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Meeting in Public of the Camden CCG Governing Body Wednesday 8 November 2017, 14:00 Camden Town Hall Judd Street WC1H 9JE
PART I AGENDA
Item Title Presenter Action Paper Time Page
1. Introduction
1.1 Apologies for Absence Dr Neel Gupta Note Verbal 14:00 -
1.2 Declarations of Interest Dr Neel Gupta Note 1.2 14:01 4
1.3 Declarations of Gifts and Hospitality Dr Neel Gupta Note 1.3 14:03 -
1.4 Minutes of the Previous Meeting Dr Neel Gupta Approve 1.4 14:05 7
1.5 Action Log
Dr Neel Gupta Note 1.5 14:10 17
2. Chair, Accountable Officer, Patient and Quality Reports
2.1 Chair’s Report
Dr Neel Gupta Note 2.1 14:15 19
2.2 Accountable Officer’s Report Helen Pettersen
Note 2.2 14:20 21
2.3 The Patient Voice Report
Kathy Elliott Note 2.3 14:25 25
2.4 Quality and Clinical Effectiveness Report
Jane Davis Note 2.4 14:35 33
3. Strategy
3.1 Healthy London Partnership Update Jane Lindo Note 3.1 14:45 43
3.2 Camden CCG Estates Strategy 2018-2023
Gordon Houliston
Approve 3.4 15:00 65
3.3 Camden 2017/18 Winter Plans Trevor Myers Note 3.5 15:15 91
3.4 Camden Better Care Fund 2017/19 Richard Lewin Note 3.6 15:25 97
4. Finance and Performance
4.1 Finance Report
Simon Goodwin
Note 4.1 15:35 153
4.2 Developing the 2018/19 Operating Plan Rebecca Booker
Note 4.2 15:45 161
4.3 Integrated Performance Report Charlotte Mullins
Note
4.3 15:50 167
4.4 Business Plan Report Sarah Mansuralli
Note 4.4 16:00 199
5. Governance
5.1 Board Assurance Framework Richard Strang Note 5.1 16:10 215
5.2 Safeguarding Adults Annual Report Charlotte Cooley
Note 5.2 16:20 227
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5.3 Primary Care Co-Commissioning Committee – Terms of Reference
Helen Pettersen
Approve 5.3 16:30 239
5.4 2017 AGM Minutes Dr Neel Gupta Note 5.4 16:35 255
6. Committee Reports – For information
6.1 Audit Committee
Richard Strang Note 6.1 263
6.2 Finance and Performance Committee
Dr Birgit Curtis Approve/Note
6.2 265
6.3 Health and Wellbeing Board
Julie Billett Note 6.3 271
6.4 Integrated Commissioning Committee
Dr Matthew Clark
Note 6.4 275
6.5 Localities Report
Dr Jonathan Levy
Note 6.5 279
7. Any other Business
7.1 Draft Agenda January 2018 Meeting Dr Neel Gupta Note 7.1 16:40 283
7.2 2018 Meeting Dates Dr Neel Gupta Note 7.2 285
8. Questions from the Public Verbal 16:45 -
Members of the public have the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should take no longer than three minutes per person.
9. Date of Next Meeting: 17 January 2018
REGISTER OF INTERESTS
A register of members’ interests is available on the Camden CCG website http://www.camdenccg.nhs.uk
A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or
assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”.
Managing conflicts of interests in the NHS: Guidance for staff and organisations 2017.
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Tyrieana Long
Board Secretary
Dr Neel Gupta
Chair
Helen Pettersen
Accountable Officer
Sarah Mansuralli
Chief Operating Officer
Kathy Elliott
Vice Chair
Simon Goodwin
Chief Finance Officer
Ian Porter
Director Corporate
Services
Dr Birgit Curtis GP
Dr Matthew Clark
Secondary Care Clinician
Dr Martin Abbas GP
Dr Kevan Ritchie GP Dr Jonathan Levy GP
Richard Strang
Lay Member
Glenys Thornton
Lay Member
Jonathan Duffy
Practice Manager
Dr Sarah Morgan GP
Jane Davis OBE
Registered Nurse
Dr Philip Taylor GP
Charlotte Cooley
Practice Nurse
Julie Billett
Director of Public Health
Neeshma Shah
Director Quality & Clinical
Effectiveness
Richard Lewin
LA Representative
Saloni Thakrar
Healthwatch
Representative
Hilary Lance
Patient Representative
Simone Hensby
Voluntary Action Camden
Dr Farah Jameel
LMC Observer
Trevor Myers
Interim Commissioning
and Contracting Director
Charlotte Mullins
Director of Sustainable
Insights
Sally MacKinnon
Transformation
Programme Director
Rebecca Booker
Deputy Chief Finance
Officer
Table Plan - November 2017 Meeting
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Camden Clinical Commissioning Group Governing Body Members' Register of Interests 2017/18
Declared From Updated
Fin
an
cia
l In
tere
sts
No
n-F
inan
cia
l
Pro
fessio
nal In
tere
sts
No
n-F
inan
cia
l P
ers
on
al
Inte
rests
Swiss Cottage Surgery Yes Yes No Direct Owner and GP Partner 16/12/2016 01/07/2007 13/6/2017
Haverstock Healthcare Ltd Yes Yes No Direct Swiss Cottage Surgery is a shareholder 16/12/2016 01/07/2007 13/6/2017
Swiss Cottage Private General Practice Yes Yes No Direct Owner and Shareholder 16/12/2016 01/01/2016 13/6/2017
CHE Neighbourhood Yes Yes No Direct Swiss Cottage Surgery is affiliated to this neighbourhood 16/12/2016 01/08/2016 13/6/2017
Cadence Minerals PLC Yes No No Direct Shareholder 16/12/2016 01/07/2014 13/6/2017
Docmartin Residential Yes No No Direct Owner shareholder of property investment company 18/02/2017 13/6/2017
Children's Trust Partnership No Yes No Indirect CCG Representative 16/12/2016 01/07/2014 13/6/2017
North Camden Zone No Yes No Indirect CCG Representative 16/12/2016 01/07/2015 13/6/2017
Camden Youth Foundation No Yes No Indirect CCG Representative 16/12/2016 01/08/2016 13/6/2017
Central Health Evolution Limited Yes Yes No Direct Shareholder and Founding Member 22/03/2017 13/6/2017
Hampstead Group Practice Yes Yes No Direct Nurse Practitioner 18/07/2017
Haverstock Healthcare Limited Yes Yes No Direct Works at out of hours hub at weekend 18/07/2017
Camden LMC No Yes No Direct Practice Nurse Representative, Not voting, observer role 18/07/2017
Royal College of Nursing No Yes No Direct Member 18/07/2017
City University Yes Yes No Direct Honourary lecturer for nursing and midwifery 29/09/2017
West Hampstead Medical Centre Yes Yes No Direct GP Partner 14/12/2016 01/11/2012 05/07/2017
Haverstock Healthcare Ltd Yes Yes No Direct West Hampstead Medical Centre is a shareholder 14/12/2016 01/11/2012 05/07/2017
KCA Architects No No Yes Indirect Company Secretary and husband is a Director 14/12/2016 01/01/1998 05/07/2017
Central Health Evolution Limited Yes Yes No Direct Shareholder 22/03/2017 05/07/2017
Prince of Wales Group Practice Yes Yes No Direct Practice Manager 13/12/2016 12/06/2017
SanKtus Welfare Project - Welfare Charity No No Yes Direct Treasurer 13/12/2016 12/06/2017
Dr Neel Gupta Elected GP and GB Chair The Keats Group Practice Yes Yes No Direct Salaried Employee 15/11/2016 01/08/2011 14/8/2017
James Wigg and Queens Crescent Practices Yes Yes No Direct GP Partner 15/11/2016 01/09/2015 12/06/2017
Haverstock Healthcare Ltd Yes Yes No Direct Shareholder in GP Federation 15/11/2016 01/09/2015 12/06/2017
Hampstead Group Partner Yes Yes No Direct Partner 29/11/2016 14/06/2017
Haverstock Healthcare Ltd Yes Yes No Direct Shareholder in GP Federation 29/11/2016 14/06/2017
CCAS Assessor Yes Yes No Direct GP Assessor 29/11/2016 14/06/2017
Bloomsbury Surgery Yes Yes No Direct GP Partner 13/06/2017 13/06/2017
Haverstock Healthcare Ltd Yes Yes No Direct GP Practice is a Member 13/06/2017 13/06/2017
Central Health Evolution Limited Yes Yes No Direct GP Practice is a Member 13/06/2017 13/06/2017
CCAS Assessor Yes Yes No Direct 2-4 sessions per month 13/06/2017 23/8/2017
Parliament Hill Medical Centre Yes Yes No Direct
Salaried Employee. The partners at Parliament Hill Medical
Centre are shareholders of Haverstock Health. 11/07/2017
Care UK, HMP Pentonville Yes Yes No Direct Salaried GP (1 day per week) 11/07/2017
Public Health England No No Yes Indirect
Partner, Mr Peter Graham is a civil servant and works at
Public Health England as a partnership marketing manager. 11/07/2017
Charlotte Cooley
Dr Philip Taylor Elected GP Representative
Dr Martin Abbas Elected GP Representative
Dr Birgit Curtis Elected GP Representative
Elected GP Representative
Elected Practice Nurse
Elected Voting Members
Jonathan Duffy Elected Practice Manager
Dr Jonathan Levy Elected GP Representative
Dr Sarah Morgan
Dr Kevan Ritchie Elected GP Representative
Nature of InterestDeclared Interest- (Name of the
organisation and nature of business)Name
Position (s) held- i.e. Governing
Body, Member practice,
Employee or other
Date of InterestType of Interest
Is the interest
direct or
indirect?
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Camden Clinical Commissioning Group Governing Body Members' Register of Interests 2017/18
Director of Public Health Camden and IslingtonYes Yes No Direct Salaried Employee 15/11/2016 01/02/2013 12/06/2017
Vice-chair of London Association of Directors
of Public Health No Yes No Direct 15/11/2016 01/01/2014 12/06/2017
Lewisham and Greenwich NHS Trust Yes Yes No Direct Paediatric Registrar 15/11/2016 01/03/2013 12/06/2017
Welbodi Partnership - registered UK Charity No No Yes Direct Board Member 15/11/2016 08/08/2008 12/06/2017
Kings College London No No No Indirect
Wife is a research fellow which is funded by the NHS
National Institute of Health Research and Tommy's
Charitable Trust 15/11/2016 01/10/2014 12/06/2017
Nursing and Midwifery Council No Yes No Direct Registrant Panellist for the Conduct and Competence Panels 16/11/2016 01/02/2013 12/06/2017
The Order of St John Priory Group for Greater
London No No Yes Direct Member 29/03/2017 12/06/2017
Caversham Group Practice No Yes No Direct Member of the Patient Participation Group 12/12/2016 13/06/2017
Kaeconsulting - independent consultancy Yes No No Direct Owner/Director 12/12/2016 13/06/2017
UK Public Health Register (UKPHR) No Yes No Direct Assessor and Chair of the Registration Panel 12/12/2016 13/06/2017
Faculty of Public Health No Yes No Direct Member 12/12/2016 13/06/2017
PHAST - public health consultancy No Yes No Direct Associate 12/12/2016 13/06/2017
Simon Goodwin Chief Finance Officer, NCL CCGs East London NHS Foundation Trust Yes No No Indirect Wife is a senior manager 14/06/2017 14/06/2017
Helen Pettersen
Accountable Officer, NCL CCGs
and NCL STP Convenor No declared interests Nil return 05/04/2017
Richard Strang Lay Member Tavistock and Portman NHS Foundation Trust No Yes Yes Direct Former Non-Executive Director 31/07/2017
Young Foundation Yes Yes No Direct Chief Executive Officer 09/08/2017
Member of the House of Lords Yes Yes No Direct
Baroness Thornton - Labour and Co-operative Member
From 1.11.2017: Opposition spokesperson for Health 09/08/2017 23/07/1998 1/11/2017
London School of Economics No Yes Yes Direct Emeritus Governor 09/08/2017
Social Enterprise UK No Yes Yes Direct Patron 09/08/2017
Healthcare and Assistive Technology Society No Yes Yes Direct Chair of the Advisory Panel and Patron 09/08/2017
Cabinet Member for Health and Adult Social
Care Yes Yes No Direct Councillor, Camden Borough Council 02/10/2017
St Michael's Primary School No Yes No Direct Governor of St Michael's Primary School 02/10.2017
Unison No Yes No Direct Union Member 02/10/2017
Camden LMC No Yes No Direct Chair 20/09/2016 18/06/2017
Camden, Barnet and Brent GP Practices Yes Yes No Direct
Locum GP working across multiple GP practices and GP
Appraiser (paid work) 18/01/2017 18/06/2017
Medical Women's Federation No Yes No Direct Trustee - unpaid 18/01/2017 18/06/2017
UK General Practitioners Committee Yes Yes No Direct Elected Member - paid honoraria for attendance 18/01/2017 18/06/2017
NHS Digital Yes Yes No Indirect
Husband is a member of an advisory panel for e-Consult and
is currently seconded to NHS Digital as a national medical
director clinical fellow 18/01/2017 18/06/2017
Pulse Live Conferences Yes Yes No Direct Speaker - paid honoraria 18/01/2017 18/06/2017
Medical Student OSCE examiner Yes Yes No Direct Paid for work completed 18/01/2017 18/06/2017
Simone Hensby Voluntary Sector Representative Voluntary Action Camden Yes Yes No Direct Executive Director 19/12/2016 18/06/2017
Glenys Thornton Lay Member
Dr Farah Jameel LMC Observer
Patricia Callaghan Health and Wellbeing Board
Observer
Lay Member
Jane Davis OBE Registered Nurse
Non-Voting Members
Appointed Voting Members
Julie Billett Public Health Representative
Dr Mathew Clark Secondary Care Doctor
Kathy Elliott
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Camden Clinical Commissioning Group Governing Body Members' Register of Interests 2017/18
Camden Patient & Public Engagement Group No Yes Yes Direct Chair 16/08/2017 14/08/2017
Adelaide Medical Centre No Yes Yes Direct Chair of Patient Participation Group 16/08/2017
Universal Offer Delivery Group No Yes Yes Direct CPPEG Patient Representative 27/09/2017
London Borough of Camden Yes Yes No Direct Director of Integrated Commissioning 23/11/2016 13/06/2017
Camden Schools Project Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017
Camden BSF SPV Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017
Camden SPV Holdings Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017
Camden Healthwatch No Yes No Direct Chair 29/06/2017 12/07/2017
Chomley Garden Surgery Practice No Yes No Direct Patient Participation Group Representative 06/01/2016 12/07/2017
UK National Thalassemia and Sickle Cell
Group (NHS England) No Yes No Direct Lay Member 06/01/2016 12/07/2017
Ambassador Little Village Charity No No Yes Direct 12/07/2017 12/07/2017
Camden Reach Pregnancy Project Yes Yes No Direct Project Coordinator 12/07/2017 12/07/2017
London Antenatal Screening Programme No Yes No Direct Lay Member representative 12/07/2017 12/07/2017
Rebecca Booker Deputy Chief Finance Officer No interests declared Nil return 18/10/2017
Mike Cooke Chief Executive No interests declared Nil return 21/11/2016 28/06/2017
Sally MacKinnon Transformation Programme Director Change the Record Management Consultancy No No Yes Indirect Executive Director. Company owned by husband David
MacKinnon 25/11/2016 01/10/2014 20/06/2017
Sarah Mansuralli Chief Operating Officer No interests declared Nil return 12/06/2017 12/06/2017
Charlotte Mullins Director of Sustainable Insights No interests declared Nil return 28/11/2016 13/06/2017
Trevor Myers Interim Director of Commissioning
and Contracting
Goosegate Consultancy Ltd Yes Yes No Direct Director
04/09/2017
Ian Porter Director of Corporate Services No interests declared Nil return 14/11/2016 16/06/2017
Neeshma Shah Director of Quality and Clinical
Effectiveness
Independent consultant Yes Yes No Direct Occasional ad hoc consultancy work on sole trader basis on
subject matter relating to medicine, the pharmacy profession
and the health and social care landscape 25/11/2016 24/04/2013 18/06/2017
Attendees
Saloni Thakrar Healthwatch Representative
Richard Lewin Local Authority Representative
Patient RepresentativeHilary Lance
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Agenda Item 1.4
Page 1 of 10
CAMDEN CLINICAL COMMISSIONING GROUP GOVERNING BODY
Minutes of the Part 1 Meeting held on Wednesday, 13 September 2017
Committee Room 2, Camden Town Hall, Judd Street, WC1H 9JE
Present: Elected Voting Members: Dr Neel Gupta Chair Dr Martin Abbas Elected GP Representative Dr Birgit Curtis Elected GP Representative Dr Jonathan Duffy Elected Practice Manager Dr Sarah Morgan Elected GP Representative Dr Kevan Ritchie Elected GP Representative Dr Philip Taylor Elected GP Representative Appointed Voting Members: Jane Davis OBE Registered Nurse Kathy Elliott Lay Member Simon Goodwin Chief Finance Officer, NCL CCGs Helen Pettersen Accountable Officer, NCL CCGs Glenys Thornton Lay Member Non-Voting Members: Simone Hensby Voluntary Action Camden Hilary Lance Patient Representative Richard Lewin Local Authority Representative, London Borough of Camden (LBC) Cllr Richard Olszewski Health and Wellbeing Board Observer Saloni Thakrar Healthwatch Representative In Attendance: Matthew Black Commissioning Manager, Camden CCG (item 3.2) Rachel De Souza Senior Communications and Engagement Manager, Camden CCG Gordon Houliston Assistant Director Primary Care, Camden CCG (item 3.2) Barry Moffatt Interim Deputy Chief Finance Officer, Camden CCG Tyrieana Long Board Secretary, Camden CCG Sally MacKinnon Transformation Programme Director, Camden CCG Sarah Mansuralli Chief Operating Officer, Camden CCG Charlotte Mullins Director of Sustainable Insights Partnerships, Camden CCG Trevor Myers Interim Director of Commissioning and Contracting, Camden CCG Ian Porter Director of Corporate Services, Camden CCG Paul Sinden NCL Director of Performance and Acute Commissioning, (items 3.1 and 5.2)
1. Introduction
1.1 Welcome and Apologies for Absence 1.1.1 The Chair welcomed Hilary Lance, Councillor Richard Olszewski and Glenys Thornton as new
Governing Body members. 1.1.2 Apologies were received from Julie Billett, Dr Mathew Clark, Mike Cooke, Charlotte Cooley,
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Agenda Item 1.4
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Dr Farah Jameel, Dr Jonathan Levy, Neeshma Shah and Richard Strang. 1.2 Declaration of Interests 1.2.1 Dr Martin Abbas advised that he was now a trustee at the Camden Youth Foundation. There
no further new declarations of interest. 1.3 Declarations of Gifts and Hospitality 1.3.1 There were no declarations of gifts or hospitality. 1.4 Minutes of the meeting held on 12 July 2017 1.4.1 The Governing Body considered the minutes of the meeting held on 12 July 2017. Two
amendments were requested: 1. 1.6.3 - To clarify that the data quality work at the Royal Free and Barnet hospitals was a
work in progress. 2. 5.3.5 – To raise an action for Emdad Haque regarding the introduction of the new
workforce disability equality standard. Action 1: Ian Porter 1.4.2 Subject to the above amendments the Governing Body agreed that the minutes of the
meeting held on 12 July 2017 were a true record. 1.5 Action Log 1.5.1 The Governing Body considered the updates on the actions arising from the previous meeting. 1.5.2 With regard to the first action point, Ian Porter confirmed that neighbourhood discussion packs
had been produced by the CCG to assist practices with patient engagement activity. Discussions were also ongoing with neighbourhood leads to identify further support in involving patients in service development.
