Newham CCG Board

Meeting 8th October 2014 1.30pm – 3.30pm Committee Rooms Newham CCG Warehouse K 2 Western Gateway London E16 1DR

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ACRONYM MEANINGAC Audit CommitteeACC Acute Commissioning CommitteeA&E Accident & EmergencyAPMS Alternative Provider Medical Services (a type of Primary care contract)AQP Any qualified providerBDG Board Development GroupBart's / BHT Barts Health NHS TrustBAF Board Assurance FrameworkBMA British Medical Association BCP Business Continuity PlanCCC Community Commissioning CommitteeCQC Care Quality CommissionCAG Clinical Academic group CCG Clinical Commissioning GroupCQRM Clinical Quality Review MeetingCQUINs Commissioning for Quality and Innovation (Payment Framework)CSU Commissioning Support Unit CHN Community Health Newham DirectorateCHS Community Health SystemsCPD Continuing Professional Development CCU Critical Care UnitDTOC Delayed Transfers of CareDoH Department of HealthDRSS Diabetes Retinopathy Screening ServiceDES Direct Enhanced ServiceDASL Drug and Alcohol Service in LondonELFT East London Foundation TrustEMIS web Egton Medical Information Systems (System that records patient consults)EPR Electronic Patient RecordEPCS Extended Primary Care ServiceEPCT Extended Primary Care TeamFOI Freedom of InformationGMC General Medical Council GMS General Medical Services (a type of Primary care contract)GP General PractitionerHoT Heads of Terms (Contract Summary)ICTP Integrated Care Transformation ProgrammeIMT Information Management and TechnologyIMCA Independent Mental Capacity AdvocateIG Information GovernanceITU Intensive Therapy Unit ITT Invitation to TenderKPI Key Performance IndicatorLD Learning DisabilityLD SAF Learning Disability Self-Assessment Framework

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LAP Local Area Partnership LAs Local AuthoritiesLCFS Local Counter Fraud SpecialistLES Local enhanced serviceLMC Local Medical Committee LAS London Ambulance ServiceLBN London Borough of NewhamMM Medicines Management MHCC Mental Health Commissioning CommitteeMPIG Minimum Practice Income GuaranteeNICE National Institute of Health and Care ExcellenceNUH Newham University HospitalNHSE NHS England NELCSU North East London Commissioning Support Unit NCCG Newham Clinical Commissioning GroupOOH Out of hoursPG Procurement GroupPC Practice CouncilPCC Partnerships Commissioning CommitteePALS Patient Advice and Liaison ServicePPE Patient and Public EngagementPPG Patient and Public GroupPREM Patient Reported Experience MeasurePROM Patient Reported Outcome MeasuresPMS Personal Medical Services (a type of Primary care contract)PCT Primary Care TrustsPHE Public Health EnglandQC Quality CommitteeQOF Quality Outcome Framework (Assessor Validation Reports)QIPP Quality, Innovation, Productivity and PreventionRAID Rapid Assessment Interface DischargeRAG Red, Amber, GreenRC Remuneration CommitteeRTT Referral to Treatment R&D Research & DevelopmentRLH Royal London HospitalSPR Service Program ReviewSPA Single Point of AccessTOR Terms of referenceTIC Transformation and Innovation Committee TDA Trust Development AuthorityUCTP Urgent Care Transformation ProgrammeUCC Urgent Care CentreUCC Urgent Care Centre

WELC Waltham Forest, East London and City (Integrated Care Programme)

Whipps X / WX Whipps Cross HospitalWTE Whole Time Equivalent

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Newham Clinical Commissioning Group Board Meeting Part I

Wednesday 8th October 2014 1:30pm – 3.30pm

Committee Rooms, Warehouse K, 2 Western Gateway, Royal Victoria Dock, Custom House, London, E16 9DR

No. Time Item Page Presenter

1. Administration & Updates

1.1 13:30 – 13:35 Welcome, Introductions, Apologies and Declarations of Interest Verbal Chair

1.2 13:35 – 13:40 Minutes of the Part I meeting 10th September 2014 Chair 1.3 13:40 – 13:50 Part I Action Log Chair 1.4 13:50 – 13:55 Chair’s Actions Chair 1.5 13:55 – 14:15 Chief Officer’s Report S Gilvin

2. Patient & Public Engagement

2.1 14:15 – 14:25 Questions Verbal Chair

3. Strategic Items for Approval

14:15 – 14:25 Appointment of Board Members – portfolios and Chairs of Committees and Transformation Programmes

To follow Chair

3.1 14:25 – 14:40 Newham CCG Constitution – proposed amendments

To follow S Sanghera

3.2 14:40 – 14:55 Newham Community Prescription (NCP) Evaluation Review.

S Sanghera

3.3 14:55 – 15:00 NCCG BAF – Month 6 Report S Sanghera 3.4 15:00 – 15:15 NCCG Finance – Months 5 Report C Whitton 3.5 15:15 – 15:25 NCCG Quality – Month 5 Report S Gilvin

4. Information Items to Note

4.1 15:25 – 15:30 Summary of September Committees and Transformation Programme meetings S Sanghera

5. Dates of Next Meetings

12th November 2014 1.30pm – 3.30pm 10th December 2014 1.30pm – 3.30pm

REGISTER OF INTERESTS

A register of members’ interests is available for viewing by the public. The register will be available at the meeting, on the website, or during working hours at Warehouse K, Custom House, London E16 9DR

PART II MEETING

To resolve that as publicity on items contained in Part II of the agenda would be prejudicial to public interest by reason of their confidential nature, representatives of the press and members of the public should be excluded from the remainder of the meeting. Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

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Item 1.2

Newham Clinical Commissioning Group (NCCG)

Minutes of the Part I meeting of the Board held on Wednesday 10th September 2014, 1.30pm- 3.30pm

Warehouse K, 2 Western Gateway Custom House London E16 9DR Present: Elected Voting members Dr Zuhair Zarifa Chair Elected GP Representative Newham CCG Dr Ashwin Shah Deputy Chair Elected GP Representative Newham CCG Dr Prakash Chandra Elected GP Representative Newham CCG Dr Elizabeth Goodyear Elected GP Representative Newham CCG Dr Ambady Gopinathan Elected GP Representative Newham CCG Dr Bhupinder Kohli Elected GP Representative Newham CCG Dr Jim Lawrie Elected GP Representative Newham CCG Dr Muhammad Naqvi Elected GP Representative Newham CCG Dr Stuart Sutton Elected GP Representative Newham CCG Dr Rima Vaid Elected GP Representative Newham CCG Appointed voting members Augustina Eyeson Practice Nurse Representative Newham CCG Steve Gilvin Chief Officer Newham CCG Paul Hendrick Lay Member Governance Newham CCG Charlotte Ladyman Healthwatch Representative Newham CCG Hazel Trotter Practice Manager Representative Newham CCG Chad Whitton Chief Finance Officer Newham CCG Appointed non - voting members Prof S. Milner Interim Director of Public Health LBN In attendance: Satbinder Sanghera Head of Governance and Engagement Newham CCG Chetan Vyas Director of Quality and Development Newham CCG Ian Tritschler Commissioning Support Director North East London

Comissioning Support Unit Mike Sims Board Secretary Newham CCG

1. Administration and Updates 1.1 Welcome, Introduction, Apologies for Absence & Declarations of Interest

1.1.1 1.1.2

Welcomes and introductions The Chair welcomed all to the meeting. The Chair advised that he had written on behalf of the Board to retiring members Dr Lise Hertel, Dr Hardip Nandra, Prof Graeme Betts and Mark Santos expressing the Board’s gratitude for their work. The Chair welcomed new Board members A Eyeson, Dr R Vaid and Dr M Naqvi.

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1.1.3 1.1.4

Apologies were given for: • Dr Rizwan Hasan Secondary Care Consultant Newham CCG • Andrea Lippett Lay Member Remuneration Newham CCG • Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement

Newham CCG • Grainne Siggins, Director of Adult Social Services LBN

There were no declarations of interest.

1.2 Minutes of the Part I meetings 9th July 2014

1.2.1

The Chair took matters of accuracy and matters arising together. The minutes of the meeting of 9th July 2014 were approved as an accurate record of the meeting

1.3 Part I Action Log

1.3.1 1.3.2 1.3.3 1.3.4

CCG49 – Development of IT systems permitting GPs access to updated children at risk data – still awaiting automatic updates from LBN on the spine. No new date. S Milner agreed to chase up on behalf of LBN and Dr L Goodyear undertook to raise the issue at the next Safeguarding meeting, as well as consider how the Out of Hours service would access the same data. CCG55 – Develop Cluster risk registers – The Chair reported that an email had been circulated to the Board advising that all clusters now have a risk register where identified risks at cluster meetings are entered into the risk log. Risks are discussed with risk owner and actions for mitigating discussed. Risks which may require attention at the cluster leads meeting are collated and taken to this meeting so a cluster leads the risk log. CCG61 – Relationship with LBN in terms of being partners or stakeholders within governance arrangements – S Gilvin and K Bromley-Derry, LBN’s Chief Executive, would be progressing this item jointly with a presentation to the Board at its October development session. Board agreed to close the action. CCG96 – Letter to Bart’s on colorectal closure – has been sent by the Quality Committee and a response received. S Gilvin also reported that he had, as the Board had requested, held provisional discussions with Homerton hospital on a possible alternative permanent provision of the service should this eventually be considered the way forward. Board agreed to close the action.

1.4 Chairs Actions

1.4.1 1.4.2

The Chair advised the Board that there were no Chairs actions to report. The Chair advised the Board that at Practice Council BHT had presented an explanation of their actions concerning the colorectal service closure as well as advising of the potential of developing both a Breast Clinic and the expansion

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1.4.3 1.4.4 1.4.5 1.4.6 1.4.7 1.4.8

of high volume short stay clinics at Newham Hospital. The Chair advised that the CCG Board had met with BHT Board on 3rd September which had been extremely positive, had discussed issues relating to finance, Newham Hospital and future communications arrangements with a view to a further meeting in December. The Chair advised that the CCG had met with senior clinicians from Newham Hospital at a Newham Clinical Forum and encouraged clinical members of the Board to attend future meetings. Dr A Gopinathan expressed some concern that as yet the CCG had not had sight of a plan from BHT on the reintroduction of colorectal surgery. S Gilvin advised that no decision had, as yet, been taken on colorectal cancer services and that the CCG was still awaiting proposals for that particular pathway. Dr E Goodyear advised that the message from the Board to Board meeting with BHT had been clearly that the CCG was being asked to recognise that the Trust operated in a broader healthcare system than just Newham and that the Board needed to work in a more collaborative manner with the trust in order to avoid a situation where NHSE might feel it was more appropriate to deal with the financial issues BHT faced by way of intervention. Dr J Lawrie advised that whilst he agreed it was important to recognise BHT’s role in a wider health economy, the CCG should bear in mind that hospitals had some history of claiming that changes to a specific service might result in an overall collapse of services as a technique for not implementing change. P Hendrick stated that the Board should retain its focus on the specific requirements that Newham, as a single client, requires much in the same way a large corporation would aim to meet the specific needs on its clients in the private sector. The report was noted

1.5 Chief Officer’s Report

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1.5.1

S. Gilvin introduced a verbal report updating Board on:

• Everyone Counts guidance – that the CCG had met with Clusters and agreed a way forward

• Operational resilience – that winter monies will be released to the CCG in September

• Bettercare Fund – that a final joint submission with LBN to NHSE will be made on 19th September with the only issue being that the submission will need to explain why the 3.5% emergency admission target was not appropriate to Newham.

• That a contract query notice had been served on BHT at the end of July requesting a recovery plan for finance activity and data, patient transport and SI reporting, RTT performance and Cerner upgrade issues at Whips Cross Hospital , and that performance on these areas was being monitored fortnightly.

• That detail of the Five-Year plan continued to be discussed between the CCG collaborative and NHSE and that a revised plan will be submitted to Board in November for approval.

The report was noted

2. Patient and Public Engagement 2.1. Questions

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2.1.1

There were no questions to the Board.

3. Strategic items for Approval 3.1

3.1.1 3.1.2 3.1.3

Commissioning Intentions 2015-16 . C. Vyas introduced a report for decision asking Board to agree the timeline and process for considering new commissioning intentions for 2015-16. C. Vyas advised that a total 115 commissioning ideas were generated which were reviewed resulting in 72 being rejected for variety of reasons leaving 43 ideas that were developed into 36 scoping papers. These were reviewed by Executive Committee on 27 August 2014. The Committee requested that 20 proceed to Business Case stage with no commitment at this stage for further detailed information and suggested that the rejected 16 scoping papers be referred to Commissioning Committees / Transformation Programmes for project development. C Vyas advised that a two stage Gateway process is being developed for Business Cases with Gateway 1 being 30th September 2014 and Gateway 2 31st October 2014 and that a Board Development session would be used for a further update in November 2014 with the intention to provide a final update to the Board in December 2014 for approval. H Trotter sought clarification on whether those cases originally rejected were as a result of clarifying that the service already existed within an existing contract. C Vyas advised that this was the case in relation to some proposals that had been put forward from the Clusters and that clearly the learning for the CCG was a requirement to more clearly communicate to Practices the

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3.1.4 3.1.5

existing content of contracts as part of this process. Dr E. Goodyear remarked that the process compared with 2013 had been a lot clearer and well managed and that this was a visible sign of the CCG maturing. S Gilvin reminded the Board that commissioning intentions letters would be signed off by Committee Chairs, noting that Dr E Goodyear would get oversight of all matters relating to children and maternity prior to issue. The Board approved;

• The process and timeline for 2015-16 Commissioning intentions

3.2 3.2.1 3.2.2 3.2.3 3.2.4 3.2.5

Newham CCG Gifts, Hospitality and Anti-Bribery Policy S Sanghera introduced a report for decision asking the Board to approve an organisational Gifts, hospitality and anti-bribery policy, explaining that the purpose of the policy was to provide guidance to staff and office holders on the action that can, or should, be taken in the event that they are offered gifts and/or hospitality, making it clear where the boundaries of acceptable conduct lie and to protect the property and finances of the NHS and of patients in the CCG’s care. S Sanghera advised that the Audit Committee had already reviewed the policy and in particular had enquired about the relationship specifically with pharmaceutical companies and the receipt of small hand-out gifts at conferences and lunches concluding that; • Overall, for small gifts that can be picked up at stalls, there was no reason to declare. • Best practice was, however, to always err on the side of caution and if in doubt declare. • Where any patterns of companies continuing to invite the same specific CCG members exists then most certainly declare. • Where an individual feels that the offer of refreshments or small gifts feels receipt is contingent on implicit favour, again declare. • That the CCG should consider the policy as applicable to co-optees as well as paid staff, Clinical Leads, Cluster Leads or Board members. S Sanghera advised that overall, the Audit Committee felt that the policy was appropriate and should be presented to Board for approval and implementation as soon as possible thereafter, also reminding Board that in January all Board members, clinical and cluster leads had attended a session on the Bribery Act and a further session would be scheduled for 2015. Dr S Sutton sought clarification on lunches provided by pharmaceutical companies at CCG events. S Sanghera advised that it was for officers to have arranged the meeting and take into account the policy when doing so but the key issue was whether there might be a perceived relationship between any hospitality and procurement. Dr S Sutton advised that it was his view that therefore it was probably inappropriate for such companies to in fact be present CCG events. S Gilvin advised that he would ask S Sanghera to arrange a presentation to

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the Medicines Management Transformation Programme on the interpretation of gifts and hospitality guidance in relation pharmaceutical companies (Action CCG101 – Arrange presentation to MMTP – S Sanghera) The Board approved;

• The Newham CCG Gifts, Hospitality and Anti-Bribery Policy

3.3 3.3.1 3.3.2

Newham CCG Organisational Development (OD) Strategy C Vyas introduced a report for decision asking Board to approve an organisational OD Strategy explaining that four headline priorities were proposed:

• Excellent clinical and management leadership in health for Newham and its communities

• A clear vision, brought to life • A well-tuned delivery engine • A system for continuous learning and development

C Vyas clarified the strategy did not cover issues relating to primary care development, and that the CCG Management Team felt it had the capacity to deliver the strategy because much of the work was not about doing something new, only changing the way in which development was delivered and that a development officer was now in post to support the process. The Board approved; • The Newham CCG Organisational Development Strategy

3.4 3.4.1 3.4.2 3.4.3

Care Quality Commission (CQC) Inspection of health services for Looked After Children and Safeguarding - Action Plan S. Gilvin introduced a report for decision asking the Board to approve the Action Plan that had been agreed with stakeholders and submitted to the CQC as a result of review of health services for Looked After Children and Safeguarding in Newham. Dr J Lawrie requested that the CCG ensured systems were in place that were robust enough to capture all electronic information automatically from the GP record that would be relevant from a safeguarding perspective explaining his concern was that if a problem occurs around Child protection, safeguarding or other issues the GP may be found at fault for failing to comply with this requirement. Dr J Lawrie advised that a way to deal with this would be to be very specific about the exact data needed but ideally that the system automatically uploaded the data needed into a referral form. Dr S Sutton raised concern about the fact that communication from the Local Authority child assessment & safeguarding team was generally poor, often using a generic template that did not correctly report the level of concerns raised (i.e. Child in Need as opposed to Child Protection) which also could omit signed consent or, if relevant, the fact that parents have declined to consent to sharing information. Dr E Goodyear advised this issue was under review in her capacity as clinical lead for Children and Maternity with C Vyas as Safeguarding Lead and this would be addressed through the joint Health

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3.4.4 3.4.5 3.4.6 3.4.7

Safeguarding group that reports to the CCG Quality Committee. It was agreed a report back could be made on progress. (Action CCG102 – provide assurance that communication systems with Social Services for such cases are under review – C Vyas) Dr B Kohli and Dr E Goodyear advised that recommendation 1.1 recommending a review of current information sharing protocols provided an opportunity to prioritise the data sharing agenda across the health sector and required the Board to provide high level support on the priority of primary and community care IT integration, stating that IT requirements should therefore be a key priority within the response to the CQC’s recommendations. C Vyas confirmed that the CCG would be using relevant Commissioning Intentions letters in September to enforce that data sharing was a key priority for the CCG. C Vyas reminded the Board that the action plan being considered was not a draft and had already been signed off with the CQC advising that the CCG would ensure anything outside the scope of the Action plan could be addressed through the Joint Health Safeguarding Group (Action CCG103 –ensure issues relating to 1.2 of report are addressed through the Joint Health Safeguarding Group – C Vyas) S. Gilvin added that the requirement to agree the Action Plan prior to the Board Meeting was unfortunately driven by the CQC’s response timetable, although there was nothing to prevent the CCG from considering further actions required to enhance service delivery that the Board felt appropriate. The Board approved; • The Care Quality Commission (CQC) Inspection of health services for

Looked After Children and Safeguarding Action Plan

3.5 3.5.1 3.5.2 3.5.3

Transforming Services Changing Lives (TSCL) – Interim Case for Change S Gilvin introduced a report for decision asking Board to approve an Interim Case for Change noting that a final report will be submitted to Newham together with Tower Hamlets and Waltham Forest CCGs Boards in November for final approval. S Gilvin advised that the programme had been established by commissioners and providers in East London to enable joint planning of services to address the shared challenges that the NHS faced and that the first phase of the programme developed an Interim Case for Change which had focused on looking at the quality, performance and arrangement of existing services, what was best practice and the challenges facing services. S Gilvin advised that as a result of discussions held within forums in Newham the Board was being asked to approve the following principles: • Primary Care - That a clinically-led forum should be established to

consider the implications for primary care particularly in relation to resources, workforce, ICT and infrastructure to enable primary care to fulfil such an expanded role.

• Newham University Hospital - That the CCG’s engagement in the work of

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3.5.4 3.5.5 3.5.6 3.5.7 3.5.8

the TSCL programme in redesigning pathways of cares should be based on the principles and services that the Board approved should exist at its December 2013 meeting.

• Digital Technology – That the CCG commits to revolutionising the patient experience through the use of digital technology to drive sharing of records and to ensure diagnostic tests are easily accessible both in terms of clinicians viewing the test results and ease of access for patients to the tests.

Dr Sutton suggested that at this stage the in principle proposals of the TSCL programme were to be welcomed but that the real issue was what this meant in terms of translation into practical measures in terms of proposals for funding and local implementation. Dr P Chandra stated that the TSCL programme was to be supported but that the case for change should state that there would be a local programme for its delivery in Newham. S Gilvin reconfirmed a recognition that whilst the programme recognised the merit in collaborative models of care that thereafter it was recognised that there would have to be local, site specific implementation. S Gilvin reminded the Board that primacy in relation to the TSCL programme remained with the Board and not with a North East Group of CCGs, although he agreed to ensure that the Interim Case for Change would include a paragraph relating to local delivery. (Action CCG104 - Include paragraph on local delivery in the Interim Case for Change – S Gilvin) H Trotter requested confirmation that a Practice Nurse was on the Primary Care Forum and that consideration be given to the inclusion of a Practice Manager on the same group. (Action CCG105 – confirm inclusion of Practice Nurse on Primary Care Forum and that consideration to Practice manager also joining group is being made – S Gilvin) Dr B Kohli agreed to assist S Gilvin in revising the wording of the Interim Case for Change in relation to digital technology. The Board approved; The Transforming Services Changing Lives Interim Case for Change

3.6 3.6.1

Newham CCG Board Assurance Framework (BAF) – Month 5 S Sanghera introduced a report for decision asking Board to approve the revised format of the BAF risk summaries, approve the risk status of the BAF and note updates to actions and risk ratings. The Board approved;

• The risk status of the BAF • Noted updates to actions and risk ratings.

3.7

3.7.1

NCCG Finance – Month 4 Report C. Whitton introduced a report recommending to Board the approval of the

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3.7.2 3.7.3 3.7.4 3.7.5 3.7.6 3.7.7 3.7.8

current (month 4) CCG accounts. C. Whitton advised the Board that the significant issue for consideration was the overperformance of acute spending and in fact that initial data for month 5 now projected a £13,300,000 overperformamce of which some £10,000,000 related to BHT, meaning that his advice to the Board was that the evidence for a significant year-end Acute overperformance was likely. C Whitton advised that current reserves had been set aside to cover this eventuality and, whilst a challenging position, at this stage the overperformance did not put at risk any existing proposals any other proposed commitments for the year but that should the position deteriorate at a rate more significantly than at current the Board may have to consider changes to its currently proposed programme. C Whitton advised that the month 5 Report would provide more specific detail on the drivers of Acute overperformance with significantly more detail than usual given the identified risk. C Whitton reported that QIPP savings remained, overall, on target although e not aligned to current individual target areas. S Gilvin added that initial indications were that overperformance was being driven by urgent care and non-elective surgery costs. DR B Kohli commented that a further significant change in forecast related to BMI spend and C Whitton advised that Finance staff would be reviewing this data with the Clusters. Dr M Naqvi advised that he would be working with CCG staff to ensure that the financial data resulting from the Urgent care Centre activity was as accurate as possible. The Board approved;

• The Month 4 financial report.

