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Meeting of the West Suffolk CCG Governing Body

to be held from 0915–1200 hrs on Wednesday 28 March 2018 at Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

AGENDA

The Governing Body will be available to meet with members of the public from

0900 – 0915

GENERAL BUSINESS 1. Apologies for Absence Dr Christopher Browning 2. Declarations of Interest

To declare any interests specific to agenda items Declarations made by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available via contact with the CCG’s Corporate Governance officer or at the CCG website.

All

3. Minutes of the previous West Suffolk CCG Governing Body

meeting. To approve as a correct record Minutes of the West Suffolk CCG Governing Body meeting held on 24 January 2018

Dr Christopher Browning

4. Matters Arising and Action Log Dr Christopher Browning 5. General Update

To receive a verbal report from the Chief Officer Ed Garratt

STRATEGY AND SERVICE DEVELOPMENT 6. Mental Health Transformation: Refresh of the Suffolk Mental

Health Strategy and Clinical Model of Care. To receive and approve a report from the Chief Transformation Officer.

Richard Watson Report No:

WSCCG 18-14

7. Aligning Clinical Commissioning Groups to support development

of the Integrated Care System (ICS) To receive and approve a report from the Chief Corporate Services Officer.

Richard Watson Report No:

WSCCG 18-15

FINANCE, PERFORMANCE AND SCRUTINY 8. Better Care Fund Section 75 Agreement

To receive and approve a report from the Chief Finance Officer Jane Payling

Report No: WSCCG 18-16

9. 2018/19 Operational and Financial Plans Jane Payling

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a) Financial Plans 2018/2019 b) Operational Plans 2018/2019 To receive and approve reports from the Chief Finance Officer.

Report No: WSCCG 18-17a WSCCG 18-17b

10. Procurement Update

To receive and note a report from the Acting Chief Contracts Officer Jon Reynolds

Report No: WSCCG 18-18

11. Integrated Performance Report - Are the CCGs finances,

performance and quality on track? To receive and note a report from Chief Officers.

Chief Officers Report No:

WSCCG 18-19 12. Governing Body Assurance Framework

To receive and approve a report from the Chief Corporate Services Officer

Geoff Dobson Report No:

WSCCG 18-20 GOVERNANCE AND CORPORATE BUSINESS 13. Minutes of Meetings:

To receive a report from the Lay Member for Governance seeking the endorsement of minutes and decisions of West Suffolk CCG Sub Committees, those being; a) Audit Committee

The unconfirmed minutes of a meeting held on 6 February 2018.

b) Remuneration and HR Committee The confirmed minutes of 19 September 2017 (previously not presented) and unconfirmed minutes of a meeting held on 13 February 2018

c) Finance and Performance Committee

The confirmed minutes of a meeting held on 20 December 2017 and 17 January 2018.

d) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 28 February 2018

a) CCG Joint Collaborative Group The unconfirmed minutes of a meeting held on 1 February 2018

e) West Suffolk CCG Primary Care Commissioning Committee

The unconfirmed minutes of a meeting held on 24 January 2018.

f) Commissioning Governance Committee Decision from a virtual meeting held on 22 November 2017

Committee Chairs Report No:

WSCCG 18-21

PATIENT AND PUBLIC ENGAGEMENT 14. Community Engagement Group Minutes

To receive and endorse minutes of the Community Engagement Group meeting held on 19 February 2018

David Taylor Report No:

WSCCG 18-22

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15. Community Engagement Group Terms of Reference To receive and ratify revised terms of reference

David Taylor Report No:

WSCCG 18-23 16. Engagement in West Suffolk

To receive and note a report from the Lay Member for Patient and Pubic Engagement

Jo Finn Report No:

WSCCG 18-24 17. Any Other Business 18. Date and Time of future Governing Body meetings

0915 - 1200 Wednesday 23 May 2018, Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

Questions from the public – Maximum 15 minutes

Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.

Financial Interests

Non Financial Professional

Interests

Non Financial Personal Interests

From To

Governing Body GP Member Zohra Armitage GP Angel Hill Surgery Direct 16/01/2017 Ongoing 06/11/2017 No further action required YesHusband is a consultant urologist at Addenbrookes Hospital Indirect 01/01/2014 Ongoing 06/11/2017 No further action required Yes

Governing Body GP Member Simon Arthur Practice is a member of Suffolk GP Federation Direct Ongoing 01/11/2017 To declare when appropriate YesLay Member for Governance and Vice Chair CCG Geoff Dobson Nil 20/10/2017 YesCCG Chair Christopher Browning PMS Provider, Practice Partner Long Melford Direct 2000 Ongoing 01/11/2017 To be declared at relevant meetings Yes

Chair, Hartest Parish Council Direct 2012 Ongoing 01/11/2017 To be declared at relevant meetings YesOut of Hours doctor for Care Uk Direct 2000 Ongoing 01/11/2017 To be declared at relevant meetings YesGP+ doctor for Suffolk GP Federation Direct 2000 Ongoing 01/11/2017 To be declared at relevant meetings Yes

Lay Member Steve Chicken Owner and MD of Galliform Ltd, consultancy and training company. No NHS activity Indirect 2009 Ongoing 05/11/2017 No further action required YesLay Member for Patient and Public Involvement Jo Finn Previous Chief Executive of West Suffolk Hospital NHS Trust Direct 1993 2001 30/10/2017 None Yes

Ex-husband was Consultant Obstetrician and Gynaecologist Indirect 1978 1993 30/10/2017 None YesPatient under care of neurologists, rheumatalogists and orthopaedics at West Suffolk Hospital Direct 1998 Ongoing 30/10/2017 None Yes

Chief Officer Ed Garratt Chief Officer for Ipswich and East Suffolk CCG Direct Mar-16 Ongoing 03/10/2017 To be declared at all relevant meetings and events YesGoverning Body GP Member Andrew Hassan Nil 11/10/2017 YesActing Chief Nursing Officer Chris Hooper Wife works for Community Services Provider in senior role Indirect 2013 Ongoing 03/10/2017 None YesChief Corporate Services Officer Amanda Lyes Chief Corporate Services Officer for Ipswich and East Suffolk CCG Direct Ongoing 03/10/2017 None YesChief Finance Officer Jane Payling Audit Committee Chair for Tower Hamlets GP Care Group Direct Ongoing 01/11/2017 To declare when appropriate Yes

Chief Finance Officer for Ipswich and East Suffolk CCG Direct 25/09/2017 Ongoing 01/11/2017 None YesGoverning Body GP Member Bahram Talebpour Partner in a GP Practice holding a contract with Hazell Court Direct Ongoing 20/12/2017 To declare when appropriate YesChair of Community Engagement Partnership David Taylor Trustee of Charity Avenues East Direct 2009 Ongoing 18/04/2017 None YesChief Operating Officer Kate Vaughton Nil 02/11/2017 YesGoverning Body GP Member Firas Watfeh Local Medical Committee member Direct 01/08/2015 Ongoing 31/03/2017 To be declared at relevant meetings Yes

Works for Care UK and GP+ Direct 01/04/2013 Ongoing 31/03/2017 To be declared at relevant meetings YesGP Partner at Haverhill Family Practice Direct 04/07/1905 Ongoing 13/10/2017 To be declared at relevant meetings Yes

Chief Transformation Officer Richard Watson Chief Transformation Officer for Ipswich and East Suffolk CCG Direct Jun-16 Ongoing 13/10/2017 None YesActing Chief Contracts Officer Jane Webster Nil 06/10/2017 YesGoverning Body GP Member Vacant GP PostGoverning Body GP Member Vacant GP PostGoverning Body PM Member Vacant PostGoverning Body PM Member Vacant PostSecondary Care Doctor Vacant Post

West Suffolk CCG Governing Body and Sub Committee Members

Title First Name Last Name Direct or Indirect

Date of Interest Date of Receipt

Action Taken to Mitigate Consent to Publish

Type of InterestDeclared Interest

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Minutes of a meeting of the West Suffolk CCG Governing Body held in public on

Wednesday 24 January 2018 in the The Edmund Room, St Edmundsbury Cathedral, Bury St. Edmunds, Suffolk

PRESENT: Dr Christopher Browning CCG Chair Dr Zohra Armitage GP Member Dr Simon Arthur GP Member Steve Chicken Lay Member Geoff Dobson Lay Member for Governance Jo Finn Lay Member for Patient and Public Engagement Ed Garratt Chief Officer Amanda Lyes Chief Corporate Services Officer Jane Payling Chief Finance Officer Karen Smith Head of Patient Safety and Clinical Effectiveness Dr Bahram Talebpour GP Member Kate Vaughton Chief Operating Officer Richard Watson Chief Transformation Officer Dr Firas Watfeh GP Member Jane Webster Acting Chief Contracts Officer David Taylor Chair of Community Engagement Group IN ATTENDANCE: Dr Peter Holloway GP Lead for Cancer, Ipswich and East Suffolk CCG (Item 18/015 only) Dr David Kanka Assistant Director of Public Health Jo Mael Corporate and Governance Officer 18/001 WELCOME AND APOLOGIES FOR ABSENCE

The CCG Chair welcomed everyone to the meeting and apologies for absence were

noted from: Dr Andrew Hassan GP Member Chris Hooper Acting Chief Nursing Officer Dr Abdul Razaq Director of Public Health

18/002 DECLARATIONS OF INTEREST

No declarations of interest, other than those already published, were received.

18/003 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 29 November 2017 were approved as a correct record.

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18/004 MATTERS ARISING AND ACTION LOG

There were no matters arising and the action log was reviewed and updated.

18/005 GENERAL UPDATE

The Chief Officer reported; • West Suffolk Hospital had received a rating of ‘outstanding’ from the Care Quality

Commission, which was a great achievement. Ipswich Hospital had received a rating of ‘good’.

• West Suffolk CCG had been rated as ‘good’ in relation to the 2016/17 Diabetes Assessment. The rating had been a result of focus from planned care to drive work forward and thanks was extended to all those involved. It was felt that the introduction of improved training for diabetes nurses had been a key benefit.

• The CCG had appointed a new Chief Nursing Officer – Lisa Nobes who was currently Director of Nursing at Ipswich Hospital. Lisa would be joining the CCG from the Spring. Chris Hooper was thanked for his work as Interim Chief Nursing Officer.

• The system had performed well over winter and all those involved were thanked for their support and contribution, which included members of the Community Engagement Group who had spent time in A&E.

• The Department of Education had noted strong progress and indicated increased confidence in the work being carried out the CCG in relation to Special Educational Needs and Disabilities (SEND).

The Governing Body noted the Chief Officer’s verbal update.

18/006 CHAIR AND CHIEF OFFICER ACTION – 01/2018 – DISCHARGE TO OPTIMISE

AND ASSESS

The Governing Body was in receipt of a Chair/Chief Officer Action taken in respect of Discharge to Optimise and Assess. The Governing Body is reminded that, at its meeting held on 29 November 2017, it received a report informing of the national drive to implement discharge to optimise and assess. That report had not made it explicit that the Governing Body was being asked to approve funding of £268,631 to West Suffolk Hospital to implement the scheme. Having sought feedback from Governing Body members via email, the Chair and Chief Officer subsequently approved the funding via the presented Chair and Chief Officer action. The Governing Body endorsed the reported Chair and Chief Officer Action – 01/2018.

18/007 PATIENT STORY

Gail Cardy, Senior Transformation Projects Officer and Lisa Frain, Level 2 Navigator

for Dementia Together were welcomed to the meeting to present the patient story on behalf of a vascular dementia patient. A presentation in relation to ‘Dementia Together’ prepared for the Health Service Journal award was circulated to members. Following diagnosis of vascular dementia the patient had concerns that her partner might not be able to cope going forward as she had previously managed household bills and finances. GP referral was subsequently made to ‘Dementia Together’ who

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had provided patient information and advice which included how to identify key signs of an episode, and the provision of physical and mental well-being support. Help had been provided to look ahead which included making sure that issues such as legal support were put in place, together with consideration of future residential care. Help and support was also made available to family members. ‘Dementia Together’ was able to receive referrals from GPs, other community healthcare professionals or via self-referral. The Governing Body thanked Gail and Lisa for the informative presentation.

18/008 DEMENTIA UPDATE

The Governing Body was informed of the current situation regarding Dementia

Diagnosis Rates in West Suffolk and of progress made by the ‘Dementia Together’ service. Current dementia figures were 61.5% (November 2017) for West Suffolk Clinical Commissioning Group which did not meet the current NHS England target of 67%. An action plan was in place to improve the CCG’s position and key actions were detailed within paragraph 1.1 of the report. ‘Dementia Together’ offered a unique service, which supported anyone who was curious or concerned about their memory and or dementia. The service ensured that an individual’s story only had to be told once. Entry into the service could be from self-referral or via primary / secondary care, health professional, Adult Community Service, Suffolk County Council etc. The service was jointly commissioned by Suffolk County Council Adult Community Services and Ipswich & East and West Suffolk Clinical Commissioning Groups, and had been launched on 01 April 2017. Bespoke care plans were created and support for families and those living with dementia offered. The service currently had seen approximately 600+ people since April 2017. ‘Dementia Together’ had received a Health Service Journal (HSJ) Award in November 2017, and Jo Churchill, West Suffolk MP had acknowledged the award was “testament to the superb work done by staff in delivering the Dementia Together service”.

Having been advised that the diagnosis process might be traumatic for older people, it was suggested that work be carried out to explore how the process might be made easier and how those that did not take up the option of an assessment might be reviewed. The Governing Body noted the challenges for the Clinical Commissioning Group to meet the 67% diagnosis rate and supported the actions underway. The Governing Body noted the patient story, success of Dementia Together and the Health Service Journal award.

18/009 PROCUREMENT UPDATE

The Governing Body was in receipt of a report, which detailed procurements

completed since the last update and those currently in progress and planned for 2017/18. Key points highlighted during discussion included;

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• The Ophthalmology procurement was underway and a market event had recently been held.

• Integrated Urgent Care Service – following termination of the original procurement the specification was being reviewed.

The Governing Body noted the content of the report.

The Chair advised that agenda item 10 (Cancer Services Update) would be delayed to await the arrival of Dr Peter Holloway.

18/010 WEST SUFFOLK NHS TRUST GLOBAL DIGITAL EXEMPLAR FUNDING

The Governing Body was in receipt of a report from the Chief Finance Officer that sought approval to pass through future funding receipts to West Suffolk Foundation Trust as part of the Global Digital Exemplar Programme. West Suffolk Foundation Trust (WSFT) had been successful in a bid to become one of a limited number of organisations to take part in the NHS Global Digital Exemplar (GDE) Programme. In order to support the programme the participants were able to access up to £10m each, over three years, of central funding. There had been a number of national delays with the funding of the GDE sites and a lack of clarity on the proportion of capital or revenue funding. That had now been clarified and the expected funding schedule for WSFT dependent upon achievement of milestones was set out in paragraph 2.1. Whilst capital funding would flow directly to the providers there was no direct national route for the provision of revenue funding, which would need to be provided via CCGs who would receive the funding via additional allocation in the months where payment might be required. The agreement would continue to be held between NHS England and WSFT and the CCG would only be required to pay in line with funding received. In line with the scheme of delegation the size of the potential revenue payments required approval by the Governing Body. A copy of the agreement was attached to the report at Appendix A with the signed cover note at Appendix B. The Governing Body approved the payment of funding received by the CCG to West Suffolk Hospital NHS Trust in relation to the Global Digital Exemplar funding agreement held between NHS England and the Trust, and requested that it receive an update to a future Executive meeting.

18/011 WINTER UPDATE

The Governing Body was provided with an update on system surges, pressures and

performance over the ‘winter’ period across Suffolk. The ‘Winter Plan – Ipswich and East Suffolk and West Suffolk’ was presented to the Governing Body in September 2017. It was approved by the two Suffolk Local Delivery Boards (West and East), which had continued to monitor its day-to-day delivery. A dedicated Winter Director and escalation team was put in place to oversee day-to-day delivery of the plan and liaise across all of the commissioning and provider organisations to ensure the plan’s implementation. The escalation team provided a rapid and coordinated approach to dips in performance during the winter period using

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combined intelligence to ascertain what additional actions were required during that time. Both acute providers had had issues with fluctuations in performance, which was exacerbated over the Christmas and New Year period. West Suffolk Foundation Trust’s (WSFT) delivery of the four-hour A&E performance requirement was particularly challenged between 1 to 7 January 2018, with weekly performance at 67.4%, including 54.7% on 3 January 2018. However, performance swiftly recovered and stood at 82.9% for the week ending 13 January, and 95.7% on 15 January2018. The overall year to date position had remained above 90%.

Weekly templates indicated that the average Delayed Transfers of Care (DTOC) for September to December was 2.3% of occupied beds. It had been as low as 1.6% and peaked at 3.2%. During December, the daily average was 2.2%, which remained below the target of 3.5%.

Local issues and pressures included:

• High numbers of acutely unwell patients presenting to both primary and acute

service providers with resultant impact for Ambulance and Community Services as well as Care providers. Some staffing shortages, in line with the rest of the health and care sector;

• An increase in patients in hospital for more than seven days. At the start of January 2018, in addition to the actions agreed in the ‘Winter Plan’ to support all providers, a further robust programme of work was instigated across the Suffolk health and care economy to help sustain high quality standards. Key actions undertaken across the local system were detailed at Appendix A. It was suggested that focus in future years should be directed to preventing attendances over the winter period, rather than how to deal with the increased demand at the hospital. New housing developments and subsequent increased population would continue to be a challenge for the strategic alliance. The Governing Body was reminded that primary care and the ambulance service had also been extremely busy over the winter period. The Governing Body noted the content of the report.

18/012 COMMUNITY ENGAGEMENT GROUP MINUTES

The Chair of the Community Engagement Group (CEG), presented the minutes of

the Group’s last meeting, which had been held on 21 December 2017. Key points highlighted included; • CEG members had attended integrated neighbourhood team training. • Links had been forged with the community diocese in an attempt to reduce rural

social isolation. • Volunteers had participated in West Suffolk NHS Foundation Trust’s winter

plans. • At its meeting on 21 December 2017 the CEG had been provided with an update

on finance from the CCG’s Chief Finance Officer. • The CEG was currently recruiting new members and Anne Nicholls was due to

leave in March 2018. Anne was thanked for her contribution and hard work.

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• The next meeting was due to be held in Mildenhall and the local patient participation group had been invited to participate.

The Governing Body noted the update.

18/013 PATIENT REVOLUTION 2017

The Governing Body was provided with an update on feedback from the Patient

Revolution event held in 2017. West Suffolk CCG had adopted patient and public engagement as a key priority and an annual Patient Revolution event was held in the community to talk to and receive feedback from people within the populations served by the CCG. One of the main principles of Patient Revolution had been to publish feedback from the event and update attendees the following winter on progress. There had been some recurring themes, which included dementia, long-term conditions, mental health, and making better use of resources. The 2017 event had been attended by approximately 70 people, with key themes being;

• Involving young people • Care in the community and discharge • Mental health – access and assessment • Better use of pharmacy services • Planning for the future, eg Sustainability and Transformation Plans (STP) • Joint working • Access to Patient Records incl IT and translation

Feedback from the event assisted the CCG in its plans and identified those areas that were important to the public and patients.

During 2017, the communications and engagement team had seen some significant changes. A joint maternity cover post with St Edmundsbury and Forest Heath councils had allowed the trialling of working arrangements. The CCG had also worked closely with the councils, NHS partners, voluntary sector and across footprints to develop a common framework of participation and communications. The length of time to publish the outcome of the event was questioned and as a number of themes were the same as previous years the need to provide reassurance that they were being taken forward was highlighted. It was suggested that thought be given to the feasibility of carrying out an Alliance Resolution Event in future.

The Governing Body noted the content of the report and approved that the seventh Patient Revolution event be held on 13 June 2018.

18/014 INTEGRATED PERFORMANCE REPORT

The Governing Body was in receipt of the Integrated Performance Report, which

provided members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial performance and acute activity, together with detailing work being carried out by the transformation, project management office and primary care teams.

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National reporting measures had been included at the front of the report. Clinical Quality and Patient Safety Key points highlighted included; • Infection control – West Suffolk Hospital had reported four cases of C.Difficile

against a trajectory of one. The CCG had recently appointed a new Infection Control Nurse.

• Harm free care – there was increased focus on prevention and all falls were reviewed at the CCGs quality meeting.

• Serious incidents – there had been a ‘never event’ at West Suffolk Hospital in relation to medication and the matter was currently subject to report.

• Patient satisfaction across providers was average. • Transforming Care was ahead of trajectory. • Across Suffolk, one care home had been rated ‘inadequate’. Having noted that 24 care homes had been rated as ‘requires improvement’ and 79 as ‘good’, how to obtain improvement was queried. The Governing Body requested that more detailed information be provided to a future Executive to instigate some focused work. It was explained that there remained ongoing issues with the availability of data from the hospital that might have contributed to a number of indicators being rated as ‘red’. The Governing Body was reminded that concerns with regard to poor performance could be taken forward at contract review meetings. Finance • At the end of month nine, the CCG was on track to achieve its year-end control

total of a break-even position. • Risks were associated to prescribing and the national pressure in relation to high

cost drugs and lack of availability of some lower cost medications. Although the CCG had forecasted mitigation to the risk, NHS England had asked that the CCG flag the risk in order to highlight the issue nationally.

• There was currently an underlying surplus of £1.2m. Planning guidance from NHS England was awaited.

• QIPP delivery was slightly under plan although good progress was being made. Transformation Integrated Care – A&E was currently 1% above plan and non-elective admissions 1.1% above plan. Delayed transfers of care were at 2.8%, which was below the national target of 3.5%. Emergency Department streaming had performed well over winter. The East of England Ambulance Service Trust had introduced a falls car in December 2017. A Care Home workshop had been held to review initiatives and agree governance and strategy going forward. Barrow had been identified as the pilot site for Buurtzog and recruitment was ongoing. The ambulance service had seen a 5% reduction in call outs year to date. Planned Care – outpatient activity was 0.4% below plan and GP referrals were 5% below plan. Referral to treatment times were below the 92% national target and work to address the situation was underway. The CCG was participating in NHS England’s 100-day challenge in relation to three specialties in an attempt to understand key issues and make improvement. There had been good engagement

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from Consultants and GPs. Mental Health and Learning Disabilities – the dementia diagnosis rate target continued to be challenging and was currently 61.5% against a target of 67%. Recruitment and mobilisation of the enhanced psychiatric liaison service was underway. Speech and Language Therapy work was to be relaunched. A meeting with the Department of Education in respect of Special Educational Needs and Disability (SEND) progress had gone well. Contractual Performance Key points highlighted included; • West Suffolk NHS Foundation Trust – A&E performance was at 90.4% in

November 2017 and referral to treatment performance at 89.04%. 62-day cancer performance was compliant and Delayed Transfers of Care were at 2.4%.

• Norfolk and Suffolk NHS Foundation Trust – positive relationships were being built with the management team and support offered.

• West Suffolk Community Healthcare – the new contract had commenced and trajectories were being monitored closely. An improvement plan was in place with regard to paediatric wheelchair provision within 18 weeks. Procurement of the wheelchair service was underway.

• 111/Out of Hours – the service was performing well and had been responsive over winter.

• East of England Ambulance Service Trust (EEAST) – there were performance concerns and the CCG was being supportive.

It was suggested that future reports contain some context to missed targets in order to ascertain the exact consequence. Project Management Office There had been slight under-achievement of QIPP as detailed within the report. Primary Care • There were now two practices that had been rated as ‘outstanding’. The Governing Body noted the content of the report

(Dr Peter Holloway joined the meeting)

18/015 CANCER SERVICES UPDATE

Achieving World-Class Cancer Outcomes, A Strategy for England 2015-2020 set the ambition to improve radically the outcomes for people affected by cancer. It outlined a series of initiatives across the patient pathway and emphasised the importance of earlier diagnosis and of living with and beyond cancer.

The national strategy recommended the establishment of Cancer Alliances in each region as the main vehicle for local service improvement in cancer services. The East of England Cancer Alliance had been designated by the National Cancer Team to cover 19 acute trusts, with a population of 6.3 million. The Alliance had a four-year programme of work to improve cancer services through implementation of the 96 recommendations in the National Cancer Strategy. National cancer transformation funding of £200m had been ring fenced for two years for Cancer Alliances to deliver cancer transformation across Sustainability and Transformation Plans (STPs).

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To support local delivery of the cancer transformation programme funding had been made available for clinical and programme management resource from East of England Cancer Alliance for the STP. Those posts were being hosted by North East Essex CCG giving leadership and change management resource into the STP for the local delivery of cancer transformation. Within the CCG, a number of initiatives were in progress that supported delivery of the strategy. The work was led by the West Suffolk Cancer Locality Group and would be further enhanced by a number of transformation projects being co-ordinated by the Cancer Alliance particularly around early diagnosis. Updates in relation to cancer performance, early diagnosis and living with and beyond cancer was outlined within Section 2 of the report, with key points highlighted during discussion being; • West Suffolk’s cancer performance was rated as “outstanding” against the

Improvement and Assessment Framework outcomes:

Cancer Diagnosed at an early stage: 58.8% (target to get to next rating 60%)

People with urgent GP referral having first treatment for cancer within 62 days of referral: 83.3% (target to get to next rating 85%)

One year survival from all cancers: 71.8% (target to get to next rating N/A)

Cancer patient experience: 8.8 (target to get to next rating unknown)

It was hoped that transformation funding would become available in February 2018 when it was anticipated that the cancer 62-day wait target would be achieved. A new screening test for bowel cancer was due to be introduced regionally in the near future. It was suggested that there should be increased communications in respect of the availability of the unexplained weight-loss clinic. Having questioned how the CCG might access the £200m of transformation funding made available nationally, it was explained that each cancer alliance would be invited to submit bids. Early diagnosis remained a key focus and work was underway to review cancer pathways which should include improved direct access to diagnostics and the screening of ‘at risk’ groups. The Governing Body noted current cancer performance and endorsed the programme of work outlined to implement the national cancer strategy within the CCG

18/016 GOVERNING BODY ASSURANCE FRAMEWORK

The Chief Corporate Services Officer presented the Governing Body Assurance

Framework (GBAF) for January 2018 together with a summary of Chief Officer local risk registers. Amendments and additions to the GBAF were detailed within Section 2 of the report, with key aspects of departmental risk register being listed in Section 3.

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Points highlighted included; • Risk 38 (Significant reduction in the capacity of GP services in Haverhill) had

been added. • The CCG’s Risk Forum regularly reviewed risks entered onto the department risk

registers and ‘Datix’ risk management software was due to go live in the near future.

The Governing Body noted and approved the GBAF as presented.

18/017 FREEDOM OF INFORMATION

The Governing Body was in receipt of a report from the Chief Corporate Services

Officer, which provided an update on freedom of information activity during the first three quarters of 2017/18 to the end of December 2017. Requests continued to be received at an average of 20 per month, although there had been a spike in quarter two where an average of 30 requests had been received each month, the reason for that was unknown. Almost all of the requests were applicable to both CCGs with only one or two being directed specifically to one or other CCG. During the period, all apart from one request had been answered within the 20 working days allowed under the Act. The source of requests remained consistent with the majority being received from requesters identifying themselves as members of the public. Interest groups were responsible for high numbers of requests and patterns seemed to develop dependent upon what was being reported in the newspapers and on TV. The media (local and national) also made a number of requests, generally related to issues currently being discussed by parliament or other media sources. Main topics were the commissioning of services by the CCGs, and financial questions in relation to the allocation of resources. Having questioned whether there might be engagement opportunities within the responses, the Chief Corporate Services Officer agreed to investigate and report to the Lay Member for Patient and Public Involvement outside of the meeting. The Governing Body noted the content of the report.

18/018 PRIMARY CARE COMMISSIONING COMMITTEE TERMS OF REFERENCE

At its meeting held on 29 November 2017, the Primary Care Commissioning

Committee considered a report from the Accountable Officer which set out the direction of travel in respect of collaborative working with neighbouring CCGs and provided an opportunity to influence how that might operate in future.

The Committee endorsed the overall direction of travel, agreed to alternate individual and Committees ‘in common’, and approved the development of appropriate governance arrangements to facilitate that approach. The individual Committee meeting would focus on local practice matters whilst the Committee in common would consider progress against wider area and shared transformation programmes as set out in our primary care strategy and the GP Forward View.

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Whilst the 2012 Health and Social Care Act did not permit CCGs to form joint committees, a Legislative Reform Order introduced in October 2014 allowed CCGs to form joint committees for exercising some functions – but not for primary care commissioning functions.

Committees ‘in common’ were used by many CCGs to enable collaborative commissioning prior to the introduction of the Legislative Reform Order and do provide an option for CCGs wishing to meet together to exercise their non-commissioning functions (including audit, remuneration, governing body meetings, and primary care commissioning functions). For example, the CCGs Audit and Remuneration and HR Committees currently meet under an ‘in common’ arrangement. In line with national guidance, the Primary Care Commissioning Committees Terms of Reference, as appended to the report, had been amended to facilitate ‘in common’ arrangements. The revised terms of reference had been approved at a ‘virtual’ meeting of the CCGs Primary Care Commissioning Committee in January 2018 and now required ratification by the Governing Body, prior to establishment of the first ‘in common’ Committee in March 2018. The Governing Body approved the amendments to the Terms of Reference for the Primary Care Commissioning Committee, as appended to the report

18/019 MINUTES OF MEETINGS

The Governing Body received the following minutes and decisions from meetings:

a) Audit Committee

The unconfirmed minutes of a meeting held on 5 December 2017.

b) Remuneration and HR Committee The unconfirmed minutes of a meeting held on 19 December 2017.

c) Finance and Performance Committee

The confirmed minutes of a meeting held on 22 November 2017.

d) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 20 December 2017

e) CCG Joint Collaborative Group The confirmed minutes of a meeting held on 14 September 2017 and unconfirmed minutes of a meeting held on 21 December 2017

f) West Suffolk CCG Primary Care Commissioning Committee

The unconfirmed minutes of a meeting held on 29 November 2017 The Governing Body received and endorsed the presented minutes and decisions.

18/020 ANY OTHER BUSINESS

Congratulations were extended to West Suffolk Hospital on its ‘outstanding’ CQC

rating. 18/021 DATE AND TIME OF FUTURE GOVERNING BODY MEETINGS

0915 - 1200 Wednesday 28 March 2018, Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

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_____________________________ _______________________ Chair (Dr Christopher Browning) Date

18/022 QUESTIONS FROM MEMBERS OF THE PUBLIC

1) Having noted that A&E performance was reported in relation to achievement of the four-hour target, it was questioned whether additional information such as an indication as to how many patients had waited a long time, was available.

The Acting Chief Contracts Officer advised that such information was collected on a daily basis and that patient length of stays could be tracked. The person that had asked the question was invited to request information in writing and a response would be provided.

WEST SUFFOLK CCG Governing Body

ACTION LOG: 24 January 2018 (updated) MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE Meeting of 29 November 2017 17/113 Discharge to

Optimise and Assess That the Governing Body receive a further update to a future meeting.

Richard Watson

March 2018

Meeting of 24 January 2018 18/010 West Suffolk NHS Trust

Global Digital Exemplar Funding

The Governing Body approved the payment of funding received by the CCG to West Suffolk Hospital NHS Trust in relation to the Global Digital Exemplar funding agreement held between NHS England and the Trust, and requested that it receive an update to a future Executive meeting.

Jane Payling

18/014 Integrated Performance Report

Quality Having noted that 24 care homes had been rated as ‘requires improvement’ and 79 as ‘good’, how to obtain improvement was queried. The Governing Body requested that more detailed information be provided to a future Executive to instigate some focused work Contracts It was suggested that future reports contain some context to missed targets in order to ascertain the exact consequence.

Karen Smith Jane Webster

Paper to be presented to Clinical Exec by 4 April 2018, detailing the approach being taken to quality improvement in care homes. Now being provided where possible - Complete

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE 18/017 Freedom of

Information Having questioned whether there might be engagement opportunities within the responses, the Chief Corporate Services Officer agreed to investigate and report back to the Lay Member for Patient and Public Involvement outside of the meeting

Amanda Lyes

Page 1 of 6

GOVERNING BODY

Agenda Item No. 06

Reference No. WSCCG 18-14

Date. 28 March 2018

Title Mental Health Transformation: Refresh of the Suffolk Mental Health Strategy and Clinical Model of Care.

Lead Chief Officer Richard Watson, Chief Transformation Officer

Author(s) Eugene Staunton, Associate Director of Transformation

Purpose To inform the Governing Body of the launch of a new programme of work to refresh and redesign the Mental Health model of care

Applicable CCG Priorities 1. Develop clinical leadership X 2. Demonstrate excellence in patient experience & patient engagement X 3. Improve the health & care of older people X 4. Improve access to mental health services X 5. Improve health & wellbeing through partnership working X 6. Deliver financial sustainability through quality improvement X

Action required by Governing Body:

To seek approval from the Governing Body for the launch of this new programme of work to refresh and redesign the Mental Health model of care.

1. Background 1.1 Sustainability and Transformation Partnership (STP) leaders are committed to integrate

mental, physical health and social services in localities building on the Health and Care Review conducted a number of years ago.

1.2 The time is right to review our Mental Health Strategy and Clinical Model in light of the

national Five Year Forward View (FYFV) for Mental Health which set out a range of national priorities (see appendix one) and the local development of Alliances in Ipswich and East and West Suffolk to see if it is fit for purpose and redevelop it accordingly.

1.3 In addition the NHS Planning Guidance issued in February 2018,:

• includes a commitment for each CCG to meet the Mental Health Investment Standard – passing on equivalent or higher uplift in mental health spend as the increase in CCG budget

• includes a set of expected deliverables against each national FYFV programme including Mental Health.

1.4 This paper sets out a proposed way forward for the refresh of the Strategy and Clinical Model

of Care and moves onto a brief outline of the expected deliverables against the national Mental Health FYFV.

2. Refresh of the Strategy and Clinical Model of Care 2.1 We propose to commence this piece of work now and complete by October 2018 with a

focus on: • Refreshing the Joint Strategic Needs Assessment (JSNA) and clearly identifying the

challenges that we face locally around mental health. • Refreshing the Strategy produced in 2015 and clinical model through a series of

workshops building on work done to date. 2.2 Our aim is to bring a paper through to the Governing Body in November 2018 on the revised

clinical model and how this can be put into place. 2.3 To enable us to take this work forward we are proposing to bring together a joint clinical and

management team. The key roles and individuals are set out below: • Richard Watson, Chief Transformation Officer for the CCGs and Pete Devlin, Director of

Operations for Norfolk and Suffolk Foundation Trust (NSFT) and Operations Director for Mental Health and Learning Disabilities, Suffolk County Council (SCC) will provide management leadership

• Dr John Hague (IESCCG) and Dr Roz Tandy (WSCCG) alongside Dr Viv Peeler (NSFT) and a couple of other NSFT clinical leads will provide the clinical leadership

• Eugene Staunton, Associate Director of Transformation for the CCGs and Margaret Little, Deputy Director of Operations, NSFT will provide the day to day management of this work.

2.4 The existing Suffolk Mentally Healthy Communities Board will provide the

governance/oversight for this programme of work given the Board has a good representation of Alliance partners, voluntary sector and service user representatives. The Board meets on a monthly basis and feeds into Suffolk Commissioners Group and the two Alliance Steering Boards.

2.5 The following principles are proposed to guide this work over the coming months:

• The delivery of true co-production with service users and their families and carers should be at the centre of our programme of work (to also include professionals).

• The Mental Health 5 Year Forward View expectations will be met and are not negotiable.

• Funding for mental health provision will not be cut and parity of esteem funding requirements for CCGs will be met.

• The morale and engagement of our local mental health service workforce is paramount. • Future provision will be rebalanced so that there is effective community support that is

closer to home, integrated with primary care, which will reduce need for crisis and acute secondary mental health care.

• Physical and mental health will be completely intertwined with core options to achieve this being explored such as co-location of secondary and physical health services.

• This is a system wide conversation requiring system wide engagement and CCGs will seek to gain commitment from key partners including the local authorities to taking this forward.

• The dialogue and programme will be driven by population needs not who provides what.

2.6 A more detailed programme plan is now being developed to underpin this work. Some key

issues are being worked through including: • considering the best ways of involving service users, their families and carers within this • needing the commitment of local partners to become involved in the development of the

clinical model - both clinicians and managers • balancing this work against the immediate priority areas for development linked to the

Five Year Forward View. 2.7 At the same time as we embark on this programme of work we remain committed to

continuing to support NSFT in their CQC Action Plan including additional funding as part of the 2018/19 contract allocation to meet key CQC requirements.

3. Mental Health Five Year Forward View: 2018/19 National Deliverables 3.1 The NHS Planning Guidance was issued in February 2018 which:

• includes a commitment for each CCG to meet the Mental Health Investment Standard – passing on equivalent or higher uplift in mental health spend as the increase in CCG budget

• includes a set of expected deliverables against each national FYFV programme including Mental Health.

3.2 The CCG is honouring this national commitment by passing on a 3.32% uplift in spend on

mental health in 2018/19 in large part to support the Mental Health FYFV priorities as detailed below. The majority of our mental health spend currently sits with NSFT and the table below sets out the proposed uplift in the two main contracts the CCGs have with the provider.

3.3 In addition, the CCG continues to have a Children and Adolescent Mental Health (CAMHS)

fund amount to £1.8m utilised specifically against the CAMHS Plan and the priorities within it.

3.4 The 2018/18 Five Year Forward View Deliverables are set out in the table below alongside

a RAG rating of our local progress and a brief commentary. We are in a relative good position

2018/19 Deliverables RAG Update Each CCG must meet the Mental Health Investment Standard (MHIS) by which their 2018/19 investment in mental health rises at a faster rate than their overall programme funding. CCGs’ auditors will be required to validate their 2018/19 year-end position on meeting the MHIS.

Green Commitment given to pass on a 3.32% financial uplift to mental health spend including the NSFT contract.

Ensure that an additional 49,000 children and young people receive treatment from NHS-commissioned community services (32% above the 2014/15 baseline) nationally, towards the 2020/21 objective of an additional 70,000 additional children and young people. Ensure evidence of local progress to transform children and young people’s mental health services is published in refreshed joint agency Local Transformation Plans aligned to STPs

Amber Coincides with the introduction of the Emotional Wellbeing Hub, enhancing capacity within the Children & Family pathways in the IDTs to provide timely access to assessment followed by treatment. This investment will see an increase in the number & timeliness (against the contractual 15 week RTT target) of children and young people accessing appropriate treatments. Deploying resource to these teams aligns with the wider programme of transformation for Children and Young People in Suffolk and supports the care pathway between the Emotional Wellbeing Hub and Integrated Delivery Teams. Proposed additional investment tied to NSFT 18/19 contract uplift of £215k.

Make further progress towards delivering the 2020/21 waiting time standards for children and young people’s eating disorder services of 95% of patient receiving first definitive treatment within four weeks for routine cases and within one week for urgent cases.

Amber NSFT meeting this standard but maintaining this is challenging as demand is exceeding national predictions of prevalence as evidenced by recent review locally and regional review conducted by Anna Freud Centre.

Deliver against regional implementation plans to ensure that by 2020/21, inpatient stays for children and young people will only take place where clinically appropriate, will have the minimum possible length of stay, and will be as close to home as possible to avoid inappropriate out of area placements, within a context of 150-180 additional beds.

Amber Suffolk has a low level of inpatient stays. However, seven acute mental health beds currently closed with a commitment from NSFT to have these beds back open by end of May 2017.

Continue to increase access to specialist perinatal mental health services, ensuring that an additional 9,000 women access specialist perinatal mental health services and boost bed numbers in the 19 units that will be open by the end of 2018/19 so that overall capacity is increased by 49%.

Amber We have invested £317k in perinatal mental health in 2017/18 and are in the process of bidding for one year funding to cover 18/19-19/20 (£366K- Phase 2). NHSE have confirmed that the funding will be contained within CCG 19/20 baselines.

Continue to improve access to psychology therapies (IAPT) services, delivering a national access rate of 19% for people with common mental health conditions. Support HEE’s commissioning of 1,000 replacement practitioners and a further 1,000 trainees to expand services. Approximately two-thirds of the increase to

Amber We are in a relatively good position against this target of 19% currently standing at around 17% and the uplift in the IAPT contract will be used to support achievement of this target and focus on long term conditions.

2018/19 Deliverables RAG Update psychological therapies should be in new integrated services focused on people with co-morbid long term physical health conditions and/or medically unexplained symptoms, delivered in primary care. Continue to ensure that access, waiting time and recovery standards are met.

Proposed additional investment of £253,158 tied to IAPT contract to further develop the service.

Continue to work towards the 2020/21 ambition of all acute hospitals having mental health crisis and liaison services that can meet the specific needs of people of all ages including children and young people and older adults; and deliver Core 24 mental health liaison standards for adults in 50% of acute hospitals subject to hospitals being able to successfully recruit.

Amber Agreement for additional funding to support increased psychiatric liaison service (PLS) provision in particular onto all acute wards across both Trusts. In addition, in the West an increase in working hours. Local agreement that the 2 local PLS will not be fully 24/7. Proposed additional investment of £347,500 for IES and £239,400 for WS tied to NSFT 18/19 contract uplift.

Ensure that 53% of patients requiring early intervention for psychosis receive NICE concordant care within two weeks.

Amber Business case jointly developed for this area. Agreement to review the business case again and in principle to review at the end of Q1 18/19 with the Trust and use any slippage to invest against recruitment to EIP service. EIP to be first call on recurrent growth in 19/20.

Support delivery of STP-level plans to reduce all inappropriate adult acute out of area placements by 2020/21, including increasing investment for Crisis Resolution Home Treatment Teams (CRHTTs) to meet the ambition of all areas providing CRHTTs resourced to operate in line with recognised best practice by 2020/21. Review all patients who are placed out of area to ensure that have appropriate packages of care.

Amber Suffolk is in a relatively good position against this deliverable with low levels of out of area placement. However, it is proposed to bolster the capacity of the crisis assessment service by offering improved access to 24/7 advice and support. This additional capacity will enhance the capability and resilience of the current NSFT service model as a step change towards the development of a system-wide mental health crisis pathway (under the Urgent Care Pathway) during 2018. Proposed additional investment of £198k tied to NSFT 18/19 contract uplift.

Deliver annual physical health checks and interventions, in line with guidance, to at least 280,000 people with a severe mental health illness.

Amber This is a new area for which we are currently in the process of developing an action plan and understanding what our baseline is in both CCGs. The CCGs need to achieve 60% of patients receiving an annual assessment in primary care who have an SMI in 2018/19.

Provide a 25% increase nationally on 2017/18 baseline in access to Individual Placement and Support services

Red NHSE STP bids (Feb 18) only open for CCGs with existing local services (i.e Essex). This programme is aimed at SMU patients and providing employment support- no current bespoke local provision in place. It is expected that Suffolk will need to meet this target from 2019/20 with funding provided in the

2018/19 Deliverables RAG Update baseline.

Maintain the dementia diagnosis rate of two thirds (66.7%) of prevalence and improve post diagnostic care

Amber As at Jan 2018, I&E CCG at 66.6%, WSCCG at 61.9%. Additional Band 7 Dementia Specialist Dementia Nurse agreed with NSFT in 18/19 contract uplift. Band 4 Support Worker to interface between NSFT and CCGs (6 months) also agreed.

Deliver their contribution to the mental health workforce expansion as set out in the HEE workforce plan, supported by STP-level plans. At national level, this should also specifically include an increase of 1,500 mental health therapists in primary care in 2018/19 and an expansion in the capacity and capability of the children and young people’s workforce building towards 1,700 new staff and 3,400 existing staff trained to deliver evidence based interventions by 2020/21.

Amber This is not a specific target being pursued by the CCGs but the development of children's IAPT and investment into meeting the children's access trajectories will support the delivery of this standard.

Deliver against multi-agency suicide prevention plans, working towards a national 10% reduction in suicide rate by 2020/21

Amber Suicide Prevention Strategy in place led by Public Health.

Deliver liaison and diversion services to 83% of the population

Blue Not CCG led work. CCG's make a contribution to the <18 Youth Offending Team.

Ensure all commissioned activity is recorded and reported through the Mental Health Services Dataset

Blue Business as Usual.

4. Recommendation 4.1 To seek approval from the Governing Body for the launch of this new programme of work to

refresh and redesign the Mental Health model of care.

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GOVERNING BODY

Agenda Item No. 07

Reference No. WSCCG 18-15

Date. 28 March 2018

Title Aligning Clinical Commissioning Groups to support the development of the Integrated Care System (ICS)

Lead Chief Officers Amanda Lyes – Chief Corporate Services Officer & Kirsty Denwood – Director of Resources, NEECCG

Author(s) Amanda Lyes – Chief Corporate Services Officer

Purpose To request Governing Body approval of the actions necessary to achieve further CCG organisational alignment on the journey to establish a strategic commissioning organisation for Suffolk and North East Essex

Applicable CCG Clinical Priorities: 1. Develop clinical leadership2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people4. Improve access to mental health services5. Improve health & wellbeing through partnership working6. Deliver financial sustainability through quality improvement

Action required by Governing Body: To Note and Approve

V1 090318 Page 2 of 5

1. Context 1.1 Health leaders across the Suffolk and North East Essex area have collectively

committed to changing the way certain elements of healthcare are provided to the local population in order to deliver the highest quality of care possible within the resources available.

1.2 The guiding principle for this change is the commitment to put the patient at the heart of

how services are designed, rather than these services being based around the existing organisational forms. In order to facilitate this three separate provider Alliances have been created, West Suffolk, East Suffolk and North East Essex. Within these Alliances providers and commissioners from across health, mental health and social care, have committed to work in collaboration to provide a more joined up offer for the public they serve.

1.3 In order for these emerging Alliances to be able to make the changes necessary and achieve the level of transformation required to deliver improved integrated care for their local population, there will also need to be changes made to the commissioning landscape in which they operate.

1.4 The Suffolk and North East Essex CCGs have already been successfully working together to deliver effective clinical commissioning in collaboration with patients, provider organisations and partner local authorities. This has involved jointly planning services that deliver improvements for their respective populations and working together to improve efficiencies across the Sustainability and Transformation Plan (STP) footprint.

1.5 Within the context of the Suffolk and North East Essex STP and as part of the development of the wider Integrated Care Systems (ICS) there is now a compelling case for the three CCGs within this footprint to come together on a more formal basis, in order to strengthen commissioning capacity and capability as a single strategic commissioning body. This would also allow existing resources to be delegated to the local provider ‘alliances’ to support the development of integrated services at a locality level within each area.

1.6 The creation of a single Strategic Commissioner also offers the opportunity to review

some of the historic and complex commissioning and system leadership arrangements in Suffolk and North East Essex, across both health and where appropriate social care. Opening up the function to include more than just traditional health services is required to look at how other public sector commissioning impacts on the wider determinants of the health of the population.

1.7 This paper therefore sets out the steps needed to realise this ambition.

2. Background

2.1 The NHS has a new shared vision for the future to transform the traditional divide between primary care, community and mental health services and hospitals, which is known to be an increasing barrier to the personalised and coordinated health services that patients need.

2.2 Local ambition is to join up these services to establish by 2019-20 an ICS. This will bring together a number of providers to take responsibility for the cost and quality of care for our defined population and within an agreed budget. This forms part of the wider STP for Suffolk and North East Essex, one of 44 across England with five-year plans covering all aspects of NHS spending.

V1 090318 Page 3 of 5

2.3 The current system of commissioning is based on arrangements set out in the Health and Social Care Act 2012, which aimed to put GPs at the forefront of the process. Although the structures established by the Act have remained in place since it came into force in 2013, the way that commissioning is delivered in practice has evolved since then and is continuing to do so.

2.4 The evolution in commissioning has been in response to growing financial and

operational pressures and new care models being implemented in the wake of the NHS five-year forward view. Health and Care organisations are also working together to develop STP’s into Integrated Care Systems.

2.5 An Integrated Care System is defined as the operating model for collaborative leadership across commissioners and providers, in the NHS and local government.

2.6 Strategic commissioning is a function where the clinical expertise and knowledge of CCGs is retained, but in a footprint that is coterminous with the Integrated Care System and ideally with representation from other NHS and local government partners.

2.7 Strategic commissioning is also quite different to how commissioning is currently

understood and practised. The focus will be on defining and measuring outcomes, putting in place capitated budgets with appropriate incentives for providers to deliver these outcomes, and using longer-term contracts extending over five to ten years. This will reduce transaction costs and free up resources to invest in improving health and care.

2.8 It also provides the opportunity for bringing together commissioning functions that are

spread across different organisations; for example, Public Health commissioning, or NHS performance and quality assurance.

3 Key Issues

3.1 The Suffolk and North East Essex CCGs share a common purpose and aspire to deliver

a sustainable health and care system through a more coherent approach to the planning and commissioning of services which will help them become more effective and give them a better chance of achieving their shared objectives more rapidly.

3.2 By beginning to immediately align CCG functions and governance arrangements, Suffolk

and North East Essex will be better able to shape a strategic commissioner that can deliver improved outcomes across a bigger geographical footprint. It will also aim to delegate commissioning resources to support local and agile decision making in our alliances.

3.3 In addition to five legal requirements, NHS England, in consideration of CCGs coming together, will assess whether proposals demonstrate the following six tests, which are considered relevant to one or more of the matters set out in section 14C(2) of the NHS Act 2016. Suffolk and North East Essex can already demonstrate progress and/or existing compliance with each:

1. Strategic Purpose: to provide a more relevant footprint for the STP/ICS 2. Prior Progress: demonstrable evidence of systematically implementing shared

functions together with evidence of a willingness to work together 3. Leadership Support: the proposal enjoys the support of the STP & constituent

CCGs 4. Future Proofing: the proposal provides the right footprint for oversight of likely

local transformation 5. Ability to Engage with Local Communities: assurance that a move to a larger

geographical footprint is not at the expense of a locality focus 6. Optimising Administrative Resources: gaining efficiencies from alignment

V1 090318 Page 4 of 5

3.4 In order to take the CCGs to the next stage of organisational alignment, a number of

changes will be required and these are now set out for Governing Body consideration and approval.

4 Proposals for Further Organisational Alignment

4.1 Supporting Alliance Development: Each Alliance within the Suffolk and NEE STP has

committed to providing a initial strategy and delivery plan for each of their localities by the end of March. Within this they will identify their key priorities for their individual system footprints, as well as to evidence how they will deliver against the wider programmes of work across the ICS. The outputs from these will help to inform the discussion on the future strategic commissioning function and support the further development of the emerging Alliances.

4.2 Establishment of a Joint Committee: Joint Executive Team meetings have already

taken place but moving this to the next level, would establish a formal Joint Committee comprising the Ipswich & East Suffolk, West Suffolk and North East Essex Clinical Commissioning Groups with delegated authority from their respective Governing Bodies. The NHS Act 2006 (as amended) (‘the NHS Act’) was amended through the introduction of a Legislative Reform Order (“LRO”) to allow CCGs to form joint committees. This means that two or more CCGs may form a joint committee as a result of the LRO amendment to s.14Z3 (CCGs working together) of the NHS Act giving them an additional option for collective decision making. The respective CCG Governing Bodies however, as the existing statutory bodies, remain accountable for meeting their statutory duties.

4.3 Appointment of a Single Accountable Officer: It is now recognised that there are a

number of areas where joint leadership is needed to coordinate the collective work of the CCGs to rapidly achieve key ambitions but in a way that adds value to the efforts at a local level. The Suffolk and North East Essex CCGs are therefore proposing to appoint a single Accountable Officer to support the work of the three statutory bodies and also to work closely with the STP Lead.

4.4 Further Alignment of Governance functions: Establishing Committees in Common

for the CCGs statutory committees. Whilst this is already in place for the Suffolk CCGs Audit and Remuneration Committees, this would be extended to include the North East Essex CCG committees and also the Primary Care Commissioning Committees, ensuring coordinated approaches.

4.5 Maximising Opportunities for Joint Working: the CCGs have recently undertaken

joint commissioning activities and most recently a new Lay Member Forum was established which brings together the non-executive Governing Body members to discuss matters of mutual concern. Indeed, the first meeting held in February 2018 has agreed processes for Lay Members to assist in the journey to establishment of committees in common. In addition, with further organisational alignment, there are opportunities for sharing management teams across the constituent CCGs in order to avoid duplication of effort and as has already commenced, CCG policies are being aligned to facilitate joint working.

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5. Proposed Timeline

5.1 Time is of the essence in moving forward towards the CCGs shared goals and the timeline set out here is therefore proposed:

DATES KEY MILESTONES

March/April 2018

• Continue joint executive team meetings • Understand & formalise future functions • Develop & implement a communications plan for stakeholders • Inaugural Joint Lay Member Forum meeting • Confirm process & timeline for single AO appointment. The

three CCG chairs to agree the recruitment and selection process

May 2018 • Continuation of communications & engagement

August 2018 • Establishment of Joint CCG Committee • Establishment of Committees in Common • Complete recruitment of single AO post (detail yet to be defined)

6. Communication and Engagement

6.1 As the moves to organisational alignment and strategic commissioning are significant

there will be the need for a comprehensive communications process in order to engage and communicate effectively with patients, public, trade unions, LMC, Member Practices, partners, staff and stakeholders across Suffolk and North East Essex, setting out in detail how we will work with them to improve and deliver the health and care needs through transformation.

6.2 In developing our plans, we recognise what people and communities want from their

local health and care services and the shift from a clinically and managerially led process to a co-produced approach to health and care will be at the heart of our consultation, communication and engagement plans.

7. Recommendations for Approval

7.1 The Governing Body is requested to consider and approve, in line with the proposed

timeline:

• Agreement to strengthen the governance of local alliance arrangements to allow for delegation of CCG resources where supported and appropriate.

• Appointment of a single Accountable Officer for the Ipswich and East Suffolk, West Suffolk and North East Essex CCGs with the recruitment and selection process to be agreed with the three CCG chairs.

• Establishment of a Joint Committee between the Ipswich and East Suffolk, West Suffolk and North East Essex CCGs.

• Further alignment of governance functions across the constituent CCGs, to include

the establishment of committees in common.

• Maximising opportunities for joint working to include the sharing of management and staff teams across the constituent CCGs as considered necessary and appropriate.

• Development and initiation of a comprehensive engagement plan.

• Begin discussions with system partners, to develop the Strategic Commissioner.

Page 1 of 4

GOVERNING BODY

Agenda Item No. 08

Reference No. WSCCG 18-16

Date. 28 March 2018

Title Better Care Fund Section 75 Agreement

Lead Chief Officer Jane Payling, Chief Finance Officer

Author(s) Jane Payling, Chief Finance Officer Richard Watson, Chief Transformation Officer

Purpose To present the Better Care Fund section 75 agreement for approval

Applicable CCG Clinical Priorities: 1. To promote self care X

2. To ensure high quality local services where possible X

3. To improve the health of those most in need X

4. To improve health & educational attainment for children & young people5. To improve access to mental health services6. To improve outcomes for patients with diabetes to above national averages7. To improve care for frail elderly individuals X

8. To allow patients to die with dignity & compassion & to choose their placeof death

9. To ensure that the CCG operates within agreed budgets x

Action required by the Governing Body

To approve the final Better Care Fund agreement and proposed monitoring arrangements

1. Background

1.1 The Better Care Fund (BCF) was first announced in 2013 with the aim of promoting service integration between the NHS and Local Authorities (LA). The BCF provides a mechanism for joint health and social care planning and commissioning, bringing together ring-fenced budgets from Clinical Commissioning Group (CCG) allocations, the Disabled Facilities Grant (DFG) and funding paid directly to local government for adult social care services - the Improved Better Care Fund (IBCF).