1.5.3 In addition Members suggested a standard briefing to place on the website and which could be
shared with GP practices as a useful summary of the changes. Members also favoured alternative ways of engaging with patients to avoid over reliance on PPGs. Simone Hensby requested a seminar on neighbourhood working for Camden’s voluntary and community groups. Action 2: Ian Porter
1.5.4 With regard to the second action point, Helen Pettersen advised that the origin of the plan to
bring together the funding used for locally commissioned service (LCS) and the premium spent on personal medical services to establish a single LCS contract for all of North London, as quoted in the STP was not known. The matter had not been raised with the NCL Primary Care Co-commissioning Committee and no agreement had been reached.
1.5.5 With regard to action point three, the Governing Body noted that a paper had been circulated
separately which provided a breakdown of STP programme spend and a summary of STP programme structures. Helen Pettersen suggested that the Governing Body also receive the STP progress reports. The Governing Body agreed to consider detailed STP programme spend, evidence of delivery and evidence of value for money in 6 months’ time. Action 3: Helen Pettersen
1.5.6 In relation to action point four, Helen Pettersen confirmed that the NCL Joint Commissioning
Committee had considered the request to include an LMC member within the Committee’s membership to represent general practice. The request had not been approved on the basis that no other provider body was part of the Committee’s membership and the committee’s remit was largely focused on acute commissioning. Meetings were held in public and the LMC were welcome to attend. Dr Farah Jameel would be formally notified of the decision. Action 4: Helen Pettersen
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Agenda Item 1.4
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1.5.7 With regard to the final action point the outcome of the national ballot of GP practices had just
been released. The Chair requested that the press release was circulated to Members. Action 5: Board Secretary
1.5.8 The Governing Body agreed to note the Action Log.
2. Chair, Accountable Officer, Patient and Quality Reports
2.1 Chair’s Report 2.1.1 The report was taken as read. The Chair highlighted the departure of Judith Hunt, Lay Member
and Dr Imogen Staveley, Clinical Lead for Cancer and thanked them for the contribution they had made to the CCG.
2.1.2 The Chair also highlighted the CCG’s nomination for the Health Service Journal (HSJ) award in
connection with the joint pilot initiative on addressing complex persistent pain with University College London Hospital. A second HSJ nomination had also been received in relation to the CCG’s Care Integrated Digital Record (CIDR) work.
2.1.3 The Governing Body agreed to note the Chair’s Report. 2.2 Accountable Officer’s Report 2.2.1 Helen Pettersen extended a warm welcome to Trevor Myers and confirmed that a permanent
Director of Commissioning and Contracting had been appointed. Rebecca Booker, Deputy Chief Finance Officer was due to start on 25 September.
2.2.2 Interviews had been held to recruit an independent chair for the NCL Joint Commissioning
Committee but an appointment had not been made. The Committee will now be chaired by a lay member on a rotating basis and the requirement for an independent chair reviewed in 6 months’ time. The Chair added that the Committee’s main focus was to build trust and currently there was not a strong need for an independent chair to operate at NCL level.
2.2.3 Helen Pettersen confirmed that John Wardell had been appointed as the Chief Operating
Officer at Enfield CCG and that the NCL Senior Management Team was complete. 2.2.4 The ongoing work to prepare for winter and to submit the winter plan to NHS England by 8
September was highlighted. Hilary Lance drew attention to recent media reports concerning Australian flu and whether that particular strain would be included in the flu vaccine. Appropriate communications were requested to manage patient anxiety and also messaging for staff. Action 6: Ian Porter/Neeshma Shah
2.2.5 The Governing Body agreed to note the Accountable Officer’s Report. 2.3 The Patient Voice Report 2.3.1 Kathy Elliott introduced the Patient Voice Report advising that it had been made more succinct
with relevant web links included for information. Items of note were:
a) The focus on a wide range of activity with partners and not just with CPPEG. b) The presentation delivered by AT medics on the Camden extended GP access service. c) Continued interest in neighbourhood working and the intention to receive regular
update reports. d) The Citizen’s Panel survey to assess the impact of the Local Care Strategy. e) The alignment of NCL and STP patient engagement with CCG activity.
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Agenda Item 1.4
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2.3.2 Hilary Lance followed on with a patient story of personal interest involving a lady who suffered a fall and broke a vertebra. The X-ray revealed that one vertebra was broken in several places. The hospital was reluctant to admit and the patient was sent home with pain killers and with no back brace. Over the next two weeks the patient deteriorated at home and was unable to get out of bed and requested painkillers from the GP. The GP however was unable to prescribe because the practice did not do home visits and the general attitude was unsupportive.
2.3.3 Eventually the patient presented at A&E at another hospital where it was revealed that the
vertebra had collapsed dangerously and they also discovered an undiagnosed cracked sternum. A back brace was subsequently prescribed for a period of 3 months. Although the patient care did not occur in Camden, the example reinforced Hilary’s view of the importance of patient engagement in the development of positive health outcomes and patient experience. She was confident that the lack of professional and clinical care displayed would not have happened at a hospital or GP practice in Camden.
2.3.4 The example of positive patient care involved someone with a routine annual outpatient
appointment where blood test results needed to be available. At the outpatient appointment the doctor had no access to the patient’s blood test results on the hospital system. However the patient had heard about the Care Integrated Digital Record (CIDR) and suggested that the doctor access her CIDR record. Although sceptical the doctor managed to access the patient’s record and blood test results which prevented a wasted out-patient appointment.
2.3.5 The example of negative patient care involved a husband and wife who had both received
hospital letters which had caused confusion. Both patients have osteopenia and are being monitored regularly. Mrs X was puzzled when her first letter arrived inviting her for an appointment in the Endocrinology Department with no mention of osteopenia or osteoporosis. She was further confused when a further appointment letter invited her to attend the Kidney and Urology Centre.
2.3.6 Her husband also received a letter inviting him to see a member of the Rheumatology Team,
again with no mention of osteopenia or osteoporosis. Both letters necessitated telephone calls to ascertain whether they had been referred incorrectly for other clinical conditions. The issue of hospital letters with clear medical signposting was highlighted otherwise patients are left bewildered and confused.
2.3.7 The Governing Body noted that more work was needed to improve patient communication by
hospital trusts. The partnerships that had formed in the development of the STP was thought to be key to the future success of working with patients to improve communications and engagement
2.3.8 Saloni Thakrar highlighted complaints from parents about the allocation of appointment times
by Great Ormond Street Hospital which were resulting in ‘DNA’ being recorded at GP practices owing to the inflexibility around changing appointment times. Jane Davis advised that the matter would be addressed through the quality and safety assurance process.
2.3.9 The Governing Body welcomed the more succinct report and agreed to note the Patient
Voice Report. 2.4 Quality and Clinical Effectiveness Report 2.4.1 Jane Davis introduced the above report which was taken as read. The Governing Body:
a) Expressed disappointment that the Wellesley Road Care Home still required improvement following the CQC’s inspection. The joint action plan developed with the local authority and regular monitoring was noted.
b) Noted the serious incidents which had occurred within the maternity division at the Royal Free Hospital and sought assurances that they were not symptomatic of wider systemic issues. Action 7: Neeshma Shah
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Agenda Item 1.4
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c) Noted that the Royal Free London Hospital had served notice on Camden CCG to discontinue the community dermatology service. The gap in service provision and requirement to review pathways across NCL was also noted.
d) Noted that the Integrated Commissioning Committee was due to consider a business case on long term conditions at the September meeting.
e) Requested further information on the improvement actions put in place in response to the Community Health Annual Patient Survey at CNWL. Action 8: Neeshma Shah
f) Requested further details on the scale and impact of unforeseen cost pressures related to NHS England’s decision to retain savings on category M drug prices.
Action 9: Neeshma Shah 2.4.2 The Governing Body agreed to note the Quality and Clinical Effectiveness Report.
3. Strategy
3.1 2018/19 System Intentions 3.1.1 Paul Sinden introduced a paper which set out the initial draft system intentions for North
Central London CCGs in 2018/19. The draft system intentions are based on a number of principles agreed at the July 2017 meeting of the NCL Joint Commissioning Committee.
3.1.2 Paul Sinden advised that:
Intentions for 2018/19 build on the collaborative approach in developing the Sustainability and Transformation Plan (STP), and to the contract round for 2017/18 and 2018/19 facilitated through the STP.
Continuation of this collaborative approach is underpinned by a move from commissioning intentions in 2017/18 to system intentions in 2018/19.
All NCL providers will receive a letter confirming the 2018/19 commissioning priorities.
There were a number of strategic challenges and local CCG priorities that had been considered.
In terms of the financial challenge developing the STP led to a common understanding that we operate as a system in deficit. Therefore work was needed to better understand the cost of delivering services and also changes to the way of working to align incentives, reduce duplication, and take cost out of the system.
CCGs intend to work with providers in 2018/19 to further develop system incentives and options for alternative contract forms that better support the new models of care in the STP.
With both health and social care organisations facing financial and operating challenges, closer working with local authorities was required. The strong joint commissioning relationship in Camden was acknowledged.
Two-year contracts for 2017/18 and 2018/19 were signed in December 2016. Some key contract terms will require local negotiation and agreement to underpin the second year of the 2017/19 contract (2018/19).
3.1.3 The Chair invited questions and discussion. The Governing Body:
a) Welcomed the joint commissioning arrangements in place and in particular the flexibility offered in responding to local conditions.
b) Noted that the document was not an easy read for stakeholders or the public. c) Welcomed that a more user friendly version of the system intentions was being
developed for a wider audience and would be ready at the beginning of October 2017. d) Was supportive of the closer working with social care organisations to reduce costs and
find savings, especially in relation to Camden’s estate. e) Identified that a return on investment in prevention was difficult to demonstrate and
achieve. f) Noted that measurement of prevention initiatives were possible and that thinking as a
broader system was the best approach.
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Agenda Item 1.4
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g) Noted that the favoured approach was to work with providers of a reputable quality before testing the market and embarking on procurement exercises.
3.1.4 The Governing Body agreed to note the draft system intentions for 2018/19 and the draft
procurement principles included within the system intentions. 3.2 Primary Care Estates: Review and Refresh of Estates Strategy 3.2.1 The Chair welcomed Gordon Houliston and Matthew Black to the meeting and advised that the
paper had been requested to confirm the current status of the CCG’s commissioned estate and to set out proposed estates criteria to develop a framework for a revised Estates Strategy to be considered at the November 2017 Governing Body meeting.
3.2.2 The paper was taken as read and the Chair invited discussion. The Governing Body:
a) Noted that each CCG developed a draft Estates Strategy in 2015/16, led by NHS
England, which set out the utilisation of primary care estate and confirmed shortfalls within the borough and areas for new development.
b) Noted that with the development of the Local Care Strategy, STP and delegated primary care commissioning a tighter grip was needed on estates issues to build on existing provision and to prepare for future needs.
c) Noted that the CCG was working closely with the local authority to rationalise existing estate and to develop where necessary.
d) Requested a map of all health and social care sites in Camden to illustrate the entire estates provision. This includes primary care estate and estate held by other partners, e.g. CNWL, C&I, LBC.
e) Noted that Table 2 in the paper implied that smaller GP practices were at risk of closure based on criteria used by Haringey CCG in 2015/16 and that this might cause undue alarm.
f) Acknowledged the importance of wider ‘viability’ as part of the decision-making framework including the size of practice lists as one indicator.
g) Noted that patients and the public were keen that CCG’s spend resources wisely and not spend unnecessary funding on void costs for example.
h) Noted that estimated savings outlined in the paper were not large and that GP practices often hosted other services at no additional cost.
i) Requested that population projections were triangulated with GP list size. j) Requested that business as usual activity was reflected in the estates criteria as well
as the strategic elements. k) Welcomed the Local Authority’s support and wider engagement as part of Camden’s
community investment programme. l) Urged some caution in the use of data from the GP practice survey. A more targeted
approach was recommended to secure accurate data. m) Requested that the revised Estates Strategy also include the wider voluntary
community as there were a number of self-help groups attached to GP practices. n) Acknowledged Camden’s financial position which meant that expansion of the primary
care estate was limited. A clear decision-making framework was therefore essential. o) Identified that demand was increasing in terms of population growth and increasing
consultation times. Having adequate clinical and waiting room space was also identified as important factors with quality buildings for any new developments.
3.2.3 With regard to the estates criteria the Governing Body:
Requested estates costs per patient as opposed to cost per practice to avoid taking into consideration practice size
Noted that NHS England guidance included standard criteria and that there were higher costs in Camden because of central London location.
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Agenda Item 1.4
Page 7 of 10
Identified that there were other factors to take into consideration such as physical condition of the estate, quality and clinical effectiveness and value for money. Any decision should not just be limited to list size or space utilisation.
Identified the fit with the out of hospital model and the use of clinical outcomes in relation to quality were important factors.
Noted that ambulance transfers and transport also needed to be considered.
Noted that a period of consultation would be required to engage stakeholders and to reflect on potential areas of health inequalities.
Acknowledged that some solutions for primary care estate would need to be identified from thinking more widely.
3.2.4 The Governing Body agreed to:
Note the status of the CCG’s commissioned estate.
Note the forthcoming refresh of the Estates Strategy.
Receive the revised Estates Strategy at the November 2017 Governing Body meeting.
4. Finance and Performance
4.1 Finance Report 4.1.1 Simon Goodwin introduced the above report and confirmed that at month 4 the CCG was
broadly on track to meet its control total at the end of the year. The month 5 figures also revealed that this position would be held.
4.1.2 It was anticipated that the £2m deficit that originated from the delegated primary care
commissioning budget will be funded from underspends in other NCL CCG budgets. A resolution paper will come to the next Governing Body meeting.
4.1.3 It was noted that new QIPP schemes had been found to mitigate the risk of under delivery in
the STP Transformation schemes. Sarah Mansuralli advised that work had been undertaken to recover the Transformation QIPP position and that implementation plans were in progress for 2018/19.
4.1.4 Simon Goodwin reminded the Governing Body that there were different starting points to
enable growth across the NCL CCGs and that growth was only possible for Camden CCG if there was sufficient QIPP in place to offset transformational investment.
4.1.5 Dr Philip Taylor requested further details on the forecast variance in primary care non-acute
expenditure. Action Point 10: Simon Goodwin agreed to report back with further details. 4.1.6 The Governing Body agreed to note the Finance Report. 4.2 Integrated Performance Report 4.2.1 Charlotte Mullins highlighted the key performance issues from the August 2017 Integrated
Performance Report (IPR). These were:
a) Cancer waiting times and A&E 4 hour waits remain the key areas of concern and focus for the CCG. The July data revealed that performance had deteriorated and that the referral to treatment time standard (RTT) had not been met at UCLH. Increased scrutiny was in place for the performance areas of concern.
b) Four red areas of performance against the Operating Plan with regard to Referrals, Follow Up Outpatient Attendances, Elective Admissions and A&E Attendances. A deep dive report was due to be considered at the September Finance and Performance Committee to understand all of the relevant issues.
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Agenda Item 1.4
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4.2.2 In discussion the Governing Body:
a) Noted that UCLH was unlikely to achieve the cancer 62 day standard until the next financial year. Work was ongoing at RFL and UCLH to reduce the backlogs.
b) Noted that there was a data issue with regard to the reporting of CNWL community services access targets.
c) Acknowledged that there were limited opportunities for education around patient or family choice and that hospitals had different approaches to social care provision. It was noted that more streamlined hospital discharge processes were to be implemented in Camden.
d) Noted that sharing good practice and colleagues working closer together were some early benefits of NCL working. Being able to speak with one voice had also brought greater influence in addressing acute performance.
4.2.3 The Governing Body agreed to note the contents of the Integrated Performance Report.
5. Governance
5.1 Board Assurance Framework 5.1.1 Ian Porter introduced the Board Assurance Framework (BAF) and confirmed four new risks
had been added to the BAF since the last Governing Body meeting and the new risks had been escalated from the NCL Joint Commissioning Committee risk register.
5.1.2 Sarah Mansuralli advised that Sally Mackinnon was the Director responsible for the PMS
Review. The Governing Body noted the reassignment of risks to reflect new ownership. 5.1.3 Simon Goodwin commented favourably on the quality of the BAF and no questions were raised
from members. 5.1.4 The Chair thanked Ian Porter and the Corporate Services Team on their hard work in the
transition period. 5.1.5 The Governing Body agreed to note the Board Assurance Framework. 5.2 Primary Care Co-commissioning – Revisions to Governance 5.2.1 Paul Sinden introduced the above report which set out proposals to revise some of the
governance arrangements that were in place across NCL in relation to primary care co-commissioning.
5.2.2 Since the governance arrangements and Terms of Reference for the Primary Care Co-
Commissioning Committee in Common were approved in preparation for the delegation of primary care co-commissioning to the 5 NCL CCGs in April 2017, three issues have arisen which have impacted on the smooth operation of decision making. These are:
1. The change in the management model for the five NCL CCGs. 2. The need to better understand the number of items requiring decision-making outside of
Committee meetings. 3. The need to formally agree a process for decision making outside of Committee meetings
and to have appropriate administration of these processes. 5.2.3 The proposed solutions for the above issues were:
1. To formalise the delegated arrangements within the Committee’s Terms of Reference so that the NCL Accountable officer is able to delegate decision making authority to Chief Operating Officers.
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Agenda Item 1.4
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2. To amend the Committee’s Terms of Reference so that non-contentious, low risk, decisions can be made by a panel consisting of the NCL Director of Performance and Acute Commissioning and a Committee lay representative. This will make provision for low level decisions to be made outside of the Committee.
3. The implementation of a decision making process to support decision making outside of the Committee.
5.2.4 The Governing Body noted the proposals would introduce more efficient and effective decision
making processes in relation to primary care co-commissioning. It was confirmed that the non-contentious opening of a patient list was only concerned with temporary closures.
5.2.5 The Governing Body agreed to approve
a) The amendments to the Terms of Reference for the Primary Care Co-Commissioning Committee in Common (‘Committee’) and
b) the processes for making decisions outside of Committee meetings and for professional central administration of this process
5.3 Safeguarding Children’s Annual Report 2016/17 5.3.1 Jackie Dyer introduced the above report and highlighted the progress that had been made over
the last year. Overall, the annual report showed that there was good evidence of safeguarding compliance especially in relation to supervision, engagement with vulnerable children and primary care participation in the Child Protection Case Conference Scheme.