3.8 3.8.1 3.8.2 3.8.3

NCCG Quality – Month 4 Report C. Vyas introduced a report recommending Boarding the approval of the CCG’s Quality Report relating to Month 4 RAG (Red, Amber and Green) ratings for Bart’s Health and ELFT. C. Vyas advised the Board that a summary of the Red risk indicators for BHT was; • Serious Incidents overdue 6 months or more • Mixed Sex Accommodation • Amber Alerts actioned within 10 working days • MRSA • Friends and Family Test C. Vyas advised the Board that a summary of the Red risk indicators for ELFT was;

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3.8.4 3.8.5 3.8.6

• Serious Incidents overdue by 6 months or more • Adult Community DNA rates • Adult inpatient re-admissions within 28 days C Vyas confirmed to Dr A Gopinathan that there were financial penalties associated with Serious Incidents C Vyas advised the Board of the decision to permit ELFT to trial responses to amber alerts within ten as opposed to five working days on the basis that the quality of the response would improve. Vyas advised the Board of the quality matters relating to the Barts Health Contract Query Notice previously referred to in the Chief Officer update as follows: Serious Incidents - 91 originally overdue - At 21 Aug this has been reduced to 55 (does not include Maternity) - Total clearance agreed by 30 Sept with Collaborative Commissioners based on the Remedial Action Plan - Project initiated between Newham CCG, Tower Hamlets CCG and Waltham Forest CCG led by Director of Nursing, Quality and Governance at WFCCG on behalf of the Barts Health Collaborative Commissioners to manage the appropriate closure and review of all SIs - All cases closed are being reviewed individually by the Director of Nursing, Quality and Governance - All maternity Sis will be reviewed on 11 Sept - Each CAG has a SOP agreed re managing Sis which was not on place previously - A Remedial Action Plan has been developed which will be closely monitored Patient Transport - Barts Health went from 14 Service Providers to one Provider post-merger - Change agreed prior to the Independent Panels to sign off CIPS at Barts Health in 2014 - GP Practices and other Providers raised this issue with Newham CCG and it became apparent this was part of a larger issue across the patch covered by Barts Health - Raised formally at Barts Health CQRM meetings to improve quality for patients – assurances provided however slow progress to remedy quality concerns - Serious Incidents formally raised and all have been reviewed against a clinical harm matrix - This position was stabilised by the end of July with some outstanding issues remaining for renal services. This situation has greatly improved during August - Commissioners not assured subsequently led to a formal CQN - A Remedial Action Plan has been developed and approved by Commissioners which will be closely monitored

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The Board approved; • The Month 4 Quality Report.

4. Items to Note 4.1

4.1.1

Appointment of Board and Chair S Sanghera invited the Board to congratulate Dr Z Zarifa’s reappointment as Chair. The report was noted

4.2 Summary of August Committees and Transformation Programme Meetings The report was noted

4.3

Newham Healthcare Summary The report was noted

The Chair closed the meeting at 3.30pm.

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ITEM 1.3 - highlighed items represent a recommendation to remove from register

Action reference

Meeting date

Minute reference Action Owner Deadline Update

CCG49 13/11/2013

3.2.3

Develop IT systems via IT Group that permit GPs to be able to access data on children at risk Steve Gilvin none

still awaiting automatic updates from LBN on the spine. No new date. S Milner agreed to chase up on behalf of LBN and Dr L Goodyear undertook to raise the issue at the next Safeguarding meeting, as well as consider how the Out of Hours service would access the same data.

CCG55 11/12/2013

3.3.2

Develop Risk Register at Cluster level Jane Lindo none

Board on 10th September 2014- reported that all clusters now have a risk register where identified risks at cluster meetings are entered into the risk log. Risks are discussed with risk owner and actions for mitigating discussed. Risks which may require attention at the cluster leads meeting are collated and taken to this meeting so a cluster leads the risk log.

CCG101 10/09/2014

3.2.5

Arrange a presentation to Medicines Management Transformation Programme on guidance on the Gifts and hospitality Policy on pharmaceutical company relationships

Satbinder Sanghera none

CCG102 10/09/2014

3.4.3

Safeguarding – provide assurance that communication systems with Social Services between GPs and Social Serices reChild in Need and Child Protection cases are under review

Chetan Vyas none

CCG103 10/09/20143.4.6

Ensure issues relating to 1.2 of report are addressed through the Joint Health Safeguarding Group

Chetan Vyas none

CCG104 10/09/2014 3.5.6TSCL - include paragraph on local delivery in the Interim Case for Change Steve Gilvin none

CCG105 10/09/20143.5.7

TSCL - Put forward proposal to include Practice Manager / Practice Nurse on Primary Care Forum

Steve Gilvin none

Newham CCG Board Action Log Part I at 8/10/2014

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Board Meeting - NCCG

08 October 2014 Title:

Newham Community Prescription (NCP) Evaluation Review.

Agenda item:

3.2

Author:

Andrew Paterson- Senior Commissioning Manager, Newham CCG

Presented by:

Satbinder Sanghera, Head of Governance & Engagement Newham CCG

Contact for further information:

Andrew Paterson, Senior Commissioning Manager, Newham CCG

This Paper is for: Decision

☒

Monitor

☐

Discuss

☐

Information

☐

Action required: The Board is asked to :

• Note the quantitative and qualitative executive summaries, attached in appendix A

• Agree the proposed methodology to be followed by the evaluation group in next steps and future ambition

• Agree to receive an options appraisal paper at November board.

Executive summary:

A review of the evidence published to date suggests that the Newham Community Prescription (NCP) is an innovative option to improve upon current challenges experienced across Newham with regards to improving physical activity levels and healthy eating behaviours. Utilising the 3rd Sector community groups has proved successful in engaging with Newham’s ethnically diverse community, which previous approaches have failed to do. The experience of the CCG and the national direction of travel strongly support an integrated approach across the health and social care sector to meet the long term conditions challenges of the future.

Supporting papers:

NICE guidance: http://www.nice.org.uk/guidance/ph38/resources/preventing-type-2-diabetes-risk-identification-and-interventions-for-individuals-at-

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high-risk-costing-report2

How does this fit with Newham CCG Strategy:

The Newham Community prescription is aligned to the Newham Clinical Commissioning Group (NCCG) priority: ‘To improve patient experience and better manage demand, the CCG will join up local primary, community and acute care services to help people prevent and manage long term conditions, promote resilience and independence’. NCCG identified the delivery of the NCP as a key strategic objective; it is also a vital component of its Patient and Public Engagement (PPE) Strategy, a major contribution to the joint Health and Well Being Strategy and LBN resilience strategy; The single CCG value and aim which best described this initiative are as follows: Value: Working with our partners to improve health outcomes Aim: Improving health outcomes through developing models of integrated care and focusing on prevention

Where has the paper been already presented?

Senior Management Team 30.09.2014

Risk: Chronic long term conditions continue to be a challenge for Newham, which

has some of the highest incidences in the country and many patients are presenting at an earlier age than in other parts of London and England1 An integrated approach across all stakeholders in the borough including the 3rd sector organisations is required as this challenge is set to worsen over the next 2-5 years.

Equality Impact:

Chart 1: Comparing ethnicity and deprivation of Newham CCG with England. As can be seen from chart 1 above, there are significant differences in both deprivation and ethnicity in Newham when compared to England Further analysis to understand the breakdown by gender and ethnicity across long term conditions for Newham will be undertaken to identify any particular groups of society that are at greatest risk. The results will be

1 Aston Mansfield’s Community Involvement Unit (2013) Newham Key Statistics 2013: A detailed profile of key statistics about Newham, London: Aston Mansfield.

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presented in the options appraisal should the board agree to progress.

Stakeholder engagement:

Clinical engagement in the development of the NCP began in February 2012, as part of the McKinsey supported board development programme and presentation to the 2012 NHS Confederation Conference. Further extensive engagement was undertaken within the PPE domain of the CCG authorisation process together with the National Patient Champions Network Launch (Dec 2011) and a Diabetes Education Consultation event (March 2012). A wider consultation workshop with key stakeholders (including UEL, WHUFC, co-production forum, public health and LBN) was held in September 2012 and endorsed the concept and strategy. At the beginning of the Newham Community Prescription pilot it was agreed to undertake evaluation at the conclusion of the pilot. The CCG commissioned the University of East London to conduct both a quantitative and qualitative evaluation. The evaluation exercises undertaken by University of East London involved interviews with patients, practitioners and stakeholders.

Financial Implications

This innovative approach does present elements of risk on account of certain academic studies which the review highlights. However through partnering with a number of stakeholders including London Borough of Newham the CCG would be reducing that risk. A financial modelling exercise will be undertaken to identify any savings in the system that can be realised, and ensure the assumptions from published evidence holds true.

1.0 Introduction

1.1 1.2 1.3 1.31

The NCP pilot project sought to explore an innovative approach to prevent or delay the onset of diabetes locally by equipping primary care clinicians’ with ‘prescribing solutions’ that connects patients with new community based services to help them embrace healthier life style choices and health promoting behaviours. Following the completion of the NCP pilot, a task and finish evaluation group comprising GPs, NCCG officers and LBN was formed to undertake a comprehensive review of the community prescription pilot and develop an options appraisal for the CCG board to consider. Background In 2012/13 there were 20,645 people aged 17 years and older diagnosed with diabetes in NHS Newham CCG, with the prevalence of both recorded and modelled estimated being significantly greater than both London and England, as illustrated below: Chart 2 below compares the prevalence of diabetes in NHS Newham CCG with the cluster group* and England as a whole.

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1.32 1.33 1.34 1.35

*(Grouping of CCGs that have similar characteristics: the blue group has a very high young population with a high proportion of Black and ethnic groups and high levels of deprivation.) Diabetes is a serious life-long condition, which reduces life expectancy by up to 10 years in type 2 patients2. Newham is reported to have some of the highest incidences of long term conditions in the country and many people are presenting with long term conditions at an earlier age than other parts of London and England.3 Diabetes projections for England show the numbers rising by two thirds within the next 10 years. With Newham’s diverse population and high deprivation rates the growth locally will be higher than the English average. In Newham we are currently observing 1800 new diabetes and 1000 new pre-diabetes diagnoses per year. A CEG audit held in August 2014 found there are now 8994 people in Newham in primary care coded as having ‘pre-diabetes’ (includes both recorded and HbA1c in range of 42-47.) Newham CCG spent a total of £6.1m on prescriptions for diabetes items between April 2012 and March 2013. This was equivalent to £297.024 per adult with diabetes. From studying chart 3below the projected diagnosed diabetics can be seen to increase over the next 2-5 years reaching just under 30,000 by 2019 and the projected prescribing costs could reach just below £9 million by 2019. This projection is not including the costs for non-elective diabetic complications, outpatients and other associated activities.

2 Department of Health (2001). National service framework for diabetes: standards. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002951 3 Aston Mansfield’s Community Involvement Unit (2013) Newham Key statistics 2013: A detailed profile of key statistics about Newham, London: Aston Mansfield. 4 Diabetes Clinical Commissioning Group Profile 2013

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Chart 3: Projected Diabetes Prevalence and Prescribing Costs for Newham CCG5

2.0

Physical Activity Evidence

2.1 2.2 2.3 2.4 2.5 2.6

Physical Activity is very cost effective for health gain. Below compares the cost per QALY for physical activity interventions with smoking cessation and primary prevention for statins. Quality Adjusted Life Year (QALY) is an estimate of a person's life expectancy coupled with an estimation of the person's future quality of life. A year of perfect health is worth 1 and a year of less than perfect health is worth less than 1. The QALY itself cannot tell you if a treatment provides value for money. Instead, we combine the QALY for a new medicine with the cost of the new medicine. This produces a ratio called the cost per QALY. The cost per QALY shows how many extra quality adjusted life years the new medicine gives and how much extra it costs compared with the current treatment. This enables clinicians and commissioners to judge if a ‘new intervention ‘is good value for money’ Each cost per QALY costs can be compared below67:

• £17,000 for Statin supplement • £9,515 for smoking cessation • £440 for physical activity

Physical activity improves control of blood glucose in type 2 diabetes mellitus due to improved insulin sensitivity. This may enable reduction and even discontinuation of medication in a substantial proportion of patients.i ii iii iv

5 NCCG September 2014 6 Department of Health 2009 Let’s Get Moving HMSO 7 Cost of QALY worked example-see Appendix C

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2.7 2.8 2.9 3.0 3.1 3.2

Either aerobic or resistance training improves glycaemic control (measured with HbA1c) in type 2 diabetes mellitus, but the improvements are greatest when combined with aerobic and resistance training.v High sugar levels in the blood can lead to conditions such as diabetes. Blood sugar levels can be measured through glycated haemoglobin (HbA1c); a protein within red blood cells that carries oxygen. Exercise programmes can reduce HbA1c levels by approximately 0.6% as well as reducing body fat; adipose tissue and triglyceride levels.vi There is strong and consistent evidence that the incidence and progression of type 2 diabetes mellitus can be reduced with physical activity in people with impaired glucose tolerance (pre-diabetes) and that the effects are independent of weight lossvii. In a meta-analysis,viii regular physical activity halved the risk of developing diabetes (hazard ratio = 0.49). This compares favorably to diet only (HR = 0.67), but identical to combined diet and exercise (HR 0.49).In the same study, numbers needed to treat (NNT) to prevent a case of diabetes were 6.4 for diet and exercise, 10.8 for anti-diabetic medication (e.g. metformin). Much of the increase in type-2 diabetes in Newham is due to rising rates of obesity, sedentary lifestyles, dietary trends and an ageing population (YHPO 2010). However lifestyle interventions targeting these risk factors have been shown to reduce its incidence by about 50% amongst high risk individuals. (Gillies et al 2007). NICE guidance (PH38 2012) on identifying people at high risk of type-2 diabetes and preventing or delaying its onset states that this group should be reviewed at least annually and provided with appropriate education and lifestyle interventions. A combination of both diet and exercise was shown to have more effect than either diet or exercise alone.

4.0 Key Evaluation Findings-Quantitative 4.1 4.2 4.3 4.4

The NCP pilot (need to state sample size) was successful in increasing physical activity and improving mental well-being for previously inactive diabetic and pre-diabetic individuals who attended 12 weeks of physical activity. The primary outcome measures for this study were mental wellbeing, measured using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and physical activity measured using the International Physical Activity Questionnaire – Short Form (IPAQ-SF). There was a 35% (27% to 62%) increase in the number of people who have reached the Government recommended levels of activity of 150 minutes per week.8 From studying table 1 below, comparing the NCP against other documented interventions, it shows that 35% is on the higher end of the range in terms of impact.

8 UEL Changes in health outcomes in diabetic and pre-diabetic patients in the Newham Community Prescribing pilot project: analysis of pre and post data. September 2014.

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4.5 4.6

Intervention Increase in

physical activity from low to moderate or 150 minutes/week

Source

Brief Intervention 9% NICE PH44 (2012) Health Walks 13% NICE PH41 (2012) Workplace walking programmes 21% NICE PH13 (2008) Community Prescription 35% UEL Evaluation Workplace one to one counselling 37% NICE PH13 (2008)

Table 1: The increase in physical activity from different physical activity interventions The evaluation found that there was a statistically significant increase in mental wellbeing as measured by the Warwick-Edinburgh Wellbeing Scale score, table 2 below.

Primary outcome variable

Pre-intervention

(mean) SD

Post-intervention

(mean) SD Test Test statistics Mental wellbeing (WEMWBS) 51.96 9.8 57.03 6.3 t-test t=3.5221 p=0.0004

Table 2: Increase in Wellbeing with the Newham Community Prescription It is also important to consider the implications of physical activity for co-morbidities in participants. Almost half of the participants in the sample were living with a diagnosis of either hypertension (40.9%) or coronary heart disease (7.6%). Physical activity levels in people with diabetes have important positive implications for some of these co-morbidities, particularly hypertension (Semlitch et al 2013) and heart disease (Bird, 2013).

5.0 Qualitative Findings 5.1 5.1.1

Three key areas for policy and commissioning consideration were identified in the qualitative evaluation:

o More effective communication between stakeholders o Increasing completion rates o Long-term sustainability of Newham Community Prescribing

More effective communication between stakeholders: The evaluation group agreed that improvements could be made to improve communication and efficiencies made in procedures used. The evaluation highlighted the need for a longer pre-intervention period in order to put in place the basis for effective communication between CCG, GP practices, navigators, managing organisation, and delivery organisations which is at the basis of the success of any Social Prescribing initiative (Simmons et al, 2013). Clear communication can be achieved by clearly specifying roles and responsibilities, particularly in the relationship between all stakeholders. This will be adopted in any future initiative.

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5.2 5.2.1 5.2.2 5.2.3 5.3 5.3.1 5.3.2

Increasing completion rates The evaluation underlined the importance on investment in ‘navigators’ as a future option to consider for improving completion, as evidence shows that they play a key role in the referral process (Brandling and House, 1997; Friedli et al 2012). The group acknowledged how further consideration should be made to this resource to increase contact with patients to ensure that a range of issues such as inappropriate referrals, and any patient’s issue with physical activity classes can quickly be addressed, and thus retention of participants secured. It was suggested that any future community prescription initiative could consider the support from volunteers, particularly when these are people who have completed the intervention and can help to promote the programme as ‘champions’ Furthermore the report cited the following factors: cost, type of activities, location, timing and age/status of groups targeted, when seeking to increase the number of completions. The evaluation group have noted these points and are looking to capitalise on the current partnership project with Morgan Stanley to utilise the professional expertise form the private sector particularly with regards to supporting 3rd groups around financial models for full cost recovery. Long-term sustainability of Newham Community Prescribing The evaluation raised the challenge which the NCP pilot has attempted to address the chronic lack of finance available to third sector organisations for the delivery of health and social services, highlighting the strategy based on funding ‘following the patient’ and paying organisations on the basis of number of physical activity classes is an innovative and crucial element that could secure the sustainability of social prescribing. It was reported that some of the groups within the pilot experienced challenges around full cost recovery. Similarly, participants reported that they could not afford paying physical activity classes in full, although there were some respondents who had effectively carried on after the end of the pilot and paid for physical activity classes in full. The report suggested a payment mechanism on a sliding scale starting from full subsidy which will encourage 3rd sector groups to maximise the number of people attending physical activity classes to a lower level which will partly subsidise the intervention encouraging providers to support part of the cost or charge participants, but still retaining a very competitive rate. This will be further investigated as part of the Morgan Stanley partnership. The intended outputs will be to support 3rd sector organisations to identify gaps in their resources, business processes and development strategies

6.0 Next Steps 6.1 6.1.1

The evaluation group reached agreement that based on the evaluation results and in the interests of equity; the NCP should be ‘opened up’ to enable the whole community access to the benefits that a Newham Community Prescription Scheme can offer.. The group has identified the following steps for the board to consider:

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6.2 6.3 6.4 6.4.1 6.4.2 6.4.3

• To understand the scale in terms of numbers of patients involved should the

community prescription seek to expand across all Long Term Conditions, as well defined cohorts such as Mental health, Obesity, Hypertension, and Pre-diabetics modelling

• From this analysis further financial modelling should focus on a defined cohort of a scale that capacity could be met and would be financially sustainable for the CCG.

• Provide a number of options for the board to consider in November At this stage, certain assumptions have been made around costing, based on NICE guidance and the Community Prescription pilot. Additional work is underway with the CCG partnering with Morgan Stanley and the Stay-well partnership to better understand full cost recovery of activities that can be provided by third sector organisations in the future. This will be used to inform future funding models, should the board agree to progress with the community prescription. In addition it is recognised that with the expansion of personal health budgets from April 2015 to include long term conditions, this increases the range of options available for future funding models. The evaluation group acknowledges there are some key aspects of the NCP pilot which will require further strengthening :

• Community prescription navigators/Health activators: It is well documented the value navigators/activators can bring to determine the activity most suitable for each individual through using the skills of a trained motivational interviewer.9 On account of this, the group in modelling for a ‘pre-diabetic’ cohort have added two follow up calls to be made to each patient engaged within the programme. It is also recognised that Active Newham Leisure Trust are using ‘health activators’ whom perform similar activities and hence further supporting the opportunity for further integration with the local authority.

• Tailoring to profiles: To build upon the issues highlighted in the NCP evaluation around types of activities and scheduled times, the group has reviewed literature available in this field. Sport England10 highlighted particular profiles that were less likely to engage in sports and physical activity. They comprised of ‘supportive singles’, ‘stretched single mothers’, ‘older working mothers’, and ‘local ‘old’ boys’. It was concluded that further work is required around supporting these groups; subsidised sessions, help with childcare; having a ‘buddy group’/companion to attend sessions with.

• Improving the retention of the NCP: The evaluation group has considered the comments from the evaluation around increasing retention and completion rates and recommends adding a Patient Activation Measure11 to the existing pathway to gauge the likely extent of a patient’s engagement. Further exploration into the use of community volunteering, providing additional befriending/support to encourage and support retention of patients once engaged with activities should also be considered for any future programme.

9 Brandling and House, 1997; Friedli et al 2012 10http://segments.sportengland.org/results.aspx?query=Segments#segment=dominant&focusType=LA&focusName=182&output=map&map=polygon&polygonType=OA&catchmentType=focus&querySource=Segments&queryType=SegRank1 11 http://www.kingsfund.org.uk/publications/supporting-people-manage-their-health

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6.5 6.6

Preliminary enquiries have been made with final year B.Sc. Health Promotion undergraduates from the University of East London. Students at the University have expressed a strong interest in working with community groups and the new academic framework will be working to support more student involvement in community projects in the future. Finally the group acknowledges that both governance arrangements and CCG staffing will need to be considered in greater detail, should the decision from the board agree to progress with the Community Prescription and request a more detailed implementation plan.