2. National Approval Process

2.1 Following feedback in the initial years, the requirements of central management and reporting connected with the BCF have been scaled back to some extent with a number of changes being introduced from 2017. Plans and associated section 75 agreements were extended from single year to two years and the national conditions which have to be met to release the funding were reduced from eight to four.

2.2 The four national conditions for the current planning period (2017-19) are set out below

(extract from Integration and Better Care Fund Planning Requirements issued July 2017):

i) That a BCF Plan, including at least the minimum contribution to the pooled fund specified in the BCF allocations, must be signed off by the Health and Wellbeing Board (HWB), and by the constituent LAs and CCGs;

ii) A demonstration of how the area will maintain in real terms the level of spending on social care services from the CCG minimum contribution to the fund in line with inflation;

iii) That a specific proportion of the area’s allocation is invested in NHS-commissioned out-of-hospital services, or retained pending release as part of a local risk sharing agreement; and

iv) All areas to implement the High Impact Change Model for Managing Transfer of Care3 to support system-wide improvements in transfers of care.

2.3 There are four national metrics which are used to measure the effectiveness of local BCFs,

with local plans needing to cover how these will be delivered:

2.4 Plans for 2017-19 were due for submission in September 2017 to undergo a regional and

national approval process. The planning submission uses a detailed national excel template. 3. BCF Plan Approval Process

3.1 Suffolk County Council, works in partnership with the three CCGs covering Suffolk to establish the local Better Care Fund Plans.

3.2 The Suffolk BCF plans were submitted for sign off by NHS England in September 2017. Following review, the plan was deemed to be approved with conditions, the one outstanding area being to provide further clarification on delivery of the reablement metric. This was provided in November 2017 enabling the plan to be finally approved in full.

4. Translating the plan to CCG level

4.1 The formal document which establishes the Better Care Fund is a section 75 agreement. As the overall BCF operates at County level, arrangements have been made to accommodate the one to many relationship between the council and the CCGs. Separate section 75 agreements have been drawn up for each CCG area to cover the 2017-19 period. A copy of the final agreement for the CCG is attached at appendix 1.

4.2 For reference, the table below shows the financial split and relative contributions

5. Monitoring arrangements

5.1 Quarterly monitoring of the BCF metrics is undertaken by NHS England. Locally, the BCF is

monitored by the Integrated Care Networks and through the Suffolk Commissioners Group. 6. Recommendation

6.1 The Governing Body is asked to approve the BCF agreement for 2017-19 and proposed

monitoring arrangements.

© Bevan Brittan LLP this document may be used by any Health service body or local authority with acknowledgment of authorship 10876404-v2

Dated 2018

SUFFOLK COUNTY COUNCIL

and

NHS WEST SUFFOLK CLINICAL COMMISSIONING GROUP

FRAMEWORK PARTNERSHIP AGREEMENT RELATING TO THE COMMISSIONING OF HEALTH AND SOCIAL

CARE SERVICES AND THE BETTER CARE FUND

i

Contents

Item Page

PARTIES 1 BACKGROUND 1 1 DEFINED TERMS AND INTERPRETATION 1 2 TERM 6 3 GENERAL PRINCIPLES 6 4 PARTNERSHIP FLEXIBILITIES 6 5 FUNCTIONS 7 6 COMMISSIONING ARRANGEMENTS 7 7 ESTABLISHMENT OF A POOLED FUND 8 8 POOLED FUND MANAGEMENT 9 9 NON POOLED FUNDS 9 10 FINANCIAL CONTRIBUTIONS 10 11 NON FINANCIAL CONTRIBUTIONS 10 12 RISK SHARE ARRANGEMENTS, OVERSPENDS AND UNDERSPENDS 10 13 CAPITAL EXPENDITURE 11 14 VAT 11 15 AUDIT AND RIGHT OF ACCESS 11 16 LIABILITIES AND INSURANCE AND INDEMNITY 11 17 STANDARDS OF CONDUCT AND SERVICE 12 18 CONFLICTS OF INTEREST 13 19 GOVERNANCE 13 20 REVIEW 13 21 COMPLAINTS 13 22 TERMINATION & DEFAULT 14 23 DISPUTE RESOLUTION 15 24 FORCE MAJEURE 15 25 CONFIDENTIALITY 15 26 DATA PROTECTION, DATA SHARING, FREEDOM OF INFORMATION AND ENVIRONMENTAL PROTECTION REGULATIONS 16 27 OMBUDSMEN 17 28 INFORMATION SHARING 17 29 NOTICES 17 30 VARIATION 18 31 CHANGE IN LAW 18 32 WAIVER 18 33 SEVERANCE 18 34 ASSIGNMENT AND SUB CONTRACTING 18 35 EXCLUSION OF PARTNERSHIP AND AGENCY 18 36 THIRD PARTY RIGHTS 19

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37 ENTIRE AGREEMENT 19 38 COUNTERPARTS 19 39 GOVERNING LAW AND JURISDICTION 19 SCHEDULE 1 – POOLED FUND MANAGEMENT AND SCHEME SPECIFICATON FOR WEST SUFFOLK CCG & SUFFOLK COUNTY COUNCIL 21 SCHEDULE 2 – GOVERNANCE ERROR! BOOKMARK NOT DEFINED.5

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THIS AGREEMENT is made on day of 2018 PARTIES

(1) SUFFOLK COUNTY COUNCIL of Endeavour House, 8 Russell Road, Ipswich, Suffolk IP1 2BX (the "Council")

(2) NHS WEST SUFFOLK CLINICAL COMMISSIONING GROUP of West Suffolk House, Western Way, Bury St Edmunds, Suffolk IP33 3YU (the "CCG")

BACKGROUND

(A) The Council has responsibility for commissioning and/or providing social care services on behalf of the population of the County of Suffolk.

(B) The CCG has the responsibility for commissioning health services pursuant to the 2006 Act for patients registered to GP practices in the West of Suffolk.

(C) The Better Care Fund has been established by the Government to provide funds to local areas to support the integration of health and social care and to seek to achieve the National Conditions and local objectives. It is a requirement of the Better Care Fund that the CCG and the Council establish a pooled fund for this purpose.

(D) Section 75 of the 2006 Act gives powers to local authorities and clinical commissioning groups to establish and maintain pooled funds out of which payment may be made towards expenditure incurred in the exercise of prescribed local authority functions and prescribed NHS functions.

(E) The purpose of this Agreement is to set out the terms on which the Partners have agreed to collaborate and to establish a framework through which the Partners can secure the future position of health and social care services through lead or joint commissioning arrangements. It is also means through which the Partners will pool funds and align budgets as agreed between the Partners.

(F) The aims and benefits of the Partners in entering in to this Agreement are to:

a) improve the quality and efficiency of the Services;

b) meet the National Conditions and local objectives;

c) make more effective use of resources through the establishment and maintenance of a pooled fund for expenditure on the Services.

(G) The Partners have jointly carried out consultations on the proposals for this Agreement with all those persons likely to be affected by the arrangements.

(H) The Partners are entering into this Agreement in exercise of the powers referred to in Section 75 of the 2006 Act and/or Section 13Z(2) and 14Z(3) of the 2006 Act as applicable, to the extent that exercise of these powers is required for this Agreement.

1 DEFINED TERMS AND INTERPRETATION

1.1 In this Agreement, save where the context requires otherwise, the following words, terms and expressions shall have the following meanings:

1998 Act means the Data Protection Act 1998.

2000 Act means the Freedom of Information Act 2000.

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2004 Regulations means the Environmental Information Regulations 2004.

2006 Act means the National Health Service Act 2006.

Affected Partner means, in the context of Clause 24, the Partner whose obligations under the Agreement have been affected by the occurrence of a Force Majeure Event

Agreement means this agreement including its Schedules and Appendices.

Alliance means the partnership formed between Suffolk Council, NSFT, Suffolk GP Federation and Ipswich Hospital/West Suffolk Foundation Trust in East and West Suffolk

Approved Expenditure means any additional expenditure approved by the Partners in relation to an Individual Scheme above any Contract Price.

Authorised Officers means an officer of each Partner appointed to be that Partner's representative for the purpose of this Agreement.

Better Care Fund means the Better Care Fund as described in NHS England Publications Gateway Ref. No.00314 and NHS England Publications Gateway Ref. No.00535 as relevant to the Partners.

Better Care Fund Plan means the plan agreed between the Partners and setting out the Partners’ plan for the use of the Better Care Fund.

CCG Statutory Duties means the Duties of the CCG pursuant to Sections 14P to 14Z2 of the 2006 Act

Change in Law means the coming into effect or repeal (without re-enactment or consolidation) in England of any Law, or any amendment or variation to any Law, or any judgment of a relevant court of law which changes binding precedent in England after the date of this Agreement

Commencement Date means 00:01 hrs on 1st April 2017.

Confidential Information means information, data and/or material of any nature which any Partner may receive or obtain in connection with the operation of this Agreement and the Services and:

(a) which comprises Personal Data or Sensitive Personal Data or which relates to any patient or his treatment or medical history;

(b) the release of which is likely to prejudice the commercial interests of a Partner or the interests of a Service User respectively; or

(c) which is a trade secret.

Contract Price means any sum payable to a Provider under a Service Contract as consideration for the provision of Services and which, for the avoidance of doubt, does not include any Default Liability.

Default Liability means any sum which is agreed or determined by Law or in accordance with the terms of a Services Contract to be payable by any Partner(s) to the Provider as a consequence of (i) breach by any or all of the Partners of an obligation(s) in whole or in part under the relevant Services Contract or (ii) any act or omission of a third party for which any or all of the Partners are, under the terms of the relevant Services Contract, liable to the Provider.

Financial Contributions means the financial contributions made by each Partner to a Pooled Fund in any Financial Year.

Financial Year means each financial year running from 1 April in any year to 31 March in the following calendar year.

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Force Majeure Event means one or more of the following: (a) war, civil war (whether declared or undeclared), riot or armed conflict;

(b) acts of terrorism;

(c) acts of God;

(d) fire or flood;

(e) industrial action;

(f) prevention from or hindrance in obtaining raw materials, energy or other supplies;

(g) any form of contamination or virus outbreak; and (h) any other event, in each case where such event is beyond the reasonable control of the Partner claiming relief

Functions means the NHS Functions and the Health Related Functions HRA means the Human Rights Act 1998

Health Related Functions means those of the health related functions of the Council, specified in Regulation 6 of the Regulations as relevant to the commissioning of the Services and which may be further described in the relevant Scheme Specification.

Host Partner means for each Pooled Fund the Partner that will host the Pooled Fund and for each Aligned Fund the Partner that will host the Aligned Fund.

Health and Wellbeing Board means the Health and Wellbeing Board established by the Council pursuant to Section 194 of the Health and Social Care Act 2012.

Indirect Losses means loss of profits, loss of use, loss of production, increased operating costs, loss of business, loss of business opportunity, loss of reputation or goodwill or any other consequential or indirect loss of any nature, whether arising in tort or on any other basis.

Individual Scheme means one of the schemes which is agreed by the Partners to be included within this Agreement using the powers under Section 75 as documented in a Scheme Specification.

Integrated Care Network means the partnership body responsible for review of performance and oversight of this Agreement as set out in clause 19 and which is referred to in this Agreement as the Partnership Board.

Integrated Commissioning means arrangements by which both Partners commission Services in relation to an Individual Scheme on behalf of each other in exercise of both the NHS Functions and Health Related Functions through integrated structures.

Joint (Aligned) Commissioning means a mechanism by which the Partners jointly commission a Service. For the avoidance of doubt, a joint (aligned) commissioning arrangement does not involve the delegation of any functions pursuant to Section 75.

Law means:

(a) any statute or proclamation or any delegated or subordinate legislation;

(b) any enforceable community right within the meaning of Section 2(1) European Communities Act 1972;

(c) any guidance, direction or determination with which the Partner(s) or relevant third party (as applicable) are bound to comply to the extent that the same are published and publicly available or the existence or contents of them have been notified to the Partner(s) or relevant third party (as applicable); and

(d) any judgment of a relevant court of law which is a binding precedent in England.

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Lead Commissioning Arrangements means the arrangements by which one Partner commissions Services in relation to an Individual Scheme on behalf of the other Partner in exercise of both the NHS Functions and the Health Related Functions.

Lead Commissioner means the Partner responsible for commissioning an Individual Scheme under a Scheme Specification.

Losses means all damage, loss, liabilities, claims, actions, costs, expenses (including the cost of legal and/or professional services), proceedings, demands and charges whether arising under statute, contract or at common law but excluding Indirect Losses and "Loss" shall be interpreted accordingly.

Month means a calendar month.

National Conditions mean the national conditions as set out in the NHS England Planning Guidance as are amended or replaced from time to time.

NHS Functions means those of the NHS functions listed in Regulation 5 of the Regulations as are exercisable by the CCG as are relevant to the commissioning of the Services and which may be further described in each Scheme Specification

Non Pooled Fund means the budget detailing the financial contributions of the Partners which are not included in a Pooled Fund in respect of a particular Service as set out in the relevant Scheme Specification

Non-Recurrent Payments means funding provided by a Partner to a Pooled Fund in addition to the Financial Contributions pursuant to arrangements agreed in accordance with Clause 10.3.

Overspend means any expenditure from a Pooled Fund in a Financial Year which exceeds the Financial Contributions for that Financial Year.

Partner means each of the CCG and the Council, and references to "Partners" shall be construed accordingly.

Partnership Board means the partnership board responsible for review of performance and oversight of this Agreement as set out in Clause 19. For the purpose of this document the Integrated Care Network is the Partnership Board.

Permitted Budget means in relation to particular Services where the Council is the Provider, the budget that has been set in relation to the particular Services.

Permitted Expenditure has the meaning given in Clause 7.3.

Personal Data means Personal Data as defined by the 1998 Act.

Pooled Fund means any pooled fund established and maintained by the Partners as a pooled fund in accordance with the Regulations

Pooled Fund Manager means such officer of the Host Partner which includes a Section 113 Officer for the relevant Pooled Fund established under an Individual Scheme as is nominated by the Host Partner from time to time to manage the Pooled Fund.

Provider means a provider of any Services commissioned under the arrangements set out in this Agreement.

Public Health England means the SOSH trading as Public Health England.

Quarter means each of the following periods in a Financial Year:

1 April to 30 June

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1 July to 30 September

1 October to 31 December

1 January to 31 March

and "Quarterly" shall be interpreted accordingly.

Regulations means the means the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000 No 617 (as amended).

Scheme Specification means a specification setting out the arrangements for an Individual Scheme agreed by the Partners to be commissioned under this Agreement.

Sensitive Personal Data means Sensitive Personal Data as defined in the 1998 Act.

Services means such health and social care services as agreed from time to time by the Partners as commissioned under the arrangements set out in this Agreement and more specifically defined in each Scheme Specification.

Services Contract means an agreement for the provision of Services entered into with a Provider by one or more of the Partners in accordance with the relevant Individual Scheme.

Service Users means those individuals for whom the Partners have a responsibility to commission the Services.

SOSH means the Secretary of State for Health.

Suffolk CCGs means Ipswich and East Suffolk Clinical Commissioning Group , West Suffolk Clinical Commissioning Group and Great Yarmouth and Waveney Clinical Commissioning Group.

Working Day means 8.00am to 6.00pm on any day except Saturday, Sunday, Christmas Day, Good Friday or a day which is a bank holiday (in England) under the Banking & Financial Dealings Act 1971.

1.2 In this Agreement, all references to any statute or statutory provision shall be deemed to include references to any statute or statutory provision which amends, extends, consolidates or replaces the same and shall include any orders, regulations, codes of practice, instruments or other subordinate legislation made thereunder and any conditions attaching thereto. Where relevant, references to English statutes and statutory provisions shall be construed as references also to equivalent statutes, statutory provisions and rules of law in other jurisdictions.

1.3 Any headings to Clauses, together with the front cover and the index are for convenience only and shall not affect the meaning of this Agreement. Unless the contrary is stated, references to Clauses and Schedules shall mean the clauses and schedules of this Agreement.

1.4 Any reference to the Partners shall include their respective statutory successors, employees and agents.

1.5 In the event of a conflict, the conditions set out in the Clauses to this Agreement shall take priority over the Schedules.

1.6 Where a term of this Agreement provides for a list of items following the word "including" or "includes", then such list is not to be interpreted as being an exhaustive list.

1.7 In this Agreement, words importing any particular gender include all other genders, and the term "person" includes any individual, partnership, firm, trust, body corporate, government, governmental body, trust, agency, unincorporated body of persons or association and a reference to a person includes a reference to that person's successors and permitted assigns.

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1.8 In this Agreement, words importing the singular only shall include the plural and vice versa.

1.9 In this Agreement, "staff" and "employees" shall have the same meaning and shall include reference to any full or part time employee or officer, director, manager and agent.

1.10 Subject to the contrary being stated expressly or implied from the context in these terms and conditions, all communication between the Partners shall be in writing.

1.11 Unless expressly stated otherwise, all monetary amounts are expressed in pounds sterling but in the event that pounds sterling is replaced as legal tender in the United Kingdom by a different currency then all monetary amounts shall be converted into such other currency at the rate prevailing on the date such other currency first became legal tender in the United Kingdom.

1.12 All references to the Agreement include (subject to all relevant approvals) a reference to the Agreement as amended, supplemented, substituted, novated or assigned from time to time.

2 TERM

2.1 This Agreement shall come into force on the Commencement Date

2.2 This Agreement shall continue until it is terminated in accordance with Clause 22

2.3 The duration of the arrangements for each Individual Scheme shall be as set out in the relevant Scheme Specification.

3 GENERAL PRINCIPLES

3.1 Nothing in this Agreement shall affect:

3.1.1 the liabilities of the Partners to each other or to any third parties for the exercise of their respective functions and obligations (including the Functions); or

3.1.2 any power or duty to recover charges for the provision of any services (including the Services) in the exercise of any local authority function.

3.2 The Partners agree to:

3.2.1 treat each other with respect and an equality of esteem;

3.2.2 be open with information about the performance and financial status of each; and

3.2.3 provide early information and notice about relevant problems.

3.3 For the avoidance of doubt, the aims and outcomes relating to an Individual Scheme may be set out in the relevant Scheme Specification.

4 PARTNERSHIP FLEXIBILITIES

4.1 This Agreement sets out the mechanism through which the Partners will work together to establish a Pooled Fund (the "Flexibilities")

4.2 The Flexibilities shall initially be limited to the matters referred to at clause 4.1 but the Partners recognise that they may by agreement wish to include Joint (Aligned) Commissioning, Lead Commissioning Arrangements and Integrated Commissioning at a later stage. Should the Partners agree to vary the Agreement by the addition of any of these arrangements, the arrangements shall also be treated as “Flexibilities” for the purposes of this Agreement

4.3 Where the Partners agree to extend the Flexibilities to include Lead Commissioning Arrangements or Integrated Commissioning as set out in clause 4.2, the Council shall delegate to the CCG and the

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CCG shall agree to exercise, on the Council's behalf, the Health Related Functions to the extent necessary for the purpose of performing its obligations under this Agreement in conjunction with the NHS Functions.

4.4 Where the Partners agree to extend the Flexibilities to include Lead Commissioning Arrangements or Integrated Commissioning as set out in clause 4.2, the CCG shall delegate to the Council and the Council shall agree to exercise on the CCG's behalf the NHS Functions to the extent necessary for the purpose of performing its obligations under this Agreement in conjunction with the Health Related Functions.

4.5 Where the powers of a Partner to delegate any of its statutory powers or functions are restricted, such limitations will automatically be deemed to apply to the relevant Scheme Specification and the Partners shall agree arrangements designed to achieve the greatest degree of delegation to the other Partner necessary for the purposes of this Agreement which is consistent with the statutory constraints.

5 FUNCTIONS

5.1 The purpose of this Agreement is to establish a framework through which the Partners can secure the provision of health and social care services in accordance with the terms of this Agreement.

5.2 This Agreement shall include such functions as shall be agreed from time to time by the Partners.

5.3 Where the Partners add a new Individual Scheme to this Agreement a Scheme Specification for each Individual Scheme shall be completed and agreed between the Partners.

5.4 The Partners shall not enter into a Scheme Specification in respect of an Individual Scheme unless they are satisfied that the Individual Scheme in question will improve health and wellbeing in accordance with this Agreement.

5.5 The introduction of any Individual Scheme will be subject to business case approval by the Partners.

6 COMMISSIONING ARRANGEMENTS

6.1 Where there are Integrated Commissioning arrangements in respect of an Individual Scheme, both Partners shall work in cooperation and shall endeavour to ensure that the NHS Functions and Health Related Functions are commissioned with all due skill, care and attention.

6.2 Where there are Integrated Commissioning arrangements or Joint (Aligned) Commissioning arrangements in respect of an Individual Scheme, both Partners shall be responsible for compliance with and making payments of all sums due to a Provider if this is what is agreed and required pursuant to the terms of the relevant Service Contract.

6.3 Both Partners shall work in cooperation and endeavour to ensure that the relevant Services as set out in each Scheme Specification are commissioned within each Partner’s Financial Contribution in respect of that particular Service in each Financial Year.

6.4 The Partners shall comply with the arrangements in respect of any Joint (Aligned) Commissioning as set out in the relevant Scheme Specification if this is what is agreed and required by the terms of the relevant Scheme Specification.

6.5 Each Partner shall keep the other Partners and the Partnership Board regularly informed of the effectiveness of the arrangements including the Better Care Fund and any Overspend or Underspend in a Pooled Fund or Non Pooled Fund.

6.6 The Partnership Board will report back to the Health and Wellbeing Board as required by its Terms of Reference.

Appointment of a Lead Commissioner

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6.7 Where there are Lead Commissioning Arrangements in respect of an Individual Scheme the Lead Commissioner shall:

6.7.1 exercise the NHS Functions in conjunction with the Health Related Functions as identified in the relevant Scheme Specification;

6.7.2 endeavour to ensure that the NHS Functions and the Health Related Functions are funded within the parameters of the Financial Contributions of each Partner in relation to each particular Service in each Financial Year.

6.7.3 commission Services for individuals who meet the eligibility criteria set out in the relevant Scheme Specification;

6.7.4 contract with Provider(s) for the provision of the Services on terms agreed with the other Partners;

6.7.5 comply with all relevant legal duties and guidance of both Partners in relation to the Services being commissioned;

6.7.6 where Services are commissioned using the NHS Standard Form Contract, perform the obligations of the “Commissioner” and “Co-ordinating Commissioner” with all due skill, care and attention and where Services are commissioned using any other form of contract to perform its obligations with all due skill and attention;

6.7.7 undertake performance management and contract monitoring of all Service Contracts;

6.7.8 make payment of all sums due to a Provider pursuant to the terms of any Services Contract.

6.7.9 keep the other Partner and the Partnership Board regularly informed of the effectiveness of the arrangements including the Better Care Fund and any Overspend or Underspend in a Pooled Fund or Non Pooled Fund.

7 ESTABLISHMENT OF A POOLED FUND

7.1 In exercise of their respective powers under Section 75 of the 2006 Act, the Partners have agreed to establish and maintain a Pooled Fund for expenditure as set out in Schedule 1.

7.2 The Pooled Fund shall be managed and maintained in accordance with the terms of this Agreement.

7.3 It is agreed that the monies held in a Pooled Fund may only be expended on the following:

7.3.1 the Contract Price;

7.3.2 where the Council is to be the Provider, the Permitted Budget;

7.3.3 Approved Expenditure

("Permitted Expenditure")

7.4 The Partners may only depart from the definition of Permitted Expenditure to include or exclude other expenditure with the express written agreement of each Partner.

7.5 For the avoidance of doubt, monies held in the Pooled Fund may not be expended on Default Liabilities unless this is agreed by all Partners.

7.6 Pursuant to this Agreement, the Partners agree to appoint a Host Partner for each of the Pooled Funds set out in the Scheme Specifications. The Host Partner shall be the Partner responsible for:

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7.6.1 holding monies contributed to the Pooled Fund on behalf of itself and the other Partners – where all partners agree;

7.6.2 providing the financial administrative systems for the Pooled Fund;

7.6.3 appointing the Pooled Fund Manager; and

7.6.4 ensuring that the Pooled Fund Manager complies with its obligations under this Agreement.

8 POOLED FUND MANAGEMENT

8.1 When introducing a Pooled Fund in respect of one or more Individual Schemes, the Partners shall agree:

8.1.1 which of the Partners shall act as Host Partner for the purposes of Regulations 7(4) and 7(5) and shall provide the financial administrative systems for the Pooled Fund;

8.1.2 which officer of the Host Partner shall act as the Pooled Fund Manager for the purposes of Regulation 7(4) of the Regulations.

8.2 The Pooled Fund Manager shall have the following duties and responsibilities:

8.2.1 the day to day operation and management of the Pooled Fund;

8.2.2 ensuring that all expenditure from the Pooled Fund is in accordance with the provisions of this Agreement and the relevant Scheme Specification(s);

8.2.3 maintaining an overview of all joint financial issues affecting the Partners in relation to the Services and the Pooled Fund;

8.2.4 ensuring that full and proper records for accounting purposes are kept in respect of the Pooled Fund;

8.2.5 ensuring action is taken to manage any projected under or overspends relating to the Pooled Fund in accordance with this Agreement;

8.2.6 preparing and submitting to the Partnership Board Quarterly reports (or more frequent reports if required by the Partnership Board) and an annual return about the income and expenditure from the Pooled Fund together with such other information as may be required by the Partners and the Partnership Board to monitor the effectiveness of the Pooled Fund and to enable the Partners to complete their own financial accounts and returns. The Partners agree to provide all necessary information to the Pooled Fund Manager in time for the reporting requirements to be met.

8.2.7 preparing and submitting reports to the Health and Wellbeing Board as required by it.

8.3 In carrying out their responsibilities as provided under Clause 8.2 the Pooled Fund Manager shall have regard to the recommendations of the Partnership Board and shall be accountable to the Partners.

8.4 The Partners may agree to the viring of funds between Pooled Funds.

9 NON POOLED FUNDS

9.1 Any Financial Contributions agreed to be held within a Non Pooled Fund will be notionally held in a fund established for the purpose of commissioning those Services as set out in the relevant Scheme Specification(s). For the avoidance of doubt, a Non Pooled Fund does not constitute a pooled fund for the purposes of Regulation 7 of the Partnership Regulations.

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9.2 When introducing a Non Pooled Fund in respect of one or more Individual Schemes, the Partners shall agree:

9.2.1 which Partner if any shall host the Non-Pooled Fund

9.2.2 how and when Financial Contributions shall be made to the Non-Pooled Fund.

9.3 The Host Partner will be responsible for establishing the financial and administrative support necessary to enable the effective and efficient management of the Non-Pooled Fund, meeting all required accounting and auditing obligations.

9.4 Both Partners shall ensure that Services commissioned using a Non Pooled Fund are commissioned solely in accordance with the relevant Scheme Specification(s)

9.5 Where there are Joint (Aligned) Commissioning arrangements, both Partners shall work in cooperation and shall endeavour to ensure that:

9.5.1 the NHS Functions funded from a Non-Pooled Fund are carried out within the CCG Financial Contribution to the Non- Pooled Fund for the relevant Service in each Financial Year; and

9.5.2 the Health Related Functions funded from a Non-Pooled Fund are carried out within the Council's Financial Contribution to the Non-Pooled Fund for the relevant Service in each Financial Year.

10 FINANCIAL CONTRIBUTIONS

10.1 The overarching Financial Contributions of the Council and all Suffolk CCGs are set out at Schedule 1, together with the Financial Contributions of the CCG and the Council to the Pooled Fund and any Non-Pooled Fund which are established by this Agreement.

10.2 Financial Contributions of the Partners will be paid as set out in Schedule 1.

10.3 With the exception of Clause 13, no provision of this Agreement shall preclude the Partners from making additional contributions of Non-Recurrent Payments to the Pooled Fund from time to time by mutual agreement. Any such additional contributions of Non-Recurrent Payments shall be explicitly recorded in Partnership Board minutes and recorded in the budget statement as a separate item.

11 NON FINANCIAL CONTRIBUTIONS

11.1 Schedule 1 shall set out non-financial contributions of each Partner including staff (including the Pooled Fund Manager), premises, IT support and other non-financial resources necessary to perform its obligations pursuant to this Agreement (including, but not limited to, management of Service Contracts and the Pooled Fund).

12 RISK SHARE ARRANGEMENTS, OVERSPENDS AND UNDERSPENDS

Risk share arrangements

12.1 The Partners have agreed risk share arrangements as set out in this Agreement, which provide for financial risks arising within the commissioning of services from the pooled funds and the financial risk to the pool arising from the payment for performance element of the Better Care Fund.

Overspends in Pooled Fund

12.2 Subject to Clause 12.3, the Host Partner for the relevant Pooled Fund shall manage expenditure from a Pooled Fund within the Financial Contributions and shall ensure that the expenditure is limited to Permitted Expenditure.

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12.3 The Host Partner shall not be in breach of its obligations under this Agreement if an Overspend occurs PROVIDED THAT expenditure from a Pooled Fund has been in accordance with Permitted Expenditure and it has informed the Partnership Board in accordance with Clause 12.4.

12.4 In the event that the Pooled Fund Manager identifies an actual or projected Overspend the Pooled Fund Manager must ensure that the Partnership Board is informed as soon as reasonably possible and the provisions of this clause shall apply.

Overspends in Non Pooled Funds

12.5 Where in Joint (Aligned) Commissioning Arrangements either Partner forecasts an overspend in relation to a Partners Financial Contribution to a Non-Pooled Fund or Aligned Fund that Partner shall as soon as reasonably practicable inform the other Partner and the Partnership Board.

12.6 Where there is a Lead Commissioning Arrangement the Lead Commissioner is responsible for the management of the Non-Pooled Fund and Aligned Fund. The Lead Commissioner shall as soon as reasonably practicable inform the other Partner and the Partnership Board.

Underspends

12.7 In the event that expenditure from any Pooled Fund or Non Pooled Fund in any Financial Year is less than the aggregate value of the Financial Contributions made for that Financial Year in respect of the relevant Pooled Fund or Non Pooled Fund (an Underspend) then the Partners shall agree how the surplus monies shall be spent, carried forward and/or returned to the Partners provided that the Partners acknowledge that they will operate to the principle that the Partner responsible for the Services shall be entitled to retain the Underspend unless the Partners agree to the contrary. Such arrangements shall be subject to the Law and the Standing Orders and Standing Financial Instructions (or equivalent) of the Partners.

13 CAPITAL EXPENDITURE

With the exception of the Disabilities Facilities Grant neither Pooled Funds or Non Pooled Funds shall normally be applied towards any one-off expenditure on goods and/or services, which will provide continuing benefit and would historically have been funded from the capital budgets of one of the Partners. If a need for capital expenditure is identified this must be agreed by the Partners.

14 VAT

The Partners shall agree the treatment of the Pooled Funds for VAT purposes in accordance with any relevant guidance from HM Customs and Excise.

15 AUDIT AND RIGHT OF ACCESS

15.1 All Partners shall promote a culture of probity and sound financial discipline and control. The Host Partner shall arrange for the audit of the accounts of the relevant Pooled Fund and shall require the appropriate person or body appointed to exercise the functions of the Audit Commission under section 28(1)(d) of the Audit Commission Act 1998, by virtue of an order made under section 49(5) of the Local Audit and Accountability Act 2014 to make arrangements to certify an annual return of those accounts under Section 28(1) of the Audit Commission Act 1998.

15.2 All internal and external auditors and all other persons authorised by the Partners will be given the right of access by them to any document, information or explanation they require from any employee or member of the Partner in order to carry out their duties. This right is not limited to financial information or accounting records and applies equally to premises or equipment used in connection with this Agreement. Access may be at any time without notice, provided there is good cause for access without notice.

16 LIABILITIES AND INSURANCE AND INDEMNITY

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16.1 Subject to Clause 16.2, and 16.3, if a Partner (“First Partner”) incurs a Loss arising out of or in connection with this Agreement or the Services Contract as a consequence of any act or omission of another Partner (“Other Partner”) which constitutes negligence, fraud or a breach of contract in relation to this Agreement or the Services Contract then the Other Partner shall be liable to the First Partner for that Loss and shall indemnify the First Partner accordingly.

16.2 Clause 16.1 shall only apply to the extent that the acts or omissions of the Other Partner contributed to the relevant Loss. Furthermore, it shall not apply if such act or omission occurred as a consequence of the Other Partner acting in accordance with the instructions or requests of the First Partner or the Partnership Board.

16.3 If any third party makes a claim or intimates an intention to make a claim against either Partner, which may reasonably be considered as likely to give rise to liability under this Clause 16. the Partner that may claim against the other indemnifying Partner will:

16.3.1 as soon as reasonably practicable give written notice of that matter to the Other Partner specifying in reasonable detail the nature of the relevant claim;

16.3.2 not make any admission of liability, agreement or compromise in relation to the relevant claim without the prior written consent of the Other Partner (such consent not to be unreasonably conditioned, withheld or delayed);

16.3.3 give the Other Partner and its professional advisers reasonable access to its premises and personnel and to any relevant assets, accounts, documents and records within its power or control so as to enable the Indemnifying Partner and its professional advisers to examine such premises, assets, accounts, documents and records and to take copies at their own expense for the purpose of assessing the merits of, and if necessary defending, the relevant claim.

16.4 Each Partner shall ensure that they have in place appropriate arrangements in respect of all potential liabilities arising from this Agreement through:

16.4.1 the maintenance of policies of insurance or equivalent arrangements through schemes operated by the National Health Service Litigation Authority; or

16.4.2 self-insurance arrangements in line with the relevant Partner’s practices

16.5 Each Partner shall at all times take all reasonable steps to minimise and mitigate any loss for which one party is entitled to bring a claim against the other pursuant to this Agreement.

17 STANDARDS OF CONDUCT AND SERVICE

17.1 The Partners will at all times comply with Law and ensure good corporate governance in respect of each Partner (including the Partners’ respective Standing Orders and Standing Financial Instructions).

17.2 The Council is subject to the duty of Best Value under the Local Government Act 1999. This Agreement and the operation of the Pooled Fund is therefore subject to the Council’s obligations for Best Value and the other Partners will co-operate with all reasonable requests from the Council which the Council considers necessary in order to fulfil its Best Value obligations.

17.3 The CCG is subject to the CCG Statutory Duties and these incorporate a duty of clinical governance, which is a framework through which they are accountable for continuously improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. This Agreement and the operation of the Pooled Funds are therefore subject to ensuring compliance with the CCG Statutory Duties and clinical governance obligations.

17.4 The Partners are committed to an approach to equality and equal opportunities as represented in their respective policies. The Partners will maintain and develop these policies as applied to service provision, with the aim of developing a joint strategy for all elements of the service.

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18 CONFLICTS OF INTEREST

The Partners shall have in place processes for identifying and managing conflicts of interest.

19 GOVERNANCE

Overall strategic oversight of partnership working between the partners is vested in the Health and Wellbeing Board, which for these purposes shall make recommendations to the Partners as to any action it considers necessary.

The Partnership Board with responsibility for review and oversight of this agreement in each of the three Health and Wellbeing Board CCG areas is as follows:

Ipswich and East Suffolk – Integrated Care Network and the Suffolk Commissioners Group will review progress quarterly.

West Suffolk – Integrated Care Network and the Suffolk Commissioners Group will review progress quarterly.

Waveney – Great Yarmouth and Waveney Integration Group will review progress quarterly.

In all systems the programmes contained within the Better Care Fund Plan are integral to delivery of the relevant Sustainability and Transformation Plan. The STP programme will therefore be reviewing and leading on transformational delivery, including the BCF schemes and ambitions.

.

19.1 Each Partner has secured internal reporting arrangements to ensure the standards of accountability and probity required by each Partner's own statutory duties and organisation are complied with.

19.2 The Partners shall be responsible for the overall approval of the Individual Schemes, ensuring compliance with the Better Care Fund Plan and the strategic direction of the Better Care Fund.

19.3 Each Scheme Specification shall, if relevant, confirm the governance arrangements in respect of the Individual Schemes and how that Individual Scheme is reported to the Partnership Board relevant partnership board and Health and Wellbeing Board.

20 REVIEW

20.1 Save where the Partnership Board agree alternative arrangements (including alternative frequencies) the Partners shall undertake an annual review (“Annual Review”) of the operation of this Agreement, any Pooled Fund, Non Pooled Fund and Aligned Fund and the provision of the Services within 3 Months of the end of each Financial Year.

20.2 Subject to any variations to this process required by the Partnership Board, Annual Reviews shall be conducted in good faith and, where applicable, in accordance with the governance arrangements set out in Schedule 2.

20.3 The Partners shall within 20 Working Days of the annual review prepare a joint annual report documenting the matters referred to in this Clause 20. A copy of this report shall be provided to the Partnership Board.

20.4 In the event that the Partners fail to meet the requirements of the Better Care Fund Plan and NHS England the Partners shall provide full co-operation with NHS England to agree a recovery plan.

21 COMPLAINTS

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The Partners’ own complaints procedures shall apply to this Agreement. The Partners agree to assist one another in the management of complaints arising from this Agreement or the provision of the Services.

22 TERMINATION & DEFAULT

22.1 This Agreement shall commence on the Commencement Date and continue for 24 months until 31 March 2019 provided that the Agreement may be extended for a further period of 12 months (or such other period as the Partners may agree) by written agreement of the Partners.

22.2 The Partners shall work together in a timely manner to consider whether an extension of the Agreement is appropriate.

22.3 Each Individual Scheme may be terminated in accordance with the terms set out in the relevant Scheme Specification provided that the Partners ensure that the Better Care Fund requirements continue to be met.

22.4 If any Partner (“Relevant Partner”) fails to meet any of its obligations under this Agreement, the other Partner may by notice require the Relevant Partner to take such reasonable action within a reasonable timescale as the other Partner may specify to rectify such failure. Should the Relevant Partner fail to rectify such failure within such reasonable timescale, the matter shall be referred for resolution in accordance with Clause 23.

22.5 Termination of this Agreement (whether by effluxion of time or otherwise) shall be without prejudice to the Partners’ rights in respect of any antecedent breach.

22.6 Upon termination of this Agreement for any reason whatsoever the following shall apply:

22.6.1 the Partners agree that they will work together and co-operate to ensure that the winding down and disaggregation of the integrated and joint activities to the separate responsibilities of the Partners is carried out smoothly and with as little disruption as possible to service users, employees, the Partners and third parties, so as to minimise costs and liabilities of each Partner in doing so;

22.6.2 where either Partner has entered into a Service Contract which continues after the termination of this Agreement, both Partners shall, where relevant, continue to contribute to the Contract Price in accordance with the agreed contribution for that Service prior to termination and will enter into all appropriate legal documentation required in respect of this;

22.6.3 where relevant, the Lead Commissioner shall make reasonable endeavours to amend or terminate a Service Contract (which shall for the avoidance of doubt not include any act or omission that would place the Lead Commissioner in breach of the Service Contract) where the other Partner requests the same in writing. Provided that the Lead Commissioner shall not be required to make any payments to the Provider for such amendment or termination unless the Partners shall have agreed in advance who shall be responsible for any such payment.

22.6.4 where a Service Contract held by a Lead Commissioner relates all or partially to services which relate to the other Partner's Functions then provided that the Service Contract allows the other Partner may request that the Lead Commissioner assigns the Service Contract in whole or part upon the same terms mutatis mutandis as the original contract.

22.6.5 where the Partners jointly fund a contract, the Partnership Board shall continue to operate for the purposes of functions associated with this Agreement for the remainder of any such contracts and commitments relating to this Agreement; and

22.6.6 termination of this Agreement shall have no effect on the liability of any rights or remedies of either Partner already accrued, prior to the date upon which such termination takes effect.

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22.7 In the event of termination in relation to an Individual Scheme the provisions of Clause 22.6 shall apply mutatis mutandis in relation to the Individual Scheme (as though references as to this Agreement were to that Individual Scheme).

23 DISPUTE RESOLUTION

23.1 In the event of a dispute between the Partners arising out of this Agreement, either Partner may serve written notice of the dispute on the other Partner, setting out full details of the dispute.

23.2 The Authorised Officers shall meet in good faith as soon as possible and in any event within seven (7) days of notice of the dispute being served pursuant to Clause 23.1, at a meeting convened for the purpose of resolving the dispute.

23.3 If the dispute remains after the meeting detailed in Clause 23.2 has taken place, the Partners' respective chief executives or nominees shall meet in good faith as soon as possible after the relevant meeting and in any event with fourteen (14) days of the date of the meeting, for the purpose of resolving the dispute.

23.4 If the dispute remains after the meeting detailed in Clause 23.3 has taken place, then the Partners will attempt to settle such dispute by mediation in accordance with the CEDR Model Mediation Procedure or any other model mediation procedure as agreed by the Partners. To initiate a mediation, either Partner may give notice in writing (a "Mediation Notice") to the other requesting mediation of the dispute and shall send a copy thereof to CEDR or an equivalent mediation organisation as agreed by the Partners asking them to nominate a mediator. The mediation shall commence within twenty (20) Working Days of the Mediation Notice being served. Neither Partner will terminate such mediation until each of them has made its opening presentation and the mediator has met each of them separately for at least one (1) hour. Thereafter, paragraph 14 of the Model Mediation Procedure will apply (or the equivalent paragraph of any other model mediation procedure agreed by the Partners). The Partners will co-operate with any person appointed as mediator, providing him with such information and other assistance as he shall require and will pay his costs as he shall determine or in the absence of such determination such costs will be shared equally.

23.5 Nothing in the procedure set out in this Clause 23 shall in any way affect either Partner's right to terminate this Agreement in accordance with any of its terms or take immediate legal action.

24 FORCE MAJEURE

24.1 Neither Partner shall be entitled to bring a claim for a breach of obligations under this Agreement by the other Partner or incur any liability to the other Partner for any losses or damages incurred by that Partner to the extent that a Force Majeure Event occurs and it is prevented from carrying out its obligations by that Force Majeure Event.

24.2 On the occurrence of a Force Majeure Event, the Affected Partner shall notify the other Partner as soon as practicable. Such notification shall include details of the Force Majeure Event, including evidence of its effect on the obligations of the Affected Partner and any action proposed to mitigate its effect.

24.3 As soon as practicable, following notification as detailed in Clause 24.2, the Partners shall consult with each other in good faith and use all best endeavours to agree appropriate terms to mitigate the effects of the Force Majeure Event and, subject to Clause 24.4, facilitate the continued performance of the Agreement.

24.4 If the Force Majeure Event continues for a period of more than sixty (60) days, either Partner shall have the right to terminate the Agreement by giving fourteen (14) days written notice of termination to the other Partner. For the avoidance of doubt, no compensation shall be payable by either Partner as a direct consequence of this Agreement being terminated in accordance with this Clause.

25 CONFIDENTIALITY

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25.1 In respect of any Confidential Information a Partner receives from another Partner (the "Discloser") and subject always to the remainder of this Clause 25, each Partner (the "Recipient”) undertakes to keep secret and strictly confidential and shall not disclose any such Confidential Information to any third party, without the Discloser’s prior written consent provided that:

25.1.1 the Recipient shall not be prevented from using any general knowledge, experience or skills which were in its possession prior to the Commencement Date; and

25.1.2 the provisions of this Clause 25 shall not apply to any Confidential Information which:

is in or enters the public domain other than by breach of the Agreement or other act or omission of the Recipient;

is obtained by a third party who is lawfully authorised to disclose such information;

is disclosed in connection with any Dispute Resolution;

is disclosed to any appropriate regulatory or supervisory body; or

is disclosed to NHS Bodies for the purposes of carrying out their duties

25.2 Nothing in this Clause 25 shall prevent the Recipient from disclosing Confidential Information where it is required to do so in fulfilment of statutory obligations or by judicial, administrative, governmental or regulatory process in connection with any action, suit, proceedings or claim or otherwise by applicable Law.

25.3 Each Partner:

25.3.1 may only disclose Confidential Information to its employees and professional advisors to the extent strictly necessary for such employees to carry out their duties under the Agreement; and

25.3.2 will ensure that, where Confidential Information is disclosed in accordance with Clause 25.3.1, the recipient(s) of that information is made subject to a duty of confidentiality equivalent to that contained in this Clause 25;

25.3.3 shall not use Confidential Information other than strictly for the performance of its obligations under this Agreement.

26 DATA PROTECTION, DATA SHARING, FREEDOM OF INFORMATION AND ENVIRONMENTAL PROTECTION REGULATIONS

26.1 The Partners acknowledge their respective obligations arising under the 2000 Act, the 1998 Act, the 2004 Regulations and the HRA, and under the common law duty of confidentiality, and shall assist each other as necessary to enable each other to comply with these obligations.

26.2 The Partners shall agree an Information Governance Protocol and audit their practices against it. 26.3 Where the Partners or the Partnership Board require information for the purposes of

quality management of care processes, the Partners shall provide anonymised, pseudonymised or aggregated data, and must not disclose Personal Data for those purposes without written consent or some other lawful basis for disclosure

26.4 The Partners shall agree, in respect of each Individual Scheme, who is the Data Controller and who

is the Data Processor (this may be one of the Partners or a third party provider) and shall ensure that they have in place or that their provider has in place suitable provisions to ensure that personal data for the purposes of the 1998 Act is controlled and processed in accordance with the 1998 Act.

26.5 The Partners agree that they will each cooperate with each other to enable any Partner receiving a

request for information under the 2000 Act or the 2004 Act to respond to a request promptly and within the statutory timescales. This cooperation shall include but not be limited to finding, retrieving and

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supplying information held, directing requests to other Partners as appropriate and responding to any requests by the Partner receiving a request for comments or other assistance.

26.6 Any and all agreements between the Partners as to confidentiality shall be subject to their duties under the 2000 Act and 2004 Act. No Partner shall be in breach of Clause 26 if it makes disclosures of information in accordance with the 2000 Act and/or 2004 Act.

27 OMBUDSMEN

The Partners will co-operate with any investigation undertaken by the Health Service Commissioner for England or the Local Government Commissioner for England (or both of them) in connection with this Agreement.

28 INFORMATION SHARING

The Partners will agree an Information Governance Protocol, and in so doing will ensure that this Agreement complies with Law, in particular the 1998 Act.

29 NOTICES

29.1 Any notice to be given under this Agreement shall either be delivered personally or sent by first class post or electronic mail. The address for service of each Partner shall be as set out in Clause 29.3 or such other address as each Partner may previously have notified to the other Partner in writing. A notice shall be deemed to have been served if:

29.1.1 personally delivered, at the time of delivery;

29.1.2 posted, at the expiration of forty eight (48) hours after the envelope containing the same was delivered into the custody of the postal authorities; and

29.1.3 if sent by electronic mail, at the time of transmission and a telephone call must be made to the recipient warning the recipient that an electronic mail message has been sent to him (as evidenced by a contemporaneous note of the Partner sending the notice) and a hard copy of such notice is also sent by first class recorded delivery post (airmail if overseas) on the same day as that on which the electronic mail is sent.

29.2 In proving such service, it shall be sufficient to prove that personal delivery was made, or that the envelope containing such notice was properly addressed and delivered into the custody of the postal authority as prepaid first class or airmail letter (as appropriate), or that the facsimile was transmitted on a tested line or that the correct transmission report was received from the facsimile machine sending the notice, or that the electronic mail was properly addressed and no message was received informing the sender that it had not been received by the recipient (as the case may be).

29.3 The address for service of notices as referred to in Clause 29.1 shall be as follows unless otherwise notified to the other Partner in writing:

29.3.1 if to the Council, addressed to;

Mike Hennessey Director of Adult and Community Services Suffolk County Council Endeavour House 8 Russell Road Ipswich Suffolk IP1 2BX

Tel: 01473 260726 E.Mail: mike.hennessey@suffolk.gov.uk

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and

29.3.2 if to the CCG, addressed to:

Ed Garratt West Suffolk House Western Way Bury St Edmunds Suffolk IP33 3YU Tel: 01284 758010 E Mail: ed.garratt@suffolk.nhs.uk

30 VARIATION

No variations to this Agreement will be valid unless they are recorded in writing and signed for and on behalf of each of the Partners.

31 CHANGE IN LAW

31.1 The Partners shall ascertain, observe, perform and comply with all relevant Laws, and shall do and execute or cause to be done and executed all acts required to be done under or by virtue of any Laws.

31.2 On the occurrence of any Change in Law, the Partners shall agree in good faith any amendment required to this Agreement as a result of the Change in Law subject to the Partners using all reasonable endeavours to mitigate the adverse effects of such Change in Law and taking all reasonable steps to minimise any increase in costs arising from such Change in Law.

31.3 In the event of failure by the Partners to agree the relevant amendments to the Agreement (as appropriate), the Clause 23 (Dispute Resolution) shall apply.

32 WAIVER

No failure or delay by any Partner to exercise any right, power or remedy will operate as a waiver of it nor will any partial exercise preclude any further exercise of the same or of some other right to remedy.

33 SEVERANCE

If any provision of this Agreement, not being of a fundamental nature, shall be held to be illegal or unenforceable, the enforceability of the remainder of this Agreement shall not thereby be affected.

34 ASSIGNMENT AND SUB CONTRACTING

The Partners shall not sub contract, assign or transfer the whole or any part of this Agreement, without the prior written consent of the other Partners, which shall not be unreasonably withheld or delayed. This shall not apply to any assignment to a statutory successor of all or part of a Partner’s statutory functions.

35 EXCLUSION OF PARTNERSHIP AND AGENCY

35.1 Nothing in this Agreement shall create or be deemed to create a partnership under the Partnership Act 1890 or the Limited Partnership Act 1907, a joint venture or the relationship of employer and employee between the Partners or render either Partner directly liable to any third party for the debts, liabilities or obligations of the other.

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35.2 Except as expressly provided otherwise in this Agreement or where the context or any statutory provision otherwise necessarily requires, neither Partner will have authority to, or hold itself out as having authority to:

35.2.1 act as an agent of the other;

35.2.2 make any representations or give any warranties to third parties on behalf of or in respect of the other; or

35.2.3 bind the other in any way.

36 THIRD PARTY RIGHTS

Unless the right of enforcement is expressly provided, no third party shall have the right to pursue any right under this Contract pursuant to the Contracts (Rights of Third Parties) Act 1999 or otherwise.

37 ENTIRE AGREEMENT

37.1 The terms herein contained together with the contents of the Schedules constitute the complete agreement between the Partners with respect to the subject matter hereof and supersede all previous communications representations understandings and agreement and any representation promise or condition not incorporated herein shall not be binding on any Partner.

37.2 No agreement or understanding varying or extending or pursuant to any of the terms or provisions hereof shall be binding upon any Partner unless in writing and signed by a duly authorised officer or representative of the parties.

38 COUNTERPARTS

This Agreement may be executed in one or more counterparts. Any single counterpart or a set of counterparts executed, in either case, by all Partners shall constitute a full original of this Agreement for all purposes.

39 GOVERNING LAW AND JURISDICTION

39.1 This Agreement and any dispute or claim arising out of or in connection with it or its subject matter or formation (including non-contractual disputes or claims) shall be governed by and construed in accordance with the laws of England and Wales.

39.2 Subject to Clause 23 (Dispute Resolution), the Partners irrevocably agree that the courts of England and Wales shall have exclusive jurisdiction to hear and settle any action, suit, proceedings, dispute or claim, which may arise out of, or in connection with, this Agreement, its subject matter or formation (including non-contractual disputes or claims).

IN WITNESS WHEREOF this Agreement has been executed by the Partners on the date of this Agreement

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THE COMMON SEAL of SUFFOLK COUNTY COUNCIL

)

) was hereunto affixed in the presence of: ) ……………………………………… Authorised Officer Signed for on behalf of NHS WEST SUFFOLK CLINICAL COMMISSIONING GROUP _________________________ Authorised Signatory

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SCHEDULE 1 – POOLED FUND MANAGEMENT AND SCHEME SPECIFICATON FOR WEST SUFFOLK CCG & SUFFOLK COUNTY COUNCIL

1. This schedule outlines the funding and schemes for the Better Care Fund relating to the financial years

2017/18 and 2018/19. 2. The combined total of the Better Care Fund across Suffolk, consisting of the three Suffolk CCGs and the

Council, will be £67.8m in 2017/18 and £74.3m in 2018/19. 3. The pooled fund relating to the West Suffolk area will be £20.4m in 2017/18 and £22.2m in 2018/19. The

Financial Contributions to the Pooled Fund are summarised in the table below:

Application of Funding 4. The Pooled Fund shall be used to support the following schemes:

Pool 1 Pool 2 Pool 3 Total Pool 1 Pool 2 Pool 3 TotalSuffolk BCF Funding Ipswich & East West Suffolk Waveney Ipswich & East West Suffolk Waveney

CCG Revenue FundingFormer Section 256 8,338,514 4,710,407 2,429,545 15,478,466 8,496,945 4,799,905 2,475,707 15,772,557 Care Act allocation 972,282 597,558 339,033 1,908,873 990,755 608,911 345,474 1,945,141 Carers Breaks Funding 858,937 572,625 323,912 1,755,474 875,257 583,505 330,066 1,788,828 Reablement Funding 1,982,163 1,321,442 747,489 4,051,094 2,019,824 1,346,549 761,691 4,128,064 Other 12,015,676 7,651,190 4,587,208 24,254,074 12,243,974 7,796,563 4,674,365 24,714,901 Sub Total 24,167,572 14,853,222 8,427,187 47,447,980 24,626,755 15,135,433 8,587,303 48,349,492

Local Authority Revenue FundingImproved Better Care Fund 7,937,479 4,216,711 2,889,403 15,043,593 10,758,057 5,591,759 3,910,178 20,259,994

Sub Total Revenue Funding 32,105,051 19,069,933 11,316,590 62,491,574 35,384,812 20,727,192 12,497,481 68,609,486

Local Authority Capital FundingBabergh 571,840 571,840 620,938 620,938 Forest Heath 397,748 397,748 433,134 433,134 Ipswich 1,025,456 1,025,456 1,116,795 1,116,795 Mid Suffolk 262,585 262,585 525,170 285,033 285,033 570,066 St Edmundsbury 695,152 695,152 754,865 754,865 Suffolk Coastal 847,104 847,104 917,875 917,875 Waveney 1,209,068 1,209,068 1,304,830 1,304,830 Disabled Facilities Grant Total 2,706,986 1,355,486 1,209,068 5,271,540 2,940,641 1,473,032 1,304,830 5,718,503

Total 34,812,036 20,425,420 12,525,658 67,763,113 38,325,453 22,200,225 13,802,311 74,327,989

2017/18 2018/19

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Hosting and Reporting Arrangements 5. The Council agrees to act as the Host Partner for the Pooled Fund. 6. As Host Partner, the Council shall be responsible for the preparation and collation of the in year reporting

statements with the cooperation of other partners. As a minimum, reports shall be presented to the Partnership Board and the Health and Wellbeing Board on a quarterly basis based on the format of Government returns. Alliance partners will also receive details of iBCF pump priming initiatives commitments and spend on a quarterly basis.

7. The reports shall be prepared in such a format as is agreed by the Partners but may be varied from time

to time with the agreement of the Partners.

