If a Committee member wishes to include an item on the agenda they must notify the Chair

via the Committee’s Secretariat no later than 7 days prior to the meeting. The decision as to whether to include the agenda item is at the absolute discretion of the Chair.

17. Minutes and Reporting 17.1 The minutes of the proceedings of a meeting shall be prepared by the Committee’s Secretariat

and submitted for agreement at the following Committee meeting. 17.2 The approved minutes will be presented to the NHS England area team. They will also be

presented to each individual NCL CCG Governing Body as per their local requirements. 17.3 Each individual CCG will comply with their own Governing Body’s reporting requirements. 18. Conflicts of Interest 18.1 Conflicts of Interest shall be dealt with in accordance with the NCL Conflicts of Interest Policy

and NHS England statutory guidance for managing conflicts of interest. The NCL Conflicts of Interest Policy is a master document containing the single conflicts of interest policy agreed by each of the NCL CCGs together with a schedule setting out each CCG’s local variations to that policy.

18.2 Each CCG shall ensure appropriate local safeguards are in place to maintain the integrity of

the role of Conflicts of Interest Guardian. 18.3 The Committee shall have a Conflicts of Interest Register that will be presented as a standing

item on the Committee’s agenda. 19. Gifts and Hospitality 19.1 Gifts and Hospitality shall be dealt with in accordance with the NCL Conflicts of Interest Policy

and NHS England statutory guidance for managing conflicts of interest.

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19.2 The Committee shall have a Gifts and Hospitality Register that will be presented as a standing item on the Committee’s agenda.

20. Meetings Held in Public 20.1 Meetings of the Committee shall be held in public unless the Committee resolves to exclude

the public from a meeting. In which case the meeting, in whole or in part, may be held in private. The Committee may also exclude non-voting attendees and observers. Meetings or parts of meetings held in public will be referred to as ‘Meeting Part 1’. Meetings or parts of meetings held in private will be referred to as ‘Meeting Part 2.’

20.2 Non-voting attendees, observers and the public may be excluded from all or part of a meeting

at the Committee’s absolute discretion whenever publicity would be prejudicial to the public interest by reason of:

The confidential nature of the business to be transacted; or The matter is commercially sensitive or confidential; or The matter being discussed is part of an on-going investigation; or The matter to be discussed contains information about individual patients or other

individuals which includes sensitive personal data; or Information in respect of which a claim to legal professional privilege could be

maintained in legal proceedings is to be discussed; Other special reason stated in the resolution and arising from the nature of that

business or of the proceedings; or Any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as

amended or succeeded from time to time; or To allow the meeting to proceed without interruption, disruption and/or general

disturbance.

21. Confidentiality 21.1 Members of the Committee shall respect the confidentiality requirements set out in these

Terms of Reference unless separate confidentiality requirements are set out for the Committee in which event these shall be observed.

21.2 Committee meetings may in whole or in part be held in private as per section 20 above. Any

papers relating to these agenda items will be excluded from the public domain. For any meeting or any part of a meeting held in private all members and/or attendees must treat the contents of the meeting and any relevant papers as strictly private and confidential.

21.3 Decisions of the Committee will be published by Committee members except where matters

under consideration or when decisions have been made in private and so excluded from the public domain in accordance with section 20 above.

22. Standards of Business Conduct 22.1 Committee members, attendees and/or observers must maintain the highest standards of

personal conduct and in this regard must comply with: The law of England and Wales; The NHS Constitution; The Nolan Principles; The standards of behaviour set out in each NCL CCG Constitution; Any additional regulations or codes of practice relevant to the Committee.

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23. Training and Information 23.1 It is the responsibility of each organisation referred to in section 1.3 above to ensure that their

representatives at the Committee are provided with appropriate training and information to allow them to exercise their responsibilities effectively.

24. Sub-Committees 24.1 The Committee and each individual Primary Care Commissioning Committee may not

delegate any of its powers to a committee or sub-committee but it may appoint sub-committees and/or working groups to advise and assist it in carrying out its functions.

24.2 Any sub-committees or working groups must abide by the NCL Conflicts of Interest Policy and

NHS England statutory guidance for managing conflicts of interest.

26. Review of Terms of Reference 26.1 These Terms of Reference will be reviewed from time to time, reflecting experience of the

Committee in fulfilling its functions and the wider experience of CCGs in primary medical services co-commissioning.

26.2 These Terms of Reference will be formally reviewed in April each year following the

establishment of the Committee. These Terms of Reference may be changed or amended by mutual agreement of the Committee and on being approved by each of the Governing Bodies of the NCL CCG’s in accordance with their Constitutions.

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Schedule 1 - List of Members This schedule sets out the membership, attendees, Chair and Vice Chair of each individual Primary Care Commissioning Committee and the Committee.

NHS Barnet Primary Care Commissioning Committee The voting members of the NHS Barnet Primary Care Commissioning Committee are as follows:

Position Name Title Clinical representative Dr Michelle NewmanTal

Helbitz Governing Body GP Representative

Lay representative Ms Bernadette Conroy Lay Member Officer representative Mr Leigh Griffin Director of Strategic

Development Member with casting vote Ms Bernadette Conroy Lay Member

NHS Camden Primary Care Commissioning Committee The voting members of the NHS Camden Primary Care Commissioning Committee are as follows:

Position Name Title Clinical representative Dr Neel GuptaKevan

Ritchie Governing Body GP Representative

Lay representative Ms Kathy Elliott Lay Member with General Portfolio

Officer representative Ms Susan AchmatowiczSarah Mansuralli

Chief Operating OfficerLocal Executive Director

Member with casting vote Ms Kathy Elliott Lay Member with General

Portfolio NHS Enfield Primary Care Commissioning Committee The voting members of the NHS Enfield Primary Care Commissioning Committee are as follows:

Position Name Title Clinical representative Dr Alpesh PatelJahan

Mahmoodi Governing Body GP Representative

Lay representative Ms Karen Trew Lay Member Officer representative Ms Deborah McBeal Deputy Chief Officer Member with casting vote Ms Karen Trew Lay Member

NHS Haringey Primary Care Commissioning Committee The voting members of the NHS Haringey Primary Care Commissioning Committee are as follows:

Position Name Title Clinical representative Dr Dina Dhorajiwala Governing Body GP

Representative

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Lay representative Ms Cathy Herman Lay Member for Public and Patient Engagement and CCG Vice Chair (Non-Clinical)

Officer representative Ms Jennie Williams Executive Nurse & Director of Quality, Haringey CCG

Member with casting vote Ms Cathy Herman Lay Member for Public

and Patient Engagement and CCG Vice Chair (Non-Clinical)

NHS Islington Primary Care Commissioning Committee The voting members of the NHS Islington Primary Care Commissioning Committee are as follows:

Position Name Title Clinical representative Dr Katie ColemanDominic

Roberts Governing BodyClinical Director, GP Representative

Lay representative Ms Sorrel Brooks Lay Member for Public and Patient Engagement

Officer representative Ms Alison Blairr Paul Sinden

Chief OfficerNCL Director of Performance and Acute Commissioning

Member with casting vote Ms Sorrel Brooks Lay Member for Public

and Patient Engagement Non-Voting Attendees The following non-voting attendees sit as non-voting attendees on all of the NCL Primary Care Co-Commissioning Committees as attendees in common:

Position Name Title Practice Nurse representative Katherine Gerrans Vacant Lead Nurse and Quality

Workforce Manager, Haringey CCG

Health and Wellbeing Board representative(s)

TBC

Healthwatch representative(s) Ms Emma Whitby Chief Executive, Islington

Healthwatch LMC Representative Mr Greg Cairns Director of Primary Care

Strategy LMC Representative Dr Manish Kumar Chair, Enfield LMC NHS England Representative Liz WiseTBC TBCDirector Primary Care

Commissioning, London External Clinician TBC TBC

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External Clinician TBC TBC External Clinician TBC TBC

The roles referred to in the list of voting members and non-voting attendees above describe the members’ and non-voting attendees’ substantive roles and/or any successor equivalent roles only and not the individual title or titles of any member. Names and job titles are provided for information purposes only and may be updated as required without the need to formally amend the Terms of Reference. Chair and Vice of the Committee in Common The Chair and Vice Chair of the Committee are as follows:

Position Name Title CCG Geographical Area

Chair Ms Cathy Herman (from Haringey CCG)

Lay Member for Public and Patient Engagement and CCG Vice Chair (Non-Clinical)

Haringey

Vice Chair Ms Sorrel

Brooks Lay Member for Public and Patient Engagement

Islington

Schedule 2- Template Delegation

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week 2 week 4 week 6 week 8 week 2

Feed In LineProcess Line

NCL Primary Care Committee In Common Decision Making Process Map

Primary Care Committee In

Common

Primary Care Committee

Secretariat

CCG Primary Care Team

NSHE Primary Care

Commissioning Team

LEGEND

ProcessAlternative

Process

DecisionDocument

pre-decison investigative

work completed

Is the decisionurgent?

Yes

CQC Report

PMS change Practice request

No Is the decision likely to be :- Contentious

Yes

Primary Care Committee in Common

Paperapproved by

CCG Lead

Does the paper meet/contain any of

the following:

- Commercially sensitive information- Contains patient data- Confidential data part of ongoing review/investigation- Potential for interruption, disruption or

Part 2 Papers

Part 1 papers

No

paper for approval

Yes

No

paper for approval

paper for approval

Routine Decision Group Papers

Decision Log

No

Yes

PCCC Minutes

Decision Actioned

Question/query

Is there an PCCC scheduled within the timeframe of the

decision required?

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Routine Decision Group

Urgent Decision Process

Quorum Met

Reports from other

Primary Care Transformation Group Reports

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Report Title Camden CCG 2016-17 Annual Safeguarding Children Report

Agenda Item

5.3

Date

29 August 2017

Lead Director Neeshma Shah, Director of Quality and

Clinical Effectiveness


Report Author Jackie Dyer, Designated Nurse for Safeguarding Children



Charlotte Cooley, Elected Practice Nurse


Report Summary This annual report provides assurance in regards to the Governing Body’s

statutory responsibilities to Safeguarding Children. Included is an update in regards to progress and developments since the last safeguarding report. This report includes: 1. The CCG Governing Body Members and Staff Safeguarding Children Training

Reports which demonstrates compliance. 2. Progress of the Safeguarding Metric Reports that shows which health Trusts

have robust arrangements in place for capturing evidence of compliancy with safeguarding processes.

3. Camden & Islington NHS Foundation Trust (CIFT) have made progress on capturing supervision data, though have not developed a robust system for capturing Child Protection Conference data. Their participation in this process was raised as a concern by the Camden Safeguarding Children Board (CSCB). Included in the report are the actions to address and monitor this.

4. Tavistock & Portman NHS Foundation Trust have not been able to provide

reliable assurance regarding safeguarding supervision. The Trust have added this concern to their Risk Register and devised actions to address this.

5. Great Ormond Street Hospital NHS Foundation Trust (GOSH) have not been compliant with their statutory safeguarding training levels 2 and 3. The report details the actions taken to address and monitor this.

6. GOSH have experienced capacity issues within their safeguarding team and interim arrangements which were put in place are included. Despite these issues, the safeguarding team have successfully managed to increase their supervision offer.

7. Updates on the progress made by University College London Hospital (UCLH) and Central North West London (CNWL) NHS Foundation Trusts in regards to their domestic abuse screening processes.

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8. Progress on the GP participation in the Child Protection Case Conference Scheme, which includes the details of the work taken forward to ensure improvements were maintained. In the later part of last year compliancy had fallen, but data for March 2017 has demonstrated an improvement. The GP Safeguarding Leads Forum is demonstrating good engagement across Camden Practices and findings from recent audits and safeguarding metric reports demonstrates good assurances in regards to safeguarding.

9. Assurances regarding the safeguarding arrangements with London Central

West Unscheduled Care Collaborative, Young People’s Sexual Health Services, Marie Stopes & Family Nurse Partnership.

10. Update and progress report into Camden’s Serious Case Reviews (SCRs) Child C and Child D.

11. A summary of Achievements and Developments for 2016-17, which includes health agencies contribution to Camden Safeguarding Children Board (CSCB) Business Plan.

12. Future Objectives for 2017-18


Information

Approval To note

Decision

Recommendation The Governing Body is asked to: Note the safeguarding children arrangements across Camden. Note the progress which is being made to provide assurance in regards to

these arrangements. Challenge and support these arrangements to ensure Camden’s Children

have the most effective safeguarding arrangements possible. The report is provided for information and discussion.

Strategic Objective Links

To ensure access to and the delivery of safe, effective and responsive services that reduces inequalities, meet identified needs.


These are highlighted in the report at page 31.


Nil


There are no equality issues arising from this report.

Report History This report was presented to Camden’s CCG Quality & Safety Committee on 19th

July 2017.

Next Steps Continued monitoring and oversight by Camden CCG Quality & Safety Committee.

Appendices

None

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1

Camden CCG Safeguarding Children’s Annual Report

2016/17

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2

CONTENTS

Page 1. Introduction 3

2. Key Professionals in Post 3

3. Accountability and Structure 3

4. Governance arrangements 4

4.1 Safeguarding Training Camden CCG 5

4.2 Camden Safeguarding Children Board (CSCB) 5

5. Safeguarding Monitoring of Providers 6

5.1 CNWL Camden Provider Services 6

5.2 University College London Hospitals NHS Trust (UCLH) 10

5.3 Royal Free London NHS Foundation Trust 12

5.4 Camden and Islington Foundation NHS Trust 13

5.5 Tavistock and Portman NHS Foundation Trust 15

5.6 Great Ormond Street Hospital NHS Foundation Trust (GOSH) 16

6. The Named GP Safeguarding Lead 18

6.1 CCG support and monitoring scheme for improving GP involvement

in the child protection process

18

6.2 The GP safeguarding children forum 19

6.3 Information sharing in MASH 19

6.4 Safeguarding training 20

6.5 Safeguarding assurance metric audit 20

6.6 Child protection plan audit 20

6.7 Ante-natal liaison audit 21

7. London Central West (LCW) Unscheduled Care Collaborative/Out of

Hours Service

21

8. Monitoring Young People’s Sexual Health Services 22

9. Marie Stopes International 22

10. Family Nurse Partnership (FNP) 22

11. Multi-Agency Safeguarding Hub MASH 23

12. Serious Case Review (SCR) and Case Reviews 23

13. Independent Contactors 25

14. Safeguarding Audits 25

14.1 Section.11 Audits1 25

14.2 CSCB Multi Agency Audits 25

1 Section 11 Children Act 2004 places a duty on a range of organisations in regards to their functions in regards to safeguarding and promoting the welfare of children.