7.0 Future Ambition

7.1 7.2 7.3 7.4 7.5

It is the ambition of the CCG to have a fully integrated physical activity and healthy eating programme which spans across the borough and involves a partnership with the London Borough of Newham and community groups for both the prevention and management of long term conditions. The NCP pilot demonstrated the importance of localised activities for Newham’s diverse community groups particularly when targeting the least active members of Newham’s community. Third sector groups can play a key role in delivery. The NCP pilot was innovative in terms of providing a ‘money follows the patient’ model where delivery organisations are paid on the basis of the extent of physical activity they provide to the target population. It is recognised that a pivotal role within the NCP pilot was that of the community navigator. Having a trained motivational interviewer to review each patient for approximately 30 minutes allowed patients to be directed to activities tailored to their identified preferences. Greater resource around this role and how similar roles are currently being used across the borough will be reviewed, and options presented for consideration. The evaluation group recognises the importance of ‘pooling resources’ to minimise duplication of public monies and enable a more coordinated approach and ensure equal access across the borough. This will also result in more efficient use of resources for training programmes, staffing, and recording/collection of information.

8.0 References

i Wing RR, Epstein LH, Paternostro-Bayles M, et al. Exercise in a behavioral weight control programme for obese patients with type 2 diabetes. Diabetologia 1988; 31: 902. ii Heath GW, Leonard BE, Wilson RH, et al. Community-based exercise intervention: Zuni diabetes project. Diabetes Care 1987; 10: 579–583. iii Boule NG, Haddad E, Kenny GP, Wells GA, and Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Journal of the American Medical Association 2001; 286 (10): 1218–1227 ivDengel DR, Pratley RE, Hagberg JM, Rogus EM, and Goldberg AP. Distinct effects of aerobic exercise training and weight loss on glucose homeostasis in obese sedentary men. Journal of Applied Physiology 1996; 81 (1): 318–325 v Sigal RJ, Kenny GP, Boule NG, Well GA, Prud’home D, Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jenning A and Jaffey J. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Annals of Internal Medicine 2007; 147 (6): 357–369 vi Thomas, D., Elliot, E.J. & Naughton, G.A. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2006, Issue 3 Art. No.: CD002968

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vii Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med. 2000;132:605–611 viii Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW, Priest EL, Blair SN: Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 27:83– 88, 2004

Appendices: Appendix A

ex summary qual and quant evaluation of N

Appendix B

.

Diabetes Summary for Newham CCG (2).

Appendix C Cost of a QALY worked example would be as follows: A patient is receiving intervention A. If he continues with intervention A he will live for 10 years and his quality of life will be 50% of normal (0.5). If he receives a new intervention B, he will live for 12 years and his quality of life will be 70% of normal (0.7). The new medicine, medicine B, is compared with medicine A in terms of QALYs gained as follows:

•Intervention A: QALY = 5 (10 years x 0.5) •Intervention B: QALY = 8.4 (12 years x 0.7)

Therefore, intervention B results in 3.4 additional QALYs when compared with intervention A. Intervention B costs £10,000 more than A. The difference in treatment cost is divided by the number of QALYs gained. This provides the cost per QALY i.e. £10,000 / 3.4 = £2,941. Therefore, intervention B would cost £2,941 per QALY.

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October 2014 Prepared by: Institute for Health and Human Development (IHHD), University of East London Project Team for qualitative evaluation Dr Marcello Bertotti Loreta Martinaityte Ruby Farr Project team for quantitative evaluation Dr Marcello Bertotti Dr Paul Watts Irram Akhter David Eselebor Main contact: Dr Marcello Bertotti, Senior Research Fellow, IHHD, University of East London Water Lane Stratford E15 4LZ t: +44(0)20 8223 4139 m: +44 (0)7900 593 655 e: m.bertotti@uel.ac.uk w: http://www.uel.ac.uk/ihhd/

An evaluation of Newham’s Community Prescribing Scheme: executive summary of qualitative

and quantitative evidence

Commissioned by Newham Clinical Commissioning Group Acknowledgements for qualitative evaluation We gratefully acknowledge the contribution made by patients and other stakeholders who participated in this research. We also would like to thank Forum for Health and Well-being and in particular Mrs Irram Akhter for her help with accessing participants. Disclaimer The views expressed in this report are those of the authors and do not necessarily represent those of Newham Clinical Commissioning Group

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Executive Summary 1 Background and Rationale Long-term conditions, health inequalities and the rising cost of health to the NHS are calling for the development of a new approach to healthcare alongside the dominant bio-medical model. The Newham Community Prescribing (NCP) pilot is part of this new approach. It is centred upon people’s choice, well-being, prevention, management of health conditions, is delivered by a team of people including doctors, nurses, but also community organisations and community workers; and where medical and social approaches are integrated to create a new hybrid (Horne et al, 2013). In the NCP pilot, pre-diabetic and diabetic people are referred by their GP to community navigators who meet patients and discuss what type of physical activity is most suitable to them. Patients are then referred to suitably accredited organisations in the community and voluntary sector to attend physical activity classes for a period of 12 weeks. 2 Methodology We conducted a qualitative evaluation looking at two aspects of the pilot: (i) the experience of participants who have completed 12 weeks of physical activity; (ii) the experience of all stakeholders in relation to the implementation of the pilot. We also conducted a literature review which examined lessons for implementation of similar initiative across the UK and reviewed the evidence on the impact of different Social Prescribing models on participants. We also carried out an analysis of quantitative data. Some 69 patients completed questionnaires before the referral to physical activity classes delivered by Communities of Health (CoH)1 delivery organisations and after the completion of 12 weeks of physical activity. Questionnaires included questions about physical activity collected through the International Physical Activity Questionnaire (IPAQ) and about mental well-being collected through the Warwick Edinburgh Mental Well-being Scale (WEMWBS). Our main research question for this was: ‘To what extent has the Newham Community Prescribing pilot project led to changes in levels of physical activity and/or mental well-being in pre-diabetic and diabetic patients?’ 3 Overall findings from qualitative and quantitative evaluation 3.1 Findings from qualitative evaluation Wide range of improvements in health and mental well-being for patients who were previously inactive. Health improvement included better flexibility and

1 Communities of Health (CoH) is a scheme that recognizes and validates physical activity and other health promoting activities in the borough. Accredited organisations can evidence capability to deliver appropriate physical activity, healthy eating advice, condition appropriate self-care, and health promotion programmes (NCP business case).

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mobility, lowering use of medication reduction in joint pain, improved breathing, weight loss, and a more balanced diet. This was accompanied by a significant reduction in mental health problems including isolation, increased social networks, and improved mental well-being. 3.2 Process evaluation Participants’ completion rate of the pilot was at the same level or exceeding other studies (17% completion rate2). There was also interesting evidence of new physical activity classes created as a result of demand from patients: creation of new markets led by patients’ demands/needs. However, some key challenges need to be considered: (i) Communication between stakeholders (ii) Realistic expectations of what could be achieved (iii) Issues with the long-term sustainability of the pilot. These are discussed in more detail in the section 4 below. 3.3 Findings from analysis of pre and post quantitative data The NCP pilot has been successful in increasing physical activity and improving mental well-being for previously inactive diabetic and pre-diabetic individuals who attended 12 weeks of physical activity. Some noticeable and statistically significant improvements in meeting physical activity recommendations (more than doubled) and mental wellbeing. There were some noticeable and statistically significant improvements in mental wellbeing, total MET minutes, in meeting physical activity recommendations (more than doubled), vigorous and moderate intensity MET minutes and a significant decrease in daily sitting time. It is also Important to consider the implications of physical activity for co-morbidities in participants. Almost half of the participants in the sample suffered from either hypertension (40.9%) or coronary heart disease (7.6%). Physical activity levels in people with diabetes have important positive implications for some of these co-morbidities, particularly hypertension (Semlitch et al 2013) and heart disease (Bird, 2013). 4 Key Recommendations from qualitative and quantitative

evaluation

2 This means that about one in six people who were referred actually completed 12 weeks of physical activity. As detailed in the qualitative report, this compares favourably with other evaluations which show completion rates between 13% and18%. There are, however, some issues in calculating these.

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We identified three key areas for policy and commissioning consideration:

1. A more effective communication between stakeholders: a. Longer pre-intervention period to enable clarity in specifying role and

responsibilities of all stakeholders involved and to set up monitoring systems and necessary buy-in

b. Continuous monitoring to identify issues at early stages: regular steering

group meetings involving all stakeholders, particularly navigators involved in the day to day running of the pilot

c. Stronger leadership from the CCG: role and responsibilities need to be

specified at the onset and key issues addressed in a timely manner

2. Increasing completion rates: a. Greater investment in navigators supported by volunteers. Other

evaluations showed that greater number of contacts with navigators increases retention rates by addressing expectations of inexperienced exercisers (Jones et al 2005)

b. Increasing retention by extending types of physical activity classes on

offer, including other age groups (mean age was 58 years old mostly retired) and offering choices of different times to suit people in employment.

3. Long-term sustainability of Newham Community Prescribing:

a. Payment on a sliding scale: commissioners could consider a high subsidy for each participant at the beginning of the programme, so to encourage CoH to maximise participation. Payment could be reduced over time encouraging CoH to support it through other means or partially charging participants

b. Health strategies that can encourage individuals take on physical activity

permanently. These may involve a re-think of where physical activity opportunities are in relation not just to people homes but also in the workplace and in the creation of facilities for physical activity at work

c. Recruitment of ‘champions’: patients who have completed successfully

the pilot could be recruited as ‘health activators’ or ‘champions’ either paid or as volunteers in order to convince other residents in their community to take on regular physical activity and help with translation and other forms of support.

5 Key limitations Qualitative research • The near absence of non-attenders from the sample of people interviewed

may have led to an overestimation of positive impact. Some 331 patients were referred but never completed (out of a total number of 700 referrals). Future

35

evaluations should monitor and keep a database of people who are referred by GPs to navigators and from navigators to delivery organisations but never engage either with the navigator or with CoH. Qualitative as well as quantitative evaluations should be built into the intervention rather than being done post hoc.

• The inability of some participants to communicate in English effectively

with some respondents with implications for the quality and amount of information obtained.

Quantitative research • The small size of the sample limits the detection of association between

independent variables and primary/secondary outcome variables. • Lack of a control group somewhat weaken the conclusions that can be inferred.

Furthermore, in the absence of randomisation it is necessary to rule out as many alternative explanations as possible for changes in the outcome variables.

• Characteristics of the sample: this analysis ‘merely’ shows that on average

diabetic and pre-diabetic patients improved their physical activity and their mental wellbeing as a result of attending physical activity classes for a period of 12 weeks. Yet, it does not tell us anything about how other participants at pre-assessment (n=331) have performed.

6 Future research a. Experience of drop-outs: future research should concentrate on the barriers

faced by drop outs from social prescribing in order to assess how uptake of the scheme can be maximised

b. Measuring long-term benefits: Future studies should aim to measure the long-

term benefits, after the completion of the initiative to assess whether benefits last over time

c. Cost-effectiveness: evidence on the cost-effectiveness of social prescribing is

very limited but increasingly important to inform commissioning.

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Appendix B - Summary for Newham CCG 11 September 2014 Prepared by Dr William Bird

How can physical activity treat diabetes?

• Physical activity improves control of blood glucose in type 2 diabetes mellitus

due to improved insulin sensitivity. This may enable reduction and even

discontinuation of medication in a substantial proportion of patients.i ii iii iv

• Either aerobic or resistance training improves glycaemic control (measured

with HbA1c) in type 2 diabetes mellitus, but the improvements are greatest

with combined aerobic and resistance training.v

• Exercise programmes can reduce HbA1c levels by about 0.6% as well as

reducing adipose tissue and triglyceride levels.vi

Cohort studies show that among patients with diabetes, the least active and least fit

patients have the highest mortalityvii Church et alviii found that men in the lowest,

second and third quartiles of cardiorespiratory fitness had 4.5, 2.8 and 1.6-fold

greater risks for overall mortality than men in the highest quartile of cardiorespiratory

fitness (Chart 1). After adjustment for cardiorespiratory fitness, there was no

difference in mortality among normal-weight, overweight, and obese men.11

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Chart 1: Church et al. This chart shows how cardiovascular mortality increases steadily as a patient moves from high to low fitness. However moving from normal weight to obesity has very little difference in cardiovascular mortality. In this study BMI was adjusted for cardiovascular fitness which can be seen to be the dominant factor affecting cardiovascular mortality

38

Managing the overall risk of physical activity

1) For most patients with diabetes, including those at high risk of coronary heart

diseaseix, recommending light to moderate activity such as brisk walking is

safe and it is left to clinical judgment as to whether any clinical complications

identified require further referral.

2) For patients wanting to undertake vigorous activity, clinicians should use their

clinical judgment to exclude any contraindications to exercise, in particular

relating to cardiovascular disease. Up to 20% of patients newly diagnosed

with type 2 diabetes mellitus have coronary heart disease.

What effect does physical activity have on the risk of developing diabetes?

• There is strong and consistent evidence that the incidence and progression of

type 2 diabetes mellitus can be reduced with physical activity in people with

impaired glucose tolerance and that the effects are independent of weight

lossx.

• In a meta-analysis,xi regular physical activity halved the risk of developing

diabetes (hazard ratio = 0.49). This compares favorably to diet only (HR =

0.67), but identical to combined diet and exercise (HR 0.49).

• In the same study, numbers needed to treat (NNT) to prevent a case of

diabetes were 6.4 for diet and exercise, 10.8 for anti-diabetic medication (e.g.

metformin) and 5.4 for orlistat.

• 150 minutes a week of physical activity and diet induced weight loss reduces

the risk of progression from impaired glucose tolerance to type 2 diabetes

mellitus by 58%xii xiii

• In one major study, lifestyle intervention groups had a 43% lower diabetes

incidence (age and clinic adjusted) for up to 14 years after the active

intervention ceased, and diabetes onset was delayed an average of 3∙6

years. xiv

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i Wing RR, Epstein LH, Paternostro-Bayles M, et al. Exercise in a behavioral weight control programme for obese patients with type 2 diabetes. Diabetologia 1988; 31: 902. ii Heath GW, Leonard BE, Wilson RH, et al. Community-based exercise intervention: Zuni diabetes project. Diabetes Care 1987; 10: 579–583. iii Boule NG, Haddad E, Kenny GP, Wells GA, and Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Journal of the American Medical Association 2001; 286 (10): 1218–1227 iv Dengel DR, Pratley RE, Hagberg JM, Rogus EM, and Goldberg AP. Distinct effects of aerobic exercise training and weight loss on glucose homeostasis in obese sedentary men. Journal of Applied Physiology 1996; 81 (1): 318–325 v Sigal RJ, Kenny GP, Boule NG, Well GA, Prud’home D, Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jenning A and Jaffey J. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Annals of Internal Medicine 2007; 147 (6): 357–369 vi Thomas, D., Elliot, E.J. & Naughton, G.A. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2006, Issue 3 Art. No.: CD002968 vii Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med. 2000;132:605–611 viii Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW, Priest EL, Blair SN: Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 27:83– 88, 2004 ix ADA Standards of Medical Care in Diabetes 2012. Diabetes Care, 35 Suppliment 1 x Sigal RJ, Kenny GP and Wasserman DH. Physical Activity / Exercise and Type 2 Diabetes. A Consensus statement from the American Diabetes Association. Diabetes Care 2006; 29(6): 1433-1438 xi Clare L Gillies, Keith R Abrams, Paul C Lambert, Nicola J Cooper, Alex J Sutton, Ron T Hsu, Kamlesh Khunti, Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ, doi:10.1136/bmj.39063.689375.55 (published 19 January 2007) xii Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350, 2001 xiii Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403, 2002 xiv The long-term eff ect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study Guangwei Li, Ping Zhang, Jinping Wang, Edward W Gregg, Wenying Yang, Qiuhong Gong, Hui Li, Hongliang Li, Yayun Jia. Lancet 2008 371: 1783-89.

40

Newham CCG Board Meeting

Wednesday 8th October 2014

Title: Newham CCG Board Assurance Framework (BAF)

Agenda item: 3.3

Author: Mike Sims Board Secretary Newham CCG

Presented by: Satbinder Sanghera, Head of Governance & Engagement Newham CCG

Contact for further information:

Satbinder Sanghera, Head of Governance & Engagement Newham CCG

Date paper finalised: 30th September 2014

Action requested: Approve updates to actions and risk ratings as stated in the Executive Summary.

Executive Summary Material changes or risk issues in the BAF since 10th September 2014 Risk 4.1 – Monitoring and planning for the possible impact to Newham CCG from the financial and cash performance of BHT Update: In September the CFO advised the Board that the significant issue for consideration was the overperformance of acute spending and that initial data for month 5 projected a £13,300,000 overperformamce of which some £10,000,000 related to BHT, meaning that the advice to Board was that the evidence for a significant year-end Acute overperformance was likely. Board was advised that current reserves had been set aside to cover this eventuality and, whilst a challenging position, at this stage the overperformance did not put at risk any existing proposals any other proposed commitments for the year but that should the position deteriorate at a rate more significantly than at current the Board may have to consider changes to its currently proposed programme. The CFO has advised that the current risk rating should remain the same (15), although this may need to be increased within quarter three if projections remain the same.

Supporting Papers: Newham CCG Board Assurance Framework – October 2014

How does this fit with Ensures the Newham CCG Board are fully appraised of material

41

Newham CCG Strategy: risks which may affect the organisation’s ability to maintain financial stability and/or deliver against key operational objectives as outlined in the Operating Plan

Where has the paper been already presented?

Previous iterations of the Board Assurance Framework have been presented to Newham CCG Board, most recently at the Board meeting on 10th September 2014

Risk : A failure to operate a risk management system would expose the organisation to the risk of inadequate governance arrangements.

Equality Impact This is an internal risk control and assurance document and therefore has no equality impact implication

Quality Impact This is a risk and control assurance document aimed at ensuring the CCG Board is fully sighted on and understanding of risks which may affect ability to deliver upon strategic objectives, as well as mitigations in place to address those risks.

1. Introduction and Background

1.2 The BAF is the primary mechanism by which the Board of Newham CCG are appraised and updated on material risks which may affect the CCG’s ability to deliver its strategic objectives as set out in the Operating Plan.

2. Key Considerations and Sustainability

2.1 Not applicable.

3. Service Delivery

3.1 Not applicable.

4. Next Steps

4.1 The BAF is currently presented monthly to Newham CCG Board with the intention of focussing on specific risks in more detail (particularly where risk scores are deteriorating) at future meetings.

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Board Assurance Framework

Document information

Version Version 3.0

Chair: Dr Zuhair Zarifa Accountable Officer: Steve Gilvin

43

Contents

2. Purpose and Scope .............................................................................................................................. 3

2.1 Board Assurance Framework ........................................................................................................ 3

2.2 Risk Management Governance ..................................................................................................... 3

2.3 Risk Areas ...................................................................................................................................... 3

2.4 Risk Identifiers ............................................................................................................................... 4

2.5 Newham CCG Risk Grading Matrix ................................................................................................ 5

2.6 Risk Rating Matrix ......................................................................................................................... 6

2.7. Common abbreviations used in the BAF ...................................................................................... 7

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2. Purpose and Scope

2.1 Board Assurance Framework

The primary purpose of the Newham CCG Board Assurance Framework (BAF) is to:

1) Act as a mechanism for alerting and appraising the Board of the main risks to achieving to the CCG in terms of achieving strategic objectives as set out in the Operating Plan

2) List, evaluate and provide assurance to the Board regarding the mitigations in place to the reduce the likelihood or impact of the risk

3) Summarise to the Board the remedial or proposed actions that further mitigate the likelihood or impact of the risk

The BAF is also an important document for providing external assurance (to NHS England, Internal Audit and patients and public) that the CCG is sighted on its risks and has a robust system of internal control.

2.2 Risk Management Governance

Risk Management is embedded in Newham CCG’s Governance Structure:-

The Audit Committee is responsible for scrutinising the group’s Risk Management policies and procedures. Accountable to the group’s Board, the Committee provides the Board with an independent and objective view of the group’s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance.

The Executive Committee is responsible for approving internal control arrangements, risk sharing and pooling agreements.

The Chief Officer is responsible for approving the group’s arrangements for business continuity and emergency planning.

The Chief Finance Officer is responsible for approving the group’s Counter Fraud, Security Management and Risk Management arrangements.

The Governing Board is responsible for approving and monitoring the Board Assurance Framework.

2.3 Risk Areas

BAF risks have been categorised into six main risk areas. Five of these risks areas link to the core strategic objectives of Newham CCG, as outlined in the Newham CCG Operating Plan. These are:

1. To reduce health inequalities, improve access and reduce quality variation

45

2. To develop Integrated Care, in particular to support improved management of long term conditions

3. To ensure robust patient and public engagement is embedded in the operations of Newham CCG and at all stages of the commissioning cycle

4. To ensure that Newham CCG achieves robust financial stability and balance to supporting effective working and implementation of our plans

5. To support quality improvements in primary care services to ensure they are fit for purpose and able to support the shift in care out of hospital

The Board has taken the view to include a sixth risk area to highlight the importance of establishing and maintaining good governance practices to enable the CCG to effectively deliver against its core strategic objectives:

6. To ensure that Newham CCG has transparent and effective corporate and clinical governance arrangements in place to comply with relevant legislation and mitigate the risk of non-delivery of strategic objectives

It is recognised that a number of BAF risks will be linked to one or more of the above risk areas. This will be noted where applicable on the risk profile template (section 3.1).

2.4 Risk Identifiers

Each BAF risk will be assigned a unique risk identifier (number). This will be based upon the primary area of risk identified from the five designed risk areas and subsequently the order in which the risk is added to the BAF. For example, the first risk added to the BAF with a primary risk area of category 1 (to reduce health inequalities… etc.) would be assigned a risk identifier of 1.1

46

2.5 Newham CCG Risk Grading Matrix Risk Impact

Assessing the possible impact of a risk in conjunction with the likelihood of the risk occurring is used to determine the risk rating.