8. The Council shall be responsible for the preparation and arrangement of the annual external audit of the Pooled Fund.

9. The Partners agree that there shall be no sharing or recharging for costs associated with the management

of the Pooled Fund including costs incurred in hosting the Pooled Fund. 10. The Partners acknowledge that the majority of funding is already pre-committed to on-going contracts and

purchasing arrangements. The Partners agree that where there is no material change to the service or contract for services as a consequence of this Agreement, then the relevant Partner should continue with those existing contractual and payment arrangements. Consequently transfers of funding into and out of the Pooled Fund shall be accounted for on a net basis.

Pool 2 West Suffolk Commissioner 2017/18 2018/19 TotalProviding proactive care in the community

Local Authority 498,578 508,051 1,006,628

Providing proactive care in the community

CCG 3,811,873 3,884,298 7,696,171

Reactive Care Local Authority 4,396,386 4,479,918 8,876,304 Reactive Care CCG 4,465,295 4,550,136 9,015,431 Support for Carers Local Authority 66,503 67,767 134,271 Support for Carers CCG 544,772 555,123 1,099,895 Care Act Commitments Local Authority 597,558 608,912 1,206,470 NHS-commissioned out-of-hospital services

CCG 472,258 481,231 953,488

Disabled Facilities Grant Local Authority 1,355,485 1,473,032 2,828,517 Alliance pump priming initiatives Local Authority 1,794,000 1,376,000 3,170,000

Care purchasing demand and inflationary increases to support the care market

Local Authority 876,076 3,741,039 4,617,115

Learning Disability demand pressures

Local Authority 1,270,635 391,920 1,662,555

Workforce development - part of Health & Care Sector Skills Plan

Local Authority 276,000 82,800 358,800

Total 20,425,420 22,200,225 42,625,645

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11. The Partners agree to provide sufficiently detailed evidence of their expenditure and activity relating to the Pooled Fund in a timely basis to meet the reporting requirements of the Partnership Board, Health and Wellbeing Board, national reporting requirements and any other reports required to enable the Partners to fulfil their obligations under this Agreement and in Law.

Conditions associated with the transactions 12. The Partners agree that the element of the Pooled Fund which is comprised of former ‘section 256’ funding

and the element to be used to fund the Council responsibilities under the Care Act, shall transfer from the CCG to the Council quarterly in arrears. These elements are part of the protection of social care and have no conditions attached to them other than they are used for the purpose of funding social care spending.

13. The partners commit to find savings in order to deliver a fully sustainable system which includes the

protection of social care on an incremental basis up to 2020. The Better Care Fund Plan for Suffolk states this as: Meeting these challenges requires continued transformation of the health and social care system and we recognise that the best way of protecting adult social services provision is to do this together. This means developing integrated services together, commissioning jointly and differently and working to ensure that different elements of the health and care system interact in an effective, efficient way in the interests of the service user and their health and well-being outcomes. We have committed as a system to find financial savings through the System Transformation Partnership Plans to deliver on a fully sustainable system including fully protecting adult social care.

14. Therefore, savings arising from joint initiatives included in the above or in addition to it will be fairly shared amongst the partners with the specific share, period (ie one off or ongoing) and method of calculation, agreed on a case by case basis to help achieve the continued growth required to protect social care in the period to 2020.

15. The Disabled Facilities Grant element shall transfer directly to the Council from the Department of Health and shall be treated as part of the Better Care Fund Pooled Fund. The Council shall have a separate agreement with the relevant Suffolk Borough and District Councils as to how much of this funding is transferred to them and how much is retained by the Council.

16. The Improved Better Care Fund shall transfer directly to the Council from the Department of Health and

shall be treated as part of the Better Care Fund Pooled Fund. The funding can be spent on three purposes:

• Meeting adult social care needs • Reducing pressures on the NHS, including supporting more people to be discharged from

hospital when they are ready • Ensuring that the local social care provider market is supported

There is no requirement to spend across all three purposes, or to spend a set proportion on each.

17. The Council has set aside part of the funding from the Improved Better Care Fund to be allocated and

used within the West Alliance on a one off basis. This will be used on invest to save schemes to help in delivering a fully sustainable system. A provisional list of Alliance investment schemes are shown below but these may change subject to approval by the Alliance partners. Any funding not utilised in the financial year in which it is allocated can be carried forward to the next financial year subject to there being no clawback from central Government. The total funding allocated to the Alliance may change at the discretion of the Council.

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West Alliance pump priming initiatives

Commissioner 2017/18 2018/19 Total

Care Homes Local Authority 250,000 250,000 500,000 System work to improve the flow of patients- including Discharge to Assess impact of CHC changes and 5Qs and increased access to HomeFirst and short term beds to manage winter pressures

Local Authority 800,000 600,000 1,400,000

Connect - re-launch the programme

Local Authority 400,000 400,000 800,000

Buurtzorg Local Authority 100,000 90,000 190,000 CHC Joint Assessment Team Local Authority 36,000 36,000 72,000 Other Alliance pump priming initiatives - these are not yet fully developed but will include initiatives for reducing DTOC such as provision for additional homecare & care home places

Local Authority 208,000 - 208,000

Total 1,794,000 1,376,000 3,170,000

Page 1 of 7

GOVERNING BODY

Agenda Item No. 09

Reference No. WSCCG 18-17a

Date. 28 March 2018

Title Financial Plan 2018/19

Lead Chief Officer Jane Payling, Chief Finance Officer

Author(s) Robert Hudson, Interim Deputy CFO Ameeta Bhagwat, Head of Financial Planning and Management Accounts

Purpose To present the 2018/19 financial plan for approval.

Applicable CCG Clinical Priorities: 1. To promote self care2. To ensure high quality local services where possible x

3. To improve the health of those most in need4. To improve health & educational attainment for children & young people5. To improve access to mental health services6. To improve outcomes for patients with diabetes to above national averages7. To improve care for frail elderly individuals8. To allow patients to die with dignity & compassion & to choose their place

of death9. To ensure that the CCG operates within agreed budgets x

Action required by the Governing Body

Consider the financial plan presented, approve the outline plan, delegating responsibility for approving any final changes to the Financial Performance Committee.

1. Background

1.1 The CCG is required to prepare annual financial plans which are constructed with due regard to the national business rules of financial planning, setting out rules which determine the level of surplus to be generated, contingencies to be held, and a requirement to commit a proportion of expenditure on a non-recurrent basis.

1.2 A draft financial plan, approved by the Executive Committee following discussion at the Financial Performance Committee, was submitted to NHSE on 8 March; the plan set out in this paper reflects those discussions. As the plan sets out the financial strategy for the coming year, the Governing Body is the committee which approves the plan for the financial year.

1.3 The final plan submission will be made at the end of April taking account of any further changes in contract values and other refinements. The Governing Body is asked to delegate approval of any further amendments to the plan to the Financial Performance Committee in order to achieve this timetable.

2. Summary

2.1 The framework within which 2018/19 CCG plans are to be developed is set by the ongoing business rules for CCGs and the latest Planning Guidance issued in February 2018. The most relevant elements for the Governing Body to be aware of are set out below:

o NHSE has informed the CCG by letter that it will be required to deliver in year balance in 2018/19. This is in contrast to the two-year plan submitted in 2017 which required the CCG to generate a surplus of £0.3m in 2018/19, and allows £0.3m of additional expenditure to be made;

o the CCG must plan an uncommitted contingency of at least 0.5% of allocation to mitigate against in year cost pressure;

o the requirement to hold a system reserve which cannot be spent by the CCG has now been removed. As this was due to be 0.5% of allocation this change increases flexibility for the CCG;

o the CCG will receive 3.32% growth on its programme allocation and 1.71% uplift on its delegated co-commissioning allocation; and

o the mental health investment standard requires CCGs to demonstrate that mental health expenditure will be increased in line with growth in programme allocation.

2.2 A high level summary of the allocations due to be received by the CCG in 2018/19 and the

proposed deployment of this funding is set out in table 1 overleaf. Further sections of the paper provide more detail showing how this plan has been built up from the 2017/18 outturn, the investments and cost pressures included, high level savings (QIPP) plan and an analysis of overall financial risk and mitigations.

Table 1- High level summary of proposed 2018/19 financial plan

Allocation £m Programme Baseline Notified Allocation 307.73 Recurrent changes in year (2.53) Additional Funding 2.54 Primary Care Co-Commissioning 34.53 Running Cost Notified Allocation 5.53 Non Recurrent Allocation 0.34 Total Allocation 348.14 Expenditure Acute Services 178.06 Mental Health Services 28.31 Community Health services 29.53 Continuing Care services 14.78 Primary Care Services 5.95 Primary Care Prescribing 40.74 Primary Care Co-Commissioning 34.70 Running costs 5.10 Other 9.24 Contingency 1.74 Total Expenditure 348.14 In Year Surplus / (Deficit) 0.00

3. Changes from 2017/18

3.1 A bridge showing the movement from 2017/18 expected recurrent outturn (ongoing expenditure) to the 2018/19 plan is shown in appendix 1.

3.2 The forecast outturn for 2017/18 of £338.3m has been uplifted for inflation and expected growth along with £10.6m of additional recurrent funding and a further £3.5m non recurrent funding. A 3% efficiency requirement (QIPP target) of £10.5m is required.

4. Opening Expenditure Plan

4.1 The expenditure plan is set out in table 2 below, which is inclusive of QIPP savings.

Table 2 - Analysis of plan by service area

Planning Category Sub-Category Budget Holder Total £000'sWest Suffolk Hospital Chief Transformation Officer 111.78 Addenbrookes Chief Contracts Officer 29.89

Chief Contracts Officer 6.89 Chief Transformation Officer 4.83

TPP Chief Contracts Officer 4.03 Commissioning Reserves Chief Contracts Officer 0.40 Ambulance Chief Contracts Officer 9.37 PTS Chief Contracts Officer 1.75 Urgent Care Chief Transformation Officer 0.98 NCA Chief Contracts Officer 2.91

Chief Nursing Officer 0.57 Chief Contracts Officer 4.65

Community Chief Contracts Officer 24.98 Chief Contracts Officer 1.06 Chief Transformation Officer 0.32 Chief Nursing Officer 0.32 Chief Contracts Officer 0.02

Palliative Care Chief Contracts Officer 0.16 Children's ECR, Placements & Other Chief Nursing Officer 1.64 Hospice Chief Contracts Officer 1.03

Chief Nursing Officer 1.04 Chief Transformation Officer 24.16

Other MH Placements and Pooled fund Chief Nursing Officer 3.11 Prescribing Prescribing Chief Operating Officer 40.74

Chief Transformation Officer 2.96 Chief Corporate Services Officer 0.79 Chief Operating Officer 2.19

CHC Continuing Healthcare Services Chief Contracts Officer 14.78 Chief Nursing Officer 0.38 Chief Contracts Officer 0.30 Chief Finance Officer 0.70 Chief Officer 0.31 Chief Corporate Services Officer 1.23 Chief Transformation Officer 0.67 Chief Operating Officer 1.50

Better Care Fund Chief Transformation Officer 5.41 Chief Transformation Officer 0.01 Chief Officer 0.24

Contingency Chief Finance Officer 1.74 Non Recurrent Investment Chief Finance Officer - Property Recharges Chief Corporate Services Officer 0.80 General Reserve Chief Finance Officer 2.78

Delegated Primary Care Delegated Primary Care Chief Operating Officer 34.70 Grand Total 348.14

Acute

Other Acute

Other Non NHS Services

Community

Community Other

Long Term Conditions

Other

Other Programme Services

Mental HealthMental Health & LD

Primary Care Primary care

Corporate servicesShared Running Costs

Direct Running Costs

5. Investments, Cost Pressures and Contingencies

5.1 Table 3 sets out the investments, cost pressures and contingencies which are included in the plan. Business rules require 0.5% of budget to be held as a contingency. Given uncertainty regarding prescribing costs and NHS pay awards the executive have determined that a further 0.5% should be set aside as a shadow contingency giving a total of 1%. The need for this contingency will be reviewed during the year and may be released for further non-recurrent investment.

Table 3 - Investments, cost pressures and contingencies

2018/19 2018/19

Recurrent Non-Recurrent

£m £mPrimary Care Investments Other CCG reserves 0.30GP Transformation @ £2 Practice Transformation Support 0.49Transformation fund Other CCG reserves 1.13Buurtogz Other CCG reserves 0.05Methotraxate Other CCG reserves 0.46SMI Health Checks Other CCG reserves 0.29Other Acute/Other CCG reserves 0.43

Sub-Total 1.23 1.92Shadow Contingency (review in year) Other CCG reserves 1.740.5% Contingency Contingency 1.74Total Total 4.71 1.92

Area of SpendDescription

6. Mental Health Investment Standard 6.1 Mental health spending is expected to increase in excess of the 3.32% programme allocation

increase and thus meets the Mental Health Investment Standard.

7. Efficiency savings 7.1 In order to ensure the delivery of the plan the CCG needs to make £10.47m of QIPP savings

representing 3% of the CCG allocation. The initial high level split of the QIPP between expenditure areas is shown below. Further work is currently underway to refine the QIPP plan for discussion at FPC in April.

Table 4 - Efficiency savings

Area of Spend 2018/19 Net Value £m Acute Services 5.04 Mental Health Services 0.00 Community Health services 0.07 Continuing Care Services 1.86 Primary Care Prescribing 1.63 Other 1.41 Running Costs 0.46 Total 10.47

7.2 Use of the contingency and deployment of the transformation funds identified in the financial plan are dependent on the full value of the savings target (QIPP) being identified. At present £1.4 million has not been identified, with further work underway to bring the detailed savings plan for sign off in April.

8. Risks and mitigations

8.1 The risks and mitigations associated with the plan are shown in table 5 below. The main risk areas involve final agreement of contracts (and ongoing movement in variable contracts e.g. Addenbrooke’s) and identification and delivery of savings.

Table 5 - Risks and mitigations

£mRisksQIPP Under-Delivery 1.34CHC 0.30Acute Contracts 0.20Primary Care 0.05Prescrbing 0.81Total 2.70

MitigationsContract/ General Reserve 0.64Delay/Reduce Investments 0.70Contingency 1.36Total 2.70

Net Risk 0.00

2018/19

8.2 To mitigate this risk, the financial plan presented contains sufficient reserves to cover the

expected risk and investments will be delayed if necessary.

9. Recommendation

9.1 The Governing Body is asked to:

• Approve the plan for 2018/19, subject to any further changes to guidance or allocation • Note the contingencies, investments, risk and mitigations • Delegate authority to Financial Performance Committee to approve any changes

required to the final submission and to approve the detailed financial budgets for the CCG.

Total spendAcute

Mental Health & LD

CommunityPrescribing

Other Primary

Care

Primary Care Co-

commissioningContinuing Care

Other Programme

ServicesRunning Costs

£000£000

£000£000

£000£000

£000£000

£000£000

17/18 Forecast outturn338,320

173,18727,319

29,04841,094

3,97734,256

14,19610,854

4,388Non-recurrent adjustments

-5,776-1,963

-1744

37-308

01,042

-4,557-53

Recurrent 17/18 spend332,544

171,22427,302

29,09141,131

3,66934,256

15,2386,297

4,335Net inflation and efficiency

2,8661,815

2726

45236

42381

087

Demographic growth3,623

2,740164

175247

20187

910

0Non-demographic growth

7,2705,137

715440

53543

10290

1010

Recurrent cost pressures9,152

1,478104

-1320

889205

6394,836

1,134Recurrent investments

1,2300

00

00

00

1,2300

Recurrent QIPP-10,469

-5,0390

-74-1,627

00

-1,860-1,409

-460Recurrent 18/19 plan

346,215177,354

28,31329,525

40,7384,657

34,69914,779

11,0545,096

Non-recurrent investments1,920

00

00

4940

01,425

0Total planned budget

348,135177,354

28,31329,525

40,7385,152

34,69914,779

12,4805,096

Percentage of recurrent spend100%

51%8%

9%12%

1%10%

4%3%

1%Change since 17/18

4.1%3.6%

3.7%1.5%

-1.0%26.9%

1.3%-3.0%

75.5%17.5%

Percentage of total spend100%

51%8%

8%12%

1%10%

4%4%

1%Change since 17/18

2.9%2.4%

3.6%1.6%

-0.9%29.5%

1.3%4.1%

15.0%16.1%

Appendix 1 Expenditure Bridge from 2017/18 to 2018/19

GOVERNING BODY

Agenda Item No. 09

Reference No. WSCCG 18-17b

Date. 28 March 2018

Title 2018/19 Operational Plan

Lead Chief Officer Jane Payling, Chief Finance Officer

Author(s) Andrew Eley, Deputy Chief Operating Officer, West Suffolk CCG

Purpose To set out, for approval, the activity plan and performance trajectories.

Applicable CCG Priorities 1. Develop clinical leadership2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by the Governing Body:

The Governing Body is requested to:

• note and approve the current activity plan and performance trajectories• delegate final sign off plans to the Financial Performance Committee in April 2018.

1. Background 1.1 The CCG already has two-year contracts and improvement priorities set for the

period 2017/19. These were based on the NHS Operational Planning and Contracting Guidance 2017-2019 published in September 2016 and reflected in the March 2017 document Next Steps on the NHS Five Year Forward View.

1.2 Given that two-year contracts are in place, 2018/19 is a refresh of plans already prepared. This will enable organisations to continue to work together through STPs to develop system-wide plans that reconcile and explain how providers and commissioners will collaborate to improve services and manage within their collective budgets.

1.3 This paper presents the draft refreshed plans which were submitted to NHS England on 8th March 2018 for approval.

2. Key Issues

Activity Plan and Performance Trajectories

2.1 The activity plan and performance trajectories (Appendix 1) have been jointly developed by officers within the CCG’s finance, transformation and contracts directorates to conform with national guidance and align with local provider plans. The initial submission of plans was approved by NHS England’s local team on 8th March 2018.

2.2 Activity plans are summarised below:

2.3 Activity growth follows national guidance and assumptions and is triangulated with

local provider activity plans.

2.4 Performance trajectories have been developed for the following areas:

• NHS Constitution targets: Referral to Treatment and Cancer Waiting Times, A&E;

• Mental Health targets: Dementia diagnosis, Improving Access to Psychological Therapies (IAPT), Early Intervention in Psychosis (EIP), Children & young People’s Mental Health, and Eating Disorders;

• Primary Care targets: Extended Access; • Other commitments: E-referrals, Personal Health Budgets, Children wheelchair

services, Annual Health Checks for those with Learning Disabilities.

2.5 Performance trajectories follow national guidance although, in some cases (e.g. RTT, A&E) will not immediately deliver the constitutional standard due to current levels of performance

2.6 The plans submitted to NHS England may be subject to minor amendment during April. In accordance with national guidance, final plans will need to be approved by the CCG’s Governing Body prior to the national deadline of 30th April 2018. Given that the next meeting is in May 2018, it is recommended that the Governing Body delegate final approval of the plans to the Financial Performance Committee at its meeting on 17th April 2018.

3. Public Engagement

3.1 Whilst public engagement is not required for the purposes of approving the financial

and activity plans, and performance trajectories, patients and members of the public were sighted on the development of the CCG’s overarching Operational Plan 2017/18 – 2018/19 available at https://www.westsuffolkccg.nhs.uk/about-us/operational-plan/

4. Recommendation 4.1 The Governing Body is requested to:

• note and approve the activity plan and performance trajectories; and to • delegate final sign off to the Financial Performance Committee in April 2018.

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

13 14 15 16 17 18 19 20 21 22 23 24

25 26 27 28 29 30 31 32 33 34 35 36

12,519 12,727 13,388 13,253 14,016 13,922 13,706 13,682 13,515 13,133 13,000 12,803

13,347 13,410 14,012 13,942 14,752 14,665 14,485 14,521 14,359 14,000 13,861 13,613

93.8% 94.9% 95.5% 95.1% 95.0% 94.9% 94.6% 94.2% 94.1% 93.8% 93.8% 94.0%

13,382 14,571 16,593 17,522 17,577 18,047 17,439 17,520 16,954 16,810 17,003 17,052

14,129 15,331 17,515 18,806 18,932 19,604 18,925 19,018 18,461 18,569 18,864 18,894

94.7% 95.0% 94.7% 93.2% 92.8% 92.1% 92.1% 92.1% 91.8% 90.5% 90.1% 90.3%

17,089 16,858 16,083 15,738 14,915 14,949 14,822 - - - - -

20,335 20,538 18,915 18,096 17,161 17,290 16,906 - - - - -

84.0% 82.1% 85.0% 87.0% 86.9% 86.5% 87.7% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1

19,277 19,512 18,011 17,269 16,406 16,572 16,257 16,131 15,880 18,872 19,172 19,203

21,372 21,585 19,880 19,019 18,029 18,172 17,768 17,572 17,258 20,511 20,837 20,870

90.2% 90.4% 90.6% 90.8% 91.0% 91.2% 91.5% 91.8% 92.0% 92.0% 92.0% 92.0% 0 0

2015/16 - 1 1 - - - - - - 1 1 -

2016/17 - - 1 1 1 2 1 1 - 7 7 8

2017/18 9 12 7 25 18 27 26 16 13 - - -

2018/19 5 5 5 5 5 5 3 3 2 2 2 2

0

1%

25%

259 313 300 142 87 77 80 69 60 33 25 15

2,852 3,089 3,188 2,825 2,190 2,474 2,440 2,467 2,223 2,467 2,561 2,766

9.1% 10.1% 9.4% 5.0% 4.0% 3.1% 3.3% 2.8% 2.7% 1.3% 1.0% 0.5%

40 80 166 149 178 176 84 18 106 90 12 4

2,809 2,491 2,710 2,880 2,644 2,853 2,719 2,587 2,549 2,776 2,796 2,655

1.4% 3.2% 6.1% 5.2% 6.7% 6.2% 3.1% 0.7% 4.2% 3.2% 0.4% 0.2%

14 12 11 13 36 21 21 - - - - -

2,555 2,660 2,587 2,481 2,407 2,248 2,445 - - - - -

0.5% 0.5% 0.4% 0.5% 1.5% 0.9% 0.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

25 26 26 25 24 22 24 26 26 28 28 27

2,581 2,687 2,613 2,506 2,431 2,270 2,469 2,602 2,648 2,832 2,852 2,708

1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 0 0 0 0

93%

25%

611 613 648 740 644 673 740 699 711 557 704 733

658 627 663 759 659 704 752 711 722 570 712 744

92.9% 97.8% 97.7% 97.5% 97.7% 95.6% 98.4% 98.3% 98.5% 97.7% 98.9% 98.5%

749 633 636 694 762 685 740 813 668 614 629 782

763 674 783 712 813 727 766 839 699 691 652 806

98.2% 93.9% 81.2% 97.5% 93.7% 94.2% 96.6% 96.9% 95.6% 88.9% 96.5% 97.0%

651 799 774 796 736 682 763 - - - - -

703 862 799 846 769 743 888 - - - - -

92.6% 92.7% 96.9% 94.1% 95.7% 91.8% 85.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

879 776 902 820 936 837 964 911 926 731 913 954

944 834 969 881 1,003 900 1,036 979 994 785 981 1,025

93.1% 93.0% 93.1% 93.1% 93.3% 93.0% 93.1% 93.1% 93.2% 93.1% 93.1% 93.1% 0 0 0 0

93%

25%

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Values Below 100%

Cancer Waiting Times - 2

Week Wait

2018/19

Plan

Number Seen < 2 Wks

Total Number Seen

%

Monthly Changes Within

ToleranceMonthly % Meets Standard

Validation Tests

Ensure all have passed and become green

Values Below 100%

All Data Entered Values Below 100%Monthly Changes Within

ToleranceMonthly % Meets Standard

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

All Data Entered

All Data Entered

February MarchSeptember October November DecemberAugust JanuaryStandard

E.B.7 April May June JulyMonthly Diff. Tolerance

October

Total Number Seen

%

2017/18

Number Seen < 2 Wks

Total Number Seen

%

2016/17

Number Seen < 2 Wks

November February MarchMonthly Diff. Tolerance

2015/16

Number Seen < 2 Wks

Total Number Seen

%

August September

Pathways >52 Weeks

December

%

JanuaryStandard

E.B.6 April May June July

E.B.4

Pathways < 18 Weeks

Total Pathways

SeptemberJune July August

%

May

Pathways >52 Weeks

%

2017/18

Number Waiting > 6 Wks

2016/17

Number Waiting > 6 Wks

Total Number Waiting

2018/19

Plan

Number Waiting > 6 Wks

Total Number Waiting

%

Monthly Diff. ToleranceApril

2015/16

Number Waiting > 6 Wks

Total Number Waiting

Total Number Waiting

2018/19

Plan

Pathways < 18 Weeks

Total Pathways

Diagnostics Test Waiting

Times

October NovemberStandard

%

%

RTT 52 Week Waits

%

August November

2016/17

2017/18

RTT Incomplete Pathway

June JulyE.B.3

2015/16

Pathways < 18 Weeks

Total Pathways

%

Pathways < 18 Weeks

January

Total Pathways

Enter Data in Cell

April May

YES

February MarchSeptember October December

Planning 2018/19 | Planned

Constitution Performance

Sheet Validation - do all cell values only have whole

numbers entered?

CCG Code

07K

CCG Name

NHS West Suffolk CCG

Calculated Field

Prepopulated Cell

June July December January February March

December January February

Pathways >52 Weeks

Pathways >52 Weeks

March

All Data Entered

E.B.18 NovemberApril MayValidation Tests

Ensure all have passed and become green

August September October

88 89 102 110 99 103 95 93 103 90 105 113

93 92 105 110 99 107 100 98 105 90 111 113

94.6% 96.7% 97.1% 100.0% 100.0% 96.3% 95.0% 94.9% 98.1% 100.0% 94.6% 100.0%

103 87 59 57 66 86 101 106 93 81 109 136

104 93 92 74 108 87 101 108 102 92 113 146

99.0% 93.5% 64.1% 77.0% 61.1% 98.9% 100.0% 98.1% 91.2% 88.0% 96.5% 93.2%

90 111 89 96 107 95 114 - - - - -

97 111 103 99 108 96 114 - - - - -

92.8% 100.0% 86.4% 97.0% 99.1% 99.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

92 105 97 94 102 91 108 89 85 87 107 137

98 112 104 100 109 97 115 95 91 93 114 147

93.9% 93.8% 93.3% 94.0% 93.6% 93.8% 93.9% 93.7% 93.4% 93.5% 93.9% 93.2% 0 0 0 0

96%

25%

97 108 117 116 113 143 111 124 102 122 98 121

103 110 118 117 114 147 113 124 103 123 100 122

94.2% 98.2% 99.2% 99.1% 99.1% 97.3% 98.2% 100.0% 99.0% 99.2% 98.0% 99.2%

100 99 96 108 117 121 119 134 101 105 112 152

102 100 98 108 117 121 119 135 102 107 113 152

98.0% 99.0% 98.0% 100.0% 100.0% 100.0% 100.0% 99.3% 99.0% 98.1% 99.1% 100.0%

90 127 119 129 126 105 118 - - - - -

90 128 119 130 126 106 118 - - - - -

100.0% 99.2% 100.0% 99.2% 100.0% 99.1% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

90 128 119 130 126 106 118 135 105 105 111 149

93 133 123 135 131 110 122 140 109 109 115 155

96.8% 96.2% 96.7% 96.3% 96.2% 96.4% 96.7% 96.4% 96.3% 96.3% 96.5% 96.1% 0 0

94%

25%

36 16 19 28 21 25 41 41 29 29 24 31

37 16 19 29 22 25 42 42 29 31 25 31

97.3% 100.0% 100.0% 96.6% 95.5% 100.0% 97.6% 97.6% 100.0% 93.5% 96.0% 100.0%

34 30 26 37 31 34 34 36 37 28 39 28

34 27 19 19 11 14 22 30 26 22 15 29

100.0% 111.1% 136.8% 194.7% 281.8% 242.9% 154.5% 120.0% 142.3% 127.3% 260.0% 96.6%

16 17 18 25 24 23 20 - - - - -

17 17 19 25 26 23 20 - - - - -

94.1% 100.0% 94.7% 100.0% 92.3% 100.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

2018/19 26 21 15 15 9 11 29 29 20 21 17 21

27 22 15 15 9 11 30 30 21 22 18 22

96.3% 95.5% 100.0% 100.0% 100.0% 100.0% 96.7% 96.7% 95.2% 95.5% 94.4% 95.5% 0 0 0 0

98%

25%

51 43 55 52 47 57 61 58 39 52 45 50

51 44 55 52 47 57 61 58 39 52 45 50

100.0% 97.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

40 36 54 59 39 47 41 28 25 53 44 42

40 36 54 59 39 47 41 28 25 54 44 42

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.1% 100.0% 100.0%

35 51 37 52 47 30 41 - - - - -

35 51 37 52 47 30 41 - - - - -

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

34 30 45 49 33 39 47 45 30 40 35 38

34 30 45 49 33 39 47 45 30 40 35 38

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0 0 0 0

94%

25%

44 51 56 53 38 36 45 48 43 38 55 47

45 51 56 56 38 37 45 49 43 39 55 47

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

November DecemberAugust September January

Total Number Seen

April May

February

2018/19

Plan

Number Treated < 31 Days

Total Number Seen

%

2017/18

Number Treated < 31 Days

Total Number Seen

%

All Data Entered

All Data Entered

Total Number Seen

%

February MarchOctober

Values Below 100%Monthly Changes Within

Tolerance

Values Below 100%

Cancer Waiting Times - 31

Day First Treatment

2018/19

Plan

Number Seen < 2 Wks

Total Number Seen

%

Total Number Seen

%

2017/18

Number Treated < 31 Days

Total Number Seen

%

February MarchAugust September October November December January

2015/16

Number Treated < 31 Days

Total Number Seen

%

2016/17

Number Treated < 31 Days

Cancer Waiting Times - 2

Week Wait (Breast

Symptoms)

Total Number Seen

%

2017/18

Number Seen < 2 Wks

Cancer Waiting Times - 31

Day Drugs

Cancer Waiting Times - 31

Day Surgery

Number Treated < 31 Days

All Data Entered2018/19

Plan

Number Seen < 2 Wks

Total Number Seen

%

Monthly % Meets Standard

Values Below 100%

Values Below 100%Monthly Changes Within

ToleranceMonthly % Meets Standard

Monthly Changes Within

Tolerance

Monthly Changes Within

ToleranceMonthly % Meets Standard

0

Monthly % Meets Standard

All Data Entered

June July

2015/16

Number Treated < 31 Days

Cancer Waiting Times - 31

Day Radiotherapy

2015/16

Number Treated < 31 Days

Total Number Seen

%

2016/17

Number Treated < 31 Days

StandardE.B.11

Monthly Diff. Tolerance

August September OctoberE.B.10 April May June July

2017/18

Number Treated < 31 Days

Total Number Seen

%

Total Number Seen

%

February

MarchMonthly Diff. Tolerance

November December JanuaryStandard

MarchMonthly Diff. Tolerance

2015/16

Number Treated < 31 Days

Total Number Seen

%

2016/17

Number Treated < 31 Days

AugustJuly

Total Number Seen

%

September October November December JanuaryStandard

E.B.9 April May June

StandardE.B.8 April May June July

Monthly Diff. Tolerance

%

2016/17

Number Seen < 2 Wks

2015/16

Number Seen < 2 Wks

Total Number Seen

%

Total Number Seen

0

97.8% 100.0% 100.0% 94.6% 100.0% 97.3% 100.0% 98.0% 100.0% 97.4% 100.0% 100.0%

36 41 35 33 48 39 31 36 35 37 50 41

36 42 36 34 48 42 32 36 35 39 50 44

100.0% 97.6% 97.2% 97.1% 100.0% 92.9% 96.9% 100.0% 100.0% 94.9% 100.0% 93.2%

28 35 41 48 56 45 48 - - - - -

29 36 43 48 57 48 51 - - - - -

96.6% 97.2% 95.3% 100.0% 98.2% 93.8% 94.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

30 36 44 48 57 48 51 49 30 33 43 37

31 38 46 51 60 51 54 52 31 35 45 39

96.8% 94.7% 95.7% 94.1% 95.0% 94.1% 94.4% 94.2% 96.8% 94.3% 95.6% 94.9% 0 0 0 0

85%

25%

45 47 51 52 49 51 51 45 48 56 45 46

55 60 55 63 60 68 59 55 58 69 54 50

81.8% 78.3% 92.7% 82.5% 81.7% 75.0% 86.4% 81.8% 82.8% 81.2% 83.3% 92.0%

44 43 43 44 56 55 51 60 39 42 43 61

54 51 48 54 66 68 61 72 48 52 51 73

81.5% 84.3% 89.6% 81.5% 84.8% 80.9% 83.6% 83.3% 81.3% 80.8% 84.3% 83.6%

47 49 48 66 61 44 55 - - - - -

54 61 56 76 73 53 57 - - - - -

87.0% 80.3% 85.7% 86.8% 83.6% 83.0% 96.5% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

49 54 48 68 65 46 51 66 57 42 42 61

57 63 56 80 76 54 59 77 66 49 49 71

86.0% 85.7% 85.7% 85.0% 85.5% 85.2% 86.4% 85.7% 86.4% 85.7% 85.7% 85.9% 0 0 0 0

90%

25%

10 6 8 8 3 11 12 16 6 7 9 8

10 7 8 9 3 12 12 16 6 8 10 8

100.0% 85.7% 100.0% 88.9% 100.0% 91.7% 100.0% 100.0% 100.0% 87.5% 90.0% 100.0%

6 7 7 9 8 7 9 7 15 9 4 16

6 7 8 9 9 7 5 2 - 3 6 3

100.0% 100.0% 87.5% 100.0% 88.9% 100.0% 180.0% 350.0% 300.0% 66.7% 533.3%

4 14 5 10 6 4 3 - - - - -

5 5 3 3 5 3 5 - - - - -

80.0% 280.0% 166.7% 333.3% 120.0% 133.3% 60.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

7 8 9 9 9 8 13 18 7 9 11 9

7 8 9 10 10 8 14 19 7 9 12 9

100.0% 100.0% 100.0% 90.0% 90.0% 100.0% 92.9% 94.7% 100.0% 100.0% 91.7% 100.0% 0 0 0 0

N/A

25%

3 4 5 3 5 9 3 2 5 1 1 6

5 2 2 3 4 4 5 2 - 3 6 3

60.0% 200.0% 250.0% 100.0% 125.0% 225.0% 60.0% 100.0% 33.3% 16.7% 200.0%

3 2 2 2 3 4 5 1 - 2 6 3

5 2 2 3 4 4 5 2 - 3 6 3

60.0% 100.0% 100.0% 66.7% 75.0% 100.0% 100.0% 50.0% 66.7% 100.0% 100.0%

4 4 3 2 4 3 4 - - - - -

5 5 3 3 5 3 5 - - - - -

80.0% 80.0% 100.0% 66.7% 80.0% 100.0% 80.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 1 1 1

4 4 3 3 4 3 4 4 1 2 4 2

5 5 3 3 5 3 5 4 1 2 5 2

80.0% 80.0% 100.0% 100.0% 80.0% 100.0% 80.0% 100.0% 100.0% 100.0% 80.0% 100.0% 0 0 0 0

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Validation Tests

Ensure all have passed and become green

Data Warning

Check data and correct for errors

Monthly Changes Within

ToleranceMonthly % Meets Standard

Number Treated < 31 Days

%

2018/19

Plan

Number Treated < 31 Days

All Data Entered Values Below 100%

%

Number Treated < 62 Days

Total Number Seen

%

Number Treated < 62 Days

Monthly Changes Within

ToleranceMonthly % Meets Standard

All Data EnteredMonthly Changes Within

ToleranceMonthly % Meets Standard

Cancer Waiting Times - 62

Day Upgrade

Cancer Waiting Times - 62

Day Screening

Cancer Waiting Times - 62

Day GP Referral

2018/19

Plan

2018/19

Plan

2018/19

Plan

2017/18

2017/18

2016/17

2016/17

%

Number Treated < 62 Days

Total Number Seen

Total Number Seen

%

Number Treated < 62 Days

Number Treated < 62 Days

All Data Entered Values Below 100%Monthly Changes Within

ToleranceMonthly % Meets Standard

%

Number Treated < 62 Days

Total Number Seen

Number Treated < 62 Days

Total Number Seen

Total Number Seen

%

Total Number Seen

%

Total Number Seen

%

Data Warning

Check data and correct for errors

Data Warning

Check data and correct for errors

All Data Entered Values Below 100%

Values Below 100%

Validation Tests

Ensure all have passed and become green

Validation Tests

Ensure all have passed and become green

February MarchMonthly Diff. Tolerance

2015/16

Number Treated < 62 Days

Total Number Seen

%

August September October November December JanuaryStandard

E.B.14 April May June July

February MarchMonthly Diff. Tolerance

2015/16

Number Treated < 62 Days

Total Number Seen

%

August September October November December JanuaryStandard

E.B.13 April May June July

2017/18

Number Treated < 62 Days

Total Number Seen

%

2016/17

Number Treated < 62 Days

February MarchMonthly Diff. Tolerance

2015/16

Number Treated < 62 Days

Total Number Seen

%

August September OctoberStandard

E.B.12 April May June July November December January

Total Number Seen

%

Total Number Seen

%

2017/18

Number Treated < 31 Days

Total Number Seen

%

2015/16

2016/17

Cancer Waiting Times - 31

Day Radiotherapy

2

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

13 14 15 16 17 18 19 20 21 22 23 24

25 26 27 28 29 30 31 32 33 34 35 36

WEST SUFFOLK NHS FOUNDATION TRUST RGR

No Provider

No Provider

95%

25%

361 229 208 236 305 196 190 258 342 353 438 656

5,127 5,397 5,392 5,443 5,344 5,305 5,398 5,324 5,302 5,413 5,370 6,197

93.0% 95.8% 96.1% 95.7% 94.3% 96.3% 96.5% 95.2% 93.5% 93.5% 91.8% 89.4%

499 775 917 861 652 674 806 830 744 681 812 419

5,322 5,930 5,578 5,996 5,712 5,717 5,814 5,358 5,511 5,353 5,050 5,887

90.6% 86.9% 83.6% 85.6% 88.6% 88.2% 86.1% 84.5% 86.5% 87.3% 83.9% 92.9%

268 319 265 461 578 635 766 573 997 - - -

5,578 5,971 5,922 6,124 5,831 5,743 6,065 5,985 5,959 - - -

95.2% 94.7% 95.5% 92.5% 90.1% 88.9% 87.4% 90.4% 83.3%

553 573 544 543 499 479 474 437 497 457 324 313

5,818 6,228 6,177 6,387 6,082 5,990 6,326 6,242 6,215 5,719 5,395 6,289

90.5% 90.8% 91.2% 91.5% 91.8% 92.0% 92.5% 93.0% 92.0% 92.0% 94.0% 95.0%

95%

25%

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

- - - - - - - - - - - -

- - - - - - - - - - - -

0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

95%

25%

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

- - - - - - - - - - - -

- - - - - - - - - - - -

0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

WEST SUFFOLK NHS

FOUNDATION TRUST

2018/19

Plan

Number Waiting > 4 Hrs

Total Attendances

2018/19

Plan

Number Waiting > 4 Hrs

Total Attendances

%

2018/19

Plan

Number Waiting > 4 Hrs

Total Attendances

%

2016/17

Number Waiting > 4 Hrs

Total Attendances

%

2017/18

Number Waiting > 4 Hrs

StandardE.B.5 April

November DecemberMay June July

Monthly Diff. Tolerance

%

07K NHS West Suffolk CCGPrepopulated Cell

Enter Data in Cell

CCG Code CCG Name Calculated Field

September

Provider 1

Provider 3

Provider 2

StandardE.B.5 April

Monthly Diff. Tolerance

2015/16

Number Waiting > 4 Hrs

Total Attendances

%

August

2016/17

Number Waiting > 4 Hrs

Total Attendances

%

2017/18

Number Waiting > 4 Hrs

Total Attendances

%

November DecemberJune July August September January February March

October January February March

October

2015/16

Number Waiting > 4 Hrs

Total Attendances

%

May

Number Waiting > 4 Hrs

Total Attendances

%

2017/18

Number Waiting > 4 Hrs

Total Attendances

%

2016/17

December January February MarchMonthly Diff. Tolerance

July August September October NovemberStandard

E.B.5 April May June

2015/16

Number Waiting > 4 Hrs

Total Attendances

%

Total Attendances

%

Sheet Validation - do all cell values only have whole numbers entered?

Please note: We will provide separate guidance in the Unify planning forum about how you might profile annual activity across months.

Code April May June July August September October November December January February March

E.M.7 NHSE Produced 8,216 8,231 8,419 8,462 8,179 8,920 8,763 8,834 6,798 8,490 7,938 9,225

E.M.7a NHSE Produced 5,062 5,141 5,279 5,258 4,743 5,564 5,477 5,443 3,996 5,416 5,262 5,949

E.M.7b NHSE Produced 3,154 3,090 3,140 3,204 3,436 3,356 3,286 3,391 2,802 3,074 2,676 3,276

E.M.8 NHSE Produced 8,063 8,245 8,477 8,477 8,361 8,045 9,201 9,363 7,295 9,136 8,225 8,641

E.M.9 NHSE Produced 15,611 15,968 16,416 16,416 16,192 15,579 17,819 18,133 14,128 17,693 15,929 16,735

E.M.10 NHSE Produced 2,647 2,759 2,714 2,911 2,810 2,627 3,101 3,203 2,400 3,001 2,768 2,934

E.M.10a NHSE Produced 2,220 2,317 2,300 2,465 2,377 2,230 2,659 2,738 2,027 2,617 2,389 2,509

E.M.10b NHSE Produced 427 442 414 446 433 397 442 465 373 384 379 425

E.M.11 NHSE Produced 2,227 2,288 2,272 2,273 2,182 2,186 2,382 2,380 2,460 2,437 2,211 2,498

E.M.11a NHSE Produced 591 606 602 602 578 579 631 631 652 646 586 662

E.M.11b NHSE Produced 1,636 1,682 1,670 1,671 1,604 1,607 1,751 1,749 1,808 1,791 1,625 1,836

E.M.12 NHSE Produced 5,430 5,742 5,717 5,920 5,589 5,561 5,831 5,627 5,623 5,641 5,239 6,085

E.M.18 NHSE Produced 2,107 2,187 2,048 2,204 2,143 1,965 2,188 2,300 1,847 1,901 1,873 2,104

E.M.19 NHSE Produced 4,929 5,041 5,182 5,182 5,112 4,918 5,625 5,725 4,460 5,586 5,029 5,283

E.M.20 NHSE Produced 7,588 7,706 7,913 7,882 7,109 8,340 8,209 8,159 5,990 8,118 7,888 8,917

*

Code

E.M.7E.M.7aE.M.7bE.M.8E.M.9

E.M.10E.M.10aE.M.10bE.M.11

E.M.11aE.M.11bE.M.12E.M.18E.M.19E.M.20

98,013

* For the 17/18 FOT to 18/19 Plan growth percentages in cells K26 to K33, the FOT that is used to calculate growth is the CCG supplied FOT which takes into account

the FOT difference column of the activity waterfall (e.g. NHSE supplied FOT + FOT difference in the Activity Waterfall). The growth percentage is therefore calculated

using the following formula: Forecast growth from 17/18 FOT to 18/19 plan = (18/19 Plan - (NHSE FOT + CCG entered FOT Difference)) / (NHSE FOT + CCG entered

FOT Difference).

Number of New RTT Pathways (Clockstarts)

Activity Line

Total Referrals (General and Acute)

Total Other Referrals (General and Acute)

Consultant Led Follow-Up Outpatient AttendancesTotal Elective Admissions

Number of New RTT Pathways (Clockstarts) 90,213

All Data Entered

All Data Entered

90,213

65,201

All Data EnteredAll Data Entered

All Data EnteredAll Data Entered

93,819

Number of Completed Non-Admitted RTT Pathways 57,370

Total Non-Elective Admissions 26,675

Total A&E Attendances excluding Planned Follow Ups 65,201 68,005

27,796

62,072

9.0%

6.0%

4.0%

8.2%

5.1%

4.2%

4.3%

5.8%

20,430

5.6%

3.7%

Total Non-Elective Admissions - 0 LoSTotal Non-Elective Admissions - +1 LoS

6,975

19,700

37,885

196,619

Total Elective Admissions

Number of Completed Admitted RTT Pathways 23,514 24,867

Consultant Led Follow-Up Outpatient Attendances 185,490

33,875

7,366

4,756 5,027 5.7%

32,230

Total Elective Admissions - Day Cases 27,474 28,848 5.0%

Total Elective Admissions - Ordinary

1.2%

4.8%

Total GP Referrals (General and Acute 61,861 62,590

Consultant Led First Outpatient Attendances 93,139 101,529

Total Other Referrals (General and Acute) 36,152

Total Referrals (General and Acute) 98,013 100,475

Forecast Growth

from CCG

Supplied 17/18

FOT to 18/19

Plan*

Activity LineCCG Supplied

17/18 FOT18/19 Annual Plan

2.5%

Planning 2018/19 | Planned Activity

All Data EnteredAll Data EnteredAll Data Entered

Validation Tests

Ensure all have passed and

become green

All Data EnteredAll Data EnteredAll Data Entered

YES

Calculated Field

07K NHS West Suffolk CCGPrepopulated Cell

Enter Data in Cell

YTD Offsets

61,861

Total A&E Attendances excluding Planned Follow UpsNumber of Completed Admitted RTT PathwaysNumber of Completed Non-Admitted RTT Pathways

93,139

185,490

32,230

26,675

23,514

57,370

Consultant Led First Outpatient Attendances

Total Elective Admissions - Ordinary

Total Non-Elective Admissions - 0 LoSTotal Non-Elective Admissions - +1 LoS

27,474

4,756

6,975

19,700

Total Non-Elective Admissions

2018/19 Activity

CCG Code CCG Name

Total Elective Admissions - Day Cases

36,152

CCG Adjusted

17/18 FOT

Total GP Referrals (General and Acute)

66.7%

25%

1,976 1,945 1,965 1,979 1,972 1,991 1,992 2,009 1,994 1,995 2,014 2,030

3,161 3,161 3,161 3,161 3,161 3,161 3,161 3,161 3,161 3,161 3,161 3,161

62.5% 61.5% 62.2% 62.6% 62.4% 63.0% 63.0% 63.6% 63.1% 63.1% 63.7% 64.2%

2,084 2,092 2,106 2,139 2,163 2,172 2,170 2,159 - - - -

3,453 3,453 3,453 3,453 3,453 3,453 3,453 3,453 3,453 3,453 3,453 3,453

60.4% 60.6% 61.0% 61.9% 62.6% 62.9% 62.8% 62.5% 0.0% 0.0% 0.0% 0.0%

2,303 2,338 2,362 2,367 2,369 2,381 2,384 2,387 2,388 2,391 2,393 2,391

3,566 3,566 3,566 3,566 3,566 3,566 3,566 3,566 3,566 3,566 3,566 3,566

64.6% 65.6% 66.2% 66.4% 66.4% 66.8% 66.9% 66.9% 67.0% 67.0% 67.1% 67.0%

4.20%

1,015

23,254

18/19 StandardQ4

23,254

4.75%

17/18 Standard

January February March

IAPT roll-out

Dementia - Estimated

Diagnosis Rate for

people aged 65+

2016/17

Number of people aged 65 or over diagnosed with dementia

%

2018/19

Plan

Number of people who have depression and/or anxiety disorders

E.A.3

2017/18 Estimated prevalence of dementia based on GP registered

population

Q2

Number of people who receive psychological therapies

Number of people who have depression and/or anxiety disorders

Monthly Diff. ToleranceOctober November DecemberJuly

Q3

Number of people who have depression and/or anxiety disorders

August SeptemberStandard

May June

07K NHS West Suffolk CCGPrepopulated Cell

Enter Data in Cell

E.A.S.1

CCG Code CCG Name Calculated Field

2015/16

Number of people who receive psychological therapies

Number of people aged 65 or over diagnosed with dementia

Estimated prevalence of dementia based on GP registered

population

%

2018/19

Plan

%

2016/17

2017/18

%

%

April

Estimated prevalence of dementia based on GP registered

population

Number of people aged 65 or over diagnosed with dementia

%

Number of people who have depression and/or anxiety disorders

945

23,254

Q1

23,487

23,254

0.0%

23,722

4.2%

3.5%

4.1%%

Number of people who receive psychological therapies

Number of people who receive psychological therapies

4.5%

930

1,060

4.2%

23,722

4.0%

4.8%4.2%

1,005

23,254

4.3%

3.6%

-

820

4.4%

23,254

-

830

23,722 23,722

-

-

0.0%

-

0.0%

5.0%

23,254

-

985

23,254

4.2%

1,165

997 997 997 1,139

50.00%

25%

75%

25%

The number of people who have finished treatment within the

reporting quarter (having attended at least two treatment

contacts and coded as discharged) minus the number of people

who have finished treatment not at clinical caseness at initial

assessment.

495

44.9%

280 280

Q1

2016/17

Standard

Diff. Tolerance

Standard

Diff. Tolerance

2017/18 The number of people who have finished treatment within the

reporting quarter (having attended at least two treatment

contacts and coded as discharged) minus the number of people

who have finished treatment not at clinical caseness at initial

assessment.

IAPT Recovery Rate

%

E.H.1 _A1

620

%

% *

The number of people who have finished treatment having

attended at least two treatment contacts and are moving to

recovery (those who at initial assessment achieved "caseness”

and at final session did not).

The number of people who have finished treatment within the

reporting quarter (having attended at least two treatment

contacts and coded as discharged) minus the number of people

who have finished treatment not at clinical caseness at initial

assessment.

Q2

2018/19

Plan

The number of people who have finished treatment having

attended at least two treatment contacts and are moving to

recovery (those who at initial assessment achieved "caseness”

and at final session did not).

2015/16

The number of people who have finished treatment having

attended at least two treatment contacts and are moving to

recovery (those who at initial assessment achieved "caseness”

and at final session did not).

%

E.A.S 2

220

615 485

50.0%

Number of ended referrals that finish a course of treatment in

period who received their first appointment within 6 weeks of

referral

The number of people who have finished treatment having

attended at least two treatment contacts and are moving to

recovery (those who at initial assessment achieved "caseness”

and at final session did not).

48.6%

*IAPT quarterly Recovery Rates are published by CCG on the NHS Digital Publication site and are available quarterly from Q1 2016/17. Previous quarterly recovery rates by CCG were calculated using suppressed published data, while from Q1 2016/17 onwards, NHS Digital

published quartely recovery rates by CCG using unsuppressed data.

% *

2016/17

510

480

655

530

535

98.5% 94.1%

IAPT Waiting Times - 6

Weeks

50.0%

510

200

46.5%

Q1

285

The number of people who have finished treatment within the

reporting quarter (having attended at least two treatment

contacts and coded as discharged) minus the number of people

who have finished treatment not at clinical caseness at initial

assessment.

525 Number of ended referrals that finish a course of treatment in

period

94.7%

500

555 490 460 535

270 245

54.5% 45.5% 45.4%

430

95.2%

570 580

50.0%

Q3 Q4

50.0%

295

-

- -

0.0%

300

0.0%

46.7%

600

46.5%

Q4Q3

50.0%

-

0.0%

290

-

230

215

Q2

590

-

240

95%

25%

50%

53%

25%

%

545

Number of referrals to and within the Trust with suspected first

episode psychosis or at ‘risk mental state’ that start a NICE-

recommended package care package in the reporting period

within 2 weeks of referral.

1

50.0%

Number of ended referrals that finish a course of treatment in

period who received their first appointment within 18 weeks of

referral

2017/18

%

470 -

Q4

-

519 518 520

Number of referrals to and within the Trust with suspected first

episode psychosis or at ‘risk mental state’ that start a NICE-

recommended care package

75.0%

0.0%

-

95.1%

1

0.0%

%

521

95.1% 95.1%

5

Q3

2

1

Diff. Tolerance

Number of ended referrals that finish a course of treatment in

period who received their first appointment within 18 weeks of

referral

E.H.4

*IAPT entered 18 week treatment rates (completed) are published by CCG on the NHS Digital Publication site and are available quarterly from Q1 2016/17. NHS Digital published entered 18 week treatment rates (completed) by CCG using unsuppressed data.

9

2016/17

18/19 Standard

2017/18

Number of ended referrals that finish a course of treatment in

period who received their first appointment within 18 weeks of

referral

Number of ended referrals that finish a course of treatment in

period

Number of ended referrals that finish a course of treatment in

period

%

17/18 Standard

2018/19

Plan

IAPT Waiting Times - 18

Weeks

2016/17

95.0%

510

Q1 Q2

470 -

548

525

525 Number of ended referrals that finish a course of treatment in

period

% *

470

93.6%%

-

-

Number of ended referrals that finish a course of treatment in

period-

- -

StandardE.H.2_A2

Diff. Tolerance

IAPT Waiting Times - 6

Weeks

Number of ended referrals that finish a course of treatment in

period

409 410

-

546

440

2018/19

Plan

Number of ended referrals that finish a course of treatment in

period who received their first appointment within 6 weeks of

referral

Number of ended referrals that finish a course of treatment in

period who received their first appointment within 6 weeks of

referral

33.3% 55.6%

547

50.0%

0.0%

75.1%

Q3Q1

548

100.0%

Q4

535 505

100.0%

535

100.0% 0.0%

545 547

0.0%0.0%

655

Q2

75.1%

*IAPT entered 6 week treatment rates (completed) are published by CCG on the NHS Digital Publication site and are available quarterly from Q1 2016/17. NHS Digital published entered 6 week treatment rates (completed) by CCG using unsuppressed data.

411

-

650

75.0%

99.2%

-

99.0%

EIP - Psychosis treated

with a NICE approved

care package within two

weeks of referral

411

546

2 3

30%

32%

245 65 65 65 65

17/18

Estimate18/19 Plan

17/18 to

18/19

change

245 260 6.1%

17/18 CCG

Revised

Estimate**

Q1 18/19 Q2 18/19 Q3 18/19 Q4 18/1918/19

estimate

1,265 540 270 270 270 1,350

4,213 4,213

30.0% 32.0%

Q3 18/19 Q4 18/19

-

-

4

2017/18

Number of referrals to and within the Trust with suspected first

episode psychosis or at ‘risk mental state’ that start a NICE-

recommended package care package in the reporting period

within 2 weeks of referral.

1

%

-

Number of referrals to and within the Trust with suspected first

episode psychosis or at ‘risk mental state’ that start a NICE-

recommended package care package in the reporting period

within 2 weeks of referral.

4 4

0.0%16.7%

6 -

EIP - Psychosis treated

with a NICE approved

care package within two

weeks of referral

0.0%

5

2018/19

Plan

E.H.9

2017/18 Standard

1a - The number of new children and young people aged 0-18 receiving treatment from NHS funded community services in the reporting period.

Number of referrals to and within the Trust with suspected first

episode psychosis or at ‘risk mental state’ that start a NICE-

recommended care package

62.5%

6 6 6 6

4

Number of referrals to and within the Trust with suspected first

episode psychosis or at ‘risk mental state’ that start a NICE-

recommended care package

2018/19 Standard

66.7%% 66.7%

Improve Access Rate to CYPMH

8

66.7%

Q1 18/19

17/18 CCG

Revised

Estimate*

Q2 18/19

66.7%

Annual change for 1a - The number of new young people receiving treatment from NHS funded community services

2a - Total number of individual children and young people aged 0-18 receiving treatment by NHS funded community services in the reporting period.

2b - Total number of individual children and young people aged 0-18 with a diagnosable mental health condition.