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3

14.3 Reviews and Inspections 25

15. Achievements and Developments 26

15.1 Children subject to Child Protection Plans 26

15. 2 CSCB Work Plan 26

15. 3 Child Sexual Exploitation (CSE) 27

15.4 Child Protection Information Sharing (CP-IS) System 28

15.5 Female Genital Mutilation FGM 28

15.6 The Barnahus model for Child Sexual Abuse 28

15.7 CSCB Senior Team Practitioners Governance Assurance Visits 28

15.8 Wood Review of LSCBs 29

16. CSCB Child Death Overview Panel (CDOP) 29

17. Summary of achievements 31

18. Challenges (Gaps/Risks/Mitigations) 31

19. Future Objectives 32

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1. Introduction

The purpose of this report is to provide assurance to the Camden’s CCG Governing Body that the CCG is fulfilling its statutory responsibilities2 for Safeguarding Children. It is also provides a progress report in regards to safeguarding developments since the last safeguarding report in July 2016. 2. Key Professionals in Post Camden CCG has all the statutory safeguarding children team members in post and they ensure that safeguarding is discharge across the health economy;

Executive Lead for Safeguarding Elected Clinical Lead for Safeguarding Designated Nurse 0.9.WTE Designated Doctor 0.4 WTE Named GP Safeguarding Lead (Interim post3) 0.2 WTE

3. Accountability and Structure NHS Camden CCG has clear safeguarding children accountability and reporting arrangements which takes account of national and statutory guidance. Accountability for Safeguarding sits with the Accountable Officer who is responsible for ensuring that health providers’ functions are discharged with regard to the need to safeguard and promote the welfare of children4. This is delivered through contractual arrangements. Robust accountability for safeguarding is demonstrated through the reporting line of the Designated Professionals and Named GP Lead to the Director of Quality and Clinical Effectiveness and scrutiny by the elected Governing Body Lead for Safeguarding Children. The monitoring of safeguarding takes place through the Quality and Safety Committee. The Director of Quality and Clinical Effectiveness has the responsibility to alert the Accountable Officer of safeguarding risks. 2 Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children 2015, NHS England Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework 2015, 3 Covering the substantive post as maternity cover 4 S11 Children Act 2004

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4. Governance Arrangements Safeguarding governance arrangements are clearly documented in the reports to the Quality and Safety Committee. The reports to the Committee include;

Quarterly safeguarding reports Bi-monthly reports from Camden’s Safeguarding Children Board Other reports as required The annual safeguarding children report to NHS Camden’s Governing Body.

4.1 Safeguarding Training Camden CCG Training data reports are produced by the Commissioning Support Unit (CSU) and are monitored through the Safeguarding Children Quarterly Reports to the Quality and Safety Committee. Governing Body The Governing Body training rates are demonstrating 90% compliancy. Training sessions were held in August and evaluations demonstrated that Governing Body Members found the training helpful and relevant to their roles. CCG Staff Staff training reports are provided quarterly by the Commissioning Support Unit (CSU). Updates are included in the quarterly Quality and Safety Committee Safeguarding Children Reports. Table 1

Camden CCG Staff Training

2015-16 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

80% 50% 78% 59% 92% 79% 84% 88% 88%

4.2 Camden Safeguarding Children Board CSCB The CCG demonstrates compliancy with Section 13 Children Act 20045 through good engagement in CSCB. The following staff are all Board members,

Executive Safeguarding Lead, Director of Quality and Clinical Effectiveness, Designated Nurse and Doctor Interim Named GP Safeguarding Children Lead

The Designated Doctor and Nurse attend the following CSCB Sub- Groups

SCR Panel Health Committee (Chaired by Designated Doctor) Child Sexual Abuse (CSA) Task and Finish Group Disable Children Task and Finish Group

The Designated Nurse attends

Quality Assurance Group Learning and Development Group (Chaired by Designated Nurse)

5 ‘‘ to cooperate and engage fully with partner agencies as competent members of their LSCBs”

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Child Death Overview Panel Child Protection Support and Challenge Panel Child Sexual Exploitation CSE Strategic Group Children living with parents who experience mental health Task and Finish Group

The Designated Nurse also attends the following Providers’ safeguarding committees;

Central and North West London NHS Foundation Trust (CNWL) Camden Provider Services

University College London Hospitals NHS Foundation Trust (UCLH) Royal Free London NHS Foundation Trust (RFL) Camden and Islington NHS Foundation Trust (CIFT) Tavistock and Portman NHS Foundation Trust (T&P) Great Ormond Street Hospital NHS Foundation Trust (GOSH)

The Designated Nurse supervises;

CNWL Provider Services Named Nurse UCLH Named Nurse Royal Free Named Nurse (supervised by Barnet’s Designated Nurse) GOSH Named Nurse Tavistock and Portman Named Professional CIFT Named Professional (supervised by Islington’s Designated Nurse).

The Designated Doctor supervises;

CNWL Provider Services Named Doctor UCLH Named Doctor Royal Free Named Doctor GOSH Named Doctor Tavistock and Portman Named Doctor

5. Safeguarding Monitoring of Providers The safeguarding children metric reports provide a robust system for monitoring health Trusts. These reports are produced quarterly, give assurance in regards to structures, processes and compliance with training, child protection case conference attendance and supervision. Most Trusts are maintaining steady compliancy with their safeguarding training. During the year there has been some improvement in Trusts capturing meaningful case conference attendance and supervision data. 5.1 CNWL Camden Provider Services The safeguarding team comprises of:

Executive Safeguarding Lead Named Nurse Named Doctor Child Protection ( CP) Advisor Multiagency Safeguarding Hub MASH6 Health Lead

CNWL has three divisions and Camden Community Services report into the Goodhall Safeguarding Group. The Divisional Nursing Director chairs the Goodhall Safeguarding Group and this group contributes to the CNWL Trust Safeguarding Children Annual report.

6 Multi Agency Safeguarding Hub is a team of multi-disciplinary professionals who collated to assess risk , share information and in a coordinated way to ensure vulnerable children and young people are kept safe

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The Trust has good compliance with safeguarding children training (Table 2). Their level 3 Training Program continues to be run in collaboration with the Named GP Safeguarding Children Lead7. Evaluations demonstrate that participants rate these courses as good and value the multi-agency experience, gaining insight and understanding of another agency’s perspective. In 2016 the Trust changed the training criteria for their staff requiring level 2 - these staff now access a level 3 program every three years. Table 2

CNWL Safeguarding Children Training Stats

2015-16 2016-17 Level Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 80% 96% 76% 97% 96% 94% 95% 97% 96%

2 80% 90% 91% 94% 95% 96% 96% 95% 93% 3 80% 80% 73% 94% 87% 89% 78% 81% 83%

4 80% 100% 100% 100% 100% 100% 100% 100% 100%

The Named Nurse and CP Advisor monitor Health Visitors and School Nurses participation in Child Protection Case Process (Table 3) during supervision, where all these cases are reviewed. In Q4 there was a drop in compliancy and this will be monitored in their next report. Table 3

CNWL Case Conference Attendance/Participation 2015-16 2016-17

Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 100% 93% 87% 94% 93% 91% 90% 95% 85%

The Safeguarding team collected supervision data for health visitors and school nurses and this demonstrates good compliancy. Table 4

CNLW Safeguarding Supervision 2015-16 2016-17

Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 100% 98% 95% 94% 95% 89% 95% 96% 91%

CNWL Audits

1. Supervision

The Named Nurse carried out a supervision audit earlier this year, which aimed to examine practitioners’ experience and assess how it supports their work with vulnerable children. 7 This is a joint program for health visitors, school nurses, sexual health staff and GPs and practice nurses

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Effective professional supervision can play a critical role in ensuring a clear focus on the child’s welfare’ (HM Government, 2015).8 The survey was sent out to two groups (113 staff);

Group 1. Camden Integrated Children’s Service9 (ICS) and paediatricians Group 2. Health visitors and school nurses

Response rates differed significantly between both groups, with a

17% response rate for Group 1 50% for Group 2.

Findings demonstrated different experiences from both groups;

7 professionals in Group 1 had never received specific Child Protection Supervision; 2 professionals in Group 210 had never received specific Child Protection Supervision 89% of all staff reported supervision was excellent, very good/ good 11% responded standard was average or unsatisfactory. (All from Group 2) 7 professionals reported they felt unsupported when difficulties arose in the network.

Junior doctors’ response in this audit highlighted that would like more support from the consultants when undertaking Child Protection Medicals. This was addressed by the Named Doctor and this practice has now been changed and where possible, consultants are now more often present in the same building when junior doctors are undertaking CP medicals making it easier to provide support and consultancy. The findings of this audit were shared with the ICS Manager. A further audit is planned for next year to monitor the impact of these changes.

2. Domestic Abuse Screening The Safeguarding Team have carried out a further audit on routine health visitor screening for Domestic Abuse11 at the New Birth Visit. The audit performed in September 2016 demonstrated a 21% improvement in screening. In this audit a 100 cases were reviewed and evidenced that;

51% of cases screening was documented 32% not screened due to partner or other present 17% no evidence of screening.

To assist health visitors with screening the Safeguarding Team have developed a new birth template for which has embedded domestic abuse screening questions. The impact of this tool will be audited next year.

3. Communication Audit The Named Nurse performed an audit to test what improvements had taken place following implementation of the Child B SCR and Significant Incident Learning Process (SILP) action plans in 2015, which recommended improving communication between professionals and advised that more face to face meetings should take place.

8 HM Government, 2015. Working together to safeguard children - A guide to inter-agency working to safeguard and promote the welfare of children. [Online] Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/592101/Working_Together_to_Safeguard_Children_20170213.pdf 9 This service includes, physiotherapist, occupational therapist, speech therapists and CAMHs 10 These participants were newly qualified staff who don’t hold child protection cases 11 Camden’s SCR Child B, recommended that “UCLH and CNWL to review their domestic abuse policies and procedures and provide assurance to Commissioners that there are robust domestic abuse screening arrangements in place”.

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The method chosen for this audit was an online survey sent to 55 health visitors and schools nurses asking if there had been improvement over past 6-12 months. There was a 58% response rate and findings demonstrated;

16% noted there had been an improvement in communication 74% noted no change 10% check it was worse

When asked if they had been invited /involved in more face to face meetings such as Child in Need Reviews, strategy meetings, professional meetings with children’s social care, the responses were positive;

Yes 87% No 13%

The audit identified that there was good awareness in regards to CSCB Multi-agency Child in Need (CIN), Escalation and Non-engagement policies. Staff responded that when cases where escalated, they were listened to and a plan was put in place to address concerns. The audit demonstrated difficulties in information sharing, and identified the benefits of the role of a MASH Health Lead; respondents reported that this role improved communication. The findings of this audit were shared with the CSCB Quality and Assurance Group.

4. The Voice of the Child The Named Doctor has been leading a piece of working looking at safeguarding health outcomes for children, as part of the development work of the Metrics, which includes, “the voice of the child”. Children and young people who had Child Protection Medicals are a group for which health outcomes could be obtained. A new Child Protection Proforma Template was devised to collect information obtained during the Child Protection Medicals, which captured data in regards to the child’s voice. This was piloted and is now being rolled out12. Some of the outcomes shared include,

A child who had an urgent Child Protection Medical, was also a bit constipated, and said “I know I should eat more vegetables but I can’t find one that I like”. The Doctor then included in the health care plan a recommendation for the parents to take this child on a trip to a fruit and veg stall at the market in order to choose new vegetables.

A sibling who had a medical, reported feeling upset and anxious when being pulled out

of class to speak to the Police at school (after sister disclosed abuse). As part of the health plan from this medical a recommendation was made for the school to follow this up (counsellor/mentor) to ensure there was no on-going anxiety about this experience needing further support.

Camden Integrated Early Years’ Service. This year the Children’s Commissioner has worked in partnership with CNWL and the Camden Local Authority to establish a new integrated service for children aged 0-5 and their families, “Camden Integrated Early Years’ Service”. This service brings together two existing service teams: the Early Years Family Support Team, and the Health Visiting service, to form a single integrated team under a single management structure. The Designate Nurse sought assurances in regards to the safeguarding children process for the health visiting team under

12 The Safeguarding Clinic run at UCLH is now also using this tool and capturing the voice of the child.

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this new structure. Existing safeguarding children arrangements are to continue. This new service went live on April 1st 2017. 5.2 University College London Hospitals NHS Trust (UCLH) The members of the safeguarding team include:

Executive Lead Named Nurse Named Doctor Named Midwife Safeguarding Midwife

The Safeguarding Team produce an annual safeguarding children report which is reported to their Trust Board and hold a quarterly safeguarding committee which has representatives from all hospital sites. This year the Trust has reviewed the capacity and structure of the safeguarding midwifery team. Currently this team is covered by two band 7 posts, one who holds the Named Midwife tittle. Plans are for the capacity in this role to be increased to include Named Midwife Band 8a and two Safeguarding Midwives at band 7. The Trust have maintained compliancy in their safeguarding training. (Table 5). Table 5

UCLH Safeguarding Children Training Stats 2015-16 2016-17 Level Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 80% 91% 88% 96% 98% 96% 89% 93% 93% 2 80% 93% 89% 91% 95% 95% 88% 95% 91% 3 80% 78% 76% 79% 83% 84% 85% 87% 88% 4 80% 100% 100% 100% 100% 100% 100% 100% 100%

Case conference participation is demonstrating good compliancy.

Table 6

UCLH Case Conference Attendance/Participation 2015-16 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Number of invites

3 13 40 47 32 34 45 31

100% *unreliable data

90% 100%

64%

93% 97% 100% 100%

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Overall the Trust are evidenced good supervision arrangements. Table 7

UCLH Safeguarding Supervision 2015-16 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

100% No Data

100% 81% 100% 81% 100% 66% 96%

The Named Nurse reports she had initiated a supervision audit for community midwives, however the response rate was poor. Another audit has been planned. Maternity Domestic Abuse Screening In response to the recommendations from Camden’s Serious Case Review (SCR) Child B, 2015, the Trust were asked to review their Domestic Abuse procedures and provide assurances in regards to the screening performed by their midwifery team. The last screening report produced in August 2016 showed 80% compliancy with screening in pregnancy. The Trust have been asked for further audit evidence and this was discussed at their last CQRG in February. In response the Trust have implemented a standard that all women will be screened at booking and prior to discharge. The Named Midwife will implement a monitoring systems for domestic abuse screening which will be included in the quarterly Metrics Report. The Voice of the Child Following feedback from the CNWL pilot of capturing the voice of the child, Dr Hodes (in her role as consultant community paediatrician at UCLH) has implemented the use of this template at the safeguarding clinic. They are also asking for parental feedback. So far the results are very positive despite the often difficult safeguarding situation that has led to the appointment with the doctor. CQC Inspection In October 2016 UCLH NHS Trust took part in the City of London CQC Review of Safeguarding and Looked after Children’s Inspection. The following recommendations were made following this inspection:

Improve the screening for Child Sexual Exploitation (CSE) within maternity services to help identify risk in young pregnant women.

Ensure that GPs are invited to share any relevant medical and social history with midwives at the time of pregnancy booking so that the most appropriate support can be planned.

Improve the safeguarding risk assessment used within maternity services to ensure that expectant women benefit from a comprehensive and holistic assessment of their vulnerability. The trust should ensure that this safeguarding risk assessment is revisited throughout pregnancy.

Ensure that the routine enquiry around domestic abuse is made more than once during pregnancy as per NICE guidance.

Ensure that midwives attend sufficient level 3 safeguarding training which complies with the specialist levels of competence as described in the relevant intercollegiate guidance.

Develop and introduce effective supervision for community midwives The Trust has developed an action plan to address these recommendations and are being monitored by the City of London CCG and the Designate Nurse in Camden.