Score

5

4

3

2

1

Risk Impact

Description Impact Description

Severe There is a very major and potentially disastrous impact on the achievement of the corporate objective(s)

Major There is a major impact on the achievement of the corporate objective(s)

Moderate There is a significant impact on the achievement of the corporate objective

Minor There is some impact, albeit not significant, on the achievement of the corporate objective(s)

Insignificant There is minimal impact on the achievement of the corporate objective(s)

Risk Rating

Risk Category

High(Risk Rating 15-25)

Medium(Risk Rating 8-14)

Low(Risk Rating 1-7)

High categorisation level risks are not acceptable under any circumstances as they will (i) be highly likely to prevent the achievement of the corporate, principle and business objectives and will damage the organisation’s reputation, politically and financially as well as creating a

significant and unacceptable response from stakeholders, (ii) impact on individual or population health outcomes resulting in death. They require specific monitoring and

appropriate action plans at Board level to ensure that their impact is mitigated at the earliest opportunity

Medium categorisation risks are generally not acceptable as they are likely to (i) cause much disruption and efficiency losses to the achievement of corporate, principle and business objectives, (ii) impact on individual or population health outcomes resulting in greater

chances of suboptimal health outcomes. They require specific monitoring and appropriate action plans at individual directorate senior management level to ensure that their impact

does not increase to a higher risk level

Low categorisation risks are in general at an acceptable level of risk as they are (i) unlikely to cause much disruption and efficiency losses to the achievement of corporate, principle and

business objectives, (ii) impact on individual or population health outcomes resulting in some chances of suboptimal health outcomes. They are unlikely to require specific application

of resources and will be subject to on-going review and monitoring at a departmental / functional level

Risk Category desription

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2.6 Risk Rating Matrix The table below can used to help to determine an appropriate risk rating. Examples are not exhaustive and are given to aid assessment only.

48

2.7. Common abbreviations used in the BAF

Below is a list of commonly used abbreviations that are found in the risk summary of the BAF. These are detailed below for ease of reference:

Barts/BHT Barts Health NHS Trust

BCP Business Continuity Plan

CEG Clinical Effectiveness Group (provider of primary care data quality and informatics and analytics services to the CCG and Newham GP Practices)

CCG Clinical Commissioning Group

COI Conflict of Interest

CQC Care Quality Commission

CQN Contract Query Notice

CQRM Clinical Quality Review Meeting

CQUIN Commissioning for Quality and Innovation

DES Direct Enhanced Service

DoH Department of Health

ELFT East London Foundation Trust (The provider of Community and Mental Health Services in Newham)

EPCT Extended Primary Care Team

EPCS Extended Primary Care Services

FBC Full Business Case

F&A Finance and Activity

FOI Freedom of Information

HoT Heads of Terms

HWBB Health and Wellbeing Board

IAPT Improving Access to Psychological Therapies

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IC Integrated Care

IG Information Governance

IM&T Information Management and Technology

ITT Invitation to Tender

KPI Key Performance Indicator

LA Local Authority

LAS London Ambulance Service

LBN London Borough of Newham

LD Learning Disability

LIS Local Incentive Scheme

LMC Local Medical Committee

NEL(CSU) North East London (Commissioning Support Unit)

NELIE North and East London Information Exchange (A web based commissioning analytics tool)

NHSE NHS England

NUH Newham University Hospital

OOH Out of Hours

PDP Personal Development Plan

PMC Practice Member Council

PPE Patient and Public Engagement

QIPP Quality, Innovation, Productivity and Prevention (a large-scale programme developed by the Department of Health to drive forward quality improvements in NHS care, at the same time as making up to £20 billion of efficiency savings by 2014/15)

RAID Rapid Assessment, Interface and Discharge

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RAG Red, Amber, Green (e.g. the status of a risk or performance indicator)

RAP Remedial Action Plan

RLH Royal London Hospital

RTT Referral to Treatment

SI Serious Incident

SLA Service Level Agreement

SMT Senior Management Team

SPG Strategic Planning Group

SPR Service Performance Review Meeting

TDA Trust Development Authority

TNA Training Needs Analysis

ToR Terms of Reference

UCC Urgent Care Centre

WEL Waltham Forest and East London (CCGs) – WEL CCGs are: Newham, Tower Hamlets and Waltham Forest. *WELC CCGs also includes City and Hackney CCG.

WHX Whipps Cross Hospital

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Board Assurance Risk Profile

Risk ID Risk Summary Risk Owner Initial Risk

Rating (April 2014)

Latest Forecast Trend End of Year Target Review Date

1.1 Failure to deliver 2014/15 QIPPs to meet planned targets Chad Whitton 10 10 5 02-Oct-2014

1.2 Failure to develop and quality assure QIPP plans for 2015/16 in a timely and robust manner Chad Whitton 15 10 5 02-Oct-2014

1.3 Provision of Commissioning Support services to meet need with appropriate capability and capacity Satbinder Sanghera 20 10 5 02-Oct-2014

1.4 Failure to effectively manage and monitor the quality of commissioned services at Barts Health and other acute care providers Chetan Vyas 15 5 5 02-Oct-2014

1.5 Failure to effectively understand, manage and monitor the quality of non-acute commissioned services Chetan Vyas 15 10 5 02-Oct-2014

1.6 Failure to maintain effective engagement and collaborative working arrangements with the Local Authority

Satbinder Sanghera 9 6 3 02-Oct-2014

2.1 Integrated Care - Failure to develop systems functionality to support the integration and sharing of information as an enabler for the delivery of integrated care Steve Gilvin 15 10 5 02-Oct-2014

2.2 Lack of communication and defined business and reporting processes regarding the Integrated Programme Steve Gilvin 20 20 5 02-Oct-2014

3.1 Failure to embed meaningful and measurable patient engagement at all levels of the CCG structure and throughout the commissioning cycle

Satbinder Sanghera 15 10 5 02-Oct-2014

4.1 Monitoring and Planning for the possible impact to Newham CCG from the financial and cash performance of Barts Health Chad Whitton 20 15 10 02-Oct-2014

4.2 Failure to effectively monitor performance and activity levels at Barts Health Chad Whitton 15 20 5 02-Oct-2014

4.3 Financial management of Newham CCG - Failing to plan for a sustainable financial future Chad Whitton 10 5 5 02-Oct-2014

4.4 Financial risk in relation to the Specialised Commissioning budget Chad Whitton 10 5 5 02-Oct-2014

5.1 Failing to build appropriate capacity and support for the development of Primary Care Jane Lindo 12 8 4 02-Oct-2014

5.2 Failing to develop new and functional Extended Primary Care providers Jane Lindo 12 12 8 02-Oct-2014

5.3 Failing to develop the role of GP Practices and Clusters as Commissioners Jane Lindo 12 12 4 02-Oct-2014

5.4 Failing to develop staff skills and competencies to support the organisational and operational development of the CCG Chetan Vyas 16 8 4 02-Oct-2014

5.5 Failure to develop and maintain appropriate Board skills and competencies Chetan Vyas 12 8 4 02-Oct-2014

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Risk ID Risk Summary Risk Owner Initial Risk

Rating (April 2014)

Latest Forecast Trend End of Year Target Review Date

6.1 Failing to progressively develop and review the CCG's corporate governance structure to ensure the CCG is able to effectively discharge its duties

Satbinder Sanghera 15 10 5 02-Oct-2014

6.2 Failure to effectively embed awareness of information governance issues and standards across the organisation

Satbinder Sanghera 8 8 4 02-Oct-2014

53

1.1 Failure to deliver 2014/15 QIPPs to meet planned targets

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chad Whitton Executive Committee 27-Oct-2014 Amber

This could result in: 1. A reduced ability to deliver local service improvements for patients (this year and beyond) 2. Reputational risk - including the increased risk of performance management measures from NHS England 3. Adverse media coverage 4. Failure to meet agreed QIPP financial targets with a resultant deterioration in the CCG's financial position, impacting ability to implement service redesign and invest to save initiatives to support planned improvements in commissioned care and development of integrated care and out of hospital services

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 2 10 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

1.1a Commissioning Committees

Every approved QIPP has oversight via a monthly QIPP tracker to monitor key milestones and progress against expected outcomes and planned savings. Each QIPP is monitored via a lead commissioning Committee as a standing committee agenda item. This includes specific input from finance team to provide additional support and oversight where QIPPs are red rated

1. Example Commissioning Committee agendas to demonstrate regular oversight and monitoring of QIPP initiatives

Fully Effective

1.1b Newham CCG Executive Committee

The Executive Committee provides oversight where QIPPs require escalation (i.e. off target and require further remedial action or escalation beyond commissioning committee level).

1. ToR for Newham CCG Executive Committee to demonstrate remit of monitoring and assuring QIPP delivery

Fully Effective

1.1c Monthly QIPP Tracker Monthly QIPP tracker managed by NELCSU team to monitor key milestones and progress against expected outcomes and planned savings.

1. Monthly QIPP tracker template

Fully Effective

1.1d Agreed NCCG programme approach to support 14/15 QIPP Delivery

NCCG programme approach approved by Executive Committee on 14 April 2014.

1. Evidence of approved programme approach to support QIPP delivery in 2014/15

Fully Effective

1.1e 4 key work programmes structured around QIPP business cases

4 key work programmes (Long Term Conditions, Tuberculosis, integrated Care and CVD) structured around QIPP business cases. Each has a Programme Director at SMT level and an overall programme Lead to ensure delivery. Programmes may also have workstream leads depending on specific requirements

1. Evidence of Board approved programme approach to supporting delivery of QIPPs.

Fully Effective

1.1f Monthly QIPP performance report to Executive Committee

NELCSU team prepare a monthly QIPP performance report for NCCG Executive. report gives an overview of all QIPPS by lead committee and includes detail of YTD plan vs forecast with a summary of RAG rated delivery initiatives for each QIPP from the monthly tracker.

1. Example of monthly QIPP performance report

Fully Effective

1.1g Monthly QIPP Performance report to Commissioning Committees

Each Commissioning Committee receives a QIPP performance report solely focussed on the QIPPs managed by the Committee. This is derived from the monthly performance reports on all QIPPs to CCG Executive.

1. Example of Committee specific monthly QIPP report

Fully Effective

1.1h NHSE oversight of QIPPs

2014/15 QIPP final QIPP plans submitted to NHSE - April 2014.

1. Final list of 14/15 QIPPs submitted to NHSE April 2014.

Fully Effective

1.1i Monthly Borough Summary Report to NCCG Board

Monthly Borough summary report includes high level QIPP summary, rag status and detail of overall performance vs plan

1. Example of Monthly Borough Summary Report

Partially Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

1.1a Focus on stakeholder and PPE strategy to ensure 31-Mar-2015 Sabeena

Subba On Track SMT representation for CCG at Health and

Social Care network meeting in September In Progress

54

patient engagement on QIPPs

2014 and further detailed discussion will take place in terms of QIPP initiatives and 14/15 commissioning intentions at Community Reference group in October 2014.

55

1.2 Failure to develop and quality assure QIPP plans for 2015/16 in a timely and robust manner

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chad Whitton Executive Committee 27-Oct-2014 Amber

This could result in: 1. Reputational risk including risk of performance measures, loss of public confidence and adverse media coverage 2. Financial risk including risk of failure to deliver required QIPP savings targets and resultant cost pressure on CCG commissioning budgets

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

1.2a Initial scoping exercise undertaken for all proposed new QIPPs

2 page scoping template to be completed to provide initial overview of proposed QIPP initiative for early feedback and quality assurance. This is assessed and reviewed via specific QIPP committee workshop and if approved goes forward to development of a full business case

1. QIPP scoping template (for proposed new QIPPs)

Fully Effective

1.2b Full business case and finance and activity template

If scoping template is approved, QIPP leads must produce a full business case with completed finance and activity template for consideration by QIPP committee. As part of this process all QIPPs are quality assured to HRG level to ensure initiatives can be linked to billable tariff and are assessed down to impact on activity lines. All QIPPs are also reviewed by NCCG finance team to provide assurance on data and financial projections. If approved at this stage the FBC will go forwards for consideration at the appropriate lead commissioning Committee.

1. FBC and F&A QIPP templates

Fully Effective

1.2c Board oversight and final approval of QIPP schemes

Once QIPPs have been quality assured through QIPP Committee and commissioning Committees, all QIPPs require Board oversight and final approval

1. Board papers relating to discussion and approval of QIPPS

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

56

1.3 Provision of Commissioning Support services to meet need with appropriate capability and capacity

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Satbinder Sanghera **Board 27-Oct-2014 Amber

Newham CCG's Commissioning Support is currently provided by NELCSU by way of a SLA. Failure of the provider to deliver contracted services to need and in line with agreed SLA could result in: 1. Newham CCG failing to deliver upon key strategic financial and operational objectives 2. Inadequate performance and monitoring arrangements in respect of QIPP and commissioned contracts 3. Ineffective monitoring of quality issues in commissioned services and delays in resolution of quality issues with service providers 4. Inconsistencies in the value and responsiveness of service delivery

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 4 20 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

1.3c Monthly SLA review meetings

Monthly SLA review meetings between senior CCG and CSU teams to monitor commissioning support provision against terms of SLA

1. Minutes from monthly CSU review meetings to demonstrate focus on performance and delivery

Fully Effective

1.3b Annual review and market testing exercise

Annual market testing exercise of providers on LPR framework to determine value for money of NELCU commissioned support against comparable service offerings.

No assurance currently in place

Gap in Control

1.3a SLA with NELCSU for Commissioning Support Services

SLA with NELCSU for commissioning Support Services sets out agreed service areas and performance requirements covered in the contract

1. Service level agreement 2. Monthly CSU Executive meeting to manage any issues escalated in relation to performance against the SLA

Fully Effective

1.3d Monthly scorecard reports

CCG submits a monthly scorecard to rate performance against all CSU services lines within the contract. This forms basis of discussion at monthly review meetings and allows for issues to be highlighted and remedial action implemented where required.

1. Monthly scorecard reports to CSU to rate performance and delivery against all service lines under SLA

Fully Effective

1.3e Board Report on CSU SLa (1 year review)

Report to NCCG Board summaries first year performance of SLA arrangements with recommendations for contract arrangements in 14/15 and 15/16. Recommendation to move certain services in-house for 2014/15 and secure overall cash reduction in SLA value

1. CSU SLA report to Board - March 2014

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

1.3c Board Development session on CSU SLA 01-Dec-2014 Satbinder

Sanghera On Track Board development session planned before

end 2014. In Progress

1.3a Moving agreed service lines in-house for 2014/15 31-Mar-2014 Steve Gilvin

Completed

The following services were moved from CSU to in-house CCG functions commencing 1st April 2014: - Barts Health contracting (WEL CCG Collaborative) - Medicines Management - Finance (FIMS Management Accounting Function)

Completed

1.3b Detail on service line costs in CSU SLA 01-Sep-2014 Chad Whitton

Completed

Service line costs have been provided against all major service line headings in the SLA agreement. This will allows NCCG to effectively market test particular areas of service delivery once the lead provider framework (LPF) has been fully established.

Completed

57

1.4 Failure to effectively manage and monitor the quality of commissioned services at Barts Health and other acute care providers

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas Quality 27-Oct-2014 Green

This could result in: 1. Reputational risk from failing to adequately identify, monitor and manage quality and/or performance issues. This could result in a loss of public trust and adverse media coverage. 2. Clinical/patient safety risk resulting from unacceptable standards of care - with the resultant potential in the risk of serious incidents occurring. 3. Poor value for money for the CCG and patients and public.

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 1 5 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

1.4a Barts Health CQRM and SPR meetings

Barts Health specific Clinical Quality review meetings (CQRM) and Service Performance Review (SPR), include trend analysis and assurance reports across key quality indicators (plus CAG specific presentations on a rolling basis). CQRM is the key fora for CCG to raise and discuss and obtain assurance on quality issues in relation to Barts services

1. Example minutes of Barts Health CQRM and SPR Meetings 2. ToR for Barts CQRM meeting to evidence quality assurance remit.

Fully Effective

1.4b WELC Pod Quality leads meeting

Acts as a forum to allow WELC CGGs to collaboratively discuss and address specific service issues in relation to Barts health (as a jointly commissioned contract)

1. Example minutes of WELC Quality leads meetings to evidence collaborative discussion around quality/service issues.

Fully Effective

1.4c Newham CCG Quality Committee

NCCG Quality Committee has oversight of the quality of commissioned services for the resident population of Newham and provides appropriate assurances to the CCG Board about the quality of the services it commissions for the local residents.

1. Example minutes of Quality Committee 2. ToR of Quality Committee to evidence remit of the group in terms of assurance and monitoring of the quality of commissioned services.

Fully Effective

1.4d Amber Alerts Process NCCG has developed an amber alerts process to enable GP practices to notify service providers (Barts and ELFT) of patient concerns in relation to the quality of services (with a built in model of patient consent)

1. Amber Alerts form for GP Practices 2. Amber alerts GP response form for providers.

Fully Effective

1.4e SLA with CSU to support performance and monitoring arrangements

1. CSU provide support for administration and development and planning of agendas for CQRM meetings.

Partially Effective

1.4f Monthly WEL Serious Incident (SI) Panel Meeting

The core purpose of the panel is to ensure that the CCGs are assured that all serious incidents for which the CCG has either a lead or associate commissioning responsibility are being systematically reviewed and any concerns identified and escalated

1. Example minutes of WEL SI panel meeting 2. ToR of WEL SI Panel meeting

Fully Effective

1.4g CQUINS with Barts Health

Cquins agreed as part of annual contract to encourage improvement in key areas of quality and delivery

1. 2014/15 CQUINS signed off in July 2014.

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

1.4b Review of Barts CIP - 2014/15 from quality perspective

27-Oct-2014 Chetan Vyas

On Track

A collaborative CCG assessment has taken place and Barts Health have been invited to a Clinical Strategy Group Meeting in Sept. 2014 to provides assurances. Following this meeting the final CCG position will be reviewed via Quality Committee. Deadline accordingly revised to October 2014

In Progress

1.4a 2014/15 CQUINS to be agreed and signed-off 01-Jul-2014 Chetan Vyas

Completed

2014/15 CQUINS for Barts Health (national and site specific) agreed and signed off in July 2014.

Completed

58

59

1.5 Failure to effectively understand, manage and monitor the quality of non-acute commissioned services

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas Quality 27-Oct-2014 Amber

This could result in: 1. Reputational risk from failing to adequately identify, monitor and manage quality and/or performance issues. This could result in a loss of public trust and adverse media coverage. 2. Clinical/patient safety risk resulting from unacceptable standards of care - with the resultant potential in the risk of serious incidents occurring. 3. Poor value for money for the CCG and patients and public.

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

1.5a Monthly CQRM meetings for Community and Mental Health services

Monthly Clinical Quality review meetings are held with ELFT (the Community and Mental Health provider in Newham) to ensure robust discussion and performance and monitoring of quality issues with assurance reports provided to CCG on areas of concern. Forward planning for agendas in place supported by CSU team to ensure quality issues are effectively addressed at these meetings.

1. Example minutes of monthly CQRM meetings for ELFT Community and Mental Health services 2. ToR for CHS and MH monthly CQRM meetings

Partially Effective

1.5b CCG Monthly Quality report to Board

Monthly Quality report to Board includes progress updates and summary of quality issues relating to ELFT services (Community and Mental Health)

1. Example of monthly Quality report to CCG Board to demonstrate assurance around management of quality issues in CHS and MH services

Partially Effective

1.5c Commissioned support from CSU Quality team

CSU Quality team undertake review and analysis of Quality issues relating to commissioned services on behalf of the CCG

1. Director of Quality and Development submits monthly scorecard for review at monthly CCG/CSU SLA meetings in terms of CSU support around quality and performance monitoring.

Partially Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

1.5e Agree 14/15 CQUINS for Community and Mental Health Services

31-Jul-2014 Chetan Vyas

Likely to be Overdue

014/15 CQUINS for Mental health agreed and signed off in August 2014. Community Health CQUINS remain overdue but the expectation that these would be concluded by the end of September 2014 has not materialised.

Overdue

1.5a Deep dive analysis of quality care in nursing/care homes

01-May-2014 Chetan Vyas

Completed Care Home Quality Assurance report presented to NCCG Quality Committee - May 2014.

Completed

1.5b Data mapping exercise in relation to quality of Children's services

12-May-2014 Chetan Vyas

Completed Action completed - May 2014

Completed

1.5c Agree forward reporting process for quality indicators for Children's services

31-Jul-2014 Chetan Vyas

Completed

This work and been completed and the outcomes embedded into the (jointly commissioned) work around Children and Maternity services. Child data reporting elements are also forming part of the final 2014/15 CQUIN negotiations with ELFT for Community Health services

Completed

1.5d To develop a quality assurance process for care/nursing homes

30-Jun-2014 Chetan Vyas

On Track

Nursing homes visits have started using the existing quality assurance process. Quality metrics are being enhanced with a view to embedding as part of the process form the next tranche of site visits.

Completed

60

1.6 Failure to maintain effective engagement and collaborative working arrangements with the Local Authority

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Satbinder Sanghera

Partnerships Commissioning 27-Oct-2014 Green

This could result in: 1. Reputational risk from loss of public confidence and adverse media coverage 2. Services which fail to meet population needs, are fragmented or offer poor value for money 3. Duplication of effort around jointly commissioned services

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

3 3 9 3 2 6 3 1 3 31-Mar-2015

Control Control Description Control Assurance(s) Status

1.6a Partnerships Commissioning Committee

Partnerships Commissioning Committee meets monthly and includes senior reps from LBN to discuss and focus on jointly commissioned areas of care

1. ToR for Partnerships Commissioning Committee 2. Example minutes of Partnerships Commissioning Committee to demonstrate effective partnership working

Fully Effective

1.6b Monthly joint operations meeting with Local Authority

Monthly joint operations between CCG CEO and LBN Director of Adults Social Care. This acts as a problem solving forum and allows for early identification of issues to be cascaded to Partnerships Commissioning Committee for resolution.

No specific paper assurance exists as this meeting is not formally minuted

Fully Effective

1.6c Contracts are in place for jointly commissioned areas of care

Section 75 and Section 256 agreements have been jointly signed off by CCG and LBN for all Jointly commissioned areas of care.

1. Evidence of S75 and s256 agreements

Fully Effective

1.6d Communications and Engagement Strategy

The NCCG Comms and Engagement Strategy highlights the range of communication mediums used to engage and collaborate with stakeholders and support partnership working. ref page 13 -. Available on NCCG website: http://www.newhamccg.nhs.uk/news/policies-and-procedures.htm

1. NCCG Communications and Engagement Strategy

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

1.6g Review Terms of Reference 03-Oct-2014 Satbinder

Sanghera

Unlikely to be Completed on

Time

Review of ToR deferred to October 2014 in line with overall review into CCG Constitution and governance structure.