5.3.2 The report highlighted the safeguarding monitoring of providers and the actions that had been
taken to address areas of concern. 5.3.3 The Chair invited questions from members. The Governing Body:
a) Welcomed the report. b) Noted that the numbers of children subject to a child protection plan were similar to
previous years as illustrated in the graph on page 26 of the report. c) Noted the request from junior doctors for more support from consultants when
undertaking child protection medicals. d) Noted the concerns raised by GP Leads regarding the lack of information sharing from
the Multi-Agency Safeguarding Hub (MASH) and requested further details. Action 11: Jackie Dyer e) Expressed disappointment at the numbers of case conference reports being sent to the
wrong GP practice as identified from the Child Protection Plan Audit. f) Noted the small sample size in relation to the Antenatal Liaison Audit which may not
reveal the true picture of Camden antenatal self-referrals. g) Noted the difference in provider safeguarding training compliance and the opportunity
to share good practice from high performing hospitals such as the Royal Free. It was noted that training compliance at Great Ormond Street Hospital had recently improved.
h) Noted that the Ofsted inspection at Camden Council would include a review of the Safeguarding Children Board.
i) Noted that Camden was a high risk for FGM and that a nationally respected designated doctor was a member of the Community Engagement sub committee of the Camden Safeguarding Children Board.
5.3.4 The Chair thanked Jackie Dyer for her work and comprehensive report. 5.3.3 The Governing Body agreed to note the 2016/17 Annual Safeguarding Children’s Report. 5.4 2016/17 Health and Safety Report
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Agenda Item 1.4
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5.4.1 Sarah Mansuralli introduced the above report and confirmed that there had been no significant health and safety incidents reported in the last year. She acknowledged the good work of the Corporate Services Team in relation to health and safety matters.
5.4.2 The Governing Body agreed to note the 2016/17 Health and Safety Report.
6. Committee Reports
6.1 Finance and Performance Committee Report and Terms of Reference 6.1.1 The Governing Body received proposed amendments to the terms of reference for the Finance
and Performance Committee to reflect new Governing Body member responsibilities. 6.1.2 The Governing Body agreed to approve the revised Finance and Performance Terms of
Reference and note the summary report of the August 2017 meeting. 6.2 Health and Wellbeing Report 6.2.1 The above report was taken as read. 6.2.2 The Governing Body agreed to note the summary report of the July 2017 meeting of the
Health and Wellbeing Board. 6.3 Integrated Commissioning Committee Report 6.3.1 The above report was taken as read. 6.3.2 The Governing Body agreed to note the Integrated Commissioning Committee Report. 6.4 Localities Report 6.4.1 The above report was taken as read. 6.4.2 The Governing Body agreed to note the Localities Report.
7. Any Other Business
7.1 Draft November 2017 Meeting Agenda 7.1.1 The Governing Body agreed to note the planned agenda items for the November 2017
Governing Body meeting.
8. Questions from the Public
8.1 There were no members of the public present. 8.2 There was no further business and the Chair closed the meeting at 16:35.
These minutes are agreed to be a correct record of the Part 1 meeting of Camden Clinical Commissioning Group held on 13 September 2017
Signed ………………………………………….. Date …………………………………
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Agenda Item: 1.5
CAMDEN CLINICAL COMMISSIONING GROUP GOVERNING BODY
2017/18 ACTION LOG - PART 1
Meeting Date
Action No.
Action Lead Deadline Update
13 September
1 July Minutes Raise an action for Emdad Haque regarding the introduction of the new workforce disability standard in 2018.
Ian Porter November 2017
The Workforce Disability Equality Standard (WDES) Indicators are due to be finalised early next year. In the meantime we continue to monitor our disability data in recruitment, training, disciplinary and staff survey for the purpose of action planning and any future WDES reporting.
13 September
2 Neighbourhood Working and Patient Engagement Arrange a seminar on neighbourhood working for Camden’s voluntary and community groups.
Ian Porter November 2017
Engaging with the voluntary and community sector is due to be discussed at the Primary Care Transformation Group on 1 November. A verbal update will be provided at the meeting.
13 September
3 STP Programme Spend GB to consider detailed STP programme spend and evidence of delivery/value for money at March 2018 meeting.
Helen Pettersen
March 2018
13 September
4 NCL Joint Commissioning Committee Respond formally to Dr Farah Jameel regarding the request to include the LMC in the Committee’s membership.
Helen Pettersen
November 2017
Completed. Email correspondence has been issued.
13 September
5
Primary Care National Ballot Circulate an update to the GB regarding the outcome of the BMA ballot.
Board Secretary
October 2017
Completed. The update was circulated on 22 September 2017.
13 September
6 Winter Planning Prepare relevant messaging for staff and patients with regard to this year’s flu vaccine to help alleviate patient concerns about reports of a flu epidemic and which flu strains are included in the vaccine.
Ian Porter/ Neeshma Shah
November 2017
Public Health England are aware of news on seasonal flu in Australia and their national experts have explained that “The strains of flu circulating in Australia this past winter have led to a significant increase in cases but it’s too early to know which will be the dominant strains of flu to circulate in England”. Australia has seen cases of H3N2 more than the other strains, and this strain is included in the WHO’s recommendations for this year’s vaccines, and was also included in last year’s vaccine. 17 of 291
Agenda Item: 1.5
13 September
7 Quality and Clinical Effectiveness Report Provide the GB with assurance that the serious incidents that occurred within the maternity division at the Royal Free London are non-systemic.
Neeshma Shah November 2017
Assurance was provided at CQRG on 26 July, and a lead commissioner visit found no evidence of poor care. An external reviewer investigated these admissions to NICU soon after birth for therapeutic cooling. The Trust undertook immediate actions to mitigate any further incidents.
13 September
8 Quality and Clinical Effectiveness Report Report back at the next meeting on the improvement actions put in place in response to the Community Health Annual Patient Survey at CNWL.
Neeshma Shah November 2017
The update which was presented to the GB in September provided detail on progress made against the findings of this survey which is a Trust wide plan, rather than a plan aimed at the services commissioned by Camden. Assurance was received at August CQRG regarding progress on these actions. CNWL have a well-structured patient experience and carer network across the entire Trust.
13 September
9 Medicines Management Provide further details on the scale and impact of unforeseen cost pressures regarding related to NHSE’s decision to retain savings on category M drug prices
Neeshma Shah November 2017
For Camden CCG based on April – July data indicates a cost pressure at month 6 of £578,314.
13 September
10 Finance Report Provide further details on the forecast variance in relation to non-acute expenditure in primary care.
Simon Goodwin November 2017
In the September GB Finance Report the primary care non-acute budget was forecasting an under-performance against budget. This under-performance was due to a requirement for a budget adjustment to be processed. This adjustment has been made and this service is currently projected to deliver a balanced budget at the end of the year.
13 September
11 Safeguarding Children’s Annual Report Provide further details on the GP Leads concerns about the lack of information sharing from the Multi-Agency Safeguarding Hub (MASH).
Neeshma Shah November 2017
The specific concerns were that requests were received from MASH with no explanation to the reason for the referral. GPs are placed in a position that without this information (e.g. domestic abuse, neglect) it is difficult to know what is relevant to share and how it influences continuous assessment of the family. Social Care teams, nationally have been reluctant to share information since the Haringey House of Lords ruling. This issue was raised in March this year with Martin Pratt and the Camden Safeguarding Children’s Board. A new process has been put it place where MASH teams seek consent from carers / parents. Compliance with this new practice will be evidenced through audit.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Chair’s Report Agenda Item 2.1
Date 30/10/2017
Lead Director N/A Tel/Email
Report Author Dr Neel Gupta, Chair Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Tel/Email
Report Summary
The purpose of this report is to highlight the Chair’s business activities and to provide an update on key areas of work.
Purpose (tick one box
only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the contents of this report.
Strategic
Objectives Links
The Chair’s business activities are linked to all of the CCG’s strategic objectives.
Identified Risks
and Risk
Management
Actions
Where applicable any risks are identified within the report.
Conflicts of Interest
None
Resource
Implications
Not applicable.
Engagement
Engagement activities are contained with the report.
Equality Impact
Analysis
There are no equality impacts arising from this report.
Report History
The Chair’s Report is a standing item on the Governing Body agenda.
Next Steps
None
Appendices
None
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Chairs Report
September to November 2017
1. Introduction
This is my regular written report to the Governing Body, updating on the business that I undertake on behalf of the CCG and highlighting key areas of work. 2. Meetings and Visits Together with the Chief Operating Officer, Sarah Mansuralli, I have been conducting introductory visits to
our member practices. To date, we have visited seven practices, with six visits scheduled for later this
month. Discussions have been constructive and focused on how we can collectively achieve high quality
and cost-effective healthcare for Camden’s population, against a backdrop of significant national
transformation and financial constraint. We have also had constructive dialogue about CCG priorities
and plans over the coming year.
Sarah and I have also continued our introductory meetings with the CCG’s main providers. In September
we met with the Chief Executive and Chair of University College London Hospitals NHS Foundation
Trust and in October the Chief Executive, Chair and Medical Director of Tavistock and Portman NHS
Foundation Trust. In November we will be meeting with the Chief Executive, Chair and Chief Operating
Officer for Central and North West London Foundation Trust.
These supplement earlier meetings with senior leaders at Royal Free London and Camden and Islington
Foundation Trust which were reported at our last Governing Body meeting.
3. Governing Body Priorities Workshop The Governing Body met for a workshop on 2018/19 Business Plan Priorities on 11 October, which
would inform the manner in which the CCG would deploy its resources to achieve key priorities for the
year ahead.
Governing Body members agreed that the key focus for the year ahead would be achieving financial
sustainability while continuing to commission high quality yet cost effective services. The Governing
Body clearly identified enablers for delivering the priorities, such as estates and workforce. The next step
is to refine the discussions and outputs from this workshop to inform the business plan for next year.
The Governing Body again noted that collaborative partnerships are essential to the CCG to achieve our
statutory accountabilities and therefore it will remain imperative to continue to build effective
relationships with providers, partners and key stakeholders.
4. Celebrating Success Camden CCG and Orion Health have been shortlisted for two prestigious awards for the Care Integrated
Digital Record (CIDR).
The award shortlists are Health Tech Newspaper’s ‘Tech Project of the Year’ and the Health Service
Journal’s ‘Enhancing Care by Sharing Data and Information’.
These nominations are a significant achievement and recognise CIDR’s considerable contribution to
improving outcomes and experiences for our patients.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Accountable Officer’s Report
Agenda Item 2.2
Date 26/10/2017
Lead Director N/A
Tel/Email
Report Author Helen Pettersen, NCL Accountable Officer
Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Tel/Email
Report Summary The Accountable Officer’s Report highlights key issues for the Governing Body’s consideration that are not covered elsewhere on the agenda.
Purpose (tick one
only)
Information Approval To note
Decision
Recommendation The Governing Body is asked to note the contents of this report.
Strategic
Objectives Links
The Accountable Officer highlights a variety of issues within the report and these may link with all strategic objectives.
Identified Risks
and Risk
Management
Actions
Where applicable any risks are identified within the report.
Conflicts of Interest
There are no conflicts of interest arising from this report.
Resource
Implications
No direct implications, although each area described has resource implications
for the CCG.
Engagement
Engagement activities are highlighted as appropriate.
Equality Impact
Analysis
There are no equality impacts arising from this report.
Report History This report is a standing item on the Governing Body agenda.
Next Steps None
Appendices None
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1. Introduction
This report provides an update on the key activities that the senior team and I have been involved in since the last Governing Body meeting.
2. Welcome A warm welcome to Rebecca (Becky) Booker who joins the CCG as Deputy Chief Finance Officer for Camden CCG. Becky will support Simon Goodwin and Sarah Mansuralli to ensure Camden CCG meets its statutory financial duties and developing the medium term financial strategy. We look forward to welcoming Jennifer Murray-Robertson in December. Jennifer takes up the role of Director of Commissioning and Contracting on 18th December, taking over from Trevor Myers. I would like to take this opportunity to thank Trevor for his substantial contribution to the CCG over a short period of time and I am pleased to advise that Mr Myers will remain for a further three months leading on the contracts review project.
3. Winter Planning
There has been considerable work across the CCG and Integrated Commissioning team to progress initiatives and plans designed to improve resilience this winter. In view of the increasing emphasis on this area of work by NHS England and NHS Improvement, there has been significant effort at both NCL STP and Camden levels to develop and accelerate service developments designed to alleviate acute demand and improve the out of hospital offer available to patients at home and in the community. Given the sustained pressure on the A&E waiting time standard during 2017 systems have been asked to:
Co-produce a winter plan to support winter resilience
Develop contingency plans to manage periods of peak demand
Agreeing trigger points that would result in the contingency plan being enacted Alongside overall A&E performance the litmus test that will be used by regulators will be the effectiveness of CCG and Social Care support to the system as measured by:
The use of primary care hubs and redirection initiatives away from A&E;
The reduction of delayed transfers of care and medically optimised patients to less than 5% of acute hospital bed base;
Less than 15% of continuing healthcare (CHC) assessments being carried out in hospital beds (85% carried out in the community).
The Governing Body is therefore asked to note:
The winter plan co-produced by UCLH and Camden CCG, approved by the Camden A&E Delivery Board and submitted to NHS England.
The additional contingencies it has identified that would support systems resilience in periods of peak demand and the trigger points that would result in the contingency plan being enacted.
4. Joint Commissioning Committee
Members will recall that we did not appoint to the post of Independent Chair following interviews in August 2017. The Committee has now decided not to advertise for the post again and has agreed that a Lay Member will be asked to chair the Committee for the next few months. Karen Trew, Lay Vice Chair for Enfield CCG has agreed to take on this role.
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5. Corporate Services in the CCG
The Leadership team across the CCGs has been reviewing the way corporate services work. This review included Governance, HR, Communications and Engagement. It was clear from an initial discussion with staff, Governing Body members and managers that there are recruitment difficulties, some areas of duplication and inefficiency as well as skills shortage in key areas of work. A proposed structure has been developed and a consultation with staff started on 30 October for 30 days. No redundancies are expected. We look forward to hearing the views of staff and will feedback the results of consultation in December.
Helen Pettersen Accountable Officer
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title The Patient Voice Report
Agenda Item 2.3
Date 24/10/2017
Lead Director Ian Porter, Director of Corporate Services
Tel/Email [email protected]
Report Author Martin Emery, Deputy Head of Engagement & Francesca McNeil, Head of Communications and Engagement
Tel/Email [email protected] [email protected]
GB Sponsor(s) (where applicable)
Kathy Elliott, Lay Member Public and Patient Engagement
Tel/Email [email protected]
Report Summary
This paper provides a synopsis of the patient and public engagement activity undertaken since the previous Governing Body meeting. Also included at Appendix 1 are details of the work that Camden Healthwatch has focused on over the last 12 months, and their plans from autumn 2017 to spring 2018.
Purpose (tick one box
only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the content of the report.
Strategic
Objectives Links
Objective E: Work jointly with the people and patients of Camden to shape the services we commission
Identified Risks
and Risk
Management
Actions
Not Applicable
Conflicts of Interest
Not Applicable
Resource
Implications
Not Applicable
Engagement
Engagement is documented within the report.
Equality Impact
Analysis
No equality impact assessment is required for this report.
Report History
The Lay Governing Body member responsible for Public and Patient
Engagement presents a bi-monthly report to the Governing Body.
Next Steps None
Appendices
Not Applicable
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The Patient Voice Report (November 2017)
This paper covers work undertaken over the past two months, relating to: 1. Camden Patient and Public Engagement Group (CPPEG)
2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission.
3. Appendix 1 explains the core purpose of Healthwatch Camden, the work that Healthwatch has focused on over the last 12 months and plans for autumn 2017 and spring 2018.
1. Camden Patient & Public Engagement Group (CPPEG) Since the last Governing Body meeting, the CCG has held one CPPEG operational meeting and one open public meeting. Key themes and issues arising are described below.
1.1 CPPEG operational meeting (11/09/2017) There was representation from all locality Patient Participation Groups, Healthwatch Camden and the voluntary sector groups, including Voluntary Action Camden, Camden Carers, and Camden Disability Action, at the September meeting. The following topics were discussed by CPPEG members:
CCG Committee reports (here) Developing Camden GP Neighbourhoods (here) Universal Offer (here) Systems Intentions (here) Patient Participation Group (PPG) forum update (here)
You Said
We Did
CPPEG committee report: CPPEG committee reports were approved.
Developing Camden GP Neighbourhoods: CPPEG members welcomed the presentation and the clarity given on What is a GP neighbourhood What GP neighbourhoods will and
will not mean Why GP neighbourhoods are
evolving the way they are A map showing General Practices
by neighbourhoods The objectives for embedding GP
neighbourhoods during 2017/18
Universal Offer: CPPEG members welcomed the presentation and clarity given on
The current status of the universal offer
The 10 schemes related to the offer The timetable and actions to be
taken to support delivery during 2017/18
Systems Intentions: CPPEG members welcomed the presentation and the clarity given on
Camden CCG has: Disseminated CPPEG committee member reports and staff presentations to PPGs via the monthly PPG newsletter and made available on the public webpage.
Camden CCG has: Disseminated a pack to general practices to help them talk to patients about neighbourhoods.
Camden CCG will: Ensure that the development of GP neighbourhoods remains on the bi-annual PPG agenda.
Host a meeting on the 30 October with the Chair of CPPEG to discuss current status of the neighbourhoods and to clarify remit of CCG and practices in future development.
Camden CCG will: Update CPPEG and PPGs throughout 2017/18.
Camden CCG will: Update CPPEG and the public in a timely manner on significant service changes during 2017/18.
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The process and timeline for
notifying service providers of commissioning intentions for 2017/18.
The relationship between the 5 CCG’s under the North Central London (NCL) footprint.
CPPEG members asked that when information on the systems intentions is disseminated to the wider public that the complexity of the process as presented would make it challenging for the general public to understand and give input.
PPG forum update: CPPEG members welcomed the PPG forum update.
Camden CCG will: Ensure that information disseminated to the general public related to system intentions is presented in plain English to ensure that people understand and can give input.
Camden CCG will: Ensure that the future agenda topics continue to reflect the suggestions given by General Practice PPG members.
1.2 CPPEG open meeting (09/09/2017) CPPEG open meetings occur bi-monthly and allow an opportunity for members of the public to hear about and engage with the work of the CCG. The September open meeting was attended by 42 members of the public and the following topics were discussed: Long Term Conditions (LTC) Strategy (here) General Practice Integrated Paediatric Service (here)
You Said
We Did
Long Term Conditions (LTC) Strategy: Attendees welcomed the presentation and the clarity given on The challenges facing health and
social care providers to address the inequality gap & the variability of care across providers.
The opportunities and challenges for care providers over the next 3 years.
The timeline and plan for engaging with service users and the public over the next 3 months.
General Practice Integrated Paediatric Service: Attendees welcomed the presentation and the plans for rolling out the service across all the neighbourhoods.
Camden CCG has: Disseminated a service user survey to collate people’s views of What is the best things that they
receive from health care providers & What would they like to change to
improve care
Camden CCG will: Host a workshop (patients & carers) in November to discuss the strategy and aspirations for future services.