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5.3 Royal Free London NHS Foundation Trust The safeguarding team consists of a:

Executive Lead Interim Head for Safeguarding (adults and children) and Named Nurse for

Safeguarding Children Child Protection Advisor 0.613 Named Doctor Named Midwife Safeguarding Trainer

The Trust are compliant in their level 1and 2 training, and non- compliant in their level 3. This was reviewed by the Designates at the Trust Safeguarding Committee in May 2017. The safeguarding team reported that the frequency set for their level 3 training is annually and this is impacting on their compliancy with training. The team report that if they break down this group for training over three years14, their compliancy would be over 90%. An action taken from this meeting was for the team to meet with their learning department to look at reporting systems for level 3 training. Table 8

Royal Free Safeguarding Children Training Stats 2015-16 2016-17 Level Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 80% 83% 83% 84% 86% 87% 86% 87% 87% 2 80% 79% 77% 78% 78% 79% 77% 79% 80% 3 80% 78% 73% 86% 86% 82% 77% 74% 75% 4 80% 100% 100% 100% 100% 100% 100% 100% 100%

Training Audit In Q3 the trainer performed an audit to measure the impact of 3 training update sessions, which focus on Domestic Abuse, Child Sexual Exploitation and Harm Online. Participants were asked in an evaluation post training to scale on a score 1-6 (6 being the highest) whether they felt more confident/ able to recognise and respond to concerns. The average responses ranged from 4.72 to 5.66, and demonstrated a good impact of these sessions. The Trust has maintained good compliancy in child protection participation. Table 9

Royal Free Case Conference Attendance/Participation

2015-16 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 No. of invites 35 26 35 30 34 25 35 19 Conference attended/ report sent

100% 91% 88% 97% 100% 76% 84% 97% 100%

13 The Trust has two Child Protection Advisor Posts, covering the three sites, Royal Free, Barnet and Chase Farm. 14 Safeguarding children and young people roles and competencies for health staff Intercollegiate Document 2014, Royal College of Paediatrics and Child health recommends as a training minimum this group should receive 6 hours over 3 years.

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This year the Trust has evidenced an overall improvement in their safeguarding supervision arrangements compared with last year. Table 10

Royal Free Safeguarding Supervision 2015-16 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

100% 32% 62% 74% 70% 91% 74% 82% 65%

Supervision Audit The Safeguarding Team carried out qualitative audit in regards to the impact of their supervision. The audit sample size was 35 and 12 responses were received

All respondents agreed supervision enables them to develop their knowledge 92% agreed – encourage reflection and 1 partially agreed. 100% agreed – it helped explore the risk

Domestic Abuse The maternity team have a robust audit program which monitors domestic abuse screening15 in the antenatal period and prior to discharge. This area is audited quarterly and demonstrates that a 100% of women are screened once, though the results for the second screening are lower,

Q1 95% compliancy Q2 75%. Q3 90% Q4 95%

The target set for screening twice is 100; to address compliancy the maternity matrons have developed an action plan, which will be monitored through the Metric Reports. 5.4 Camden and Islington Foundation NHS Trust The safeguarding posts at the Trust are joint children and adult posts. Included in the team are:

Executive Lead Head of Social Care and Social Work16 Safeguarding Manager/Named Nurse17 Named Doctor MASH Health Lead ( vacancy)

The Trust holds a quarterly Safeguarding Committee and produces an annual report to the Board.

15 In September’s report audit information was provided about UCLH quarterly audit program for monitoring midwives domestic abuse screening. This program is evidencing some improvement, with their last results for screening once in pregnancy in August 2016 demonstrating 80% compliancy. 16 This post holder manages the safeguarding manager post 17 This post holder is a joint children and adult post and is supported by 6 social work posts allocated to each directorate who also hold a responsibility for leading safeguarding.

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The Safeguarding Manager 18 came in to post in June 2016. Earlier that year there was a structure review of the safeguarding team which took into account capacity issues, and requirements from Camden and Islington’s Safeguarding Children and Adult Partnership Boards. This led to the development of a new safeguarding team which comprises of six social worker posts, who have a lead for safeguarding and work across the five directorates. Five post holders have been recruited to and the Head of Social Care reports recruitment process are in place for the vacant social worker post and MASH Lead, and has been asked to provide a further update to the designated professionals. A review of the safeguarding training criteria in 2015 led to an increase in the numbers of staff eligible for level 3 training. This resulted in a dramatic fall in safeguarding children training rates across levels 2-4. Concerns were escalated by the Designate Nurse and the safeguarding team were asked to respond. The Trust’s CQC Quality Inspection (February 2016) published in June 2016 identified this poor training compliancy as a breach. In response to these findings the safeguarding team developed a new training strategy and action plan to address this with trajectory dates for completion. The Trust’s training action plan has evidenced improvement over this year and the Trust are now compliant. Table 11

Camden and Islington Foundation NHS Trust Safeguarding Training Stats

2015-16 2016-17 Level Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 80% 92% 95% 94% 94% 93% 90% 81% 92% 2 80% 95% 30% 56% 58% 57% 52% 80% 81% 3 80% 97% 9.8% 37% 64% 67% 69% 85% 86% 4 80% 82% 0% 100% 100% 100% 100% 100% 100%

This year the Trust has succeeded in setting up a system for capturing supervision data and are producing regularly quarterly reports. Table 12

Camden and Islington Safeguarding Supervision 2015-16 2016-17 Target

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

100% No data

86% 88% 85% No data

No data

88% 80%

The Trust have not developed a reliable system for collecting child protection case conference data. Their participation in the case conference process was raised as a concern by the CSCB at their meeting in January 2017. The Board reviewed the data which highlighted that only 49% compliancy in Q2. The Executive Lead was asked to investigate this area and provided an update. At the Board meeting in March, the Executive Lead reported the Safeguarding Team were exploring options of how to better manage this data collection so that activity is accurately reflected. The Designate Nurse will monitor this area and provide a progress report to Quality and Safety Committee

18 There have been previous retention difficulties with the Safeguarding Manager Nurse Post, and this instability had an impact on safeguarding within the Trust

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In their CQC Inspection February 2016 a breach was identified, in that the Trust had not ensured that all staff were aware of the process of making safeguarding referrals. The Safeguarding Manager addressed this area as a priority and implemented the following actions:

Referral pathways for children and adults were revised. These pathway flow charts were made available at all sites

The Safeguarding Manager liaised with matrons to assess training needs of ward managers and charge nurses regarding their responsibilities to manage a safeguarding concern

Trust Bed Managers who support staff out of hours with safeguarding concerns were identified as a group requiring specialist support training

The Safeguarding Manager has set up a system to review and monitor safeguarding concerns reported on Trust Datix

In September 2016 a series of joint assurances visits with Islington CCG took place across Trust sites in order to assess progress. These visits provided assurances to the progress made and raised a series of ‘considerations’ that were incorporated into the Trust’s CQC Action Plan. 5.5 Tavistock and Portman NHS Foundation Trust The safeguarding team include

Joint post Executive Lead/ Named Doctor Named Professional

The Trust produces an annual safeguarding report which is presented to the Trust Board and the have a safeguarding committee which meets three times a year.

Over this year the Trust has evidenced good compliancy in their safeguarding training. Table 13

Tavistock and Portman Training Stats 2015-16 2016-17 Level Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 80% 93% 94% 91% 91% 94% 94% 95% 96% 2 80% 98% 98% 97% 92% 92% 92% 81% 19 3 80% 94% 93% 93% 90% 94% 96% 90% 94% 4 80% 100% 100% 100% 100% 100% 100% 100% 100%

Their case conference attendance/participation has improved this year. (Table 14). Table 14

Tavistock and Portman Case Conference Attendance/Participation 2015-16 2016-17

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Number invites *No

Data 14 5 *Unreliable

data 13 6 10 14

Target 100%

21% 100%

58% 34% 90% 93%

19 The Trust have very low staff numbers who require level 2. From Q4 all staff requiring level 2 training are now being offered level 3 courses.

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Table 15

Tavistock and Portman Supervision

2015-16 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 100% No

Data 21% 100% Unreliable

data 41% 13% 27% 5%

This year the Trust has been unable to provide assurances in regards to its safeguarding supervision. A new safeguarding supervision template was launched in October 2016, and data collected throughout the year has demonstrated poor compliancy. In Q4 the Named Professional performed an audit to investigate why the supervision numbers were low and, to ascertain whether supervision was being recorded elsewhere. For this audit 9 cases were randomly selected, 3 for each month in Q4 (cases were examined for evidence of either a Safeguarding Supervision Form/ Case Discussion Record). The audit demonstrated;

2 cases had supervisory entries There was no evidence of the Safeguarding Supervision Form being used

In response to the concern about these findings safeguarding supervision has been added to the Trust’s Risk Register and an action plan has been devised to address this area which includes,

All allocated Child Protection Plan cases without a safeguarding supervision record will be identified; the clinicians will be informed about the omission and follow up will be undertaken by Clinical Governance Team

Associated Directors will be asked to advise ‘what the current system for monitoring Child Protection Plan Cases is within their teams and identify gaps that could potentially cause ‘harm’

Clinical Governance Team will move to a model of monthly monitoring to enable Team Managers to address any non-compliance issues in a timely manner.

Named Professional to attend the Departmental Executive Meeting to raise this issue The Designated Professional will monitor this and provide a progress report to the Quality and Safety Committee. The Safeguarding Team have been reviewing their Disclosure Barring Service (DBS) review processes, in order to provide assurances that systems are robust. Progress in this area will be monitored through their safeguarding committee and by the Designate Nurse. 5.6 Great Ormond Street Hospital NHS Foundation Trust (GOSH) The safeguarding team at GOSH comprises of:

Executive Lead Named Nurse Named Doctor 0.6 WTE 20 2 Safeguarding Nurse Specialists 211. WTE

20 A new clinician came into post in March. The hours for this post were increased following findings from the Trust’s safeguarding internal review 21 One post holder is a 6 month secondment

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The safeguarding team produce an annual report to the Trust Board. Their Safeguarding Children Group reports through the Trust’s Quality Safety Committee. Their safeguarding assurance arrangements are monitored by NHS England, Designated Professionals and CSCB. GOSH are engaged in CSCB and representatives attend the sub-groups. This year the Trust have been implementing recommendations made in their safeguarding review, which looked at the capacity of the safeguarding team. Improvements made this year have been the increasing in hours to the Named Doctor Post, by from 0.2 to 0.6 WTE. The Trust is to finalise their arrangements for the Safeguarding Nurse Posts and have agreed to fund an interim post until all decisions have been agreed. During this year the Trust failed to reach compliancy for its safeguarding for children training levels 2 and 3 (Table 16) and NHS England were informed. The Trust have a new level 3 training program and the Designated Professionals asked for further assurances of how this new system was being implemented, monitored and a trajectory for compliance. An update will be provided to the Quality and Safety Committee. Table 16

GOSH Safeguarding Training Stats 2015-16 2016-17

Level Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 80% 96% 94% 86% 82% 78% 83 % 83% 84% 2 80% 89% 88% 72% 69% 64% 69% 74% 77% 3 80% 95% 92% 89% 80% 70% 72% 62% 67% 4 80% 100% 100% 100% 100% 100% 100% 100% 100%

GOSH has evidenced an improvement in the uptake of supervision this year and this has been an achievement considering the team’s capacity. Table 17

GOSH Child Protection Supervision 2015-2016 2016-17 Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

100% *280 *107 *232 *181 *225 *230 *270 303 5.6.1 Supervision Audit This year the Safeguarding Team undertook a supervision audit, which looked at the quality and impact. The group chosen for the audit were the Clinical Site Practitioners22. This group access quarterly group supervision provided by the Safeguarding Team. The sample group for this audit was the 15 Clinical Site Practitioners and 8 responses were received. The audit demonstrated that

75% respondents felt it provided an opportunity for reflection and constructive challenge

100% reported it increased their awareness of current and new areas of safeguarding knowledge, (i.e. SCR’s)

22 These are Senior Nurse who have a key management responsibility

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88% said it offered opportunity to reflect on the impact of work with children and families

25% reported it was supportive and helped to manage stress

Participant’s fed back that they would like a more structured approach to their group sessions. Other feedback included it was “great learning from others and group discussions” “It offered an opportunity to discuss cases and listen to how others dealt with situations”. To address these findings the Safeguarding Team’s plans include,

The assessment framework triangle as a supervision tool to support the practitioners with identifying concerns and themes arising from group supervision

Future supervision audits for 2017/18 - to have an ongoing quarterly audit looking at group supervision and individual consultation/supervision separately, to identify the different strengths and weaknesses of each approach. It will enable to review the question about stress.

Review of supervision policy

The safeguarding team are collecting reliable case conference data. This year there has been an increase in notifications. In Q4 there was decrease in the participation response and the team reports this was due to the late notification of 14 cases (Table 18). Table 18

GOSH Child Protection Case Conference Attendance/Participation 2015-16 2016-17

Target Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Number Invites

100% 12 5 12 38 34 36 56 66

attended/ report sent

100% 100% 100% 100% 63% 100% 96% 82% 75%

6. The Named GP Safeguarding Lead

The Named GP Lead post holder went on maternity leave in July 2016 and arrangements were made for a secondment to this post. This interim post holder has been supported in this role by the Designated Nurse and Doctor. The work plan for Named GP Safeguarding Lead includes covering improving GP participation in Child Protection Case Conferences, the GP Safeguarding Forum, safeguarding training, maternity liaison audit and safeguarding assurance. 6.1 “CCG Support and Monitoring Scheme for improving GP involvement in the Child Protection Process” The “CCG Support and Monitoring Scheme for improving GP involvement in the Child Protection Process” demonstrated improvement in the early part of this year, though this was not maintained in the latter part of the year (Table 19). The system and processes were reviewed again at the GP Forum, where leads have been actively pursuing and improving participation at a practice level and at the Quarterly Monitoring (held between the Named GP, Designated Nurse and Camden LA Social Care Administrator Team Manager). Recent changes which have been implemented are:

A review of the practice contact list Interim Named Safeguarding GP Lead has agreed to follow up non compliancy directly

with each practice.

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Individual conference data reports to be sent to GP Leads from April 2017 Future data reports to be separated for Camden and out of boroughs GPs to whom

Camden residents are registered ( in order to identify the difference in compliancy of these two groups)23

Table 19

Camden GP Child Protection Conference Participation 2016-17

Target April May June July Aug Sep Oct Nov Dec Jan Feb Mar 100% 62% 71% 78% 85% 73% 85% 68% 66% 65% 62% 63% 79%

6.2 The GP Safeguarding Children Lead Forum

The GP Safeguarding Children Lead Forum24 has continued to evidence good participation from practices throughout the year .The Forum facilitates service improvement by enabling a process for the monitoring of child safeguarding across practices. Camden’s Children Social Care contribute to the Forum and a Service Manager is a member of this group. At the Forum in 2016 -17 the following topics were covered;

Review CCG Support and Monitoring Scheme for improving GP involvement in the Child Protection Process

Private Fostering MASH Information Sharing Female Gentile Mutilation ( FGM) Liaison Health Visiting Teams and Midwifery Teams Liaison with Camden’s Social Care Teams Review “Training for Trainers Program”( new level 1 program) Review Camden’s Parent’s Council Child Sexual Exploitation (CSE) Awareness Video Children’s Society Seen and Heard Presentation on Child Sexual Abuse (CSA) Presentation from Camden CSE Analyst Review GP Safeguarding Web Page Safeguarding Metric and Audit Tool Review Camden’s SCR Child B and SILP Significant Incident Learning Process

Action Plans 6.3 Information Sharing in the MASH The GP Leads concern about the lack of information sharing from MASH was escalated by the Designate Professionals to Camden’s Local Authority Executive Director for Supporting People. To address this issue he requested that the Designates should meet the Children’s Social Care Service Managers for MASH and Brief Intervention Team to explore how this could be resolved. At this meeting agreement was reached to change Children’s Social Care information sharing process and amendments agreed where: When MASH contact parents/carers for consent to contact an agency for information

they will also ask permission to share brief details in regards to the reason for the referral with that agency.