Check Progress

1.6c Joint strategy on priorities relating to Children's services

31-Oct-2014 Satbinder Sanghera

On Track

Joint strategy paper setting out joint priorities submitted to (and accepted by) HWBB in July 2014. Additionally, regular reporting on child health and wellbeing now forms part of the standing agenda at HWBB. Agreed that next stage is to provide more narrative around the joint priorities specified, in particular the early start agenda.

In Progress

1.6a Joint away day with LBN 31-Jul-2014 Satbinder Sanghera

Completed

Joint away day with key HWBB stakeholders held in August 2014. Key agreed actions included further discussion around Better Care Fund agenda and opportunities to better align CCG commissioning intentions with the Local Authority

Completed

1.6b Better Care Fund workgroup 19-Sep-2014 Satbinder

Sanghera Completed Better Care Fund submission completed 19th

September. Completed

1.6d Better Care fund submission 01-May-2013 Satbinder

Sanghera Completed

Better care Fund - Joint submission with LBN to NHSE and the local government association. *Commitment to develop further

Completed

61

through joint working group.

1.6e Identify CCG representation on Children's Trust Board

03-Feb-2014 Satbinder Sanghera

Completed Dr Lizi Goodyear and Satbinder Sanghera confirmed as CCG reps. on Children's Trust Board

Completed

1.6f Agree approach to address partnership working issues

03-Jun-2013 Satbinder Sanghera

Completed

Agreed that partnership working issues, i.e. jointly owned CCG/LBN strategies will be discussed initially at CCG Partnerships Commissioning Committee to agree a common approach before taking to HWBB to be finalised and approved.

Completed

62

2.1 Integrated Care - Failure to develop systems functionality to support the integration and sharing of information as an enabler for the delivery of integrated care

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Steve Gilvin Integrated Care 27-Oct-2014 Amber

This could result in: 1. Fragmentation of care as a result of failure to join up information to provide properly integrated care via provision of a single integrated care record (view only) to support clinicians involving in the provision of integrated care to support high risk and very high risk patients. 2. Negative patient experience and potential clinical risk if clinicians are unable to access relevant medical information at the point of care

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

2.1a IC Project lead IC project lead appointed to lead a process of evaluation and recommendations for procurement of an 'integration engine' solution to present a single shared view of the patient record for providers involved in the delivery of integrated care

IC project lead appointed to produce an options appraisal to support procurement of a system solution to support multiple healthcare provider data feeds to create a linked integrated digital patient record

Partially Effective

2.1b IC Business Analyst Business Analyst recruited to define business processes and establish a baseline to determine what a shared integrated care record will look like in order to procure a fit for purpose systems solution

Post recruited on a interim basis - June 2014

Partially Effective

2.1c IC IT enabler Project Board and Working Groups

Project Board and working groups established with representatives from all major stakeholders involve in integrated to ensure that the recommended solution ifs fit for purpose for all stakeholders and meets the requirements for an integrated digital record. The working group involves representatives from all organisations that will be involved at a delivery level.

1. Project Board ToR and agreed scope 2. Working group T0R and agreed scope (TBC)

Partially Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

2.1a Define and agree scope of information to form part of a shared view only integrated digital record

01-Oct-2014 Tolu Awofisayo

Likely to be Overdue Progect deadline now 31/12/14

Overdue

2.1d Procurement of chosen system 31-Dec-2014

Unlikely to be Completed on

Time

Update pending Board approval of recommended system to be procured from options appraisal

Unassigned

2.1f System training and familiarisation 27-Feb-2015

On Track Action pending dependent upon finalisation

of options appraisal and system procurement Unassigned

2.1c Board approval for procurement of 'integration engine' to support view only integrated care record

20-Oct-2014 Tolu Awofisayo

On Track IC Programme Board and IMT Committee have agreed the direction of travel for Health Information Exchange (HIE) as the main platform for an integrated record.

Check

Progress

2.1e System implementation and governance 27-Feb-2015 Luke Moore

On Track Action pending dependent upon finalisation

of options appraisal and system procurement Assigned

2.1b Options appraisal for procurement of 'integration engine' solution for view only integrated care record

31-Jul-2014 Tolu Awofisayo

Completed

It has been agreed that NCCG will support the HIE (Health Information Exchange) platform as the primary integration engine for Newham based health and social care services

Completed

63

2.2 Lack of communication and defined business and reporting processes regarding the Integrated Programme

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Steve Gilvin Integrated Care 27-Oct-2014 Red

This could result in: 1. Insufficient stakeholder buy-in and lack of clarity impacting delivery and patient experience 2. Lack of clarity for other areas of the CCG which may impact on delivery of workstreams following transition to business as usual, for example in areas such as on-going service performance and monitoring arrangements 3. Lack of a shared common understanding of what Integrated Care means in Newham 4. Gaps in service delivery 5. A lack of effective patient and public engagement 6. Inconsistency in the application of governance processes and controls 7. Lack of effective on-going performance monitoring and reporting arrangements

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 4 20 5 4 20 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

2.2c Structured handover of work via Commissioning Committees

To support the handover of specific work areas relating to the integrated care programme a formal handover process is in place to agree the a process and timeline and accountabilities for the handover of work

1. Evidence of handover documents taken through relevant commissioning committee (e.g. RAID for Mental Health)

Partially Effective

2.2a Newham Integrated Care Strategy

Development of a Newham Integrated Care strategy to ensure a common collaborative understanding of all aspects and key objectives of the Integrated Care programme

Current gap in assurance. There is no single strategy which articulates the vision, objectives and deliverables for Integrated Care in Newham

Gap in Control

2.2b Monthly newsletter Monthly newsletter is produced to provide internal and external stakeholders with key information and updates

1. Evidence of monthly newsletter for IC programme circulated to key internal and external stakeholders 2. IC programme Director acts as link with CCG comms manager to ensure CCG comms channels to staff and GP practices are utilised to disperse relevant comms messages about integrated care.

Partially Effective

2.2d Information resources and training for clinicians to support care planning for high risk patients

Information resources and training developed for clinicians to support care planning for unplanned admissions DES and EPCS. This includes information of effectively managing patient consent.

1. Care plan template agreed and signed off by IC programme leads. 2. Further work is required to provide training on coding and consent for care planning

Partially Effective

2.2e Information resources (fair processing notices) for patients and public

Fair processing notices to and information for patients and public to support awareness of integrated care and in particular how patient information may be used and the rights of patients to consent/dissent to how their information is used

Current gap in control as further work is needed to develop a full suite of comms information to support the delivery of integrated care in Newham. *Update Sept 14. Model fair processing notice has been developed as part of an overarching information sharing protocol which is being designed to support a single standard for sharing information across all Newham health and social care providers

Gap in Control

2.2f Integrated Care workstreams Monthly reports

Monthly reports on all key integrated dare workstreams (, self-care, care-coordination, rapid response and supported discharge) are taken to Integrated Care Programme Board on a monthly basis.

1. Evidence of monthly workstream reports

Partially Effective

2.2g Performance monitoring Regularly reports run by CEG on care plans produced in line Assurance cannot be fully assessed until

Partially

64

arrangements for DES care planning for high risk patients

with DES requirements practices begin care planning using the coordinated care template from July 2014.

Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

2.2c Produce a single source Integrated Care strategy for Newham

11-Aug-2014 Yvonne Thomas

On Track Now planned to precent to ICTP 10/10/14

Overdue

2.2e Agree process of clinical audit for care planning 31-Jul-2014 Yvonne

Thomas Likely to be

Overdue Will now complete by 31/12/14

Overdue

2.2g Develop checklist template for handover of IC work

01-Oct-2014 Yvonne Thomas

Likely to be Overdue Now due to complete 31/10/14

Overdue

2.2a Information and training for clinicians on information sharing and managing consent and dissent in relation to care planning for high risk patients

31-Oct-2014 Yvonne Thomas

On Track

Phase one of training for high risk DES patients completed (as codes and instructions on recording consent are recorded as part of the care plan template. A wider programme of training needs to be rolled out via CCG IMT meetings such as emis user group and PMC to support all practices in understanding and managing consent in relation to information sharing.

In Progress

2.2b Information for patients and public re integrated care and how their information is used (fair processing)

03-Nov-2014 Luke Moore

On Track

A model fair processing notice has been developed as part of an overarching information sharing protocol (OISA) being developed to support a consistent approach to information sharing across all Newham health and social care providers. The OISA is to be taken to ELFT and NCCG programme Boards for approval during September and early October before wider rollout to other health economy stakeholders.

In Progress

2.2d Regular reporting to SMT on IC workstreams 14-Jul-2014 Yvonne

Thomas Completed

Interim Director for Integrated Care attends NCCG SMT meetings on a monthly basis to provide project briefings on IC workstream

Completed

2.2f Agree processes for identifying, reporting on and monitoring patients given care plans

01-May-2014 Yvonne Thomas

Completed

Patients most at risk of hospital admission can be identified via NELIE tool. For those patients given care plans CEG can run monthly reports to identify patients coded as a high risk of admission and to identify those patients that have had a care plan completed

Completed

65

3.1 Failure to embed meaningful and measurable patient engagement at all levels of the CCG structure and throughout the commissioning cycle

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Satbinder Sanghera **Board 27-Oct-2014 Amber

This could result in: 1. NCCG being unable to deliver its responsibilities under Section 242 of the NHS Act 2006, which mandates NHS organisations to involve patients in the planning and development of proposals and commissioning of health services 2. Reputational damage resulting in loss of public confidence and the potential for adverse media 3. Commissioned services which fail to meet population needs and consequently offer poor value

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

3.1A Communications and Engagement Strategy

Newham CCG Comms and engagement strategy sets out CCG approach to comms and engagement and details local engagement structures. (ref: pages 9-11) Available on NCCG website: http://www.newhamccg.nhs.uk/news/policies-and-procedures.htm

1. NCCG Communications and Engagement Strategy

Fully Effective

3.1b Quarterly Patient Engagement Events

Quarterly engagement events with patients, the public and voluntary sector to to ensure the CCG effectively captures experience of commissioned services and captures PPE input at all stages of the commissioning cycle to enable to enable the CCG to plan and commissioned services to meet local population need.

1. Evidence of Community engagement in relation to commissioning and planning of services

Fully Effective

3.1c Engagement Forward Plans for Commissioning Committees

All Newham Commissioning Committees have completed an engagement forward plan to demonstrate how PPE is being effectively embedded at all stages of commissioning in relation to the work of each committee

1. Engagement forward plan template 2. Example of completed Commissioning Committee Engagement Forward Plan 3. All Commissioning Committee ToRs include a requirement to develop Engagement Forward plans

Fully Effective

3.1d Use of Social Media - Twitter

Newham CCG have launched a Twitter account: @NHSNewhamCCG to communicate key CCG messages and provide a two-way channel of communication for patients and public accessible via CCG public website: www.newhamccg.nhs.uk

1. NCCG Twitter feed: @NHSNewhamCCG

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

3.1a Develop joint patient experience data agreement 03-Nov-2014 Sabeena

Subba On Track

A patient experience data dashboard is being developed by NHSE at a thematic level. A scoping exercise is taking place between local health partners to asses the viability of taking this work forward as a way of jointly capturing and measuring patient experience across service boundaries. This is expected to last until end October. The deadline for this action has therefore been adjusted accordingly.

In Progress

3.1b Finalise Communications and Engagement Strategy

16-Dec-2013 Sabeena Subba

Completed Communications and Engagement Strategy approved by NCCG Board in December 2013.

Completed

3.1c Patient feedback to be captured for key commissioning intentions 2014/15

03-Feb-2014 Sabeena Subba

Completed Community Reference Group (CRG) workshops took place in October and November 2013 around key commissioning intentions for 14/15:

Completed

66

- Bi Lingual Health Advocacy - District Nursing - IAPT (Improving Access to Psychological therapies) service

3.1d Annual report to NHSE to summarise PPE engagement 2013/14

30-Sep-2014 Sabeena Subba

Completed

CCGs are required to provider an annual report to NHS England to summarise PPE activity in the last year and evidence how patients and public have been involved in shared decision making., The first report is due to be submitted in September 2014.

Completed

67

4.1 Monitoring and Planning for the possible impact to Newham CCG from the financial and cash performance of Barts Health

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chad Whitton Barts Health Collaborative 27-Oct-2014 Red

This could result in: 1. A reduced ability to plan for or shift care out of hospital 2. A reduction in local acute services and consequential impact on local patient population 3. Requirements for allocation of contingency funding to support Barts Health which could reduce the CCG's bargaining power in other provider contract negotiations 4. A deterioration in the cash flow position which may result in severe financial pressure with a consequential impact on services

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 4 20 5 3 15 5 2 10 31-Mar-2015

Control Control Description Control Assurance(s) Status

4.1a WEL Collaborative Commissioning Governance Structure

WEL Collaborative have oversight of Barts health contract including in-depth analytics and claims management. Monthly Service Performance Review (SPR) meetings with monitoring against projected activity and review of Barts productivity improvement plan

1. Terms of Reference for WEL Collaborative

Fully Effective

4.1b NELCSU Contract Management

NELCSU are employed to provide effective monitoring and contract management

1. Monthly SLA contract review meetings between CCG and CSU senior teams

Fully Effective

4.1c WEL Clinical Strategy Group

Updates on Barts financial performance and CIP programme are picked up through discussions with collaborative leads via WEL Clinical Strategy Group (attended by COs, Chairs and CFOs of all WEL collaborative CCGs). Pertinent updates are fed back via reports at CCG Board level

1. ToR for WELC Clinical Strategy Group

Fully Effective

4.1d Monthly cash flow forecasts

Agreement with Barts Health for the provision of monthly cash flow forecasts to enable CCG oversight of risk re cash position

NIL Assurance to date

Gap in Control

4.1e Barts Health cash Position

Joint agreement with Barts Health on cash flow position As at June 2014: Following discussions between NCCG and Barts Health, the CCG have received assurance that BH have access to sufficient cash for at least their short term requirements. CCG will continue to monitor via Service performance Review (SPR) meetings.

Partially Effective

4.1f NCCG Oversight of Barts CIP

NCCG have oversight of Barts CIP programme but have no direct control over financial plans as the Trust Development Authority (TDA) has overall responsibility for Barts financial position

1. Newham CCG has oversight of Barts CIP in terms of assurance from a quality impact perspective but this assurance is only partly effective as a financial control as the TDA retains overall approval of the CIP

Partially Effective

4.1G Dedicated Barts Health Collaborative Commissioning team

Dedicated Barts Health collaborative commissioning team established to work across the WEL CCGs (Newham, Waltham Forest and Tower Hamlets) (to work closely in conjunction with the NELCSU Barts MDT team) Team includes a Director of Commissioning and Senior Finance lead, jointly funded by WEL CCGs in the Barts Collaborative.

1. Barts Collaborative Meetings map provides overview of key meetings and topics covered by the Barts Collaborative Commissioning Team

Fully Effective

4.1H Regular meetings with TDA and Monitor

Chief Officer input into regular financial performance (turnaround) meetings with the TDA and Monitor

No paper assurance - assurance derived from CCG attendance at these meetings.

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

4.1d Barts Health cash flow position 03-Oct-2014 Richard

Quinton On Track Under discussion between BH collaborative

lead for WEL and BH Director of Finance. Check

Progress

68

4.1a Board Development session to focus on mitigation strategies for Barts financial risk

01-Jul-2013 Chetan Vyas

Completed Board Development session on Barts Health took place in July 2013.

Completed

4.1b Appointment of dedicated WEL Barts Collaborative team

01-Jan-2014 Steve Gilvin

Completed WEL Barts Collaborative Team in place from January 2014.

Completed

4.1c 14/15 Barts Contract to be signed 05-May-2014 Richard

Quinton Completed 2014/15 contract signed with Barts Health -

30.05.2014 Completed

69

4.2 Failure to effectively monitor performance and activity levels at Barts Health

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chad Whitton Barts Health Collaborative

24-Nov-2014 Red

This could result in: 1. Risk to the CCG as a result of Trust failure to deliver upon agreed targets including national standard targets 2. Increased risk of over performance due to transition from 5% cap and collar arrangement and move to PBR arrangement, with associated risk of uplift in contract value 3. A reduction in the CCG's budget to support the shift in care out of hospital and integrated care initiatives 4. Disaggregation of specialised commissioned services which could lead to misattribution of charge

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 4 20 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

4.2a Demand management initiatives

Focus on demand management initiatives at cluster level to mitigate referrals to acute that can be safely and more appropriately managed in a community setting.

1. Monthly cluster plan dashboard reports to Board 2. ToR of weekly cluster commissioning group meetings 3. ToR of cluster meetings to demonstrate role of clusters in demand management 4. Cluster lead job role (re demand/referral management) 5. 2013/14 cluster plans (demonstrating focus on demand and referral management initiatives) 6. Example Practice Plan to demonstrate focus on demand/referral management

Fully Effective

4.2b Monthly SPR Meetings Monthly SPR meetings to review service and performance issues at the Trust.

1. ToR of monthly Barts Health SPR Meeting

Fully Effective

4.2c Barts Health Quality and Performance Assurance Committee

Bi-weekly Quality and Performance Assurance Committee to review performance and achievement against standards. This includes focus on RTT and cancer targets. Attended by TDA, Chief Officers, CFOs, Barts collaborative lead and Barts Senior Leadership

1. ToR for Barts Health Quality and Performance Meeting (*Last updated August 2014) 2. Minutes of Quality and Performance meeting to demonstrate focus and control measures on RRT and performance targets 3. Evidence of regular review of RTT performance 4. Agenda of meetings to demonstrate focus on performance metrics and recovery plans

Fully Effective

4.2d Competition Commission quarterly performance reviews

CCP quarterly review meetings - provides assurance against required performance metrics agreed as part of merger Barts Health Trust merger approval. Barts collaborative lead provides local link and reporting on a quarterly basis to CCP from collaborative via NELCSU

No specific paper assurance relates to this control. Assurance obtained through updates with Barts Collaborative lead.

Fully Effective

4.2e NELCSU MDT team provides dedicated analytics support

NELCSU Barts MDT team providing reports and data to support analysis of Barts performance position and activity in relation to contract

1. SLA with NELCSU for contract and finance activity monitoring arrangements

Partially Effective

4.2f Dedicated Barts Health Collaborative Commissioning Team

Dedicated Barts Health collaborative commissioning team established to work across the WEL CCGs (Newham, Waltham Forest and Tower Hamlets) (to work closely in

No specific assurance relates to this control

Fully Effective

70

conjunction with the NELCSU Barts MDT team) Team includes a Director of Commissioning and Senior Finance lead, jointly funded by WEL CCGs in the Barts Collaborative.

4.2g Contract Query Notice (CQN)

Formal CQN notice issued on 18th July 2014 requiring the trust to provide assurance around improved performance across 5 key areas: 1. Cerner migration to single instance of Millennium 2. Outstanding Serious Incidents and underlying processes 3. Patient Transport issues resulting from change in service provider 4. Data quality and timeliness (including F&A) 5. RTT and Cancer performance

1. CQN notice issued on 18 July 2014. (*Remedial Action Plans for each item due to be agreed and signed off with BH by 12 Sept. 2014.)

Partially Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

4.2b End of year balances for 2013/14 contract to be agreed as final

18-Jun-2014 Richard Quinton

On Track

CCG and BH are in process of final discussions on the position on end of year balances. At stage of negotiation of CCG and Associates total contract position with Barts Health CFO.

Overdue

4.2a Develop informatics support re Barts performance and activity metrics

03-Nov-2014 Richard Quinton

On Track

Improved performance around data quality is one of the 5 key areas addressed as part of the CQN notice issued in July 2014 and will form part of the Trust's Remedial Action Plan to address areas of underperformance identified in the CQN. The % of coded activity reported at the flex date has improved significantly from around 60% to over 95% which substantially mitigates the risk of specialised commissioned activity being misattributed due to reporting of uncoded activity and data quality issues.

In Progress

4.2c On-going review of Remedial Action Plan resulting from Contract Query Notice

31-Mar-2015 Richard Quinton

On Track

Formal CQN notice issued on 18 July 2014 requires Barts Health to provide assurance by way of agreed Remedial Action Plans (RAPs) against each of the quality and performance issues raised under the CQN *expected to be jointly agreed and signed off by 12 Sept 2014. The RAP will outline agreed improvement measures and timelines for delivery across 5 key areas: *If targets are not met within agreed deadlines, the next step would be for the CCG to review withholding funds under contract in line with the national standard terms as set out in the CQN notice. This action will be on-going as the CCG will continually monitor the RAP via established contact and performance meetings. 1. Cerner migration to single instance of Millennium 2. Outstanding Serious Incidents and underlying processes 3. Patient Transport issues resulting from change in service provider 4. Data quality and timeliness (including F&A) 5. RTT and Cancer performance

In Progress

71

4.3 Financial management of Newham CCG - Failing to plan for a sustainable financial future

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chad Whitton Finance 27-Oct-2014 Green

This could result in: 1. Operational risk: A major impact on the CCG's ability to deliver its strategic objectives and QIPP targets 2. Financial risk: Severe impact on CCG finances and a likelihood of deterioration in the budget position with possibility of budget deficit 3. Reputational damage: including loss of public confidence, possible performance measures and adverse media coverage

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 2 10 5 1 5 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

4.3a Quarterly Assurance reporting to NHSE

Quarterly assurance reporting to NHSE enables external oversight of financial management and controls

1. Evidence of quarterly assurance report to NHSE

Fully Effective

4.3b Finance plan 2014/15 Finance plan 2014/15 has a 2% surplus target and 2.5% nonrecurrent headroom and 1% contingency.

1. Newham CCG Board approval of 14/15 financial plan (operating plan financial template) - April 2014 and approval of detailed budgets in May 2014. *Consolidation into WEL Strategic Planning Group (SPG) will be submitted as final on 19th Sept. 2014

Fully Effective

4.3c Monthly finance and budget reporting to Board

A finance and budget report is presented to Board every month as a standing agenda item. This includes a summary of the monthly budget position vs plan with a forecast surplus/deficit position

1. Monthly Finance and budget report to Board

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

4.3a Newham CCG Finance Committee 01-Sep-2014 Chad Whitton

Completed NCCG Finance Committee established and

commenced July 2014. Completed

72

4.4 Financial risk in relation to the Specialised Commissioning budget

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chad Whitton Finance 27-Oct-2014 Green

There is a risk that Newham CCG will not be able to fully recover funding transferred pro rata to NHSE to enable the Londonwide costs of Specialised Commissioning to be met. This could impact upon: 1. Financial planning and control 2. Effective utilisation of budgets in year An allocation of £12.2m was returned to Newham CCG in September 2013 however, inherent in year risk remains in 2014/15 due to the possibility of further adjustments in the specialised commissioning budget following final agreement of the split of the Barts Plan.