Percentage of children and young people aged 0-18 with a diagnosable mental health condition who are receiving treatment from NHS funded community services.

95%

25%

95%

25%

66.7% 83.3% 83.3%%

61.5%

85.7%

7

Q4

Q4

Standard (to be

achieved by 2020) Q3E.H.10 Q1

**For indicator 2b, there is limited recent data available on the estimated prevalence. In the absence of recent data an estimate has been created by applying the 5-16 year old estimates as provided in the PHE fingertip tool (https://fingertips.phe.org.uk/profile-group/mental-

health/profile/cypmh/data) to 0-17 ONS 2014- based population projections (https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/datasets/clinicalcommissioninggroupsinenglandz2). Please note that where CCG data wasn’t available a

regional estimate was used.

CCGs have therefore been provided with an opportunity to use local intelligence and additional information on prevalence to improve the estimates in cell M105. These estimates will be validated.

Q2

Diff. Tolerance

Number of CYP with ED (routine cases) referred with a suspected

ED that start treatment within 4 weeks of referral

% 53.8%

7

%

7

61.5%

5 5

53.8%

Number of CYP with a suspected ED (routine cases) that start

treatment

2017/18

Plan 6 Waiting Times for

Urgent Referrals to CYP

Eating Disorder Services -

Within 1 Week

Waiting Times for

Routine Referrals to CYP

Eating Disorder Services -

Within 4 Weeks6

4 5

1

2017/18

Plan

8 7

13 13 13

8

2

7

6

71.4%

Q1

66.7%

6

5

7

71.4% 71.4%

Q3

5 4

2018/19

Plan

2018/19

Plan

Number of CYP with ED (routine cases) referred with a suspected

ED that start treatment within 4 weeks of referral

Number of CYP with a suspected ED (urgent cases) that start

treatment 6

% 50.0%

Number of CYP with ED (urgent cases) referred with a suspected

ED that start treatment within 1 week of referral

Number of CYP with ED (urgent cases) referred with a suspected

ED that start treatment within 1 week of referral

Number of CYP with a suspected ED (urgent cases) that start

treatment

50.0%

2

50.0%

1

2

50.0%

2

1 1

Standard (to be

achieved by 2020) E.H.11 Q2

Number of CYP with a suspected ED (routine cases) that start

treatment13

Diff. Tolerance

07K

0 1

126439 126439 126439 195704 195704 247447 247447 247447 247447 247447 247447 247447

247447 247447 247447 247447 247447 247447 247447 247447 247447 247447 247447 247447

51.1% 51.1% 51.1% 79.1% 79.1% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0 0

Proportion of CCG weighted population benefitting from extended

access services commissioned 365 days a year for each day of the

week by the CCG (including bank holiday). For Monday to Friday each

day of the week should include any extended access after 6.30pm,

before 8.00am (this would be in addition to evening provision not a

replacement or substitute for evening appointments) and any

extended access provided in-hours as long as it is distinguishable from

core services. For Saturday and Sunday this should include any

extended access provided.

All currently provided services including extended hours Direct

Enhanced Services (DES) should not be included.

100%

September October November December

100% 100%

January February

Validation Tests

Ensure all have passed and become greenMarch

Planning 2018/19 | Primary

CareNHS West Suffolk CCGPrepopulated Cell

Enter Data in Cell

April May June July

CCG Name Calculated Field

August

Extended access

(evening and

weekends) at GP

services

E.D.14

CCG weighted population benefitting from extended access services

commissioned 365 days a year for each day of the week by the CCG

(including bank holiday). For Monday to Friday each day of the week

should include any extended access after 6.30pm, before 8.00am (this

would be in addition to evening provision not a replacement or

substitute for evening appointments) and any extended access

provided in-hours as long as it is distinguishable from core services. For

Saturday and Sunday this should include any extended access

provided.

All currently provided services including extended hours Direct

Enhanced Services (DES) should not be included.

2018/19

Plan

2017/18

CCG Weighted Population

%

Values Below 100%All Data Entered

80%

100%

25%

1515 1797 1653 1585 1570 3212 0 0 0 0 0 0

5527 6815 6523 6033 6116 3420 0 0 0 0 0 0

27.4% 26.4% 25.3% 26.3% 25.7% 93.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

5,519 5,617 5,804 5,680 5,638 5,532 6,201 6,307 5,062 6,620 5,717 5,980

5,519 5,617 5,804 5,680 5,638 5,532 6,201 6,307 5,062 6,620 5,717 5,980

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

2) New personal health budgets that began during the quarter (total number per

CCG)5 5 4 4

3227

E.N.1 Q1 Q2 Q3

CCG Code CCG Name Calculated Field

2017/18 Standard

07K NHS West Suffolk CCGPrepopulated Cell

Enter Data in Cell

23 27 32

August September

2018/19

Plan

3) Total number of PHB in the quarter = sum of 1) and 2) (total number per CCG) 2017/18

Plan

1) Personal health budgets in place at the beginning of quarter (total number per

CCG)19

Rate of PHBs per 100,000 GP registered population9.24

4) GP registered population (total number per CCG) 249,006 249,006 249,006

23

249,006

37

10.84 12.85 14.86

1) Personal health budgets in place at the beginning of quarter (total number per

CCG)9 12 18 27

Personal Health

Budgets

E.P.1 April May June July

Monthly Diff. Tolerance

2018/19 Standard

E-Referral Coverage

2017/18

Total number of patients referred to 1st Outpatient Services (including two-week-

waits), via e-RS

Overall number of patients referred to 1st Outpatient Services (including two-

week-waits)

%

2018/19

Plan

Total number of patients referred to 1st Outpatient Services (including two-week-

waits), via e-RS

Overall number of patients referred to 1st Outpatient Services (including two-

week-waits)

%

February MarchOctober November December January

Q4

92%

100%

25%

985

25%

2018/19 Target for

CCG

Diff. Tolerance

E.K.3 Q1 Q2 Q3 Q4

2712 18

3 12 9 6

2018/19

Plan

2) New personal health budgets that began during the quarter (total number per

CCG)

4) GP registered population (total number per CCG) 250,794 250,794 250,794 250,794

3) Total number of PHB in the quarter = sum of 1) and 2) (total number per CCG) 39

Rate of PHBs per 100,000 GP registered population4.78 7.18 10.77 15.55

2017/18 Standard

E.O.1 Q1 Q2 Q3 Q4

Diff. Tolerance

2018/19 Standard

2016/17

Number of children whose episode of care was closed within the reporting period

where equipment was delivered in 18 weeks or less of being referred to the

service6 1 4 2

Total number of children whose episode of care was closed within the quarter

where equipment was delivered or a modification was made.10

% 37.5% 14.3% 36.4% 20.0%

-

Total number of children whose episode of care was closed within the quarter

where equipment was delivered or a modification was made.9 19 - -

Number of children whose episode of care was closed within the reporting period

where equipment was delivered in 18 weeks or less of being referred to the

service4 3

12

0.0% 0.0%

100.0% 100.0% 100.0% 100.0%

12 12

Children Waiting more

than 18 Weeks for a

Wheelchair

2017/18

Personal Health

Budgets

%

%

12

-

16 7 11

2018/19

Plan

Number of children whose episode of care was closed within the reporting period

where equipment was delivered in 18 weeks or less of being referred to the

service12 12

44.4% 15.8%

Total number of children whose episode of care was closed within the quarter

where equipment was delivered or a modification was made.12 12

1177 1177 11772018/19

Plan

0.0%

22.2% 19.0% 26.4%

311

Population on the GPs Learning Disability Register (18+ only)1177

10.5% 0.0%

Patients aged 14 or over on the GPs Learning Disability Register receiving a

health check within the quarter 189 261 224

Population on the GPs Learning Disability Register (18+ only)1177 1177 1177 1177

AHCs delivered by GPs

for patients on the

Learning Disability

Register

2017/18

Patients aged 14 or over on the GPs Learning Disability Register receiving a

health check within the quarter 150 123

%16.1%

% 12.7%

Page 1 of 3

GOVERNING BODY

Agenda Item No. 10

Reference No. WSCCG 18-18

Date. 28 March 2018

Title Procurement Update: Summary of Activity 2017/18

Lead Chief Officer Jane Webster, Acting Chief Contracts Officer

Author(s) Jane Garnett, Procurement Lead

Purpose To update the Governing Body on the procurements completed since the last procurement update and those currently in progress and planned for 2017/18 and 2018/19.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

It is recommended that the Governing Body note the work undertaken and the evolving procurement work programme for 2017/18 and 2018/19.

1. Update 1.1 The table below summarises the current health service procurement activity.

Procurement Name PQQ Bidders

ITT Bidders

Awarded to Contract Start

Integrated Urgent Care (OOH / 111) TBC TBC 01/11/2018

Ophthalmology Referral Refinement and Remote Review Platform (Lot 1)

TBC TBC 01/09/2018

Integrated Pain Management Services TBC TBC TBC

Current Procurements

1.2 Integrated Urgent Care (OOH / 111)

The procurement for this service re-started in January 2018 and is running jointly with Ipswich & East Suffolk CCG and North East Essex CCG as part of the Sustainability and Transformation Plan (STP). The revised procurement is being led by North East Essex Clinical Commissioning Group and is currently waiting for bidder’s submissions which are due on the 15th March.

1.3 Ophthalmology Referral Refinement and Remote Review Platform

A procurement to secure ophthalmology providers for an Ophthalmology Referral Refinement and Remote Review Platform and a Community Ophthalmology Service (IESCCG only) has started. This is a joint procurement with West Suffolk NHS Foundation Trust, Ipswich and East Suffolk CCG and Ipswich Hospital NHS Trust. The procurement for two services is being undertaken as a single process with two distinct lots to allow a reduction in duplication where possible and to allow the option of joint submissions across the lots. Ipswich and East Suffolk CCG and Ipswich Hospital NHS Trust will be procuring the Community Ophthalmology Service under Lot 2 as this will be restricted to the Ipswich and East Suffolk locality, whereas the Ophthalmology Referral Refinement and Remote Review Platform will extend across both CCGs. This procurement is currently in the evaluation stage.

Future Procurements

1.4 Integrated Pain Management Services

A review of the current Pain Management Service is underway and as part of this review a prior information notice was released to the wider market to allow interested parties to express an interest in the services. This is an informal market engagement process to understand the potential for a successful competitive tender process versus looking to carry out a ‘most capable provider’ process with the incumbent providers who form part of the West Alliance. The outcome of the market engagement will inform the procurement route to secure the delivery of the updated service specification.

2. Key Points 2.1 The following list of services are likely to be in the procurement portfolio over the coming

year; the shaded areas denote when it is anticipated that these will be actively tendered and mobilised.

Please note this list does not include any Ipswich & East Suffolk CCG only procurements 3. Patient and Public Involvement 3.1 No evaluation and moderation panels have taken place during this reporting period;

however, the procurement team have secured patient representation for the Ophthalmology Services tender, and will look to seek involvement in the Integrated Pain Management procurement process.

4. Recommendation 4.1 It is recommended that the Governing Body note the work undertaken and the evolving

procurement work programme for 2017/18 and 2018/19.

1

GOVERNING BODY

Agenda Item No. 11

Reference No. WSCCG 18-19

Date. 28 March 2018

Title Integrated Performance Report

Lead Chief Officer Chief Officer Team

Author(s) Alex Briggs, Head of Corporate Intelligence

Purpose To provide members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial position and transformation activity.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

To note the position regarding financial and service performance; review actions being taken with regard to patient safety and clinical quality issues; and any actions to mitigate risks or poor performance.

Integrated Performance Report

March 2018

1

Part 1 - Clinical Quality & Patient Safety ……………………………………………………

Part 2 - Finance and Information………………………………………………………………

Part 3 - Transformation…………………………………………………………………………

Part 4 – Contractual Performance by Provider…………………………………………….

Part 5 – PMO ……………………………………………………………………………………..

Part 6 – Chief Operating Officer………………………………………………………………

3-6

7-9

10-13

14-15

16-17

18-22

2

Clinical Quality

March 2018

3

4

5

(1) Infection Prevention and Control - The RAG rating is subjective based on an expert review of the individual organisations overall infection prevention and control performance with particular consideration being given to performance in relation to MRSA and C Diff infection rates.(2) Falls - WSFT falls per 1,000 occupied bed days Green ≤6.63; Amber 6.64 - 7.00; Red ≥7.01(3) Falls - Community falls per 1,000 0ccupied bed days Green ≤8.60; Amber 8.61 - 9.50; Red ≥9.51(4) Pressure Ulcers - Total number of avoidable pressure ulcers reported.(5) Serious Incidents - The number of actual serious incidents raised by the individual organisations; excluding pressure ulcers.(6) Patient Experience - The RAG rating is subjective based on an expert review of the individual organisations overall patient experience performance with particular consideration being given to performance in relation to the Friends and Family Test and time frames to respond to complaints.(7) Transforming Care - The RAG rating is subjective based on an expert review of the organisation overall performance.(8) Care Homes - The RAG rating is subjective based on an expert review of performance within the care home sector.

6

Finance

March 2018

7

8

Month Ending 28th February 2018

Finance – Headlines

Rating Key Movement Key

l On or better than target h Improvement

l Below target 1 No Change

i Deterioration

Variance from Plan £0.0m l 1 1 1

At the end of month 11, the CCG was on target to hit in year break even. Principle overspends

year to date include Acute Services (£2.0m), Prescribing (£0.6m) and Mental Health Services

(£0.5). These are mitigated by the release of Contingency (£1.4m) and underspends in

Continuing Care (£0.8m), Other Programme Services (£0.6m), Running Costs (£0.2m) and

Property Recharges (£0.1m).

Forecast Risks and Mitigations £0.0ml 1 h i

The CCG has reported a balanced position to NHS England. Identified risks are QIPP under

delivery, additional contract risks, potential Continuing Healthcare historical claims and

delegated Primary Care budget overspends. These are mitigated by contingency, reserves and

quality premium. The CCG’s balanced plan position currently includes costs for a scaled back

GP Access and GP streaming service.

Underlying Surplus / (Deficit) £4.3m l h h h

This indicator adjusts the forecast surplus by removing the impact of non-recurrent costs and

allocations and the full year effect of in year adjustments in order to show the recurrent

position. Key adjustments include adjusting for the mandatory 0.5% system reserve, 0.5% non-

recurrent reserve and other non recurrent/ full year adjustments.

QIPP Delivery 95%l i i h

At month 11, the CCG has delivered £9.0m of QIPP against a target of £9.5m (95% delivery).

This is mainly delivered through QIPP from WSFT GIC, Corporate QIPP, Prescribing QIPP and

CHC QIPP. Up to M10, delivery of 97% had been achieved. The decrease in delivery seen in

M11 is mainly due to a decline in the Corporate and Acute QIPP. Full year forecast is 97%

delivery.

Key Metric ValueLast 3 Months

MovementRating Headlines

8

9

Month Ending 28th February 2018

Finance – Key Variances

Acute Services (£2.0m) (1.3%) l i i h Mainly due to non delivery on other acute QIPP - £1.9m

Continuing

Healthcare Services£0.8m 5.7% l h h h

This is mainly due to PUPOC 2 underspend YTD and CHC pay and non-pay costs below plan

YTD.

Mental Health &

Learning Disability

Services

(£0.5m) (2.0%) l i i i This is mainly due to overspends in MH placements Shared care and S12 payments.

Corporate Running

Costs£0.2m 4.3% l i h h

This is due to various vacancies which are included within the budget but are yet to be

recruited to and delays in recruitment.

Prescribing (£0.6m) (1.7%) l i i h

Mainly due to overspend on drugs where no cheaper stock is obtainable (NCSO) and impact

of category M benefits being clawed back centrally. (Note: includes actual expenditure up to

month 9 and forecasts for M10 & 11)

CategoryVariance

£mRating

Last 3 Months

MovementCommentary%

9

Transformation

March 2018

10

Transformation Overarching HeadlinesProgramme Key Indicators

March 2018Key Highlights March 2018

Key Actions April 2018

Integrated Care

A&E 0.7% above planEmergency Admissions 0.2% below plan(Based on NHSE activity YTD at M9)

WSFT Acute DTOC 3.3% (week commencing 26/2/18)

• Service variation for streaming nurses to start shift before GP to front load appointments signed off and implemented.

• Trusted Assessment policy sent to all organisations for individual sign off. Privacy impact assessment signed off by IG Leads (CIAG) and sent to LMC for input.

• First Trusted Assessment patient and staff engagement event completed and IT requirements specification submitted for consideration by IT subgroup.

• Job Description for Integrated Care Coordinator role interfacing across acute and community services to support pull based discharge now agreed

• “Personalise My Zimmer” in west Suffolk approved by TDG and launched to care homes.

• Revised DEXA referral pathway approved by WSCCG Executive. FLS service to commence referring mid-March 2018.

• DTOC improvement plan continues to be implemented across all hospital sites. Focus on improving validation and escalation processes

• 3 Locality ‘Connect’ review meetings completed – one further meeting in progress / information collated

• System wide care homes workshop completed to inform strategy going forward

• Updated DVT ES approved and circulated to primary care. Glenn Allen (head of anticoagulation, WSFT) attended locality meetings to provide information on this and answer queries.

• System winter review and draft Surge plan completed

• Joint review of streaming app (WSFT/IHT/Suffolk GP Fed) to make this less risk adverse and therefore increase service appointment utilisation.

• Recruitment to Integrated Care coordinator commenced

• D2OA pathway 1 project manager post commenced• D2OA pathway 2 paper approved by Alliance Steering

Group• Integrated Therapies Priorities agreed and paper

presented to TDG • West Suffolk Integrated Therapies implementation plan

developed• Care Home demand management action plan approved• 100 day challenge focus on 30% discharges before

noon metric to commence• Support to Go Home evaluation completed and paper

presented to TDG and Alliance Steering Group • Virtual Ward assessment for Discharge to Optimise and

Assess completed and presented to TDG• Priorities for Locality work agreed by organisational

leads to inform strategy• Falls car business case submitted to TDG• Suffolk falls strategy to be reviewed and approved by

Falls Steering Group.• Updated DVT ES to be launched on 01 April 2018.• Delirium pathway scoping completed• Integrated Respiratory Pathway scoping completed• Integrated EOL strategy drafted and presented to

Alliance Steering Group

Transformation Overarching Headlines

Programme Key Indicators March 2018

Key Highlights March 2018

Key Actions April 2018

Planned Care

Elective activity is 0.6% above plan.Total Outpatients are 4.1% below plan.(Based on NHSE activity at M9)

• Elective Care Collaboration progress is on track• Planning is taking place for the 100 day mid point reviews• QIPP plans being finalised following draft submission to

NHSE. • Alignment of QIPP with the Trust CIP plans is in progress• RTT trajectory submitted to planning. 92% to be achieved

by December 2018• RTT demand and capacity models are to be shared with

the Trust operations teams with support and training from the CCG

• Trust Access Policy presented to Clinical Executive• Ophthalmology procurement is progressing and tenders

are currently being assessed and moderated• Pain shadow board meetings continue to take place

monthly. Progress towards an Alliance fully integrated model is slow

• Prior Information Notice (PIN) for the Pain Service, closed on March 5th. One expression of interest

• Rightcare review meeting held with entire team. Awaiting revised data for reviewing 17/18 Rightcare plans

• Successful ESHN bid for 42 handheld ECG monitors across the system

• eRS roll out of paper free switch off is on track • Annual planner for Planned care transformation and

Contract SDIP have been agreed internally and shared with WSFT

• 100 day challenges in ENT, Urology and Cardiology have identified milestones and activity in month

• QIPP programme will be agreed t specialty level and discussed with Trust departments to gain their buy in.

• Consideration of a ‘Pathway for Pathways’ model to support demand management

• RTT trajectory to be agreed with WSFT• Pain provider who responded to PIN will be

invited to meet and discuss with the CCG• Rightcare reviews to begin based on revised 16/17

data• eRS go live for full paper switch off takes place on

April 2nd. Full comms and operational support in place

• Integrated physiotherapy strategy to be developed and signed off by close of Q1

• Trust Access Policy to be finalised and rolled out at WSFT

• On-going meetings for STP specialty teams to ensure sharing of information and practice

Transformation Overarching HeadlinesProgramme Key Indicators

March 2018Key Highlights March 2018

Key Actions April 2018

Mental Health and LD

Dementia Diagnosis Target Rate of 67%.Actual at Jan 18:West: 61.9%I&E: 66.6%

• Agreement to launch a new Mental Health programme of work across the CCG’s and NSFT to set out a new clinical model by November 2018. Discussed at STP Board, Mentally Healthy Communities Board and CCG Patient Engagement Groups in early March.

• Mental Health system wide workshop held on 08.02.18 at the hub in Stowmarket to discuss the range of information and literature provided by agencies to support service users and their families.

• IAPT- ‘Living Life to the Full’ pilot moving into implementation phase with 13 East GP Practices. Will provide self care materials to support patients and GPs in primary care.

• Formal launch of first wave East and West Suffolk Perinatal service on 23.02.2018 at the mix in Stowmarket.

• Perinatal bid (phase 2) submitted to NHSE on 09.03.18.• Further meeting with NHSE Assurance team planned to

discuss dementia diagnosis progress on 21.03.18.• Assurance meeting with NHSE to consider CAMHS

Transformation Plan on 14.03.18.• Annual health check in primary care for patients with

Serious Mental Illness (SMI). Target 30% in 17/18 and 60% in 18/19. Options to be considered on 20.03.18.

Children, YoungPeople and Maternity

• Next SALT & Communication scoping workshop (3) completed on 20.02.2018. Next meeting to take place on 27.03.18.

• SEND Letter received from Nadhim Zahawi MP, Parliamentary Under Secretary of State at Department for Education on 05.03.18 confirming positive progress on our SEND Plan.

• CYP Emotional Wellbeing Hub. Implementation continues with plan to be operational by 16.04.2018. Team now fully recruited to. Update provided to GP Education event in the East on 07.03.18 and West on 13.03.18.

• Interview for new joint Associate Director of Transformation: Children and Young People post accountable into the CCGs and Suffolk County Council on 08.03.18.

• Neurodevelopmental and Behaviour Pathway (ND&B) stocktake meeting agreed for 23.03.18.

• Continued implementation of £500k <18 years CAMHS crisis service with NSFT to go live by April/May 2018.

Contracts

March 2018

14

Contracts headlines

Contract CurrentMonth

Previous 6 months (most recent

on left)

Headlines

The Ipswich Hospital Trust January

• A&E performance remains below the 95% requirement (90.2% Jan from 86.2% in Dec). A system wide recovery plan is in place that will be managed through the A&E Delivery Board.

• Overall 18 week standards were missed (90.3% against 92% standard). Urology, T&O, General Surgery, Neurology, Ophthalmology and Rheumatology breached in January. Recovery plans in place.

• Delayed Transfers of Care were 4.5% in December 2017 (target 3.5%).• 62 day cancer performance (unvalidated) fell to 74.3% from 90.1% (85% target)• Diagnostic Tests within 6 weeks was 98.8% (was 99.6%) against 99% target

West Suffolk Hospital NHS Foundation Trust

January

• A&E performance rose to 84% in January from 83% in December, all actions to improve this performance are managed through the A&E delivery board.

• There was a small improvement to 90% in January against 92% target. The action plan is discussed at a 2 weekly steering group.

• 14 patients breached 52 weeks.• 62 day cancer target was achieved at 86%.

Norfolk and Suffolk NHS Foundation Trust

December

• CQC rated NSFT Inadequate• Early Intervention in Psychosis performance met standard at 100% in 14 days (target 50%).• AAT routine referral to assessment within 28 days performance rose to 67% from 60% for children and

rose from 76% to 82% for adults. Staff capacity is the primary cause, recruitment should stabilise or improve performance.

• NSFT remain on track for Improving Access to Psychological Therapies access at over 14% seen against standard of 12.6%. 50% recovery rates have been achieved for the last 5 months.

Suffolk Community Healthcare

January• The local teams met response times for referrals , 4hrs, 72hrs and 18 weeks,• DTOCs remain above plan in the community provisions and actions are being monitored through the

delivery boards

Care UK: GP Out Of Hours January• January demand was very high and out of hours did not meet response standards• Care UK have agreed to a contract extension to allow for the delay in procurement.• The procurement for both OOH and 111 is in progress

Care UK: 111 January

• The 111 service did not meet the 60 second response standard 95% requirement, only achieving 71.55% due to high demand

• 48% of green ambulance calls were diverted to a more appropriate service after clinical validation against the trajectory of 34%.

East of England Ambulance Service NHS Trust

January• Cat 1 category response improved to 09:33 mins in January for IES (was 09:55) and improved to 10:14

from 10:47 for WS. A recovery plan is agreed between EEAST and CCG consortium. • New ARP standards introduced from October 2017

Key

Improvements and/or continued good performance – no major concerns/risks noted

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

15

PMO

March 2018

16

West Suffolk CCG PMO Monthly Reporting March 2018

Savings Summary

• YTD have achieved 95% of planned QIPP savings• 97% of the total required QIPP has been identified • 87% of the total planned YTD QIPP has been

achieved• MH OOA is not going to achieve target QIPP• CHC continues to over perform

Original

Full Year

Revised

Full YearPlan Plan Plan Actual

JT WSFT GIC Contracts 3,116,447£ 3,116,447£ 3,116,447£ 11 2,856,743£ 2,856,743£ -£ 0% G G G

KV Prescribing Prescribing 2,068,116£ 2,068,117£ 1,507,061£ 11 1,895,773£ 1,444,741£ 451,032-£ -24% G G A

JT CHC CHC 1,660,137£ 1,660,137£ 3,895,236£ 11 1,521,795£ 3,242,826£ 1,721,031£ 113% G G G

CH MH OOA Placements CYP/MH/LD 557,063£ 557,063£ 309,857£ 11 510,642£ 288,517£ 222,125-£ -43% G R R

AL Corporate Pay Costs Corporate 147,830£ 147,830£ 147,830£ 11 135,511£ 272,344£ 136,833£ 101% G G G

AL Corporate Non-pay Cost Corporate 55,713£ 55,713£ 55,713£ 11 51,070£ 50,520£ 550-£ -1% G G G

JT Non Acute Contracts Contracts 215,470£ -£ 54,810£ 11 197,516£ 67,740£ 129,776-£ -66% R R

JT Community Contracts Contracts 678,919£ 443,000£ 308,189£ 11 622,347£ 278,056£ 344,291-£ -55% R R

CA Corporate budget hoovering Corporate 193,765£ 193,765£ 602,424£ 11 177,618£ 149,380£ 28,238-£ -16% G G

JT Other Acutes Contracts 2,083,947£ -£ 415,220£ 11 1,910,282£ 350,275£ 1,560,007-£ -82% R R

JT Ambulance Contracts 527,898£ -£ -£ 11 483,912£ -£ 483,912-£ -100% R R

JT Investment Contracts 923,000-£ -£ 308,000-£ 11 846,087-£ -£ 846,087£ -100% G G

RW Integrated Care Programme WS ICN -£ -£ -£ 10 448,186£ 464,930£ 16,744£ 4% G G G

RW CYP and Maternity CYP/MH/LD 201,565£ -£ -£ 10 134,339£ 221,161£ 86,822£ 65% G G G

RW Pain Planned Care 115,500£ -£ -£ 10 96,100£ 60,774£ 35,326-£ -37% A G G

RW MSK Planned Care 306,600£ -£ -£ 10 273,180£ 839,648£ 566,468£ 207% G G G

JT CHC FYE 16/17 NA 600,000£ -£

KV GP Access slippage NA 400,000£ -£

AL Additional Corporate NA -£ -£

10,382,305£ 9,242,072£ 10,104,786£ 9,517,122£ 9,001,142£ 515,980-£ -5%

10,382,305£ 10,382,305£ 87%

1,140,233-£ 277,519-£

89.02% 97.33%

Reported

NHSE

Forecast

No

n

PM

O

Target Savings Requirement

Variance to plan

Ca

sh Q

IPP

Exec

ownerProgramme/Projects Workstream

No

n

PM

O

Totals

In G

IC

MntYTD PMO

Confidence

Scheme

finance

On

Budget?Var

QIPP Coverage Variance

Benefit will be released in corresponding QIPP line above

17

Chief Operating Office

March 2018

18

Regulator Inspections: CQC

Practices visited: 24Visits pending: 0• Outstanding 2• Good 21• Requires Improvement 1• Special Measures -

Primary CareList closures:One practice in west Suffolk has informally (temporarily) closed its list due to capacity issues. The CCG is actively supporting remedial action.

Experience of making an appointment (Quality Premium):

Target: Achieve a level of 85% (or 3% increase on July 17

baseline) of respondents who said they had a ‘good’

experience of making a GP appointment

Current position (July 17 i.e. baseline):

• CCG overall: 77.7% (national avge. 72.7%)• 10/24 practices achieved >85%• 11/24 practices achieved >73% and <85% • 3/24 practices below national avge.Note: Results not statistically significant at practice level due to small

sample size.

Learning Disabilities – Annual Health Checks:

Target: 75% of adults and young people (over 14) with learning disabilities to have an Annual Health Check.

Current position (Qtr 3 2017/18):

• CCG overall: 36% (431 checks in Q1,Q2 & 3 1,201 on registers)• Estimated number of checks required – 901 p.a.• 3/24 practices on target to achieve target at year end

Dementia Diagnosis:Target: Achieve a diagnosis rate of 67%.Current position (January 18):

• CCG overall: 61.9% • 8/24 practices achieved >67%• 9/24 practices achieved >50% and <67% • 7/24 practices <50%

QOF Dementia Register - 2,168 patients.

19

Programme Summary

QIPP

CCGPM

Exec Owner

Workstream

G G A

QIPP target YTD (Month 9)

Actual QIPP Schemes YTD (Month 9)

Milestone

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 1,895,773 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ £ 172,343 £ 172,343 £ 172,343 £ 172,343 £ 172,343 £ 172,343

Actual £ 1,444,741 406,233£ 115,589£ 28,463-£ 246,634£ 67,747-£ 80,100£ £ 234,134 £ 82,241 £ 350,387 -£ 15,156 £ 40,789

Variance -£ 451,032 £ 233,890 -£ 56,754 -£ 200,806 £ 74,291 -£ 240,090 -£ 92,243 £ 61,791 -£ 90,102 £ 178,044 -£ 187,499 -£ 131,554

Risks/Issues

No milestones due in January. All milestones are on track.

Key Issue

QIPP schemes have delivered planned savings, however the effect of NCSO drug cost pressure has had a significant effect on the prescribing budget. The finance RAG reflects the overall

budget position and not the performance of the prescribing schemes. The unforseen cost of NCSO drugs was £1.03m to WSCCG.

Summary

Objectives

A range of prescribing projects to realise £2.068m QIPP.

Overall Confidence Project delivery RAG Finance RAG

Total QIPP target for 2017/18 2,068,116£

1,940,645£

1,551,088£

Note: January and February figures are projected estimates.

Milestones Status Comment

Prescribing

• Prescribing visits have been fine-tuned further with a particular and sustained focus

on supporting 9 practices that are still in an overspend position, according to Dec 2017

data

As last month, Wale and I will update our Workbooks, showing significant points in

green for you to extract for the IPR as needed.

• Prescribing policies and supporting documents have been updated for gluten free

food and specialist infant formula, enabling on-going progress to be made in containing

prescribing costs in these areas.

• Significant progress is now being made on prescribing of continence and stoma items,

with dedicated support from our primary care stoma nurse and appliance nurse.

Prescribing - QIPP Scheme Top Achievements

West Suffolk

Linda Lord

Kate Vaughton

20

Prescribing QIPP SchemesProject (Planned Savings)

Project Plan Status

£YTD Actual

(Planned)

Key points/highlights

P01 – Analgesics (£300k)£768.9k(£225k)

* Work is underway, in collaboration with the West Suffolk Pain Services, to develop a range of supporting documents for GPs to aid reduction in inappropriate prescribing of analgesics.

* Medicines Management technicians and practice staff continue to actively switch Lyrica and Alzain to generic pregabalin for all indications. This is a significant cost saving initiative.

* Prescribing Reports discussed at prescribing visits and they are also posted on the WSCCG website. The reports include a detailed analysis of analgesics prescribed and show where practices are outliers regarding cost per 1000 patients and items per 1000 patients. They also show the top 20 analgesics prescribed.

P02 – Continence(£50k)

£25.8k(£37.5)

* Qufora leg and night bags switch matrix updated

* Switch to Qufora leg and night bags ongoing

* Appliance nurse now actively supporting practices with cost-effective prescribing of continence products

P03 – Diabetes and Endocrine(£70k)

£325.8k(£52.5k)

• All milestones for this project now complete.

• Some practices now reporting switch from liothyronine to levothyroxine.

• Further implementation of WSCCG Policies on cost effective prescribing of BGTS, lancets and needles; follow up at Q4 practice meetings.

P04 – Enabler Workbook(£778k) (£583.6k)

* RAP scheme continues to be promoted at practice meetings as a tool to encourage implementation of prescribing savings

* Revised antibiotic formulary strongly promoted to all practices across West and East Suffolk, with supporting data, including national KPIs.

* Technicians and clinical pharmacists actively engaged in cost effective prescribing initiatives

* Cost effective and appropriate dietetic prescribing continues to be implemented.

* GF and IF policies updated.

* Further initiative launched to ensure no prescribing of ONS or enteral feeds without advice from a dietitian.

P05 – Mental Health(£70k)

£84.7k(£52.5k)

* Letter written to practices where trimipramine is prescribed. Practices advised to carry our reviews under the terms of thepolypharmacy LES with a view to stopping the medication or switching to a modern antidepressant if on-going treatment still indicated

* WSCCG Prescribing Lead GPs' education event held on 17 January to discuss and explain key issues regarding cost-effective prescribing of two mental health drugs - quetiapine and trimipramine. An expert speaker from NSFT was in attendance with excellent GP attendance and engagement

21

Prescribing QIPP Schemes

Project (Planned Savings)

Project Plan Status

£ YTD Actual (Planned)

Key points/highlights

P06 – Polypharmacy(£200k)

£167k(£150k)

• All milestones for this project now complete.

• Potential extension of the LES to 2018-19 not yet agreed. Discussions continue.

P07 - Rebates(£120k)

£69.7k(£90k)

• All milestones for this project now complete.

• Rebate schemes accepted continue to be reviewed .

• Rebate schemes accepted by the WSCCG posted on WSCCG website.

P08 – Respiratory(£200k)

£311.5k(£150k)

• All milestones for this project now complete.

• Additional COPD kits made up and distributed to practices to further support adherence to the COPD formula.

• Prescribing reports actively promoted to demonstrate to each practice where savings can be made regarding prescribing of formulary inhalers for COPD.

• Continued promotion of the updated COPD guidelines , promoting cost effective treatments aligned to each patient’s GOLD grade

P09 - Wound Care(£70k)

12.8k(£52.5)

* Prescribing reports actively promoted to WSCCG practices. The reports demonstrate to each practice where further savings can be made on woundcare items and other therapeutic areas

* Adherence to the Suffolk Woundcare formulary continue to be promoted

* Appliance nurse now actively supporting WSCCG practices with cost-effective prescribing of wound care and continence products

P10 – ScriptSwich(£100k)

£136.7K(£75k)

* ScriptSwitch profile updated with safety/cost-effective messages relating to dietetic products, beta-blocker containing eye drops for glaucoma, prednisolone soluble tablets, etc.

* Monthly report sent to all practices

P11 - Self Care (£60k)

£36.6K(£45k)

• All milestones for this project now complete.

• Prescribing of self care medicines continue to be discussed at Q4 practice prescribing meetings. GPs strongly encourage not to prescribe OTC medicines for minor conditions.

P12 – Stoma(£50k)

£1.2k(£37.5k)

• All milestones for this project now complete.

• Hollister sub-contract with WSFT in place .

• Hollister nurse now carrying out stoma reviews across practices.

22

Integrated Performance Report Clinical Quality & Patient Safety

Supporting Information

March 2018

2

CONTENTS

Infection Control

• WSCCG - Slides - 3-5• WSHFT - Slide - 6

WSHFT and West

Community

• Falls Slides - 7-8• Pressure Ulcers Slides – 9-12• Cancer Breaches (WSHFT) - Slide 13• Serious Incidents - Slide 14• SHMI - Slide 16

Other Providers

• Slide - 15

Patient Safety

• Safeguarding - Slides - 17-19

Patient Experience

• PALS - Slides – 20-34• Complaints - Slides - 20-34

Clinical Effectiveness

• Transforming Care - Slide – 35-36• Care Homes - Slides - 37• Individual Funding Requests 38-39

West Suffolk CCG – C.Diff• WSCCG reported 5 cases of CDI for the month of

January against a monthly trajectory of 4.

• This breaks down into 1 acute and 4 non-acute (community) None were diagnosed out of area.

• Total CCG YTD cases are 51 against YTD trajectory of 37 and an end of year trajectory of 45.

• Non-acute YTD cases are 30 against a YTD trajectory of 23.

• WSCCG – remains above trajectory.

Clostridium Difficile and MRSA

INFECTION PREVENTION AND CONTROL

3

58

1216

22

28

39

46 4651

3 33 4 4 6

10 14 14 15

2 47

1015

1822

26 2630

0

10

20

30

40

50

60

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

WSCCG cumulative C.diff reporting for year to January 2018

WSCCG YTD WSCCG Traj WSH YTD WSH Traj Non Acute YTD Non Acute Traj

0

20

40

60

80

April

May

June July

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

West Suffolk CCG C.Diff figures 2014/15 to 2017/18

2014/15

2015/16

2016/17

2017/18 3 3 3 4 4 6 10 14 14 15 15 152 4 7 10 15 18 22 26 26 30 30 30

5 8 12 16 22 2839

46 46 51 51 51

April May June July August September October November December January Feburary March

0

20

40

60

80

100

120 WSCCG cumulative C.Diff reporting for year to January 2018

WSH YTD Non Acute YTD WSCCG YTD WSH Traj Non Acute Traj WSCCG Traj

INFECTION PREVENTION AND CONTROL

Clostridium Difficile and MRSA

West Suffolk CCG – MRSA• WSCCG reported 0 cases of MRSA bacteraemia

for the month of January 2018.

• Total MRSA YTD cases are 0 against end of yeartrajectory of 0.

4

0

1

2

3

4

5

Number of MRSA cases reported 2017/18

WSCCG

WSH

ASSIGNED TO THIRDPARTY

ASSIGNED TOANOTHER CCG

WSCCG baseline is 168. A QP reduction of 10% means that there is a trajectory of 151.

Current position at January 2018 is 137. Anticipated end of year position at this rate is 164.

INFECTION PREVENTION AND CONTROL

West Suffolk CCG E.coli Bacteraemia

April 2017 to March 2018 Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar YTDTotal 12 8 15 20 10 17 15 15 16 9 137Acute 2 0 1 2 0 0 1 2 2 3 13Community 10 8 14 18 10 17 14 13 14 6 124Female 6 5 5 10 7 5 7 10 5 5 65Male 6 3 10 10 3 12 8 5 11 4 72UTI associated 8 3 8 11 7 14 10 13 9 5 88Emergency admission 3 3 8 12 2 11 6 3 11 4 63From home 7 5 13 18 5 16 13 7 15 8 107From nursing/care/sheltered home 4 3 1 1 4 1 1 8 0 1 24

5

12

8

15

20

10

1715 15 16

9

0

5

10

15

20

25

WSCCG E.coli Bacteremia April 2017 to March 2018

total

West Suffolk Hospital Foundation Trust – MRSA• West Suffolk Hospital Foundation Trust has

reported 0 cases of MRSA for the month ofJanuary 2018.

• Total MRSA YTD case are 0 against end ofyear trajectory of 0.

West Suffolk Hospital Foundation Trust – C.Diff• WSHFT had 1 case against a trajectory of 2, which

was a WSCCG patient.

• WSHFT YTD is 15 against a YTD trajectory of 14.

• WSHFT - hospital onset CDI remains above trajectory.

INFECTION PREVENTION AND CONTROL

West Suffolk Hospital Foundation TrustClostridium Difficile and MRSA

6

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2017-18 3 0 0 1 0 2 4 4 0 12016-17 2 1 3 3 3 1 3 3 2 0 0 1

0

2

4

6

8

WSHFT C.Diff

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2017-18 0 0 0 0 0 0 0 0 0 02016-17 0 0 0 0 0 0 0 0 0 0 0 0

012345678

WSHFT MRSA Bacteraemia

7

West Suffolk Hospital Foundation Trust – FallsThe Trust reported 76 falls for the month of January.

The Trust continues to experience issues with the new reporting system e-Care. Performance for falls per 1000 bed days remains unavailable.

The CCG continues to work with the Trust to obtain missing reporting information that has been requested via the contract.

Data not reported due to e-Care (falls /1000 days)

Apr May Jun Jul Aug SepOct Nov Dec Jan Feb Mar2017-182016-17 5.1

0

1

2

3

4

5

6

WSHFT Falls per 1000 bed days

West Suffolk Hospital Foundation TrustFalls

PATIENT SAFETY – HARM FREE CARE

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2017-18 53 52 50 66 68 39 39 73 69 762016-17 64 61 62 61 56 61 67 62 65 61 55 71

01020304050607080

WSFT No of Falls

8

West Suffolk CommunityFalls

PATIENT SAFETY – HARM FREE CARE

The graphs show whole service data for East and West Suffolk Community

2017-18

Falls Oct Nov Dec Jan Feb Mar

East Community (in-patient) 28 35 30 36

West Community (in-patient) 10 17 9 9

2017-18

Falls Per 1,000 Bed Days Oct Nov Dec Jan Feb Mar

East Community (in-patient) 13.95 18.01 14.31 15.75

West Community (in-patient) 7.5 14.42 7.35 7.11

8

05

10152025303540

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Falls

East Community (in-patient) West Community (in-patient)

02468

101214161820

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Falls Per 1,000 Bed Days

East Community (in-patient) West Community (in-patient)

West Suffolk Hospital Foundation TrustPressure Ulcers

PATIENT SAFETY – HARM FREE CARE

West Suffolk Hospital Foundation Trust – PressureUlcersThe Trust reported 19 Grade 2 pressure ulcers for the month of January, 2 of which were deemed as avoidable. *11 are pending grading and avoidability status.

The Trust reported 12 Grade 3 pressure ulcers for the month of January, 3 of which was deemed as avoidable. *4 are pending grading and avoidability status.

The Trust reported 0 Grade 4 pressure ulcers for the month of January.

Grade 4 Pressure Ulcers Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Grade 4 Avoidable 0 0 0 0 1 0 0 0 0 0

Grade 4 Unavoidable 0 0 0 0 0 0 0 0 0 0

Grade 4 Pending 0 0 0 0 0 0 0 0 0 09

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarGrade 2 Avoidable 4 0 1 2 2 3 3 0 0 2Grade 2 Unavoidable 2 6 9 5 5 6 10 9 1 6Grade 2 pending 0 0 0 0 0 1 2 4 8 112016-2017 Total 24 11 8 10 5 10 12 20 4 11 6 4

0

5

10

15

20

25

WSHFT Grade 2 Pressure Ulcers

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarGrade 3 avoidable 0 3 3 1 3 1 1 0 1 3Grade 3 unavoidable 4 0 5 1 2 3 2 1 0 5Grade 3 pending 0 0 0 0 0 0 1 2 5 42016-2017 Total 6 2 3 5 6 5 9 6 3 8 3 0

02468

10

WSHFT Grade 3 Pressure Ulcers

PATIENT SAFETY – HARM FREE CARE

West Suffolk CommunityPressure Ulcers

10

0

1

2

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Grade 2 Pressure UlcersWest Suffolk Community (in-patients)

G2 PU - West Community (in-patient) - Avoidable G2 PU - West Community (in-patient) - Unvoidable G2 PU - West Community (in-patient) - Pending

02468

1012

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Grade 2 Pressure UlcersWest Suffolk Community

G2 PU - West Community - Avoidable G2 PU - West Community - Unavoidable G2 PU - West Community Pending

PATIENT SAFETY – HARM FREE CARE

West Suffolk CommunityPressure Ulcers Contd.

11

0

1

2

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Grade 3 Pressure UlcersWest Suffolk Community (in-patients)

G3 PU - West Community (in-patient) - Avoidable G3 PU - West Community (in-patient) - Unavoidable G3 PU - West Community (in-patient) - Pending

0123456

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Grade 3 Pressure UlcersWest Suffolk Community

G3 PU- West Community - Avoidable G3 PU - West Community - Unavoidable G3 PU - West Community - Pending

12

2017-18

West Community Grade 4 Pressure Ulcers Oct Nov Dec Jan Feb Mar

West Community -Avoidable 0 0 0 0

West Community -Unavoidable 0 1 0 0

2017-18

West Community (in-patients)Grade 4 Pressure Ulcers Oct Nov Dec Jan Feb Mar

West Community (in-patient) - Avoidable 0 0 0 0

West Community (in-patient) - Unavoidable 0 0 0 0

PATIENT SAFETY – HARM FREE CARE

West Suffolk CommunityPressure Ulcers Contd.

NHS Improvement and NHS England are working together to deliver a regional cancer recovery plan. We are required to;• Routinely report numbers of over 62 day breaches and outcomes/learning themes to Public Board/Governing Body meetings.• Routinely report numbers of over 104 day breaches and outcomes/learning from RCAs and harm reviews to Public Board/Governing Body meetings.

The CCG are not aware of any patient harms caused as a result of WSFT breaching the cancer standards. Each case that breaches 104 days is reviewed by a clinician at WSFT and an assessment of harm is made. No patient harms recorded for the breaches reported.

West Suffolk Hospital Foundation TrustCancer Breaches

PATIENT SAFETY – HARM FREE CARE

13

14

West Suffolk Hospital Foundation Trust• Serious Incidents – there were 14 incidents reported for the

month of January 2018.

• Unexpected/potentially avoidable death – 2 (2x Maternity Incidents)

• Unexpected/potentially avoidable injury causing serious harm – 10 (9x Grade 3 Pressure Ulcers, 1x Slip/Trip/Fall)

• Unexpected/potentially avoidable injury requiring treatment to prevent death or serious harm – 1 (1x Treatment delay)

• Incident threatening organisations ability to continue to deliver an acceptable quality of healthcare services – 1 (1x Infection control)

West Suffolk Hospital Foundation Trust and West Suffolk CommunitySerious Incidents and Never Events

PATIENT SAFETY – HARM FREE CARE

West Suffolk Community• Serious Incidents – there were 7 incidents reported for the

month of January 2018.

• Unexpected/potentially avoidable injury causing serious harm – 7 (7x Grade 3 Pressure Ulcers)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2017-18 8 5 8 10 7 7 10 14 11 142016-17 2 3 6 4 2 6 9 11 11 16 8 10

02468

10121416

WSHFT Serious Incidents

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2017-18 0 0 0 0 0 0 0 1 0 02016-17 0 0 1 0 0 0 0 1 0 0 0 1

0

1

2

3

4

5

WSHFT Never Events

15

Norfolk and Suffolk Foundation Trust (West Suffolk)• Serious Incidents – there was 1 incident

reported for the month of January 2018.

• Unexpected/potentially avoidable death – 1 (1x Apparent/actual/suspected self-inflicted harm

Never Events will now be reported by exception only

Other ProvidersSerious Incidents and Never Events

PATIENT SAFETY – HARM FREE CARE

The graph shows whole service data, for IESCCG and WSCCG

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2017-18 3 7 2 3 5 5 4 3 3 42016-17 5 3 2 5 4 1 4 6 3 6 7 7

012345678

NSFT - Serious Incidents

GP• Serious Incidents – there was 1 incident

reported for the month of January 2018.

• Unexpected/potentially avoidable injury requiring treatment to prevent death or serious harm – 1 (1x Medication incident)

East of England Ambulance Service• Serious Incidents – there were 2 incidents

reported for the month of January 2018.

• Incident demonstrating existing risk that is likely to result in significant future harm – 1 (1x Sub-optimal care of the deteriorating patient)

• Incident threatening organisations ability to continue to deliver an acceptable quality of healthcare services – 1 (1x Confidential

• Information Leak)

16

The darker circle represents West Suffolk NHS Foundation Trust (RGR) Last Updated: February 2018

Summary Hospital-level Mortality Indicator (SHMI)

PATIENT SAFETY – HARM FREE CARE

17

Number of ContactsAdults over the last 12 months

The above shows the total number of contacts received by Adult Services and the dotted line shows a variance +/- 10%.

Safeguarding

PATIENT SAFETY

January data not available at time of reporting

18

The below table indicates the outcomes for adult safeguarding.

Level 1 - 3 outcomes indicate the investigation stages.Levels 1 - 3 adult safeguarding investigation depending on severity and/or significance.

Safeguarding

PATIENT SAFETY

January data not available at time of reporting

19

The vast majority of contacts originate from provider services. Such contacts account for around the same volume as the next sixreferral sources combined.

Safeguarding Safeguarding

PATIENT SAFETY

January data not available at time of reporting

PATIENT EXPERIENCE

The overall number of contacts for January 2018 for West Suffolk CCG was 170.

Patient Advice and Liaison Service

20406080

100120140160180200

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of PALS contacts to West Suffolk CCG

Number of contacts received

Average number of contacts over the last 6months (86.6)

January 2018 breakdown

PALS continues to work closely with the Medicines Management team following changes to the prescribing of generic medication or removal of items from prescriptions which are available to purchase over the counter. There has also been several enquiries regarding the Libre Freestyle Glucose Monitoring tests kits and requests for more than 28 day prescriptions due to holidays abroad. PALS and Medicines Management have liaised with GPs to ensure patients are prescribed appropriately.

The team continue to see a significant rise in Extra Contractual Request (ECR) transport journeys. From 13th November 2017 EEAST declined to continue to provide ECR journeys to patients attending appointments at hospitals out of area (or needing to be discharged/transferred), attending ICANHO or requiring special requests such as a bariatric vehicle or needing to travel alone. The Patient Experience Team have taken on the role of booking transport for these patients to ensure continuity of care.

This work has greatly impacted on the team as each patient who contacts the service provides the appointment details, the team then has to contact and source a provider and then allocate the journey. The details are then passed to the patient or clinic and transport booking confirmed. The Patient Experience Team then provide a courtesy call to the patient to confirm the booking.

The Patient Experience team have also been contacted by patients and carers experiencing long delays when contacting PTCAAS to book transport and delays in collecting patients which fell under the remit of EEAST. Some of these have resulted in formal complaints.

Calls from patients wanting to register with a dentist, or requiring an emergency dental appointment, continue to come through to the team and remain at a steady number each month. Likewise the team receive a steady number of calls regarding GP registration and medicine management queries regarding changes to prescribing.

20

PATIENT EXPERIENCE

Indicator Red Amber Green Nov 17 Dec 17 Jan 18

Acknowledged within 3 working days <75% 75 – 89% >90% 100% 100% 100%

Response within 25 working days or negotiated timeframe <75% 75 – 89% >90% 100% 67% (3/5) 100%

No of second letters received >6 2-6 0-1 2 1 2

No of complaints accepted by the Ombudsman >2 1 0 0 0 0

Complaints received and coordinated by West Suffolk CCG (continued over the next page)

3 complaints were received during January 2018 forthe West Suffolk CCG to coordinate in comparison to9 during January 2017

0

1

2

3

4

5

6

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of complaints coordinated by West Suffolk CCG

Number of complaintsreceived

Average number ofcomplaints over the last6 months (3.4)

Of the complaints received in December, two remain outstanding for a response and these complainants have been updated and informed as to progress of the ongoing investigations. Out of the 3 already responded to, one was outside of the 25 working day timeframe as the information provided in the investigation report was incorrect and needed to be re-investigated. Unfortunately this delayed the response by 5 days.

21

Provider Complaint details Outcome/Actions and Learning

EEAST TRANSPORT (ambulances only)Husband had a number of journeys cancelled leading to missed appointments. Wife feels this that his contributed to his delay in diagnosis

Not upheld

EEAST already responded to complaint directly back in October 2017. Nothing further to add. Reiterated difficulties around securing specialist transport and apologies from EEAST that they could not always accommodate.

EEAST TRANSPORT (ambulances only)Not happy with the erratic driving of the hospital transport driver

Upheld

Apologies from ambulance service. Driver was stepped down at time of receiving complaint and had to pass driving assessment before being allowed back to driving duties. Driver reminded of importance of being courteous when speaking with patients and their relatives.

Actions/Learning

Staff member to re-sit driving exam.CCGIFR

ACCESS TO TREATMENT OR DRUGS (including decisions made by Commissioners)Has been declined funding for breast surgery

WSFT responding directly.

Response from CCG to assist with WSFT response: An Individual Funding Request was received for breast augmentation to the CCG on 15th May 2015. The panel took in to account the clinical information provided but concluded that the patients BMI was above 30. The partially excluded policy PE109 stipulates that the BMI must be below 30 for at least one year. A letter closing the case was sent on the 23rd July 2015, and we have had no further contact.

Breakdown of complaints received during April 2017PATIENT EXPERIENCEComplaints received and coordinated by West Suffolk CCG contd.

22

PATIENT EXPERIENCE

Complaints received but not managed by West Suffolk CCG

02468

101214

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of complaints received but not managed by West Suffolk CCG

Number of complaints received

Average number of complaints over thelast 6 months (4.2)

2 complaints were received during January 2018 by the West Suffolk CCG in comparison to 3 during January 2017.

When these complaints are received, consent is requested in order to share with the provider involved so they can be managed through their own complaints process. The CCG request to remain informed of the progress and outcome of the complaint.

Provider IssueWest Community

CLINICAL TREATMENT – Injury sustained during treatment or operationUnhappy with the professionalism demonstrated by Phlebotomist while conducting the blood test, which resulted in painful bruising to her arm

NSFT ACCESS TO TREATMENT OR DRUGS – Access to ServicesDifficulty in accessing services and help for daughters eating disorder

23

0

1

2

3

4

5

6

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of MP letters received by West Suffolk CCG

Number of MP lettersreceived

Average number of MPletters over the last 6months (1.8)

PATIENT EXPERIENCE

MP Letters

Indicator Red Amber Green Nov 17 Dec 17 Jan 18

Resolved within 10 working days <75% 75 – 89% >90% 100% 0% 50%

One of the MP letters received in January remains outstanding as it is a very complex letter.

24

NHS Continuing Healthcare AppealsFrom 1st April 2017 a new local appeals process has been implemented and future reports will reflect this information in a graph. For Aprilreporting onwards this is detailed in a chart and the appeals backlog will continue to be recorded in a separate graph (see below).

PATIENT EXPERIENCE

Stage 1CCG

Local Review by a Senior Nurse from CHC team

Stage 2CCG

Review by Local Panel consisting of Chair, Local Authority rep and

CCG Nurse rep

Stage 3NHS England

Independent Review process

Number of new appeals received per month

Appealsbacklog from 1st April 2017

Number of new appeals heard at stage 1

Number of backlog appeals heard at stage 1

Number of new appeals heard at stage 2

Number of backlog appeals heard at stage 2

Number of new appeals heard at stage 3

Number of backlog appeals heard at stage 3

Number of new appeals closed

Apr 2017 9 3 0 1 0 2 0 0 1

May 2017 1 4 1 2 0 1 0 0 1

Jun 2017 3 3 0 2 0 1 0 0 0

Jul 2017 2 8 0 0 0 0 0 0 1

Aug 2017 2 10 3 0 0 3 0 0 1

Sep 2017 5 10 0 0 0 0 0 0 1

Oct 2017 2 13 0 1 0 0 0 0 2

Nov 2017 2 14 0 0 0 0 0 0 0

Dec 2017 5 15 1 0 0 0 0 1 2

Jan 2018 3 19 0 1 0 0 0 1 0

2 1 1 1 2 2 2 2 1

8

6 6 52 2 3 4 5 6

4

4 4 4

3 3 2 1 1 0

0

5

10

15

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Awaiting LRM

Awaiting Local Panel

Awaiting IRP

NHS CHC Appeals Backlog – Cases received prior to 1st April 2017

Cases received prior to 1st April 2017 aredetailed in the chart opposite. This chartshows the appeals backlog and at whatstage each case is currently awaiting.