1.3. CPPEG catch up meeting (09/09/2017) Following each open meeting a catch-up meeting is held with CPPEG members to discuss topics of interest. Two items were discussed: PMS update (here) MSK update (here)
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You Said
We Did
PMS update: CPPEG members welcomed the current status of the PMS review and timetable for transition.
Camden CCG has: Disseminated the catch up meeting presentations to PPGs via the monthly PPG newsletter and made available on the public website.
Camden CCG will: Will update CPPEG and PPGs on an ongoing basis of the implementation of the PMS transition.
UCLH MSK update: CPPEG members welcomed the update and the progress made on mobilising the service.
Camden CCG has: Has invited representatives from UCLH to attend the December CPPEG open meeting to update the public on the current status of fully mobilising the service
2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission The following summarises other key activity the communications and engagement team has delivered to support Objective E during the last two months:
2.1 Supported AT Medics in collating patient feedback on the model for the Camden extended GP access service through four Citizens Panel Focus Groups. The themes and trends will be fed back to participants, disseminated to patients via the PPG newsletter and made available on the public website.
2.2 Supported the primary care team in: (a) Developing and disseminating a resource pack to all Camden General Practices to assist them in engaging with their PPGs on the development of Neighbourhoods; (b) Requesting patient feedback on the CCG draft estates strategy with the themes and trends to be disseminated to PPGs via the PPG newsletter and made available on the public website. An update on progress made will also be presented at an upcoming CPPEG open meeting.
2.3 Supported the Transformation Directorate in presenting the Camden Local Care Strategy to carers registered to Camden Carers service, with the feedback filtered into Local Care Strategy work streams.
2.4 Supported the Adults integrated commissioning team in designing and disseminating a Long Term Conditions service user survey to collate their experiences of using services in Camden and hosting a workshop for patients and carers to help influence the direction of travel for the long term conditions strategy. The feedback will be fed back to participants, reported back at a CPPEG meeting,
disseminated via the PPG newsletter and made available on the public website.
2.5 Supported the Mental Health integrated commissioning team in drafting communications and engagement plans to collate service user and public views on: (a) Adult day services (b) Site development plans at St Pancras Hospital in collaboration with Camden and Islington NHS Foundation Trust.
2.6 Supported the Acute commissioning team to develop draft communications and engagement plans, working with North Central London CCGs, to consult on the NCL Procedures of Limited Clinical Effectiveness Policy (PoLCE). Once service users have been consulted the themes will be presented to CPPEG and disseminated via the PPG newsletter and made public on the website.
2.7 Delivering a briefing, in collaboration with the Consultation Institute, for senior management and clinical staff on the 25 October. The topics discussed covered: (a) Duties to consult and engage (public and service users) (b) Best practice public consultation & (c) Observing best practice standards in public engagement
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2.8 Deaf Awareness Training (a) A second deaf awareness training workshop has been delivered by a deaf service user to CCG, LBC and General Practice staff on Friday October 13 October. Due to the success of the workshop a third has been arranged for February 2018. The outcomes that attendees achieved were as follows: Build up confidence to talk to Deaf people directly A basic understanding of Deafness and acceptable terminology Ability to use basic everyday signs and clear lip-reading skills To be aware of technology and services available to meet Deaf and hard of hearing client’s
needs and How to work with a BSL Interpreter
(b) The CCG is offering deaf awareness training sessions in General Practices with 2 accepting the training to date. The CCG is also offering General Practices advice on using loops and which has resulted in 1 General Practice saving £900 in purchasing portable hearing loops.
2.9 Accessible Information Standard in General Practice In collaboration with Healthwatch Camden the elected GB Practice Manager and communications and engagement team are building upon the work of the clinical lead for learning disabilities by visiting General Practices to support them in ensuring that large print and easy read materials (hard copy and electronic) for registering of patients in General Practice are available and accessible for the public. This topic was also covered at the October Locality Committees.
2.10 Camden CCG Annual General Meeting (AGM) The AGM was held on the 21 September which was well received by staff and the public. From the feedback forms that were completed and returned we know that: The majority of respondents rating the organisation of the event and venue as ‘good’ to ‘very
good’ The presentation on Camden CCG’s performance and NCL activity was rated most useful Quality of the presentations was rated between ‘average’ and ‘very good’
The communications and engagement team are producing a ‘You Said and We Did’ report to respond to the feedback received, which will be published.
2.11 Camden CCG Key Achievements 2016-17 This report is designed for the public, summarising our performance and spending over the previous financial year. It was widely distributed in September.
2.12 Patient Choice The CCG has promoted messages on patient choice via our public website, social media, Voluntary Action Camden & PPG newsletters.
2.13 Winter resilience We are supporting the national Stay Well This Winter campaign, aligning local messages and co-ordinating public engagement with Camden Council’s public health team and University College London Hospital NHS Foundation Trust communication teams. Outcomes will relate to: Dissemination of flu and winter material through the Winter Wellbeing project in partnership with
Camden & Islington councils to support older neighbours over the age of 65 Campaign material posted on Camden Tenants’ & Residents’ Association (TRA) notice boards
and housing associations Campaign material on digital screens in Camden 5PS library and children centres.
3. Looking ahead 3.1 November - CPPEG operational meeting (6 Nov) 3.2 November – Patient & Carer Workshop to discuss Long Term Conditions Strategy (21 Nov) 3.3 December - Question Time with local Somali adolescents (date to be confirmed) 3.3 December – CPPEG open meeting (11 December) 3.4 November/December – event with local patient and voluntary groups to discuss the development of Neighbourhoods (date to be confirmed).
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Appendix 1: Healthwatch Report
Healthwatch Camden — current work priorities
Healthwatch Camden is an independent organisation with a small team of six (4 Full Time Equivalent) staff. Our work is based on what local people tell us. We listen by networking with the diverse voluntary and community organisations in the borough and by meeting people on the streets and at local events. We invite local people to help set our priorities, choosing which aspects of local health and care services need to be improved. We carry out enquiries in these priority areas, and write reports on what we find. We have legal powers, set out in the 2012 Health and Social Care Act, which mean that providers and commissioners must respond to our recommendations.
The core purposes of local Healthwatch are:
• to provide information and advice about local health and social care services; • to make the views and experiences of members of the public known to health and social care providers and commissioners; • to enable local people to have a voice in the development, delivery, improvement and equality of access to local health and social care services and facilities; • to support the community in understanding and monitoring local health and social care services and facilities.
Over the past year Healthwatch Camden has focused on………….
Mental health – research with service users at The Highgate Day Centre to monitor impact of service change using audio diary data collection and framework analysis. Report now being used in Camden and beyond to inform better management of service change.
Disabled people – facilitating co-design of a service for disabled people at the new Centre for Independent Living (at the Greenwood Centre).
Bangladeshi community – work to support implementation of Council’s strategic action plan for improvement of Bangladeshi health and wellbeing (plan developed in response to Healthwatch Camden 2016 report in partnership with Adult Health and Social Care Scrutiny panel).
Residential care homes – a partnership with national charity, Independent Age, to develop new and user-friendly indicators of quality in care homes and field test these with visits to Camden’s 7 homes. The project has gained national recognition and is being replicated across England with support from MPs and local authorities.
Dental services – research with local people on barriers to access and uptake of dental services. Partnership with Local Dental Committee and public health to promote regular check-ups.
Accessible Information Standard - work with CCG and LMC to encourage GP practices to implement the Accessible Information Standard.
Somers Town and St Pancras Living Centre - developing a new information and support service for local people.
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Coming up in autumn 2017 - spring 2018 ………..
Accessible Information Standard – in partnership with CCG, offering free practical support sessions (1 hour visits) to every GP practice in response to request from Local Medical Committee and from GP reception staff.
Health and Housing – mixed methods research project to gather evidence from local residents on barriers to accessing support services for private rental tenants and social housing tenants and possible solutions. Community Centres – visits with disabled residents to assess access to Camden’s community centres – and relate this to the Council’s strategy to develop new approaches to adult social care.
Urgent and Emergency Care – working with neighbouring local Healthwatch to do engagement work across NCL, gathering evidence on what is working well or not so well to inform re-design of urgent care services.
Disabled people – working with Camden Disability Action and Council to develop a new “model of engagement”.
Young people – social media campaign and film making project with local schools exploring the health and wellbeing priorities of Camden’s teenagers.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Quality and Clinical Effectiveness Report
Agenda Item 2.4
Date 25 October 2017
Lead Director Neeshma Shah Tel/Email [email protected]
Report Author
Quality and Safety Team Tel/Email
GB Sponsor
Charlotte Cooley, Elected Practice Nurse
Tel/Email [email protected]
Report Summary This report provides a summary of key quality, safety and clinical effectiveness information for Camden CCG.
Areas to highlight to the Governing Body are:
UCLH The Trust provided assurances regarding the implementation of learning and changes to practice following a series of Never Events (NE) which occurred within Dentistry. RFL Four Never Events have been reported since April 2017, three relating to wrong site surgery, the fourth being a medication error. These have been reported as Serious Incidents and are currently being investigated as part of the SI process. CIFT There remain outstanding actions that still require focus against the “Must Do” recommendations from the CQC visit. Safeguarding Update on the CCG’s compliance with statutory functions relating to safeguarding children and vulnerable adults. Camden Medicines Management Committee A number of risks that impact on the GP prescribing budget, and consideration of a number of national consultations.
Purpose
Information Approval To note
Decision
Recommendation The Governing Body is asked to note the content of this report, and to read in conjunction with the CCG’s Annual Safeguarding Adults Report (item 5.2 on the agenda).
Strategic
Objectives Links
Objective A: Commission the delivery of NHS Constitutional rights and pledges Objective B: Improve the quality and safety of commissioned services Objective C: Improve health outcomes, address inequalities and achieve parity of esteem
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Identified Risks
and Risk
Management
Actions
Provider management of quality and safety issues affecting patient care and experience. These are being managed through regular clinical quality review (CQR) meetings and regular liaison with respective provider leads.
Resource
Implications
Competent and resourced teams
Equality Impact
Analysis
An equality impact assessment has not been conducted on this document as it is a
summary report and record of the key outcomes of the Quality and Safety
Committee meeting.
Report History This report is a summary report of the work of the Committee.
Next Steps None.
Glossary
AAT Assessment and Advice Team
AQP Any Qualified Provider
CIP Cost Improvement Programme
CHR Clinical Harm Review
CNS Clinical Nurse Specialist
CLIPS Complaints, Litigation, Incidents and
Patient Feedback
CPN Contract Performance Notice
CQC Care Quality Commission
CQRG Clinical Quality Review Group
CQR Clinical Quality Review
CIFT Camden and Islington NHS
Foundation Trust
CNWL Central North West London NHS
Foundation Trust
CSCB Camden Safeguarding Children’s
Board
DoLS Deprivation of Safeguard Liberties
DHR Domestic Homicide Review
ED Emergency Department
IAPT Improving Access to Psychological
Therapies
IPC Infection Prevention and Control
IPU Integrated Practice Unit
KPIs Key Performance Indicators
LAS London Ambulance Service
LBC London Borough of Camden
LeDeR Learning Disability Mortality Review
Programme
LCS Locally Commissioned Services
LSCBs Local Safeguarding Children’s
Boards
LCW London Central and West
Unscheduled Care Collaborative
MCA Mental Capacity Act
MAR Medication Administration Record
MSI Marie Stopes International
MCA Mental Capacity Act
MDT Multidisciplinary Team
NBOCA National Bowel Cancer Audit
NCPES National Cancer Patient Experience
Survey
NE Never Event
NNU Neonatal Unit
NHSE NHS England
NELCSU North East London Commissioning
Support Unit
PALS Patient Advisory Liaison Service
QAS Quality Alert System
QI Quality Improvement
QSC Quality and Safety Committee
RCA Root Cause Analysis
RAP Remedial Action Plan
RFL Royal Free London Foundation Trust
RTT Referral to Treatment
SAPB Safeguarding Adults Partnership
Board
SAR Safeguard Adults Review
SI Serious incidents
STEIS Strategic Executive Information
System
STP Sustainability & Transformation
Partnership
TAP Team Around the Practice
T&P Tavistock and Portman NHS
Foundation Trust
UCLH University College London Hospital
NHS Foundation Trust
VBC Value Based Commissioning
RCGP Royal College of General
Practitioners
WHO World Health Organisation
WRAP Workshop Raising Awareness on
Prevent
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Executive Summary
This report provides an update on Provider quality and safety, including medicines management and the CCG’s statutory duties under safeguarding children and vulnerable adults. The CCG received reports from Team Around the Practice (TAP), Improving Access to Psychological Therapies (IAPT), Integrated Urgent Care and LAS report, Adult Hearing services, Termination of Pregnancy Services, NCL Maternity Report, Safeguarding vulnerable adults, CCG Safeguarding Adults policy, Learning Disability Mortality Review Programme, Safeguarding Children, CCG Safeguarding Children Policy and the Camden Medicines Management Committee. The Quality and Clinical Effectiveness Risk Register is reviewed monthly.
Key points and actions from these reports and discussions are noted below.
University College Hospital London The Trust provided assurances regarding the implementation of learning and changes to practice following a series of Never Events (NE) which occurred within Dentistry.
One maternal death occurred during Q1 2017/18. A comprehensive investigation was undertaken by the Governance and Risk department within maternity service, which concluded the lady’s death was as a result of her long term condition and unrelated to her pregnancy. This death has been reported to the London Maternity Strategic Clinical Network for independent investigation, which was established in March 2016, to provide a standardised process for investigating all maternal deaths across London, to ensure objective investigation, consistency and London wide learning from these tragic events. Cancer compliance has been sustained during Q1 2017/18 with the two week wait standard. The Trust continues to be challenged in meeting the 62 day standard, with patient choice, complexities and delays in receiving referrals from other organisations cited as the main root causes. Clinical Harm Reviews (CHR) are undertaken by the Trust on all patients who have breached and are reported monthly at CQRG. There have been no incidents of harm associated with waiting times reported to date. Results of the 2016 National Cancer Patient Experience Survey (NCPES) published in July 2017, demonstrated that patient access and contact with their Clinical Nurse Specialist (CNS) has improved. Findings from the National Bowel Cancer Audit (NBOCA) published in February 2017, showed that the number of laparoscopic bowel resections performed to treat bowel cancer have increased, with over 50% of patients undergoing laparoscopic resection. 100% of patients were seen by the colorectal CNS, and 90 day mortality as reported within the audit was 0%. The audit indicated that the number of patients who remained in hospital for five days or longer, following bowel surgery was 92%, against a national average of 89%. Pre-operative staging of cancer was recorded in just 94% of patients. UCLH have developed a Remedial Action Plan (RAP) to address these issues. The results of the Cancer Peer Review, UCLH self-declaration published in July 2017 indicated that the Multidisciplinary Team (MDT) quorum was not met by several cancer MDT teams. The review also showed that not all patients who require referral to the rehabilitation MDT are on Spinal patient pathway. An improvement plan is in place to address these.
The Trust reported that there were no incidents of harm associated with waiting times associated with RTT and cancer. The Safeguarding Annual report was received from the Trust demonstrating governance arrangements and activity for 2016-17 and priorities for 2017-18.
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Royal Free London The Trust reported four Never Events (NE) at the RFL since April 2017. Three of these are related to wrong site surgery and the fourth is a medication dosage error. These have been reported as Serious Incidents and are currently being investigated as part of the SI process. A “deep dive” into Urology services identified that the closure of a theatre as part of a Cost Improvement Programme (CIP) has had a negative impact on the renal cancer pathway. Assurances were provide by the Medical Director that this theatre has re-opened. Theatre capacity is currently under review to create one or two additional theatre sessions to accommodate the capacity and demand within in the renal cancer pathway.
RFL continues to be challenged with achieving the 62-day urgent GP referral standard, the majority of
breaches are occurring within Urology and Lower Gastrointestinal specialities. Barnet CCG as lead
commissioner, has received a recovery plan from RFL to achieve compliance against this standard.
Clinical Harm Reviews (CHR) are undertaken by the Trust on all patients who have breached and are reported at CQRG. There have been no incidents of harm associated with waiting times reported to date. The Trust are working with NHS Improvement and the Discharge 2 Assess (D2A) teams, to streamline the process and improve patient flow through the hospital, in a continued effort to meet the four hour waiting times in the Emergency Department and improve patient outcomes and experience. The Safeguarding Annual Report indicated that the Trust’ priorities for 2017-18 include improvements around MCA and DoLS compliance and responding to individuals with a learning disability affected by domestic abuse. A sample audit of DoLS compliance showed that further improvements are required with both requested DoLS authorisations and completed capacity assessments at the Trust. Safeguarding teams are supporting wards in identification and referrals to raise compliance with DoLS. The development of a new training strategy for 2017-2019 aims to increase training compliance and will be reported against throughout that period. RFH have highlighted challenges in achieving timely outcomes for allegations against staff and this has an impact on the organisation and individuals involved where a member of staff is suspended, removed from patient facing duties or requires high levels of supervision during an investigation. The safeguarding adult’s leads within RFL, Camden and Barnet CCGs will work in partnership with the local authorities to explore any areas for improvements in timely outcomes of allegations. RFL have provided assurance that they are reviewing their training reporting systems for safeguarding children.
Camden and Islington Foundation Trust (CIFT) The Trust completed a mock inspection in September, as part of their preparation for the forthcoming CQC inspection on the 4th December 2017. CIFT reported concerns regarding staff shortages on four of their in-patient wards. Assurances were provided by the Trust that they have processes in place to review acuity of patients, delegate appropriately trained staff to provide support, and ward managers undertaking clinical duties. Staffing is now an agenda item at CQRG to ensure that patient safety and quality of care is maintained. The Trust have some outstanding actions still within their “Must-Do” action plan relating to robust and effective governance systems to monitor the quality, performance and risk management of services, completion and updating risk assessments, record keeping related to a number of areas; quarterly audits of supervision records for non-medical staff to be carried out by service managers, and review of how teams monitor those on waiting lists.
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The CQC have completed a series of Mental Health Act (MHA) monitoring visits. These monitoring visits are completed separately from full inspections and are designed to review the Trust’s compliance against the Mental Health Act legal framework. Areas were identified as requiring improvement with regard to MHA compliance include patients’ consent to treatment and/or capacity to consent to treatment was not tested prior to first administration of treatment, ensuring that rights of a patient under a section of the MHA were explained and understood, and patients’ views not adequately reflected in Care Planning. In order to address these areas, the Trust is planning on introducing consent to treatment and Section 132 rights key performance indicators (KPIs) for all divisions in 2017/18. The Trust priorities for 2017-18 include raising the profile of safeguarding within the Trust accompanied by robust referral systems and good training compliance. Considerable work has taken place to target staff to undertake safeguarding adults training. The progress of training will be monitored through CQRG meetings. Following a safeguarding adult’s self-assessment in January 2017, the Trust has developed referral forms and pathways to compliment the training. Further work is required to embed these and measure effectiveness. CIFT have not included a supervision report this quarter for safeguarding children leads and report a further update will be provided in Q2.The Trust have not provided any progress in regards to data collection for Child Case Conference Process. Central and North West London (CNWL) Foundation Trust Assurances were provided on the impact of training provided by the pharmacy team to all clinical staff on medication transcription, which has resulted in a reduction in the number of transcription incidents. The pharmacy team will be undertaking spot audits to monitor this and have agreed a revised Medication Administration Record (MAR), which was implemented across the Trust during September. The Patient and Carer Feedback annual report 2016/17 demonstrated the following:
An increase in the patient and carer feedback received by CNWL, through compliments,
complaints, Patient Advisory Liaison Service (PALS) and comments. The Trust have developed
an action plan for addressing some of the concerns raised.