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 2 10 5 1 5 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

4.4a CCG input into London area technical group

A technical group led by London area Directors of Finance is working with the specialised commissioning group at NHSE to ensure CCG contributions are matched to commitments throughout the year with appropriate repatriation of excess funding.

1. CFO represents Newham CCG on the technical working group.

Fully Effective

4.4b Funds retained in contingency to mitigate in year risk

Due to the possibility of in-year budget adjustments in respect of specialised commissioning activity, the CCG has retained contingency funding to mitigate this risk without in-year impact on agreed commissioning budgets

1. Evidenced through finance reports to Newham CCG Board

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

4.4a Capturing and coding of CCG specialised commissioning activity

02-Apr-2014 Chad Whitton

Completed Completed

Completed

73

5.1 Failing to build appropriate capacity and support for the development of Primary Care

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Jane Lindo Primary Care Transformation 27-Oct-2014 Green

This could result in: 1. Reputational risk in terms of a loss of public confidence and potential for adverse media coverage 2. Reduced patient satisfaction and poor patient experience of primary care services 3. An under skilled and under resourced workforce 4. Primary care facilities that are not fit for purpose 5. An inappropriate skills mix to cope with the anticipated increased demands on Primary Care 6. Failure to meet NHS Outcomes Framework indicators 7. Variations in the quality and standard of care and service delivery

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 3 12 4 2 8 4 1 4 31-Mar-2015

Control Control Description Control Assurance(s) Status

5.1a Newham CCG Primary Care Strategy

Newham Primary Care strategy includes details on the development of the commissioning role of clusters

1. NCCG Primary Care Strategy

Fully Effective

5.1b Cluster Plans Cluster plans with focus on developing clusters as commissioners with indicative budgets and focus on demand management initiatives

1. Evidence of Cluster plans

Partially Effective

5.1c Monthly Cluster meetings

Monthly cluster meetings includes opportunity to collaboratively review quality and activity data, discuss ideas and share best practice

1. ToR for monthly cluster meetings 2. Example minutes from cluster meeting

Partially Effective

5.1d Quarterly cluster leads meeting

To coordinate ideas, share concerns and best practice between practices/clusters to feed into the CCG structure

1. ToR for Cluster Leads Meetings 2. Cluster Leads JD (role profile)

Fully Effective

5.1e Newham Education and Training Academy (NETA)

1. NETA Terms of Reference

Fully Effective

5.1g Programme of training and support for GP IT

NCCG are working with NELCSU as a contracted service provider for GP IT support to deliver a programme of training aimed at increasing utilisation of emis web and emerging technologies to improve productivity and patient experience

1. Monthly Newham GP IT briefing note provides overview of training and support delivered in the reporting period 2. Annual training plan for 14/15 to be finalised.

Partially Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

5.1a Finalise 2014/15 Cluster Plans 03-Oct-2014 Jane Lindo

Unlikely to be Completed on

Time

Deferred to October 2014 in line with overall review of CCG Constitution which will include reconfiguration of CCG clusters. Also finalising cluster plans will be linked into 2014/15 commissioning intentions.

Check

Progress

5.1b Cluster meeting ToR to be reviewed and updated 30-Jun-2014 Jane Lindo

On Track Completed August 2014

Completed

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5.2 Failing to develop new and functional Extended Primary Care providers

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Jane Lindo Primary Care Transformation 27-Oct-2014 Amber

This could result in: 1. Reputational risk from adverse media coverage and resultant loss of public confidence 2. Lack of provision for the expected increase in demand for Primary care services resulting from planned shift increase of community based services 3. Increase in activity under PBR arrangement with Barts Health with consequential financial risk

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 3 12 4 3 12 4 2 8 31-Mar-2015

Control Control Description Control Assurance(s) Status

5.1a Newham CCG Primary Care Strategy

Newham Primary Care strategy includes details on the development of the commissioning role of clusters

1. Newham Primary Care Strategy includes detail on the development of Extended Primary Care providers

Partially Effective

5.2b CEG contract 14/15 Within CCG-CEG contract 14/15 CEG have been commissioned to develop new/amended clinical templates for EPCS services and to train practices in using the new templates. CEG have also been commissioned to develop performance monitoring and payment tools to support the new EPC services.

1. CEG contract 2014/15

Fully Effective

5.2c NETA - Newham Education and Training Academy

NETA has been established to support Primary Care workforce development (both clinical and non-clinical) in order to improve the quality of primary care service provision and enhance patient experience of primary care services.

1. NETA Terms of Reference

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

5.2d Contracting and mobilisation of new EPC services

01-Oct-2014 Jane Lindo

Likely to be Overdue

LIS aspects now with LMC for consideration - noy yet signed off

Overdue

5.2a Finalise 2014/15 EPCS contracts 30-Apr-2014 Satbinder

Sanghera Completed

EPCS contracts issued to all practices. AF spec on hold until October and further work on Care planning spec to reflect agreed position re £5 per patient allocation to support care planning for high risk patients

Completed

5.2b Agree 2013/14 forward support arrangements with CEG for EPCS development

03-Feb-2014 Luke Moore

Completed

An addendum, to the contract for 13/14 was agreed with CEG to fund forward develop of performance and monitoring tools for the EPC contracts based on the developed service specifications.

Completed

5.2c Finalise 2014/15 CEG contract in relation to EPCS development and support

31-Mar-2014 Luke Moore

Completed CEG Contract for 2014/15 has been finalised and includes provision of support for EPC services

Completed

5.2e Performance and monitoring arrangements for 14/15 EPCS contracts

01-Sep-2014 Jane Lindo

Completed

CEG are providing regular reporting on all EPCS services. Minor changes are being made to clinical templates to reflect minor service spec changes to be completed by October 2104.

Completed

5.2F Develop an invoice and payment tool for EPCS services

01-Sep-2014 Jane Lindo

Completed

Invoice and payment tool has been developed by CEG as part of the contract for 14/15. This is being revised to ref;lect minor changes in service specifications which will form part of the contract variation notice.

Completed

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5.2h Determine on-going contract management function for EPC Services

01-Jul-2014 Jane Lindo

Completed EPCS lead confirmed in CCG structure and additional resource has been recruited to support the delivery and contract management of EPC services.

Completed

5.2i Clinical Training for GP Practices around EPCS services

30-Sep-2014 Susanna Statton

Completed

Training for Latent TB on counselling and initiation of treatment delivered on 22 April. Further training session for pharmacists on latent TB scheduled for 11 June. Training focussed on COPD and CVD to be delivered by 1st September.

Completed

5.2j CEG training on new/amended EPCS templates

01-May-2014 Jane Lindo

On Track Training delivered via GP education sessions and also a CEG facilitated workshop at the Practice Manager's Forum.

Completed

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5.3 Failing to develop the role of GP Practices and Clusters as Commissioners

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Jane Lindo Cluster Team 27-Oct-2014 Amber

This could result in: 1. Financial risk due to the lack of budgetary ownership and control at practice/cluster level 2. Increased activity and therefore cost under Barts Health PBR contract

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 3 12 4 3 12 4 1 4 31-Mar-2014

Control Control Description Control Assurance(s) Status

5.3a Newham Primary Care Strategy

Includes detail on the development of the commissioning role of clusters.

1. Newham Primary Care Strategy

Partially Effective

5.3b Monthly Cluster meetings

Monthly cluster meetings provide a forum for practices to share ideas, concerns and best practice to work collaboratively together to commission and plan services effectively

1. ToR of cluster meetings 2. Example minutes of cluster meeting

Fully Effective

5.3c Newham CCG Constitution

Clearly defines (pages 6-7) the role of clusters in terms of informing and developing commissioning intentions.

1. Newham CCG Constitution

Fully Effective

5.3d Weekly Cluster Commissioning meeting

Weekly cluster commissioning meeting (from May 2014) to focus on development cluster and practice level shadow budgets to focus on acute activity and prescribing spend with shadow budgets to be managed at cluster level.

1. ToR for weekly cluster commissioning meeting

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

5.3a Agree shadow budget allocation methodology for cluster level budgets (for acute activity and prescribing spend)

30-Sep-2014 Jane Lindo

Likely to be Overdue

Cluster level budgets to be agreed to allow clusters to manage devolved shadow budgets for acute activity and prescribing spend. Expected in draft for review by July 1st with final agreed cluster budgets by September.

Overdue

5.3c Agree operational capacity to deliver agreed workstreams of primary care strategy

01-Oct-2014 Jane Lindo

Likely to be Overdue

Resources Proposal still to be signed off by Senior mgt team although now been considered

Overdue

5.3b Agee CCG finance support required to develop clusters as commissioners

02-Jun-2014 Jane Lindo

Completed Named finance leads are in place to support the development of devolved commissioning budgets at cluster level.

Completed

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5.4 Failing to develop staff skills and competencies to support the organisational and operational development of the CCG

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas Quality 27-Oct-2014 Green

This could result in: 1. Failure to deliver key strategic objectives as a result of inappropriate skills mix 2. Ineffective succession planning and loss of organisational memory 3. Errors or significant incidents resulting in financial and/or reputational loss 4. Failure to comply with mandatory training requirements, for example safeguarding and health and safety.

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 4 16 4 2 8 4 1 4 31-Mar-2015

Control Control Description Control Assurance(s) Status

5.4a Monthly CCG staff Meeting

The CCG staff meeting is being re-shaped to encourage collective development in meetings

1. Staff meeting development feedback - May 2014

Partially Effective

5.4b SMT Development sessions

Externally facilitated SMT development sessions held to development strategic and leadership skills.

1. Agendas and feedback from SMT development sessions

Fully Effective

5.4c Personal development plans and appraisal process

All staff have completed PDPs to identify structured development targets to support core business delivery and continued learning and skills development. Six monthly appraisals provide assurance and monitoring to ensure agree PDP targets are on track.

1. Record of PDP and appraisal process

Fully Effective

5.4d Staff Development Sessions

Externally facilitated staff development sessions took place for CCG staff (and jointly for CCG and CSU staff)

1. Feedback report form CCG staff development 2. Feedback report from CCG/CSU joint staff development

Partially Effective

5.4e Coaching Programme All substantive CCG staff were offered the opportunity of 3 personal development coaching sessions with Talent Transitions Ltd, with the aim of setting objectives and outcomes to aid individual development and support business delivery by equipping staff with relevant skills to enable them to maximise productivity in their role.

1. Talent Transitions Coaching Programme details

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

5.4c Clinical and Business Leaders Development Programme

01-Oct-2014 Sue Nicol

Unlikely to be Completed on

Time Now due 31/10/14

Overdue

5.4d Safeguarding Children Training 31-Mar-2015 Reagender

Kang On Track

Safeguarding Children training has been delivered to 90% of NCCG staff. However, further mop up sessions will continue to be delivered in-year to support new starters in the organisation to ensure continual compliance with the requirement for all staff to complete level 1 training.

In Progress

5.4a SMT Development sessions 31-Jul-2014 Chetan Vyas

On Track

ALL SMT planned SMT development sessions have been completed with a focus on reviewing SMT functions, effective team working and CCG priorities.

Completed

5.4b Training Needs Analysis 30-Sep-2014 Sue Nicol

Completed TNA has been completed and was launched at NCCG staff meeting on 3rd September 2014

Completed

5.5e Counter Fraud Training 14-Apr-2014 Chad Whitton

Completed Counter fraud and bribery Training was provided by the counter Fraud specialist at

Completed

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Baker Tilly to CCG staff via the monthly CCG staff meeting in April 2014.

5.5f Equality and Diversity Training 14-Apr-2014 Satbinder

Sanghera Completed

Equality and diversity Training was provided to all Newham CCG staff via two dedicated sessions facilitated by the CSU equality and diversity lead in February and April 2014. These training sessions were aimed at equipping all CCG staff with the appropriate knowledge and understanding of the importance of equalities and diversity and also understanding of how to build in equality and diversity impact assessment as a standard part of any new procurement or commissioning process.

Completed

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5.5 Failure to develop and maintain appropriate Board skills and competencies

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas Quality 27-Oct-2014 Green

This could result in: 1. Errors or significant incidents resulting in reputational and/or financial loss 2. Ineffective succession planning and resultant loss of organisational memory 3. Failure to deliver key strategic objectives on time and on target 4. Potential for external performance management measures

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 3 12 4 2 8 4 1 4 31-Mar-2015

Control Control Description Control Assurance(s) Status

5.5a Board Development Plan 13/14

Structured plan for Board development agreed and signed off for 2013/14

1. 2013/14 Board Development plan

Fully Effective

5.5b Monthly Board Development Group meetings

Monthly Board development group meetings which focus upon key strategic topics and areas of priority to enable more intensive discussion and focus on specific topics at a Board level.

1. Example of Board development group agenda 2. Board Development group forward plan

Fully Effective

5.5c Personal Development review process for all Board members

Every NCCG Board member has had a one-to-one personal development review meeting with the CCG Chair, followed up with an agreed and documented personal development plan, which will be supported by on-going appraisal throughout the year.

1. Individual PDPs for all Board members

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

5.5a Board away day 20-Oct-2014 Chetan Vyas

On Track

Board away day planned to reflect on the 1st year or operation for Newham CCG as a statutory body. This is being planned for October 2014 to allow for completion of the CCG Board election.

Check

Progress

5.5d PDP and Objective setting for 2014/15 13-Oct-2014 Chetan Vyas

On Track

It was agreed that the process of agreeing PDPs at board level would be deferred pending the election of the new NCCG Board in Sept 14. Consequently this deadline ahs been revised to mid October.

Check

Progress

5.5b COI Training 17-Feb-2014 Chetan Vyas

Completed Externally facilitated COI training for all Board Members took place in February 2014.

Completed

5.5c Board Devt. sesison focussed on Board roles and behaviours

31-Jul-2014 Chetan Vyas

On Track Board development session was held in July 2014.

Completed

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6.1 Failing to progressively develop and review the CCG's corporate governance structure to ensure the CCG is able to effectively discharge its duties

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Satbinder Sanghera **Board 27-Oct-2014 Amber

This could result in: 1. A Constitution that is not fit for purpose 2. Inconsistencies in the application of the scheme of delegation 3. Lack of clarity around the responsibilities and accountabilities of committees and transformation programmes and potential for duplication of work 4. Lack of effective financial control and no deliver in key areas such as QIPP 5. The potential for external performance management 6. Adverse media coverage

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

5 3 15 5 2 10 5 1 5 31-Mar-2015

Control Control Description Control Assurance(s) Status

6.1a Working group to review CCG Constitution and corporate governance arrangements

A working group will be convened , including reps from SMT, clinicians and Non-exec Board lay member for governance to review the CCG's governance arrangements and agree required changes to the Constitution to submit to NHSE.

Working group established - August 2014

Fully Effective

6.1b NCCG Practice Member Council

The Practice Member Council acts as a forum to scrutinise and ratify proposed Constitutional changes to ensure full engagement and support from members practices as a clinically led commissioning organisation.

1. ToR of Practice Member Council

Fully Effective

6.1c Monthly assurance meetings with NHSE

CEO and Head of Governance and Engagement meeting monthly with NHSE to provide assurance around the CCG's corporate governance arrangements and to ensure full engagement on proposed changes to the constitution and governance arrangements.

1. No specific paper based assurance but any concerns raised are fed back at a Senior Management level to ensure that where required, appropriate changes to the CCG's corporate governance arrangements are considered.

Fully Effective

Action Due Date Assigned To Expected Outcome Latest Update Status

6.1c Submission of proposed changes to NCCG Constitution and scheme of delegation to NHSE

10-Nov-2014 Satbinder Sanghera

On Track

There are 2 submission windows annually for all CCGs to submit proposed constitutional changes to NHSE. review of governance arrangements and CCG Constitution is underway to meet the next available window for submission in November.

In Progress

6.1d Establish an annual process of review for CCG governance arrangements and Scheme of Delegation

03-Mar-2015 Satbinder Sanghera

On Track

A process needs to be agreed to embed an annual review of CCG governance and scheme of delegation to ensure that the CCGs governance structures continue to be robust and effective. This will be shaped by the Constitution and Governance working group to be established by July 2014.

In Progress

6.1a Establish working group to review Constitution and CCG governance arranegments

13-Oct-2014 Satbinder Sanghera

Completed

Constitution working group was established in August 2014 and will reports recommendations by October 2014 in line with requirement to submit proposed changes to NHSE by November 2014. Action due date for report recommendations amended accordingly.

Completed

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6.1b Report to Board and Practice Member Council to seek approval on proposed changes to governance and constitution arrangements following outcome of CCG governance review

08-Oct-2014 Satbinder Sanghera

Completed

Report to NCCG Board to agree and sign off outcome of governance review in order to meet deadline of November submission to NHSE of any proposed changes to CCG Constitution or Scheme of Delegation.

Completed

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6.2 Failure to effectively embed awareness of information governance issues and standards across the organisation

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Satbinder Sanghera IMT 27-Oct-2014 Green

Newham CCG has met all IG toolkit requirements at level 2 and demonstrated robust controls and processes around Information Governance. However, failure to effectively engage with all staff and GP practices to promote good IG practice could result in: 1. Inconsistent application of IG controls and standards across the organisation 2. Lack of clarity on responsibility and ownership of IG issues 3. Potential for data to be used inappropriately with consequential potential for serious incident, patient harm and/or financial penalty

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 2 8 4 2 8 4 1 4 31-Mar-2015

Control Control Description Control Assurance(s) Status

6.2a Named IG Lead, Caldicott Guardian and SIRO

NCCG has designated leads for to ensure that IG is effectively managed and staff re fully supported at all levels of the organisation

1. JD's for IG roles 2. Confirmation of Caldicott Guardian registration

Fully Effective

6.2b IG training for all Newham CCG staff

All Newham CCG staff are required to complete mandatory IG training annually via the national Information governance online training tool. Staff with additional IG responsibilities are required to undertake additional training to support them in their roles

1. IG training lead by NCCG IG lead. Training compliance at 100% for 2013/14 and training plan in place to for 14/15.

Fully Effective

6.2c Regular IG updates via email and staff newsletter

Regular updates and reminder on IG issues are cascaded via email and (frim July 2014) through the staff newsletter to ensure awareness of IG issues is maintained.

1. Evidence of previous staff IG updates

Fully Effective

6.2d Fair processing notices on CCG website

Newham CCG has published details on the frontpage of its website to provide information to patients and public on uses of their information in line with fair processing requirements

See link to NCCG website front page for fair processing notices: http://www.newhamccg.nhs.uk/

Fully Effective

6.2e Fair processing notices for GP Practices

Fair processing notices developed to support GP practices in raising patient awareness of how information is used and their rights to determine how their information can be used.

1. Current gap in control

Gap in Control

6.2f Training for GP practices to improve understanding of IG issues and in particular patient consent in relation to information sharing

Additional support and education provided to GP Practices to ensure they they can effectively address patient /public queries or concerns about information governance issues

Current gap in control

Gap in Control

Action Due Date Assigned To Expected Outcome Latest Update Status

6.2a Develop fair processing notices for GP practices to highlight local information sharing initiatives

30-Sep-2014 Luke Moore

Likely to be Overdue

A model fair processing notice has been developed as part of an overarching information sharing protocol (OISA) being developed to support a consistent approach to information sharing across all Newham health and social care providers. The OISA is to be taken to ELFT and NCCG programme Boards for approval during September and early October before wider rollout to other health economy stakeholders.

Overdue

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84

Newham Clinical Commissioning Group Board Meeting

Wednesday 8th October 2014

Title: NCCG Finance - Month 5 Report

Agenda item: 3.4

Author: Chad Whitton Chief Finance Officer Newham CCG

Presented by: Chad Whitton Chief Finance Officer Newham CCG

Contact for further information:

Chad Whitton Chief Finance Officer Newham CCG

Date paper finalised: 1st October

Action requested: Approve the report (including Appendix 1)

Executive summary: Executive Summary: The CCG submitted a balanced final Operating Plan Financial Template (OPFT) in line with financial requirements to NHSE on 18th April. Budgets in line with the OPFT were loaded in May At Month 5 the CCG total resource allocation was £410,834,000 and planned expenditure, including reserves was £398,834,000 generating a surplus of £12,000,000 (3%). A significant projected over-performance on acute activity will be managed through the application of reserves held against that risk. The Running Cost Allowance is set at £8,068,000. Planned capital spend (still to be confirmed) is £400,000. The net QIPP savings target is £10,292,295. The plan has been reviewed with NHSE as part of the routine CCG assurance meetings. The CCG submitted its Operating Plan Financial Template for 2014/15 to 2018/19 and the finance template for the Better Care Plan on 4th April. A final revision of the OPFT was submitted on 25th July. A final revision of the BCF plan was sent on 19th September. As a challenged local economy the CCG is part of a joint local health economy 5 year plan submission to NHSE on 20th June. A final version of the 5 Year Plan including a section on LHE financial sustainability was completed for the WEL SPG on 19th September. Additional detail on the above items is provided in Appendix 1 and an Acute over-performance review in Attachment 1

85

How does this fit with Newham CCG Strategy:

Accountability and Responsibility - Requirement to meet target surplus.

Where has the paper been already presented?

n/a

Impact on risk: The Financial Plan (including the QIPP programme) as identified in the Operating Plan Financial Template is an essential component in identifying and managing financial risk and ensuring the CCG delivers its financial requirements.

Quality Impact Effective financial planning, monitoring and control delivering value for money enables effective targeting of resources to support delivery and continuous improvement of high quality services for patients.

Equality Impact: Effective delivery of the financial plan will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham.

Stakeholder Consultation

This report has been subject to no specific prior consultation but reflects any comments from NHSE scrutiny and assurance processes and any comments, queries or suggestions raised by CCG members, the Board or Newham residents in relation to earlier reports.