Children’s Social Care to amend their discharge process to ensure the referrer is sent a copy of the parents/carers discharge letter

23 New data reports in February this demonstrated that there was a 67% compliancy rate for Camden GPs and 30% for out

of borough.

24 A support group for GP Safeguarding Children Leads which facilitates clinical discussion, peer support, multi-agency liaison and sharing good practice.

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Information Sharing was an agenda item at March’s Safeguarding Children Board where progress on the above was discussed.

6.4 Safeguarding Training Named GP in conjunction with the CNWL Named Nurse and contribution from the Designated Professionals deliver a level 3 joint Training Program for GPs and staff form CNWL Children Provider Services. In 2017 a new training program was developed covering the learning from Camden’s Serious Case Review Child D, including focusing on safeguarding children and young people who are exposed to domestic abuse. Camden Safety Net25 are also contributing to this training. The program focuses on promoting joint working, information sharing and “Think Family” awareness26. Evaluations to date demonstrate that the course content is good.

6.5 Safeguarding Assurance Metric Audit

A Safeguarding Assurance Metric Audit Template was set out to all practices in order to seek assurances in regards to safeguarding structures, processes and the themes identified in recent SCRs. This audit had a 74% response rate and the findings have demonstrated that;

92% of practices are using safeguarding alerts on their electronic records 100% report safeguarding is discussed at practice meetings and recorded in patient

records 84% report Health Visitor meetings are occurring regularly 83% report their practices use a “Think Family Approach” 85% reported they have a system for identifying if a patient is a parent or carer 68% reported they had a system for identifying parental concerns.eg. drug and alcohol

misuse on a child’s records on a child’s records The findings will be reported back to the next GP Forum and this will contribute towards the Named GP Work Plan for 2017-18.

6.6 Child Protection Plan Audit

The audit was instigated to test whether case conference plans and minutes were being sent to GP surgeries. Some practices reported they were not receiving these documents, although the Camden’s Social Care Administration Team stipulated that these documents are always routinely sent. GP leads were sent a list of children who had conferences during 1st October 2016 – 30th November 2016 and were asked to check if conference plans were received in 48 hours and reports within 4-6 weeks. There was a 69% response rate (23 of 35 practices) and findings supported that reports are sent by Camden’s Social Care in regards to plans, and showed that the compliancy rate for sending minutes was lower, see findings below:-

Total of number of conferences = 105 No. CP plans received in 48 hours = 91% No. minutes received in 4-6 weeks = 70% Reports were sent to the incorrect practices = 15% (i.e. where the children were not

registered). In 15 % of these cases the reports were sent to the wrong practice. In the CP Conference Participation scheme, GPs report similar occurrences, although the reported numbers are lower. It is unclear as to why the correct information is not logged with the social worker and this needs further exploration as to whether it is the parents giving information in error or

25 A service for victims of domestic abuse 26 This is a joint program for health visitors, school nurses, sexual health staff and GPs and practice nurses

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another explanation. These findings will be shared and Camden Local Authority Social Care Administrator Team Manager. 6.7 Ante natal Liaison Audit This audit was performed to test whether the antenatal notification liaison process between Hospitals and the GP was satisfactory. The need to improve these process was identified in the recommendations made in Child B SCR 2015 and the SILP (Significant Incident Learning Process) Child a Review 2015. As part of this review, acute trusts reviewed these processes and gave assurances that they had automatic notification process in place. The findings from these reviews were also shared with the North Central London Maternity Commissioner. In this audit GPs were asked to identify 10 patients who had had their 6 week post-natal checks and then to check retrospectively as to whether they had been referred by the GP or self-referred to hospital in the antenatal period. For all those identified as self–referred, the GP retrospectively reviewed the record to determine if they had received communication from the hospital antenatal service regarding the booking and pregnancy. The audit was sent out to all 35 practices and there was a 66% response rate. Findings from the audit demonstrated;

No. of GP practices participating in audit 23 No. Antenatal referrals: 207 (100%) No. GP antenatal referrals 150 No. self-referrals : 57 Nos ante natal notification received by GP 14/57 (25%)

As the sample size is small it may not be a true representation of the Camden antenatal self-referrals, as those practices who did not participate may be those who have a higher number of women who self-refer. The findings have been shared with NCL Maternity Commissioner who plans to use this information on future work on the referral / self-referral for the Better Births project and the work on the single point of access. The audit findings have also been shared with the CCG Maternity/Gynaecological Clinical Lead and will be shared at the next GP Forum. 7. London Central West (LCW) Unscheduled Care Collaborative /Out of hours Service London Central West Unscheduled Care Collaborative took over the arrangements for Camden’s out of hour’s service on the 1st October 2016. The Designate Nurse facilitated arrangements with Camden Local Authority in order for this service to obtain their Child Protection Plan list. The Commissioner and Safeguarding Lead have been linked in to the planning arrangements for Child Protection Information System (CP-IS). This is an NHS England initiative which aims to improve information sharing about children subject to a child protection plan or those children who are looked after between Local Authorities (LA) and all out of hours health care settings, emergency departments, walk in centres, minor injury units, maternity units and ambulance services. Camden’s CP-IS went live in March 2017. Staff within LCW have access to this system, and is not fully operational as they are awaiting for all of the boroughs they cover to sign up to this process. The Designated Nurse is due to attend the Clinical Quality Review Group in May to discuss implementation of this systems and concerns which have been raised from the local authority regarding access. The first safeguarding report was received in Q3 which demonstrated an overall compliance 85%. The Safeguarding Team were asked to split data into the three levels and that has now down actioned. Q4 Training stats are: Level 1 100%, Level 2 98%, Level 3 99%

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8. Monitoring Young People’s Sexual Health Services Camden and Islington Public Health commission these services. Safeguarding is monitored through the joint quarterly safeguarding meetings with the Designate Professionals from Islington. The Safeguarding Lead now regularly attends the CSCB Health Committee and is linked into the MASE (Multi Agency Sexual Exploitation) Group.

Safeguarding activity reports are provided to the commissioner and in recent months these have demonstrated an increase in historical abuse disclosures.

This year the safeguarding team performed an audit to measure services against the recommendations made in the Brook Spotting the Signs Child Sexual Abuse Tool Kit. Brandon and Homerton devised an action plan to address the findings identified.

9. Marie Stopes This service is one of the commissioned services in Camden which provide termination of pregnancy services in Camden27. The monitoring of safeguarding for this service takes place through commissioner meetings and progress reports are presented bi-annually to the Quality and Safety Committee At their CQC Inspection in 2016 concerns were raised in relation to poor governance arrangements which have given rise to specific immediate concerns relating to the lack of assurance in areas such as safeguarding. A warning notice was issued to Marie Stopes International (MSI), in response to regulatory breaches around ‘safeguarding’. The CQC and NHS England have been working with MSI to make sure that patients are protected from potential harm when undergoing pregnancy terminations. An action plan was devised to address the issues raised by the CQC. The Safeguarding Lead has led work on improving the quality and compliancy with safeguarding training and has reviewed all safeguarding policies as part of this work stream. In 2016 their Safeguarding Lead become a member of CSCB Health Committee and contributes to the work plan. 10. Family Nurse Partnership (FNP) FNP forms part of the Camden First 1001 Days, a programme of work which aims to improve care during pregnancy, early childhood and the coordination of services so that those with the greatest need are identified and supported as early as possible. This service reports in to the 1001 days Children’s Steering Group28 and produces an annual report. Safeguarding assurances are reviewed at the quarterly Camden Safeguarding Meetings, where the supervisor provides assurance in regards to cases, supervision and training. Their child protection participation is included in the CNWL data reports. The service experienced some challenges in retention and recruitment in 2016 and there was a gap in service provision until May 2016, when staff were appointed. The Camden team are now co-located with the Islington FNP nurses. This change was implemented in response to feedback from the FNP’s, who reported feeling isolated at their previous base. The new team reported that being co-located offers greater support and flexibility.

27 They provide services nationally and across the word. Their headquarters are in Camden 28 This group focuses on services provided in the 1001 critical days between conceptions to age 2 and aims to enhance the outcomes for children. Representatives attended form provider and commissioning organisations.

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During the period when there was a gap in provision, clients with a Child Protection Plan were transferred to the Camden Health Visiting Service. Once both FNPs nurses were in posts these safeguarding clients (11 families) were offered the opportunity of returning to the programme, 5 clients accepted this offer and have continued to make good use of the FNP programme. The team report again this year that there are a high number of safeguarding issues associated with the current caseload and this is also reflected across London, it is often the most complex young people who decide to continue with their pregnancies. 11. Multi-Agency Safeguarding Hub MASH The Designated Nurse, CNWL, Tavistock and Portman NHS Trust and Camden and Islington NHS Foundation Trust representatives are engaged in the MASH Multi-Agency Steering Group. Camden Safeguarding Children’s Board receives regular MASH Update Reports which demonstrate there has been an increase in contacts. The highest presenting concerns reported to MASH remains Domestic Abuse, Family in Distress and Physical Abuse. Referrals are reviewed by using a Rag Rating System; this assesses the level of need and urgency. Before the MASH Team review each case it is the responsibility of the Social Care Team to contact the parents to obtain consent. The Designate Nurse this year was nominated by NHS England London Designate Group to be their representative on the London Safeguarding Children Board MASH Group. The Designate Nurse’s role in this group is to provide a health perspective and share feedback or consultations with the London Designate Group. 12. Serious Case Review (SCR) and Case Reviews There were two SCRs instigated this year. Camden CCG are responsible for co-ordinating the health component of Serious Case Reviews, in accordance with current national and local guidance29. Child C SCR Child C was a baby seven weeks who died following a significant injury and abuse was suspected. This family were known to universal health services and an Independent30 Health Overview Report was commissioned by CSCB. In September 2016 the Draft Independent Health Overview Report was presented to the CSCB. The report concluded from the evidence available there were no warning signs missed and made the following recommendations;

To identify what services are available for fathers and for commissioner and provider organisations to consider ways in which this could be improved.

29 Draft NHS London Region Policy to Manage the Health Elements of a multi-agency Children’s Serious Case

Review March 2014 30 The SCR Process, usually includes a separate Overview Report for health which is written by the Designate Professionals and the Board commissions the Multi-Agency Independent Report. In this case as there were only health agencies involved it was decided that only one report would be produced and NHS England were informed.

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The Board was asked to consider how the link between crying babies and non-accidental head injury is currently highlighted to new parents and whether there is a role for Public Health in addressing this problem.

The Board agreed with the content of the report and instructed the Chair of the 1,001 Days Steering Group to lead the work on implementing these recommendations. Designated Professionals are members of this group. The Draft Action Plan has been shared with the Health Committee and the GP Forum, where agencies have been asked to embed the learning from this review. Findings have also been shared with the Safeguarding Team at NHS England. The Draft Overview Report will be published once criminal proceedings have been concluded. Child D This case involved a 2 year old child who died following a significant non accidental injury and abuse is suspected. In this SCR a Health Overview Report and Independent Multi -agency Overview Report were instigated. The Designate Professionals concluded in their Health Overview Report there was no evidence to suggest that Child D’s death could have been predicted or prevented. The report recommended that

The need for health agencies to improve their understanding of the impact of culture on women who experience domestic abuse31;

The need for the health visiting transfer process to be robust, GPs should be mindful of using a Think Family Approach; Ante natal domestic abuse screening should be robust Systems should be robust for liaison between maternity units and GPs in regards to

women with complex medical issues This report has been shared with NHS England, providers and an action plan has been devised which is being monitored through the CSCB Health Committee. Child D SCR Independent Overview Report The Draft Independent Serious Case Review Report was presented to the CSCB in November 2016. The report concluded there was no evidence to suggest that the death of Child D could have been predicted or prevented by local agencies. The draft recommendations made were agreed by the Board. These recommendations included;

The LSCB should address the extent to which it and members agencies will be able to meet the expectations of the recently published ‘Guidance for Joint Targeted Inspections on the Theme: Children Living with Domestic Abuse’ ref.160046 (which should be read alongside ‘Joint Targeted Area Inspections (JTAIs).

Multi-agency training provided or commissioned by the LSCB should reflect the additional culture-specific needs of Bangladeshi Muslim women in the UK who experience domestic abuse and draw on the ‘toolkit’ available from http://www.eachcounselling.org.uk/downloads/DV_toolkit.pdf

A sub-group was set up to review the recommendations. The Designate Professionals were members of this group. This group met in February and developed an action plan which will be monitored by the Board. The Overview Report will be published once criminal proceedings are concluded.

31 Referencing use of toolkit http://www.eachcounselling.org.uk/downlads/DVtoolkit.pdfF

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13. Independent Contactors NHS England monitors their safeguarding arrangements. 14. Safeguarding Audits 14.1 Section.11 Audits32 The Board review agencies statutory safeguarding responsibilities through these audits. There have been no health agencies audits reviewed this year.

14.2 CSCB Multi Agency Audits The Quality Assurance Group facilitates the program for the multi-agency audits. Two multi-agency audits are undertaken each year.

In May 2016 the audit was on Safeguarding Children who self-harm. This audit identified that children in this sample come from troubled family backgrounds, and mental health concerns in family members featured in a number of cases. A number of these children were noted to have had a disturbed eating pattern when younger. Results demonstrated that in these cases children had been protected and in most cases there was a reduction in the incidence of self-harm though their risks and needs remain high. The recommendations made in this audit include:

The Looked after Children (LAC) Health Reviewer and LAC social worker should ensure there is sufficient communication between them over their respective views, so actions are appropriately taken forward.

Practitioners encountering children with disturbed eating pattern should be alert to potential cross over to self-harm.

The second audit focused on “children with parents who have mental health problems” and findings identified that adult and children services should be more joined up. Recommendations include:

Adult mental health workers should attend core groups or other child-focused meetings; and the children’s social worker should attend Care Program Approach (CPA) meetings whenever appropriate.

Participation from Adult Mental Health, and Drugs and Alcohol Service at Child Protection Case Conferences should be improved.

Initial assessments in mental health services should consider whether a client/patient has contact/looking after children (Think Family) and consider how their mental health may affect their parenting.

Where there is a parental mental issue the mental health worker should always be invited to participate in children social care teams’ systemic supervision.

A task and finish group was set up in January 2017 to review and address these recommendations. A joint working protocol between Children's Safeguarding and Social Work, and adult mental health services (CIFT) is being developed. This group is planning a joint workshop on working together for Children’s Services and Adult Mental Health. The Designate Nurse and health agencies are contributing to planning for this workshop.