Recording and learning from informal concerns and compliments as recommended to the Trust
by the CQC.
A key focus of the Trust for this year is measuring the impact on practice of learning from safeguarding reviews and incidents. In Q1 2017-18, the Trust were compliant with safeguarding adults level1 and level 2 training.
The Trust does not currently provide information on individuals in receipt of Continuing Health Care who may be deprived of their liberty in supported living or their own home. The Designated Nurse is in discussion with the safeguarding lead at the Trust to ensure the CCG gains assurance of compliance in this.
Team Around the Practice (TAP) The committee were assured of the positive outcomes this service provides for patients in relation to their mental well-being, and in many cases, their functioning at work and socially. Patients value the smooth referral process; short waiting time between referral and treatment, and the service being provided in a GP surgery. GPs fed back that TAP increased their confidence in supporting patients with mental ill health and increasing wider practice staff’s knowledge of mental health and appropriate responses.
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Improving Access to Psychological Therapies (IAPT) The IAPT service is delivered to people aged 18 years and over, registered with a Camden or Islington GP or who live in either boroughs and do not have a GP. CIFT provide IAPT under the service name i-Cope, supported by five other partners offering a range of choices tailored to Camden’s population and representing a strength in local services.
i-Cope are based in GP practices, Camden mental health teams, community centres, long-term
condition, clinics, job centre, and other community venues. i-Cope offers a flexible service in patient’s
homes, as well as morning and evening appointments and support workshops. The service has a
particular focus on supporting people with other long-term conditions, as this group are more likely to
experience anxiety and depression.
Developing improved Primary Care Mental Health services is a priority in the Sustainability and
Transformation Plan (STP) and Local Care Strategy and is central to transforming the model of delivery
to be more community based. The service performed well during 2016-17 and exceeded the national
wait times of 75% and 95% target for 6 and 18 weeks from referral to first treatment, the service
achieved 84% and 98% respectively.
Integrated Urgent Care and London Ambulance Service There was one SI reported by the service during Q1 2017/18, relating to adverse media coverage by an undercover journalist into the conduct of call handlers. A full investigation was undertaken by the service and reported to the North Central London Serious Incident Panel in August. The panel were satisfied with the outcome of the investigation and recommended the SI for closure. The CQC conducted an inspection of LCW in March 2017, the services were rated as good in each of the 5 CQC domains. LCW safeguarding children Q1 training reports demonstrates compliancy for levels 1 and 2, but not level 3. The Designate Nurse has asked that this is investigated and for level training stats to be included in future reports. The CQC conducted a second comprehensive inspection of London Ambulance Service (LAS) in February 2017. The inspectors were complimentary of the significant improvements which have been made across all five domains since the 2015 inspection, with improvements still required in some areas. It is anticipated that the CQC will conduct a further inspection of LAS services in February 2018. The National Medical Director for NHSE in conjunction with the Secretary of State for Health, endorsed the recommendations made by the Ambulance Response Programme trial. These new national response times have been accepted, it is anticipated that the changes will be made before winter 2017 and roll out in London is expected to commence in October 2017.
AQP Audiology Camden CCG commissions Adult Hearing Services for people older than 50 years from a mix of acute and private providers – UCLH, RFL, Scrivens, Specsavers and InHealth The QSC committee was not sufficiently assured at the previous review of this service in relation to the processes to collect patient satisfaction feedback and accreditation of providers by Improving Quality in Psychological Services (IQPS). The review presented last month provided some assurance regarding concern raised previously; it did not provide sufficient evidence in relation to the points raised below;
Themes, trends and learning from all incidents, including near misses.
Evidence of learning and changes to practice, following complaints.
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Concerns were in relation to number of patients presenting to GP practices for removal of ear wax. This was not referenced within the report as a concern.
There concerns regarding the processes for capturing feedback from patients, carers and advocates on this service.
A response to these questions has been requested. Termination of Pregnancy Services (TOPS) An update report provided assurance of the well-being and safety of Camden residents who receive Termination of Pregnancy Services, following the previous report to this committee in June 2017. The CQC published its report on 21 July 2017, highlighting 18 areas where Marie Stopes International
has failed to progress actions previously identified. These were discussed at the Pan London ToP
Commissioners’ and Providers’ meeting where a decision was taken to convene a separate meeting with
MSI to discuss the findings of the latest CQC’s report. MSI is making progress to address the breaches
in regulation improvements, which includes:
MSI has reviewed its system of leadership and governance.
Reassurance was provided around recruitment to key positions, including senior key clinical roles.
There are integrated dashboards within Datix reporting on incidents, complaints, risk allowing a quality report to complied; an integrated quality dashboard will be established focusing on workforce, quality, operational and finance activity.
A revised compliance toolkit is in place, which will also allow for compliance auditing of the WHO checklist. This toolkit will be monitored electronically to provide assurance.
Infection Prevention Control (IPC) audits are now in place. From the 1st October 2017, hand hygiene and Intravenous Peripheral Cannulae will be included in the compliance monitoring programme/audit.
NCL Quarterly Maternity Report An update in relation to maternity services across NCL was received.
UCLH reported that two immunisation midwives, funded through NHS England, are in post and are undergoing training to enable them to provide BCG vaccinations in October 2017. They are able to administer flu and pertussis. Incident reporting demonstrates that delays in care are a key feature, especially within the maternal assessment unit. An audit is currently being undertaken for quarter 1 and 2. Outcomes and progress against actions will be reported via the CQRG.
GPs in both Camden and Islington have raised a number of concerns where pregnant women are being referred back from UCLH to their GP for routine 32 and 38 week antenatal checks as part of shared care. These concerns were discussed with the Trust who reassured CCG representatives that there has been no change in policy and that the service has capacity to see all women for their antenatal appointments. In the longer term, the Service will explore opportunities to move a larger number of services into the community as well as examining the possibility of group sessions for women. These will be taken up as part of the wider Better Births workstream.
RFL reported on the imminent introduction of the NCL specialist perinatal mental health service and ways in which this will be supported by the maternity service. There are community teams in both the Royal Free and Barnet catchment areas with a specific remit in caring for women with additional social vulnerability. These teams have now begun to caseload women to provide continuity of care across the whole pathway. They will be working closely with the perinatal team to support women. This is the first Trust in NCL to begin working in this way.
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Safeguarding Vulnerable Adults Assurance was provided for safeguarding vulnerable adults within health Providers. Safeguarding adults training and support sessions are planned for the coming months for GPs and practice safeguarding leads, focusing on domestic abuse, mental capacity and learning from statutory reviews. Safeguarding professionals have developed a draft template to help with requesting information for statutory safeguarding adult enquiries from GP practices, this will be shared with GPs prior to implementation. The CCG submitted its contribution for the Safeguarding Adults Partnership Board (SAPB) Annual Report and identified the following three priorities to report progress against for 2017-18:
Contribution to, and oversight of, the delivery of the Prevent agenda
Development of a GP Safeguarding Adults Lead network
Embedding the Integrated safeguarding adults dashboard within commissioned services
Prevent
The Designated Nurse for Safeguarding Adults represents the CCG on the Camden Channel Panel, a multi-agency conferencing system to support individuals at risk of radicalisation. Camden, along with 22 other London Boroughs, remain a high priority area for the Government. NHS Trusts serving the population are required to report compliance figures quarterly to the NHSE London Prevent region. Providers are required to demonstrate 85% compliance that all staff are trained in basic Prevent awareness and appropriate staff have the hour long 'Workshop Raising Awareness of Prevent (WRAP) training by 2018. All CCG staff are required to complete basic Prevent awareness as part of mandatory training. This has been added to the e-learning suite of mandatory training. Currently CIFT and Tavistock & Portman are the only local health Providers compliant with the basic Prevent Awareness training and none of the local Providers are compliant with the WRAP training. The Camden CCG Designated Nurse for Safeguarding Adults is looking at various approaches for improving compliance.
The Learning Disability Mortality Review Programme (LeDeR)
The LeDeR Programme supports local reviews by health and social care professionals of deaths of people with learning disabilities aged 4-74 years of age across England. In London, the review period for all deaths is from December 2016-April 2018.
Seven deaths have been reported locally for review with one completed and others in progress. The CCG, UCHL, RFL and CNWL all have reviewers who have completed the required training while CIFT, and Tavistock and Portman have been approached by the steering group to release staff for the training. Camden is one of the few areas in London to have successfully completed a review. Challenges for reviews are around the time to gather records from partner agencies, respectfully approaching bereaved families for their involvement and capacity of professionals to undertake reviews in addition to their main roles, all of which have been raised with the NHSE Regional Coordinator. Until reviews are completed it is not possible to obtain and disseminate learning around good and poor practice in this area. The Camden LeDeR steering group will present an options paper to the Safeguarding Adults Partnership Board meeting regarding local governance arrangements for the steering group going forward.
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Statutory Reviews
Safeguarding Adult Reviews (SAR) A SAR was commissioned by the SAPB following the death of an adult who was in receipt of significant health and social care and support. On conclusion of the review, learning will be disseminated to member practices via the first session of the Practice Safeguarding Adults Lead Network and the Quality Matters newsletter. Domestic Homicide Reviews (DHR)
A DHR was commissioned by the Community Safety Partnership Board following the murder of a woman from Camden by her partner. The CCG submitted an action plan for member practices based on the following recommendations from the review:
All agencies will develop a domestic abuse identification and referral pathway, including potential signs that someone is experiencing domestic abuse or witnessing domestic abuse (for services to children).
All agencies will encourage and support staff to use their professional curiosity to explore possible indicators of domestic abuse and refer clients on appropriately.
All agencies will ensure that public-facing staff have sufficient training to be able to explore, recognise and respond to domestic abuse appropriately.
The actions have been completed through the commissioning of the IRIS project which has had a positive impact after the tragic death reviewed in this case. The actions will be subject to on-going audit as part of the project specification. The DHR report will be sent to the Home Office for scrutiny and approval prior to its publication.
CCG Safeguarding Adults Policy This Policy has been reviewed and updated to further align to the requirements set out in the NHS England Safeguarding Vulnerable People in the NHS: Accountability and Assurance Framework 2015. Safeguarding Children Camden has been assured through:
Training Compliancy reports for CCG Staff and Governing Body Members. GB training compliancy has fallen due to the election of new members and a training session is being organised.
Progress reports for safeguarding training for Camden Providers. GOSH this quarter are demonstrating improvements across all their training levels. Tavistock & Portman this quarter have made a significant improvement in their supervision reporting demonstrating 90%.
The “Child Protection Case Conference Support Scheme for GPs” is demonstrating improvement from 68% to 85% compliancy this quarter.
Safeguarding monitoring arrangements are in place for Brook, Brandon and the Homerton University Hospital NHS Foundation Trust, Young People’s Sexual Health Services and Family Nurse Partnership.
In September, Ofsted performed an Inspection of Camden’s Children’s Social Care Services and reviewed the function and effectiveness of the Safeguarding Children Board. The inspection focused on the experience of children and young people at risk of harm, subject to child protection, or known to Early Help Services and Looked after Children and Care Leavers services. During this review, Inspectors reviewed case files and spoke to social workers, other local authority staff, the Looked after Children’s Health Team, councillors, as well as children, young people, their families and carers.
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Health agencies contributed to this process through meetings with the Inspector, where they demonstrated their contribution to the Board, how they effectively challenge, contribute to multi-agency processes and work in partnership to protect children and young people. The Executive Director, Supporting People Camden Council and Camden Safeguarding Children’s Board Independent Chair have shared the initial findings from the Inspectors and these have been positive about the quality of work in Camden, the effectiveness of the CSCB and the strength of our partnership working. Ofsted’s actual judgement will be included in their final report which will be published on the 24th November 2017. CCG Safeguarding Children Policy The existing version has been updated. The policy has been reviewed and amendment’s made in regards to:
Structures updated
Revised Guidance in London Safeguarding Children Board Procedures 2017.
Children & Social Care Act 2017. The Children & Social Work Act 2017, sets out revised arrangements for local multi-agency safeguarding partnerships to replace the previous model of Local Safeguarding Children Boards (LSCBs).
Under the new provisions, safeguarding partners for a local authority area (named as the local authority, clinical commissioning group and police) are required to make arrangements for themselves and relevant agencies to work together in exercising their functions for the purpose of safeguarding and promoting the welfare of children in the area. This Act also makes amendments to the Child Death Overview and Serious Case Review Processes. Medicines Management Committee
The Committee was apprised of a number of risks affecting the budget:
The Department of Health (DH) change to budget setting methodology in relation to forecasting prescribing expenditure.
NHS England’s intention to retain the savings that would have resulted from the reduction in Drug Tariff Category M (generic drugs) prices.
The unexpected in year rise in prices of certain medicines when ‘no cheaper stock option’ (NCSO) is available. The current NCSO cost pressure in Camden for April to July 17 (month 4) is £268,360 and to month 6 £578,314., whereas the NCSO cost pressure for the entirety of 2016/17 was £105,852. These are pressures which cannot be offset, and will impact on the delivery of the QIPP plan savings (currently this is flagged as amber).
The different prescribing arrangement options outlined in the NHS England consultation on Gender Identity Services for adults were considered. Many medico-legal responsibilities are associated with the proposals and good governance is needed to support a transfer of responsibility from specialist teams to GP practices, and formal shared care arrangements should be in place.
The response to the national consultation launched by NHS England on items that should not be routinely prescribed in primary care was discussed by the Committee. Careful consideration will need to be given to ensure that particular groups of people are not disproportionately affected, and that principles of best practice clinical prescribing are followed. Possible implication of a national decision was discussed and the requirement for local engagement should changes in local guidance be necessary.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Healthy London Partnership Update
Agenda Item 3.1
Date 18.10.2017
Lead Director Jane Lindo, Healthy London Partnership’s (HLP) Deputy Programme Director for Primary Care,
Tel/Email [email protected]
Report Author Maria Vidal-Read, Director of Communications, Healthy London Partnership
Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Dr Neel Gupta Tel/Email [email protected]
Report Summary
The Governing Body considered and approved the 17/18 Healthy London Partnership funding request at the March 2017 meeting. This paper provides an update on the work of Healthy London Partnership.
Purpose (tick one box
only)
Information
Approval To note
Decision
Recommendation The Board is asked to note the update and raise any queries or comments on the HLP programme to Jane Lindo and John Sheedy during the Governing Body meeting.
Strategic
Objectives Links
Improve the quality and safety of commissioned services Improve health outcomes, address inequalities and achieve parity of esteem Integrate and enable local services to deliver the right care in the right setting at the right time
Identified Risks
and Risk
Management
Actions
This update is for information only.
Conflicts of Interest
This update is for information only.
Resource
Implications
This update is for information only.
Engagement
This paper includes details on how Healthy London Partnership engages and involves stakeholders.
Equality Impact
Analysis
This paper includes information about how Healthy London Partnership is working to make sure all Londoners have access to the best possible health and care services, including people experiencing homelessness and people experiencing a mental health crisis.
Report History The Governing Body receives regular HLP updates.
Next Steps To be determined by the Governing Body.
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Supported by and delivering for:
London’s NHS organisations include all of London’s CCGs, NHS England and Health Education England
Healthy London Partnership
Working together to make London the healthiest city in the
world
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01
Transforming London’s health and care together
Introduction
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Who are we?
Healthy London Partnership
3
Collaborative
Aspirational
Strategic
Innovative
• Formed in May 2015 as a collaboration between London’s 32 CCGs and NHS England (London Region)
• Funded annually by CCGs and NHS England (London Region)
• To deliver the Five Year Forward View and Better Health for London
• We work to deliver the things best done once for London
• We believe that collectively we can make London the healthiest global city in the world.
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What do we do?
We work to deliver the changes best done once for London to make the vision of the NHS Five Year Forward
View and Better Health for London a reality.
We also support the delivery of the sustainability and transformation plans in the five areas across
London with strategic advice, resources and staff embedded in the areas. We:
• Work across London to deliver on national, London and local aspirations aiming to make London the
healthiest city in the world
• Bring together political drive, academic research, clinical and managerial expertise, and delivery
networks to make sure change is taken forward at every level
• Attract additional funding to London for transformation work – in 2017/18 London will benefit from up to
£18 million of extra funding
• Horizon scan, summarise and share best practice, data and policy to make sure London’s health and
care system has access to the most up to date information
• Bring together and facilitate London wide networks to build consistent guidelines and standards of
care so all Londoners have access to the best possible health and care services
• Work on once for London projects where this is the most efficient and economic model for improving
health and care for Londoners
• Facilitate evaluation and learning across the entire health and care system; benchmarking information
and building capacity and capability for delivering change locally.
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Why do we do it?
Health challenges affecting Londoners
5
• One-year cancer survival rates vary significantly across London, Londoners don’t know how to spot the signs and symptoms of cancer and screening uptake is low
• Children and young people in London have higher levels of mortality and serious illness and higher levels of childhood obesity than any other global city
• People with severe mental illness die 17 years earlier than the general population
• Only 14% of Londoners get the support they need in a mental health crisis
• London has the highest demand for child and adult mental health services in the country
• People who are homeless have a life expectancy of only 43-47 years, are more afflicted with mental ill health and are very high users of hospital services
• Three quarters of Londoners with several long term conditions say each condition is treated separately rather than holistically
• More than half of adults in London are overweight or obese and 1.8 million adult Londoners report they do less than 30 minutes moderately intense physical activity each week
• Only 50 per cent of Londoners think it’s easy to access GP services
• 500 lives could be saved if weekend care were the same as during the week
• Patients are still defaulting to A&E due to confusion in the current system
• NHS organisations in London can’t share patient records across artificial geographical boundaries
• Many qualified professionals leave London for a number of reasons including the high cost of living
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How we fit in - governance
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Across programmes HLP operates under joint leadership
7
Programme Clinical lead CCG lead (Joint SRO)NHSE lead
(Joint SRO)Local Authority Lead
Programme leads
(HLP)
Cancer Anthony Brzezecki Andrew Eyres Khadir Meer Dawn Sacker Liz Wise
Care Closer to
Home
Tom Coffey / Simon
Eccles / Marilyn PlantTBC Oliver Shanley Grainne Siggins Eileen Sutton
Children and
Young PeopleRussell Viner Martin Wilkinson Ceri Jacobs TBC Tracy Parr
Devolution Marc Rowland Andrew Eyres Anne Rainsberry Will Tuckley Nabihah Sachedina
Digital Adrian McLachlan Terry Huff Jane Barnacle Elisa Hakan-Lector Mike Part
Estates Marc Rowland
Marc Rowland
(CCG rep on LEB); Peter Kohn
(Office of London CCGs)
David Slegg
(LEB Chair)
Dick Sorabji (London
Councils LEB member)
Geoff Alltimes
(LEB Independent
Co-Chair)
Homelessness Adrian McLachlan Tonia Michaelides Kenny Gibson Rosemary Westbrook Susan Harrison
Mental HealthPhil Moore / Vincent
KircherJane Milligan Oliver Shanley Simon Pearce George Howard
Prevention/
Health and
Wellbeing
Zoe Williams Jo Murfitt Matthew Bazeley
Kath Gill, Clive Grimshaw,
Sally Parkinson & Enise
Radley (London Councils)
Jemma Gilbert
Primary Care Marc Rowland Andrew Bland David Slegg Grainne Siggins Liz Wise / Jane Lindo
Proactive care Jay John Jane Barnacle Bernie Flaherty
Specialised
CommissioningMichael Marsh Sarah Blow
Andrew Goodman
(interim)TBC Stephen Waring
Urgent &
Emergency
Care
Tom Coffey / Simon
EcclesSarah Blow Dr Vin Diwakar Grainne Siggins
Patrice Donnelly
(UEC) /
Eileen Sutton
(111/IUC)
Workforce Etheldreda KongAngela Bhan
(with Julie Screaton)
Helen Bullers
(with Julie
Screaton)
Tristan Brice & Matthew
Kendall
Nigel Burgess/ Lizzie
Smith (HEE)50 of 291
Us and STPs
8
• Since we were established STPs have emerged as local ‘structures’ with a
formal role in the delivery of transformation.