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Item 3.4 – Appendix 1 Newham CCG Board – 8th October 2014

CCG 2014/15 Month 5

Summary The CCG submitted a balanced final Operating Plan Financial Template (OPFT) in line with financial requirements to NHSE on 4th April. Budgets in line with the OPFT were loaded in May. At Month 5 the CCG total resource allocation was £410,834,000 and planned expenditure, including reserves was £398,834,000 generating a surplus of £12,000,000 (3%). A further version of the OPFT was submitted on 20th June and a final version will be provided as part of the SPG 5 year plan. Month 5 Outturn At Month 5 the CCG is showing an underspend of £53,000 and projecting achievement of the year-end outturn target surplus. Details of spend are summarised below.

A more detailed analysis is provided in the Month 5 Activity and Finance Report that is provided by CSU to the CCG Commissioning Committees. However, the Board should note that there is significant over-performance against acute providers, with the major contributors tabled below:

Area 2013/14 Final

Outturn

2014/15 Draft

Annual Budget

Cumulative Budget

Cumulative Actual

Cumulative Variance

2014/15 Projected

Final Outturn

£'000 £'000 £'000 £'000 £'000 £'000Acute Services 215,021 207,842 86,601 92,133 5,532 221,201Mental Health 47,719 45,720 19,050 19,071 21 45,770Community Health 41,586 39,389 16,412 16,376 -36 39,301Other Non-Acute 28,535 21,269 8,940 8,949 9 21,527Primary Care 44,645 47,174 19,792 20,078 286 47,672Reserves 0 29,372 5,864 0 -5,864 15,295Running Cost 7,988 8,068 3,362 3,361 -1 8,068Total Spend 385,494 398,834 160,021 159,968 -53 398,834

Total Allocation -397,590 -410,834 -165,021 -165,021 0 -410,834

(Suplus)/Deficit -12,096 -12,000 -5,000 -5,053 -53 -12,000

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Key areas of over-performance at Barts Healthcare are in A&E, Non-Elective, Outpatients and Critical Care. The detailed Month 5 report has been considered by the Acute Committee. An analysis on the data has been undertaken to determine drivers of the over-performance reporting and is summarised in Attachment 1 to this appendix. There has also been a significant increase in a number of out of sector trusts including BMI and this is also referred to in Attachment 1. It is clear that in part some over-performance is in response to the lengthening waiting times at Barts. The deterioration in the projected position at Month 4 was significant. At Month 5, the additional analysis and consolidation of the first Quarter position has shown stabilisation of the position with a small improvement in the projection and a lessening of risk. There is still, however, a serious financial challenge to the CCG. Although the application of risk and contingency reserves held for this purpose currently offsets this adverse variance and the CCG can still deliver its financial target, the level of contingency still available is now significantly reduced and all other reserves are committed. The Barts Healthcare position has taken a prudent view of QIPP delivery particularly in the expectation of UCC and Virtual Ward savings. However, should there be a further reduction in QIPP delivery, or above trend increase in over-performance, the CCG will need to review reserve commitments to identify scope for additional retention. Other variances are of smaller scale and will be reported to the relevant Committee for consideration.

Acute over-performance 2013/14 Final

Outturn

2014/15 Draft

Annual Budget

Cumulative Budget

Cumulative Actual

Cumulative Variance

2014/15 Projected

Final Outturn

2014/15 Projected

Final Variance

£'000 £'000 £'000 £'000 £'000 £'000 £'000Barts Healthcare 171,249 166,538 69,391 73,411 4,020 176,187 9,649Guys & St Thomas 2,556 2,128 887 1,065 178 2,525 397Homerton 3,736 3,612 1,505 1,647 142 3,979 367Royal Free 591 540 225 380 155 752 212BHRUT 3,955 3,967 1,653 1,808 155 4,339 372UCLH 3,078 2,874 1,197 1,534 337 3,713 839BMI 1,570 1,330 554 861 307 2,093 763Other 28,252 26,853 11,189 11,427 238 27,613 760Total Spend 214,987 207,842 86,601 92,133 5,532 221,201 13,359

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QIPP In the Operating Plan the net QIPP Programme is £10.2million with a risk rated anticipated delivery of £8.5million. In 2014/15 delivery of QIPP savings will be crucial to enable the CCG investment plans to be fully rolled out. In Month 5 the CCG reported achievement of £4.16m against a target of £4.29m and is projecting full achievement. However, acknowledging the limited data available at this point in the year there are significant variances emerging in achievement. Investigations are in progress and it anticipated that the Month 6 Report will include an additional appendix reviewing the CCG QIPP performance identifying remedial action. Capital A capital bid for £200,000 has been submitted as part of the OPFT. This is for equipment maintenance and replacement. A further bid for £200,000 supporting minor service re-location and additional refurbishment has been submitted and a response is awaited on both bids from NHSE. Operating Plan 2014/15 to 2018/19 and Better Care Plan submission The CCG submitted its draft Operating Plan Financial Template (OPFT) on 14th February and further iterations on 7th March, 4th April, 20th June and 25th July. The OPFT includes a list of investments and savings agreed as part of the 2014/15 QIPP programme. A final submission on the Better Care Fund with significant additional detail required on the achievement of targets was forwarded on 19th September. The returns is currently being reviewed nationally for approval. The CCG is collaborating with the Borough and other stakeholders to ensure that the submission meets the necessary criteria and, in particular, the targets required to deliver the performance payments. North East London was identified as one of eleven Challenged Health Economies by NHSE in April The CCG is currently working with other CCGs (as part of the WEL Strategic Planning Group (SPG)), NHSE and local providers supported by McKinseys and the CSU to finalise a joint local health economy 5 year plan. An initial plan was provided to NHSE on 20th June and a number of discussions have been held subsequently with the Regional NHSE team. A final WEL SPG submission reflecting those discussions and the plans identified in the Transforming Services Together/Transforming Services Changing Lives Programme (TST/TSCL) was prepared in final draft on 19th September and due to be submitted to NHSE in October.

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Appendix 2

Acute over-performance analysis – QIPP Non-Delivery Analysis.

Barts Healthcare over-performance

Background In 2013/14 the Barts Healthcare moved from a block contract to a PBR contract. Through 2013/14 projecting the final outturn of the contract was complicated by issues surrounding the disaggregation of specialised commissioning and significant disputes between the Trust and the commissioning collaborative over data quality and content. The contract was not signed off until very late in the financial year and final confirmation of the year-end position is still outstanding. In 2014/15 there have been improvements as follows: • Closer and more positive engagement with Barts Healthcare through establishing a PMO office

managed by a Director of Barts Health Commissioning, supported by a consolidated dedicated CSU MDT

• Resolution of outstanding issues relating to the disaggregation of SCG budgets and correct Trust invoicing

• Contract sign off by end June with resolution of all outstanding issues by end September. • Improvements in quality and consistency of information However, there are still a significant number of issues and disputes which serve to add risk to year-end projections that are already made complex by the inevitable and unavoidable timing delays. Complexity example - Quarter 1 • Freeze (finalised) data based charge is £47.592m which on a straight-line basis would show a

final out-turn of £190.371m against a contract of £166.538m. • Adjustments for CQUINs, Claims, Challenges, Coding errors, Misattributions, Productivity,

Threshold, Re-admissions and penalties, most of which are risk rated as they have still to be finalised and agreed, reduce the projected Final Out-turn total by 17.2m to £173.17m.

(note that this is not the M5 projected Final Out-turn figure reported as this will include additional data and a more prudent view of risk in relation to over-performance and risk). 2014/15 Position The Month 5 position for Acute providers for NCCG is summarised in Table 1 below:

90

Key areas of over-performance identified in the Month 4 detailed report to the Acute Committee are highlighted below:

These variances compare in-year performance with plan. Plans are constructed primarily from the six month activity position in the previous year doubled with, depending on previous trend an adjustment for seasonal factors. In 2014/15 the plan agreed with the Trust in the Contract took this standardised approach. However, 2013/14 was an a-typical year in that due to the problems with data early in the year the Month 6 position was understated. This was further impacted upon through the reduction in activity to reflect anticipated QIPP. Where programmes have not started or under-delivered, primarily in non-elective, this would generate a variance. Analysis of the activity rate for Months 7-12 indicate an annual activity cost that would have been £5.2 million above Months 1-6 and £2.6m above the actual out-turn. This is reflected in the comparison to final out-turn shown in the above table where the variance is £4.938m or 2.9%. It should be taken into account that although agreement is still outstanding, the likely final position for NCCG might be up to £1.5m lower than the initial final outturn as claims and non-activity related items are finalised. Analysis of the position comparing 13/14 with 14/15 projected outturn indicates a number of areas with significant variance as follows:

Acute over-performance 2013/14 Final

Outturn

2014/15 Draft

Annual Budget

2014/15 Projected

Final Outturn

2014/15 Projected

Final Variance

% Variance

on contract

% Variance on 13/14

FOT£'000 £'000 £'000 £'000 % %

Barts Healthcare 171,249 166,538 176,187 9,649 5.8% 2.9%Guys & St Thomas 2,556 2,128 2,525 397 18.7% -1.2%Homerton 3,736 3,612 3,979 367 10.2% 6.5%Royal Free 591 540 752 212 39.3% 27.2%BHRUT 3,955 3,967 4,339 372 9.4% 9.7%UCLH 3,078 2,874 3,713 839 29.2% 20.6%BMI 1,570 1,330 2,093 763 57.4% 33.3%Other 28,252 26,853 27,613 760 2.8% -2.3%Total Spend 214,987 207,842 221,201 13,359 6.4% 2.9%

Area M4 YTD Price Plan

M4 YTD Price Actual

M4 YTD Price

Variance

M4 YTD Activity

Plan

M4 YTD Activity Actual

M4 YTD Activity Variance

A&E £2,740,472 £3,296,599 £556,127 21,417 45,436 24,019Inpatient Elective £8,341,389 £8,770,371 £428,983 8,186 8,684 498Inpatient Non-Elective £14,064,919 £16,407,471 £2,342,551 10,215 13,441 3,226Outpatients £9,266,063 £10,602,711 £1,336,649 65,517 75,838 10,321Maternity £8,558,805 £8,815,476 £256,671 6,586 6,504 -82 Critical Care £2,606,010 £3,168,041 £562,031 1,514 1,784 270High Cost Drugs and Devices £1,404,006 £1,390,158 -£13,848 2,600 3,475 875Other £9,164,340 £9,677,141 £512,801 699,334 641,637 -57,697

91

• Critical Care – The Trust would appear to have significantly increased recent charges for Critical

Care although no known specific factor would account for this. The Trust may be changing practice with regard to charging. A challenge has been raised to determine whether any changes are contractually permissible and a reduction is anticipated.

• Excess Bed Days – The increase in Excess Bed Days is primarily in Cardiac, Eyes and Mouth, Head and Neck procedures. This is significantly (10%plus) above the Month 7-12 13/14 run rate and raised as a query for the Trust to clarify how this sudden increase has arisen.

• High Cost Drugs - Queries have been raised regarding drugs charges to the CCG made in 2014/15 that were previously not charged.

• Maternity Pathway – Query raised with the Trust as the volume of patients on the Ante-natal pathway is significantly greater than the expected number of births

• Outpatient Procedures – Activity increase is significantly higher than in 13/14 and challenges have been raised to determine if an approach not agreed with the CCG has been implemented. However, the increase might also reflect changes from Daycase to Outpatients agreed as part of productivity programmes.

With regard to the substantial number of outstanding claims lodged with the Trust it is anticipated that resolution of these claims will generate a material reduction in these adverse variances. A risk rated assessment is currently being conducted as part of the Month 6 reporting cycle and will be tabled at the Board meeting. However, the likely position based on the above considerations is that the projected variance may reduce by up to two million. Homerton and Out of Sector Acute Table 1 identifies the significant variances by volume and percentage for out of sector acute providers. For most trust the CCG works through a lead commissioner and this can add difficulty in getting a swift and focused response. The CCG is, therefore, targeting UCL and BMI as areas where we will most actively pursue the variance.

Area Sum of Price - 2013-14 Outturn

Sum of Price - 2014-15 Mths 1-4

Extrapolation

Movement

Accident and Emergency 9,666 9,890 224Adult Critical Care Bed Days 7,977 9,504 1,527Adult Renal Dialysis 0 90 90Diagnostic Imaging whilst Out-Patient 3,800 3,677 (124)Direct Access 13,076 13,284 209Elective/Day Case 24,686 24,168 (518)Excess Bed Days 2,679 3,933 1,254High Cost Drugs/Devices/Treatment 4,616 5,568 952Maternity Pathway 12,706 13,952 1,246Non-Elective 42,168 42,510 342Non-Elective Non Emergency 16,109 15,842 (267)Occupied Beddays 6,308 5,723 (586)Other 4,890 4,787 (103)Outpatient Procedures 3,745 5,436 1,690Outpatients 27,341 26,264 (1,077)

92

• Guys and St Thomas increase is small compared to 13/14 outturn and the variance reported reflects a reduction in the contract value which was set by the lead CCG. Future contract setting will be based on the projected previous year outturn.

• The Homerton increase is due to variances on Outpatients and Excess Bed Days. Overall the variance is not material compared to the previous years out-turn but will be monitored in collaboration with City & Hackney CCG to ensure there is no further shift in the projection.

• Royal Free increase is significant and primarily due to a high level of spend on critical care. • The BHRUT contract has been agreed as a block contract and the contract value will be adjusted

to reflect this • UCL over-performed against contract in 2013/14 and is projected to over-perform in 2014/15.

This trend is concerning and is being pursued with NCL who are the lead commissioners. The over-performance is due to over-performance in a number of areas suggesting that overall there has been an increase in the volume of activity going to this trust from Newham.

• BMI – This contract is projected to over-perform significantly against both plan and 13/14 out-turn. The pressure is mainly in the T&O specialty reflecting a transfer of activity from Barts Healthcare in response to long waiting times. Although a query is being pursued with the provider to confirm their charging methodology reflects the agreed contract parameters, resolution of the problem at Barts Healthcare is seen as the best way of relieving this pressure.

Conclusions Acute contracting and performance management is a specialist area. It contains a high degree of complexity compounded by the volumes and breadth of the information. The size of the main London providers compared to CCGs and the collaborative or lead commissioner approaches thereby necessitated, add to the difficulty of pinpointing and resolving variances. At Barts, the analysis indicates that although reporting will continue to reflect variances to the agreed plan, comparison to 13/14 activity is more likely to provide a clear view of the drivers of over-performance. Five areas where this is occurring have been identified and queries are being urgently pursued with the Trust. Based on these queries and the ongoing monthly reviews the projected final outturn appears to be reducing slightly, thereby lessening the level of financial risk to the CCG. However, the over-performance is still substantial. Considering the Acute Sector as a whole the over-performance on 2013/14 is still in excess of £6m (2.9%) which is higher than the growth in population. While QIPP is not being effectively delivered in Urgent Care and Rehab Ward schemes this is more than offset by over-delivery in Threshold and Re-admissions savings. It is, therefore, clear that the CCG target of maintaining acute spend within a stable cash envelope is not being achieved. In the longer term continued increasing in the acute sector on this scale would be unsustainable. This underlines the importance for the CCG of ensuring that its plans to implement integrated care as a way of levering in additional efficiency as well as improvements in patient quality and safety are pursued and implemented, and that QIPP plans are realistic and achieved.

93

Newham CCG Board

Wednesday 8th October 2014

Title: NCCG Quality - Month 5 Report

Agenda item: 3.5

Author: Saem Ahmed, Quality and Development Manager Newham CCG

Presented by: Chetan Vyas, Director of Quality and Development Newham CCG

Contact for further information:

Chetan Vyas, Director of Quality and Development Newham CCG

Date paper finalised: 01st October 2014

Action requested: Approve the status of the current quality indicators

Executive summary: The Newham CCG Quality Report (Barts Health) at Month 5 and RAG rates performance as follows: Green • Amber Alerts acknowledged within 3 working days • Safeguarding Children Training • Safeguarding Adults Training • C.DIFF • VTE Assessment • Friends and Family Test

Red • Serious Incidents overdue 6 months or more • Mixed Sex Accommodation • Amber Alerts actioned within 10 working days • MRSA Non RAG indicators • Serious Incidents • Never Events • Summary Level Hospital Mortality Indicator October 2012 to

September 2013 (published July 2014)

All Red issues are being discussed with Barts Health and assurances are sought on improvement plans and trajectories through the Barts Health CQRM meetings.

.The Newham CCG Quality Report (East London Foundation Trust – Mental Health) at Month 5 RAG rates performance as

94

follows: Green • Discharge notification sent to GP within 48 working hours of

patient discharge • Medicine reconciliation within care plans within 72hours of

admission • Patients on CPA with diabetes, CHD, COPD HTN and obesity

have completed annual physical health check • Smoking status of patients recorded electronically • Older Adult Community DNA rate

Amber • Clinical sharing information with GP

Red • Serious Incidents overdue by 6 months or more • Adult Community DNA rates • Adult inpatient re-admissions within 28 days • Child and Adolescent Mental Health Service DNA rates

(CAMHS)

Non RAG indicators • Serious Incidents • Never Events All Red issues are being discussed with East London Foundation Trust and assurances are sought on improvement plans and trajectories through the East London Foundation Trust CQRM meetings. The Newham CCG Quality Report (East London Foundation Trust – Community Health) at Month 5 RAG rates performance as follows: Green • Safeguarding Children, due once Level 1 • Safeguarding Children, due once Level 2 • Patient Reported Experience Measures (PREMS) • Amber Alerts acknowledged within 2 days • Amber Alerts actioned within 5 days • MRSA • C.DIFF • VTE assessment • Safeguarding Children compliance, due 3 yearly Level 1

Amber • Safeguarding Children compliance, due 3 yearly Level 2 • Safeguarding Children compliance, due 3 yearly Level 3

Red 95

• Serious Incidents overdue by 6 months or over No RAG • Children’s Safeguarding Incidents • Adult Safeguarding Incidents • Serious Incidents

All Red issues are being discussed with East London Foundation Trust and assurances are sought on improvement plans and trajectories through the East London Foundation Trust CQRM meetings. Other quality matters • Nursing Home Quality Assurance Visit

Supporting Papers: • Quality Indicators

• CQC inspection report. • Francis Report.

How does this fit with Newham CCG Strategy:

Quality covers all aspects of the CCG Strategy however the Aim and Value this report best fits are; Value: Working with our partners to improve health outcomes. Aim: Reducing quality variation.

Where has the paper been already presented?

No previous presentation to any meeting

Risk : The risks in relation to Barts Health and East London Foundation Trust are around non-delivery and these are reported on in the appended report.

Equality Impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.

Stakeholder Engagement Impact (ie. have patients groups, community groups, health watch, LBN, LMC etc been involved)

Not required specifically for this report, however there are elements of engagement of patients through the Friends and Family Test, Patient Reported Experience Measures and the Quality Assurance Visits.

1. Introduction and Background

1.2 The Board are asked to note this month’s Quality Report and be informed of the various updates that are included in the entire report in relation to Barts Health and East London Foundation Trust. 96

2. Key Considerations and Sustainability

2.1 A number of key risks and issues are explicitly outlined in the report and the mitigation plans in place to ensure the Providers deliver against planned trajectories.

3. Service Delivery

3.1 Enhanced reporting on the quality of care provided by local providers will enable the CCG Board to become more informed of the quality of commissioned services for the resident population of Newham and these reports will enable this.

4. Next Steps

4.1 The relevant CQRM meetings will closely monitor progress against improvement plans and provide updates through the Quality Committee.

97

Quality Report October 2014

Purpose:

The purpose of this report is to provide the CCG Board with an update on quality matters across our local Provider organisations.

98

Areas of improvement

Areas achieving

Non RAG indicators

Barts Health Quality Report

Purpose:

This report will cover an update on the following areas:

Serious Incidents overdue 6 months or more Mixed Sex Accommodation Amber Alerts actioned within 10 working days MRSA

Amber Alerts acknowledged within 3 working days

Safeguarding Children Training Safeguarding Adults Training C.DIFF VTE Assessment Friends and Family Test

Serious Incidents Never Events Summary Level Hospital Mortality Indicator October 2012 to September 2013 (published July 2014)

99

Indicator Q1 Q2 Q3 Q4 Summary

Serious Incidents overdue by 6 months or more Target = 0

Apr 4

Jul 6

Oct Jan Trust

- Barts Health has a total of 4 Serious Incident reports overdue more than 6 months. - None related to Newham site in August 2014.

CCG/CSU - The CCGs are discussing with the Trust on the next steps to the workshop. - The CSU are continuing to monitor and follow up the outstanding investigations.

May 9

Aug 4

Nov Feb

Jun 4

Sep Dec Mar

Mixed Sex Accommodation breaches Target = 0

Apr 40

Jul 35

Oct Jan Trust

- Barts Health has reported 46 breaches in August. - Majority of the breaches are from Royal London (35), Newham (9) and London Chest (2). - Majority of these breaches come from critical or intensive care.

CCG/CSU - Monitored through the CQRM and monthly reporting by the CSU. - Focussed on at the CAG specific CQRM.

May 25

Aug 46

Nov Feb

Jun 28

Sep Dec Mar

Amber Alerts actioned within 10 working days Target = 100%

Apr 65%

Jul 30%

Oct Jan Trust

- The Trust is still underperforming in relation to meeting their deadline dates.

- However, compared to last year the number of days of delay has reduced.

- August data suggests that the alerts in relation to the Newham site are related to delays in receiving results, and referral to service issues. In relation to the other sites the themes are, unable to book appointments, referral issues, and quality of clinical letter.

CCG - The CCG Quality team monitors this daily and reminder for outstanding alerts are sent to the Trust. - The CCG raises thematic issues at CQRM with the appropriate CAG.

May 38%

Aug 36%

Nov Feb

Jun 23%

Sep Dec Mar

Under achieving indicators

Performance

Performance

Performance

100

Indicator Q1 Q2 Q3 Q4 Summary

MRSA Target = 0

Apr 1

Jul 1

Oct Jan Trust

- Barts Health reported 1 MRSA case in July. - The Public Health England reporting timetable means July is the most recent published figure. - The 1 case was at the Royal London site and none at the Newham site. CCG/CSU - MRSA’s are subject to Post Infection Reviews which are reported to Public Health England by the

Trust. - The CCG receive real time alerts from Public Health England when an MRSA is reported.