14. 3 Reviews and Inspections In November 2016 Tavistock and Portman NHS Foundation Trust had a CQC Inspection of Mental Health Act responsibilities and Mental Capacity Act/Deprivation of Liberty Safeguards and these services were rated as good. 32 Section 11 Children Act 2004 places a duty on a range of organisations in regards to their functions in regards to safeguarding and promoting the welfare of children.

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In October 2016 UCLH NHS Trust took part in the City of London Review of Safeguarding and Looked after Children’s Inspection. (Refer to section 5.2). Marie Stopes International had a CQC inspection. (Refer to section 9). 15. Achievements and Developments 15.1Camden Children subject to Child Protection Plans In March 2017 268 children were made subject to a child protection plan and the category breakdown was as follows:

Emotional abuse: 47% Neglect: 42% Physical abuse: 10% Sexual abuse: 1%

The following graph below shows the number of new protection plans in 2016/17 compared to figures for the past five years33.

15. 2 CSCB Work Plan

During 2016-17 Camden Safeguarding Children Board (CSCB) agreed to focus on the following priorities in their Business Plan: • Troubled adolescence • Parental mental health • Intra familial sexual abuse • Online safety, youth violence and gangs Health agencies contributed to these areas. Troubled adolescence: contributing to CSCB multi-agency audit on self-harm, which included devising specific health questions. This audit recognised the impact of parental mental health on the emotional health of their children as well as the need for further training and risk assessment in relation to children that self-harm across all agencies. Health agencies contributed to the work plan to address findings.

33 Camden’s Children’s Schools and Families Social Work Service Full Year Performance Assessment Management Report March 2015

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Parental mental health: contributed to CSCB multi-agency audit on parents who have mental health problems. Health agencies have been involved in addressing a plan for the developing a multi -agency workshop. Intra familial sexual abuse: The Designate Professionals and Named Doctor from the Tavistock and Portman NHS Trust have participated in CSA Task and Finish Group. At this group they designed a training programme in partnership with the NSPCC. This was developed in response to the recommendations from the Children’s Commissioner’s Child Sexual Abuse CSA Inquiry report, which advised that teachers need to be ready to respond to the children and young people when they disclose. The pilot training programme that included recognition and communication with troubled children who may be experiencing CSA, was delivered to one of Camden’s secondary schools and was well received. The pilot continues and there are plans to offer this program to another school. Health agencies contributed to the planning of, and presented at the CSCB Annual Conference in February 2017 which was aimed to raise awareness and equip frontline professionals with the tools and confidence to deal with CSA. On- Line safety Youth violence and gangs. The Seen and Heard “Children’s Society course on Child Sexual Abuse http://seenandheard.org.uk/ commissioned by the Department of Health has been promoted across health agencies in Camden. GOSH Safeguarding Nurse Facilitated a CSCB multi-agency Prevent Workshop June 2016. Health Agencies also contributed to the Task and Finish Group to look at how Camden partner services are delivering services for Children and Young People with Disabilities (CYPDs). This group investigated how Camden was performing in comparison to the Ofsted requirements which were audited in the National Survey of safeguarding disabled children “the national working group report recommendations on LSCBs response to disabled children (July 2016)”. Findings from the Camden review showed Camden was performing well. When presented to the Board in January, it was agreed that a separate subgroup for disabled children was not required but that the CSCB Template should include a section on “How are Children and Young people with disabilities considered”

15.3 Child Sexual Exploitation CSE The CSE Strategic Plan supports the Strategy to prevent, identify, support, disrupt and prosecute. Part of this year’s work plan is to identify links between Prevent and CSE nominals in regards to vulnerability around grooming, and safeguarding interventions are explored on a case by case basis. Every Channel Panel case is now cross-referenced against CSE victims and perpetrators. Data reports evidence that peer to peer exploitation remains the most prevalent model of CSE. There has been a significant increase in police interventions/disruptions. Safer London Foundation offered free training awareness courses through CSCB, and three of these courses were offered to health agencies.

Young People’s Sexual Health Service joint course GPs and Tavistock and Portman NHS Trust Joint course Tavistock and Portman and Royal Free NHS Trusts

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15.4 Child Protection Information Sharing System CP-IS

Royal Free, ULCH NHS Trusts and London Central West (LCW) Unscheduled Care Collaborative (GP out of hours service) have developed work within their IT departments in regards to engagement in CP-IS Child Protection Information Sharing Project. Royal Free NHS Trust has gone live with this system, UCLH and London Central West Unscheduled Care Collaborative are progressing this area. GOSH NHS Trust have been having discussions with NHS England Project Lead in regards to extending the access to service out of hours health services. 15.5 Female Genital Mutilation FGM The Designate Doctor became a member of the Community Engagement Sub Committee of the CSCB following the completeion of the work of the “End FGM In Camden “ Committee. The group have instiagted a Summer campaign on to “End FGM” which aims to support schools in alerting staff and pupils to the risks of FGM over the Summer holidays. In this campaign posters, leaflets and the Home Office Health Passport were sent to schools and links to these material were also sent to all GP practices. The Designate Doctor designed an End FGM CSCB Workshop, which was held this year. Evaulations from this workshop demonstarted it was well received.. 15. 6 The Barnahus model for Icelandic model for Child Sexual Abuse The Designated Doctor has led and developed the Child House Model, which aims to improve services for children who have been victims of CSA. This decision to implement this new system was instigated following reviews and research which identified gaps in access to emotional and mental health support for children and young people disclosing sexual abuse or exploitation (CSA/CSE), and evidence demonstrating that there is a low criminal conviction rate. The plans are for a future Child House pilot that will be based in Camden and with further funding, there will be a purpose built Child House, in conjunction with the NSPCC, Mayor’s Office for Policing and Crime (MOPAC) and NHS England. This will bring together medical, investigative and therapeutic services under one roof for children who have experienced sexual abuse. As progress towards the development of the pilot, the Department of Health is funding a CAMHS Clinician and Child Advocate to provide such emotional support services. There are now additional members of the team providing medical care at the existing tertiary safeguarding clinic at UCLH led by the Designate Doctor, known as the Child Sexual Abuse (CSA) Hub. 15.7 CSCB Senior Team Practitioners Governance Assurance Visits The CSCB introduced these visits as part of governance arrangements. Senior members meet with front line practitioners to discuss what works well and what could be improved. The Designated Team were asked to facilitate the arrangements for visits to health agencies. The team visited the following health agencies,

Royal Free Community Midwives CNWL School Nurses/ Health Visitors /Sexual health staff

Feedback from the Royal Free visit which demonstrated that staff thought;

Safeguarding thresholds were clear Training offer was good

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A good range of Early Help Services were available MASH was identified as helpful Need to improve liaison with GPs Concerns were raised about the potential impact of the new NHS policy on charging

non-EU nationals and the plight of mothers with No Recourse to Public Funds. They thought this would be a particular issue for trafficked women. A

Advised that Housing representatives should be invited to Child Protection Conferences, as the issue of housing is often a significant factor.

Work with Children's Centres/ Health Visitors was described as strong. The work of the Independent Domestic Violence Advocates was valued Peril-natal mental health problems were described as an emerging issue with an

increasing frequency.

The CSCB Senior Team plan to identify themes from these visits and will present report to the Board. A visit has been arranged for the GP Safeguarding Lead Forum in April 2017.

15.8 The Wood Review Local Safeguarding Children Boards In 2016 the Wood Review of the function of Local Safeguarding Children Boards (LSCBs), was published. This focused on their effectiveness, local strategic multi-agency working, the child death review process and serious case reviews processes. The Government response was that it agreed that this process needs to change as “current arrangements were identified as inflexible and too often ineffective” and proposed to introduce a more flexible statutory framework to support local partners to work together more effectively. There will be a new requirement on three key partners – health, local authorities and the police to make arrangements for working together in a local area. This will not change the existing statutory functions or duties for any individual agencies, but will call for stronger and clearer arrangements. The government has agreed that the current serious case reviews process needs to change. This system will be replaced with a new national learning framework for inquiries into child deaths and incidences in which children have experienced serious harm. An independent National Panel, will be established to ensure the effectiveness, which will commissioning and publishing national reviews as well as investigating the most serious cases. The process for child death overview panels will be reviewed, with the aim to improve data collection. The national oversight will be transfer from the Department for Education to the Department of Health. New legislation in the Children and Social Work Bill 2017 will introduce the statutory framework for these changes. 16. CSCB Child Death Overview Panel (CDOP) All Camden child deaths are reviewed by the CDOP. The Panel is accountable to the CSCB Chair. It has a fixed core multi-agency membership which meets at regular intervals to review all deaths, collect and collate information to identify any lessons on the prevention of child deaths.34 This Panel is now chaired by an Assistant Director of Public Health, who also chairs the Islington CDOP and this facilitates the sharing of learning. There has been an increase the number of child deaths from the previous year, returning to levels that have been more typical of recent years. The trends in Camden are small and can fluctuate year on year. 34 Chapter 5 Working Together to Safeguard 2 Children 2015

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Number of child deaths and rate per 1000 in Camden 2010-16

The CDOP Report 2015- 2016 reported there 12 child deaths and 7 were unexpected and include SCRs and serious incidents.

3 children had chromosomal, genetic and congenital anomalies 1 child died due to a chronic medical condition 1 Perinatal/neonatal event 2 subject to Serious Case Reviews

Gender 6 Male 6 Female

Age 1st month of life (neonate):3 1st Year of life (infant) – 1 month to 12 months: 1 1-5 years : 3 5-11 years: 11-18 years:3

The number of child deaths in the borough remains low, so learning from trends is difficult to ascertain, but the trends on deaths has shown a linked to perinatal/neonatal event. This year the Panel received a final coroner’s report in relation to a child suicide death from 2012. This case highlighted the importance of online life for young people and how agencies have a responsibility to gain a better understanding of this. Future Plans for CDOP in 2015-2016:

Invite the Coroner to one CDOP meeting jointly with Islington. Invite a neonatologist where this could add value to case discussions. Detective Inspector to continue to attend as the CAIT representative. To support Professor Sutcliffe and his team who have been developing a project for

studying data generated by all CDOPs in the UK. To review Great Ormond Street deaths annually in order to provide oversight of their

process.

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31

17. Summary of achievements Progress on Objectives – 2016/17

To further develop the Metric process to include outcomes and capture the voice of the child. Work has been taken forward on this by the Named Doctor from CNWL who has developed a new CP Medical Proforma. This has been duplicated at UCLH.

Providers to produce an annual supervision audit. - CNWL. GOSH and Royal Free have produced audits.

CIFT to further develop the data collection of case conference attendance/participation within the safeguarding metrics. Trust is collecting reliable data on supervision.

Tavistock and Portman to develop reliable systems for capturing CP and Conference Data. Trust are capturing reliable case conference data.

To develop engagement of outstanding GPs and GOSH in MASH. Metric Report demonstrates all practices who completed audit had signed information sharing agreements (ISAs).

To develop a plan to engage those practices not involved in the GP Forum in April. Named GP improved engagement in Forum, evidenced in attendance minutes.

To promote awareness, monitor and develop the CP-IS Program. Royal Free NHS Trust are implementing the process. UCLH and LCW are developing their access arrangements. GOSH NHS Trust have been having discussions with NHS England Project Lead in regards to extending the access to service out of hours health services.

Monitor Providers’ compliancy to the Prevent training requirements. Data is produced at Trusts Safeguarding committees and submit progress reports to the London Prevent Team at NHS England.

Monitor Providers’ compliancy to Goddard Review. Arrangements have been discussed with providers, at the Health Committee and at Providers’ safeguarding committees. The Verita checklist has been shared with providers. Advice sought from NHS England regarding the storage of records.

To continue to liaison systems between LAC and Designated Professionals Developing Team. Regular meetings take place between both teams and the LAC Team are engaged in the Health Committee.

18. Challenges (Gaps/Risks/Mitigations)

CNWL to continue to strengthen their domestic abuse screening and recording by health visitors at new birth visits. The safeguarding team have an action plan and monitoring arrangements in place.

UCLH to strengthen their domestic abuse screening by midwives. In response the Trust have implemented a new standard to ensure all women will be screened at booking and prior to discharge. The Named Midwife will implement a monitoring systems which will be included in the quarterly Metrics Report.

CIFT Safeguarding Team have not set up a reliable system to record regular conference data. Further work is being taken forward by their Executive Lead and this is being monitored by CSCB and through quarterly Metric Reports.

Tavistock and Portman have been unable to provide assurances that safeguarding supervision is taking place. The Trust have put this on their Risk Register and have an action plan in place which is being monitored by the Designate Professionals and also through the Quarterly Metric Reports.

GOSH to maintain compliancy with their safeguarding training levels 2 and 3 .The Trust have a training plan in place which is being monitored by NHS England and through the safeguarding metric reports.

There are capacity issues with GOSH’s safeguarding team. Cover arrangements are in place.

GP liaison systems with maternity units are not robust. Actions to address this has been shared with hospital trusts/maternity commissioner /CCG’s GP Women’s Health Lead/GP Safeguarding Leads. Acute Trusts have provided assurances in regards to

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their liaison process. NCL Maternity Commissioner will be leading on a wider work stream in this area.GP Forum will monitor this activity.

19 Future Objectives – expected work stream for the next year 2017/18

Contribute to CSCB Key Priorities identified in their business plan for 2017-18. All Trusts to produce an annual supervision audit in Q2. CIFT to develop the data collection of case conference attendance/participation within

the safeguarding metrics. Tavistock and Portman to develop reliable systems for capturing supervision data Embedding Learning from our SCRs Review and from National Serious Case Reviews. UCLH and LCW‘s to implement the CP-IS Program. GOSH to continue discussions about implementing CP-IS To contribute towards further developments of the Child House Model CSA

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Report Title Health and Safety Annual Report 2016/17

Agenda Item 5.4

Date 01/09/2017

Lead Director Ian Porter,

Director Corporate Services

Tel/ Email

[email protected]

Report Author Caron Brittain, Customer Relations & Business Support Manager

Tel/ Email

[email protected]


Helen Pettersen, Accountable Officer

Tel/ Email

[email protected]

Report Summary This is Camden CCG’s 2016/17 Health and Safety Annual Report.

There have been no significant health and safety incidents in the last year. The report highlights key health and safety related actions that have been progressed in 2016/17 and also sets out related priority areas for 2017/18.

Purpose

Information Approval

To note

Decision

Recommendation The Governing Body is asked to consider and note the 2016/17 Health and Safety Annual Report.


This report links to the following strategic objective: Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce.


There are no specific risks directly arising from this report. The actions to be progressed in 2017/18 will continue to ensure that the CCG proactively manages any health and safety issues facing the organisation.


Training time for volunteers (Fire Marshals and First Aiders).


There are no equality issues arising from this report.

Report History This is an annual Governing Body report.

Next Steps To ensure continued compliance with the CCG’s health and safety

responsibilities.

Appendices None

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Health & Safety Annual Report 2016/17

Author: Caron Brittain, Customer Relations &

Business Support Manager September 2017

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2

Camden Clinical Commissioning Group

Health and Safety Report 2016/17 Introduction This is the annual Health and Safety report for Camden Clinical Commissioning Group (CCG) for 2016/17. I’m pleased to report that there have been no significant health and safety issues or incidents for the CCG in the last 12 months. The report highlights progress made on key health and safety related during 2016/17 and highlights the priority areas for 2017/18.