25

PATIENT EXPERIENCE

West Suffolk Foundation Trust Complaints

100110120130140150160170180190200

Number of PALS contacts WSHFT received

Number of PALScontacts received

Average number ofcontacts over the last 6months (157.6)

0

2

4

6

8

10

12

14

16

18

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of complaints WSHFT received

Number of complaintsreceived

Average number ofcomplaints over the last6 months (13.6)

Friends and Family Test Indicator Red Amber Green Nov 17 Dec 17 Jan 18

Patient Satisfaction: In-patient overall result <75% 75-84% 85-100% 96 98 97

Patient Satisfaction: Outpatient overall result <75% 75-84% 85-100% 96 99 95

Patient Satisfaction: A&E overall result <75% 75-84% 85-100% 94 94 96

Patient Satisfaction: Maternity overall result <75% 75-84% 85-100% 100 97 100

26

27

Patient Satisfaction: Community Hospitals combined <75% 75-84% 85-100% 100 100 78

Patient Satisfaction: Community Health Teams combined <75% 75-84% 85-100% 100 100 75

Patient Satisfaction: West Community combined scores <75% 75-84% 85-100% 100 96 95

Friends and Family Test Indicator Red Amber Green Nov 17 Dec 17 Jan 18

PATIENT EXPERIENCE

West Suffolk Community

0123456789

10

Dec-17 Jan-18

Number of PALS contacts received

Number of PALScontacts received

Average number ofcontacts over the last 6months (3)

0123456789

10

Dec-17 Jan-18

Number of complaints received

Number of complaintsreceived

Average number ofcomplaints over the last6 months (0)

The combined score is made up of a number of areas within the community (not just Community Hospitals and Health Teams). Reporting going forward will include these additional areas.

PATIENT EXPERIENCE

Norfolk & Suffolk Foundation Trust PALS and Complaints

0

5

10

15

20

25

30

Number of PALS contacts NSFT received in the West

Number of PALS contactsreceived

Average number of contactsover the last 6 months (17)

0

2

4

6

8

Number of complaints NSFT received in the West

Number of complaintsreceived

Average number ofcomplaints over the last6 months (4.5)

Not shown in the graphs above are those PALS contacts recorded by NSFT without an area (17) and complaints recorded as Countywide (8). Although these figures are not included in the graphs above, the subject area of the Countywide complaints are included in the quarterly trend analysis.

28

November 17 No of issues

December 17 No of issues

January 18 No of issues

All aspects of clinical treatment 3 All aspects of clinical treatment 6 All aspects of clinical treatment 8

Attitude 3 Communication 2 Attitude of staff 2

Information 3 Patient privacy and dignity 2

AppointmentsPatient’s property

11

Communication 1

PATIENT EXPERIENCE

East of England Ambulance Service PALS and Complaints

0

1

2

3

4

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of PALS contacts EEAST received in the West

Number of PALScontacts received

Average number ofcontacts over the last 6montths (1.3)

0

2

4

6

8

10

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of complaints EEAST received in the West

Number ofcomplaints received

Average number ofcomplaints over thelast 6 months (5.8)

29

November 17 No of issues

December 17 No of issues

January 18 No of issues

All aspects of clinical treatment 3 Delay 4 Medication 1

Attitude 3 Attitude 1 Transport and driving 1

Information 3 Safeguarding 1

AppointmentsPatient’s property

11

Care UK 111 and Out of Hours Complaints

0

1

2

3

4

5

6

7

8

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

111

OOH

111 - Average number ofcomplaints received over thelast 6 months (2.5)

OOH - Average number ofcomplaints received over thelast 6 months (3.5)

Number of complaints Care UK received

PATIENT EXPERIENCE

30

PATIENT EXPERIENCE

West Suffolk Foundation TrustProvisional PROMs Data April 2016 – March 2017, published February 2018 PROMs measures health gain in patients undergoing hip replacement, knee replacement, varicose vein and groin hernia surgery in England, based onresponses to questionnaires before and after surgery.

This provides an indication of the outcomes or quality of care delivered to NHS patients and has been collected by all providers of NHS-funded care sinceApril 2009. Provider level PROMs data is published quarterly in February, May, August and November, and also contains data for England and CCGs.Registered providers can access data on a monthly basis via our provider extract service. Publications are provisional until the data set is declared finalised.

Adjusted average health gains have been calculated using statistical models which account for the fact that each provider organisation deals with patientswith different case-mixes. This allows for fair comparisons between providers (‘selected’ red dot) and England (bold line) as a whole.

The control limits represent boundaries, provider falling outside of which may be stated with significantly better (if above the upper limit) or significantlyworse (if below the lower limit) than England as a whole.

WSHFT is preforming within the control limits for all procedures.Hip replacement primary EQ-5D Index Hip replacement primary - Oxford hip score

31

PATIENT EXPERIENCE

Contd.

Knee replacement primary EQ-5D Index Knee replacement primary EQ-VAS

Knee replacement primary – Oxford knee score

32

0

10

20

30

40

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Number of GP contract issues to West Suffolk CCG

Number of contract issues received

Average number of queries (21.5)

GP Contract Issues LogPATIENT EXPERIENCE

A comparison over the last 3 months of the most common issues raised through the contract issues log is detailed below. A breakdown of January’s data, by specific provider, is detailed on the next page.

November 17 No of contract issues received

December 17 No of contract issues received

January 18 No of contract issues received

Discharge summaries / discharge planning 7 Referrals 3 Discharge summaries / discharge 6

Test results 4 Discharge summaries 2 Communication 5

Referrals 2 ReferralTestsAccess to services

333

Access to services 2

33

34

Outstanding queries at time of reporting

Breakdown of queries received

Provider Query trends Date StatusWSFT C2C referral x 1

Discharge planning x 1Prescribing x 1Communication x 1Discharge x 1Medication on discharge x 1Test results x 1

06.09.1719.09.1729.09.1705.10.1725.10.1706.11.1729.11.17

OutstandingOutstandingOutstandingReopenedReopened

OutstandingOutstanding

West Community

Referral x 1District nursing x 1

22.9.1711.12.17

OutstandingOutstanding

CGH Discharge summary x 1 09.06.17 OutstandingCCG Communication x 1 29.11.17 Outstanding (with contracts)AHP Referral x 1 15.12.17 ReopenedNSFT Access to services x 1 13.11.17 Reopened

Provider No. received Query trends

WSFT 7 1 regarding discharge, 2 test results, 2 discharge summaries and 2 communicationWest Community 1 1 regarding access to servicesNSFT 4 1 regarding referral, 1 communication, 1 test results and 1 dischargeCCG 3 1 regarding communication, 1 medication and 1 referralPapworth 3 1 regarding referral and 2 discharge summariesEEAST 2 1 regarding access to services/waiting timesNEESPS 1 1 regarding access to servicesCare UK 1 1 regarding communicationBMI 1 1 regarding commissioning

Contd.PATIENT EXPERIENCE

CLINICAL EFFECTIVENESS

Transforming CareTransforming Care CohortThere were 4 patients in cohort as at the end of January for WSCCG, plus 6 for IESCCG.

3 3 3 3 3 3

4 4 4 4 4

7 7 7

6 6 6 6 6 6 6

5

2

3

4

5

6

7

8

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan-18In-patients Trajectory

1614

1314

1315

1412

11 1110

19 19 1918

1716 16

15 1514

13

68

10121416182022

Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

Combined Transforming Care In-patients vs Trajectory

In-patients Trajectory

35

CLINICAL EFFECTIVENESS

Transforming Care

0

1

2

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan-18

Admissions Discharges

WSCCG Admissions & Discharges to Transforming Care 2017-18

2015 2016 2017 2018Admissions 7 1 3 0Discharges 2 8 2 0In-patients 10 3 4 4

0

2

4

6

8

10

12

Num

ber o

f pat

ient

s

WSCCG Transforming Care Admissions & Discharges

36

37

Care HomesCLINICAL EFFECTIVENESS

Care Home Clinical Support Manager UpdateContact continues with “Top Ten” Homes in East and West Suffolk as per work plan- new data analysed and visits arranged to additional Homes.Contact made with additional Care Homes in relation to safeguarding/clinical care concerns/infection outbreaks/advice requested from Care Homes and system partners.Working with 3rd cohort additional providers in West Suffolk to promote NHS England Dementia Diagnoses Initiative - on-going work to promote system joint working/best practice dementia care for individuals and support for Care Homes-proposed CNS role working jointly NSFHT and CCG.Additional clinical skills training under discussion with partners-potential for neurological conditions training/SALT/falls prevention training.Follow up work with IG project East Suffolk- agreed plan to extend project to additional Care Homes.On-going weekly support for IG project West Suffolk - weekly IG visits commenced November 2017 - 3 month trial- project trial review currentlybeing undertaken with project partners. Potential for 2nd IG to commence April 2018-potential for Residential and Nursing Home visits.Red Bag initiative joint working East and West Suffolk - launch event 22/11/17 - 7 Care Homes West Suffolk, 30 Care Homes East Suffolk.Focused review/evaluation with Care Homes/Hospitals currently being undertaken. Plans to extend to additional Care Homes following evaluation.Joint CCG/SCC Care Homes newsletter launched November 2017 - best practice advice/signposting/winter planning guidance/current initiatives.Promotion of winter planning messages - joint working with PHE - Resident vaccination questionnaires/promotion of Care Home staff vaccinations.Care Homes Forum East and West Suffolk January/February 2018- quarterly meeting dates planned for remainder of 2018.Clinical Best Practice/Pathways Guidance document - reviewed/approved by clinical executive GP’s- final comments from providers and system partners currently being gathered- planned launch date for 31/03/18 as per EEAST risk summit action plan.Joint working/support East and West Suffolk for Falls initiatives with CCG/EEAST/Community colleagues.Support for End of Life Programme Board East Suffolk/Suffolk-promotion of MCW via IG projects and joint working Hospices East and West Suffolk. Latest newsletter planned for April 2018.

Information from Regulator (CQC)

Ratings: Outstanding: 11Inadequate: 1Requires Improvement: 26Good: 77Total homes captured: 127Updated: 02 March 2018

CQC Ratings Distribution

Oustanding Inadequate Requires Improvement Good

Total includes the care homes which have not been inspected

38

Individual Funding Requests (IFR)CLINICAL EFFECTIVENESS

Individual Funding Requests (IFR)1 April 2017 – 31 January 2018

• A total of 403 requests were received for this period, 142 for WSCCG.

• A total of 96 referrals from West were considered by the Individual Funding Panel (including Triage Group) between April 2017 –January 2018.

165237

Total Number of Referrals Received 1 April 2017- 31 January 2018

WS IP & E

9629 34 26 7

050

100150

TOTAL APPROVED NOTAPPROVED

DEFERRED REDIRECTED

Summary of Decisions of IFR Panel for West referrals

April 2017 - January 2018

1312

10

13

11 11

6

11

3

6

3

6

3 32

4

1

6

10

43

45 5

32 2

1

54

3 3 34 4

2 21

0

2

0 0

2

0 01 1

01

0

2

4

6

8

10

12

14

April May June July August September October November December January

Decisions of IFR Panel for West referralsApril 2017 - January 2018

TO PANEL APPROVED NOT APPROVED DEFERRED REDIRECTED

0102030405060

Monthly Total of Referrals Received1 April 2017 - 31 January 2018

WS IP & E TOTAL

Individual Funding Requests (IFR)CLINICAL EFFECTIVENESS

39

0

1

2

3

4

Types of Procedures Approved 1 April 2017 - 31 January 2018

WCCG IP & E

01234567

Type of Drugs Approved1 April 2017 - 31 January 2018

WCCG IP & E

1

Integrated Performance ReportFinance & Information

Supporting InformationFebruary 2018

2

ContentsMonth Ending 28th February 2018

Financial Statement…………………………………………….………………………………………………………..………….…. 3

West Suffolk Hospital (WSFT) Activity….………………………………………………………………………………………. 4

Risks/Opportunities…………….………………………………………………………………………………………………….……. 5

Underlying Financial Position………………………………………………………………………………………………….……. 6

Statement of Cashflow……………………………………………………………………………………………….……….…..…… 7

Quality Premium ……………………………………………………………………………………………….…….……..………...... 8

National Reporting Measures……………………………………………………………………………………………………….. 9

3

• At the end of month 11, the CCG was on target to hit in year break even.

• Principle overspends year to date include Acute Services (£2.0m), Prescribing (£0.6m), and Mental Health Services (£0.5).

• These are mitigated by the release of Contingency (£1.4m) and underspends in Continuing Care (£0.8m), Running Costs (£0.2m), Other Programme Services (£0.6m) and Property Recharges (£0.1m).

Financial StatementMonth Ending 28th February 2018

Source & Apps Budget Actual Variance Variance 17-18 BudgetForecast

OutturnVariance Variance

£m £m £m % £m £m £m %

Total Income 306.6 306.6 0.0 0.0 338.4 338.4 0.0 0.0

Acute Services 156.6 158.6 (2.0) (1.3%) 171.9 173.2 (1.3) (0.8%)

Mental Health Services 24.6 25.0 (0.5) (2.0%) 26.8 27.3 (0.5) (2.0%)

Community Health services 26.9 26.9 (0.0) (0.2%) 29.3 29.0 0.3 0.9%

Continuing Care Services 13.9 13.1 0.8 5.7% 15.2 14.2 1.0 6.6%

Prescribing 36.9 37.6 (0.6) (1.7%) 40.3 41.1 (0.8) (1.9%)

Other Primary care 3.6 3.6 (0.0) (0.5%) 4.0 4.1 (0.1) (1.6%)

Other Programme Services 2.4 1.8 0.6 26.0% 2.6 3.5 (0.9) (32.8%)

Better Care Fund 4.9 4.9 0.0 0.6% 5.3 5.3 0.0 0.6%

Property recharges 0.8 0.7 0.1 12.5% 0.9 0.7 0.2 19.9%

Non Recurrent Investment 0.0 0.0 0.0 1.5 1.5 0.0 0.0%

Contingency 1.4 0.0 1.4 100.0% 1.5 0.0 1.5 100.0%

Running Costs 4.5 4.3 0.2 4.3% 4.9 4.4 0.5 10.2%

Primary Care Co-commissioning 30.2 30.2 0.0 0.0% 34.1 34.1 0.0 0.0%

Total Expenditure 306.6 306.6 (0.0) 0.0 338.4 338.4 0.0 0.0

'In Year' Surplus/ (Deficit) 0.0 0.0 0.0 0.0 0.0 0.0

YTD Full Year

4

• 17/18 finance at WSFT is on plan due to the block contract agreed.

• The table to the left shows the provider’s view of M11.

West Suffolk Hospital (WSFT) Activity(Month 10 ending 31st January 2018)

SLA Plan

(Post QIPP) Act Var Var % Act YOY Var Var %

Plan (post

QIPP) Act

Var to

Plan Var % Jan 2016 YOY Var Var %

Outpatients first 6,078 6,112 (34) -1% 5,602 (510) -9% 34,609 34,270 339 1% 34,615 345 1%

Outpatients follow-up 5,087 5,080 7 0% 6,234 1,154 19% 66,303 65,836 467 1% 67,921 2,085 3%

Outpatients procedures 5,621 5,112 509 9% 5,723 611 11% 43,331 39,901 3,430 8% 38,673 (1,228) -3%

Outpatients telephone 790 744 46 6% 682 (62) -9% 19,541 18,076 1,465 7% 18,698 622 3%

Outpatients 17,576 17,048 528 3% 18,241 1,193 7% 163,784 158,083 5,701 3% 159,907 1,824 1%

Outpatients Maternity 3,476 3,075 401 12% 3,235 160 5% 3,800 3,587 213 6% 3,726 139 4%

Outpatients - other care package 368 382 (14) -4% 405 24 6% 157 196 (39) -25% 231 35 15%

Outpatient unbundled imaging 1,658 1,629 29 2% 1,814 185 10% 19,710 19,027 683 3% 19,209 182 1%

A&E 4,806 4,970 (164) -3% 4,139 (831) -20% 38,664 38,454 210 1% 36,722 (1,732) -5%

Daycase 10,811 11,937 (1,125) -10% 11,002 (934) -8% 14,932 16,441 (1,509) -10% 14,907 (1,534) -10%

Elective 7,304 7,047 257 4% 7,494 447 6% 2,844 2,485 359 13% 2,350 (135) -6%

Elective 18,115 18,983 (868) -5% 18,496 (487) -3% 17,776 18,926 (1,150) -6% 17,257 (1,669) -10%

Emergency non-elective 35,493 35,831 (339) -1% 31,816 (4,016) -13% 20,649 17,557 3,092 15% 22,829 5,272 23%

Other non-elective 5,236 5,093 143 3% 4,391 (702) -16% 3,164 2,807 356 11% 3,043 236 8%

Non Elective 40,729 40,925 (196) -0% 36,207 (4,718) -13% 23,813 20,364 3,448 14% 25,872 5,508 21%

Emergency threshold adjustment (2,720) (3,082) 363 -13% (1,954) 1,128 -58%

Readmissions (919) (904) (15) 2% (840) 65 -8%

Contract Adjustments (385) (456) 71 -18% (752) (296) 39%

SUS (National Data) 82,704 82,569 136 78,992 (3,577) -5% 267,703 258,637 9,066 262,924 4,287 2%

Cost and Volume excl drugs 3,296 3,359 (62) -2% 3,331 (27) -1%

Pathology 179 173 6 3% 219 46 21%

Drugs & Devices 4,301 4,653 (352) -8% 3,960 (694) -18%

Block 167 167 (0) -0% 1,599 1,432 90%

Winter - EEIT 645 645 0 0% 645 (1) -0%

Financial consequences (see table) 0 0 0 (22) (22)

91,293 91,567 (273) 0 88,724 (2,843) -3% 267,703 258,637 9,066 262,924 4,287 2%

CQUIN 2,175 2,174 1 2,120 (54) -3%

Block Contract Adjustment (2,700) (2,972) 272 811 3,783 467%

Contract Consequences annual (see table) 0

Total excluding contract SVs 90,768 90,768 0 91,654 886 1% 267,703 258,637 9,066 262,924 4,287 2%

M10 YTD 2017 M10 YTD 2016

Finance £'000 Finance £'000 Activity Activity

M10 YTD 2017 M10 YTD 2016

(see below)

5

• The CCG has reported a balancedposition to NHS England.

• Identified risks are QIPP under delivery,additional contract risks, potentialContinuing Healthcare historical claimsand delegated Primary Care budgetoverspends.

• These are mitigated by contingency,reserves and quality premium.

Risks/Opportunities(Month 11 ending 28th February 2018)

Risks

Potential

Risk Value

Mth 10

Full Risk

Value

£m

Probability

of risk being

realised

%

Potential

Risk Value

£m

Proportion

of Total

%

Acute SLA's 0.30 3.54 8% 0.30 8%

Continuing Care SLAs 0.38 1.27 30% 0.38 30%

QIPP Under-Delivery 0.31 10.38 3% 0.31 3%

Prescribing 0.00 1.55 0% 0.00 0%

Primary Care 0.45 0.50 88% 0.45 88%

TOTAL RISKS 1.43 17.24 1.43

Please enter the probability of success of mitigating action

Mitigations

Expected

Mitigation

Value Mth

09

Full

Mitigation

Value

£m

Probability

of success of

mitigating

action

%

Expected

Mitigation

Value

£m

Proportion

of Total

%

Uncommitted Funds (Excl 1% Headroom)

Contingency Held 0.44 0.66 67% 0.44 0%

Contract Reserves 0.97 4.29 23% 0.97 23%

Uncommitted Funds Sub-Total 1.41 4.95 1.41

Actions to Implement

Mitigations relying on potential funding 0.02 0.02 0.02 100%

Actions to Implement Sub-Total 0.02 0.02 0.02 100%

TOTAL MITIGATION 1.43 4.97 1.43 100%

NET RISK / HEADROOM 0.00 (12.27) 0.00

CCGs

6

Underlying Financial PositionMonth Ending 28th February 2018

• At Month 11 the CCG has reported an underlying surplus of £4.3m.

• The underlying surplus adjusts the forecast surplus by removing the impact of non-recurrent costs and allocations and the full year effect of in year adjustments in order to show the recurrent position.

• Key adjustments include adjusting for the mandatory 0.5% system reserve, 0.5 % non-recurrent reserve, and other non recurrent benefits.

Source & Apps 17-18 Budget

Other Non-

Recurrent

Adjustments

Prior Year

Impacts

Other FY

Effects

CHC Risk

Pool

Impact of

Fines/CQU

IN etc

Underlying

Position

£m £m £m £m £m £m £m

Total Income 338.4 (1.6) 336.8

Acute Services 171.9 (0.3) (0.8) 170.8

Mental Health Services 26.8 (0.0) 26.8

Community Health services 29.3 0.0 29.4

Continuing Care Services 15.2 1.0 16.2

Prescribing 40.3 40.3

Other Primary care 4.0 (0.1) 0.0 3.9

Other Programme Services 2.6 (0.2) (1.6) 0.8

Better Care Fund 5.3 5.3

Property recharges 0.9 (0.7) 0.2

Non Recurrent Investment 1.5 (3.0) (1.5)

Contingency 1.5 1.5

Running Costs 4.9 (0.3) 0.0 4.6

Primary Care Co-commissioning 34.1 34.1

Total Expenditure 338.4 (4.6) 0.0 (1.3) 0.0 0.0 332.5

'In Year' Surplus/ (Deficit) 0.0 3.0 0.0 1.3 0.0 0.0 4.3

Underlying PositionFull Year

7

Statement of Cash FlowMonth Ending 28th February 2018

At 28th February 2018 Total Assets employed were (£16.1m)/ Jan 18 (16.9m).At 31st March 2017 Total Assets employed were (£10.5m) • Significant liabilities were as follows:-

Prescribing Creditor - £6.1m / Jan 18 £6.2m Payables and Accrued Expenditure with NHS Bodies - £4.2m / Jan 18 £4.6m Payables and Accrued Expenditure with Non NHS Bodies - £13.4m / Jan 18 £14.1m Continuing Healthcare Provision - £0.3m / Jan 18 £0.4mOther Provisions - £0.1m / Jan 18 £0.1m

• Significant assets were as follows:-Cash - £0.1m / Jan 18 £0.8mReceivables with NHS and Non NHS Bodies: £1.6m / Jan 18 £1.4mPrepaid Expenditure - £4.0m / Jan 18 £4.8mAccrued Income - £1.5m / Jan 18 £1.5m

• West Suffolk CCG closed the month with a balance of £1,506k in the bankaccount at 31st January 2017. This has been adjusted to £1,016k on theStatement of Financial Position after accounting for unpresented cheques andpayments by Bacs transfer clearing in the following month.

• NHS England requires CCGs to limit the cash held in their bank accounts at themonth-end to 1.25% of the main cash drawdown for the month. The CCGrequisitioned £25,200k as its main cash drawdown for the month. Under theKPI the target closing bank account balance was £315k . The CCG missed thetarget balance by £1,191k (£1,506k minus £315k) this month.

• The CCG's Maximum Cash Drawdown (MCD) final control total for 2017/18has been set at £333,561k / Jan 18 £333,447k. There has been an increase of£114k in the month as the CCGs Resource Allocation increased by this. TheMCD total is the CCGs assessment of its cash requirement which is based onthe forecast outturn for net operating costs.

• Percentage of months completed in year - 91.67%• Percentage of MCD utilized - 90.25%• Under Utilisation of Cash - 1.42%

West Suffolk CCG 17/18Statement of Cash Flows YTD Actuals

Feb 18Period 11

£000CASH FLOWS FROM OPERATING ACTIVITIESNet Operating Cost Before Interest -306,646Depreciation and Amortisation 82Impairments and Reversals 0

(Increase)/Decrease in Current AssetsSales Debtors 2,184Prepaid Expenditure -3,077Accrued Income -1,388Other Receivables -47

Increase/(Decrease) in Current LiabilitiesPrescribing Creditor 108NHS Payables and Accruals 1,634Non NHS Payables and Accruals 6,878Tax, Social Security & Other Payables 426

Increase/(Decrease) in movement in non cash ProvisionsContinuing Healthcare Provision 65Other Provisions 0Net Cash Inflow/(Outflow) from Operating Activities -299,781

CASH FLOWS FROM INVESTING ACTIVITIES(Payments) for Property, Plant and Equipment -362Net Cash Inflow/(Outflow) from Investing Activities -362

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING -300,143

CASH FLOWS FROM FINANCING ACTIVITIESNet Funding 301,033Net Cash Inflow/(Outflow) from Financing Activities 890

NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTSCash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 126Cash and Cash Equivalents (and Bank Overdraft) at YTD 1,016

Check:SOFP: Cash and Cash Equivalents (Line 2.1) 1,016

8

Quality PremiumMonth Ending 28th February 2018

Note – the data used for tracking is a combination of monthly, quarterly and annual performance and crosses various periods so should be used as an indication at this stage.

Maximum Quality Premium earnable is £1.25m. Final funds are provided in 2018/19 and cannot be used to support the 2017/18 position.

Currently the CCG is forecasting £0k on Quality Premium from 2017/18. This is due to failing all of the National Metrics and therefore 100% reduction is applied.

Maximum QP

Value

Probability of

SuccessQP

Projection

Latest

Data

YTD

Target

YTD

ActualComments

Cancers Diagnosed at Early Stage

Cancers diagnosed at stages 1 and 2 to be greater than 60% or 4% improvement 17% 211,655£ Possible Q3 16/17 60% 56.5%60% or 4% improvement on 16/17. Latest data is Q3

16/17 and shows 1 year roll ing average

Overall Experience of making a GP Appointment

GP patient survey on overall experience for making a GP appointment (Question 18) to

achieve 85% or improve by 3% from July 1717% 211,655£ Possible Jul-17 80.7% 77.7% Target confirmed

NHS Continuing Healthcare

a) In more than 80% of cases with a positive NHS checklist, the NHS CHC eligibility

decision is made by the CCG within 28 days from receipt of the checklist105,828£ Challenging Feb-18 >80% 39.0% YTD position shown for CCG

b) Less than 15% of all full NHS CHC assessments take place in an acute hospital

setting105,828£ Challenging Feb-18 <15% 29.0% YTD position shown for CCG

Mental Health

C. Improved rates of access to Children & Young People's Mental Health Services -

At least 14% increase in the number or increase in activity to enable 32% of individual

children and young people aged 0-18 with a diagnosable MH condition starting

treatment in NHS funded community services when they need it

Bloodstream Infections

a) Reducing gram negative blood stream infections (BSI) across the whole health

economy

i. 10% reduction (or greater) in all E coli BSI reported at CCG level 74,079£ Possible Jan-18 151 164Projected Year End position from PHE DCS based on

latest data

ii. Collection and reporting of a core primary care data set for all E coli BSI in Q2-4

2017/1821,166£ On Track 21,166£ Jan-18 Yes Yes Data collection ready to go live for Primary Care

b) Reduction of inappropriate anitbiotic prescribing for urinary tract infections (UTI) in

primary care

i. 10% reduction (or greater) in the Trimethoprim: Nitrofurantoin prescribing ratio 47,622£ On Track 47,622£ Dec-17 1.922 1.603

i. 10% reduction (or greater) in the number of Trimethoprimitems prescribed to patients

aged 70 years or greater 47,622£ Possible Dec-17 6708 6877 Rolling 12 months data

c) Sustained reduction of inappropriate prescribing in primary care

Items per STAR-PU must be equal to or below England 2013/14 mean performance

value of 1.161 items per STAR-PU.21,166£ On Track 21,166£ Dec-17 1.161 1.128

Local Measure (Rightcare Measure)

Respiratory System Problems

Emergency admission rate for children with asthma per 100,000 population aged 0–19

years

100% 1,245,030£ 276,708£

The % of Referral to Treatment (RTT) pathways within 18 weeks for incomplete

pathways-33% (415,010) Challenging (92,236) Jan-18 92% 86.6%

A&E Waiting Time - total time in the A&E department -33% (415,010) Challenging (92,236) Jan-18 95% 90.1% WSFT position

62 day wait from urgent GP referral to first definitive treatment for cancer -33% (415,010) Possible (415,010) Jan-18 85% 84.0%

Ambulance clinical quality - Category A (Red1) 8 minute response times (CCG

Performance)No longer counted Oct-17 75% 60.9% CCG performance

-£ Expected Quality Premium based on current known performance

17%

WSCCG QUALITY PREMIUM

Po

ten

tial

Red

uct

ion

s

17%

NA

TIO

NA

L M

EASU

RES

17% 211,655£ Possible Q2 17/18 1072 547Increase children seen by 14% based on CCG plan

(target is 1072 seen in 17/18.) Actual shown is

roll ing 12 months total.

15% 186,755£ 2% reduction on the number of Emergency

admissions for children with Asthma, baseline

2016/17 Outturn (178 admissions)On Track £ 186,755 Dec-17 131.3 91

9

National Reporting Measures

Month Ending 28th February 2018

Indicator Ref Description Framework

Reporting Frequency

Current Period

Current Period Target

Current Period Actual

Rolling 6 Months

Latest Applicable

TargetYTD Actual Comments

NHS 2.3.i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (WC1.1.1) NHS Outcomes Monthly Jan-18 196 169 1504 1,348WSFT (indication of performance on Annual

measure E.A.4)

NHS 2.3.ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (WC1.1.2) NHS Outcomes Monthly Jan-18 16 20 198 182WSFT (indication of performance on Annual

measure E.A.4)

E.A.S.1 Estimated diagnosis rate for people with dementia NHS EC Annex A Support Measure

Monthly Jan-18 67% 61.9% 67% 61.9% WSCCG

NHS 3a Emergency admissions for acute conditions that should not usually require hospital admission (WC1.1.3) NHS Outcomes Monthly Jan-18 285 278 2546 2,128WSFT (indication of performance on Annual

measure E.A.4)

NHS 3.2 Emergency admissions for children with Lower Respiratory Tract Infections (WC1.1.4) NHS Outcomes Monthly Jan-18 23 26 204 178WSFT (indication of performance on Annual

measure E.A.4)

E.A.S.4 Healthcare acquired infection (HCAI) measure (MRSA) NHS EC Annex A Support Measure

Monthly Jan-18 0 0 0 0 WSCCG

E.A.S.5 Healthcare acquired infection (HCAI) measure (clostridium difficile infections) NHS EC Annex A Support Measure

Monthly Jan-18 4 5 37 51 WSCCG

E.B.1The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted pathways

NHS EC Annex B Measure

Monthly Jan-18 90% 74.8% 90% 77.0% WSCCG

E.B.2The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted pathways

NHS EC Annex B Measure

Monthly Jan-18 95% 89.2% 95% 88.0% WSCCG

E.B.3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways NHS EC Annex B Measure

Monthly Jan-18 92% 90.3% 92% 86.6% WSCCG

E.B.S.4 Number of 52 week Referral to Treatment Pathways NHS EC Annex B Support Measure

Monthly Jan-18 0 23 0 311 WSCCG

E.B.4 Diagnostic test waiting times NHS EC Annex B Measure

Monthly Jan-18 1% 1.18% 1% 0.82% WSCCG

E.B.5 A&E waiting time - total time in the A&E department NHS EC Annex B Measure

Monthly Jan-18 95% 83.8% 95% 90.1% WSFT

E.B.S.5 Trolley waits in A&E NHS EC Annex B Support Measure

Monthly Jan-18 0 0 0 0 WSFT

NATIONAL PERFORMANCE MEASURES - 2017/18 - WEST SUFFOLK CCG (1/2)

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Treating and caring for people in a safe environment and protecting them from avoidable harm

Referral To Treatment Pathways

Diagnostic test waiting times

A&E waits

10

National Reporting Measures

Month Ending 28th February 2018

Indicator Ref Description Framework

Reporting Frequency

Current Period

Current Period Target

Current Period Actual

Rolling 6 Months

Latest Applicable

TargetYTD Actual Comments

E.B.6 All Cancer 2 week waits NHS EC Annex B Measure

Monthly Jan-18 93% 97.7% 93% 94.1% WSCCG

E.B.7 Two week wait for breast symptoms (where cancer was not initially suspected) NHS EC Annex B Measure

Monthly Jan-18 93% 96.4% 93% 97.1% WSCCG

E.B.8Cancer day 31 waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis

NHS EC Annex B Measure

Monthly Jan-18 96% 100.0% 96% 99.5% WSCCG

E.B.9 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-surgery NHS EC Annex B Measure

Monthly Jan-18 94% 93.8% 94% 97.0% WSCCG

E.B.10 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-anti cancer drug regimens NHS EC Annex B Measure

Monthly Jan-18 98% 100.0% 98% 100.0% WSCCG

E.B.11 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-radiotherapy NHS EC Annex B Measure

Monthly Jan-18 94% 98.0% 94% 97.0% WSCCG

E.B.12Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer

NHS EC Annex B Measure

Monthly Jan-18 85% 80.0% 85% 84.0% WSCCG

E.B.13Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service

NHS EC Annex B Measure

Monthly Jan-18 90% 87.5% 90% 89.5% WSCCG

E.B.14Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

NHS EC Annex B Measure

Monthly Jan-18 86% 0.0% 87% 77.1% WSCCG - Target is Monthly National Average

E.B.15.i Ambulance clinical quality – Category A (Red 1) 8 minute response timeNHS EC Annex B

MeasureMonthly Oct-17 75% 52.7% 75% 60.9% WSCCG

E.B.15.ii Ambulance clinical quality – Category A (Red 2) 8 minute response timeNHS EC Annex B

MeasureMonthly Oct-17 75% 45.9% 75% 53.0% WSCCG

E.B.16 Ambulance clinical quality - Category A 19 minute transportation time NHS EC Annex B Measure

Monthly Oct-17 95% 80.4% 95% 81.5% WSCCG

EBS7a Ambulance handover time - 1) Handover delays over 30 minutes NHS EC Annex B Support Measure

Monthly Jan-18 0 231 0 1396 WSFT

EBS7b Ambulance handover time - 2) Handover delays over 1 hour NHS EC Annex B Support Measure

Monthly Jan-18 0 60 0 343 WSFT

E.B.S.1 Mixed Sex Accommodation (MSA) Breaches NHS EC Annex B Support Measure

Monthly Jan-18 0 0 0 1 WSCCG

E.B.S.2 Cancelled Operations NHS EC Annex B Support Measure

Monthly Jan-18 0 6 0 95 WSFT

E.B.S.6 Urgent Operations cancelled for a second time NHS EC Annex B Support Measure

Monthly Jan-18 0 0 0 0 WSFT

E.A.3 IAPT Roll Out NHS EC Annex A Measure

Monthly Jan-18 1.25% 1.9% 12.50% 16.0%

E.A.S.2 IAPT Recovery Rate NHS EC Annex A Support Measure

Monthly Jan-18 50% 50.3% 50% 50.4%

E.B.S.3 Mental Health Measure – Care Programme Approach (CPA)NHS EC Annex B Support Measure

Monthly Jan-18 95% 100.0% 95% 97.8% WSCCG

Cancer waits - 2 week wait

Cancer waits - 31 days

NATIONAL PERFORMANCE MEASURES - 2017/18 - WEST SUFFOLK CCG (2/2)

Cancer waits - 62 days

Ambulance Measures

Mixed Sex Accommodation

Cancelled Operations

Mental Health

WSCCG position. Performance is from local NSFT data w hich historically differs to NHSE reported by 4-5% better. June NHSE data is

now w ithin 1%

Integrated Performance ReportProject Management Office

Supporting Information

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream

G G A

QIPP target YTD (Month 9)Actual QIPP Schemes YTD (Month 9)

Milestone

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 1,895,773 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ £ 172,343 £ 172,343 £172,343 £ 172,343 £ 172,343 £ 172,343 Actual £ 1,444,741 406,233£ 115,589£ 28,463-£ 246,634£ 67,747-£ 80,100£ £ 234,134 £ 82,241 £350,387 -£ 15,156 £ 40,789 Variance -£ 451,032 £ 233,890 -£ 56,754 -£200,806 £ 74,291 -£ 240,090 -£ 92,243 £ 61,791 -£ 90,102 £178,044 -£ 187,499 -£131,554

Risks/Issues

Prescribing - QIPP Scheme Top AchievementsWest SuffolkLinda LordKate VaughtonPrescribing

• Prescribing visits have been fine-tuned further with a particular and sustained focus on supporting 9 practices that are sti l l in an overspend position, according to Dec 2017 data

• Prescribing policies and supporting documents have been updated for gluten free food and specialist infant formula, enabling on-going progress to be made in containing prescribing costs in these areas.

• Significant progress is now being made on prescribing of continence and stoma items, with dedicated support from our primary care stoma nurse and appliance nurse.

No milestones due in January. All milestones are on track.

Key Issue

QIPP schemes have delivered planned savings, however the effect of NCSO drug cost pressure has had a significant effect on the prescribing budget. The finance RAG reflects the overall budget position and not the performance of the prescribing schemes. The unforseen cost of NCSO drugs was £1.03m to WSCCG.

SummaryObjectives

A range of prescribing projects to realise £2.068m QIPP.

Overall Confidence Project delivery RAG Finance RAG

Total QIPP target for 2017/18 2,068,116£

1,940,645£ 1,551,088£

Note: January and February figures are projected estimates.

Milestones Status Comment

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream CHC

G G G

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £1,521,795 £138,345 £138,345 £ 138,345 £ 138,345 £ 138,345 £ 138,345 £ 138,345 £138,345 £138,345 £138,345 £ 138,345 £138,345 Actual £3,242,826 £138,345 £202,200 £ 92,997 £ 383,745 £ 399,193 £ 325,002 £ 385,297 £423,390 £409,072 £174,073 £ 309,512 Variance £1,721,031 £ - £ 63,855 -£ 45,348 £ 245,400 £ 260,848 £ 186,657 £ 246,952 £285,045 £270,727 £ 35,728 £ 171,167

Risks

Likelihood Consequence Score

3 4 12

3 4 12

3 2 6

Access to Social Workers for CHC assessments (needed to provide lawful MDTs for 28 day process)

West social care staff continue to be aligned rather than integrated into the team, however opportunity has arisen to explore whether staff can now become integrated into the CHC team as they are in the East; meeting due with ACS Head of Operations and Partnership – West.CHC administration staff have had training on Carefirst6 (ACS PAS) to enable more efficient working; IT departments now working on install ing the software to make this operational for CHC admin (IG agreements have been approved by both parties).

Broadcare - transfer to cloud based version of Broadcare required by 31 December 2017.

Migration set for 25/4/18. Two training sessions booked with Bray Leino for 17 and 18/4/18. Additional UAT testing continuing, reports being tested and weekly project calls with Bray Leino.

Limited capacity to deliver 12 monthly FNC reviews

Review team has concentrated effort on reviewing Fast Track and CHC eligible patients during 2017/18 due to capacity restrictions of current staffing levels. FNC reviews must commence in 2018/19 which will have resource implications for the review team. Both I&ESCCG and WSCCG have high numbers of FNC eligible patients compared with other CCGs in the region.

SummaryObjectives

In more than 80% of cases with a positive NHS CHC Checklist, the NHS CHC eligibil ity decision is made by the CCG within 28 days from receipt of the Checklist (or other notification of potential

)

At risk but recoverable As at 9/3/18 there were only 2 patients who had waited in excess of 28 days for assessment, both of these had assessments postponed due to episodes of acute i l lness. All new referrals now being booked within the 28 days. NSHE assured of processes and have cancelled future monitoring calls.

Risk Mitigation

Less than 15% of all full NHS CHC assessments take place in an acute hospital setting.

On Track

WSCCG have achieved this target in WSH since implementation of D2A in September 2017, however, December 2017 and January 2018 overall target marginally missed as a result of patients being assessed in Addenbrookes and out of area hospitals. Agreement now reached for Addenbrookes to operate D2A for Suffolk patients and stop assessments in the acute setting. Target met Feb 2018.

Maintain patient administrations system (PAS) for CHC service At risk but recoverable

Milestones Status Comment

Migration set for 25/4/18. Two training sessions booked with Bray Leino for 17 and 18/4/18. Additional UAT testing continuing, reports being tested and weekly project calls with Bray Leino.

Total QIPP target for 2017/18 1,660,140£

Overall Confidence Project delivery RAG Finance RAG

The overarching aim of the NHS CHC programme is to embed operational quality assurance, improved productivity through operational innovation into the CCG Continuing Healthcare service to create value for money in the delivery of this service for patients and the CCG. There is an on-going programme of service improvement across CHC

West SuffolkSarah LearneyJan Thomas

Top Achievements

• CHC team received an award from NHSE for CHC Assurance at a recent event.

CHC - Operation Delivery - 17-CHCB-01

• All new referrals now being booked with the 28 day time frame

• All cohort 2 PUPoC (BAU) cases triaged and those requiring assessment identified

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream

G R R

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 510,642 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 £ 46,422 Actual £ 288,517 £ 4,730 £ 4,730 £ 49,686 £ 53,647 £ 32,830 £ 71,364 £ 52,169 £ 91,013 -£ 91,186 -£ 330 £ 19,864 Variance -£ 222,125 -£ 41,692 -£ 41,692 £ 3,264 £ 7,225 -£ 13,592 £ 24,942 £ 5,747 £ 44,591 -£137,608 -£ 46,752 -£ 26,558

Risks

Likelihood Consequence

Score

Chris HooperCYP/MH/LD

Total QIPP target for 2017/18 557,064£

Milestones Status Comment

No milestones due this month.

There are currently no risks within the Mental Health Out Of Area Placement programme that have a RED post mitigation score. All AMBER risks are monitored by the PMO and reviewed on a monthly basis with the project manager.

Top Achievement

This scheme will not meet it's planned savings target due to more placements than anticipated being required.

SummaryObjectives

Overall Confidence

Risk Mitigation

Project delivery RAG Finance RAG

Continual month-by-month review of all OOA placements, measuring clinical quality and outcomes. By ensuring that each person has a care plan, discharge plan and a pathway of cl inical progress is evident. Reports and evidence is applied by OOA care co-ordinators who report directly to OOA service lead and CCG.

MH OOA Placement - 3.11West SuffolkWendy Scott

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream

G G G

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 135,511 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 £ 12,319 Actual £ 272,344 £ - £ 58,716 £ 26,154 £ 27,794 £ 25,170 £ 31,726 £ 18,118 £ 25,208 £ 26,251 £ 19,929 £ 13,278 Variance £136,833 -£12,319 £46,397 £ 13,835 £ 15,475 £ 12,851 £ 19,407 £ 5,799 £ 12,889 £ 13,932 £ 7,610 £ 959

Risks

Likelihood Consequence ScoreThere are currently no risks within the Corporate Pay programme that have a RED post mitigation score. All AMBER risks are monitored by the PMO and reviewed on a

monthly basis with the project manager.

Risk Mitigation

No milestones due this month.

SummaryObjectives

Overall Confidence Project delivery RAG Finance RAG

This project will review all opportunities to reduce Corporate pay cost non-recurrently during 2017/18 through a series of targeted actions

• All vacancies and leavers have been projected into the QIPP Savings for the next quarter.

• QIPP Savings are available by breakdown of post.

Total QIPP target for 2017/18 147,830£

Milestones Status Comment

Top 3 Achievements

• PAY is on track to meet QIPP target. However, as posts are recruited into, we will see a reduction in the over delivery of savings within corporate.

Corporate Pay Cost Review - 7.34West SuffolkGiles TurnerAmanda LyesCorporate

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream

G G G

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 51,070 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 £ 4,643 Actual £ 50,520 £ 6,504 £ 6,504 £ 412 £ 4,478 £ 4,923 £ 5,011 £ 4,894 £ 4,568 £ 4,482 £ 4,418 £ 4,326 Variance -£ 550 £ 1,861 £ 1,861 -£ 4,231 -£ 165 £ 280 £ 368 £ 251 -£ 75 -£ 161 -£ 225 -£ 317

Risks

Likelihood Consequence ScoreUnder developmentRisk Mitigation

No milestones due this month. Milestones Status Comment

SummaryObjectives

This project will review all opportunities to reduce Corporate non-pay efficiencies through removal of non-committed spend in the following areas:Centralisation of corporate (non-GP) training budgetsReview of all uncommitted budgets, and determine which budgets can be removed non-recurrently

Overall Confidence Project delivery RAG Finance RAG

• Non-PAY is underachieving against YTD budget. The main areas currently contributing to the Non-PAY scheme are RAIDR, underspends in Agency fees, Consultancy fees and Professional fees.

Corporate

Top Achievement

Total QIPP target for 2017/18 55,713£

Corporate Non Pay Cost Review - 7.35West SuffolkGiles TurnerAmanda Lyes

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream

G G GIC

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 448,186 £ 38,345 £ 39,363 £ 37,637 £ 40,932 £ 40,759 £ 39,788 £ 53,979 £ 51,617 £ 52,699 £ 53,068 £ 49,257 £ 55,600 Actual £ 464,930 £ 16,748 £ 29,918 £ 90,334 £148,526 £ 24,453 £ 46,506 £ 64,772 £ 36,459 £ 5,927 £ 1,287 Variance £ 16,744 -£ 21,597 -£ 9,445 £ 52,697 £107,594 -£ 16,306 £ 6,718 £ 10,793 -£ 15,158 -£ 46,772 -£ 51,780

Risks/Issues

Likelihood Impact ScoreThere are currently no significant risks or issues within the Reactive or Proactive programme. All risks and issues are monitored by the PMO and reviewed on a

monthly basis with the project manager.

Risk/Issue Mitigation

SummaryObjectives

Development of the reactive care model in Suffolk is to provide a single integrated community response that covers a range of services including front door services at the acute hospital, the ambulance service, 111, GP practices and other primary care services including out of hours primary care, community crisis response services such as the Early Intervention Team (EIT), and other health (including mental health) and social services.

• Trust Access Policy presented to Clinical Executive

• Successful ESHN bid for 42 handheld ECG monitors across the system

Overall Confidence Project delivery RAG Finance RAG

Total QIPP target for 2017/18 553,043£

Milestones Status CommentNo milestones due this month. Programme on track

West Integrated Care Programme - 17-ICW-01/02 West Suffolk Sandie Robinson • RTT trajectory submitted to planning. 92%

to be achieved by December 2018Richard WatsonICN

Top Achievements

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPMExec OwnerWorkstream

G G GIC

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 134,339 £ - £ - £ - £ 330 £ 275 £ 275 £ 33,237 £ 32,263 £ 33,962 £ 33,997 £ 32,267 £ 34,959 Actual £ 221,161 £ 17,787 £ 3,019 £ 22,011 £ 28,067 £ 58,749 £ 28,989 £ 31,482 -£ 7,259 -£ 9,906 £ 48,222 Variance £ 86,822 £ 17,787 £ 3,019 £ 22,011 £ 27,737 £ 58,474 £ 28,714 -£ 1,755 -£ 39,522 -£ 43,868 £ 14,225

Risks

Likelihood

No milestones due this month.

201,565£

Milestones Status Comment

Total QIPP target for 2017/18

Top Achievements

SummaryObjectives

Overall Confidence Project delivery RAG Finance RAG

Emergency attendances and admissions at both acute hospitals have shown year on year increases in recent months: Attendances = WSFT Dec 2016 up 404 (6.1%) on Dec 2015. Admissions = WSFT Dec 2016 up 245 (10.8%) on Dec 2015.

CYP and Maternity - 3.11West SuffolkHannah Neumann-MayRichard WatsonCYP/MH/LD

• No new achievements provided

There are currently no risks within the CYP and Maternity programme that have a RED post mitigation score. All AMBER risks are monitored by the PMO and reviewed on a monthly basis with the project manager.

MitigationRisk Consequence Score

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPM

Exec Owner

Workstream

G A GIC

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 96,100 £ 8,100 £ 9,600 £ 10,000 £ 9,300 £ 9,600 £ 9,700 £ 10,100 £ 10,700 £ 8,400 £ 10,600 £ 9,400 £ 10,000 Actual £ 60,774 £ 5,227 -£ 924 £ 2,495 -£ 3,697 £ 12,163 £ 10,360 £ 3,733 -£ 5,916 £ 13,121 £ 24,212 Variance -£ 35,326 -£ 2,873 -£ 10,524 -£ 7,505 -£ 12,997 £ 2,563 £ 660 -£ 6,367 -£ 16,616 £ 4,721 £ 13,612

SummaryObjectives

Drive the benefits expected from the introduction of the integrated tiered approach that incorporates the Community Pain Management Service (Tier 2):This will lead to more people being seen in the community service and integration between the community and acute services to develop effective and efficient pathways with excellent outcomes. There is a 50% expected reduction in acute outpatient activity in Pain and other reductions in T&O that will be enhanced by the MSK project and be realised from June 2017.

• Shared care arrangements in place. Trust referral data shows a decline in referrals from Primary Care direclty to WSFT, which indicates that the Single Point of Access is working.

Overall Confidence Project delivery RAG Finance RAG

Total QIPP target for 2017/18 115,500£

Milestones Status CommentContract & Finance - Approval by WSCCG, WSFT and GP Federation Executive Boards of final contractual, cl inical and financial model

At risk but recoverable

IPMS Workforce - Appoint IPMS Manager Providers going through most capable provider process. Agree new deadlines at next workstream

At risk but recoverable

Top Achievements

Contract & Finance - Shadow commissioning and contracting arrangements At risk but recoverable

Providers going through most capable provider process. Agree new deadlines at next workstream

• Prior Information Notice period closed on 5 March. One potential provider has come forward. Meeting with the potential provider scheduled Wednesday 14 March 2018.

• WSFT and SGPF working together to develop the IPMS Financial model.

Pain - 17-TW-05West SuffolkRenu Mandal

Richard Watson

Planned Care

Providers going through most capable provider process. Agree new deadlines at next workstream

West Suffolk CCG PMO Monthly Reporting March 2018

Programme Summary

QIPPCCGPM

Exec OwnerWorkstream

G G GIC

Key Milestones

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 273,180 £ 24,150 £ 28,460 £ 29,550 £ 27,490 £ 21,070 £ 21,000 £ 38,190 £ 41,470 £ 15,130 £ 26,670 £ 16,280 £ 17,160 Actual £ 839,648 £ 2,670 £ 93,781 -£ 2,400 £ 73,758 £ 93,302 £ 17,475 £ 93,419 £144,119 £112,246 £211,279 Variance £ 566,468 -£ 21,480 £ 65,321 -£ 31,950 £ 46,268 £ 72,232 -£ 3,525 £ 55,229 £102,649 £ 97,116 £184,609

Risks

Likelihood Consequence

Score

Claire Jay

Richard WatsonPlanned Care

Top Achievements17-TW-09-MSKWest Suffolk

• The MSK Project plan has been refreshed for 18/19 and will be signed off at the PCCN on 14 March 2018.

•The MSK SPoR is now business as usual with an evaluation in May and June of one year of service.

There are currently no risks within the MSK programme that have a RED post mitigation score. All AMBER risks are monitored by the PMO and reviewed on a monthly basis with the project manager.

Risk Mitigation

No milestones to report on this month

SummaryObjectives

Overall Confidence Project delivery RAG Finance RAG

MSK SPoR - take the implementation of a single point of access MSK service taking a "teams without walls" approach to business as usual. This project will reduce the number of acute first outpatient appointments by 26%, follow up appointments by 9% and 2.8% reduction in orthopaedic clinical threshold procedures.

Total QIPP target for 2017/18 306,620£

Milestones Status Comment

Integrated Performance ReportContractual Performance

Supporting Information

March 2018

Finance/Activity

What are the top 3 risks and issues?Rank Risk Owner Likelihood Impact Mitigation

1

Underachieving against C1 ambulance targets resulting in potential safety and outcomes risks to patients. (NB. Ambulance Response Programme (ARP) changed performance targets from October 2017)

EEAST/CCG High High

• Weekly performance meeting in place with EEAST and commissioners, focus on Cat 1. EEASTpredicting of demand and modelling capacity have greater scrutiny at OPG meetings.

• Risk Summit actions will support improving performance for C1. • External review received includes performance achievement of new standards and efficiency,

will include trajectory for compliance.

2

Increasing activity of high risk categories. The risk is the more serious calls are not seen in a timely manner. Ongoing review of impact of new Cat1-4 targets. Further review of ability to increase validation of 111 calls ongoing.

EEAST/CCG Med High

• 111 and 999 are meeting monthly to review referred calls. • EEAST focus on high acuity calls. Cat 1 achievement progress discussed in bi-weekly

performance meeting• ARP actual impacts now being reviewed developing operational model• Discussions with 111 service provider to ensure validation is maximised with changing targets

3Recruitment/Staffing , EEAST continues to struggle to recruit and retain sufficient levels of qualified staff to meet target requirements.

EEAST High High• On-going recruitment plan – to be re-reviewed following final outcome of ARP service review• Development of Ops plan to encourage career pathway new band 6 paramedic post developed• Plans are in place with other Providers to trial staff cross working/rotation.

East of England Ambulance Service NHS TrustPerformance

Activity reporting in October was from 1st-18th only due to ARP implementation. November un-validated full month activity. There is a block finance agreement in place for 17/18.

RAG Indicator Comments Change

Cat 1mean time <07:00min

January Category 1 performance mean arrival time 10:14mins (was 10:47mins in December).

↑

Arrival to Handover>15mins

January performance handover <15mins 33%. STP trajectory target of 100% of patients being clinically handed over <15mins for WSH in April

↑

Cat 2 mean time <18:00min

January Category 2 performance mean arrival time 29:38min (was 30:08 mins in December).

↑

Clinical QualityPerformance Indicator Threshold Oct Nov Dec Change month on

monthYTD –2017/18

Comments

ROSC (Return of Spontaneous Circulation) at time at arrival at hospital

27% 40% 40% 33% -7% 36%December cases - 6

Outcome for Cardiac Arrest –Survival to Discharge overall survival rate

7% 20% 0% 17% 17% 13%December cases – 6

Outcome for Cardiac Arrest –Survival to Discharge – Utstein comparator group

25% 100% 0% 50% 50% 45%December cases – 2

Outcome for Cardiac Arrest –Survival to Discharge STEMI appropriate care bundle

81% 100% 100% 100% 0% 92%December cases – 7

Stroke - FAST positive stroke patients HASU <60mins 56% 8% 44% 17%

-27%43%

December cases – 12

Updates• 999 EEAST ‘Risk Summit’ actions being worked through, actions include,

ensuring bottom line hours of staff ‘on the road’, implementing 30 min maximum handover process (started from 26th Feb), reducing demand from care homes and implementing GP triage of pathways triggered ambulance response calls.

• Independent service review (including Ambulance Response Target trajectories) being finalised prior to being presented to governing bodies in March.