• In light of this, in June 2016 the London Transformation Group agreed an in-depth
review of activity needed to transform the whole system so the partnership
could develop in the right direction.
• During engagement with stakeholders there was broad acknowledgement that a
transformation resource on a London level is beneficial and getting activity
and the interface with STPs right was critical.
• Recommendation that three functions should be done on a London level:
• Healthy London Partnership to prioritise resources and activity to move from
planning to delivery – bespoke plans and evidence were developed for each STP
footprint to support planning
Horizon scanning function
looking at new emerging
priorities
Products and support that are
best done once for London
Embedded resource in STPs
that links back to London level
work
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How do we engage and involve Londoners?
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02
Transforming London’s health and care together
Highlights 2016/17
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Things we’ve made happen in 2016/17
11
• New technology we’ve led the development on and
implemented means Londoners calling NHS 111
with care plans and crisis information can now be
directed to a clinician who can see their
information in real time helping them make the right
clinical decision and making sure callers are referred
to the right service, first time. The technology has
already won several awards including the prestigious
UK IT Industry Award for best use of cloud services.
• Mayor of London, Sadiq Khan launched London’s
section 136 pathway and Health based Place of
Safety specification, following extensive
engagement across London’s crisis care system.
Engagement with over 300 service users, mental
health and acute trusts, LAS, local authorities and
London’s three police forces. This resulted in formal
endorsement from these agencies as well as the
Royal College of Psychiatry and National Crisis Care
Concordat.
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Things we’ve made happen in 2016/17
12
• London has launched the first mental health
dashboard in the world. This will help the health
and care system improve mental health services for
Londoners by having access to up to date
information. The dashboard will help providers and
commissioners benchmark performance and
improve and transform services.
• 67% of children attending A&E could have been
seen by a GP. London’s young people helped us
design and launch a mobile app called NHS Go
downloaded by over 40,000 people already, giving
them targeted health information plus health advice
and signposting to services.
• More than 40 NHS organisations and around
100,000 NHS employees in London took part in
Healthy Living Week. Over 250 events took place
across London, we led this with NHS Trusts and the
London NHS Charities Group.
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Highlights 16/17
13
• 220,000 Londoners now survive cancer. We have developed the pathway and tools for treating
cancer as a long term condition in GP practices covering psycho-social and physical needs, the
needs of carers and support for patients to improve their health and their experience of the NHS.
• Our Early Intervention in Psychosis team supported the mental health system with the new
psychosis target and developed a range of materials to support GPs if they suspect someone
may be experiencing a first episode of psychosis.
• Three children in every classroom has asthma. NHS services in London are working towards the
aim of ‘no child dies from asthma’ by improving asthma care for all children and young people.
The London Asthma Toolkit for GPs, pharmacists hospital clinicians, schools and parents
officially launched at the British Thoracic Society’s winter symposium in December
• Our evaluation of a GP led service in Croydon for men with prostate cancer, showed that it is
better value for money and improves the patient’s experience. Four areas in London (south east,
south west, north central and north west) are now going to roll out this service which will benefit
over 3,000 men.
• The Transforming Primary Care team have successfully negotiated with the national team on
behalf of London’s CCGs to secure agreement to spend the allocated £25.4m of GP Access
Monies this year (and next) to spread the offer across London to serve a greater population (9m
patients) as opposed to national allocation for pilot areas only.
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Highlights 16/17
14
• Homeless people are eight times more likely to go to A&E than other Londoners. 20,000
cards were sent out to homeless centres in London which along with the training we’ve
designed for frontline staff means that people who are homeless or sleeping rough can
use GP services when they need them rather than waiting until they are so ill they go to
A&E.
• Through our partnership working, all 32 CCGs, all 33 borough councils, the Mayor of
London, NHS England and Public Health England signed a London Health and Care
Collaboration Agreement and London Devolution Agreement in 2015. This paves the
way for central government and national bodies to devolve powers and funding to London to
support local, sub-regional and London-wide transformation. In 2017, central government
announced their commitment to a further London health and care devolution agreement.
• In a trial with professional football clubs like Spurs, Brentford and Fulham FC, 77 men who
started off overweight or inactive lost a combined weight of 244kg via the Fanactiv
project which we are now extending, showing how working locally where Londoners are is
how you can bring about the biggest changes.
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03
Transforming London’s health and care together
What does once for London
look like?
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Case study: Mental health crisis care
Bringing an entire system together to improve care for the most vulnerable Londoners
16
Around 5,000 Londoners will be detained
under section 136 and taken to one of
London’s 20 health based places of safety
or A&E each year. However, the care
people receive when they are detained and
the standards of these places of safety vary
across London. It makes sense to take a
once for London approach to improving care
and so far we have:
• Developed a pan-London pathway for
section 136
• Published a specification for health
based place of safety sites
We are now working with CCGs, trusts and
other key partners to implement the new
model of care.
https://www.youtube.com/watch?v=um9fz
2AubAk
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Case study: Great Weight Debate
Mobilising partners and investment to make change happen on a London level?
17
Two out of five children starting secondary
school are already overweight or obese.
We worked with the London Obesity
Leadership Group, Public Health England,
London Councils and borough obesity leads
to raise awareness of childhood obesity and
seek ideas from Londoners on what would
help young people in London lead healthier
lives.
The Great Weight Debate reached over
half a million Londoners on social media,
saw 3,900 people fill in our survey, nearly
2,000 people attend roadshows and
culminated in 60 teenagers working through
the issues at a Hackathon at City Hall,
raising awareness of the issue of childhood
obesity in London and creating a strategy
for change in the London boroughs.
https://www.youtube.com/watch?v=sNTYw
qWj5CI
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Case study: Improving health of homeless people
Raising standards by pooling resources
18
Hundreds of people are homeless in
London every night. They represent a small
portion of the population and often move
around London, experiencing varied care
and outcomes – this is why we are taking a
once for London approach to improving
care.
After engaging with over 100 organisations
and individuals, including every London
CCG and more than 90 people with
experience of homelessness: we have
developed:
• Commissioning guide for CCGs
• Online training package for GP
receptionists and practice managers
• ‘My right to access health services’
card for people who are homeless
https://www.youtube.com/watch?v=5QuBz
aEUuh0
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What next?
19
• Each STP has been assigned a lead from the partnership to work with, to provide support and
ensure a clear route of communication and joined up working between the footprint area and
London level.
• Joint membership across STP programme boards and partnership transformation delivery
boards to also ensure clear communications and interface between London and boroughs.
• Embedded Healthy London Partnership staff working in STPs across a wide variety of
programmes linking London level work with sector level work to support delivery.
• Supporting the Mayor of London's new citywide movement to improve mental health and
wellbeing in the capital. Thrive LDN aims to encourage Londoners to step up to tackle mental
health so that every person in London can live happier, healthier lives.
• Setting up the Urgent and Emergency Care Improvement Collaborative to work with staff and
leaders across urgent and emergency care, and out of hospital care to define what the future
support for improvement across London needs to address.
• Work is well underway on the London Health and Care Information Exchange which aims to
join up NHS organisations across London. The exchange aims to give NHS clinicians secure
access to real-time patient records and information.
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05Questions?
2063 of 291
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Camden CCG’s Refreshed Estates Strategy Agenda Item 3.2
Date 26/10/2017
Lead Director Gordon Houliston Tel/Email [email protected]
Report Author Matthew Black Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Dr Kevan Ritchie Tel/Email [email protected]
Report Summary
Overview At the meeting of the Governing Body on 13 September 2017, members discussed the organisation’s approach to the development of a refreshed CCG Estates Strategy. In light of predicted demographic changes, population increases, changes to the CCG’s operating environment and the transfer of primary care commissioning to the CCG, the group agreed to receive a refresh of the Estates Strategy in November 2017. Estates Strategy A predicted increase in the Camden population of approximately 6% over the next ten years is expected to result in significant growth in the demand for local healthcare services. To reflect these predictions and new primary care commissioning arrangements, the CCG Estates Strategy has been refreshed. The strategy sets out the approach to managing the estates portfolio over the next five years. The CCG has already set out its vision for services which are accessible, person-centred, coordinated, preventative and effective in the Local Care Strategy. The CCG Estates Strategy responds to this and the financial challenges facing the local health economy. It aligns to the Camden Local Care Strategy by ensuring that there will be a greater focus on future estate capacity and adaptability to enable multi-disciplinary working. The strategy also identifies partnership working as a key enabler. Recognising that although it is the primary care estate which comes under the direct responsibility of the CCG, the organisation does not work in isolation and there is a need to work jointly with partners to explore and develop opportunities for estates development. The Estates Strategy has been drafted with input from local stakeholders such as UCLH, CNWL, C&IFT, and Camden Local Authority. It was shared with the Locality Committees and the Camden Patient Public Engagement Group for comment. At the same time it was hosted on CitizenSpace and advertised via the CCG Facebook page and Twitter. While no comments were received from the public, useful comments were received from the Governing Body and other stakeholders and are reflected in this final version.
Purpose (tick one
box only)
Information
Approval
To note Decision
Recommendation The Governing Body is asked to approve the refreshed CCG Estates Strategy.
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Strategic
Objectives Links
Commission the delivery of NHS Constitutional rights and pledges
Improve the quality and safety of commissioned services
Identified Risks
and Risk
Management
Actions
No risks identified in this paper. Ongoing estate risk management will take place on a day to day basis and through the Camden Premises Steering Group. Financial risks associated with individual estate proposals will be managed by the CCG Finance, Performance and QIPP Committee.
Conflicts of Interest
No conflicts of interest arising.
Resource
Implications
Management resource will be required to carry out the implementation plan set
out in the strategy, which will be sourced from existing management resource.
Engagement
Public engagement took place via CitizenSpace, CPPEG, Twitter and Facebook.
Equality Impact
Analysis
An Equalities Analysis has been carried out and has found no negative effects. The Estates Strategy should enable the CCG to better meet the needs of its local population by, for example, ensuring buildings provide good access and are fit for purpose.
Report History
First presented to this meeting.
Next Steps Subject to approval, the implementation plan will be delivered and overseen by the Camden Premises Steering Group.
Appendices
1. Estates Strategy
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1
m m
Estate
2018 - 2023
Strategy
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0
Contents
Executive
SummaryContents
Executive Summary ............................................................. 1
Where Are We Now? ........................................................... 2
Health in the United Kingdom ........................................... 2
Health in North Central London ........................................ 2
Health in Camden ............................................................ 2
Local Deprivation ............................................................. 4
Population Predictions...................................................... 5
Population Density and Development Areas .................... 5
Healthcare Estate in Camden .......................................... 7
Primary Care Estate ......................................................... 9
Partner Development Plans ........................................... 10
Sustainability & Transformation Plan ............................. 11
London Partners ............................................................. 11
Where Do We Want to Be?................................................ 12
Camden CCG Vision ...................................................... 12
Local Care Strategy ....................................................... 12
Key Issues for Estates Management .............................. 13
Addressing the Issues .................................................... 13
How Will We Get There? ................................................... 14
Objectives ...................................................................... 14
Estate Appraisal ............................................................. 14
Partnership Working ....................................................... 15
Funding Opportunities .................................................... 15
Environmental Sustainability .......................................... 15
One Public Estate .......................................................... 15
Strengths, Weaknesses, Opportunities, Threats ............ 16
Strategic Priorities .......................................................... 17
Area Priorities ................................................................. 18
Implementation Plan ...................................................... 19
References ........................................................................ 20
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1
This strategy sets out NHS Camden Clinical Commissioning Group’s
(CCG) approach to managing its estates portfolio over the next five
years. It takes into account the recent transfer of primary care
commissioning to the CCG along with the accompanying
responsibility for the buildings which house these services.
Camden CCG has already set out a vision for services which are
accessible, person-centred, coordinated, preventative and effective
in its Local Care Strategy. The Estates Strategy responds to this and
the challenges facing the local health economy.
Camden is a diverse and mobile population of around 246,200
people. The healthcare that people receive in the borough is
delivered from a variety of sites including two large teaching
hospitals, thirty-four GP surgeries, several community health centres,
specialist units, as well as pharmacies and opticians. Our aim is to
ensure that with such a wide range of services in the borough, health
and care services are given the opportunity to work flexibly together
to provide coordinated, proactive, accessible and good quality care.
A key challenge in meeting this vision for the future will be
affordability. Rental costs vary greatly across the borough, meaning
sourcing affordable new premises or renewing expiring leases
presents a unique challenge. The current healthcare estate is also
fragmented with services hosted in buildings which vary in overall
capacity.
While the local health economy is facing reduced financial resources
and there are increases in demand for services, a key priority needs
to be efficient use of the estate. Spaces need to be well-used, offer
capacity for the future and scope for more integrated working. At the
same time, premises will need to respond to the need for healthcare
services being delivered outside of a hospital-setting, and available
seven days a week.
The strategy sets out a vision for the estate in Camden and puts
forward a practical set of steps which will ensure that healthcare is
provided in flexible spaces, in the right places, and enhances the
patient experience.
Executive Summary
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2
Health in the United Kingdom
The general health of the country shows that people are living
longer. Between 1992 and 2012, life expectancy at birth in England
increased by 5.9 years for men and 4.1 years for women. However,
inequalities persist across the country so that people living in the
south can expect to live on average much longer than those living in
the north.
While life expectancies increase, the number of people aged over
seventy-five is predicted to rise by over 50% by 2030, and more
people are expected to be living with complex health conditions. At
the last estimate, just over 15 million people have a long-term
condition such as hypertension, depression, asthma and diabetes.
These types of conditions account for 50% of all GP appointments
and 70% of stays in a hospital bed.
This means that with general practice being the first point of call for
most users of the NHS, there will be a huge impact on these services
and the premises that accommodate them. This poses a significant
challenge while the NHS as a whole is having to deliver the same or
a better quality of care with a limited growth in resources.
Health in North Central London
In 2016/17, NHS England set out a new approach to planning
healthcare services. Forty-four Sustainability and Transformation
Plans (STPs) were developed in geographical areas across the
country and Barnet, Camden, Enfield, Haringey and Islington form
one of the five London footprints.
Jointly known as the North London Partners in Health and Care,
these CCGs, NHS providers and local authorities represent a
population of approximately 1.5 million and a combined healthcare
spend of £2.5 billion. The area has high levels of diversity and
complexity, and exhibits areas of variation, exceptionally high quality
care and innovation across the boroughs.
Meanwhile, there are challenges for the area. Variations in the
quality and accessibility of care exist while financial sustainability
poses a significant joint risk. The STP is an ambitious and innovative
plan which aims to address the complex health and social care
needs of the local population while maintaining financial balance.
Where Are We Now?
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3
Health in Camden
According to London Borough of Camden Local Authority figures, the
estimated resident population in 2017 is 246,200. Life expectancy in
the borough is 81.7 for men and 86.1 for women, which is
significantly better than the England average figure reported by
Public Health England. In terms of the age range, Camden’s
population is most represented in the younger age brackets of under-
thirty five year olds and projections are that these will reduce as the
population of Camden gets older.
The CCG’s Local Care Strategy (2016) has already identified that
improvements in life expectancies will mean there will be increases
in the relative amounts of older people, with predictions as high as a
41% increase in the over seventy-fives in the next ten years. While
the population ages, approximately 10% of those accessing
healthcare in the borough are currently obese, a further 21% are
overweight and roughly 25% drink at a level which is likely to put
them at an increased or high-risk of harm. Cardiovascular disease,
cancer and respiratory disease are the leading causes of death
across Camden.
A key factor in people’s health is the quality of their housing.
Roughly a third of social housing in Camden does not meet the
Decent Homes Standard and about 5,500 households are
overcrowded. Households with residents from black, minority and
ethnic (BME) groups are also four times more likely to be
overcrowded than residents from other groups.
Poverty indicators show that more than 28% of children in Camden
are living in poverty and that the borough is the fifteenth most
deprived in London. In terms of education, 47% of five year olds in
Camden are reaching a ‘good level of development’, which is still
lower than the London and England averages. Amongst the 16-18
year olds, 4.4% are not in education, employment or training.
Employment indicators show that unemployment levels are highest
for middle-age adults, BME groups and people with learning
disabilities. Approximately 3% of working-age residents are on
disability benefit due to mental illness.
Camden population pyramid, 2015 compared with 2001, 2025, 2035.
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4
Local Deprivation
Within 10% most deprived (32)
10% - 20% most deprived (21)
20% - 30% most deprived (18)
Other (62)
In terms of deprivation, Camden has two
distinct ‘hotspot’ areas. To the West, in
and around the Kilburn ward, there are
several areas where the residents are
amongst the most deprived in the country
(in terms of several indices such as
health, housing, etc.)
To the South / South-East, in and around
the St Pancras & Somers Town wards,
there are several areas with residents
being amongst the most deprived in the
country. This radiates outwards towards
the Regents Park and Camden Town /
Haverstock wards.
In terms of deprivation, Camden has two
distinct ‘hotspot’ areas. To the West, in
and around the Kilburn ward there are
several areas where the residents are
amongst the most deprived in the country
(in terms of several indices such as
health, housing, etc.) To the South /
South-East, in and around the St Pancras
& Somers Town wards, there are several
areas with residents being amongst the
most deprived in the country. This
radiates outwards towards the Regents
Park and Camden Town / Haverstock
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Map of Deprivation in Camden (Index of Multiple Deprivation 2015)
Camden has two distinct areas of high
deprivation in the Kilburn and
St Pancras and Somers Town wards.