The CCG has and will continue to comply with its health and safety responsibilities to ensure a safe working environment for all staff and our partners that visit Stephenson House. Health & Safety approach within Camden CCG The CCG continues to risk assess the work environment to ensure staff safety and well-being. The Customer Relations & Business Support Manager (CR&BSM) within Corporate Services is responsible for the working environment and providing competent health and safety advice. The CR&BSM has support from the facilities management staff within NHS Property Services. Fire training remains on the list of ‘mandatory training’ for staff and all staff are required to renew their training on an annual basis. With the introduction of the revised corporate induction plan, new starters are provided with information about the CCG’s and their personal health & safety responsibilities. Highlighted are our fire evacuation procedures and incident reporting process, including an orientation of the offices on both floors, the location of fire exits, our fire assembly point and the positioning of first aid kits. Health and safety law states that organisations must ensure they have access to competent health and safety advice. This advice has been provided to the CCG by the CR&BSM. Further support is available from the CSU, Regional Fire Safety Manager, Learning and Development team and potential external sources, such as the Health & Safety Executive. Staff have access to Occupational Health through AXA PPP/Human Resources (CSU). On-site assistance is available for Display Screen Equipment (DSE) assessments to support the self-assessment process.

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3

Incidents There has been one reported incident during the year in connection with continued rodent activity. Stephenson House has experienced a rodent infestation issue in the last year which has proved to be problematic in spite of regular treatment. A combined strategy has now been organised which will align all pest control schedules in the building, with the overall aim of eradicating future activity.

The CCG uses the Datix system to record Health and Safety incidents that occur. The Corporate Services Team is currently reviewing the use of Datix within the CCG to ensure it offers the best value for money as the CCG’s incident reporting tool, given the small numbers of reported incidents. Key achievements for 2016/17 The CCG successfully introduced agile working during the year which brought a significant change for staff and their working arrangements. Fixed PC’s were replaced with laptops which has allowed freedom of movement for staff and the flexibility of being able to choose where and how they work. Agile working has been widely welcomed by staff and in particular has had a positive impact with our joint commissioners, with much closer working within the integrated teams. A new Corporate Induction pack was introduced during the year and to date three induction events have taken place with very good feedback being received. A staff handbook has also been developed that complements the induction, and is available for reference. Actions for 2017/18 The health and safety actions for the CCG to progress in 2017/18 are as follows:

Action How this will be delivered Prepare and introduce a robust plan for the re-location of the CCG’s office

A Steering Group has been identified consisting of key staff at the CCG and LBC

Improve communication and engagement between the tenants and landlords at Stephenson House.

Regular meetings to be arranged leading up to the re-location of all organisations from Stephenson House

Look at alternative ways to manage the Health and Safety Incident process

CR&BSM to look at alternative methods

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Report Title Finance & Performance Committee Report

Agenda item 6.1 Date of Report 24 August 2017

Lead Director Simon Goodwin,

NCL Chief Finance Officer Tel/Email [email protected]

Report Author Brenda Thomas,

Governance Lead (Interim) Tel/Email [email protected]


Dr Birgit Curtis Tel/Email [email protected]

Report Summary The Governing Body is requested to ratify the following proposed amendments

to the Finance and Performance Committee terms of Reference to reflect the revised Governing Body Members’ portfolios:

i. Local Executive Director/Chief Operating Officer be added as a voting member;

ii. The number of elected Governing Body members be increased from two to three;

iii. The Chair of Integrated Commissioning Committee as a member be removed;

Proposed amendments to the Terms of Reference are highlighted as tracked changes. These changes were approved by the Finance and Performance Committee at its meetings on 26 July (line i) and 23 August 2017 (lines ii and iii) respectively. A summary report of the 23 August meeting is attached.

Purpose


To note

Decision

Recommendation The Governing Body is asked to: i. Note the contents of the report; and ii. Approve the revised Finance & Performance Committee Terms of

Reference.


This report links with the following strategic objectives: Commission the delivery of NHS constitutional rights and pledges; Improve health outcomes, address inequalities and achieve parity of

esteem; Maintain financial stability and ensure sustainability through robust planning

and commissioning of value-for- money services.


Any major risks are highlighted as part of the report.


The CCG will have strengthened oversight and control of its financial resources.

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mailto:Simon.goodwin1@nhs.



Engagement

This summary report is shared with the Camden Public and Patient Engagement Group.



Report History The Finance and Performance Committee reports to each Governing Body

meeting. The revised Terms of Reference contained in this report were presented for

approval to the Finance and Performance Committee on 26 July and 23 August 2017 and were approved.

Next Steps Operationalisation of the Terms of Reference.

Appendices Appendix 1 - Finance and Performance Committee Revised Terms of

Reference.

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Name of committee: Finance and Performance Committee Date of meeting: 23 August 2017 Issues discussed Finance Report: Month 4 The key issues noted were as follows:

Overall, the CCG forecasts to achieve its control total at the end of the year; The Acute position has worsened in Month 4 by £4.439m predominately due to a budget

adjustment made to RFL of £4.0m and over performance at RFL in direct access (diagnostics) £0.339m where activity is up 21% year to date (YTD);

The Acute run rate needs to reduce by c£0.6m a month for the CCG to achieve the forecast; Non-Acute is forecast to be £0.9m overspent primarily in mental health £0.2m and Children’s

Services £0.5m. The forecasted overspend has been offset by the release of contingency and use of non-recurrent reserves;

QIPP Planning Update: Month 4 The Committee noted as follows:

The CCG submitted its monthly position with an underachievement of £411k. The overall CCG rating within the finance templates reported to NHSE is amber based on a negative variance of £486k against 2017/18 forecast outturn (FOT). This is an improvement of £240k against the month 3 FOT position;

The majority of QIPP lines rated as Red or Amber are associated to transformation and STP work streams with start dates now adjusted for mid-year delivery of October;

The increase in underachievement at month 4 is highlighting the slippage of transformation projects in the first half of 2017/18. The improved FOT position is a result of the CCG seeking to identify alternative QIPP in July to offset this performance with two new lines incorporated into the plan at a total of £902k;

The CCG has introduced a new process of monthly team reviews of QIPP to understand the current and forecast QIPP positions, with any mitigating actions agreed including additional QIPP identified where appropriate.

Integrated Performance Report (IPR) The key issues noted were as follows:

A&E 4 hour waits and cancer waiting times continue to be the key areas of concern for the CCG; Diagnostics 6+week waiters - the standard of 99% was narrowly missed for a second month

(98.7%); The CCG’s headline rating for the Improvement and Assessment Framework (IAF) for 2016/17

has been announced as Good. NHS England have released ratings for three of the six clinical priority areas for 2016/17 - Cancer, Dementia, Mental Health. Ratings positively improved for Dementia and Mental Health. The rating for Cancer remained unchanged;

Improving Access to Psychological Therapy (IAPT) Recovery Rate - local data shows the CCG achieving this target 52.65% (Jul 17).

InHealth Contract Review The Committee considered a report on the InHealth contract, noting that InHealth’s Quality report has undergone a number of reiterations and Commissioners are not assured that there is a robust process for identifying and managing serious incidents and responding to complaints in a timely manner. These concerns have been raised with InHealth and a Contract Performance Notice (CPN) was issued at the Contract Review Group (CRG) meeting on 23 August 2017. The Commissioning Support Unit (CSU) will conduct an audit/deep dive of the InHealth activity data. Findings from the audit/deep dive will be fed back to the Committee. Insights around 2016/17 over performance at RFL and UCLH The Committee considered the findings of a deep dive into over performance at RFL and UCLH in 2016/17. The report provided a coherent narrative regarding acute over performance in 2016/17 and to develop an understanding of data assurance which underpins contract performance.

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Multiple interrelated issues unfolded in the data and the conclusion on UCLH and RFL’s issues were noted. A number of next steps were highlighted and a further report will be provided to the Committee at its meeting in September. Decisions made The Committee approved proposed amendments to the Finance and Performance Committee and QIPP Cabinet Terms of Reference to reflect the agreed revised Governing Body members’ portfolio. Issues for the Governing Body None. Decisions for the Governing Body The Governing Body is requested to ratify the following proposed amendments to the Finance and Performance Committee terms of Reference to reflect the agreed revised Governing Body Members’ portfolios:

iv. Local Executive Director/Chief Operating Officer be added as a voting member; v. The number of elected Governing Body members be increased from two to three; vi. The Chair of Integrated Commissioning Committee as a member be removed;

Proposed amendments to the Terms of Reference are highlighted as tracked changes. These changes were approved by the Finance and Performance Committee at its meetings on 26 July (line i) and 23 August 2017 (lines ii and iii) respectively.

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NHS Camden Clinical Commissioning Group Finance & Performance Committee

Terms of Reference

1. Introduction

1.1 The Finance and Performance Committee (‘Committee’) is established in accordance with the NHS Camden Clinical Commissioning Group’s Constitution. It is a committee of the NHS Camden Clinical Commissioning Group Governing Body.

1.2 These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee which is directly accountable to the Governing Body. The Terms of Reference shall have effect as if incorporated into the Standing Orders.

1.3 The overall purpose of the Committee is to provide the Camden CCG Governing Body with appropriate financial assurance and to provide the Governing Body with exception reports and robust recommendations for action needed to ensure performance targets are met or exceeded.

2. Membership 2.1 The Committee shall comprise of both voting and non-voting members. 2.2 The voting members of the Committee are:

Chair - An elected Governing Body member appointed as Chair of the Committee by the Chair of Camden CCG;

Two Three Elected Governing Body Members; Chair of Integrated Commissioning Committee; Local Executive Director/ Chief Operating Officer; Camden CCG Chief Financial Officer; A Patient Representative.

2.3 The non-voting members of the Committee are:

Director of Integrated Commissioning; Officer responsible for acute commissioning; Director of Transformation Programme; Director of Sustainable Insights Partnerships; Interim Operational Finance Director; Head of Performance; A Lay Member of the Governing Body; QIPP Manager; A Commissioning Support Unit representative.

2.4 Members may nominate a deputy to represent them in their absence and make decisions on their behalf.

2.5 The Chair may nominate a Deputy Chair. The Deputy Chair must be an elected member of the Camden CCG Governing Body. If all elected members of the Camden CCG Governing Body on the Committee are conflicted and so excluded from the quorum as per section 4.4 below the Chair

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shall be a director who is not the Chief Finance Officer, Deputy Chief Finance Officer nor the officer with responsibility for primary care.

2.6 The roles referred to in the list of voting and non-voting members above describe the substantive roles and any equivalent successor roles and not the individual title or titles.

2.7 The Committee may invite or allow non-voting attendees to attend meetings. People in attendance may present at Committee meetings and contribute to relevant Committee discussions but are not allowed to participate in any formal vote.

2.8 The Committee may invite or allow non-members to attend meetings as observers. Observers may not present at Committee meetings, contribute to any Committee discussion or participate in any formal vote.

2.9 Each voting member shall have one vote with resolutions case by simple majority. In the event of a tied vote the Chair shall have the casting vote.

3. Secretary 3.1 The Board Secretary or a nominated deputy will provide secretariat support to the Committee.

4. Quorum 4.1 The Committee will be considered quorate when at least 3 voting members are present. The three

voting members must include: Two elected members one of whom must be a GP; and One Camden CCG officer.

4.2 If any representative is conflicted on a particular item of business they will not count towards the

quorum for that item of business. If this renders a meeting or part of a meeting inquorate a non-conflicted person may be temporarily appointed or co-opted onto the Committee to satisfy the quorum requirements.

4.3 If a meeting is not quorate the Chair may adjourn the meeting to permit the appointment or co-

option of additional members if necessary. 4.4 If all elected Governing Body members on the Committee are conflicted on an item of business the

quorum requirements contained in section 4.1 above do not apply. In these circumstances the quorum requirements are as follows:

Three Camden CCG officers two of whom are to be directors; One of the officers must not be the officer with responsibility for Primary Care.

4.5 To meet the quorum requirements set out in clause 4.4 above non-voting officer members of the

Committee may be temporarily appointed or co-opted as voting members of the Committee for the purposes of quoracy and voting. These officers will only be voting members of the Committee for the duration of the relevant agenda item or items.

5. Frequency of Committee Meetings

5.1 Committee meetings will be held monthly, or as and when necessary. The Committee Chair may call additional meetings or cancel meetings as necessary.

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6. Notice of Meetings 6.1 Meetings of the Committee shall be called by the secretary at the request of the Committee Chair.

Unless otherwise agreed, notice of each meeting confirming the venue, time and date, together with an agenda of items to be discussed with supporting papers, will be forwarded to each Committee member and any other person required to attend, seven calendar days before the date of the meeting.

7. Minutes of Meetings 7.1 Draft minutes of Committee meetings and actions in the form of an action log will be circulated

promptly to all Committee members.

8. Purpose 8.1 The Committee has been established by the Camden CCG Governing Body to provide

assurance, focussed oversight and scrutiny of the following areas: Financial performance, budgets, investments and associated planning issues; Service performance and overall performance against CCG objectives, service delivery

indicators and targets; Quality Innovation Productivity and Prevention (‘QIPP’).

9. Responsibilities 9.1 The Committee will:

Oversee development of the CCG medium term financial strategy and Five Year Plan;

Consider draft annual revenue and capital budgets and to make recommendations to the CCG;

Receive and consider detailed monthly monitoring reports and year-end forecasts of performance against financial and performance targets;

Ensure plans for service improvement, cost effectiveness and quality are fully integrated into CCG annual revenue and capital budgets;

Consider and agree, where appropriate in-year changes to budgets in line with SFI’s and budget approval policies;

Provide scrutiny and oversight of the key performance areas, make recommendations on actions to address areas of concern and/or underperformance and monitor and review progress;

Consider the CCG’s annual performance targets and to recommend action plans to the Board for their achievement;

Provide oversight and scrutiny of financial risks and of performance risks;

Maintain oversight of the annual contracting round;

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To review the Camden CCG Standing Financial Instructions and make recommendations to Governing Body;

Review progress against key financial and other performance targets including those for service change and improvements in cost effectiveness and quality;

Consider any remedial action required and recommend appropriate financial and performance improvement strategies to the CCG;

Review Camden CCG’s investments for affordability and make decisions on whether to suspend, postpone, withdraw or declining investments where they are unaffordable, not delivering the return required and/or unsustainable;

Provide oversight and scrutiny of Camden CCG’s QIPP programme;

Review the CCG’s QIPP programme, monitor progress against implementation plans and ensure consistency of approach;

To oversee the development and embedding of a culture within Camden CCG where QIPP, the measurement of the impact of initiatives, value for money and sustainability is a core part of the organisation’s approach to commissioning;

Make decisions on suspending, postponing, withdrawing or declining investments where the QIPP schemes or the QIPP element of an investment is unrealistic, under developed, not value for money and/or is unsustainable;

To oversee the design and development of mitigating actions for QIPP non-delivery and/or budget overspend where required such as development of an in-year recovery plan and emergency measures to ensure financial stability;

Receive reports from QIPP Cabinet on QIPP and provide QIPP Cabinet with oversight and direction;

To oversee the QIPP Challenge Panel and hold it to account for operational delivery of QIPP;

To hold individual directors and/or teams and/or QIPP project leads to account for delivery of QIPP;

To make recommendations and/or give directions to QIPP Cabinet, QIPP Challenge Panel, individual directors, individual teams and/or QIPP project leads on QIPP;

Advise on best practice and policy in relation to financial and performance management.