• Performance being monitored/reviewed to improve performance• Weekly Operational Performance Group EEAST and CCGs to review

performance and implementation of ARP progress.• CQUIN – Clinical Support Desk hear and treat performance 9.2% in

January, target 9.5% (was 10.3% in December 2017)

1500

2500

3500

Activ

ity

WSCCG .v. 16/17 Outturn

2016/17 Outturn

Actual Activity

Finance/Activity

What are the top 3 risks and issues?Rank Risk Owner Likelihood Impact Mitigation

1 Number of ambulances sent from 111 CCG High High

• C3/4 ambulance referrals clinically validated by skilled clinicians across the network.• 2 week trial for Senior Clinical Validation (GP / ANP) for C3/C4 ambulances to take place in March.

2 Number of ED referrals increasing as a result of redirected ambulance referrals CGG Medium Medium

• Some clinical validation of ED referrals taking place in Suffolk. Lower rates of ED referrals have been noted.

• Care UK to look at ED efficiencies, working closely with other providers that support ED activity.

3 Slippage on KPI’s throughout transition period into IUC CCG/Care UK Medium Low

• Informal RAP in place for calls answered in 60 seconds.• Re-introduction of financial penalties for 111 for 2018/19.

No financial penalties for contract year 2017 / 18. RAG Indicator Comments ChangeOOH KPI’s Performance has continued to suffer in January due

to demand and capacity. Informal action plan to be presented at the next Contract meeting focussed around recovery.

↓

111 – Calls answered in 60 secs

71.55% against a trajectory of 95% which was a slight increase, however average speed to answer for Suffolk 111 calls was 58 seconds for January. Recovery is not expected until Spring 2018 and informal action plan is in place.

↑

Clinical Contact

Clinical contact for January was 40.26% against a target of 40%. This target increases to 50% in March. ↑

ED Referrals Number of patients sent to ED remained static in January at 7.42% of calls triaged against a trajectory of 6%.

↔

Greenambulance divert

48% of Cat 3/4 calls were diverted to a more appropriate service after clinical validation against the trajectory of 34%. ↑

Clinical Quality

Performance Indicator Threshold Oct Nov Dec Comments

Local Health Advisor Audits (111) over 3 months employment – average score 86% 100% 100% 37.4% 1 HA on action plan. 1 HA on stage 2

capability.

Local Clinical Advisor Audits (111) over 3 months employment – average score 86% 65% 42.4% 34.1%

2 staff on enhanced audits as part of 6 month probation . All Clinicians are being audited at least once per month.

Suffolk Clinicians paper records documentation and assessment audit (OOH)

90% 95% 95% 95%Feedback given to clinicians.

Suffolk Clinicians voice recording audits (OOH) 90% 98% 98% 97%

Feedback given to clinicians.

Monthly audits following Care UK audit schedule – Emergency Scenario and Hand Hygiene

n/a n/a n/a n/aMonthly audits following Care UK audit schedule.

Updates• Informal recovery plan is in place to focus on improvement of calls

answered in 60 seconds. The plan is centred around recruitment and retention.

• Procurement for the IUC is ongoing – current contract extended to November 2018.

• Current focus on Easter planning.• 2 week trial of senior clinical validation for C3/C4 ambulances to take

place in March.

PerformanceCare UK Limited – 111 & Out of Hours

0

5000

10000

15000

20000

25000

Jan-

17

Feb-

17

Mar

-17

Apr-

17

May

-17

Jun-

17

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec-

17

Jan-

18

Calls Answered

KPI penalties

Finance

What are the top risks and issues?Rank Risk Owner Likelihood Impact Mitigation

1 Children may not receive a wheelchair within 18 weeks of referral by 1 April (this is a new mandated service outcome)

WSFTand CCG Medium Medium

• Weekly monitoring of the waiting list profile and service improvement plan between the CCG and WSFT. NHSE weekly monitoring.

2 The children’s speech and language service re-design is delayed and waiting times to start a course of therapy may increase.

SCC/CCG/WSFT Medium Medium

• Closely monitor the waiting list profile. The number of children waiting has reduced in the last 3 months (Nov-Jan)

3The number of 18 week referral to assessment breaches for adult speech and language services may increase due to service capacity (clinical staffing) issues and increased demand from the pilot.

WSFT and IHT Medium Medium

• Complete evaluation of the speech and language therapy pilot Due February, 2018 but delayed by 1. month.

• Closely monitor the waiting list profile

Suffolk Community Healthcare

RAG Indicator Comments ChangeResponse times(WSFT only)

The adult Community Health Care Teams met response times for referrals within 2, 4, 72 hours, and 18 weeks. The services achieved 18 week RTT for all Consultant and non Consultant led services.

↔

Children in Care Initial Health Assessments (provided by WSFT)

The % of children who had an initial health assessment completed within 28 days of the service receiving all paperwork was 12.5%. This was caused by a combination of increased referrals and late referrals from SCC. A Director escalation meeting has been held resulting in an action plan.

↓

Care coordination centre (provided by IHT)

% of calls answered in 60 seconds; 95.39%

↔

Delayed transfers of care (WSFT only)

The number of patients whose discharge was delayed significantly improved to 12 (23 last month). Community services did not achieve the target of 3.5% bed days – DTOCs were 15.12% in Newmarket, 3.8% in Glastonbury and 0% in Hazell Court.

↑

Clinical Quality

Performance Indicator – WSFT only Threshold January YTD(from Oct 2017)

MRSA - Total number of MRSA: Community Hospital 0 0 0

Clostridium difficile – minimise rates of Clostridium difficile 2 per year 0 1

Pressure ulcers – reduce Grade 2 & 3 avoidable pressure ulcers (in-patient units) Grade 2 -13Grade 3 – 2

G2—0G3-0

1– G20– G3

Pressure ulcers – zero Grade 4 avoidable pressure ulcers (in-patient units) 0 0 0

Falls – number of inpatient falls resulting in moderate or severe harm No more than 1.25 per

month0 1 (severe)

Number of falls per 1,000 bed days 7.11

NHS Friends and Family Test (% of patients who would recommend SCH services)85% 95.15%

Number of formal complaints 0 tba

Number of formal compliments 6 tba

Performance

UpdatesThere has been a decline in the equipment service KPIs and WSFT issued the Provider with a Contract Performance Notice. An improvement plan has been agreed and performance is expected to achieve required standards by February 2018.

1,500,000

2,500,000

3,500,000

M07 M08 M09 M10 M11 M12

Community contract

East West

Finance/Activity

What are the top 3 risks and issues?

West Suffolk Hospital NHS Foundation TrustPerformance - January 2018 – data from WSFT Board report

CCG Month 9 provisional data indicates that WSCCG is £263K over and I&ESCCG £84k under plan against the GIC values

Updates• Trust received highest CQC rating ‘outstanding’ – just 1 of 7 general hospitals in

England• Wards improve ‘family carer friendly’ rating – wards G4 and G8 received a silver

recognition award• New volunteering roles developing. With the help of HelpForce Summit the Trust

held a recent event to start exploring the integrated volunteering process• The Trust now operate a pre-referral ‘advice and guidance’ service to GP’s via eRS

RAG National Quality requirement Performance Change

A & E - 4 Hour Target 84.0% ↑

Cancer 2ww 98.0% ↑

Cancer 2WW Symptomatic breast 98.0% ↓

18 Week RTT-Incomplete 90.0% ↑

RTT waits over 52 weeks 14 breaches ↑

Diagnostics 100% ↔

Cancer 62 days 86.0% ↓RAG Local Quality requirement Performance Change

Stroke – admission to unit within 4 hrs 75.0% ↑

Acute Oncology Service: Door to Needle 80.0% ↑

Rank Risk Owner Likelihood Impact Mitigation

1High numbers of patients waiting more that 52 weeks for intervention following referral giving concern over potential harm sustained

Trust High High

• Trust completing clinical harm reviews and RCA for all patients waiting over 52 weeks• Quality team discussing RCAs/Duty of Candour at monthly meetings

2 Significant challenges within RTT plan in order to deliver and sustain compliance of 18wks from October 2017 Trust/CCG High High

• Steering group in place to discuss and mitigate early risks to delivery of plan• Accurate reporting now in place,, cerner continuing to address data quality issues • IST and KPMG working within Trust to support RTT compliance and sustainability

3 Financial position, failure to deliver CIP/QIPP plans CCG/Trust Med Med• Block contract with GIC for 17/18 in place

Clinical Quality

Performance Indicator Threshold Nov Dec Jan Change mth on mth

YTD Comments

MRSA - Total number of MRSA: Hospital 0 0 0 0 ↔ 2

C.Diff - Maintain Clostridium difficile Incidence below target (total incidence pre review)

16 per yeartrajectory

4 0 1 ↓ 171 case in Jan (on ward F3). Overall summary – As of 31/01/18 = 17, 10 are non-trajectory, 7 are trajectory.

Clinical - Pressure Ulcers - No. of hospital acquired pressure ulcers (Avoidable & Unavoidable)

<5 198 13 35 ↓ 155

Significant increase in HAPU’s in Jan. Acuity & capacity exceeded expectation, placing increased pressure against backdrop of staff shortages, delays of beds in ED, impacting on patient safety & quality of care. Staffing is reviewed daily with aim to mitigate risks. Awareness teams are struggling to put in timely preventative measures.

Falls per 1000 bed days 5.6 No data

No data

No data

↔4.8%

Falls in Jan = 76 (1 major harm, 3 moderate harm). Action plan includes development of ward profiles, establishing ward champions, review of ecare processes, staff pocket guides. Ongoing work with Cerner to be able to report falls/1000 obd

Mixed Sex Accommodation breaches 0 0 1 0 ↑ 1

Patient satisfaction: ‘How likely is it that you would recommend service to friends & family?

90% 96% 98% 97% ↓ 98%

Finance: I&ESCCG and WSCCG

Risks and Issues Owner Likelihood

Impact Mitigation

1

CQC rates NSFT as inadequate:Safety – ligature points, facilities, staffing numbers and mandatory training, risk assessments, restrictive practices, physical health checks and learning from SisEffectiveness – care planning and records, appraisal and supervision, application of DOLs and Mental Health ActLeadership – improvements not addressed, missing safety narrative, data inaccuracies, risk capture and learning

CCG/ NSFT Med High

• NSFT and CCG will systematically work through any concerns raised and form plans to address them.

• Clinical Scrutiny Committee has received a ‘Deep Dive’ review.

2MH Outcomes measures (PROMS/SWEMWEBS/FFT) are not clearly defined and agreed with the Provider. Risk that Provider is not aware which interventions are effective and which require improvement.

NSFT Med High

• NSFT is working on their internal Performance Accountability Review and internal Task and Finish Group to look at outcomes measures for both adult and CYP.

• Timescale for delivery for Children and Young People is 31 May and Adults is 31 October 2017

• CCGs Clinical Lead to discuss with NSFT clinical lead on outcomes measures

3 Funding not available to implement the Mental Health Five Year Forward View must do’s delaying service improvement

CCG/ NSFT High High

• CCG and Trust pursuing all options for securing additional funds, including bid to NHSE

• Funding priorities for 18/19 agreed.

Norfolk and Suffolk NHS Foundation Trust

Suffolk CCGs Quality

RAG Indicator Comments (n.b. December data - validated) ChangeEarly Intervention in Psychosis (EIP)

100% of patients with RTT within 14 days compared to 57% in November 2017 (target 50%). ↑

CPA: 7 day follow up post inpatient care

96.5% against 95% target. This is a quarterly target and remains compliant. ↔

CPA:12 months review

95.3% against 95% target. ↔

Under 18 routine referrals seen within 28 days

66.7% of service users seen within 28 days (was 60%). Performance dip has been due to staff leaving, sick leave and maternity leave. Overtime in place and matron supervision. Clinical management of longer waits ongoing to ensure safety. Remedial action plan requested.

↑

IAPT Prevalence At M9 I&ESCCG and WSCCG are ahead of target at 15.5% and 14.1% respectively against a cumulative target of 12.6%.

↔

IAPT Recovery WSCCG at 50% and IESCCG at 50.3%. Standard is 50%. ↔Clinical Quality

Performance Indicator Threshold October November December Comments

MH Safety Thermometer(IESCCG/WSCCG) 95% 90%/

100%100%/93%

85%/94%

Percentage of bed occupancy(IESCCG/WSCCG)

90% 94%/88%

90%/87%

85%/86%

NB: Primary care MH contract is covered in a separate contract

Updates• Psychiatric Liaison Service – Business case agreed and SV in progress. • Children’s emotional wellbeing hub progressing to go live in April 2018• CCG/Trust Clinical review /audit of eating disorders service underway• Positive NHSI Inspection• Key priorities for investment within 18/19, parity of esteem funding agreed with

CCG.

Performance

Outstanding Performance Notices

Contract RAG

Performance Issue Contract Notice Stage

Last 3 months performance

Chan

ge fr

om

prev

.mon

th

Current Status

Nov Dec Jan

WSFT Acute Oncology Service: 1 hour door to needle time ‘DTN’ for all Service Users presenting to A&E or MDU with suspected neutropenic sepsis.: Target: 100% overall and 85% for Contract Management

Exception Report(ER201516_01)

73.91% 53.85% 80% ↑

A&E performance

62.5% 14.2% 50% ↑

MacMillan Unit

100% 100% 100% ↔

Delayed transfers of care of occupied bed capacity (no more than 3.5%

2.6% 2.9% No data n/a

Outstanding Performance Notices

Contract RAG

Performance Issue Contract Notice Stage

Last 3 months performance

Chan

ge

from

pr

ev.

mon

th

Current Status

Oct Nov Dec

NSFT 12 months review: Care Programme Approach (CPA) review

Target: 95%

Exception Report 2016-17-02

95.6% 95.6% 95.3% ↔• Compliant for 7 consecutive months.• Unvalidated position for January shows

target missed at 93.2%.

12 months review: nCPA patient review

Target: 95% 95.3% 96.2% 97.1% ↑

• Compliant for 2 consecutive months.• Unvalidated January data shows target just

missed (94.5%).

Access and Assessment TeamOver 18s 4 hrs emergency assessment

Target: 100%

Exception Report 2016-17-01

94.7% 100% 100% ↔• Unvalidated position for January – 86.4%.

Over 18s 72 hrs urgent assessment

Target: 98%86.5% 87.5% 89.8% ↑

• Un-validated data for January 79.5%, standard under review.

Over 18s 28 days for routine assessment

Target 95%74.1% 75.6% 82.4% ↑

• Ongoing capacity problem, additional staff recruited in September 2017.

• Unvalidated January data - 71.2%.

Page 1 of 3

GOVERNING BODY

Agenda Item No. 12

Reference No. WSCCG 18-20

Date. 28 March 2018

Title Governing Body Assurance Framework and Chief Officers Risk Registers

Lead Chief Officer Amanda Lyes, Chief Corporate Services Officer

Author(s) Tony Buckle, Risk Manager

Purpose To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for March 2018.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by the Governing Body:

The Governing Body is requested to review and approve the updated West Suffolk CCG GBAF for March 2018

1. Background 1.1 Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body, Clinical Scrutiny and Audit Committees at each of their meetings. 2. GBAF - Key Issues 2.1 Some departmental risks have been revised to remove / amend historic data. The

archiving of old information was highlighted at the February 2018 Audit Committee. 2.2 Actions highlighted with a grey background are complete and will be removed from the next

version. 2.3 The following amendments have been agreed by COT at their regular review meeting:

Risk No and Owner

Risk description and actions update

2

Jane Payling

Failure to achieve financial balance in 2017/18, secure financial sustainability and deliver optimum service from the financial resources available. Revised risk rating reduced from 15 to 10 (see below) Action 3 complete - monthly identification of risks and opportunities. March 2018 – review undertaken looking at in year risks and opportunities. Conclusion that as now in month 11, level of risk is more than offset by opportunity therefore likelihood reduced.

27a

Chris Hooper

Potential impact of service quality delivered by NSFT. Description of strategic risk – this has been revised with old information removed. The current information reflects the latest CQC re-inspection report of October 2017. Granular operational risks – three have been removed Key controls established revised – one removed and 3 new Quality dashboard established Interviews held for new Chief Executive Deep dive report presented to Clinical Scrutiny Committee Action 14 - initiate joint CQRMS quarterly (with Norfolk) – March 2018; ongoing, first meeting April 2018

34

Chris Hooper

Significant issues identified with the blood transfusion service at West Suffolk Hospital. Action 3 progress – monitoring of SIs: Ongoing - as of 27.02.18 there have been no SIs reported Action 5 progress - effective communication on developments to stakeholders E.G Primary Care: Ongoing – Service Development and Contract Group disseminate information

35

Chris Hooper

Failure to comply with SEND Reforms. Key controls established revised Written statement detailing implementation actions to achieve compliance dated May 2017. Further year of ongoing work to fully implement reforms

Appointment of SEND programme manager / leads across each organisation to deliver implementation of improvements Increased time for DCO

Assurance of controls – comprehensive revision with one removed and 4 revised (below) Ongoing inspection reviews demonstrating improvements Milestones to achieve implementation are monitored and rated green Health milestones are on target to achieve by 2019/2020 Key individuals in each organisation leading pathway changes and reforms

36

Chris Hooper

CCG will not be able to meet its statutory duties to safeguard children and adults in Suffolk. Granular operational risks – Governance section revised: Leadership for Designated Nurses needs strengthening to ensure direct access to CNO Key controls established - comprehensive revision with 3 removed and others are new / revised (below) Recruitment plan developed. CCG looking at interim recruitment of medical support Continue to advertise Designate Doctors post but more focused work required Increase hours for LAC Designated Nurse. Line Management of MASH to change. Gap Analysis undertaken. Clear line management infrastructure for Designated Nurses. Bi-monthly reporting to Clinical Executive Action 9 completed – develop an options paper on recruitment process for Designated Professionals Action 10 new action - enact recruitment plan, target date May 2018

40

Chris Hooper

Currently East of England Ambulance are unable to meet the demand for its services, which may impact on the safety of patients. Action 1 complete - monthly quality reports received by CCGs Action 3 complete - monthly contract and performance meetings

3. Chief Officers Risk Registers

3.1 As previously agreed, a brief highlight report on current risks which may cause concern to the CCGs from local Risk Registers is included in a summary table document with this report. These are reviewed on a regular basis by COT and also reviewed by the Risk Forum.

3.2 The Risk Forum reviews all the departmental risk registers each month and they are all up to

date. The Risk Forum met on 15 March 2018 and the risk register summary table has been updated as a result of the meeting.

Governing Body Assurance Framework and

Action Plan

2017 - 2018

Version Control: MONTH

VERSION No

REVIEWED BY

SUMMARY OF CHANGES

April 2017

49

COT 10 April 2017 Clinical Scrutiny Comm 26 April 2017

Approved

May 2017

50 COT 8 May 2017

Governing Body 24 May 2017 Audit Committee 13 June 2017

Approved

June 2017

51 COT 12 June 2017

Clinical Scrutiny Comm 28 June 2017

Approved

July 2017

52 COT 10 July 2017

Governing Body 26 July 2017

Approved

August 2017

53 COT 14 August 2017

Clinical Scrutiny Committee 16 August 2017 Audit Committee 5 September 2017

Approved

September 2017

54 COT 11 September 2017

Governing Body 27 September 2017

Approved

October 2017

55 COT 9 October 2017

Clinical Scrutiny Comm 25 October 2017 Approved

November 2017

56 COT 13 November 2017

Governing Body 29 November 2017 Audit Committee 5 December 2017

Approved

December 2017

57 COT 11 December 2017

Clinical Scrutiny 27 December 2017 Approved

January 2018

58 COT 15 January 2018

Governing Body 24 January 2018 Audit Committee 6 February 2018

Approved

February 2018

59 COT 12 February 2018

Clinical Scrutiny 28 February 2018 Approved

March 2018 60

COT 12 March 2018 Governing Body 28 March 2018 Audit Committee 3 April 2018

Board Assurance Framework

Overview

The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement. The GBAF should be seen as a working document and will be updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body at each of its meetings. The GBAF is linked to the CCG Risk Register, the content of which is also provided for review by the Chief Officers Team. A flow chart setting out how risks are identified and managed is set out overleaf. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above and are of strategic concern migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern. The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.

RISKS IDENTIFIED THROUGH:

External Assessment & Audit + Guidance & Alerts

Serious Incidents, Complaints, Public Health &

Quality Issues

Public & Stakeholder Engagement

Business & Service Delivery Plans

CCG Governing

Body Own & Manage Risks & the Chief

Officers Team Reviews the

Directorate Risk Registers and the

GBAF

Governing Body Assurance Framework

Overview & Scrutiny by the Audit Committee

Assurance to the Governing Body

Individual Risks Jointly Managed by Designated Chief

Officers & Clinical Leads

Work Stream Risk Assessments

Review by Clinical Scrutiny Committee

Review by Local Risk Forum

RAG Score Framework

Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain

Consequence score ↓

5: Catastrophic 5 10 15 20 25

4: Major 4 8 12 16 20

3: Moderate 3 6 9 12 15

2: Minor 2 4 6 8 10

1: Negligible 1 2 3 4 5

The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:

In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:

Define the risk explicitly in terms of the adverse consequence or consequences that might arise

Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified

RAG Score

Progress

Risk Assessment

Revising Risk Ratings

CRITICAL (15-25)

There may be significant gaps in controls to ensure effective management.

Controls are in place but insufficient resources

Controls are in place but external forces may be preventing progress.

There are insufficient controls in place to address the cause or source of the risk

Controls are considered insubstantial or ineffective Controls are being implemented but are not yet in place If this risk were to materialise, the situation could be

irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.

If controls are inadequate then the revised risk rating increases

If controls are uncertain, the revised risk rating stays the same as the original risk rating

If they are perceived as adequate, then the revised risk rating decreases

CHALLENGING (8-12)

Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.

There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.

MANAGEABLE (1-6)

Progress is being made in accordance with plans. There are no significant concerns.

The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.

Consequence score (severity levels) and example of descriptions

1 2 3 4 5

Risk Domains Negligible Minor Moderate Major Catastrophic 1. Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment. No time off work

Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects

Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients

2. Quality / complaints / audit

Peripheral element of treatment or service suboptimal Informal complaint/inquiry

Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report

Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards

3. Human resources / organisational development/staffing / competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis

4. Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation Reduced performance rating if unresolved

Single breech in statutory duty Challenging external recommendations/ improvement notice

Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report

Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report

5. Adverse publicity / reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence

6. Business objectives / projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget Schedule slippage

5–10 per cent over project budget Schedule slippage

Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met

Incident leading >25 per cent over project budget Schedule slippage Key objectives not met

7. Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget Claim less than £10,000

Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million

8. Service/business interruption

Loss/interruption of >1 hour

Loss/interruption of >8 hours

Loss/interruption of >1 day

Loss/interruption of >1 week

Permanent loss of service or facility

9. Environmental impact

Minimal or no impact on the environment

Minor impact on environment

Moderate impact on environment

Major impact on environment

Catastrophic impact on environment

RISK NUMBER: 02 DATE RISK ADDED:

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GRANULAR OPERATIONAL RISKS

IN

ITIA

L R

AG

RA

TIN

G

(LIK

ELIH

OO

D x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

ATIN

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ACTION POINTS & TARGET DATES FOR

COMPLETION

JP +

CB

Failure to achieve financial balance in 2017/18, secure financial sustainability and deliver optimum service from the financial resources available.

In 2017/18 the CCG

have a QIPP target of £10.4m, Should the QIPP not be delivered in full this could be partially mitigated through use of contingency funds but these may not be sufficient to mitigate significant under delivery and use of contingency funding places continuous ongoing pressure on the underlying position of the CCG.

Increasing demand in acute Trusts activity. Providers require extra financial support to maintain or meet clinical quality and contractual standards.

Increase in prescribing costs, with in year pressures increased due to central clawback of category M savings and increases in the number of drugs for which No Cheaper Stock is Available

Ability to maintain Continuing Healthcare expenditure within budget.

4 x 5

20

Project management approach to delivery of the QIPP plans with Head of PMO and project managers.

Continued horizon scanning for further QIPP opportunities including the Right Care initiative and NHSE MOO.

Close monitoring of the delivery of QIPP initiatives through KPI’s

Clarity of accountability improved

Regular issue of budget statements and challenging budget review meetings

Focus on activity levels at acute provider with clear actions to mitigate against over performance

Guaranteed contract values agreed with WSFT, IHT CHUFT for 17/18.

Active scrutiny and challenge of attribution of Responsible Commissioner through agreed algorithms, data validation and Claims Management Service.

COT including

business review process

Monitor of PWC report by Audit Committee

Project managers appointed

GP engagement Governing Body NHS England

performance reviews Internal & External

Audit Monthly SLA

provider meetings Financial

Performance Committee

PMO reports The CCG actively

participates in the STP including the system financial bridge to 2020/21

INTERNAL AUDIT PLAN Financial reporting &

budgetary control – Q2 Key financial assurance – Q3 Continuing Healthcare – Q3

█ CHALLENGING

3 x 5

15

2 x 5

10

5. Monthly identification of risks and opportunities Target: March 2018 Completed: March 2018 – review undertaken looking at in year risks and opportunities. Conclusion that as now in month 11, level of risk is more than offset by opportunity therefore likelihood reduced. 14. Refresh 2018/19 financial plan based on latest information. Target: End December 2017 Extended to March 2018 to reflect delays in planning guidance Completed: 16.

Additional potential risk from delegated Primary Care budgetary responsibilities in 17/18.

Encourage innovative changes to improve efficiency

Clinical Executive and Governing Body review of expenditure and significant investments

Strategic/Annual Plan – Q4

CCG PRIORITY: Deliver financial

sustainability Integrated performance report area. Finance and Performance

See following sheet for next risk

RISK NUMBER: 20 DATE RISK ADDED: MAY 2014

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

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RA

G R

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(L

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x C

ON

SEQ

UEN

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KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

MO

NTH

RE

VISE

D RA

G R

ATIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

RW

+ S

A

Failure to redesign and commission services covered by the Urgent Care and Health and Independence reviews within required timescales

Potential for services

to fall out of contract including with the pause NHS England have put onto the Integrated Urgent Care procurement

Risk that the full potential benefits of a transformational redesign are not met leading to patient care being adversely affected and inefficiencies in the system

Reputational damage

to commissioners

4 x 4

16

Contracts in place

with the Consortium (West Suffolk Hospital, Ipswich Hospital and Norfolk Community Services) for adult and children’s community services plus extension of contract to 111 and Out of Hours with Care UK all running to Oct 2017.

Redesign of core components of the Urgent Care and Health and Independence Review underway since mid-2015 such as development of Connect East Ipswich, creation go Crisis Action Team and Frailty Assessment Base at Ipswich Hospital.

Clinical Executive considered and agreed approach to wider redesign of services for

COT review Executive Group

review Health &

Wellbeing Board review

Governing Body Review

Area Team Strategic Plan Review

CCG PRIORITY: Demonstrate

excellence in patient experience and patient engagement

Improve the health and care of older people

Improve access to mental health services

Improve health and wellbeing through partnership working

Deliver financial sustainability through quality improvement

█ CHALLENGING

3 x 4

12

3 x 4

12

16. Integrated Urgent Care Service commences

Target: October 2018 Completed:

T

commissioning by Oct 2017 in Nov 2015.

Programme staff recruited to and project plan in development.

Associate Director Redesign leads agreed for each component part of the work programme and a fortnightly delivery group meeting involving all parts of the two CCGs in place.

Task and finish groups set up with wider system partners for each of the component parts of the programme to develop the clinical models and specifications.

Procurement resulted in a tie between providers. An additional 6 months likely be negotiated with Care UK while procurement is re-run.

Governing Bodies agreed in Jan 2018 to launch a new procurement for the service with an expected go live date of Oct 2018.

Project group in place to oversee the procurement

Integrated performance report area. Clinical Workstream

RISK NUMBER: 27a DATE RISK ADDED: July 2015 (Renumbered January 2016)

ACCO

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

ATIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

CH

+ R

T

Potential impact of service quality delivered by NSFT CQC re-inspection report dated October 2017 gave the Trust an overall rating of “Inadequate” placing the Trust into Special Measures for the second time

Reduction in quality of

service and inability to meet performance and clinical quality targets

Maintaining safer staffing levels in accordance with NICE & NQB guidance

Adverse financial position may impact adversely on the quality of care delivered

Potential increase in contract issue log referrals

Ligatures posing rises to patient safety

Seclusion facilities not fit for purpose.

Lack of confidence in performance data.

Failure of Board to demonstrate leadership in patient safety.

4 x 4

16

Monthly meetings to

review / challenge quality performance

Quality dashboard Attendance at

monthly stakeholder assurance meetings led by NHS Improvement / CQC

Oversight of quality improvement plans (trust / local) and monthly monitoring of progress by quality team and workstream

Support for NSFT mock CQC inspections and feedback

Announced and Unannounced quality improvement visits

Sign off provider CIPs and associated QIAs

Monitor primary care contract issues and Trust response

Appointment of Improvement Director by NHSI

Buddy Trusts identified for the

Demonstrated

improvement against identified contractual key performance indicators evidenced through quality dashboard escalation of issues via SLA meetings

Confidence that NSFT have structures in place to deliver the required quality improvements

Assurance that actions detailed in the quality improvement plan have been implemented

Test that actions detailed in the quality improvement plan have resulted in changes at an operational level

To ensure that CIP schemes do not have an adverse impact on quality

█ CHALLENGING

4 x 4

16

4 x 4

16

8. Regular monitoring of Patient Safety & Quality:- Monthly meetings with Provider reviewing comprehensive range of reporting. Undertaking quality visits to services

Target: March 2018 Completed: 11. Attendance a challenge at monthly Overview and Assurance Group Target: March 2018 Completed:

12. Monthly programme of announced/unannounced QIVs

Target: March 2018 Completed:

14. Initiate joint CQRMS quarterly (with Norfolk)

Target: March 2018 Completed: Ongoing – first meeting April 2018 15. Continue partnerships with patients & their carers to understand issues, ideas & progress Target: March 2018 Completed:

T

Trust to work with/learn from

Interviews held for new Chief Executive

Deep dive report presented to Clinical Scrutiny

Timely response to contract issues with effective learning reducing numbers

Joint review of plans to act on the areas of concern identified in the Trust mock CQC inspection report.

CCG PRIORITY: Improve access to

mental health services

16. Enhance clinical relationships between CCG, practices & NSFT Clinicians Target: March 2018 Completed: 17. Ensure on-going communications with the public

Target: March 2018 Completed:

18. Outstanding requests / concerns to be escalated formally. Target: February 2018 Completed:

See following sheet for next risk

RISK NUMBER: 27b DATE RISK ADDED: January 2016

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&

GP

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

R

AG

RAT

ING

LA

ST

MO

NTH

RE

VISE

D RA

G R

ATIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

JW /

RT

Poor performance of mental health services

There was an

absence of performance data between May and September due to the roll out of Lorenzo, the Trust’s new information system

Performance against a number of key areas has fallen significantly in this period

Key areas such as the access and assessment team (AAT), 7 day follow up for inpatients, memory assessment services, care plan reviews and overall waiting times have deteriorated

Service Users are not receiving timely interventions impacting on their health and wellbeing.

Key posts are vacant within children’s services leading to longer waits for assessment and treatment. This could result in sub-optimal outcomes.

4 x 4

16

Contract

Performance Notices for AAT, 7 day follow up and care plans issued. RAPs to be agreed

Information Notices issued on data completeness and data quality

Exception Notices issued for AAT, CMAS, CPA (completion date column amended to reflect this)

Director level escalation of children’s long waits

Reported to the

workstreams, Clinical Executive and Governing Body as appropriate

CCG PRIORITY: Improve access to

mental health services

Integrated performance report area. Contractual Performance

█

CHALLENGING

4 x 4

16

4 x 4

16

1. AAT Recovery

Target: April 2018 Completed: 2. CMAS Joint Review

Target October 2017 Completed: Complete with the exception of reporting requirements 3. Joint Exec to Execs

Target: September 2017 Completed: September 2017 (partial as future Exec to Execs meetings to be scheduled by March 2018)

T

RISK NUMBER 33 DATE ADDED February 2017

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&

GP

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RAG

RAT

ING

(L

IKEL

IHO

OD

x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATI

NG

LA

ST

MO

NTH

REV

ISED

RA

G R

ATI

NG

ACTION POINTS & TARGET DATES FOR

COMPLETION

JW

WSFT is failing in their 18 week RTT performance on both an aggregate level and individual specialty level

Due to the implementation of e-care, WSFT were estimating the RTT performance. Now the PTL has been validated, the Trust is failing the 18 week RTT performance Deep dive into specialty level demand has shown a risk of long waiting times for ENT and Dermatology Reported high numbers of 52wk breaches

4 x 4

16

Contractual performance review at each contract meeting 2 weekly RTT review

meeting RTT reduction model

developed and tracked

100 day improvement

programme launched in ENT, Cardiology and Urology.

Monthly review of waiting times going forward when e-Care allows. CCG Priority: To ensure high quality local services

█

CHALLENGING

4 x 4

16

4 x 4

16

1. Action plan received from Trust. Plan shared with NHSE and NHSI. Plan to be reviewed at 2 weekly steering group.

Target: Ongoing Completed: 2. Progress against action

plan to be monitored and scrutinized at monthly contracting meetings

Target : Ongoing Completed:

a

RISK NUMBER 34 DATE ADDED March 2017

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&

GP

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RAG

RAT

ING

(L

IKEL

IHO

OD

x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATI

NG

LA

ST

MO

NTH

REV

ISED

RA

G R

ATI

NG

ACTION POINTS & TARGET DATES FOR

COMPLETION

CH

Significant issues identified with the blood transfusion service at West Suffolk Hospital (WSH) run by NEESPS during an inspection by the MHRA – January 2017

Critical deficiencies

identified

Staffing – insufficient numbers of staff, staff without the appropriate training or competence.

Governance –

appropriate systems and processes not in place to ensure that patients receive the right blood products.

Regulator concern has raised the prospect of the service being suspended

Significant risk that

patients will receive the wrong blood products

Incidents of

inappropriate transfusion of products have been reported. No harm reported through these incidents. It is

4 x 5

20

Trust / TPP

improvement plan Monthly Trust / TPP

updates on progress against plan to MHRA / NHSI

Serious Incident Reporting

Further MHRA inspections

MHRA / NHSI review and sign off of proposed actions Target dates for improvements to made by are met leading to regulatory compliance Review of Serious Incidents to assess if harm has resulted Inspection findings support the assurance provided in the weekly updates of the improvements being made within the service. These have now changed to monthly updates. CCG Priority: To ensure high quality local services

█

CHALLENGING

3 x 5

15

3 x 5

15

3. Monitoring of SI reports

Target: March 2018 Completed: Ongoing - as of 27.02.18 there have been no SIs reported 5. Effective communication on

developments to stakeholders E.G. Primary Care

Target: March 2018 Completed: Ongoing – Service development and Contract group disseminate information

7. CCG to monitor the implementation of the provider agreed actions a. Staff to undertake concise RCA training Target: 08/08/2017 Completed: Delayed – 2 staff members to be trained No change, to be formally raised with Trust.

a

See following sheet for next risk

unknown if harm has been caused through other inappropriate / incompatible transfusions.

A service suspension would mean that an alternative service provider would have to be found for WSFT to provide: Emergency Department, Maternity, Major Surgery and Intensive Care Services amongst others.

Provider unable to provide evidence to the MHRA to support the assurances provided around safe staffing levels Provider unable to evidence that protocols were followed in the commissioning of new issue fridge

e. Recruitment plan to be

developed and implemented Target: March 2018 Completed: f. MHRA to be provided with details of the WPE LIMs validation process Target: 24/03/2017 Completed: Delayed – IT VMP remains in draft; resource for completion has yet to be agreed. New target date 31/13/2018.

RISK NUMBER 35 DATE ADDED March 2017

ACC

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

ATI

NG

ACTION POINTS & TARGET DATES FOR COMPLETION

CH

Failure to comply with SEND Reforms

The failure to

implement the requirements of the SEND reforms has resulted in the cohort of children receiving a sub-optimal service which could potentially significantly restrict their development / potential and has led to regulatory noncompliance and resultant adverse publicity

5 x 4

20

Written statement of

implementation actions to achieve compliance dated May 2017. Further year of ongoing work to fully implement reforms

SEND Programme Board (& associated sub-groups) in place to provide strategic leadership and governance overseeing implementation of improvement actions

Appointment of SEND programme manager / leads across each organisation to deliver implementation of improvements

Appointment of band 7 SEND support worker to operationally deliver SEND reforms

Increased time for DCO

Written statement signed off by Regulators Ongoing inspection reviews demonstrating improvements Milestones to achieve implementation are monitored and rated green Health milestones are on target to achieve by 2019/2020 Key individuals in each organisation leading pathway changes and reforms

█

CHALLENGING

5 x 3

15

5 x 3

15

9. Scoping of SEND need identified through accurate data collation and analysis from all stakeholder

Target: March 2018 Completed:

10. Support and monitor progress of the implementation of the strategy

Target: March 2018 Completed: 11. Develop action plans to

support development of new pathways

Target: March 2018 Complete: 12. Ensure robust leadership and

governance for SEND in CCG Target: March 2018 Completed:

RISK NUMBER 36 DATE RISK ADDED: September 2017

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

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G

ACTION POINTS & TARGET DATES FOR

COMPLETION

CH

CCG will not be able to meet its statutory duties to safeguard children and adults in Suffolk.

Capacity Designate Doctors post vacant Designate Nurse for looked after children also leading on SEND project Governance Leadership for Designated Nurses needs strengthening to ensure direct access to CNO Team Relationships Relationship difficulties within the team are distracting from the safeguarding portfolio of work

4 x 4

16

Recruitment plan developed. CCG looking at interim recruitment of medical support Continue to advertise Designate Doctors post but more focussed work required. Increase hours for LAC Designated Nurse. Line Management of MASH to change. Gap Analysis undertaken. Clear line management infrastructure for Designated Nurses. Bi-monthly reporting to Clinical Executive

Post advertised and successfully recruited to. Cover arrangements agreed until such time as a permanent appointment is made Changes to line management affected – designate nurses reporting to the Chief Nursing Officer Team relationship are improved greater focus on core work

█ CHALLENGING

4 x 4

16

4 x 4

16

1. Continue to advertise Designated Doctor vacancy Target: December 2017 Completed: Revision of vacancy process, see action 9 7. Review of resources to

support the safeguarding agenda

Target: December 2017 Completed: Ongoing 8. Action plan to be developed to support the implementation of the recommendations of the safeguarding review Target: January 2018 Completed: 9. Develop an options paper on recruitment process for Designated Professionals Target: 31 January 2018 Complete: Completed 10. Enact recruitment plan Target: May 2018 Completed:

RISK NUMBER 37 DATE ADDED: December 2017

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

ATIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

JW/S

A

A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience.

• Clinical risk of patients not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments. • Risk of patient experience deterioration due to long waits. • Risk of breaching

constitutional obligations.

4 x 4

16

Daily reporting of

performance. Escalation of Health

Dtoc daily for CCG and system support

OOH cover and 111 support continually reviewed to ensure rotas are in place to manage surges

Admission avoidance schemes fully operational and a rolling reminder in place to primary care and OOH

GP streaming in place

111 targets to reduce inappropriate referrals to A+E

A&E Board in place Assess and address

staff shortages in medical and nursing rotas 10 days in advance

Daily performance information supplied and monitored, regular discussions and monthly formal contract meetings. Formal contract notification to WSFT for joint working and review of performance in A+E requirement. Remedial Action Plan established by A+E delivery board.

CCG PRIORITY: Improve health

and wellbeing through partnership working

Integrated performance report area. Contractual Performance

█ CHALLENGING

4 x 4

16

4 x 4

16

2. Complete actions from A&E Delivery Board Action Plans:

a. Improve streaming options in A&E

b. Improve NHS111 call triage and streaming to clinicians

c. Improve ambulance triage and streaming to alternative responses

d. Improved patient flow within the hospital

e. Improved discharge from hospital Actions are monitored monthly by the A&EDB

f. Revised remedial action plan agreed with WSFT

Target: March 2018 Completed:

RISK NUMBER 38 DATE ADDED JANUARY 2018 *NEW RISK*

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

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G

ACTION POINTS & TARGET DATES FOR

COMPLETION

MB

W/C

B

Significant reduction in the capacity of GP services in Haverhill affecting access times for patients, demand for other services and retention of clinical staff

Clinical risk of patients not being seen in appropriate timescales Risk of patient experience deterioration due to increased waits Risk of Haverhill practices not being able to function List closures Increased prescribing costs Increased use of A&E and secondary care services, especially in CUHFT

4 x 4

16

CCG Primary care strategy and support team in regular contact with practices LMC/CCG/Fed meetings Weekly Clinical Executive meetings Bi-monthly Governing Body meetings Utilisation of Vulnerable Practices Fund, resilience funding and £3 per head Transformation Fund

Currently: Primary care co-commissioning strategy CCG Priority To ensure high quality local services

Integrated performance report area. Clinical Quality and Patient Safety

█ CHALLENGING

4 x 4

16

4 x 4

16

1. Ongoing support into Haverhill continues

Target: March 2018 Completed: 2. Solution to estate issues

being investigated Target: March 2018 Completed:

3. Key stakeholders are briefed, including neighbour practices

Target: March 2018 Completed: 4. Targeted extended access

(funding as a cost pressure) to Haverhill to assist with demand.

Target: March 2018 Completed: 5. Additional capacity into

extended hours initiative in Haverhill using winter monies

Target: March 2018 Completed:

a

RISK 39 *NEW RISK* DATE ADDED February 2018 – risk is owned by Ipswich and East Suffolk CCG. For note on West Suffolk CCG GBAF

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

INIT

IAL

RAG

RAT

ING

(L

IKEL

IHO

OD

x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATI

NG

LA

ST

MO

NTH

REV

ISED

RA

G R

ATI

NG

ACTION POINTS & TARGET DATES FOR

COMPLETION

JW/S

A

EEAST is failing performance targets against ambulance response categories, particular concern are delays in the higher acuity Category 1 and 2 calls.

Capacity EEAST under achieving on required number of productive paramedic hours that EEAST can deliver ‘on the road’. Demand Increase in acuity and volume of calls. Both direct to 999 and through 111 services. This includes rising care home 999 activity. Operational Procedures Reduction in productive paramedic hours due to delays in hospital arrival to handover and handover to clear.

5 x 4

20

Weekly performance reviews and forecasting update with Commissioners and Provider. EEAST risk summit convened in Feb 18 and will continue to review progress of performance. Monthly Contract Review focuses on local performance attainment and issues.

Minutes and actions circulated to attendees of weekly performance review meeting. EEAST risk summit actions regularly updated with diarised meetings internally and externally to NHSE/NHSI. Monthly review of waiting times going forward when e-Care allows. CCG Priority: To ensure high quality local services.

█

CHALLENGING

5 x 4

20

5 x 4

20

1. Action - EEAST risk summit action plans for individual areas all due to be completed by 15th February.

Adoption of 30 minute maximum handover time.

Introduction of GP Heralded scheme for booking transport to hospital.

111 enhanced clinical triage for calls triggering an ambulance.

Work with care homes to reduce reliance on 999.

Target: 15/2/18 although further actions will fall out from this. Completed

a

RISK 40 DATE ADDED FEBRUARY 2018 *NEW RISK*

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DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

IN

ITIA

L R

AG

RA

TIN

G

(LIK

ELIH

OO

D x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

R

AG

RA

TIN

G L

AST

MO

NTH

R

EVIS

ED R

AG

RA

TIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

CH

Currently East of England Ambulance are unable to meet the demand for its services, which may impact on the safety of patients

High levels of incidents / serious incidents reported end December 2017 through to February 2018. Early analysis, subject to further investigation suggests that high levels of reporting are due to system pressures and resultant delays attending.

5 x 4

20

Contract in place with

KPI’s Monthly Joint CCG

Contract Quality Review meetings

Monthly contract & performance meetings

Risk Summit Process System wide actions to

reduce demand and handover delays – including Care Homes specific

Robust investigation, then review of serious incident investigation reports through enhanced joint localities SI review Panel

External oversight of EEAST internal SI processes

EEAST weekly reporting of numbers of incidents considered SIs declared

Quality reports

received monthly

Appropriate challenge to reported quality metrics, agreeing actions where improvements required

Performance metrics

demonstrate that both demand and handover delays are reducing

Assurance that

incidents have been robustly investigated and that learning shared across system to mitigate against reoccurrence.

Assurance that robust

effective processes exist

Clear Communication of the numbers of SIs being declared

█

CHALLENGING

5 x 4

20

5 x 4

20

1. Monthly quality reports received by CCGs

Target: March 2018 Completed: Feb 2018 Monthly quality reports are received by the CCG 2. Monthly Joint CCG

Contract Quality Review Meetings

Target: March 2018 Completed: 3. Monthly contract and

performance meetings Target: March 2018 Completed: Feb 2018 Quality team attend and are part of the monthly locality contract meeting and are receiving a program of subject matter updates including IPC, safeguarding and training. 8.

Departmental Risk Register summary of top risks

Date: March 2018

For: COT and requested committees

Department Risk Description / consequences

Current controls / assurance

RAG Actions with status Completion date

Responsible person

1. Corporate Services

Failure to recruitment and retain GPs locally.

Develop new clinical models that allow the substitution of GP capacity by other clinical professionals. Work with Suffolk GP Federation on the development of schemes to attract and retain GPs

12

Leaflet produced to support the GP Retention scheme. International recruitment scheme has been supported and is planned to deliver additional GPs by 2018. In progress - plans articulated in GPFV.

31 March 2018

Amanda Lyes

2. Corporate Services

Delay in implementing GDPR

Audit committee updates Work underway with partner organisations Gap analysis done – resulting in action plan New IG Lead / Data Protection Officer appointed IG Forum have GDPR as item

10

Work commissioned re compliance Action plan to Audit Committee Dec 2017 IG Toolkit audit by TIAA in January 2018 Ongoing IG training

25 May 2018 (national deadline)

Amanda Lyes

Risk Description / consequences

Current controls / assurance

Actions with status Completion date

Responsible person

1. Chief Officer

CNO provision

Interim CNO covering post 6

Some nursing review outcomes complete. Meeting with Interim CNO to be held during November to discuss further implementation. Additional support recruited on an interim basis to assist Interim CNO

31 Mar 2018 Ed Garratt

Risk Description / consequences

Current controls / assurance

Actions with status Completion date

Responsible person

1. COO Ips & East and West

Sustainability of robust primary care, individual practices that are at risk of service failure

Continue to work with Ipswich Primary Care, utilising the funds from the Vulnerable Practices Fund Continue to work with Haverhill practices and GP Federation to ensure sustainable primary care in the town

16

IESCCG: Heat map developed and updated on monthly basis. Practices identified for support. First Practice Resilience Fund decision Feb 2017, two practices in Ipswich had successful bids WSCCG: Haverhill continues to have capacity issues; reduction in GP Partners, and both practices in the area now reliant upon locum cover. Haverhill Family Practice had had to close its list in December, services now reduced. CCG supporting Lakenheath with capacity issues and Long Melford with GP recruitment issues

31 March 2018

David Brown / Lois Wreathall

2. COO Ips & East

CCG is entering into an agreement with IBC for abortive costs with a range from £0 to £380k

Regular meetings with the 3 practices to identify and respond to issues that may cause the project to stall

16

Outline agreement drafted. Approach agreed by PCCC 27.9.17. Some practices expressing concern re negative equity Being followed up.

31 March 2018

David Brown

3. COO Ips & East and West

Potential for harm and service disruption if patient risks are not adequately managed by the SAS service

Existing controls eg police attendance may be revised and supplemented in light of outcome of review

16

New GP identified. Incident review pending Alternative premises options being assessed Participation in area wide procurement

March 2018 David Brown

Risk Description / consequences

Current controls / assurance

Actions with status Completion date

Responsible person

1. Contracts Lack of visibility on 18 week RTT at WSFT. Patients not seen in timely manner

On GBAF 12

Reviewed on GBAF Mar 2018 Jane Webster

2. Contracts IHT failing to meet A&E 4 hour standard presenting a potential risk to patient safety and experience

On GBAF 12

Reviewed on GBAF Mar 2018 Jon Reynolds

3. Contracts WSFT failing to meet A&E 4 hour standard presenting a potential risk to patient safety and experience

On GBAF 12

Reviewed on GBAF Mar 2018 Jane Webster

4. Contracts EEAST is failing performance targets against ambulance response categories, particular concern are delays in higher acuity Category 1 and 2 calls.

On GBAF 20 Reviewed on GBAF Mar 2018 Jane Webster

Risk Description / consequences

Current controls / assurance

Actions with status Completion date

Responsible person

1. Finance Controlled Environment for Finance (CEfF). Breach in respect of patient identifiable data.

Mandatory training for all staff. CEfF established and procedures in place.

16

Update 12/01/18 - No further progress to report. Additional concerns re access to footplate at EH via the fire doors - staff from other floors have been using fire doors as a shortcut to access the 1st floor kitchen and enter the CCG footplate directly into the controlled zone.

31 Mar 2018 Mark Game

2. Finance Financial data and systems unavailable due to loss of access to systems or IT failure (cyber-attack)

IT disaster recovery plans in place and tested. All staff issued with new laptops, etc.

12

Update 12/01/18 - Issues reducing now team more established at Endeavour House, still some minor issues but productivity less effected.

Mar 2018 Mark Game (in conjunction with Head of

IT)

Risk Description / consequences

Current controls / assurance

Actions with status Completion date

Responsible person

1. Nursing Paediatric speech and language service delivered by SCH has a back log

The CCG has allocated additional funding to the service and is working with SCC on a new working model

12

March18. Mapping of current services to be finalised at end of March with future service requirements developed thereafter

June 2018 Chris Hooper

2. Nursing CHC appeals. CHC team unable to release staff to support review panels resulting in unquantified financial risk as cases are unable to be processed and reviewed.

Redesigned appeals process in place

12

Revised process to be reviewed. March 2018. CHC appeals process to be transferred to CHC team allowing greater access to notes and support with the aim of reducing backlog

June 2018 Chris Hooper / Michael Wigg

Risk Description / consequences

Current controls / assurance

Actions with status Completion date

Responsible person

1. Transformation Risk of changing / competing priorities

Areas of work reviewed and prioritised

12 Ongoing issue managed via weekly Senior Team meeting. Priorities discussed weekly, distilled down into weekly team meetings.

March 2018 Deputy Chief

Transformation Officer

2. Risk of Disconnect between STP and BAU agendas

Moving towards STP working, there is a potential for duplication or gaps around local CCG level working

Communications within the team and across the STP. Regular meetings with STP partners

10 Discussion of different agendas at SMT and STP specialty meetings. Conversation with NHSE

September 2018

Chief Transformation

Officer

3. Transformation 100 day challenge programme-lack of Trust engagement—potential reputational risk

Overview from Transformation teams and planning of future meetings. NHSE overview and support

12 Escalated in Trust (9/01/18) April 2018 Chief Transformation

Officer

Page 1 of 33

GOVERNING BODY

Agenda Item No. 13

Reference No. WSCCG 18-21

Date. 28 March 2018

Title Minutes of Meetings

Lead Chief Officer Amanda Lyes, Chief Corporate Services Officer

Author(s) Jo Mael, Corporate Governance Officer

Purpose The report incorporates for endorsement, minutes and decisions from the following meetings;

a) Audit CommitteeThe unconfirmed minutes of a meeting held on 6 February 2018.

b) Remuneration and HR CommitteeThe confirmed minutes of 19 September 2017 (previously notpresented) and unconfirmed minutes of a meeting held on 13February 2018

c) Finance and Performance CommitteeThe confirmed minutes of a meeting held on 20 December 2017 and17 January 2018

d) Clinical Scrutiny CommitteeThe unconfirmed minutes of a meeting held on 28 February 2018

a) CCG Joint Collaborative GroupThe unconfirmed minutes of a meeting held on 1 February 2018

e) West Suffolk CCG Primary Care Commissioning CommitteeThe unconfirmed minutes of a meeting held on 24 January 2018.

f) Commissioning Governance CommitteeDecision from a virtual meeting held on 22 November 2017

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: To endorse the minutes as attached to the report whilst noting that ‘unconfirmed’ minutes remain subject to change by the relevant Committee/Group.

Unconfirmed Minutes of a meeting of the West Suffolk Clinical Commissioning Group Audit Committee held on Tuesday 6 February 2018

PRESENT Geoff Dobson - Lay Member for Governance (Chair) Steve Chicken - Lay Member IN ATTENDANCE Neil Abbott - Head of Internal Audit Colin Boakes - Governance Advisor, CCG Paul Cook - Information Governance Lead (Part) Mark Game - Head of Accounting and Control Lisa George - Local Counter Fraud Specialist, TIAA Mark Hodgson - Ernst and Young: External Audit Robert Hudson - Interim Deputy Chief Finance Officer Kevin Limn - TIAA Jane Payling - Chief Finance Officer Alison Riglar - Ernst & Young Keith Wood - NHS England 18/001 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted from; Amanda Lyes - Chief Corporate Services Officer

18/002 DECLARATIONS OF INTEREST

No declarations of interest, additional to those already published, were received.

18/003 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Audit Committee held on 5 December 2017 were approved as a correct record.

18/004 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising and the action log was reviewed and updated.

(The Chair advised that agenda item 13 (General Data Protection Regulation (GDPR)/Information Governance Assurance) would be taken first.

18/005 GENERAL DATA PROTECTION REGULATION (GDPR)/INFORMATION GOVERNANCE ASSURANCE

The Committee was in receipt of a report, which provided an update on the General Data Protection Regulation (GDPR) and information governance assurance. The GDPR was a new EU Regulation that was due to come into force on 25 May

2018. The GDPR sought to strengthen existing data protection law by providing individuals with more control over their information, taking into account evolving technologies.

Guidance from NHS England and the Information Governance Alliance (IGA) had not yet been received and was expected late March / early April 2018. GPs were their own data controllers and should have assurances in place as part of their annual information toolkit submission. The CCG was exploring available training via the STP or Suffolk GP Federation.

CCGs were mandated to meet the requirements set out in the Information Governance (IG) Toolkit. The IG Toolkit was a performance tool produced by the Department of Health and hosted by NHS Digital. It drew together the legal rules and central guidance and presented them in one place as a set of information governance requirements. All CCGs were required to carry out self-assessments of their compliance against the IG requirements, as indeed are all health and social care service providers, commissioners and suppliers. A minimum of level 2 compliance must be reached by the 31 March each year. All CCG staff had been asked to complete their mandatory annual information governance training via the new online data security and awareness module. To date 50% of staff had completed the training and there was a requirement to reach 95% by 31 March 2018.

The GDPR action plan was appended to the report. Each CCG Department would be completing Information Asset Registers (IAR) in order that the CCG might understand all the information it held, where it was stored, and who had access to it.

A new Data Protection Impact Assessment (DPIA) (previously known as Privacy Impact Assessment (PIA)) template had been implemented within the CCGs for any projects, new IT Systems, processing of personal, sensitive or commercially sensitive information. DPIAs become a legal requirement under the GDPR and are signed off by the Data Protection Officer and either the CCG Senior Information Risk Owner (SIRO) or CCG Caldicott Guardian. TIAA had carried out an Information Governance Toolkit Audit on 26 January 2018 and the CCG was awaiting recommendations to ensure it had the appropriate level of assurance for submission of the CCG IG Toolkit on 31 March 2018. The Committee was assured that good progress and that the CCGs benchmarked well against others. The main concern going forward was achievement of 95% of staff having completed information governance training by 31 March 2018. It was suggested that the Chief Officer Team seek to improve the uptake of training by ensuring that departmental managers were informed of those staff whose training remained outstanding. Having noted the report, the Committee requested that, prior to receipt of a further update in April 2018, that it receive a virtual update on training progress prior to the 31 March 2018 deadline.