Camden has two distinct areas of high
deprivation in the Kilburn and St
Pancras and Somers Town wards.
Camden has two distinct areas of high
deprivation in the Kilburn and St
Pancras and Somers Town wards.
Image courtesy of the London Borough of Camden Council
Image courtesy of the London Borough of Camden Council
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5
Population Predictions
The general health deprivation map of Camden shows that there are
some wards with disproportionately high levels of poor health such
as in Kilburn, Gospel Oak and St Pancras and Somers Town.
Overlaying this with predicted population increases highlights the key
areas that the estates strategy needs to focus on.
Camden is expected to see significant increases in its population in
the near future derived from the attractiveness of the borough and a
number of large-scale residential and commercial developments. For
example, developments such as the Euston area regeneration and
integration with High Speed 2, and the Kings Cross development
will greatly improve travel and create substantial new public and
residential spaces. At the same time, estimated migration inflow and
outflow will bring a net additional 3,500 people to the borough, with a
sizeable proportion of this movement coming from the annual
transfer of students to / from Camden, both internationally and within
the UK.
In total, residential developments and organic growth in the borough
are estimated to increase the population by 6% by 2028. Increases
in residential spaces will be concentrated in particular around the
St Pancras and Somers Town, Regent’s Park, West Hampstead and
Holborn and Covent Garden wards. Healthcare services in these
areas will be affected not only by residential developments but also
by commercial and office space which will increase the population
density overall.
Projected GP list size figures show a similar growth to 2028,
averaging a 1.18% increase each year. These figures put Camden’s
GP-registered population in 2015 at 260,149 meaning that in 2018 it
will grow to 269,494 and in 2028 it will be approximately 303,139.
Increase in population density and residential and commercial
development areas are depicted on the map overleaf
Areas with the greatest deprivation and
density will need to have good access
to primary and community care
services.
Areas with the greatest deprivation and
Camden population predictions 2018-2028
Population Prediction
Camden Borough Ward 2018 2028 Change
St. Pancras and Somers Town 12,821 14,536 13%
Regent's Park 11,885 13,308 12%
West Hampstead 14,500 16,111 11%
Holborn and Covent Garden 11,792 12,583 7%
Bloomsbury 12,350 13,050 6%
Camden Town with Primrose Hill 11,333 11,958 6%
Hampstead Town 4,700 4,960 6%
Highgate 3,594 3,797 6%
King's Cross 21,833 22,917 5%
Haverstock 18,714 19,643 5%
Kilburn 18,286 19,214 5%
Gospel Oak 16,929 17,857 5%
Belsize 16,438 17,250 5%
Cantelowes 16,000 16,813 5%
Kentish Town 14,300 15,000 5%
Fortune Green 12,500 13,150 5%
Swiss Cottage 10,500 11,039 5%
Frognal and Fitzjohns 8,467 8,900 5%
Total 236,941 252,085 6%
Figures courtesy of Greater London Authority
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Population Density and Development Areas
3,796.9 - 10,610.8
10,610.9 - 13,110.0
13,110.1 - 15,444.4
15,444.5 - 18,128.5
18,128.6 - 22,916.7
Significant growth areas in Camden
are expected in Kilburn, Gospel Oak
and St Pancras and Somers Town.
Significant growth areas in Camden
are expected in Kilburn, Gospel Oak
and St Pancras and Somers Town.
The density map highlights three key
areas with above average increases in
population densities: Kilburn,
Gospel Oak and St Pancras and
Somers Town.
In and around these areas, there are
significant construction projects taking
place including the Kings Cross and
Euston developments, and housing
estate regeneration in Abbey Road /
West End Lane and Cherry Court.
The density map highlights three key
areas with above average increases in
population densities: Kilburn,
Gospel Oak and St Pancras and
Somers Town.
In and around these areas, there are
significant construction projects taking
place including the Kings Cross and
Euston developments, and housing
estate regeneration in Abbey Road /
West End Lane and Cherry Court.
St Pancras & Somers Town, Kings Cross, Holborn, Regents Park Substantial development underway in the Kings Cross area (1,700+ units inc. residential, commercial, etc.) Replacement homes for those displaced by HighSpeed2 are under construction in the Euston area (100+ residential units). Also under construction are the Agar Grove Estate development (493 residential units), Maiden Lane development (273 residential units), Camden St / Plender Street (10 new homes), Arthur Stanley House (office space plus 12 residential).
St Pancras & Somers Town, Kings Cross, Holborn, Regents Park Substantial development underway in the Kings Cross area (1,700+ units inc. residential, commercial, etc.).
Gospel Oak, Kentish Town & Camden Town Significant regeneration plans in place for Gospel Oak including Cherry Ct (Bacton Low Rise) (294 new homes), Barrington Court & Lamble St (5 new homes), Kiln Place Estate (15 new homes), Maitland Pk & Aspen Hse (115 new homes). Camden Town Morrisons development in planning stage (proposed 573 residential units, retail, etc.)
Gospel Oak, Kentish Town & Camden Town Significant regeneration plans in place for Gospel Oak including Cherry Ct (Bacton Low Rise) (294 new homes), Barrington Court & Lamble St (5 new homes), Kiln Place Estate (15 new homes), Maitland Pk & Aspen Hse (115 new homes). Camden Town Morrisons development in planning stage (proposed 573 residential units, retail, etc.)
Kilburn, West Hampstead & Swiss Cottage Redevelopment of Belsize Priory Health Centre expected, Abbey Area regeneration underway (241 new homes, etc.), also underway is West End Lane and associated developments (290+ residential units, retail, etc.)
Kilburn, West Hampstead & Swiss Cottage Redevelopment of Belsize Priory Health Centre expected, Abbey Area regeneration underway (241 new homes, etc.), also underway is West End Lane and associated developments (290+ residential units, retail, etc.)
Population predictions courtesy of the Greater London Authority
Population predictions courtesy of the Greater London Authority
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
Population density (persons per sq.km) predictions at 2028
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Healthcare Estate in Camden
Healthcare delivery is spread widely
across Camden and represents what can
at times be a fragmented system.
Healthcare delivery is spread widely
across Camden and represents what can
at times be a fragmented system.
RNTNE
RNTNE
RNTNE
RNTNE
RNTNE
RNTNE
RNTNE
RNTNE
Map data © 2017 Google
Belsize Priory Health Centre
Tavistock & Portman
Foundation Trust
Royal Free
London Hospital
St Albans Health Centre
Gospel Oak
Health Centre Peckwater Health Centre
Kentish Town Health Centre
Camden & Islington Foundation Trust
Crowndale Health Centre
University College
London Hospital
Hunter Street Health Centre
Great Ormond Street Hospital
Summary of Some of the Main Healthcare Delivery Sites in Camden
Healthcare services in Camden are delivered
by a range of public, private and voluntary
organisations across hundreds of locations
including in GP surgeries, hospitals, dentists,
care homes, as well as within patients’
homes.
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Acute and urgent care services in the borough are delivered from
two main hospital locations: the Royal Free London NHS
Foundation Trust (RFL), and University College London NHS
Foundation Trust (UCLH). Also in the borough is a specialist
provider of children’s services, Great Ormond Street Hospital.
Adjacent to Camden is the Whittington Hospital which is also a
provider of community services for Camden.
A significant amount of out of hospital care in Camden is provided by
Central & North West London NHS Foundation Trust (CNWL),
who deliver services from a variety of locations across the borough.
The largest providers of mental health services in the borough are
Camden & Islington NHS Foundation Trust (C&IFT) and
Tavistock and Portman NHS Foundation Trust. Also in the
borough is St Pancras Hospital, from which a variety of mental
health, community and older peoples’ services are delivered as well
as being home to a GP practice.
Camden CCG also rents a significant part of Stephenson House
which houses the CCG’s and CNWL’s head offices, and the South
Camden Centre for Health. This building is due to be vacated in
late 2018 as the freeholder has exercised their right to take back the
premises at lease end.
Estate ownership lies with providers themselves or in some cases
with NHS Property Services or Community Health Partnerships.
These two organisations now work together jointly to deliver estates
and facilities management.
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Primary Care Estate
Camden has thirty-four GP practices
operating from a variety of locations across the
borough, including health centres, converted
domestic premises, and purpose-built
premises. Access to primary care across the
borough varies with practices offering different
opening hours throughout the week. Extended
GP appointments are offered at the Somers
Town Medical Centre, Hampstead Group
Practice and West Hampstead Medical
Centre.
The map shows how the GP practices are
spread out geographically across the borough.
Also highlighted are the ‘neighbourhoods’
which are groupings of practices which have
elected to work together to deliver enhanced
services.
Map data © 2017 Google
Where Do We Want to
Be?Map data © 2017 Google
CHE(W)
Neighbourhood
CHE(W)
Neighbourhood
CHE(W)
Neighbourhood
CHE(W)
Neighbourhood
CHE (W)
Neighbourhood
CHE (W)
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
Neighbourhood
NW3
NW5 Neighbourhood
NW5 Neighbourhood
NW5 Neighbourhood
NW5 Neighbourhood
NW5 Neighbourhood
NW5 Neighbourhood
NW5 Neighbourhood
CHE(S)
Neighbourhood
CHE(S)
Neighbourhood
South
Neighbourhood
South
Neighbourhood
South
GP Practices in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
Summary of Some of the Main Healthcare Delivery Sites in Camden
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Most of the primary care estate (82%) is leasehold with costs for
rent, rates and facilities management paid for by the CCG at an
annual cost of £5.7m. Leasehold properties can offer tenants
flexibility in terms of tenure; though at the same time they require
forward planning which takes into account lease expiry dates and the
risk that rent, for example, can be reviewed and increased
(sometimes significantly) at lease renewal.
The overall condition of the estate is currently reasonable, though it
should be expected that this could change within the next five years.
There is no rolling estates improvement plan and owing to the
financial pressures the CCG is facing, there are currently limited
options to increase the existing estates budget.
Most of the premises in Camden have little or no development
potential and some practices have less than the recommended
number of clinical rooms for their list size. Some spaces are also
operating at sub-optimal levels of space utilisation, which means that
for periods of time, rooms are left empty. The last capacity review
was carried out in 2016.
Partner Development Plans
Taking into account the estates plans of partner healthcare
organisations, the general trend is towards realising estates
efficiencies through consolidation and rationalisation.
RFL, for example, has signalled its intention to improve estate
efficiency across all of its sites. The Trust is looking to consolidate
clinical and research activity on main hospital sites while relocating
non-clinical activities offsite. Its main development activities will
concentrate around the rebuild of the Chase Farm Hospital site,
which is expected to open in 2018.
UCLH is currently well into a multi-phase redevelopment of its sites
centring around the Euston Road area. The key priorities for the
Trust include the redevelopment of its emergency department on
Euston Road. Neuroscience services are to be unified and collocated
at the Queens Square site. For cancer services, a substantial new
facility on Tottenham Court Road is well into its build to provide a
proton beam service, day surgery theatres and specialist cancer
beds, due for delivery in 2018. The Trust is also looking to expand its
women’s health provision by expanding its existing infrastructure to
support more births each year. More generally, the Trust will be
looking at the collocation of services and partnership-working to
ensure patients are treated when possible away from the hospital
environment.
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CNWL occupies several sites in Camden and across London. The
Trust is currently conducting a review and rationalisation of its entire
estate to improve quality, patient experience and ensuring buildings
are fully utilised. In Camden, the Trust is in particular looking to work
with partners on the redevelopment of the Belsize Priory Health
Centre.
Camden & Islington NHS Foundation Trust occupies several sites
across Camden, with St Pancras Hospital representing nearly half of
the Trust’s entire portfolio; the next largest site being Highgate
Mental Health Centre. The Trust’s aims are to redevelop the
St Pancras Hospital site, for which work is expected to begin within
the next five years. There will also be a work programme to
consolidate estate elsewhere in order to provide services more
efficiently from a smaller number of buildings. Meanwhile the Trust is
due to dispose of two surplus freeholds at Tottenham Mews and
Hanley Road.
The London Borough of Camden Local Authority (LBC) has an
ambitious set of ‘place plans’ in seven key wards of West
Hampstead, Gospel Oak, Kentish Town, Camden Town, Euston,
Kings Cross and St Giles Holborn. These, coupled with estate
regeneration projects, mean that hundreds of new homes are being
created across the borough in areas such as Abbey Road / Belsize
Road, West End Lane, Gospel Oak, Maitland Park, Kings Cross and
Maiden Lane.
Sustainability & Transformation Plan
The North London Partner’s Sustainability and Transformation Plan
has a workstream which focuses on estates development. A key
objective of which is to enable the delivery of a range of
transformation projects. The work also includes ensuring that the
local estate is fit for purpose, promotes integrated working and meets
accessibility requirements. A particular focus will be on optimising
the use and costs of estate.
While recognising that there is a limited availability of NHS capital
funding, the work also pulls together stakeholders from across the
STP to enable partnership working between commissioners and
providers to support the delivery of devolved estates powers. The
work will also deliver a review of opportunities to reduce facilities
management costs, utilisation improvement plans, establish a shared
robust asset base, and drive out void space costs through
collaboration.
London Partners
In 2015, all the CCGs in London came together as the London
Partners and signed the London Health and Care Collaboration
Agreement. This innovative joint working initiative contains five
‘devolution pilots’: Prevention in Haringey, Integration in Hackney,
Integration in Lewisham, Integration across Barking, Dagenham,
Havering and Redbridge, and Estates in North Central London. The
North Central London estates pilot aims to make better use of
healthcare buildings and land. All of the pilots are currently
developing business cases to explore how devolution may support
their work to go further and faster.
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Camden CCG Vision
Camden CCG has eight strategic objectives:
Commission the delivery of NHS constitutional rights and
pledges
Improve the quality and safety of commissioned services
Improve health outcomes, address inequalities and achieve
parity of esteem
Integrate and enable local services to deliver the right care in
the right setting at the right time
Work jointly with the people and patients of Camden to shape
the services we commission
Involve member practices and commissioning partners in key
commissioning decisions
Maintain financial stability and ensure sustainability through
robust planning and commissioning of value-for-money
services
Build a high performing organisation that attracts, develops and
retains a skilled and motivated workforce
The estates strategy aligns to these and will contribute to the
organisation meeting its objectives by ensuring that integrated
services can be delivered in the right setting at the right time.
Local Care Strategy
Camden CCG has also set out its plan to address the challenges
outlined in the Five Year Forward View (the health and wellbeing
gap, the care and quality gap and the funding gap) in its Local Care
Strategy. The strategy sets out how the CCG will work with local
people and partners across health and care to transform the local
healthcare system and is aligned with the STP and the Camden-level
priorities. The aim of the strategy is to deliver care that is accessible,
person-centred, coordinated, preventative and effective.
In particular, the strategy sets out a vision whereby:
The strategy also identifies that more care will be delivered in the
primary and community setting, including more specialist services
as well as promoting the use of multi-disciplinary teams.
The estates strategy aligns to this by ensuring that the estate has
capacity for the future and provides facilities which enable multi-
disciplinary working.
Health and care services will work together with local
people to provide coordinated, proactive, accessible,
good quality care in order to improve the health and
wellbeing of people in Camden.
Where Do We Want to Be?
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Key Issues for Estates Management
The population in Camden is due to increase, with some wards
seeing significant increases. The Local Care Strategy identifies
particular areas of deprivation and inequalities in the borough, and
calls for more care to be delivered in the community and an increase
in multi-disciplinary working.
In terms of financial sustainability, there are significant challenges
across the NHS in the UK while demand for healthcare services is
increasing. A significant number of GP premises leases are due to
expire in the next five years, with leases all expiring on different
timelines.
For estate sustainability, there is no estates improvement
programme, which could pose a risk to the ongoing suitability of the
existing estate and its ability to cope while more services are
expected to be delivered in an out of hospital setting. Primary care is
also beginning to move away from the traditional model of having an
independent GP practice working in isolation, towards a more
collaborative model.
The Carter Review and the Naylor Review have also set out estate
efficiencies for acute providers, recommending a reduction in the
number of sites, increasing collocation of services and being
‘smarter’ with energy management.
Addressing the Issues
To respond to these issues, we need to:
Prepare for demographic changes, with a particular focus on
the ‘hotspot’ areas. At the same time, start to use simulation
models, such as Simul8, to understand the impact that changes
in one part of the healthcare system could have elsewhere.
Explore options for reducing estate costs.
Start identifying spaces which may not be well-utilised, and
explore options for increasing efficiency. At the same time, we
should identify spaces where utilisation may be too high and
may be limiting future expansion.
Instigate a regular appraisal of the estate in order to identify
key issues affecting functionality and capacity.
Regularly assess any changes in the environment in order to
identify and schedule timely estate responses.
Take a proactive approach to lease renewals and begin to align
expiry dates.
Explore moving away from fixed-use spaces towards more
flexible ones to facilitate multi-disciplinary working.
Work jointly with our partners to identify opportunities for the
collocation of services, identifying efficiencies, and accessing
affordable premises.
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Objectives
In order to meet the local challenges, the objectives of the estates
strategy are to ensure that:
This means that in planning the management of the estates portfolio
for the future, not only should spaces be cost-effective and fit for
purpose but there should be more collocation of services, from sites
which offer opportunities for service growth.
Estate Appraisal
In order to identify pressures and opportunities in estate
management in Camden, a clear set of decision-making criteria will
give us a framework for appraising buildings in terms of function,
finance and sustainability. The criteria below sets out the key
questions for the objective appraisal of the estate.
At the same time, commissioner considerations will focus on service
quality, viability, future service models and health inequalities.
Estate developments are
commissioner-led
Spaces are fit for purpose
Spaces are well-used
Spaces represent value for money
The estate has capacity for the future
Spaces are flexible and appropriate for
multi-disciplinary working
Can change be made at net zero cost?
Is space utilisation greater than 90%?
Is space utilisation less than 60%?
How far away is the nearest neighbour?
How flexible is the space?
Does the space offer the potential to meet extra demand?
How does the space fit with the Local Care Strategy?
Does the space meet accessibility requirements and offer
good access via local transport?
Does the condition of the space require major repair or
replacement?
Does the space offer value for money?
Is the space’s total cost per patient in the highest (fourth)
quartile when ranked against all Camden practices?
How Will We Get There?
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Partnership Working
A key facet for successful estates planning and management is
partnership working. Providers and commissioners do not work alone
and are increasingly working collaboratively to improve the local
healthcare provision.
We recognise that although it is the primary care estate which comes
under the direct responsibility of the CCG, the organisation does not
work in isolation and so needs to work jointly with partners to explore
and develop opportunities for estates development. This means
working more closely with our partners such as UCLH, CNWL,
C&IFT, LBC, and other CCGs, for example, to identify opportunities.
These stakeholders are already members of the Camden Premises
Steering Group which acts as a forum for partnership working.
Funding Opportunities
NHS England recently set up the Estates and Technology
Transformation Fund (ETTF) which made available a multi-million
pound investment fund for commissioners to access in order to
improve general practice facilities between 2015/16 and 2019/20.
Camden CCG submitted several recommendations for funding.
Owing to the limited amount of funding available, an NCL process
was followed in order to identify which schemes to prioritise. None of
Camden’s schemes were allocated funding, however there may be
opportunities to bid for funding again in the future.