10. Authority 10.1 The Finance and Performance Committee is accountable to the Governing Body and will operate

as one of its committees. The Committee has not been delegated power to authorise expenditure save as set out in these Terms of Reference, enter into contracts, or agree procurement waivers.

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11. Reporting Responsibilities 11.1 The Committee will report at each formal meeting of the CCG Governing Body on all matters within

its duties and responsibilities. 11.2 The Committee will make recommendations to the Governing Body it considers appropriate on any

area within its remit where action or improvement is needed.

12. Delegated Authority 12.1The Committee may agree to delegate its authority to a Committee member to make decisions on

the Committee’s behalf outside of a Committee meeting at its absolute discretion on a case by case basis.

13. Sub-Committees 13.1 The Committee may appoint a committee or sub-committee to advise the Committee and assist it

in carrying out its duties. The Committee may not delegate any of its functions or powers to a committee or sub-committee.

14. Conflicts of Interest

14.1 Conflicts of Interest shall be dealt with in accordance with the NCL Conflicts of Interest Policy and

NHS England statutory guidance for managing conflicts of interest. The NCL Conflicts of Interest Policy is a master document containing the single conflicts of interest policy agreed by each of the NCL CCGs together with a schedule setting out each CCG’s local variations to that policy.

14.2 The Committee shall have a Conflicts of Interest Register that will be presented as a standing item on the Committee’s agenda.

15. Gifts and Hospitality 15.1 Gifts and Hospitality shall be dealt with in accordance with the NCL Conflicts of Interest Policy,

Gifts and Hospitality Policy and NHS England statutory guidance for managing conflicts of interest. 15.2 The Committee shall have a Gifts and Hospitality Register that will be presented as a standing item

on the Committee’s agenda.

16. Annual Review 16.1 The Committee will arrange for periodic reviews of its own performance and, at least annually

review its composition and terms of reference to ensure it is operating at maximum effectiveness and recommend any changes it considers necessary to the Governing Body for approval.

Approved: Date of Next Review: July 2018

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Report Title Summary of Camden Health and

Wellbeing Board - July 2017 Meeting Agenda Item 6.2 Date 15/08/2017

Lead Director Julie Billett,

Director of Public Health Tel/Email [email protected]

Report Author Phoebe Morris-Jones, Principal Officer



Julie Billett, Director of Public Health


Report Summary

This report provides a summary of the July 2017 meeting of Camden’s Health and Wellbeing Board.


Information

Approval To note

Decision

Recommendation The Governing Body is asked to note the contents of the report.


Improve the quality and safety of commissioned services Improve health outcomes, address inequalities and achieve parity of esteem.


N/A


N/A


N/A

Engagement

N/A


No equality impact assessment is required for this report.

Report History

This report provides the Governing Body with an overview of the Camden Health and Wellbeing Board’s agenda, discussions and decisions. The reports are provided Body four times a year, aligned to the Health and Wellbeing Board’s schedule of quarterly meetings.

Next Steps

N/A

Appendices None

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Report of Camden’s Health and Wellbeing Board Meeting held on 18 July 2017

1. Background

The purpose of this report is to provide the Governing Body with a summary of the agenda items, discussion and actions agreed at the Camden Health and Wellbeing Board (HWBB) meeting on 18th July 2017.

2. Key Items Discussed

2.1 Developing the Health and Wellbeing Board

Recognising the start of a new civic year, and a number of changes in membership of the Health and Wellbeing Board following Governing Body elections, the Board considered a paper focused on developing the future role of the Board, its membership, and the relationship between the Board and the wider health and care system. It was agreed that a Board development session would be organised in the Autumn to provide a welcome opportunity for Board members to take stock of progress, consider and strengthen the role of the Board and its ways of working, including patient and public engagement, and its relationship with the wider system.

2.2 The North London Sustainability and Transformation Plan (STP)

The Board considered an update report on the STP submitted by North London Partners in Health and Care, including the most recent version of the STP strategic narrative for North London, which confirms the overall vision previously set out in October 2016, but which now also reflects the detailed more granular planning which has been undertaken over the last eight months. The Board discussed and commented on a number of key issues, including the need for more public and patient engagement in both the ongoing iteration of the STP, and its implementation, the ongoing and significant financial challenge facing the health and care partnership across the North London footprint and the importance of a sustained focus on prevention, and health and care integration in order to genuinely transform and sustain the local and North London health and care system, the need for stronger grass roots engagement of primary care in the development and implementation of the plan, given the ambitions of the plan for a fundamental shift to delivering care closer to home, and the strategic alignment between Camden’s local care strategy and the STP.

It was noted that there would be continued engagement with Camden’s Health and Wellbeing Board as plan implementation progresses.

2.3 Ensuring Good Mental Health for All – thematic review

The Board received and discussed a “12 months on” progress report setting out progress against one the five priorities of Camden’s Joint Health and Wellbeing Strategy 2016-2018 (JHWS), “Ensuring good mental health for all”.

Specifically, the report described the progress made on a wide range of programmes, interventions and activities focused on promoting positive mental health and improving outcomes for people with serious and long-term mental health conditions in Camden, as well as setting out key future actions and work.

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The Board welcomed the report and the positive progress made in Camden towards improving mental health outcomes, and in particular the strength of focus on mental health promotion and supporting resilience and wellbeing, as well as ensuring timely, accessible, quality services and support for those people experiencing significant mental health problems.

The Board discussed a number of particular aspects of work, including perinatal mental health, mental health in the criminal justice system, and the importance of early identification and intervention, linked to increasing population awareness of mental health and reducing stigma. The Board welcomed the reporting of progress against the six key metrics, as set out in the Health and Wellbeing Strategy, and asked for reporting across a wider range of indicators and metrics in future reports in order to help the Board track progress and assist with benchmarking, as relevant.

2.4 Adult Social Care Transformation Programme – Update report

The Board received a report from the Director of Adult Social Care on the progress of the Adult Social Care Transformation programme. In December 2016, Camden’s Cabinet approved a new approach to adult social care to meet the significant challenges being faced, including a revised savings programme and timeline. It also agreed the development of an Adult Social Care Transformation Strategy and a programme of transformation, in order to create a sustainable model for the future. It was noted that successful delivery of a new strategy and approach will require a whole Council response and work with all our partners, supporting good access to wider Council and partner services. The ‘new proposition’ with residents specifically aims to build on people’s strengths and move away from a deficit approach to care and support. This approach is underpinned by the key principles of the Care Act:

upporting people to

use community assets

care e driving seat

It was noted that there will be further engagement with residents and partners over the summer to seek their views and shape these emerging ideas for the new Adult Social Care Transformation Strategy. The Board was also informed that the new strategy would include opportunities for working together with the voluntary and community sector.

Adult Social Care and Integrated Commissioning teams are working closely together and with partners across the system as a whole, in order to link this work to the priorities set out in Camden’s Local Care Strategy focused on community-based services, neighbourhood working, and self-care, thereby reinforcing the strengths-based approach throughout.

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2.5 Camden’s Pharmaceutical Needs Assessment Health and Wellbeing Boards in England have a statutory responsibility to publish a statement of needs for pharmaceutical services for the population in its area every three years, referred to as a Pharmaceutical Needs Assessment (PNA). The publication of an updated PNA is due before 1 April 2018. The Board received and agreed a report setting out a proposed process and timescale for the development of Camden’s updated PNA.

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Report Title Integrated Commissioning Committee Report


Lead Director Richard Lewin, Director of

Integrated Commissioning Tel/ Email

[email protected]

Report Author Tyrieana Long Board Secretary

Tel/ Email

[email protected]


Dr Matthew Clark Tel/ Email

[email protected]

Report Summary This paper presents a summary of the Integrated Commissioning

Committee meetings held on 26 July and 23 August 2017.

Purpose


To note

Decision

Recommendation The Governing Body is asked to note the Integrated Commissioning Committee Report.


Commission the delivery of NHS constitutional rights and pledges Improve health outcomes, address inequalities and achieve parity of

esteem

Identified Risks and Risk Management actions

Any major risks are highlighted as part of this report.




None

Engagement

This summary report is shared with the Camden Public and Patient Engagement Group.



Report History The Committee reports to each Governing Body meeting.

Next Steps None

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Name of Committee: Integrated Commissioning Date of meeting: 26 July and 23 August 2017 Issues discussed Review of Whittington Health Community Services Simplified Discharge Arrangements Admission Avoidance Review of Hospice Services Integrated Paediatric Service Social Prescribing Services Review Camden Fertility Policy Decisions Made: Review of Whittington Health Community Services The Committee approved the continuation of the contract with Whittington Health NHS Trust for the provision of adults and children’s community services subject to the agreement of a Memorandum of Understanding between the CCG and the Trust by 22 September 2017. Simplified Discharge Arrangements The Committee approved the decommissioning of 10 step down beds currently funded through the Better Care Fund in favour of reinvestment of simplified discharge arrangements in support of the delivery of the Supporting People at Home programme. Admission Avoidance The Committee approved a proposal to deliver QIPP savings in the admission avoidance workstream. The focus of the business case was on increasing capacity within the rapid response service to increase the numbers of avoidable admissions of people with urgent and immediate care needs. Review of Hospice Services The Committee approved an extension of the Marie Curie Hampstead (MCH) contract from 1st October 2017 to 31 March 2018 and also the recommissioning of Village Pharmacy to provide patient medication to MCH from 1/10/17 to 31/3/18. The Committee agreed to review the MCH contract and Village Pharmacy arrangement in 6 months’ time and to consider the outcome of the review of palliative and end of life services in Camden. Integrated Paediatric Service The Committee agreed to support the development of an integrated paediatric service based on the proposed service model that following a successful pilot, Integrated Paediatric Clinics and multi-disciplinary team meetings (MDTs) led by the paediatrician were expanded into 4 Camden neighbourhoods. Full approval was subject to further scrutiny of the financial modelling. Social Prescribing Services Review The Committee approved the development of a commissioning strategy for social prescribing (also known as community referral) to be considered at the November 2017 meeting. Camden Fertility Policy The Committee agreed to a public consultation on proposed changes to the CCG’s Fertility Policy.

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Issues for the Governing Body: The Governing Body is asked to note that the Integrated Commissioning Committee will receive updates on the Whittington Health community services contract on a monthly basis to ensure assurances are received on the quality of service provision.

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Report Title Locality Committee Report

Agenda Item

6.4

Date 30/08/2017

Lead Director Ian Porter, Director of

Corporate Services Tel/ Email

[email protected]

Report Author Francesca McNeil, Head of Communications and Engagement

Tel/ Email

[email protected]

Report Summary

This paper is a summary report of Locality Committees held in July 2017. There were no meetings held in August.


Information

Approval To note

Decision



Involve member practices and commissioning partners in key commissioning decisions.


There are no risks associated with this report.


None


None

Engagement Not applicable for the purpose of this report Equality Impact Analysis

Not applicable for the purpose of this report

Report History A Locality Committee Report is presented at every Governing Body

meeting. Next Steps None

Appendices None

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Camden CCG Locality Committee Report

1. Introduction

One of the key ways that Camden CCG engages with its members is through Locality Committees. The South Locality Committee is chaired by Dr Jonathan Levy, the North by Dr Martin Abbas and the West by Dr Birgit Curtis. Dr Martin Abbas deputised as chair for Dr Birgit Curtis in July. This report summarises the July Locality Committees.

2. July 2017 Locality Committees

The following commissioning items were brought:

2.1 Primary Care Mental Health business case Commissioners attended to discuss the Primary Care Mental Health business case with practices. Members welcomed the proposal as a positive plan that reflected the engagement with members over the last year. Members’ comments included the need to explore: Improving integration between primary care and the Crisis team Flexible routes into services as ‘opt in’ can be a barrier for vulnerable patients Removing the ability of Trusts to discharge a patient back to their GP if they DNA Reducing / simplify the variety of routes into services Improving cohesion between different Trusts’ services Requiring Trusts to navigate the patient around the system (not refer back to the GP) Ensuring this does not increase workload for GPs Tailoring the offer to neighbourhoods, reflecting different sizes and demographics.

2.2 QIPP Update An overview of the 2017-18 financial picture was provided and the types of transformation and reconfiguration schemes being considered over the next two years outlined. A range of QIPP schemes were highlighted. Members asked the CCG to carefully consider the impact of transferring work into primary care and ensure sufficient resource or reimbursement accompanies this. Members requested the following items were brought to future Locality Committee: RAPIDs service; Procedures of Limited Clinical Effectiveness policy; Planned Care Dermatology; Discharge to Assess. 2.3 Health visiting primary care offer and changes to GP-based baby weighing clinics Commissioners presented a proposal for future Camden Health Visiting services, setting out plans for a named Health Visitor for each GP practice and the reallocation of Health Visitor capacity from practice-based baby clinics to Camden children centres and health centres. Some practices urged caution around the following points: Practices with health visitor led baby-clinics losing a valuable local service The importance of health visitors attending practice meetings and safeguarding meetings Concerns re: each practices’ patients being allocated across multiple health visitors A clear process for raising urgent concerns and receiving personalised health visitor advice Consequences of removing practice baby clinics on achieving child health targets Potential negative impact on identifying and protecting vulnerable children in practices In-need patients in more affluent areas being disadvantaged by changes.

The presenters emphasised: Currently only a proportion of families have access to health visitor support, not targeting

those most in need. The plan improves the use of resource equitably across the borough and focuses on families with the highest need

The plan will encourage families to access baby clinics based at children centres where they will have access to diverse support services

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The proposal does not reduce access to Health Visitors in general practice, and this can still be used flexibly within general practice

Opportunities will be explored around hosting Hubs in practices. It was suggested the commissioners consider an upper N3 venue for Park End, Daleham, Adelaide, Swiss Cottage, Hampstead Group patients.

2.3 Accessible Information Standard (AIS) A Healthwatch Camden report in February 2017 showed variation across Camden practices in terms of compliance with AIS legal requirements. Dr Meena Anand attended to encourage practices to make use of the tools and easy read patient information templates created by the CCG, available on the GP website. GP IT can help activate templates if needed and Dr Anand confirmed she is happy to visit practices to discuss AIS or Learning Disability health checks. AIS is being proposed as an item for the next Camden Practice Manager meeting.

2.4 Care Integrated Digital Record (CIDR) Nigel Slator provided an update on progress and next steps with CIDR roll out, including: EMIS single sign on Radiology and safeguarding adults’ data with Royal Free Brining UCLH data on board Future plans for children social care data to be added after adults social care data Rolling out CIDR with Camden and Islington Trust and Camden Council Barnet CCG and Enfield CCG considering adopting CIDR Future plans for a patient portal.