(Paul Cook left the meeting)

18/006 EXTERNAL AUDIT BRIEFING

The Committee was in receipt of the most recent external auditor’s Audit Committee briefing and it was noted that the General Data Protection Regulation was a key topic. Points highlighted during discussion included; Having questioned the Audit Fee across both CCGs, it was explained that the overall fee was 5% less than the previous year.

Whilst, in order to avoid duplication, the external auditors made themselves aware of the work carried out by internal audit, they did not place reliance on that work as it was not felt to be the most effective way of gaining assurance. The Committee noted the external audit briefing.

18/007 EXTERNAL AUDIT PLAN

The Committee was in receipt of the External Audit Plan for year ending 31 March

2018. Key points highlighted included; Audit Risks - delegated commissioning had been added as a new risk. As it involved a material transaction flow subject to third party confirmations the risk of incorrect accounting for transactions could lead to a material misstatement in the CCGs financial statements. Materiality - For planning purposes, materiality for 2017/18 had been set at £3.4m, which represented 1% of the CCG’s prior year gross expenditure on provision of services as adjusted for delegated commissioning arrangements effective from 1 April 2017. The rationale was that user and stakeholder focus was on the management and control of expenditure and continued service delivery, not on returns on funds invested or the generation of profit. Having questioned materiality associated to the delegation of primary care commissioning it was explained that from an Audit viewpoint it was the gross expenditure in the accounts including the primary care commissioning that was the measure for materiality. Value for Money – financial resilience remained a challenge. The Chief Finance Officer reported that information recently received from NHS England in respect of Capita indicated that from 16 identified areas of concern, 14 had now been cleared. A further interim and year-end report was expected. Having been informed by the external auditors that they were carrying out a lot of internal work in relation to both Capita and Carillon, it was questioned whether the CCG was taking any similar action. The Head of Accounting and Control reassured the Committee that payments prepared and produced by Capita were reviewed by Senior Finance/Chief Operating Office staff. A new process for collating the information required for the Annual Report information had been introduced and the CCG’s finance team was now able to utilise the external auditor’s portal. The Committee noted the external audit plan.

18/008 DRAFT ANNUAL INTERNAL AUDIT PLAN

The Committee was in receipt of the draft Annual Internal Audit Plan for 2018/19

that had been previously discussed with the CCGs Chief Finance Officer. Key points highlighted included; • Key risks were identified on page 4 of the plan and were associated to cost

improvement, ICT, quality and collaborative working. GDPR and cyber security were a key focus.

• Planned internal audits were detailed on pages 5-7 and totalled 120 days that equated to an approximate cost of £19k for each CCG.

The Committee approved the draft annual internal audit plan as presented, and noted that there remained opportunity to flex and change the plan in line with the CCGs future requirements.

18/009 INTERNAL AUDIT PROGRESS REPORT INC RECOMMENDATION TRACKER

The Head of Internal Audit presented the internal audit progress report with highlighted points being; Internal Audit was on plan to deliver all audits within the year. One audit in relation to the Better Care fund was overdue but due to be progressed on 7 February 2018 and the two remaining IT audits were on track. The following two audits had been completed since the last Committee meeting and full reports were included at agenda item 9:

• Delegated Commissioning • QIPP

Recommendation Tracker The tracker contained 10 recommendations of which six were overdue. The CCGs Chief Officer Team had provided a response for each recommendation. The Head of Internal Audit confirmed that, following the previous HR Audit where ‘limited’ assurance had been given, a follow-up audit was planned for March 2018, the results of which would be incorporated into the internal audit opinion. The Committee noted the content of the report.

18/010 INTERNAL AUDIT REPORTS

The Committee received the following reports from internal audit:

a) Review of Delegated Commissioning The assurance assessment for review of delegated commissioning had resulted in an overall ‘substantial’ assurance level being achieved. b) Review of QIPP The assurance assessment for review of QIPP had resulted in an overall ‘reasonable’ assurance level being achieved. A number of quality impact and equality assessments had not been available and a management response was awaited. A new Head of Project Management Office was due to commence employment from the end of February 2018. The Committee noted the reports.

18/011 LOCAL COUNTER FRAUD PROGRESS REPORT

The Committee was in receipt of the Local Counter Fraud Progress Report;

Key points of note were: Strategic Governance – the self-review was due for completion in March 2018. The Local Counter Fraud Specialist (LCFS) would be completing the review and sending it to the Chief Finance Officer/Head of Accounting and Control for submission by 1 April 2018. • The LCFS had attended both CCGs Practice Manager forums. • A Fraud, Bribery and Corruption training module had been developed and the

LCFS continued to be available to attend staff meetings. • The LCFS had attended the Finance Team meeting on 16 January 2018 and

delivered Fraud and Bribery Act Awareness training to 24 members of the Team.

• Cyber awareness training had been issued to staff for completion by 14 February 2018. The LCFS agreed to provide information on the response

rate to the Chief Finance Officer outside of the meeting. • One crime bulletin and one fraud alert had been issued since the last meeting,

both of which were attached to the report. • Two pieces of proactive work in relation to Personal Health Budgets and a

Payment Card Review had been carried out. It was noted that the processing of personal health budgets was labour intensive and any increase in uptake was likely to necessitate a review of resources. The Committee requested that it receive an update to its June 2018 meeting. There had been no issues in respect of the Payment Card review.

• The LCFS continued to review policies in line with current legislation and from a best practice and counter fraud perspective. Policies recently reviewed included the Health and Safety Policy, Dignity at Work Policy and Individual Funding Requests Policy (and Operating Procedures).

• Hold to Account – there were currently no issues to report. • The LCFS was on target to complete the work plan. The Audit Committee noted the report and requested that the next cyber security report to the Committee planned for June 2018 take account of the National Audit Office (NAO) good practice guidance as mentioned within the report.

18/012 MONTH NINE 2017/18 ACCOUNTS UPDATE

The Chief Finance Officer introduced the report, which rather than include a full

set of accounts, consisted of a shorter presentation highlighting changes to format or emerging issues. As per previous years, NHS England provided a pro-forma which reflected the format of the NHS England consolidated accounts. The pro-forma could be reformatted to meet the CCGs’ reporting requirements. The 2017/18 pro-forma for month nine had minimal changes when compared to the 2016/17 pro-forma and key amendments were detailed within paragraph 2.2 of the report. NHS England continued to refine the Annual Report requirements, although changes to the financial elements of the report appear to be minimal for 2017/18. A first draft of the non-financial elements of the Annual Report would be presented to members for comment at the next Committee meeting. There was a requirement at month nine to report the CCGs’ forecast in-year performance, rather than cumulative performance, in the Financial Performance Targets note. There seems to be some level of uncertainty whether the requirement also applied to the year-end reporting and the issue had been queried direct with the NHS England year-end reporting team. A response was awaited. The initial stage of the month nine agreement of balances process had concluded with submission of the income and expenditure balances 6 February 2018. The Committee noted the report and welcomed the revised presentation format.

18/013 DRAFT 2017/18 YEAR END TIMETABLE

The Committee was in receipt of a report, which set out the timescales involved in

the production of the 2017/18 Annual Report and Accounts. The timetable indicated continued focus on the Annual Report (excluding the accounts) and the Governance Statement, with NHS England requiring early submission of both draft documents (by 20 April 2018) to enable a full review and interim certification. That was followed by final certification by NHS England on the day after the final audited submission (30 May 2018). As in previous years, the overall timescales were very tight for both production of the draft reports and delivery of the audit. To ensure delivery, more detailed task driven timetables would be produced allocating tasks to key individuals, with the

emphasis on bringing forward tasks and early preparation of audit working papers where possible. Careful planning of the audit would also be important and the CCGs would work closely with audit colleagues to ensure that all key staff were available to support the audit process. The Committee was informed of the intention to produce the Annual Report in-house rather than use the services of a publisher, which it was hoped, should reduce delay. The Committee noted the report.

18/014 WAIVERS OF COMPETITIVE TENDERING

No waivers of competitive tendering were received. 18/015 GOVERNING BODY ASSURANCE FRAMEWORK AND RISK REGISTERS

The Committee was in receipt of the latest Governing Body Assurance Framework

(GBAF) and risk registers. Key issues were detailed within Section 2 of the report. The score of 10 attributed to the General Data Protection Regulation (GDPR) risk was questioned in light of today’s presentation and it was highlighted that updates were required to Risk 34 in relation to the blood transfusion service at West Suffolk Hospital. The Chief Finance Officer agreed to seek review by the Chief Officer Team. Having noted that the role of the Audit Committee was purely to assure itself that a robust GBAF process was in existence, it was questioned whether the Committee felt content that the GBAF was being challenged appropriately across the Committees it was presented to on a regular basis. The Committee was reassured that the Chief Officer Team regularly reviewed each risk. It was felt that clarity within the agenda as to the purpose of its presentation would be beneficial. The Chief Finance Officer agreed to take comments of the Committee forward with the Chief Officer Team. The Committee noted the content of the GBAF presented.

18/016 ANNUAL PLAN OF WORK

The Committee reviewed the annual plan of work and noted that updates, as

agreed at today’s meeting, in relation to the General Data Protection Regulation, Personal Health Budgets and Cyber Security would be included.

18/017 ANY OTHER BUSINESS AND REFLECTION

The Committee felt that the meeting had been conducted efficiently with all

members having been provided with opportunity to participate. 18/018 DATE OF NEXT MEETING

The next meeting of the CCG’s Audit Committee was to be held on 3 April 2018 at 2.00pm in the Dorothy Room at Endeavour House, 8 Russell Road, Ipswich, Suffolk, IP1 2BX.

_____________________________ ______________________ Chairman (Geoff Dobson) Date

Minutes of a meeting of the West Suffolk Clinical Commissioning Group Remuneration and Human Resources Committee Meeting held on

Tuesday, 19 September 2017

PRESENT: Geoff Dobson Lay Member for Governance (Chair) IN ATTENDANCE: Amanda Lyes Chief Corporate Services Officer Jo Mael Corporate and Governance Officer

(Inquorate Meeting) 17/043 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were

received from Jo Finn Lay Member for Patient and Public Engagement Receipt of these apologies resulted in the meeting being inquorate.

17/044 DECLARATIONS OF INTEREST

No declarations of interest were received.. 17/045 MINUTES OF THE PREVIOUS MEETING

As the meeting was inquorate the minutes of the West Suffolk CCG

Remuneration and Human Resources Committee meeting held on 20 June 2017 could not be approved and were deferred until the next meeting.

17/046 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising and the action log was reviewed and updated

with comment as follows; 17/020 – the Committee agreed to close the action and return to the issue should there become a need to facilitate training in respect of difficult conversations with members of the public. Having recognised that some teams were more subject to stressful working, the need to consider options for dedicated support was emphasized. The Chief Corporate Services Officer agreed to take the matter forward and report back at a later date.

17/047 WORKFORCE REPORT – QUARTER 2

The Committee was in receipt of a report from the Chief Corporate Services

Part One

Officer which provided information on a wide range of key HR performance indicators and sought to benchmark where possible against national and local performance data. Points highlighted during discussion included;

• The CCGs headcount was increasing and turnover had reduced. • The CCGs had a strong grip on establishment and independent

contractors and agency staff were kept to a minimum. • The cumulative sickness/absence figure was 2.99%. • Running costs were currently below the £22.07 per head allowance. • A new Lay Member for Governance had been appointed for West

Suffolk CCG. • New starters also included an Estates Project Manager working across

both CCGs.

Concern was raised at the number of days associated to some periods of sickness and the Committee was reassured that back to work interviews were common practice. The Committee was informed that flu vaccinations were being made available to staff, together with the issue of ‘staying well this winter’ packs. Staff were referred to occupational health when appropriate. The Chief Corporate Services Officer was asked to explore the facilitation of good sickness absence management training, and to investigate the definition and causes of sickness as set out within the report. The Committee was advised that following the departure of the previous Information Governance Manager a new approach was being taken. NEL the CCGs IT Service Provider had been contacted in an attempt to seek additional support. Work had commenced to review where the CCGs were in respect of information governance and what might be required in order to be compliant with new regulations by May 2018. The Committee requested that it receive a report on progress to its December 2017 meeting.

The Committee noted the content of the report.

17/048 ACCOUNTABLE OFFICER – OBJECTIVES

As requested at a previous meeting, the Committee was presented with the

Accountable Officer’s objectives for 2017/18, those being;

• To maximise individual and team potential and performance • To build Accountable Care System with partners • To meet or beat constitutional standards and improve quality outcomes • To deliver financial control total and support delivery of system finances • To deliver above national average performance for the East of England

Ambulance Service Trust The Committee noted the objectives.

17/049 ENDEAVOUR AND LANDMARK HOUSE MOVE

The Committee was in receipt of a report from the Chief Corporate Services

Officer which outlined actions that had been taken to facilitate staff moves to Endeavour House and Landmark House. The report detailed the background to the moves, key work that had been undertaken together with the associated costs. Highlighted points included; • Move to Endeavour House would commence from 23 October 2017 with

the move of the Corporate Services and Transformation teams.

• The cumulative cost saving from the moves over a four year period would be £717k.

• A retention and recruitment premium had been agreed to minimise the financial impact of the move for staff. The CCG would fund a one year retention payment of £345 payable in monthly instalments to those staff up to pay point 26.

• The CCG was to join the County Council’s Green Travel Plan and staff would be able to access subsequent bus and train travel discounts. Park and Ride was to be free for staff until the end of January 2018 when Suffolk County Council was due to review the continuation of the discount.

• In the event that staff were not able to park at the Endeavour House car park and required to pay in excess of £3.00 per day at other car parks, they would be reimbursed via submission of a travel claim.

• All staff would be issued with new IT equipment and inductions held at Endeavour House had gone well.

• Regular communications and lunch and learns were being held in the run up to the move.

• Meeting rooms were currently being sourced both within Endeavour and Landmark Houses and at other nearby locations.

• Governance arrangements were detailed within paragraph 3.12 of the report.

The Committee noted the report and requested that it receive a further update in April 2018.

17/050 APPRENTICESHIP LEVY

The Chief Corporate Services Officer presented a report which informed of

changes to Apprenticeship Funding that came into effect on the 1 April 2017. The Government was committed to achieving three million apprenticeship starts in England by 2020 and had mandated that all employers with a pay bill of more than £3m would pay a levy to the government. Employers who paid the levy had a digital account which enabled them to invest in apprenticeship programmes for existing staff or recruit young apprentices.

The CCG was paying the levy with an estimated annual budget of £33,000 being available to spend on apprenticeships for CCG staff. The budget was being managed by the HR department to develop existing staff and pay for the training element of young apprentices joining the CCG. Employers not paying the levy, which included the majority of Primary Care, were able to access government funding to invest in apprenticeship training programmes. Employers may be required to make a financial contribution of 10% of the total cost of the training depending upon the age and background of the apprentice. There were a range of financial incentives from the government to support employers to engage with apprenticeships which included; • Paying employers and training providers £1,000 for every apprentice aged

16-19 or 19-24 with a local authority education or care plan. • Funding English and Maths for all individuals who had not achieved GCSE

A* - C. • Additional funding for any individual who required additional support.

Opportunities included; The development of degree apprenticeships particularly in clinical roles, including nursing, was creating opportunities that would benefit Primary Care, Community Care and Social Care as they would be able to recruit and train their own workforce.

• It was possible to offer apprenticeships to existing HCA’s to become

Nursing Associates or Registered Nurses. • It was possible to recruit apprentices onto Nursing Apprenticeships to

train as Primary Care Nurses. There are a growing number of new apprenticeship standards available for all job roles from a level 2 through to post graduate and masters level being developed. Those apprenticeship standards could benefit clinical and non-clinical roles and create possibilities for individuals to change career paths either by joining the NHS from other sectors or by retraining within the NHS. The Community Education Provider Network (CEPN) was developing a detailed workforce and training plan which would identify opportunities to up-skill existing staff and identify opportunities to create new apprenticeship posts. The Primary Care Workforce Plan highlighted the collaborative work that was being undertaken across health and social care to develop new recruitment opportunities through apprenticeships by offering career progression to existing staff and innovative work programmes to attract new talent. The CEPN was ensuring Primary Care had a voice at the Health Education England forums which were developing new routes into nursing and other clinical roles. The Committee noted the content of the report.

17/051 JOINT STAFF PARTNERSHIP COMMITTEE

The Committee was in receipt of a report from the Chief Corporate Services

Officer that summarised the main issues discussed and outcomes to emerge, from the most recent Joint Staff Partnership Committee meeting. The Committee was informed that George Shepherd from MiP had agreed to be available at the CCG on 27 September 2017 should any staff wish to meet with him and discuss any issues, or find out what support the Union could offer. The Committee noted the content of the report.

17/052 HEALTH AND SAFETY

The Committee was in receipt of a report which set out work currently being

undertaken in relation to Health & Safety. The last meeting of the Health and Safety and Risk Committee had been held on 7 August 2017. Issues reviewed included the following;

• Health & Safety training was now on-line. The requirements for fire

safety training were discussed, in particular whether CCG staff should have face to face training; the Safetyboss representative agreed to provide more details to the next meeting.

• The Risk Manager gave an update on the Risk Forum which was

improving the relationship between Risk Registers and the Governing Body Assurance Framework (GBAF). All directorates now used the same risk register template. Registers were regularly reviewed and ‘top risks’ identified for presentation at committee meetings.

• A recent internal audit on the GBAF and Risk Registers had

resulted in ‘Substantial Assurance’ being gained. • There had been one health and safety incident in the quarter. A

member of staff had tripped over in the farm car park.

19 December 2017 _____________________________ ______________________ Chairman (Geoff Dobson) Date

The Committee noted the report. 17/053 POLICIES FOR APPROVAL

The Committee was in receipt of the Reimbursement of expenses and

recognition for non-staff involvement policy. It was suggested that ways of ensuring that the same individuals were not being used should be explored which might incorporate the establishment and monitoring of a log. The Chief Corporate Services Officer agreed to discuss the matter with the Chief Operating Officer outside of the meeting. As the meeting was inquorate the policy could not be approved and would be circulated to members via email for decision.

17/054 APPOINTMENT OF CHIEF FINANCE OFFICER

The Committee was in receipt of a report notifying of the appointment of Jane

Payling as the CCGs new Chief Finance Officer. Jane was due to commence in the role from 25 September 2017 and would be working four days a week, two in Ipswich and East Suffolk CCG and two in West Suffolk CCG. Having noted that the current Deputy Chief Finance Officer was due to leave the CCGs employment shortly after the new Chief Finance Officer commenced, the Committee raised concern and highlighted the need to monitor the situation closely. The Remuneration and HR Committee endorsed appointment of the new Chief Finance Officer to both Ipswich and East Suffolk CCG and West Suffolk CCG’s Chief Officer Team, and asked that the Chief Officer be advised of the Committee’s concern in respect of the departure of the Deputy Chief Finance Officer. The Committee requested it receive a report to its next meeting on arrangements for addressing/filling the vacancy.

17/055 ANNUAL PLAN OF WORK

The Committee noted its current annual plan of work and that it would be

updated following today’s meeting. 17/056 ANY OTHER BUSINESS

No items of other business were received. 17/057

DATE AND TIME OF NEXT MEETING

Due to its proximity to today’s meeting, the Committee agreed that the next meeting scheduled to take place on Tuesday, 10 October 2017 be cancelled. The next meeting would therefore be that scheduled to take place on 19 December 2017 at 11.00 in the Minsmere Room at Endeavour House, Russell Road, Ipswich.

Unconfirmed Minutes of a meeting of the West Suffolk Clinical Commissioning Group Remuneration and Human Resources Committee Meeting held on

Tuesday, 13 February 2018

PRESENT: Geoff Dobson Lay Member for Governance (Chair) Jo Finn Lay Member for Patient and Public Involvement IN ATTENDANCE: Amanda Lyes Chief Corporate Services Officer Jo Mael Corporate and Governance Officer 18/001 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and no apologies for absence

were received. 18/002 DECLARATIONS OF INTEREST

No declarations of interest were received. 18/003 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Remuneration and Human Resources

Committee meeting held on 19 December 2017 were reviewed and confirmed as a correct record.

18/004 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising and the action log was reviewed and updated

with comment as follows; 17/049 – Endeavour House and Landmark House moves – whilst noting that an update report would be presented to the April 2018 meeting, the Chief Corporate Services Officer reported that both moves had gone well, with the main issue being the availability of car parking when returning from meetings. 17/065 – Gender Pay Gap – the Committee was advised that it was hoped that further information would be available following today’s East of England Directors of HR Network. Although the Pay Progression Framework had been due for presentation to today’s meeting for approval, there was a need for it to be agreed by the Joint Staff Partnership Committee and, as such, it would be scheduled for April 2018.

18/005 ANNUAL REVIEW OF TERMS OF REFERENCE

The Committee was in receipt of its current terms of reference for annual

Part One

review. Comments included; It was queried whether the Committee carried out all of its remit as set out within Section 2 of the terms of reference and, in particular, with regard to review, as required, of the Accountable Officer’s performance. Whilst it was recognised that the Committee’s role was not to performance manage, it was noted that the Accountable Officer’s objectives had previously been presented to the Committee in September 2017. Having questioned whether the terms of reference might require revision in order to reflect the changing environment it was felt that, until such time as decisions were made by Governing Bodies, they remained fit for purpose. The Committee therefore approved its terms of reference as attached to the report.

18/006 APPOINTMENT OF CHIEF NURSING OFFICER

The Committee was in receipt of a report notifying of the appointment of a new

Chief Nursing Officer. Interviews had been held on 11 January 2018 and three candidates had been shortlisted for the post. Following the withdrawal of two, one was interviewed by a panel, which comprised of both CCG Chairs, the Chief Officer, Chief Corporate Services Officer and a representative from NHS England. The panel subsequently agreed to the appointment of Lisa Nobes who accepted the position at a salary of £107,000 per annum, and was due to commence employment on 2 April 2018. In respect of salary, the Committee was reminded that a benchmarking survey carried out approximately two years previously had commented that the Chief Nursing Officer’s salary had been on the low side and should be kept under review. The salary was not subject to increments. The Committee noted and endorsed the appointment to both Ipswich and East Suffolk CCG and West Suffolk CCG’s Chief Officer Team. The Committee was informed that an additional Deputy Chief Nursing Officer was currently being sought with interviews scheduled in two weeks’ time. The Deputy Chief Contracts Officer, System Resilience and Operations who had been responsible for Continuing Healthcare had left to join Cambridge and Peterborough CCG and, at present, there were no plans to find a replacement. The Chief Corporate Services Officer agreed to provide an update on nursing directorate posts to the April 2018 meeting, which would incorporate progress against the action plan, the recruitment of an additional Deputy Chief Nursing Officer, and the review of arrangements for Continuing Healthcare. Having become aware that the school nursing contract commissioned by the local authority would shortly be up for renewal, it was queried whether there was any CCG involvement. The Chief Corporate Services Officer agreed to investigate and report back.

18/007 GP ELECTION PROCESS

The Committee was in receipt of a prospectus in respect of electing new GP

members to the CCG’s Governing Body. The prospectus clearly outlined expectations and included a timetable for the election process together with terms and conditions relevant to the role. It was noted that West Suffolk CCG’s Constitution had been revised in order to

permit representation from practice managers, allied health professionals and practice nurses on its Governing Body. Having noted the report it was suggested that thought be given to facilitating similar documents for recruitment to the Community Engagement Group (CEG) and Lay Members, together with seeking feedback from ex members of the Governing Body. The Chief Corporate Services Officer agreed to explore the feasibility of production of similar documents for CEG and Lay Member recruitment together with how feedback from ex members of the Governing Body might be incorporated.

18/008 WORKFORCE REPORT QUARTER 3

The Committee was in receipt of a report from the Chief Corporate Services

Officer, which provided information on a wide range of key HR performance indicators and sought to benchmark where possible against national and local performance data. Points highlighted during discussion included; • The personal development plan (PDP) process for 2018/19 had been

revised to incorporate talent management and patient experience within the documentation.

• Following the recent Audit Committee further communications had been issued in relation to completion of Information Governance training and all Chief Officers had been advised of those staff yet to complete the training.

• There was nothing remarkable to report in relation to sickness/absence. • Having noted the recent increase in head count, the need to monitor any

impact on management costs going forward was highlighted, together with ensuring that workload necessitated the additional recruitment. The Committee was reassured that the Chief Officer and Chief Corporate Services Officer continued to apply rigour to recruitment requests. The Chief Corporate Services Officer agreed to include a list of vacancies within future reports together with management cost information across all CCGs.

• Having queried whether there was anything to update in relation to apprenticeships, the Chief Corporate Services Officer agreed to explore the appropriateness of a further update in April 2018 in light of application of the apprenticeship levy. The update would include the Community Education Provider Network (CEPN).

• Having noted the Information Governance Independent Contractor’s current contract was due to end prior to implementation of the GDPR it was explained that the role was subject to IR35 regulations and therefore could only be contracted for six months at a time. There was an expectation that the role would continue past 14 May 2018.

The Committee noted the content of the report.

18/009 ACCOUNTABLE CARE SYSTEM UPDATE

The Committee was in receipt of the CCGs Expression of Interest submission

for the Accountable Care System (ACS) Wave 2. An announcement as to whether the submission had been successful was expected in April 2018. The CCGs Executives had attended a meeting last week to test their readiness for Wave 2, the outcome of which had been positive. Another meeting was scheduled with NHS England in two weeks’ time to explore the CCGs strategic commissioning aims and a ‘plan on a page’ had been produced, incorporating a timeline and identified key milestones. A Strategic Commissioning Workshop was planned to explore the way forward. It was anticipated that, should the submission be successful, a joint

Accountable Officer would be sought in November 2018 although clarification of the appointment process was awaited. A report would be presented to the Governing Bodies in March 2018 outlining the current position and identifying the key decisions required in order to implement the ACS. The Committee noted the update.

18/010 POLICIES FOR APPROVAL

No policies were received for approval. 18/011 HEALTH AND SAFETY

The Committee was in receipt of a report, which set out work currently being

undertaken in relation to Health & Safety. The last meeting of the Committee was held on 5 February 2018 with issues reviewed including;

• Health & Safety training continued on-line.

• Following staff moving to Endeavour House and Landmark House,

representatives from all three buildings provided updates or attended the Committee meetings to raise any health and safety concerns.

• Following the Grenfell fire tragedy, an interim report had been published

which recommended changes to the fire regulations. It was envisaged that no buildings occupied by CCG staff had any structural fire concerns.

• One health and safety incident reported since the November 2017 meeting,

had not necessitated further action. • CCG staff representatives had attended all ‘Building User Group (BUG)’

meetings. Any health and safety concerns from the Health, Safety and Risk Committee would be relayed to the relevant ‘BUG’ meeting.

• The Safetyboss representative updated the Health and Safety and Risk

Committee on provisional changes to the fire regulations, the latest Health and Safety Executive absence statistics and infection control / hygiene. Handouts were provided to staff. The Safetyboss representative was to write a fire plan for Endeavour House to reflect forthcoming changes to evacuation procedures from mid-February 2018.

• Five members of staff in Endeavour House had undertaken Evacuation

Chair training to assist with the evacuation of disabled staff members during an emergency.

The Committee noted the report.

18/012 JOINT STAFF PARTNERSHIP COMMITTEE

The Committee was in receipt of a report from the Chief Corporate Services

Officer which summarised the main issues discussed and outcomes to emerge, from the most recent Joint Staff Partnership Committee meeting, those being; Gender Pay Gap Analysis - the Joint Staff Partnership Committee was presented with the Gender Pay Gap Analysis report. Sickness Absence - the sickness absence report was shared and discussed. It had also been shared with the Staff Health and Wellbeing Committee where initiatives would be implemented to promote and encourage staff health and

wellbeing. Sustainability and Transformation Plan (STP) Overview - Susannah Howard had attended the meeting to update the group on the STP and to give an overview of the work currently underway. Trade Union representatives had welcomed the update and it was anticipated that a mini partnership forum would be established to specifically review STP development. In response to questioning, the Remuneration and HR Committee was informed that the STP had appointed a Head of Communications and branding and website development was currently a key focus. Policies - two policies were circulated to the Joint Staff Partnership Committee for comment, those being; - Dignity at work - Pay progression

The Committee noted the content of the report.

18/013 ANNUAL PLAN OF WORK

The Committee noted its current annual plan of work and that it would be

further revised in line with actions agreed at today’s meeting. 18/014 ANY OTHER BUSINESS

Staff Workload

Ipswich and East Suffolk CCG’s Lay Member for Patient and Public Involvement raised concern that since the Christmas and New Year period it seemed that some staff were working under increasing pressure with there being no peaks and troughs to workload. The concern had been raised with the Chief Officer after the January 2018 Governing Body meeting, who had advised that he would discuss the issue further with the Chief Officer Team. The Chief Corporate Services Officer reported that the matter had been discussed at the Chief Officer Team meeting held on 12 February 2018 and Chief Officers, although surprised, as they had not witnessed it themselves, had agreed to take the matter forward via team meetings. The Committee noted the CCGs intention to carry out a staff survey in the near future, which it was hoped, might highlight any issues and that, as detailed within the workforce report, there had recently been recruitment to additional posts. Staff Away Day – 14 June 2018 A staff away day had been scheduled to take place on 14 June 2018. The Integrated Care System (ICS) would be a key focus and Nick Hulme had accepted an invitation to deliver the keynote speech. Concern was raised as to whether development of the STP/ICS might dilute the individuality of CCGs and have an adverse impact on locality benefit. It was explained that the emerging alliances were currently working through functions, which should include review of the retention of locality benefit. The CCGs continued to remain statutory organisations.

18/015

DATE AND TIME OF NEXT MEETING

The next meeting was scheduled to take place on 10 April 2018 at 10.30am at West Suffolk House, Floor 2, Room 5, Western Way, Bury St Edmunds, Suffolk.

Unconfirmed Minutes of WSCCG Clinical Scrutiny Committee held on Wednesday 28 February 2018 from 1045–1200hrs

Ground Floor Room 14, West Suffolk House, Western Way, Bury St Edmunds, IP33 3SP

PRESENT: Dr Christopher Browning GP Governing Body Member and CCG Chair (Chair) Dr Zohra Armitage GP Governing Body Member Steve Chicken Lay Member (via telephone) Geoff Dobson Lay Member for Governance Jo Finn Lay Member – Public and Patient Engagement (via telephone) Dr Andrew Hassan GP Governing Body Member (via telephone) Chris Hooper Deputy Chief Nursing Officer (via telephone) Jane Payling Chief Finance Officer Dr Bahram Talebpour GP Governing Body Member Kate Vaughton Chief Operating Officer (via telephone) Jane Webster Acting Chief Contracts Officer (via telephone) Dr Firas Watfeh GP Governing Body Member IN ATTENDANCE: Helen Farrow EA to Chief Officer (via telephone) Tony Buckle Risk Manager (via telephone) Jane Rooney Head of Planned Care Transformation (via telephone) 18/001 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted

from; Ed Garratt Chief Officer Amanda Lyes Chief Corporate Services Officer Dr Simon Arthur GP Governing Body Member Richard Watson Chief Transformation Officer

18/002 DECLARATIONS OF INTEREST

No declarations of interest were received.

18/003 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 20 December 2017 were reviewed and approved as a correct record.

18/004 MATTERS ARISING & REVIEW OF ACTION LOG

There were no matters arising and the action log was reviewed and updated.

It was noted that future reference to 5Q’s (action 17/052) should be removed as this was now known as Discharge to Assessment (D2A).

18/005 ANNUAL REVIEW OF TERMS OF REFERENCE

The Committee reviewed and approved the Terms of Reference, which reflected the

current activity of the Committee.

18/006 INTEGRATED PERFORMANCE REPORT

The Committee was in receipt of the Integrated Performance Report, with key points highlighted during discussion being; Clinical Quality and Patient Safety • Infection Control – there were 4 cases of CDiff reported in December, against a

trajectory of 1 (14 cases YTD against a trajectory of 11); there were no cases of MRSA reported.

• Falls – WSHFT reported 69 incidents for the month of December. Community Hospitals reported 9 falls (7.35 per 1000 bed days)

• Pressure Ulcers – a backlog is building across providers around assessment of those pressure ulcers which were avoidable; this is due to capacity of staff to undertake reviews

• Transforming Care – performing well against trajectory with 4 patients in care against a trajectory of 6

• Care Homes – Broadacres in East Suffolk remained ‘inadequate’ in December under the CQC rating, however with the change of ownership in January 2018 the rating returned to ‘zero’ until the care home is re-inspected

• Cancer breaches – there were 8.5 62 day and 3.5 104 day cancer breaches during December. The CCG was assured that there was a structured process in place for assessment of harm due to breaches

In noting clinical quality performance, the Chief Finance Officer queried whether national targets would be met. In response, the Acting Chief Nursing Officer advised he was not aware there were national targets but, ideally, all figures would be zero. The Acting Chief Nursing Officer clarified that trajectories were based on analysis by NHSE/PHE, and based on previous years’ performance. Finance • At Month 10 the CCG was on target to achieve break-even at year end • The CCG was in a strong position in terms of the underlying surplus • QIPP delivery was £8.38m against a target of £8.65m Transformation • Integrated Care – A&E was 0.7% above plan in February 2018 • Planned Care – Outpatients were 4.1% below plan and elective activity above

plan by 0.6% as at February 2018. Contracts • A&E performance remained below the 95% target (83% in December), although

regionally West Suffolk was one of the better performing areas – a system wide recovery plan was being managed through the A&E Delivery Board.

• The 30 minute ambulance handover protocol commenced on 26 February. • OOH/111 – Due to concerns around TUPE of staff from IC24 the procurement

period had been extended by a further month to allow time for any new provider to ensure they have the right staff in place

• NSFT saw a decline in AAT routine referral within 28 day performance for children, dropping to 60% (from 85%)

In considering the headlines, it was queried whether the ‘red’ rating for NSFT was due solely to the issues around childrens’ AAT service. The Acting Chief Contracts Officer advised this had helped towards the RAG rating but was also due to the special measures the Trust had been placed in Project Management Office (PMO) • 97% of the total planned QIPP savings had been achieved YTD. CHC and

corporate schemes, which had been over-performing, showed signs of reduced variance, indicating that savings were becoming more difficult to identify and achieve

• Simon Aldridge, the new PMO Lead commenced on 26 February Primary Care • One West Suffolk practice had formally closed its list due to capacity issues –

the CCG is actively supporting remedial action • Dementia diagnosis – only 8/24 practices had achieved the target rate of 67%; it

was acknowledged that GP practices still find the dementia diagnosis rate challenging

The Committee noted the content of the report as presented.

18/007 GOVERNING BODY ASSURANCE FRAMEWORK

The Committee was in receipt of the current version of the CCG Governing Body Assurance Framework (GBAF) reviewed by the Chief Officer Team every month and by the Governing Body and Audit Committee at each of their meetings. Amendments/additions were detailed within paragraph 2.2 of the report. The Committee noted the two additional risks (risks 39 & 40) around EEAST. The Committee reviewed and approved the GBAF as presented and during consideration queried whether Risk 02 around finance should be lower than 15, given the time of year. The Chief Finance Officer concurred with this view and agreed to amend for the next iteration. Comment was made that the concerns around blood transfusion service had quietened and a query arose as to the current position. The Acting Chief Nursing Officer advised that the Trust updated the MHRA weekly against a submitted Action Plan but it was difficult for the CCG to ascertain an accurate position, as direct contact with MHRA was difficult; the Acting Chief Nursing Officer agreed to pick up with WSHFT.

18/008 CONTINUING HEALTHCARE UPDATE

The Operations Manager for CHC presented an update paper. Key headlines of

note were: • There were 131 CHC eligible patients at the end of January 2018, an

improvement on 151 in December • There were 54 fast track patients at the end of January, with the average care

package costing £661 • The number of FNC patients was reported as 328 • There were 19 patients awaiting 28 day assessment at the end of January • PUPoC – 60 cases across Suffolk; cases were now being triaged by a Band 7

nurse The Acting Chief Contracts Officer advised that one area currently being looked at was better management of FNC and a team to actively manage these cases in order to provide early indication of PUPoCs going forward.

The Committee noted the report and in considering the content, clarification was requested as to what the 5Q’s were (now Discharge to Assess – D2A). It was clarified that hospital assessment was based on five questions; these questions had reduced to four. Assessment was based on the answers provided to these questions. The Operations Manager for CHC agreed to circulate to the Committee the four questions asked during D2A.

18/009 GOVERNANCE PAPER

The Committee received and noted the paper from the Chief Corporate Services Officer and endorsed the recommendations.

18/010 NORFOLK AND SUFFOLK NHS FOUNDATION TRUST ‘DEEP DIVE’

Due to time constraints, it was agreed to defer this paper to the next Clinical Scrutiny

Committee meeting when justice could be given to scrutinising its content.

18/011 DATE OF NEXT MEETING

Wednesday 25 April 2018, 1000-1200 hrs, Room 14, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

Ipswich & East Suffolk Clinical Commissioning Group West Suffolk Clinical Commissioning Group

Unconfirmed Minutes of the CCG Collaborative Group meeting held on

Thursday, 1 February 2018, 10.00am in the Kersey Room, Endeavour House

PRESENT Martin Smith (MS) CCG Collaborative Group Chair Dr Christopher Browning (CB) Chair, West Suffolk CCG Governing Body Geoff Dobson (GD) Lay Member (Governance) West Suffolk CCG Graham Leaf (GL) Lay Member (Governance) Ipswich & East Suffolk CCG Dr Mark Shenton (MS) Chair, Ipswich and East Suffolk CCG Governing Body Ed Garratt (EG) Chief Officer, Ipswich & East Suffolk and West Suffolk CCGs IN ATTENDANCE Jo Mael (JM) Corporate Governance Officer Minute

Action

18/001 Welcome and apologies The Chairman welcomed all to the group and no apologies for absence were received.

18/002 Declarations of Interest

No declarations of interest were received.

18/003 Minutes of meeting held on 21 December 2017

The minutes of a meeting held on the 21 December 2017 were agreed as a correct record.

18/004 Matters arising and review of action log

There were no matters arising and the action log was reviewed and updated.

18/005 Chief Officer Update

The Collaborative Group was in receipt of a paper from the Chief Officer, which provided an update on the work of the CCGs. Points highlighted included; Finance • Both CCGs were on plan in respect of finance and QIPP. 2018/19

financial plans were being developed. • Contract negotiation was underway. National planning guidance was

awaited. Ipswich and East Suffolk CCG underspend was being used for transformation and to support Ipswich Hospital.

• Robert Hudson had commenced in the role of Interim Deputy Chief Finance Officer.

Alliance Working • The Community Services alliance contract was performing well. • Discussions continued in relation to commissioning plans for mental

health services.

The Group agreed that the commissioning of mental health services become a regular agenda item going forward.

• An Expression of Interest for a national Wave 2 Accountable Care

System had been submitted.

The Chief Officer reported that a meeting was to be held later in the day to review the bid and way forward from a national perspective.

• The alliance culture over winter had been strong. Primary Care • The CCGs Primary Care Committees had agreed to meet ‘in common’. • The 111/Out of Hours procurement had been re-launched following a

lessons learnt exercise. • Orchard House surgery in Newmarket had been given an ‘outstanding’

rating. Performance • There was significant focus on A&E performance at both West Suffolk

and Ipswich Hospitals. • Performance improvement in relation to 18 week referral to treatment

times at West Suffolk Hospital had stalled due to elective cancellation in January 2018.

• The report from the East of England Ambulance Service Trust (EEAST) service review was due to be published in March 2018.

• Diabetes services and been awarded an ‘outstanding’ rating in both CCGs by NHS England.

Organisational Development • Lisa Nobes had been appointed to the role of Chief Nursing Officer and

was due to commence in the role from 2 April 2018. • CCG elections were progressing. • A staff away day had been planned for June 2018. Quality • West Suffolk Hospital had achieved an ‘outstanding’ Care Quality

Commission rating, and Ipswich Hospital a ‘good’ rating. • A risk summit had recently been held in relation to the East of England

Ambulance Service NHS Trust. The summit had been Chaired by NHS England and sought to consider the Trust’s performance over the Christmas and New Year period when the whole urgent care system had been under pressure.

• The Department of Education had recently been positive with regard to the progress being made in relation to Special Educational Needs and Disability (SEND).

The Collaborative Group noted the content of the report and requested that the outcome of the East of England Ambulance Service NHS Trust service review be reported to the next meeting.

18/006 Corporate Key Performance Indicators

The Collaborative Group noted the corporate key performance indicators as presented.

18/007 Accountable Care System Wave 2

As mentioned under agenda item 5 (Chief Officer Update) a meeting was to be held later in the day, after which more information would be available.

18/008 Community Services Contract

The Collaborative Group was in receipt of a paper produced in response to a requirement to review the methodology for calculating the split of the costs of the community contract provided by Suffolk Community services between West Suffolk and Ipswich and East Suffolk CCGs. It was explained that the paper sought to establish a principle for splitting costs on any similar joint contracts going forward where the service costs were not clearly delineated between the CCGs. Section A of the report detailed the calculation in relation to the Suffolk Community Services contract and Section B outlined options for future splits. It was suggested that work to identify and report on where money had been spent by each CCG should be carried out. Having considered the paper carefully the Collaborative Group agreed; 1. That where a verified and agreed basis for allocation costs between the

CCGs existed that would be used, where that was not the case a ‘splitting’ formula would be used based on the most appropriate allocation e.g;

• Where a service was funded from the delegated primary care commissioning budget the recurrent primary care allocation to be used.

• Where the new service was exclusively funded from the Running Cost Allowance (RCA) the split to be based on the RCA.

• All other new services covering both CCGs in line with recurrent program allocation (as that was the largest element of the budget which covered most commissioning spend).

2. Splits would be updated annually in line with the relevant recurrent

allocation information provided by NHS England as soon as available, and before the planning/budgeting round for the relevant year.

3. Budgets would be set according to the above and be in line with

contract. For contracts such as the Community contract that were updated in year the CCG budgets would be adjusted in-year accordingly.

18/009 East of England Ambulance Service Trust – Service Review Report

As previously reported the service review report was not due to be published until March 2018.

18/010 Any Other Business

Non-emergency Patient Transport Dr Browning raised a concern in relation to the non-emergency patient transport contract. Since implementation of the new contract GPs were required to contact two different providers in the event that transport originally requested within 1-4 hours was required within the hour due to clinical need.

Having recognised that the use of two different numbers was unacceptable and that there should be a single point of access, the Chief Officer agreed to pursue resolution of the issue with the contracts department. West Suffolk Hospital NHS Foundation Trust (WSFT) It was reported that WSFT was continuing to issue letters to GPs advising that patients had not attended for appointments, which was contrary to the national contract. The Chief Officer agreed to investigate.

18/011 Date of next meeting

As some members were not available for the next meeting of the CCG Collaborative Group scheduled to take place on 5 April 2018, it was agreed that attempt be made to re-convene the meeting on 19 April 2018 in the Kersey Room (Ed Garratt’s Office) at Endeavour House, 8 Russell Road, Ipswich, Suffolk, IP1 2BX

Unconfirmed Minutes of a meeting of the West Suffolk CCG Primary Care Commissioning Committee held in public on Wednesday, 24 January 2018 in

The Edmund Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk

PRESENT: Jo Finn Lay Member for Patient and Public Involvement, WSCCG (Chair) Steve Chicken Lay Member, WSCCG Geoff Dobson Lay Member: Governance and CCG Vice Chair, WSCCG Ed Garratt Chief Officer, WSCCG Robert Hudson Interim Deputy Chief Finance Officer Kate Vaughton Chief Operating Officer, WSCCG Lucy James NHS England Stuart Quinton Suffolk Primary Care Contracts Manager, NHS England IN ATTENDANCE: David Brown Deputy Chief Operating Officer, Ipswich and East Suffolk CCG Dr Christopher Browning WSCCG, Chair Andy Eley Deputy Chief Operating Officer Jo Mael Corporate Governance Officer, WSCCG Lois Wreathall Head of Primary Care, WSCCG

18/01 WELCOME AND INTRODUCTIONS

The Chair welcomed everyone to the meeting.

178/02 APOLOGIES FOR ABSENCE

Apologies for absence were noted from: Wendy Cooper NHS England Representative Cllr Tony Goldson Suffolk County Council Simon Jones Local Medical Committee Jane Payling Chief Finance Officer, WSCCG Jane Webster Acting Chief Contracts Officer Andy Yacoub Healthwatch

18/03 DECLARATIONS OF INTEREST

Dr Christopher Browning declared an interest as a GP within the CCG area.

Lucy James from NHS England declared an interest in agenda item 11 (Haverhill Practice) as a patient of the practice.

18/04 MINUTES OF THE PREVIOUS MEETING

The minutes of a West Suffolk CCG Primary Care Commissioning Committee meeting

held on 29 November 2017 was approved as a correct record.

18/05 MATTERS ARISING AND REVIEW OF OUTSTANDING ACTIONS

There were no matters arising and the action log was reviewed and updated.

18/06 PRIMARY CARE CONTRACTS AND PERFORMANCE MONITORING

The Committee was in receipt of a report that provided an update in respect of; List Closures No West Suffolk practice had formally applied to close its list although the Haverhill Family Practice had informally closed its list, on the grounds of patient safety, whilst carrying out a recruitment campaign. The situation is due for review in March 2018. Extended Hours access in West Suffolk Funding for 2018/19 was £3.34 per head of population, which was in line with all CCGs nationally that had not been part of the Prime Minister’s Challenge Fund allocation. The funding would be used exclusively to provide Extended Access to GP services in West Suffolk. The CCG’s Executive had agreed to continue to provide a GP+ service in 2017/18 to support primary care with additional capacity and ease the pressure on the wider health system over winter.

The Suffolk GP Federation had moved its Bury St Edmunds base from the Swan Surgery to the West Suffolk Hospital on the 30 October 2017 in order to be co-located with the new GP streaming service. The service operated with one GP for the following days and hours of service: Monday to Friday 6:30pm – 9pm; Saturday & Sunday (and bank Holidays) 9am – 9pm.

The Suffolk Federation had launched a new GP+ service in Haverhill, based at the Clements Surgery, at the beginning of October 2017. The service was running with one GP, one Nurse Practitioner, and two other clinicians. Clinics took place every Saturday from 9 am – 9 pm. Winter funding awarded to the CCG had enabled the provision of additional clinicians in Haverhill from now until March 2018. GP Forward View Investment NHS England had written to CCGs requiring them to invest £3 per head in local practices to support implementation of the 10 High Impact Actions and working together ‘at scale’.

Practices were invited to bid for the funding of £246,973 in 2017/18. To date £199,846.98 had been invoiced from eight practices. Bids had focussed on new staff groups, which included Physicians Assistants, Clinical Pharmacists, Physiotherapists and Advanced Nurse Practitioners. Those would bring additional capacity into Primary Care and develop the Multidisciplinary Team within practices. The Primary Care Commissioning Committee noted the content of the report.

18/07 CARE QUALITY COMMISSION (CQC)

The Committee was in receipt of a report that informed on Care Quality Commission

(CQC) inspections of West Suffolk GP practices. The CQC had now finished conducting inspections within all GP practices in West Suffolk and the reported outcomes were detailed within paragraph 2.1 of the report. The

Committee was advised that since publication of the report Orchard House practice had been rated as ‘outstanding’ along with Market Cross Surgery.

The CQC’s reports to date continued to show that the quality of primary care services in West Suffolk was good or outstanding in 95% of practices. The Inspectors had identified one practice as requiring improvement and the CCG was working with the practice to improve its ratings. The CCG had mapped all 24 CQC reports into a single learning document that had been shared with practices. The CCG had contacted any practice which had scored less than good’ in any particular area and was supporting them to make the necessary improvements. Having questioned how the CCG compared nationally it was explained that the CQC published comparison information on a six monthly basis. The Head of Primary Care agreed to present comparative information to the Committee when next published. The Committee noted the content of the report.

(The Chair agreed that agenda items 9 , 11 and 12 would be taken next)

18/08 NHS WEST SUFFOLK AND IPSWICH AND EAST SUFFOLK CCGS – ASSURANCE REVIEW OF DELEGATED COMMISSIONING

In November 2017, the CCG had been informed that internal audit was to conduct an audit of how both West Suffolk and Ipswich and East Suffolk CCGs were discharging their delegated functions. The objective of the audit was to provide assurance that the Suffolk CCGs had implemented Delegated Commissioning arrangements in accordance with national guidance, taking into account local needs and risks associated with the commissioning of primary care medical services. The audit had taken place at the beginning of December 2017 and had focussed on the following areas:-

• Constitution and Governance Structure; • Policies and procedures; including scheme of delegation; • Managing conflict of interest; • Management of contracts; • Monitoring, reporting and escalation processes. Following the audit both CCGs had been rated as having ‘substantial’ assurance, which was the highest rating possible. Three ‘routine’ recommendations had been made, those being;

1) That the Primary Care Commissioning Committees Terms of Reference should

include meeting frequency. 2) That Primary Care Commissioning Committees dates should be reviewed to ensure

members could attend. 3) That the CCGs should consider developing a Memorandum of Understanding

(MOU) with NHS England for primary care contracts management processes.

Following further discussion with internal audit, the Director of Audit had confirmed that recommendation three could be removed from the final report as evidence of such a MOU had subsequently been provided.

A copy of the draft internal audit report was attached to the report for information. The Committee was pleased to note the report.

18/09 HAVERHILL PRACTICE

The Head of Primary Care reported that, as previously reported, two practices operated

from the Camps Road site in Haverhill. Both practices were currently working with the property owners to secure leases.

Primary care capacity within Haverhill was a key area of concern as, at present, Haverhill Family Practice was seeking to recruit to two full-time GP posts with Clements surgery attempting recruitment to three full-time GP posts. GP+ was continuing to support the practices and additional capacity facilitated by GP+ was being utilised. As reported under agenda item 6 (Primary Care Contracts and Performance Monitoring), Haverhill Family Practice had already informally closed its list. To date, Clements surgery had not indicated any plans to seek list closure of its list. Nearby practices had been informed of the situation and any movement of patients was being monitored closely. Resolution of the lease situation remained a key issue. The Committee noted the update.

18/10 OAKFIELD SURGERY

The Committee was in receipt of a report from the Chief Corporate Services Officer,

which outlined the current position in relation rehousing Oakfield Surgery.

Oakfield Surgery (OS) was GP owned. In 2012, the property owners had highlighted to NHS England and the CCG their intention to sell the property in March 2018. The GPs had submitted plans to move but NHS England had refused those in 2012, as the scheme had not been affordable. The CCG had been awarded £1.1m in 2017 to convert Newmarket Community Hospital into a health and social care hub and Oakfield Surgery had worked with NHS Property Services, as the owners of the Newmarket Community Hospital, to design a number of options for them to create a GP surgery within the walls of that site. The property-owning partners wished to sell their current site and the practice needed to expand capacity to accommodate a growing numbers of patients. A study of how the space at Newmarket Community Hospital was utilised, and could be utilised, had been received by the CCG prior to Christmas 2017. The idea was to create an integrated hub for patients. There was a need to explore the impact on other services, and work with partners as to how it might be facilitated when finalising wider health and social care system plans for the site. The solution for Oakfield was phased to allow initial occupation and then, at phase 2 to would allow for expansion. The property-owning partners had offered to suspend the sale for 24 months in order to allow sufficient time for Oakfield surgery to consider its options within the hospital, and go ahead with whatever building work would need to be undertaken. A steering group, which included tenants and stakeholders, had been established to take the plan forward. The need for services to be based around the health needs of patients was emphasized although the challenge of carrying out estates planning within an emerging strategic model was recognised. The Committee noted the report.

18/11 PRIMARY CARE DELEGATED COMMISSIONING – FINANCE REPORT

The Deputy Chief Finance Officer introduced a report which provided an overview of the

month nine Primary Care Delegated Commissioning Budget. At the end of month nine, the GP Delegated Budget spend was £100k below plan, the Local Enhanced Services (LESs) budget showed an adverse variance of £18k and the GP Forward View Funding received year to date was fully committed. As agreed by the CCG’s Executive, savings on the budget would be used to partially

fund the GP+ service, which was not funded through any additional funding in 2017-18. Key Risks at month nine were over achievement of 2017-18 Quality Outcome Framework (QOF), Care Quality Commission costs and Additional Primary Care Postal/Transport costs that had not been budgeted for. Those were being mitigated by the use of contingency and reserves.

The Committee noted the financial performance at month seven.

18/12 PRIMARY CARE COMMISSIONING COMMITTEE – COMMITTEES ‘IN COMMON’

The Committee was reminded that at its meeting of 29 November 2017 it had discussed a report from the Accountable Officer setting out the direction of travel in respect of collaborative working with neighbouring CCGs.

The Committee had endorsed the overall direction of travel, agreed to alternate individual and ‘committees in common’, and approved the development of appropriate governance arrangements to facilitate that approach. The report sought to establish those governance arrangements. Whilst the 2012 Health and Social Care Act did not permit CCGs to form joint committees, a Legislative Reform Order introduced in October 2014 allowed CCGs to form joint committees for exercising some functions – but not primary care commissioning functions.

Committees ‘in common’ were used by many CCGs to enable collaborative commissioning prior to the introduction of the Legislative Reform Order and to provide an option for CCGs wishing to meet together to exercise their non-commissioning functions (including audit, remuneration, governing body meetings, and primary care commissioning functions). For example, the CCG’s Audit and Remuneration & HR Committees currently met under an ‘in common’ arrangement.

The Committee’s Terms of Reference had been amended to allow for meetings to take place ‘in common’ and were approved at a ‘virtual’ meeting in January 2018, and subsequently ratified by the Governing Body on 24 January 2018. The principles of an ‘in common’ arrangement were set out within Section 2 of the report and it was proposed that the first meeting take place on Tuesday, 27 March 2018.

Whilst public engagement was not required for the purposes of establishing the governance for Committees ‘in common’, due consideration would be given to the locations and venues of ‘in common’ meetings so that patients and members of the public from both CCG areas were not (significantly) adversely impacted upon in terms of travel or accessibility. The Committee was advised that Ipswich and East Suffolk CCG’s Primary Care Committee had approved the ‘in common’ arrangements at its meeting held on 23 January 2018 and had emphasized the need for a period of reflection following the first meeting. Reassurance was provided that there would be no loss of identity for West Suffolk from the new arrangements as there remained opportunity for the Primary Care Commissioning Committees to meet individually to discuss local issues. The Primary Care Commissioning Committee noted and approved the ‘in common’ governance arrangements for immediate implementation, which included approval of the arrangements for the first ‘in common’ meeting on 27 March 2018.

18/13 ANY OTHER BUSINESS

No items of others business were received.

18/14 DATE OF NEXT MEETING

As agreed the next meeting would be a Committee ‘in common’ with Ipswich and East

Suffolk CCG’s Primary Care Commissioning Committee, and would take place from 2.00pm – 4.00pm, on Tuesday 27 March 2018, in the Dining Room, Hadleigh Town Hall, Market Place, Hadleigh, IP7 5DN.

18/15 QUESTIONS FROM THE PUBLIC

No questions were received.