May 2

Aug Nov Feb

Jun 2

Sep Dec Mar

Indicator Q1 Q2 Q3 Q4 Summary

Friends and Family Test Target = 15%

Apr B 18

N 14%

Jul B 32% N 19%

Oct Jan Trust

- Due to submission timetable July is the most recent validated position.

- Barts have achieved the response rate. CCG/CSU - Continue to monitor this through CQRM.

May B 32% N 19%

Aug Nov Feb

Jun B 12% N 14%

Sep Dec Mar

Safeguarding Children Training Level 1 Target = 85% B = Barts Health N = Newham site

Apr B 95% N 93%

Jul B 95% N 93%

Oct Jan Trust

- The Trust overall is continuing to achieve the target. - Newham site level data unavailable for August. CCG/CSU - Continue to monitor this through CQRM. May

B 93% N 93%

Aug B 95%

Nov Feb

Jun B 94% N 93%

Sep Dec Mar

Performance

Achieving indicators

Performance

Performance

101

Indicator Q1 Q2 Q3 Q4 Summary

Safeguarding Children Training Level 2 Target = 85% B = Barts Health N = Newham site

Apr B 91% N 90%

Jul B 91% N 89%

Oct Jan Trust

- The Trust overall is continuing to achieve the target. - Newham site level data unavailable for August. CCG/CSU - Continue to monitor this through CQRM.

May B 87%

N 90%

Aug B 90%

Nov Feb

Jun B 90% N 89%

Sep Dec Mar

Safeguarding Children Training Level 3 Target = 85% B = Barts Health N = Newham site

Apr B 86% N 87%

Jul B 87% N 87%

Oct Jan Trust

- The Trust overall is continuing to achieve the target. - Newham site level data unavailable for August. CCG/CSU - Continue to monitor this through CQRM. May

B 91% N 88%

Aug B 86%

Nov Feb

Jun B 87% N 88%

Sep Dec Mar

Safeguarding Adults Training Level 1

Target = 85%

B = Barts Health N = Newham site

Apr B 95% N 94%

Jul B 94% N 94%

Oct Jan Trust

- The Trust overall is continuing to achieve the target. - Newham site level data unavailable for August. CCG/CSU - Continue to monitor this through CQRM.

May B 93% N 93%

Aug B 94%

Nov Feb

Jun B 94% N 94%

Sep Dec Mar

Performance

Performance

Performance

102

Indicator Q1 Q2 Q3 Q4 Summary

Safeguarding Adults Training Level 2 Target = 85%

B = Barts Health N = Newham site

Apr B 93% N 93%

Jul B 92% N 93%

Oct Jan Trust

- The Trust overall is continuing to achieve the target. - Newham site level data unavailable for August. CCG/CSU - Continue to monitor this through CQRM.

May B 91% N 93%

Aug B 92%

Nov Feb

Jun B 92% N 92%

Sep Dec Mar

C.Diff Target = 71

Apr 6

Jul 5

Oct Jan Trust

- The Trust reported 5 C.Diff cases in July. - 1 at the Newham site. - The trajectory for the Trust for the year is 71. CCG/CSU - Continue to monitor this through CQRM.

May 8

Aug

Nov Feb

Jun 2

Sep Dec Mar

Amber Alerts acknowledged within 3 working days Target = 100%

Apr 100%

Jul 100%

Oct Jan Trust

- All alerts across Barts Health were acknowledged within the timeframe. CCG - The CCG Quality team monitor this daily. May

100%

Aug 100%

Nov Feb

Jun 100%

Sep Dec Mar

Performance

Performance

Performance

103

Indicator Q1 Q2 Q3 Q4 Summary

Serious Incidents No target

Apr 18

Jul 12

Oct Jan Trust

- Newham site reported 9 Serious Incidents (SIs) in August. - All SIs reported were Grade 1. - Majority were in relation to grade 3 or 4 pressure sores. CCG/CSU - Continue to monitor this through CQRM and WELC SI panel. - Receive real time alerts from STEIS (Serious Incident reporting system). - Quarterly thematic analysis is reviewed at the Quality Committee.

May 15

Aug 9

Nov Feb

Jun 10

Sep Dec Mar

Never Events Target = 0

Apr 0

Jul 0

Oct Jan Trust

- No never events reported at the Newham site. CCG/CSU - Continue to monitor this through CQRM and WELC SI panel. - Receive real time alerts from STEIS (Serious Incident reporting system). - Quarterly thematic analysis is reviewed at the Quality Committee.

May 0

Aug 0

Nov Feb

Jun 0

Sep Dec Mar

Indicator Q1 Q2 Q3 Q4 Summary

VTE Assessments Target = 95%

Apr 98.7%

Jul

Oct

Jan

Trust

- The data submission timetable means the June figure is the most recent validated position. - Newham site is achieving the target with 98.7%. CCG/CSU

- The CSU and CCG continue to monitor this on a monthly basis. May

98.2%

Aug

Nov

Feb

Jun 98.7%

Sep

Dec

Mar

Non RAG indicators

Performance

Performance

Performance

104

Summary Level Hospital Mortality Indicator (SHIMI) – October 2012 to December 2013 (published July 2014)

Barts Health remains in the top 10 best performing Trust in the country. The Trusts observed deaths are below the expected deaths. All unexpected deaths are reviewed by the Trust to learn lessons where appropriate.

105

East London Foundation Trust (Mental Health) Quality Report

Purpose:

This report will cover an update on the following areas:

Serious Incidents overdue by 6 months or more Adult Community DNA rates Adult inpatient re-admissions within 28 days Child and Adolescent Mental Health Service DNA rates (CAMHS)

Discharge notification sent to GP within 48 working hours of patient discharge Medicine reconciliation within care plans within 72hours of admission Patients on CPA with diabetes, CHD, COPD HTN and obesity have completed annual physical health check Smoking status of patients recorded electronically Older Adult Community DNA rate

Clinical sharing information with GP

Serious Incidents Never Events

Non RAG indicators

106

Indicator Q1 Q2 Q3 Q4 Summary

Serious Incidents overdue by 6 months or more Target = 0

Apr 1

Jul 2

Oct Jan Trust

- The Trust has 0 Serious Incident reports overdue 6 months or over, although Mental Health are green, the Trust overall is red due to Community Health.

CCG/CSU - All Serious Incident reports are reviewed by the CSU and jointly by the WELC SI panel. - CCG receive regular updates from CSU on patient related Serious Incidents.

May 1

Aug 0

Nov Feb

Jun 1

Sep Dec Mar

Adult Community DNA rates Target = 10%

Apr 20.5%

Jul 17.7%

Oct Jan Trust

- The Trust is continuing to fail on this indicator. - The Trust identified that the data incorrectly includes some service which should be excluded. - The Trust is working on cleaning the data to identify the impact on performance. CCG/CSU - By the end of quarter 2 the CSU and CCG has asked for a trajectory against an agreed target.

May 20.7%

Aug 19.4%

Nov Feb

Jun 17.6%

Sep Dec Mar

Adult inpatient re-admissions within 28 days. Target = 7.5%

Apr 13.0%

Jul 12.8%

Oct Jan Trust

- The Trust is continuing to fail on this indicator.

CCG/CSU - The CCG Quality Committee has written to the Mental Health Commissioning Committee to look at

whether changes to service in the community have had an impact on the re-admissions rates. - The CCG Quality Committee requested an update at the October Committee.

May 10.9%

Aug 12.7%

Nov Feb

Jun 22.7%

Sep Dec Mar

Under achieving indicators

Performance

Performance

Performance

107

Indicator Q1 Q2 Q3 Q4 Summary

Child and Adolescent Mental Health Service DNA rates (CAMHS) Target = 15%

Apr 15%

Jul 20.0%

Oct Jan Trust

- The Trust performance has declined since June. - The Trust has a recovery DNA action plan in place, with targets and milestones to be achieved.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 14%

Aug 20.0%

Nov Feb

Jun 15.0%

Sep Dec Mar

Indicator Q1 Q2 Q3 Q4 Summary

Clinical sharing information with GP Target = 90%

Apr 85.4%

Jul 86.8%

Oct Jan Trust

- The Trust has failed the target for this indicator with 85.2%. - However compared to last year, there has been on-going continued improvement. - Last year January 2013-14 the Trust performance was red at 78.7% and over the last 6 months

there has been continued improvement. CCG/CSU - Agenda item at the next CQRM.

May 87.4%

Aug 85.2%

Nov Feb

Jun 87.9%

Sep Dec Mar

Performance

Performance

108

Indicator Q1 Q2 Q3 Q4 Summary

Discharge notification sent to GP within 48 working hours of patient discharge Target = 95%

Apr 99.4%

Jul 99.7%

Oct Jan Trust

- The Trust is continuing to achieve this indicator.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 99.5%

Aug 99.8%

Nov Feb

Jun 99.0%

Sep Dec Mar

Medicine reconciliation within care plans within 72hours of admission Target = 95%

Apr 95.5%

Jul 97.5%

Oct Jan Trust

- The Trust is continuing to achieve this indicator.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 95.1%

Aug 96.8%

Nov Feb

Jun 94.7%

Sep Dec Mar

Achieving indicators

Performance

Performance

109

Indicator Q1 Q2 Q3 Q4 Summary

Patients on CPA with diabetes, CHD, COPD HTN and obesity have completed annual physical health check Target = 80%

Apr 89.6%

Jul 96.4%

Oct Jan Trust

- The Trust is continuing to achieve this indicator.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 89.1%

Aug 93.0%

Nov Feb

Jun 90.0%

Sep Dec Mar

Smoking status of patients recorded electronically Target = 80%

Apr 95.4%

Jul 95.4%

Oct Jan Trust

- The Trust is continuing to achieve this indicator.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 94.6%

Aug 95.3%

Nov Feb

Jun 94.3%

Sep Dec Mar

Older Adult Community DNA rate Target = 10%

Apr 7.1%

Jul 7.7%

Oct Jan Trust

- The Trust is continuing to achieve this indicator.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 9.3%

Aug 6.4%

Nov Feb

Jun 9.4%

Sep Dec Mar

Performance

Performance

Performance

110

Indicator Q1 Q2 Q3 Q4 Summary

Serious Incidents No target

Apr 4

Jul 6

Oct Jan Trust

- - Of the 1 reported in August related to Grade 3 Pressure Ulcer.

- CCG/CSU - Continue to monitor this through CQRM and WELC SI panel. - Receive real time alerts from STEIS (Serious Incident reporting system). - Quarterly thematic analysis is reviewed at the Quality Committee.

May 1

Aug 1

Nov Feb

Jun 2

Sep Dec Mar

Never Events Target = 0

Apr 0

Jul 0

Oct Jan Trust

- No never events reported. CCG/CSU - Continue to monitor this through CQRM and WELC SI panel. - Receive real time alerts from STEIS (Serious Incident reporting system). - Quarterly thematic analysis is reviewed at the Quality Committee.

May 0

Aug 0

Nov Feb

Jun 0

Sep Dec Mar

Non RAG indicators

Performance

Performance

111

Cannot be RAG scored:

East London Foundation Trust (Community Health) Quality Report

Purpose: This report will cover an update on the following areas:

Serious Incidents overdue by 6 months or over

Safeguarding Children, due once Level 1 Safeguarding Children, due once Level 2 Patient Reported Experience Measures (PREMS) Amber Alerts acknowledged within 2 days Amber Alerts actioned within 5 days MRSA C.DIFF VTE assessment Safeguarding Children compliance, due 3 yearly Level 1

Children’s Safeguarding Incidents Adult Safeguarding Incidents Serious Incidents

Safeguarding Children compliance, due 3 yearly Level 2 Safeguarding Children compliance, due 3 yearly Level 3

112

Indicator Q1 Q2 Q3 Q4 Summary

Serious Incidents overdue by 6 months or more Target = 0

Apr 1

Jul 1

Oct Jan Trust

- The Trust have 1 serious incident overdue more than 6 months, this is in relation to a Grade 4 Pressure Ulcer.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings. - The CSU patient safety team send reminders to providers on their overdue SIs. - The CSU provide a SI status report which comes to every CQRM to escalate any cases which

breach the KPI.

May 2

Aug 1

Nov Feb

Jun 4

Sep Dec Mar

Safeguarding Children compliance, due 3 yearly Level 2 Target = 85%

Apr 67.9%

Jul 78.58%

Oct Jan Trust

- Named Nurse Safeguarding Children to screen list of outstanding staff to identify those who are working directly with children and prioritise training.

- Line managers to discuss with each individual expectation to undertake training by end of Q2 monitor in 1:1 supervision.

- Weekly review of uptake bookings made on current training slots and identifies gaps to meet outstanding requirement by end of Q2.

- On-going screening of staff that are on long term absence/leavers to ensure accurate position of compliance.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 72.18%

Aug 71%

Nov Feb

Jun 76.96%

Sep Dec Mar

Safeguarding Children compliance, due 3 yearly Level 3 Target = 85%

Apr 77.6%

Jul 76.27%

Oct Jan Trust

- As above. CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings. - As above.

May 72.77%

Aug 76%

Nov Feb

Jun 77.87%

Sep Dec Mar

Performance

Performance

Performance

Under achieving indicators

113

Indicator Q1 Q2 Q3 Q4 Summary

Amber Alerts acknowledged within 2 days Target = 100%

Apr 100%

Jul 100%

Oct Jan Trust

- All Amber Alerts are acknowledged on time.

CCG

- Monitor this on a daily basis.

May 100%

Aug 100%

Nov Feb

Jun 100%

Sep Dec Mar

Amber Alerts actioned within 5 days Target = 100%

Apr 100%

Jul 100%

Oct Jan Trust

- All Amber Alerts actioned on time. - Majority of alerts are in relation to District Nursing, with one relating to Diabetes service. - The alerts in relation to District Nursing Service are patients being asked to see GP or DNs not

attending timely. The alert in relation to Diabetes service was in relation to patients unable to get through to the service.

CCG

- Monitor this on a daily basis.

May 100%

Aug 100%

Nov Feb

Jun 100%

Sep Dec Mar

MRSA Target = 0

Apr 0

Jul 0

Oct Jan Trust

- No MRSA reported. CCG

- Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 0

Aug 0

Nov Feb

Jun 0

Sep Dec Mar

C.DIFF Target = 0

Apr 0

Jul 0

Oct Jan Trust

- No C.DIFF reported. CCG

- Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 0

Aug 0

Nov Feb

Jun 0

Sep Dec Mar

VTE Assessments Target = 100%

Apr 100%

Jul 100%

Oct Jan Trust

- The Trust is continuing to perform at 100%. CCG

- Continue to monitor progress through monthly Service Performance Review and CQRM meetings

May 100%

Aug 100%

Nov Feb

Jun 100%

Sep Dec Mar

Achieving indicators

Performance

Performance

Performance

Performance

Performance

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Indicator Q1 Q2 Q3 Q4 Summary

Safeguarding Children compliance, due 3 yearly Level 1 Target = 85%

Apr 97.28%

Jul 98.23%

Oct Jan Trust

- The Trust is still continuing to achieve this target.

CCG/CSU - Continue to monitor progress through monthly Service Performance Review and CQRM meetings.

May 97.28%

Aug 98.43%

Nov Feb

Jun 97.08%

Sep Dec Mar

**Patient experience indicators for Urgent Care

Confidence Apr 98%

Jul 84%

Oct Jan Trust

- The Trust is continuing to achieve this measure. CCG/CSU

- Monitor this through the Urgent Care Centre SPR.

May

Aug 80%

Nov Feb

Jun 76%

Sep Dec Mar

Treated with respect

Apr 98%

Jul 92%

Oct Jan Trust

- The Trust is continuing to achieve this measure.

CCG/CSU

- Monitor this through the Urgent Care Centre SPR.

May

Aug 92%

Nov Feb

Jun 96%

Sep Dec Mar

Information given understandable

Apr 98%

Jul 83%

Oct Jan Trust

- The Trust is continuing to achieve this measure. CCG/CSU

- Monitor this through the Urgent Care Centre SPR.

May

Aug 86%

Nov Feb

Jun 89%

Sep Dec Mar

Helpful answers Apr 96%

Jul 79%

Oct Jan Trust

- The Trust is continuing to achieve this measure.

CCG/CSU

- Monitor this through the Urgent Care Centre SPR.

May

Aug 75%

Nov Feb

Jun 89%

Sep Dec Mar

Involved as much as you wanted

Apr 95%

Jul 76%

Oct Jan Trust

- The Trust is continuing to achieve this measure. CCG/CSU

- Monitor this through the Urgent Care Centre SPR.

May

Aug 81%

Nov Feb

Jun 84%

Sep Dec Mar

Performance

Performance

Performance

Performance

Performance

Performance

** The patient experience indicators are now presented in more detail, hence the variation in performance.

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Indicator Q1 Q2 Q3 Q4 Summary

Safeguarding Children Incidents No target

Apr 3

Jul 0

Oct Jan Trust

- July data not available at the time of authoring this report. CCG/CSU

- Monitor this through CQRM. May

4

Aug 0

Nov Feb

Jun 0

Sep Dec Mar

Safeguarding Adults Incidents No target

Apr 11

Jul Oct Jan Trust

- August data not available at the time of authoring this report. CCG/CSU

- Monitor this through CQRM. May 21

Aug Nov Feb

Jun 4

Sep Dec Mar

Serious Incidents No target

Apr 7

Jul 1

Oct Jan Trust

- The Trust reported 7 serious incidents in August. Majority are in relation to Grade 3 Pressure Ulcers (5) and others in relation to treatment and procedure (2). These cases are subject to investigation.

CCG/CSU

- Final reports are reviewed by the CSU patient safety team and the WELC SI panel.

May 13

Aug 7

Nov Feb

Jun 2

Sep Dec Mar

Performance

Performance

Performance

Non RAG indicators

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Other quality matters

Topic Subject matter Summary Nursing Home Quality Assurance Visit

Joint Quality Assurance Visit with the London Borough of Newham and the CCG Quality Team.

The CCG participated in a joint visit with the London Borough of Newham (LBN) at a Nursing Home on the 26th September 2014.

There were no significant concerns. This home was also visited by the CQC, and the home has an action plan to address the findings of the CQC. There will be a re-visit by the CCG Quality Team and LBN.

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Newham Clinical Commissioning Group

Board Meeting Wednesday 8th October 2014

Title: Reports Back – Committees, Commissioning & Transformation

Programme Committees

Agenda item: 4.1

Author: Mike Sims Board Secretary Newham CCG

Presented by: Satbinder Sanghera Head of Governance & Engagement

Contact for further information:

Satbinder Sanghera Head of Governance & Engagement

Date paper finalised: 1st October 2014

Action requested: Note the report

Executive summary: To provide Newham CCG Board with summaries of the meetings of committees, commissioning committees and transformation programmes held in the month.+-

Supporting Papers: None

How does this fit with Newham CCG Strategy:

Values - Transparency with our decision-making and leadership

Where has the paper been already presented?

This report has not been presented to any other meeting. It summarises the work of the committees during the period

Risk : Failure of the Board to maintain an overview of the business of the organisational governance structure risks a failure of the Board to fulfil its requirement to ensure internal governance arrangements are not working.

Quality Impact This is an internal report back and therefore is not required specifically for the report

Equality Impact This is an internal report back and therefore is not required specifically for the report

Stakeholder

Engagement

This is an internal report back and therefore is not required specifically for the report

1. Introduction and Background

To provide the Board with a summary the key issues under consideration by the committees within the governing structure in the period.

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2. Summary Report of the Executive Committee 2.1 Executive Committee meeting held on 24th September 2014. The committee

considered and discussed: • Commissioning Intentions 2015/16

• QIPP Report 3. Summary Report of the Quality Committee 3.1 Quality Committee meeting due to be held on 25th September was cancelled due to the

high number of apologies received. 4. Summary Reports of the Commissioning Committees 4.1 Acute Commissioning Committee meeting held on 3rd September 2014. The

committee considered and discussed: • Future use of Clinical Assessment & Triage Services in Newham

• Improving Cardiovascular care in Newham - Initial Report on current CVD Business Case Review

• QIPP • Virtual ward / Rehab • UCC / ED • Acute productivity

• Commissioning Intentions • Activity and Financing Reports - Barts Health • Activity and Finance - Other Providers

Activity and Finance - Performance and activity • Barts Health Pathology Update

4.2 Mental Health Commissioning Committee meeting held on 18th September 2014. The

committee considered and discussed: • NCCG Commissioning Intentions 2015-16 update

• Engagement Plan • Performance Report • Raid Update • Big White Wall and Head Start Lottery Update • Risk Register

4.3 Community Commissioning Committee meeting held on 11th September 2014. The

committee considered and discussed:

• Headache Clinic • Commissioning Intentions 2015/16 • Proposed Model for Musculoskeletal (MSK) Services • Personal Health Budgets and Personal Health Budgets - Commissioning intentions

with respect to Children's PHB arrangements • CCG Reviews & Long Stops

• East Ham Care Centre (EHCC) • QIPP 2013/2014 Delivery

• Virtual Ward Update • Activity & Finance • Winterbourne • Continuing care update

4.4 Partnerships Commissioning Committee meeting held on 18th September. 2014. The

committee considered and discussed: • Community Prescription – recommendation to Board

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• Children’s Personal health budgets and SEND – presentation • Continuing Care Update • Bettercare Fund - update

5. Summary Reports of the Transformation Programmes

5.1 Primary Care Strategy Development Transformation Programme meeting held on 8th September 2014. The meeting considered and discussed:

• Extended Primary Care Services development and contract management • NETA Working Group Update • Clusters as Commissioners Development • Integrated care programme • Co-Commissioning • IM&T Update • Estates Working Group

5.2 Integrated Care Transformation Programme meeting held on 12th September 2014. The meeting considered and discussed:

• Programme Reports: • Key Delivery Partners Comments • integrated Care Governance arrangements for Bart’s Health • Highlights of WELC IC Programme and update on latest progress • Financial Profiling for Integrated Care Programme 14-15 and 15-16 • Programme Report and Programme Risk Register • Integrated Care ITC Business Case

5.3 Urgent Care Transformation Programme meeting held on 21st August 2014. The meeting considered and discussed:

• NHS 111 – Re-commissioning • LAS - Intelligent Conveyance - “Access to EMIS pilot” • LAS - Recovery Plan • LAS - Commissioning Intentions • Operational resilience and capacity planning for 2014/15 • Urgent Care Dashboard – Framework for approval • Urgent Care Dashboard including discussion across the system – Monthly Report • Vicarage Lane Walk-In Service – Update

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