2.5 CPPEG Representative Update PPG members of the Camden Patient and Public Engagement Group (CPPEG) attended an updated practices on the bi-annual PPG Forum and July CPPEG operational meeting, where the following topics were discussed: PPG success stories; GP Neighbourhoods; QIPP saving plans; Extended Hours Service; CCG Population Health tool.

CPPEG has invited the primary care team to attend a future operational meeting to discuss neighbourhood development further, to understand the patient-facing care delivery and how this work aligns with the investment via the Universal Offer.

3 Forward Look

Practice visits are planned by Dr Neel Gupta and Sarah Mansuralli in Quarter 3 2017-18 Locality Committees will take place in:

o September: North Thurs 15th / West: Fri 16th / South: Wed 20th Agenda: POLCE; PMS Review; Universal Offer; Tissue Viability and Wound

Care work in general practice; Adult Social Care transformation strategy o October: South: Wed 18th / North: Thurs 19th / West: Fri 20th o November: South: Wed 15th / North/West joint: Thurs 16th o December: no commmittees.

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Meeting in Public of the Camden CCG Governing Body Wednesday 8 November 2017, 14:00 Camden Town Hall Judd Street WC1H 9JE

PART I AGENDA

Item Title Presenter Action Paper Time Page 1. Introduction 1.1 Apologies for Absence Dr Neel Gupta Note Verbal -

1.2 Declarations of Interest Dr Neel Gupta Note 1.2

1.3 Declarations of Gifts and Hospitality Dr Neel Gupta Note 1.3

1.4 Minutes of the Previous Meeting Dr Neel Gupta Approve 1.4

1.5 Action Log

Dr Neel Gupta Note 1.5

2. Chair, Accountable Officer, Patient and Quality Reports 2.1 Chair’s Report

Dr Neel Gupta Note 2.1

2.2 Accountable Officer’s Report Helen Pettersen

Note 2.2

2.3 The Patient Voice Report

Kathy Elliott Note 2.3

2.4 Quality and Clinical Effectiveness Report

Jane Davis Note 2.4

3. Strategy 3.1 Local Care Strategy Update Dr Sarah

Morgan Note 3.1

3.2 2017/18 Business Plan Sarah Mansuralli

Note 3.2

3.3 CCG Accommodation Ian Porter Approve 3.3

4. Finance and Performance 4.1 Finance Report

Simon Goodwin

Approve 4.1

4.2 Operating Plan Charlotte Mullins

Note 4.2

4.3 Integrated Performance Report Charlotte Mullins

Note

4.3

5. Governance

5.1 Board Assurance Framework Ian Porter Note 5.1

5.2 Safeguarding Adults Annual Report Charlotte Cooley

Note 5.2

5.3 Joint Commissioning Annual Report Richard Lewin Note 5.3

5.4 2017 AGM Minutes Dr Neel Gupta Note 5.4

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6. Committee Reports – For information

6.1 Audit Committee

Richard Strang Note 6.1

6.2 Finance and Performance Committee

Dr Birgit Curtis Note 6.2

6.3 Health and Wellbeing Board

Julie Billett Note 6.3

6.4 Integrated Commissioning Committee

Dr Matthew Clark

Note 6.4

6.5 Localities Report

Dr Jonathan Levy

Note 6.5

7. Any other Business 7.1 Draft Agenda January 2018 Meeting Dr Neel Gupta Note 7.1

7.2 2018 Meeting Dates Dr Neel Gupta Note 7.2

8. Questions from the Public Verbal - Members of the public have the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should take no longer than three minutes per person.

9. Date of Future Meetings

REGISTER OF INTERESTS A register of members’ interests is available on the Camden CCG website

http://www.camdenccg.nhs.uk/publications/camden-ccg-board-register-of-interests

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http://www.camdenccg.nhs.uk/publications/camden-ccg-board-register-of-interests

GLOSSARY

Acronym Meaning A A&E Accident and Emergency ACHS Adult Community Health Services ADHD Attention Deficit Hyperactivity Disorder AHSNC Academic Health Science Networks and Centres ALB Arms’ Length Body AMR Anti-Microbial Resistance AMS Ancillary Medical Services AoMRC Academy of Medical Royal College APE Accountable Provider Entity APMS Any Provider Medical Services AQP Any Qualified Provider ASC Adult Social Care AWP Any Willing Provider B BAU Business As Usual BC Business Continuity BCDR Business Continuity and Disaster Recovery BCF Better Care Fund BEHMHT Barnet, Enfield and Haringey Mental Health Trust BMA British Medical Association BME Black and Minority Ethnic BNF British National Formulary C C2C Clinician to Clinician CAF Common Assessment Framework CAMHS Child and Adolescent Mental Health Services CAP Common Assurance Process CBT Cognitive Behavioural Therapy CC2H Care Closer to Home CCAS Camden Clinical Assessment Service CCG Clinical Commissioning Group CCU Critical Care Unit CDiff Clostridium Difficile CDF Cancer Drugs Fund CDS Commissioning Data Set CDU Clinical Decision Unit CEPN Community Education Provider Network CG Caldicott Guardian CHC Continuing Health Care CHP Camden Health Partnership CICS Camden Integrated Care Service CIDR Camden Integrated Digital Record CIFT Camden and Islington Foundation Trust CIP Cost Improvement Plans CIT Clinical Information Technology CKD Chronic Kidney Disease CLD Chronic Liver Disease CMHT Community Mental Health Team

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http://www.haringeyccg.nhs.uk/Downloads/Board%20Papers/20140130/Item%203.3a%20-%20Better%20Care%20Fund%20cover%20sheet.pdf

http://www.beh-mht.nhs.uk/

http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=68

http://www.nhs.uk/Conditions/Kidney-disease-chronic/Pages/Introduction.aspx

CMT Controlled Medical Terminology CNWL Central and North West London NHS Foundation Trust COPD Chronic Obstructive Pulmonary Disease CPPEG Camden Patient and Public Engagement Group CPRD Clinical Practice Research Datalink CQC Care Quality Commission CQN Contract Query Notice CQRG Clinical Quality Review Group CQUIN Commissioning for Quality and Innovation CSIPS Continuous Service Improvement Plans CSU Commissioning Support Unit D DBS Disclosure and Barring Service DES Directed Enhanced Service DH or DoH Department of Health DNA Did not attend DOAC Direct Oral Anticoagulants DOLS Deprivation of Liberty Safeguards DR Disaster Recovery DTOC Delayed Transfer Of Care (where patients are ready to

return home or transfer to another form of care but still occupy a hospital bed)

DVA Domestic Violence and Abuse E EA Equality Analysis E&D Equality and Diversity ED Emergency Department EDS Early Discharge Service (was REDS)

/ Equality Delivery System EMIS Electronic Management Information System EMT Executive Management Team EOLC End of Life Care EPR Electronic Patient Record ERR Enhanced Rapid Response (Lambeth) F F2F Face to Face F&P Finance & Performance FBC Full Business Case FE Frail and Elderly FFT Friends and Family Test FNC Funded Nursing Care FoI Freedom of Information FT Foundation Trust G GB Governing Body GDP Gross Domestic Product GMS General Medical Services GP General Practice (or General Practitioner)

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http://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx

http://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx

http://www.haringeyccg.nhs.uk/about-us/new_page.htm

http://www.haringeyccg.nhs.uk/about-us/EDHR.htm

http://www.haringeyccg.nhs.uk/about-us/EDHR.htm

http://www.nhs.uk/planners/end-of-life-care/pages/end-of-life-care.aspx

http://www.nhs.uk/chq/Pages/what-is-nhs-funded-nursing-care.aspx

http://www.foundationtrustnetwork.org/about-foundation-trusts/

http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspx

GPSU General Practice Support Unit H HASU Hyper Acute Stroke Unit HCA Health Care Assistant HCC Health Care Commission HEE Health Education England HHC/HHL Haverstock Healthcare Ltd HLP Healthy Living Pharmacy (Programme) HPA Health Protection Agency HPSS Health and Personal Social Services HSC Health Scrutiny Committee HSCIC Health and Social Care Information Centre HSSI Higher Severity Service Incident HVS Home Visiting Service HWBB Health and Wellbeing Board I IAPT Improving Access to Psychological Therapies ICAS Independent Complaints Advocacy Service ICAT Integrated Community Ageing Team (Islington) ICO Information Commissioner's Office iCOPE Camden and Islington Psychological Therapies ICP Integrated Care Pathway ICT Information and Communication Technology IDSVA Independent Domestic and Sexual Violence Adviser IFR Individual Funding Request IG Information Governance IHM Institute of Healthcare Management INR International Normalised Ratio IPC Integrated Personal Commissioning IPU Integrated Practice Unit IRIS Identification and Referral to Improve Safety ISBHaSC Information Standards Board for Health and Social Care ISIP Integrated Service Improvement Programme ISTC Independent Sector Treatment Centre ITF Integrated Transformational Fund ITT Invitation to Tender J JCC Joint Commissioning Committee JGPITC Joint GP IT Committee JSNA Joint Strategy Needs Assessment K KPI Key Performance Indicator L LAs Local Authority LAS London Ambulance Service LCS Locally Commissioned Service LES Locally Enhanced Service LGA Local Government Association LHB Local Health Board LHS Local Hospital Strategy LMC Local Medical Committee LSOA Lower Safer Output Access LSP Local Service Provider

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http://www.hscic.gov.uk/

http://www.haringeyccg.nhs.uk/about-us/individual-funding-requests.htm

LTC Long Term Conditions M MARSG Multi-Agency Reablement Steering Group MASH Multi-Agency Safeguarding Hub MBSR Mindfulness Based Stress Reduction MCA Mental Capacity Act MCP Multispecialty Community Providers MDT Multi-Disciplinary Team MHAAT Mental Health Assessment and Advice Team MHRA Medicines and Healthcare products Regulatory Agency MRSA Methicillin Resistant Staphylococcus Aureus MSA Mixed Sex Accommodation MSK Musculoskeletal N N.A.P.P. National Association for Patient Participation NCL North Central London NCL JFC North Central London Joint Formulary Committee NCL MON North Central London Medicines Optimisation Network NCEL North Central and East London NE Never Event NEL CSU North East London Commissioning Support Unit NES National Enhanced Service NHSE National Health Service England NHS IQ NHS Improving Quality NIB National Information Board NICA National Integration Centre and Assurance NICE National Institute for Health and Care Excellence NIHR National Institute for Health Research NMP Non-Medical Prescribing NMUH North Middlesex University Hospital NP Nurse Practitioner NPSA National Patient Safety Agency NQB National Quality Board NRLS National Reporting & Learning System NSF National Service Framework O OBC Outline Business Case OBR Office for Budget Responsibility OCD Obsessional Compulsive Disorder OOH Out of Hours P PACE Post-Acute Care Enablement PACS Primary and Acute Care Systems PALS Patient Advice and Liaison Service PAS Patient Administration System PASA Purchasing and Supply Agency PBC Practice-Based Commissioning PC Primary Care PCT Primary Care Trust PCTF Primary Care Transition Fund PD Personality Disorder PDT Programme Delivery Team PGD Patient Group Directions

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http://www.northmid.nhs.uk/

PH Public Health PHB Personal Health Budget PHE Public Health England PID Person Identifiable Data/

Project Initiation Document PIL Patient Information Leaflet PIRU Policy Innovation Research Unit PM Practice Manager PMO Project Management Office PMS Primary Medical Services PN Practice Nurse PNA Pharmaceutical Needs Assessment PPE Patient and Public Engagement PPG Patient Participation Group PPI Patient and Public Involvement PQQ Pre-Qualification Questionnaire PQS Prescribing Quality Scheme PRC Programme Review Committee PREMS Patient Related Experience Measures PREVENT Part of the government’s counter-terrorism strategy PROMS Patient Related Outcome Measures PTL Patient Tracking List PTSD Post-Traumatic Stress Disorder Q Q&S Quality and Safety QAS Quality Alerts System QGG Quality Governance Group QIPP Quality, Innovation, Productivity and Prevention QM Quality Matters Newsletter QOF Quality Outcome Framework (Assessor Validation

Reports) QP Quality Premium QP(I) Quality Performance (Indicators) R R&R Rehabilitation and Recovery RACI Responsible Accountable Consulted Informed RAG Red Amber Green (a rating system for indicating the risk

status using the traffic light colours) RAID Rapid Assessment, Intervention and Discharge Service (a

mental health service) RAPIDS Rapid Response Admission Avoidance Service (a mental

health service) RAS Rapid Access Service RCP Royal College of Physicians RCGP Royal College of General Practitioners RCT Randomised Controlled Trials REDS Rapid Early Supported Discharge RFL Royal Free London NHS Foundation Trust consisting of

Barnet, Chase Farm and Royal Free Hospitals RFL DTC RFL - Drugs & Therapeutics Committee RNTNEH Royal National Throat Nose and Ear Hospital RRP Responsible Respiratory Prescribing Subgroup RTT Referral to Treatment

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http://www.haringeyccg.nhs.uk/about-us/patient-and-public-engagement-strategy.htm

http://www.hscic.gov.uk/proms

http://www.nhs.uk/Services/Trusts/Overview/DefaultView.aspx?id=2418




S SBS Shared Business Services SCAS Assessment Service for Children with Autism SCG Shared Care Guideline SCR Serious Case Review SEND Special Educational Needs and Disabilities SFI Standing Financial Instructions SHA Strategic Health Authority SHMI Summary Hospital-level Mortality Indicator SHOT Serious Hazards of Transfusion SIGN Scottish Intercollegiate Guidelines Network SIs Statutory Instruments SI Serious Incident SLA Service Level Agreement SMI Service Measurement Index or Supplier Management

Inventory SMT Senior Management Team SOC Single Overriding Contract SPA Single Point of Access SPC Summary of Product Characteristics SPG Strategic Planning Group SPOR Single Point of Referral STEIS Strategic Executive Information System STP Sustainable Transformation Plan T TAP (Mental Health) Team Around the (GP) Practice TDA NHS Trust Development Authority TFT Thyroid Function Test TIA Transient ischaemic attack TOPS Termination of Pregnancy Service ToR Terms of Reference TREAT Triage and Rapid Elderly Assessment Team TSDO Transformation Strategy Delivery Office TTA Tablets to Take Away TUPE Transfer of undertaking protection of employment

regulations TWR Two-week referral U UCC Urgent Care Centre UCLH University College London Hospital UCLH UMC UCLH - Use of Medicines Committee UTC Urgent Treatment Centre V VBC Values Based Commissioning VSNAG Voluntary Sector National Advisory Group VTE Venous Thromboembolism W WEMWMS Warwick-Edinburgh Mental Health Wellbeing Scale WHO World Health Organisation

WRAP An interactive workshop undertaken by healthcare staff to raise awareness of PREVENT

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http://www.haringeyccg.nhs.uk/downloads/policies/Incident%20and%20Serious%20Incident%20Policy.pdf

http://www.ntda.nhs.uk/

http://www.haringeyccg.nhs.uk/talk-to-us/Value%20based%20commissioning%20presentation%20for%20CCG%20engagement%20network.pdf

http://www.connectingforhealth.nhs.uk/engagement/public/voluntary

Documents

Meeting in Public of the Camden CCG Governing Body ... · James Wigg and Queens Crescent Practices Yes Yes No Direct GP Partner 15/11/2016 01/09/201512/06/2017 ... Care UK, HMP Pentonville