Decision from a virtual meeting of the West Suffolk CCG Commissioning Governance Committee held on 22 November 2017

Commissioning Governance Committee Members: Geoff Dobson, Lay Member for Governance (Chair) Jo Finn, Lay Member for Patient and Public Involvement Ed Garratt, Chief Officer Jane Payling, Chief Finance Officer Jan Thomas, Chief Contracts Officer Declarations of Interest

No declarations of interest were received.

INTEGRATED URGENT CARE SERVICES – CONTRACT AWARD REVIEW PAPER 2

Report No: WSCCG/CGC 17-16

Decision

Integrated Urgent Care Services – Contract Award – Review Paper 2 The Committee approved the proposed route forward as follows; • Release termination letters and announcement to all potential

bidders registered on the In-tend procurement portal.

• Review specification and changes to healthcare systems since the beginning of the procurement in October 2016 to ensure requirement is still fit for purpose.

• Review tender questions, requirements, finance and evaluation and award criteria.

• Undertake a lessons learnt review.

• Re-start the procurement using an Open process due to the nature of the market and the high barriers to entry.

GOVERNING BODY

Agenda Item No. 14

Reference No. WSCCG 18-22

Date. 28 March 2018

Title Community Engagement Group

Lead Chief Officer David Taylor, Chair of Community Engagement Group

Author(s) John Troup, Acting Head of Communications

Purpose To present the unconfirmed minutes from the Community Engagement Group meeting held on 19 February 2018.

Applicable CCG Priorities 1. Develop clinical leadership2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people4. Improve access to mental health services5. Improve health & wellbeing through partnership working6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

The Governing Body is asked to consider and note the key items of discussion from the Community Engagement Group.

West Suffolk CCG Community Engagement Group

Monday 19th February 2018 St Johns Community Centre, Mildenhall

PRESENT: David Taylor (Chair) Jo Finn Dan Pennock –(on behalf of Gill Jones) Healthwatch Suffolk Peter Owen Carol Mansell Chrissy Marshall Michael Simpkin Anne Nichols David Dawson IN ATTENDANCE: John Troup – Interim Head of Communications West Suffolk CCG Katie Sargeant – Engagement Officer West Suffolk CCG David Trayer – Market Cross PPG chair Cllr Terry Clements - Interested party John Ellison – member of the public Item Action

GENERAL BUSINESS

1. Dave Taylor welcomed everyone.

2. MINUTES & ACTIONS ARISING Minutes agreed Action Log – Discussion held on actions. See attached. JF requested that action log includes details on matters arising.

APOLOGIES: Marion Fairman- Smith Graeme Norris Gill Jones Margaret Marks Jane Ballard Jon Rapley

3.

Mildenhall PPG Update The PPG and the Friends of Market Cross Surgery work closely together to offer practical and fundraising support in the surgery. David Trayer informed the meeting of the work of the Market Cross Practice. The Mildenhall PPG is involved in:-

• Coordinating display boards and information sharing to patients. This approach has prevented the waiting and reception areas being overloaded with information. The PPG work with the practice to identify topics and generate displays accordingly. Themes have included, travel vaccines, mental health, Check Your Bag campaign, winter messages.

• Linking with schools and colleges to engage young people in the development of online presence for the practice to facilitate more engagement with young people and more effective means of communication between practice and patients.

• Developing links with travelling community to break down barriers and promote health issues within the community.

• Working with ambulance service to discuss recent difficulties and to look at ways to improve things in the future.

• Working with in house pharmacy to promote ‘Check your bag’ Campaign and to reduce waste.

David Trayer described challenges facing the PPG and how these are being addressed.

• Ageing membership – PPG actively engaging with school and colleges to generate interest in health issues and promoting the good work of the practice.

• Looking at developing an effective virtual membership to facilitate engagement of working age patients who may find commitment to attend the PPG meetings too much.

• Growing populations and increased demands on the practice. David Taylor thanked David Trayer for an informative and enlightening presentation which demonstrated positive joined up working between the PPG and the practice staff. JF asked how effective the involvement of Health Outreach – the Marginalised Vulnerable Adults Service which was reviewed in 2017 – had been in supporting the work of the practice with the travelling community and other vulnerable groups. David Trayer will look into this and feedback.

KS to follow up feedback

4. Integrated Urgent Care Contract – Richard Watson Richard Watson joined the meeting via Skype to present the WSCCG Integrated Urgent Care update. The IUC incorporates 111 and GP out of hours services. See presentation attached. Questions following presentation:- PO asked if patient records would be accessible by any new IUC provider in the future. RW explained that IT solutions are required as there are 4 separate IT systems in use, this is an identified challenge and is a priority to address. In addition, there is an ongoing piece of communications and engagement work across the STP to inform patients of the benefits of consenting to sharing their health record and the confidentiality of the data. Due to connectivity issues the following questions were taken and will be feedback to RW for response:-

• Why is the public consultation delayed until July? Is there any possibility in developing a focus group to look at the issues sooner?

• How is integrated working with the VCSE sector going to be incorporated into the new contract?

• The CEG would like to see reports on the progress of this work.

KS to forward questions on to RW

5. 6. 7.

CHAIR’S REPORT – Dave Taylor DT referred to written report already circulated to members. LAY MEMBERS REPORT – Jo Finn JF referred members to her written report. MEMBERS REPORTS DD Gave feedback following recent hospital visit. Very positive experience and excellent service. DP Informed meeting that Mildenhall Lodge has gone from a requiring improvement CQC rating in 2016 to being awarded outstanding in recent CQC inspection. NSFT holding numerous stakeholder events across the county during February.

8.

Suffolk User Forum are launching the Staying Alive App for anyone experiencing thoughts of self-harm or suicide. This app offers online support and can be accessed via the app store. Crisis support is now moving from the Access and Assessment team to the Home Treatment Team in NSFT. Healthwatch will continue to ensure that calls are able to be monitored for training purposes as this was a request from patients when the service was provided by the Access and Assessment team in order to improve quality of advice, support and guidance. PO Provided link to Guildhall surgery patient survey http://www.guildhallsurgery.co.uk/info.aspx?p=11 Provided information about PALS not following up on a comment raised 3 months ago. PO is following up. Gave feedback following recent experience of poor communication between Addenbrookes, WSFT and local GP C Marshall Informed of cancer Services User Group annual forum date change from May to September 2018. Date still to be finalised CEG will be kept informed C Mansell Nothing to report MS Referred members to written report Asked for clarification of what will happen to the INT lunch and learn sessions now there is no coordinator. Asked for feedback following perfect week exercise in January JF thanked all members for their involvement in Perfect Week. AN AN attends clinical oversight group (COG) for non-priority procedures. NHSEE have challenged protocol surrounding operations that requiring issues concerning weight and smoking to be brought to the attention of patients and plans put in place to address issues before surgery. The COG is clear that being overweight or being a smoker will not prevent someone being eligible for a procedure and feel that it is good practice to address these issues as part of a patients treatment. As a result, no changes have been made to protocol for non-priority procedures. CEG Terms of reference Members requested clarification re 4 (i) as to why organisations such as Healthwatch and Suffolk Congress are referred to as non-voting attendees. Members requested that it is stated in the TORs that the Lay Member is also the vice chair Recruitment to CEG Anne Nichols notified the meeting that she will be resigning from the CEG in April 2018. The chairman thanked Anne for her commitment and dedication to the group since its development. In light of Anne’s resignation there is a need for a member with a clinical background to fill her role in the Clinical Oversight Group. There are other geographical areas that are not represented in the group including Sudbury and Newmarket. It was also discussed that a member to represent the VCSE sector would be

PO to follow up and feedback to CEG CEG to be updated KS to get feedback KS to feedback to AE and report back to next CEG

9. 10

a welcome addition. KS advised that to join the CEG you must first be a member of the Health Forum. Members to approach anyone they feel may be interested. KS will arrange for advert to go out to all health forum members. Questions from the public

KS to circulate advert for CEG members

Member of the public asked how the CCG (and the CEG) are informed of the financial position of WSHT and how the CCG plans to deal with any cost saving measures introduced by WSHT in the coming year. DT explained that regular finance updates are received from CCG. DT asked KS to look into other concerns raised and feedback.

11. AOB JT advised that a joint CEP and CEG meeting would be held on 22nd March in Stowmarket 5pm – 7pm (venue tbc) to discuss the Integrated care System Model and how this will be implemented across the STP. PO advised the group that he is now part of Moto Neurone Disease working group. Next meeting to be held 26 April 2018 West Suffolk House 10-12

FORWARD PLANNER STP update (Accountable care organisations/Connect are part of STP) Care Navigation (SF) Connect update (MB) Mental health conversation CYP Mental wellbeing Jo John

GOVERNING BODY

Agenda Item No. 15

Reference No. WSCCG 18-23

Date. 28 March 2018

Title Community Engagement Group Terms of Reference

Lead Chief Officer Amanda Lyes, Chief Corporate Services Officer

Author(s) Andrew Eley, Deputy Chief Operating Officer

Purpose To ratify amendments to the Community Engagement Group’s Terms of Reference.

Applicable CCG Priorities 1. Develop clinical leadership2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people4. Improve access to mental health services5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by Community Engagement Group:

The Governing Body is recommended to ratify the amendments to the Terms of Reference for the Community Engagement Group, which were approved by the Group at its meeting on 19th February 2018.

1. Background 1.1 The CCG has recently amended its Constitution (available at

https://www.westsuffolkccg.nhs.uk/about-us/our-constitution/) to reflect the establishment of additional committees, update GP practice details, and amend membership of the Governing Body.

1.2 As part of the approval process, NHS England requested amendment to Terms of

References for some committees to comply with national guidance. The Community Engagement Group was one such committee.

2. Key Issues 2.1 The Community Engagement Group’s Terms of Reference (Appendix ‘A’) have been

amended as follows (in accordance with national guidance):

• To clarify the agreed delegated powers as set out in Schedule 1; • To clarify that the representatives of HealthWatch and Suffolk Congress are

non-voting attendees, but who are considered to hold significant influence. This is to comply with legislation that prevents CCGs from forming joint committees with local authorities, HealthWatch or other organisations;

• To include a section on reviewing the Group’s performance and effectiveness. 2.2 The revised Terms of Reference have been approved by NHS England as part of their

overall approval of the CCG’s revised Constitution. 2.3 The Terms of Reference were approved by the Community Engagement Group at its

meeting on 19th February 2018 subject to the following:

• Members requested clarification re 4 (i) as to why organisations such as Healthwatch and Suffolk Congress are referred to as non-voting attendees.

Response: This is in accordance with legislation that prohibits CCGs from forming joint committees with local authorities, HealthWatch or other organisations. Such organisations may attend committee meetings but are not eligible to vote.

• Members requested that it is stated in the TORs that the Lay Member is also the

vice chair

Response: This has been incorporated into the final Terms of Reference. 3. Public Engagement

3.1 Whilst the nature of the assurance process is such that public engagement is not required,

the Community Engagement Group meetings are held in public. 4. Recommendation 4.1 The Governing Body is recommended to ratify the amendments to the Terms of Reference

for the Community Engagement Group, which were approved by the Group at its meeting on 19th February 2018, noting the responses at 2.3 above.

WEST SUFFOLK CLINICAL COMMISSIONING GROUP

COMMUNITY ENGAGEMENT GROUP

TERMS OF REFERENCE

1. OVERVIEW (i) The Community Engagement Group (“the Group”) is responsible for

overseeing the delivery of the patient and public engagement elements of the Communications and Engagement strategy agreed by the Governing Body. It is accountable to that body within agreed delegated powers set out in Schedule 1.

(ii) The Group functions as a sub-committee of the CCG Governing Body to provide a route for West Suffolk’s diverse communities to inform and influence commissioning processes, decision making, planning and prioritising.

2. PURPOSE OF THE COMMITTEE The purpose of the Community Engagement Group (CEG) is to:

(i) Support West Suffolk CCG’s Lay member for Patient and Public

Engagement, particularly in overseeing the implementation of the patient and public involvement aspects of the CCG’s Communications and Engagement Strategy.

(ii) Develop a programme of patient and public engagement activities

integrated with the CCG’s planning and commissioning cycle. (iii) Provide a regular forum between the West Suffolk CCG with patient,

carer and public representatives. (iv) Oversee and advise on work on equality and diversity, including in

developing, implementing and evaluating West Suffolk CCG’s Equality Delivery System.

(v) Oversee the planning of CCG engagement events (e.g. conferences,

‘Patient Revolution’ events, locality workshops). (vi) Ensure the group links with Healthwatch Suffolk and Suffolk Congress.

Appendix ‘A’

Page 2 of 4

(vii) Regularly communicate with and involve the CCG’s Health Forum members. (viii) Link with Healthwatch to provide a forum for West Suffolk’s communities to

raise issues and concerns about service quality. (ix) Offer additional opportunities for representatives to work with West Suffolk

CCG at a variety of levels e.g. focus groups, patient surveys, membership of CCG project groups and task and finish groups.

(x) Act as ambassadors of the work of West Suffolk CCG with external groups

when appropriate. 3. MEETINGS (i) The Group will meet bi-monthly to tie in with the CCG Governing body and

the meetings will take place in varying localities in West Suffolk.

(ii) The times of meetings will be varied.

(iii) The meetings will be in public.

(iv) Meeting dates and times will be determined by the members.

(v) Meeting venues will be in statutory or voluntary sector buildings which are accessible by public transport and for people with disabilities.

(vi) Extraordinary meetings can be convened by the Chair of the Group or by the Chief Operating Officer of West Suffolk CCG when appropriate

4. MEMBERSHIP (i) Membership of the Community Engagement Group is as follows:

• No more than 20 members, including the Chair and Vice Chair, will be appointed to the Group.

• Some members will be affiliated with each of the CCG’s locality areas: Bury St Edmunds, Blackbourne, Sudbury, Haverhill, Newmarket and Forest Heath.

• Some members will be selected to provide a range of backgrounds and community expertise (e.g. services for Marginalised and Vulnerable Adults).

(Non-voting attendees considered to hold significant influence are listed as follows:

• A member of HealthWatch Suffolk.

• A member of Suffolk Congress.

Page 3 of 4

(ii) The Chair and Vice Chair of the Group will be elected annually by its members. There should be a maximum term of office of 3 years.

(iii) The Vice Chair of the Group shall be the Lay Member for Patient and Public Engagement.

(iv) The Chair of the Group may attend the public Governing Body meetings with speaking rights but not voting rights.

(v) The Vice Chair will substitute the Chair in his / her absence.

(vi) The Lay Member for Patient and Public Engagement attends Governing Body meetings.

(vii) The Group will be quorate with half or more full members present. If voting is necessary, a simple majority is required to make a decision. If there is a tie, the Chair will have the deciding vote.

(viii) The Chief Operating Officer and the Lay Member for Patient & Public Engagement will attend meetings of the Group. If unable to attend, a senior member of staff will be asked to attend in their place.

(ix) Administration, including minute taking, will be serviced by the CCG.

(x) NHS staff and officers from other statutory and voluntary sector agencies in attendance have speaking rights but not voting rights.

(xi) Task or time limited subgroups to support the Group’s work can be convened, and closed, by the Group.

(xii) Subgroup members will be elected by the West Suffolk Health Forum and / or the Group.

(xiii) The Group will establish a proactive programme of engagement activities for each year, and set objectives to achieve during the following year.

(xiv) Members have voting rights when voting is applicable.

(xv) Membership of the CEG will be reviewed on a regular basis and may be altered to fill any gaps in the membership’s skills or expertise.

5. REVIEW (i) The Group will review its own performance and effectiveness on an annual

basis, including membership and Terms of Reference. 6. AUTHOR

Andrew Eley, Deputy Chief Operating Officer

Date Approved: 19 February 2018

Review Date: February 2019

Page 4 of 4

Schedule 1 – Delegation

The functions delegated to the Community Engagement Group are to:

a) Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements by implementation of the group’s communication and engagement strategy.

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GOVERNING BODY

Agenda Item No. 16

Reference No. WSCCG 18-24

Date. 28 March 2018

Title Engagement in West Suffolk

Lead Chief Officer Jo Finn, Lay Member for Patient and Public Engagement

Author(s) Jo Finn, Teresa Farley, Katie Sargeant, Communications & Engagement team

Purpose For Information and support of recommendations

Applicable CCG Priorities

1. Develop clinical leadership

2. Demonstrate excellence in patient experience & patient engagement

3. Improve the health & care of older people

4. Improve access to mental health services

5. Improve health & wellbeing through partnership working

6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

The Governing Body is asked to note the report.

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1. Purpose

• To update members on progress with the Engagement agenda in West Suffolk:

o Where we are? o How we are doing? o What next?

• To note the development of resources (Audit; Framework; Toolkit) to support the further engagement of West Suffolk people

• To confirm the maintenance & development of Engagement as a key priority of the CCG.

2. Background 2.1 Patient and Public Engagement has been a key priority for the West Suffolk CCG

since its’ inception. It has given voice to residents of West Suffolk and has enabled the CCG to better start a new culture in which Patient and Public Engagement is ‘the way we do things’. This is not negotiable.

3. Suffolk working together

3.1 The West Suffolk CCG is increasingly working with Ipswich & East Suffolk CCG as part of the emerging Sustainability and Transformation Programme. Both CCGs recognise benefits which have been realised because of successful engagement. NHSE want to capture measurable outcomes to provide a platform for the introduction of performance managing engagement activity. The two CCGs have developed resources to facilitate further development of the engagement programme across Suffolk. One element will include indicators where they add value. Currently there is no formal evaluation of engagement activity.

3.2 The engagement team brought together a report of the progress of engagement activity since 2012 by undertaking an audit during 2017/2018.

4. Where are we now?

4.1 Progress made by the two CCGs during the last 3 years was identified by Katie Sargeant and Teresa Farley, joint appointments with St Edmundsbury Council. They set out to identify techniques which have been adopted to enable patients and public to have a voice and to be confident that they have been listened to. A copy of the audit results is attached at Appendix 1.

4.2 The knowledge gained from the audit has enabled different engagement techniques to be identified and key themes found to be successful. Across the organisation staff can now contribute directly to the culture shift where patient and public engagement is ‘the way we do things’.

4.3 The accumulated experiences have been captured in a new suite of engagement resources, including a framework (attached at Appendix 2), which provides structure, support and examples of good engagement practice & contributes to a toolkit for Engagement in Suffolk.

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5. How are we doing?

5.1 Introduction of new indicator:

NHSE have introduced a new indicator - the CCG ‘IAF Community Indicator’ - which has been trialled by National Assessment and review for 2017/2018. This table top review of work to engage with patients and communities for whom we commission, a standalone indicator within the CCG Improvement & Assessment Framework (IAF). This will form part of the overall CCG assessment in 2017/2018

5.2 How did we do?

The WSCCG RAGG rating and global score for engagement practice at the time of assessment and ratings for each of the five domains have been received as well as general comment.

The CCG were rated as GREEN with an overall score of 11 out of 15, which is ‘good’. No further assessment review is scheduled for the CCG in 2017/2018.

Scores against each domain were:

Domain grade

Score Domain descriptor

A 3 Governance: involve public; implement assurance and improvement systems; hold providers to account

B 2 Annual Reporting: Demonstrate public involvement in Annual reports

C 2 Practice: Explain public involvement in commissioning plans; promote and publicise public involvement; assess, plan and act to involve; provide support for effective engagement

D 2 Feedback and evaluation

E 2 Equalities and health inequalities Advance equality and reduce health inequality

Key: 0 inadequate; 1 requires improvement; 2 good; 3 outstanding

5.3 Comments from assessors:

The CCG have an accessible and informative website and Annual Report.

‘There is clear evidence of public and patient involvement and engagement in their activities. The Annual Report includes an excellent final page on how to obtain document information in another format, in addition to the CCGs; publication to download including a series of Easy Read factsheets. Although it appears that inequalities and health inequalities are monitored and acted upon. The information relating to this seems difficult to find and is not explicitly stated. The Community Engagement Group have been noted to be working with the Lay Member for PPI work on equalities and diversity and EDS2 , however the CCG would benefit from updating – it’s the website to include up to date information and documents on equalities and explaining how it meets the Public Sector Equality Duties.’

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5.4 Highlighted areas for improvement

‘Involvement practice appears not to reach, or to exclude, known sections of your local population’

6. What next?

6.1 The Communications & Engagement team will develop an action plan for rolling out the framework to staff, explaining the toolkit and other resources, and inform the refreshment of the Communications & Engagement strategy for 2018-2021.

6.2 The West Suffolk CCG Clinical Executive is asked to

• Reconfirm the CCG’s Patient and Public Engagement Programme as a key priority of the CCG

• Approve ‘Working Together: A framework for developing patient, community and staff partnerships, (2018)’

• Approve ‘Working together: A toolkit for developing patient, community and staff partnerships (2018)’ to ensure there is a robust structure to engagement activity monitoring

• Support the engagement team developing the next strategy for Communications & Engagement, 2018 – 2021

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Working Together: A framework for developing patient, community and staff partnerships

Produced by the WSCCG and IESCCG communications and engagement teams and the lay members for patient and public involvement.

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Contents: Forward page 3

Introduction page 5

Background page 5

Aim of the Framework page 6

Overview of the Framework page 7

The Spectrum of Engagement page 10

References page 11

Appendices

Working Together: A toolkit for developing patient, community and staff partnerships page 12 Preliminary outcomes for the communications and engagement framework page 12 The Spectrum of Engagement – Tools page 15

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Foreword ‘Partnership working’ was the term chosen by patients and service users that best reflected their contribution to the work of the NHS Ipswich & East Suffolk Clinical Commissioning Group (CCG).

Those two simple words make it abundantly clear that public opinion sits at the very centre of our efforts to co-produce with members of the wider community.

While the Ipswich & East Suffolk CCG was in the process of defining what it meant by co-production, colleagues from the neighbouring NHS West Suffolk CCG were on the same journey, and, reassuringly, coming to the same conclusions.

This has led to the two CCGs working together in harmony, sharing their experiences to develop a best practice engagement model that will guide both organisations as they strive to ensure that the patient voice is heard loud and clear in the provision of future healthcare services.

In Ipswich and east Suffolk, the Chief Operating Officer and Chairman of the CCG supported the creation of joint workshops involving members of the Governing Body, Clinical Executive, Community Engagement Partnership and GP surgery patient participation groups.

Meanwhile, in west Suffolk, a group of people were recruited from the community to help forge effective relationships between the CCG, patients and the public. In addition to the annual ‘Patient Revolution’ event, where the ‘open space’ approach was used to enable members of the public to set the agenda, workshops were also held for members of the Community Engagement Group and Clinical Executive.

These initiatives led not only to a definition of partnership working, but also prompted the development of an engagement toolkit for staff and the creation of a database of patients and service users with whom both CCGs could work in partnership. The appointment of 12 ‘partnership champions’ drawn from teams across both CCGs aims to embed partnership working within all aspects of commissioning. Working together, the champions support and encourage working alongside patients in partnership. A framework demonstrating the spectrum of engagement was also designed, along with a method of capturing, monitoring and reviewing all engagement work.

‘Bucking the trend’, ‘challenging assumptions’ and ‘being brave and tenacious’ are all terms that partnership champions are likely to be heard heralding, but all parts of the organisation have a role to play. Finance colleagues can identify the need for budgets to promote public involvement, contracting staff can ensure the public voice is heard and re-design teams can transform services in partnership with patients. Clinical leaders and senior managers can support and champion working with patients in all day-to-day work.

Working in partnership is absolutely the right thing to do. Nobody is pretending it’s easy. The only easy thing is talking about it - actually doing it is much harder. In order for partnership working to become ‘the norm’ a change in culture is required. The belief that professionals know best is outdated. Technical, clinical and managerial expertise should be blended in with the lived experience, community knowledge and leadership of patients and service users in order that our communities are truly involved in their health and social care.

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We say again - we ALL have a role to play. Simply ask the question “Were patients involved in this work? And if not, why not?”. It’s a really helpful first step. Let it become second nature. The CCGs’ communications and engagement teams will be pleased to support your work.

Together we can do this.

Pauline Quinn and Jo Finn

Lay members for patient and public involvement

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Introduction This framework document sets out our approach to the engagement of patients and communities in the planning and commissioning of health services in Suffolk.

Since the two clinical commissioning groups (CCGs) were established in 2013, our priority has been to listen to and engage with the local population, as we recognise that effective two-way communication is essential to making local healthcare services the best they can be. This will remain a priority as we develop our ‘Communication and Engagement Strategy 2018-2021’.

The framework provides structure, support and examples of good engagement practice for organisations, partners and stakeholders to share and learn from. Aimed primarily at staff working in the CCGs, its simple messages are:

• Not engaging is not an option - everything we do is based on the high priority we give to involvement • This is not a ‘one size fits all’ approach - there is a spectrum of different methods we can employ

Throughout this document, the term ‘co-production’ is used interchangeably with the term ‘partnership’. Partnership working is a term chosen by the patients and service users who have supported Ipswich and East Suffolk CCG from the beginning of their co-production journey.

Our definition of ‘partnership working’ - “Partnership working is a way of working that involves people who use health and care services, carers and communities in equal partnership, and which engages groups of people at the earliest stages of service design, development and evaluation.” (Ipswich and East Suffolk CCG with CEP and PPGs 2016).

Background The CCGs believe that integrated working is the most effective way of improving the quality of local health services. The term ‘integration’ means different things to different people. Here, it is defined as a means of identifying opportunities for better team working in order to improve service delivery. In other words, “the mission of the CCG is to work with the community and clinicians to plan and commission safe, high quality services which meet the health needs of the people we serve, while maintaining financial balance” (NHS Ipswich and East Suffolk CCG website). This mission highlights the importance of working with patients and communities to gain their views, to listen and to engage with them to build better services. The values below, set out by NHS Ipswich and East Suffolk CCG, aim to keep patients at the centre of our work:

PATIENTS:

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Patients first Action orientated – drive and deliver quality improvements Teamwork – clinical leadership, patients, public, providers and staff Integration for improved results Equality of opportunity Never overdrawn – a balanced budget Timeliness – decisions and results Safe, sustainable systems

The CCGs have a legal duty to involve service users and communities in making decisions about their health and healthcare. The NHS West Suffolk CCG’s constitution sets out the responsibilities of the CCG in relation to choice and shared decision making (para 5.2.8). In addition, Section 14 of the NHS Health & Social Care Act 2012 sets out the requirement to involve patients and the public in the planning of services, in developing proposals for change and in any decisions which would impact on services.

The aim of the framework The framework is designed to support the two CCGs in meeting their commitment to listen and engage with the local community. The appendices set out practical guidance to help staff appreciate and understand how this works so that they can actively listen, engage and work in partnership. Measuring the outcomes of our work is challenging as there are no obvious key indicators with which to do this. This framework outlines the preliminary approach to producing a performance report which evidences communications and engagement in Suffolk. This will not only ensure they remain at the heart of our decision making, but will also act as a beneficial evaluation tool to drive future improvement and development. Appendix 2 sets out our preliminary approach to measuring and reporting communications and engagement outcomes.

The Engagement Cycle (Gilbert 2013) is a tried and tested practical resource used by CCGs to plan, design and deliver great services for, and with, local people. It demonstrates the importance of collecting outcomes and using them to evaluate engagement work. If we do not review the work we are doing the cycle (i.e. – the outcomes) is not complete.

The Engagement Cycle (Gilbert, 2013)

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Overview of the framework

How to engage?

CCG staff will find that by asking the right people, organisations or patients to talk about their experiences and views and to contribute to plans, proposals and decisions about services (NHSE, 2017), they can come to a better understanding of problems and achieve success.

The Community Engagement Partnership (CEP) and the Community Engagement Group (CEG), are public groups representing the patients and public of Ipswich and east Suffolk and west Suffolk respectively. Both the CEP and CEG have been set up as an advisory group to their respective CCG governing bodies and are sub-committees of the board. They have independent chairs and support the lay members of the CCGs who have lead responsibility for patient and public engagement. The CEP and CEG discuss and hear updates on important matters in

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healthcare. They are a valuable resource for gaining patient feedback and can often be the starting point for engagement work within the wider community. Different methods of engagement can be used depending on what services are being commissioned and the needs of different groups of people. We have chosen to develop our own ‘Spectrum of Engagement’ (page 10). It reflects the work of Arnstein (1969) whose ‘Ladder of Participation’ depicts engagement taking many different forms including some that are meaningless and ineffective. Our ‘Spectrum of Engagement’ focuses on the top section of Arnstein’s ladder, as we will not partake in token engagement and instead strive to embed the greatest level of engagement possible in all we do.

In the relevant policy and guidance, it is recommended that public involvement should be “fair and proportionate” and “meaningful” (Cabinet Office Principles of Engagement, 2010; Gunning Principles, 2010). Initially staff may be cautious about using engagement tools, but the spectrum sets out the options to help staff make decisions and allows for a flexible approach to communications and engagement. A piece of engagement work could, over time, move through the entire spectrum using a variety of tools at each stage. For example, a project may be co-produced with patients shaping service design from the start, then, as it develops, it may be necessary to engage with a wider section of patients on specific aspects of it. The final stage may be to inform patients and communities about the new service.

The communications and engagement team is able to give advice. Call them on 01473-770010.

When to engage:

There is no ‘right time’ to start engagement with a new project or service development. It is much simpler to start engagement at the same time stakeholders are identified. Where there are highly complex or contractually sensitive situations, you might not be able to work in partnership straight away, but you should aim to involve people as early as possible and ask their advice. They may have a perspective that would contribute to the way the whole project is set up. Projects should never be allowed to reach a point where people cannot reflect, give feedback or work in partnership before decisions are made (NHSE, 2017).

While we should make every effort to involve people, there are times when we must work at speed, particularly where there is a genuine risk to the health, safety or welfare of patients or staff. Even in these circumstances, public engagement is still possible, there are a range of involvement strategies that can be used (appendix 3). In addition advice can also be sought from the communication and engagement team to work together with patients, communities and staff in these situations.

Who to engage?

It is important to take a ‘proportionate and targeted approach’ (Cabinet Office, Consultation Principles 2016) to engagement work. Below are groups and resources that can support with identifying patients and community members with whom you should be engaging:

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• ‘Hard to reach’ groups - engaging with these groups can be particularly challenging. Healthwatch Suffolk has a specific remit to reach those people who are seldom heard, and are very supportive of the CCGs.

• Voluntary and community sector groups - talking to voluntary and community sector organisations is often beneficial. They can advise on how to overcome barriers that some people may face when working in partnership.

• The Communications and Engagement Team holds a database of individuals and organisations with varied interests and experience. The CCGs also have links to communications and engagement teams across borough, county, NHS, voluntary sector and police who can help.

• The CCGs facilitate the work of the Community Engagement Partnership (NHS Ipswich & East Suffolk CCG), Community Engagement Group (NHS West Suffolk CCG) and the Youth Engagement Forum, all of whom have a part to play and skills and experiences to share.

• The Patient Participation Group network provides access to a diverse mix of individuals who are passionate about improving healthcare services at the GP practices in their communities and help to support the CCGs in their work.

• The Health Forum and Points of View electronic newsletters provide latest news and information to hundreds of people across the county who have indicated a particular interest in health matters and may identify a suitable representative.

Engagement Techniques:

The ‘Spectrum of Engagement – Tools (Appendix 3)’ sets out the range of techniques that can be employed, depending on the issues under discussion. The four main methods are:

• Informing • Engaging • Involving • Co-producing/Partnership

A range of techniques can be used for each method, for example, running surveys, arranging focus groups or posting on social media. (Appendix 3).

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The Spectrum of Engagement:

References: Arnstein, Sherry R. “A Ladder of Citizen Participation, “Journal of the American Planning Association, Vol. 35, No 4, July 1969, pp. 216-224

http://engagementcycle.org/ with thanks to David Gilbert

Engage Involve

Informing:

Giving information to patients and communities about important messages.

Examples of tools: websites, press releases, newsletters, information stands.

Engaging:

Collecting information and feedback from patients and communities. Listening to comments and concerns to support improvement of future services.

Examples of tools: surveys, focus groups, patient stories, comment cards.

Involving:

Patients and communities are involved in developing a pre-existing idea or involved once a piece of work has been established.

Examples of tools: forums for debate, peer review.

Co-production/Partnership:

Working with patients and communities in an equal partnership with professionals at the earliest stages of service design, development and evaluation. (Co-production Model NHSE)

Examples of tools: planning and design meetings, deliberative mapping.

The Spectrum of Engagement allows for a fluid approach to communication and engagement, in that a piece of engagement work could, over time move through the

entire spectrum using a variety of tools at each stage.

NB: Further examples of tools of engagement can be found in

appendix 3.

Designed by West Suffolk and Ipswich and East Suffolk CCG. 2017.

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of InHealth Associates.

The NHS West Suffolk CCG constitution

Transforming Participation in Health and Care: Legal duties for clinical commissioning groups and NHS England https://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

NHS Health & Social Care Act 2012

Cabinet Office Principles of Engagement, 2010

The Gunning principles (propounded by Mr Stephen Sedley QC and adopted by Mr Justice Hodgson in R v Brent London Borough Council, ex parte Gunning [1985] 84 LGR 168).

Working Together: A toolkit for developing patient, communities and staff partnerships, 2017

Appendix 1:

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Working Together: A toolkit for developing patient, communities and staff partnerships. Appendix 2: Preliminary work on the collection and collation of outcomes to demonstrate the communication and engagement being carried out.

Vision: Treating people as health experts in their own lives. Aims To inform patients and the

community about key/important message.

To engage with patients and communities to gain feedback for services and listen to comments or concerns to support improvement of future services.

To involve patients and the community in shaping, changing and establishing services.

To co-produce by working with patients and communities in an equal partnership with professionals at the earliest stages of service design, development and evaluation. (Co-production Model NHSE)

Objectives Members of the community are adequately informed and act on the advice they have been given.

Members of the community are engaged through feedback in shaping health services.

Members of the community are proactively involved in developing and improving health services.

Members of the community work as equal partners to design, shape and improve health services.

Outputs ‘X’ amount of people have been reached with information on specific topics.

‘X’ amount of people have been engage in specific feedback activities i.e. patient revolution.

Increase the number of CCG residents from ‘X’ to ‘X’ and those that used their services in shaping services.

‘X’ amount of services have successfully been co-produced.

A representative cross section of CCG residents and those that used their services has been reached.

60% of suggestions from feedback activities have been investigated or actioned.

‘X’ amount of patients from priority groups (BME, YP) are involved in a meaningful way.

‘X’ amount of patients and members of the community have seen social media

Increase public attendance at CEP/CEG/Governing Body ‘x%’

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activity. ‘X’ amount of patients from

priority groups (BME, YP) are reached. (Easy read literature?)

X’ amount of patients from priority groups (BME, YP) are reached.

Outcomes -Members of the community feel more informed about their health. -Members of the community feel more able to make positive choices about their health. -Data for specific areas of work/action indicate a contribution to positive change.

-Members of the community feel empowered to contribute their views. -Members of the community report they feel they have an influence. -Positive changes have been made to services as a result of feedback.

-Members of the community report they have been proactively involved in contributing ideas. -Members of the community report they feel their ideas are valued. -Members of the community can see how their ideas have shaped services.

-Services designed are what people want, are sustainable and well used. -Services get fantastic results.

Methods – Tools to collect this information

Survey Monkey survey. Engagement app for members of the public. Tally of numbers seen.

Survey Monkey survey. Evaluation forms at events.

Survey Monkey survey. Evaluation form for members of the community to complete. Case study template.

Survey Monkey survey. Evaluation form for members of the community to complete. Case study template.

Explanation of methods: Survey Monkey survey (maybe, in time, an app) – completed by staff at the end of an engagement activity. Once submitted this information can be analysed and collated to provide outputs and hopefully outcomes. As long as all relevant information is completed this way of collecting information from participants could be determined by the member of staff. Evaluation forms for participants – These could be used at engagement events i.e. focus groups, to establish thoughts and feelings from participants, i.e. do they feel valued? Do they feel their contribution will make a difference? Case study template – Case studies can be completed at the end of a piece of engagement work to show the beginning, middle and end, including any impact the engagement has had. App – An ‘app’ could be developed to take the place of the Survey Monkey surveys if it was deemed necessary.

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Methods of collecting, recording and collating communications and engagement data (output and outcomes) is still an area for development. It is crucial to ensure that the action of collecting this information does not take away or deter staff from the action of engagement.

Appendix 3:

The Spectrum of Engagement –Tools

Establish method of engagement

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Informing

•Briefings eg to MPs, councillors, Healthwatch, local groups

•Websites•Press releases•Newsletters•Social media•Patient stories•Events•Focus groups•Presentations•Graphics/ pictures

•Use Plain English

Engaging

•Social media -with comments

•Patient stories/ storytelling

•Surveys•Community conversations

•Comment cards•Events•Presentations with opportunity for feedback

•'Open Space' events

•Use Plain English

Involving

•Clear choices, explainations & a process

•Forums for debate

•Peer review•Questionnaires•'Open Space' events

•Community conversations/ other public meetings

•Focus groups•Electronic voting•Use Plain English

Co-production

•Planning and design meetings

•Deliberative mapping.

•Storytelling•Community conversations

•Use Plain English

Feedback and collection of outcomes

R

evie

w

Designed by West Suffolk and Ipswich and East Suffolk CCG. 2017.

Working Together: A toolkit for developing patient, community and staff partnerships.

Picture from Patient & Public Participation in commissioning health and care – NHSE 2017

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Contents Acknowledgment page 2 Forward page 2 About this toolkit and CCGs’ definition page 4 Overview page 5 What is partnership working? page 7 Reflections on partnership working in practice page 8 Further reading on involving patients and partnership working page 9 Checklist page 10 Chairing skills and getting the most out of your meetings page 11 Facilitation page 14 References page 16 Appendices

Appendix 1: List of partnership champions Appendix 2: The spectrum of engagement - Tools Appendix 3: Individual and public participation duties Appendix 4: Expenses form Appendix 5: Example of electronic online collection tool Appendix 6: Example feedback from Appendix 7:Checklist for good partnership working Appendix 8: Reimbursement of expenses and recognition for non-staff involvement policy Appendix 9: Partnership Champion role description

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Acknowledgement

Thank you to all the patients from CEP, PPGs and the staff who contributed to the development of this toolkit.

Foreword

‘Partnership working’ was the term chosen by patients and service users that best reflected their contribution to the work of the NHS Ipswich & East Suffolk Clinical Commissioning Group (CCG).

Those two simple words make it abundantly clear that public opinion sits at the very centre of our efforts to co-produce with members of the wider community.

While the Ipswich & East Suffolk CCG was in the process of defining what it meant by co-production, colleagues from the neighbouring NHS West Suffolk CCG were on the same journey, and, reassuringly, coming to the same conclusions.

This has led to the two CCGs working together in harmony, sharing their experiences to develop a best practice engagement model that will guide both organisations as they strive to ensure that the patient voice is heard loud and clear in the provision of future healthcare services.

In Ipswich and east Suffolk, the Chief Operating Officer and Chairman of the CCG supported the creation of joint workshops involving members of the Governing Body, Clinical Executive, Community Engagement Partnership and GP surgery patient participation groups.

Meanwhile, in west Suffolk, a group of people were recruited from the community to help forge effective relationships between the CCG, patients and the public. In addition to the annual ‘Patient Revolution’ event, where the ‘open space’ approach was used to enable members of the public to set the agenda, workshops were also held for members of the Community Engagement Group and Clinical Executive.

These initiatives led not only to a definition of partnership working, but also prompted the development of an engagement toolkit for staff and the creation of a database of patients and service users with whom both CCGs could work in partnership. The appointment of 12 ‘partnership champions’ drawn from teams across both CCGs aims to embed partnership working within all aspects of commissioning. Working together, the champions support and encourage working alongside patients in partnership. A framework demonstrating the spectrum of engagement was also designed, along with a method of capturing, monitoring and reviewing all engagement work.

‘Bucking the trend’, ‘challenging assumptions’ and ‘being brave and tenacious’ are all terms that partnership champions are likely to be heard heralding, but all parts of the organisation have a role to play. Finance colleagues can identify the need for budgets to promote public involvement, contracting staff can ensure the public voice is heard and re-design teams can transform services in partnership with patients. Clinical leaders and senior managers can support and champion working with patients in all day-to-day work.

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Working in partnership is absolutely the right thing to do. Nobody is pretending it’s easy. The only easy thing is talking about it - actually doing it is much harder. In order for partnership working to become ‘the norm’ a change in culture is required. The belief that professionals know best is outdated. Technical, clinical and managerial expertise should be blended in with the lived experience, community knowledge and leadership of patients and service users in order that our communities are truly involved in their health and social care.

We say again - we ALL have a role to play. Simply ask the question “Were patients involved in this work? And if not, why not?”. It’s a really helpful first step. Let it become second nature. The CCGs’ communications and engagement teams will be pleased to support your work.

Together we can do this.

Pauline Quinn and Jo Finn

Lay members for patient and public involvement

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About this toolkit

Following two workshops attended by a number of patients from GP surgery patient participation groups, NHS Ipswich & East Suffolk CCG’s Community Engagement Partnership, chief officers and clinical executive GPs, the CCG made a commitment to co-production.

They unanimously decided to use the preferred term “partnership working” in place of co-production.

Developed by patients and CCG partnership leads to help build staff confidence and capacity for working in partnership with people in our communities, it recognises that staff and patients are equal partners in commissioning, aims to improve how people look after themselves and commits to drawing on the stories of people who have experienced the services themselves so that we collectively learn more. Feedback from staff and patients was used to create this toolkit, as well as evidence from engagement work previously undertaken and national and local policies.

Each directorate has a ‘partnership champions’ able to assist CCG teams explore and highlight areas where they can work in partnership with patients and the public. A list of champions as of March 2018 is included at Appendix 1.

Our definition

“Partnership working is a way of working that involves people who use health and care services, carers and communities in equal partnership, and which engages groups of people at the earliest stages of service design, development and evaluation. “Done well, partnership working helps to ground discussions in reality and maintain a person-centred perspective.” (Ipswich and east Suffolk CCG with CEP and PPGs 2016)

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Overview

Why? Ultimately, it improves services and it is the right thing to do. CCGs have a legal duty to involve service users and communities in decisions about their health and healthcare. We have taken this a step further. The governing bodies of the NHS West Suffolk and NHS Ipswich & East Suffolk CCGs have both made patient involvement and engagement a priority. Language and terminology changes, so it might help you to think of partnership/co-production as a deeper and more meaningful way of keeping us in tune with what people really need and think.

How? ‘Working Together: A framework for developing patient, communities and staff partnerships (2018)’ sets out a ‘Spectrum of Engagement’ which all communication and engagement work falls into. Co-production/partnership is the area of the spectrum that we will strive to achieve to ensure patients can play a meaningful part in shaping and designing services. Page 4 demonstrates what we are trying to achieve when we talk about co-production/partnership.

The ‘Spectrum of Engagement – Tools’ (Appendix 2) identifies the tools and techniques that can be used at each stage of the spectrum to work together with patients, communities and staff.

When working in partnership with patients and communities, consideration must be given to meeting times with plenty of notice, accessible venues, orientation to the NHS and the projects being undertaken, the provision of a named staff member for support and queries, the payment of expenses and, in the case of extensive contribution, the payment of an honorarium (Appendix 8).

Partnership Champions are working within the CCGs to support colleagues in their efforts to work together with patients and communities. Our ambition is to make working with patients and communities part of our ‘everyday business’, which informs every aspect of CCG work. (Partnership Champion Role descriptor, 2017). Appendix 9 sets out the role of our Partnership Champions.

The communications and engagement team (01473-770010) can give you advice where required.

When? It is much simpler to start engagement at the same time stakeholders are identified. Where there are highly complex or contractually sensitive situations, you might not be able to work in partnership straight away, but always involve people as early as possible and ask their advice. Projects should never be allowed to reach a point where people cannot reflect, give feedback or work in partnership before decisions are made (NHSE, 2017).

While we should make every effort to work together with patients, we recognise there are times when we have to work at speed, particularly where there is genuine risk to the health, safety or welfare of patients or staff. In these situation there are a range of involvement strategies that can be used (appendix 2). Advice can also be sought from the communication and engagement team.

Who? ‘Working Together: A framework for developing patient, communities and staff partnerships (2018)’ provides examples of who can support you in working together to ensure a ‘proportionate and targeted approach’ (Cabinet Office, Consultation Principles 2016) is taken to engagement work.

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Ipswich & East Suffolk CCG’s Community Engagement Partnership (CEP) and West Suffolk CCG’s Community Engagement Group (CEG) are public groups representing the patients in their respective areas. Both have been set up as advisory groups to their CCG’s Governing Body and are sub-committees of the board. They each have an independent chair and support the lay members of the CCG who have lead responsibility for patient and public engagement. The CEP and CEG are formal committees that discuss and hear updates on important matters in healthcare. They are also a valuable resource for gaining patient feedback and can often be the starting point for engagement work within the wider community.

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What is co-production/partnership working?

• Partnership working is a way of working that involves people who use health and

care services, carers and communities in equal partnership, and engages groups

of people at the earliest stages of service design, development and evaluation

• Partnership working acknowledges that people with ‘lived experience’ of a

particular condition are often best placed to advise on the support and services

that will make a positive difference to their lives

• Done well, partnership working helps to keep discussions relevant and patient-

centred

• Partnership working is one of a range of different approaches that includes citizen

involvement, participation, engagement and consultation

For partnership working to become part of the way we work, we will create a culture where

the following values and behaviours are the norm:

Values and Behaviours

http://coalitionforcollaborativecare.org.uk/catherine-wilton/a-co-production-model-five-values-and-seven-steps-to-make-this-happen-in-reality/

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The seven practical steps depicted below demonstrate how we can make co-

production/partnership working happen in reality:

Reflections on coproduction/partnership working in practice

“As well as using a range of methods to gather information from patients when redesigning the ophthalmology service pathway, I also made every effort to take time to speak to people at other events to get the perspective of people who were not eye patients.” – Karen-Lynne Dowsing, Transformation Lead.

“Patients have been involved in procurement panels for several years. Some examples are community, musculoskeletal, mental health and peri-diagnosis dementia services procurement. Insights from people who are living with conditions are invaluable, which means we actively seek interested individuals to take part in every procurement panel possible.” - Jane Garnett, Procurement Lead

“When I first approached the mental health services work, I was very concerned about how to properly engage. I was supported by the engagement team during a first meeting with a service user. In that first meeting he gave me such practical ideas and shared his story so honestly – I saw the benefits straight away and I haven’t looked back. Now we have Suffolk

“Seven practical steps to making co-production happen in reality”

http://coalitionforcollaborativecare.org.uk/a-co-production-model/

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User Forum members as part of our contracting meetings, which is helpful and keeps us grounded.” Lorraine Parr - Senior Transformation Lead (Mental Health)

“Three years into our Children’s and Young People’s Emotional and Wellbeing Strategy, we are seeing improvements in services. The co-chair of our group is a powerful partner in our work to this end. It has been tricky at times, but worth the debate to get to a shared solution.” Jo John – Transformation Lead (Mental Health)

Further reading on engagement and partnership working:

https://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

http://www.invo.org.uk/beyond-the-usual-suspects-towards-inclusive-user-involvement/

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/10/ohc-paper-

06.pdf

https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-health-and-care-plain-

text.docx

http://www.altogetherbetter.org.uk/Data/Sites/1/co-producing_commissioning_nef(3).pdf

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Resources for working together to develop patient, community and staff partnerships.

Do you know who you might need to involve and how you would find them?

Have you thought about how you might involve more diverse groups of people?

Do you know what information you might want to gather from the patient/public members?

Have you jointly agreed what the patient/public role will be?

Have you thought about writing a role description with clear expectations for your patient/public members?

Do you have a clear action plan/timeline for your engagement activities?

Will there be regular meetings or just a one-off?

Have you considered the need to be accessible? (Consideration of venue, transport, parking etc. when planning meeting venues).

Have you budgeted for patient expenses and remuneration? (See remuneration policy)

What information will you provide representatives about payment and how to claim expenses? (Ensure representatives are provided a non-staff expenses claim form Appendix 4).

Does your representative know who to send claims to and by which date (NB. payment of expenses can only be made up to three months in arrears)?

How will you support your patient/public members?

Is there a named contact who can answer any questions or queries throughout the process?

Have you provided a briefing in plain English regarding the background and purpose of the work you are involving them in?

Who else is involved in the process (members of staff, other organisations, other patient/public members)?

Is there any training required? If so, who will provide it?

Have you made sure that all written communications are appropriate to your audience/recipients?

How will you record, report and communicate progress (particularly if you use workshare)?

How will you measure the impact of patient and public involvement?

Have you completed the Survey Monkey questionnaire to capture your

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engagement work? Have you considered how you will involve patients and the public in reporting and disseminating information and results?

Have you completed a feedback form with your patient representatives to learn about their experience of taking part? Has this been fed in to the Survey Monkey questionnaire?

Chairing skills and getting the most out of your meetings http://www.resourcecentre.org.uk/information/chairing-a-meeting/

Effective chairing skills are essential to successful and productive meetings, particularly

when patient and public representatives are involved.

The key tasks of the chair during a meeting include:

1. getting through the business on time

2. involving everyone

3. reaching decisions, and

4. dealing with difficult or challenging individuals or conversations.

Thorough preparation and planning are essential for success.

Getting through the business on time

• Have a clear agenda with timings for each item. Ensure this is circulated in

advance of the meeting. Try to avoid “any other business” as it helps to retain the

focus of the meeting.

• Ensure it is clear why items are on the agenda, why you are discussing them,

and what the outcomes are.

• Never assume that everyone present knows what you are talking about. Take

time to go over issues. It is essential to ensure patient representatives are fully

informed prior to their attendance at any meetings.

• Keep meetings jargon free.

• Always keep an eye on the time and move agenda items on if necessary. Be

disciplined about starting times and ensure your meeting finishes on time.

• Stick to the agenda item under discussion. If a point is raised that is not relevant

to the item under discussion acknowledge this and revisit it later in the meeting.

• Stop private conversations as soon as they start.

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• Don’t use your position as chair as an opportunity to impose your views.

• Don’t be under-assertive.

Involving everyone

As chair it is essential that everyone’s views are heard and that everyone is included and

involved in the meeting. Encouraging those who are quiet or new to meetings is just as

challenging as restraining those who talk too much.

• Allow time at the beginning of the meeting for participants to get to know each

other.

• Keep a list of whose turn it is to speak next and make sure people know you have

noticed that they want to speak.

• Stop people from talking for too long.

• At regular intervals checks the participants understanding of what is being

communicated.

• Give preference, where appropriate, to those who haven’t spoken before.

• Ask questions to draw people out - for example “Does anyone else have any

thoughts on this issue”. These will provide the opportunity for everyone to put

their point of view forward.

• In a small meeting going round each person in turn to get their view often works.

• Stop people from interrupting.

• Listen carefully to what people are saying and clarify their views or discussion

points with them if required.

Reaching decisions

The role of the chair is to keep an overview, and help the meeting to reach decisions and

develop action plans.

• Listen carefully to discussions and make note of key points.

• Remind the meeting about decisions which need to be made.

• Pull together points and periodically summarise what has been discussed so far

around a specific agenda item. This will help to clarify and focus participants,

enabling them to make a clearer decision.

• Before moving on go over what has been agreed and check who will be

responsible for any actions.

Dealing with difficult/challenging individuals/conversations

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https://www.ksl-training.co.uk/free-resources/customer-service/dealing-with-difficult-

behaviour/

Often in meetings there is an individual who talks over others, interrupts, or is focused solely

on one particular issue. These situations can be disruptive, but can also be overcome by

changing ways of conducting the meeting.

• Clarify and agree on “ground rules”.

• Be firm and consistent.

• If an individual repeats the same point, reassure them their view has been heard

and steer the discussion back to the rest of the group.

• If someone is continually critical, try to turn the question around to them and ask

if they have any ideas of how this could be improved?

• If an individual becomes very disruptive it can be helpful to look to the group for

support by asking whether people would like to spend more time discussing the

issue or move onto the next topic or item?

Difficult conversations and conflicts can arise both in and outside of meetings. They often

arise due to:

• Lack of clarity regarding expectations or guidelines

• Poor communication

• Lack of important information

• Personality differences

• Conflicts of interest

• Changes within an organisation

• Changes to services

Although conflict cannot be avoided, it can be managed, and can even present benefits in

terms of improved understanding and improved quality of decision-making.

• Take time to actively listen and understand the perspective of the other person or

group. You do not need to agree with them and it is important not to interrupt or

argue. Summarise and reflect back their comments to check you understand

what they are telling you. This helps the individual or group recognise that you

are listening to their views and taking them seriously.

• Do not take anything the other person is saying personally.

• Explain and present the situation from your perspective having prepared your key

messages in advance. If you have done so for the other party, they will be more

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prepared to listen to your views and opinions. Acknowledge their viewpoint and

answer their questions calmly and rationally so that they understand.

• Develop an agreed solution and highlight the next steps. Reaffirm your

commitment to addressing the person’s concerns. Thank the individual or group

for bringing the issue to your attention.

• Ensure you update others where appropriate.

• Reflect on the situation and gain feedback from colleagues as to how you

handled the situation.

Facilitation

https://www.ksl-training.co.uk/free-resources/facilitation-techniques/tips-for-facilitating-

groups/

Group facilitation is an important skill that can really help a team achieve its goals in the

most effective and constructive manner. The role of the facilitator is to help the group make

progress and find its own solution in the easiest and most effective way.

• Ensure that the expected outcomes or objectives are clear and review these with

the group.

• Establish expectations, including the hopes and concerns of the meeting, and set

some ground rules.

• Focus the group’s discussions with questions, statements, summaries and

reflections of what you have heard or observed from the group.

• Manage participation and attempt to draw out the quieter participants. Allocating

roles i.e. note taker, or flipchart writer, to more confident contributors can help to

give quieter participants more opportunity to speak.

• Ensure your groupings have a balance of participants with different

communication styles.

• Utilise different techniques to draw ideas from the group. For example ‘round

robins’ (where each person in the group gets to express their views

uninterrupted), brainstorming, flipcharts and post-it note “meta planning” (a

simple technique which encourages individuals to express their thoughts by

writing key words onto post-it notes which are placed collectively on a flip chart or

wall space). Alternatively, split into smaller groups or pairs to have more focused

discussions before feeding back to the group.

• Assist the group to build on each other’s ideas by highlighting and reinforcing

supportive responses.

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Focus your energy on your group and try not to become distracted by other groups and

conversations within the room. The answers lie within your group and by utilising group

working methods they will become apparent.

As a facilitator there are a number of useful tools which will assist the group to achieve a

successful outcome.

• Name badges

• Note paper, pens, post-its and flipcharts

• Hand-outs or supporting documents in advance of the meeting.

• Feedback forms (if appropriate).

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References:

‘Working Together: A framework for developing patient, communities and staff partnerships (2018)’

http://www.cedar.iph.cam.ac.uk/wp-content/uploads/2014/08/PPI-checklist-11.08.14.pdf

http://coalitionforcollaborativecare.org.uk/a-co-production-model/

https://www.ksl-training.co.uk/

http://www.resourcecentre.org.uk/information/chairing-a-meeting/

‘Transforming Participation in Health and Care: Legal duties for clinical commissioning

groups and NHS England’ https://www.england.nhs.uk/wp-content/uploads/2013/09/trans-

part-hc-guid1.pdf

‘Transforming Participation in Health and Care ‘The NHS belongs to us all’, September

2013, Patients and Information Directorate, NHS England, Publications Gateway Reference

No. 00381’ https://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

Cabinet Office Principles of Engagement, 2010