Environmental Sustainability
Camden CCG has a responsibility to recognise the impact its estate
has on the environment. The Climate Change Act 2008 set a target
for an eighty per cent reduction in carbon emissions by 2050. As
such, the CCG will aim to keep its carbon footprint as low as is
practically possible within the constraints so far set out. Initiatives
recommended by the Carter Review, such as installing LED lighting,
will be carried out where funding allows and partner healthcare
providers will be encouraged to be innovative in reducing their
environmental impact. Other initiatives which have the scope to
reduce the environmental impact of services will be explored such as
harnessing technology to, for example, reduce storage space for
records.
One Public Estate
The One Public Estate programme is a national programme
delivered in partnership by the Local Government Association (LGA)
and the Cabinet Office Government Property Unit (GPU).
It provides practical and technical support and funding to councils to
deliver ambitious property-focused programmes in collaboration with
central government and other public sector partners. There is also
the opportunity to become partners and access limited funding. NCL
has been successful in being invited to bid to become one of the new
partnerships which could unlock funding for new projects for the
future.
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Strengths, Weaknesses, Opportunities, Threats
In order to make a success of finding efficiencies, strengths need to
be maximised while threats are minimised. Key considerations are
summarised in the strengths, weaknesses, opportunities and threats
(SWOT) table below which highlights joint-working as a strength.
Collocating services and concentrating on increasing utilisation
presents an opportunity for making the estate more efficient. At the
same time, there is a severe shortage of affordable estate in
Camden which makes it more important to be able to work together
with partners to find options for the future.
Efficiency means reducing the cost of the estate and may also mean
rationalising the estate so that there are fewer buildings. This does
not necessarily mean fewer GP practices or services. Instead it
allows for services to operate together out of more affordable and
more fit for purpose premises as much as possible.
The sections which follow summarise the key actions to meet the
strategic priorities, specific geographic priorities and the
implementation plan.
Strengths Weaknesses
Camden CCG is experienced in joint-working with its
estates providers and has strong links to other estates
holders.
There has been a lack of innovation in terms of estates
management in the most recent past.
Opportunities are limited to those which can be funded
within a limited envelope.
Opportunities Threats
Collocating services will enable better integration of
services and improve patient experience and access to
services.
Improving overall estate utilisation will reduce the
financial impact of the estate and free up funding to be
used elsewhere on the estate
Camden is an inner-London borough and as such has a
severe lack of affordable estate.
Security of tenure, lease expiries, and possible
redevelopment plans by landlords.
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Strategic Priorities
Ensure that estates developments are
commissioner-led
Ensure spaces are fit for purpose Ensure spaces are well-used
Care Closer to Home Integrated Networks
(CHINS) are being established to reduce the
health and wellbeing gap, and promote new
models of integrated care. We will work with the
strategies, aims and objectives of these
networks to inform any future estates planning.
Commissioning activities take place across the
CCG and are articulated in the annual
Commissioning Intentions. We will use these
plans to inform future estates planning.
In response to relevant strategies, aims and
objectives, we will develop solutions and
options for commissioner decision.
The condition of the existing estate reveals no
serious issues raised to date.
We will instigate a yearly cycle of review to
identify maintenance issues.
Any maintenance concerns will be costed and
approved via the CCG’s usual business case
route.
We will review premises’ utilisation rates.
Options will be generated for premises with
utilisations outside of the 60%-90% benchmark
in order to increase rates for commissioners to
decide upon.
Ensure that spaces represent value for money Ensure the system has capacity for the future Ensure spaces are flexible and appropriate for
multi-disciplinary working
Current premises costs reveal a north-south
divide in terms of premises costs per square
metre. Premises in the south of the borough are
at least twice the cost of those in the north.
Recognising the cost disparity, we will work with
local partners to source and access affordable
space.
Fully understand the void space liabilities.
A number of leases are known to have expired or
will be expiring in the next five years. We will
generate options appraisals for commissioners to
decide upon. Possible responses to expiring
leases could be: Renew, do not renew and
disperse the patient list, or do not renew and
relocate the service.
Using analysis of nearest neighbours, we will
ascertain whether the geographical spread is
efficient.
Where possible, new premises will be identified
which offer flexibility of use.
If necessary and where possible we will
attempt to modify existing estate to enable
flexible working.
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Area Priorities
West Camden
(CHE(W) neighbourhood)
Challenges
Population expected to increase by between
5% and 11% by 2028.
West End Lane and Abbey Road developments
will create hundreds of new residential units.
Area is within the top 10% most deprived in the
borough
Space utilisation appears to be running high.
Bids for national funding (ETTF) for
Brondesbury Medical Centre (development of a
branch surgery), Swiss Cottage Surgery
(premises expansion), and Belsize Priory
Health Centre (new build facility) have
previously been made. Funding has not been
allocated as the fund is over-subscribed.
Primrose Hill Surgery lease expires 2017, and
Belsize Priory Medical Practice lease expires
2018.
Responses
Prepare for population increases by ensuring
long-term capacity in the Kilburn area.
Develop business cases for the two premises
whose leases are expiring.
Confirm utilisation rates and explore options for
finding additional space within existing estate.
North Camden
(NW3 neighbourhood)
Challenges
Population generally healthy except around Gospel Oak /
Haverstock areas.
Population growth in line with average for the borough at 5%,
though it is still one of the most densely-populated areas.
Significant developments in and around Gospel Oak expected.
Daleham Gardens lease expires 2021, Rosslyn Hill has expired,
and Keats Group expires 2023.
A bid for national funding (ETTF) for Hampstead Group Practice
(premises expansion) has previously been made. Funding has not
been allocated as the fund is over-subscribed.
Responses
Prepare for population increase by ensuring long-term capacity in
the Gospel Oak area.
Many leases are expiring so this may present an opportunity to
consolidate the estate.
North Camden
(NW5 neighbourhood)
Challenges
Population growth in line with average for the borough at 5%.
Area of quite deprived population with several areas within 10%
most deprived.
Regents Park lease expiring (2021), and Parliament Hill lease has
expired.
Space utilisation appears to be below-optimal.
A bid for national funding (ETTF) for Queens Crescent Practice
(premises expansion) has previously been made. Funding has not
been allocated as the fund is over-subscribed.
Morrisons, Maiden Lane and Agar Grove developments will create
hundreds of new homes. The area is also affected by the Kings
Cross development.
Responses
Develop business cases for the two premises whose leases are
expiring.
Confirm utilisation rates and explore options for improving, such as
collocating services.
South Camden
(CHE(S) and South neighbourhoods)
Challenges
Population expected to increase around the
Kings Cross area. Significant in some wards
with St Pancras and Somers Town predicted to
be +13%.
Significant developments already happening in
and around the Kings Cross and Euston area.
Leases pose significant risks with Kings Cross
(2020), Somers Town (2023), Bloomsbury
(expired), Brunswick (2020), Gower Street
(2018), Museum (expired), Holborn (expired),
and St Philips (2020) all expiring in the next five
years.
Space utilisation appears to be running high
and clinical room capacity is limited.
Bids for national funding (ETTF) for Gower
Street Practice (premises relocation) and
Museum Practice (premises relocation) have
previously been made. Funding has not been
allocated as the fund is over-subscribed.
Lack of affordable space in the area at
approximately double £/m2 compared to the
north.
Responses
Prepare for the significant population increases
expected.
St Pancras Hospital site redevelopment is in
initial approvals stage. Work with the freeholder
from the ground-up to secure affordable
primary care facilities.
Develop business cases for lease renewals or
estate consolidation.
Confirm utilisation rates and explore options for
ways to release pressure within existing estate.
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19
Implementation Plan
2017/18 2018/19 2019/20 2020/21 2021/22
Evaluate the estate.
Using the results of the
evaluation, prioritise the needs
of the estate and recommend
solutions.
Review leases. Recommend
options for lease renewals.
Review the condition of
premises in order to instigate a
rolling programme of repairs.
Fully quantify void space costs.
Identify opportunities to increase
utilisation across the estate.
Identify opportunities to reduce
running costs such as installing
LED lighting and smart energy
management systems.
Set up the Camden Premises
Steering Group as a forum for
joint working with local providers.
Provide estates representation at
the Transformation Steering
Group, and Primary Care
Business as Usual Group.
Should the West Hampstead
development secure funding,
move to planning, engagement
and initial drawing stage.
Submit bids for funding for any
identified future estate
development or improvements.
Review leases. Recommend
options for lease renewals.
Move CCG head office out of
Stephenson House.
Reduce void costs.
Explore options for collocation
of services.
Rolling workplan of review,
prioritisation, planning and
implementation.
Review leases. Recommend
options for lease renewals.
Review estates strategy and
ensure alignment with CCG
priorities.
Monitor and reduce void costs.
Work jointly with C&IFT on the
redevelopment of the
St Pancras Hospital site.
Rolling workplan of review,
prioritisation, planning and
implementation.
Review leases. Recommend
options for lease renewals.
Monitor and reduce void costs.
Rolling workplan of review,
prioritisation, planning and
implementation.
Review leases. Recommend
options for lease renewals.
Update estates strategy.
Monitor and reduce void costs.
Developments under construction or
being delivered:
Chester Rd / Balmore Street,
Abbey Road, Maiden Lane,
156 West End Lane, Camden
Town Morrisons.
Leases expired or expiring:
Museum, Parliament Hill,
Bloomsbury, Rosslyn Hill,
Holborn, and Primrose Hill.
Developments under construction or
being delivered:
21-31 New Oxford Street.
Leases:
Stephenson House & South
Camden Centre for Health,
Belsize Priory, Gower Street.
Developments under construction or
being delivered:
Agar Grove, 30 Camden Street,
187-189 West End Lane,
Arthur Stanley House.
Leases:
None.
Developments under construction or
being delivered:
St Pancras Hospital.
Leases:
Kings Cross, Brunswick,
St Philips
Developments under construction or
being delivered:
Kings Cross final phases,
Midland Cresc. / Finchley Road.
Leases:
Regents Park, Daleham Gardens
(also Somers Town and Keats in
2023)
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20
Camden Clinical Commisisoning Group (September 2016) Camden Local Care
Strategy.
Camden Council, et al (October 2016) Camden’s Joint Strategic Needs
Assessment (JSNA) 2015/16: Executive Summary [online]. Available at
https://www.camden.gov.uk/ccm/cms-
service/stream/asset/?asset_id=3594447& (Accessed 22 September 2017)
Camden and Islington NHS Foundation Trust (April 2016) Operational Plan
Document for 2016-17 [online]. Available at
http://www.candi.nhs.uk/sites/default/files/Documents/Operational%20Plan
%20-%202016-17.pdf (Accessed 22 September 2017).
Care Quality Commission (no date) Regulation 15: Premises and equipment
[online]. Available at http://www.cqc.org.uk/guidance-providers/regulations-
enforcement/regulation-15-premises-equipment#full-regulation (Accessed
22 September 2017).
Care Quality Commission (2016) The state of health care and adult social care in
England 2015/16 [online]. Available at
http://www.cqc.org.uk/sites/default/files/20161019_stateofcare1516_web.pdf
(Accessed 22 September 2017).
Central and North West London NHS Foundation Trust (no date) Strategic Plan
Summary 2014-19 [online]. Available at http://www.cnwl.nhs.uk/wp-
content/uploads/CNWL_Strategic_Plan_2014-19.pdf (Accessed 22
September 2017).
Dayan, M., Arora, S., Rosen, R. & Curry, N. (2014) Is General Practice in Crisis?
[online]. Available at https://www.nuffieldtrust.org.uk/files/2017-01/general-
practice-in-crisis-web-final.pdf (Accessed 22 September 2017).
Department of Health (May 2012) Long Term Conditions Compendium of
Information; Third Edition [online]. Available at
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil
e/216528/dh_134486.pdf (Accessed 22 September 2017).
Department of Health (2013) Health Building Note 11-01; Facilities for primary and
community care services [online]. Available at
https://www.gov.uk/government/publications/guidance-for-facilities-for-
providing-primary-and-community-care-services (accessed 22 September
2017).
Institute of Health Equity (July 2017) Marmot Indicators 2017 - Institute of Health
Equity Briefing [online]. Available at
http://www.instituteofhealthequity.org/resources-reports/marmot-indicators-
2017-institute-of-health-equity-briefing (Accessed 22 September 2017).
NHS Digital (June 2017) Numbers of Patients Registered at a GP Practice – June
2017 [online]. Available at http://content.digital.nhs.uk/article/2021/Website-
Search?productid=25240&q=Number+of+Patients+Registered+at+a+GP+Pr
actice&sort=Relevance&size=10&page=1&area=both#top. Accessed
(22 September 2017)
NHS England (October 2014) Five Year Forward View [online]. Available at
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
(Accessed 22 September 2017)
North Central London Sustainability and Transformation Plan (June 2016)
Sustainability and transformation plan; Summary of progress to date
[online]. Available at
https://democracy.islington.gov.uk/documents/s8777/NCL%20STP%20Pres
entation.pdf (Accessed 22 September 2017)
North Central London Sustainability and Transformation Plan (December 2016)
North Central London Local Digital Roadmap [online]. Available at
References
88 of 291
21
http://www.candi.nhs.uk/sites/default/files/Documents/NCL%20LDR%20v%2
03.0_Final%20for%20Publication-2.pdf (Accessed 22 September 2017).
Office for National Statistics (November 2015) Life Expectancy at Birth and at Age
65 by Local Areas in England and Wales: 2012 to 2014 [online]. Available at
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmar
riages/lifeexpectancies/bulletins/lifeexpectancyatbirthandatage65bylocalarea
sinenglandandwales/2015-11-04#national-life-expectancy-at-birth
(Accessed 22 September 2017).
Public Health England (no date) Marmot Indicators for Local Authorities; Profiles
for London (2015); Camden [online]. Available at
https://fingertips.phe.org.uk/profile-group/marmot/profile/marmot-
indicators/area-search-results/E12000007?search_type=list-child-
areas&place_name=London (Accessed 22 September 2017).
Royal Free Hospital NHS Foundation Trust (April 2016) Operational Plan
Document for 2016/17 [online]. Available at http://s3-eu-west-
1.amazonaws.com/files.royalfree.nhs.uk/AboutUs/Publishable_summary_of
_operational_plan_2016-17_v1_0_18apr16.pdf (Accessed 22 September
2017).
University College London NHS Foundation Trust (January 2014) Strategic intent
summary document – UCLH [online]. Available at
https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ca
d=rja&uact=8&ved=0ahUKEwiw_cCvkdnWAhVBC8AKHeLXCyQQFggoMA
A&url=https%3A%2F%2Fwww.uclh.nhs.uk%2Faboutus%2Fwwd%2FAnnual
%2520reviews%2520plans%2520and%2520reports%2520archive%2FUCL
H%2520strategic%2520intent%2520summary%2520document%2520-
%2520October%25202014.pdf&usg=AOvVaw1u8HNOZq70a_sw8zkd9QFx
(Accessed 22 September 2017).
University College London NHS Foundation Trust (no date) University College
London Hospitals NHS Foundation Trust Members’ Event [online]. Available
at
https://www.uclh.nhs.uk/aboutus/FT/MembersMeet%20Past/UCLH%20priori
ties%202017.pdf (Accessed 22 September 2017).
For a summary of Camden’s population, its health, housing, etc., see:
Camden Council (August 2017) Camden Profile [online]. Available at
https://opendata.camden.gov.uk/download/9m7e-5qyt/application%2Fpdf
(Accessed 22 September 2017).
For information on practice size and performance, see:
Kelly, E. & Stoye, G. (2014) Does GP Practice Size Matter? GP Practice Size and
the Quality of Primary Care [online]. Available at
https://www.ifs.org.uk/uploads/publications/comms/R101.pdf (Accessed
22 September 2017)
For population density predictions, see:
London Datastore (no date) Ward Profiles and Atlas [online]. Available at
https://data.london.gov.uk/dataset/ward-profiles-and-atlas (Accessed
22 September 2017).
For GP registration calculations, see:
NHS England (no date) Calculation of CCG estimated registrations 2016-2020 –
NHS England [online]. Available at https://www.england.nhs.uk/wp-
content/uploads/2016/04/b-calculation-ccg-estmtd-reg.xlsx (Accessed
22 September 2017).
For life expectancy estimations, see:
Office for National Statistics (no date) Life expectancies [online]. Available at
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmar
riages/lifeexpectancies (Accessed 22 September 2017).
89 of 291
22
For changes in demographics, see:
Camden Council, Healthwatch Camden & Camden Clinical Commisisoning Group
(October 2016) Camden’s Joint Strategic Needs Assessment (JSNA)
2015/16; Executive Summary [online]. Available at
https://www.camden.gov.uk/ccm/cms-
service/stream/asset/?asset_id=3594447& (Accessed 22 September 2017).
For deprivation indices maps, see:
Camden Council (2015) Indices of Deprivation 2015 Maps [online]. Available at
https://opendata.camden.gov.uk/People-Places/Indices-Of-Deprivation-
2015-Maps/2nvh-fw2d (Accessed 22 September 2017).
For the coding of estate condition, see:
NHS Estates (2004) A risk-based methodology for establishing and managing
backlog. The Stationary Office, London.
For a full list of NHS Trust-owned properties, see:
NHS Digital (no date) Other NHS organisations [online]. Available at
https://digital.nhs.uk/organisation-data-service/data-downloads/other-nhs
(accessed 22 September 2017).
For a full list of Camden Council-owned properties, see:
Camden Council (no date) Local Authority Land Map [online]. Available at
https://opendata.camden.gov.uk/Your-Council/Local-Authority-Land-
Map/jcc6-q3nt/data (Accessed 22 September 2017).
For the estates efficiency reviews, see:
Lord Carter of Coles (February 2016) Operational productivity and performance in
English NHS acute hospitals: Unwarranted variations; An independent
report for the Department of Health by Lord Carter of Coles [online].
Available at
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil
e/499229/Operational_productivity_A.pdf (Accessed 22 September 2017).
Naylor, Sir Robert (March 2017) NHS Property and Estates; Why the estate
matters for patients; an independent report by Sir Robert Naylor for the
Secretary of State for Health [online]. Available at
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil
e/607725/Naylor_review.pdf (Accessed 22 September 2017)
For information on London Health and Care Devolution, see:
London Assembly (no date) Health and care devolution: Estates in North Central
London [online]. Available at https://www.london.gov.uk/what-we-
do/health/london-health-and-care-devolution/health-and-care-devolution-
estates-north-central (Accessed 22 September 2017).
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Camden 2017/18 Winter Plans Agenda Item 3.3
Date 25/10/2017
Lead Director Trevor Myers Tel/Email [email protected]
Report Author Annie Roys Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Dr Matthew Clark Tel/Email [email protected]
Report Summary
This paper provides the Governing Body with an update on preparations for winter 2017/18 in the context of:
a) national winter planning guidance and also b) plans submitted by the A&E Delivery Board for Camden in preparation
for the increase level of A&E attendances and non-elective admissions experienced over the winter months.
Purpose (tick one box
only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the paper and receive assurance on the winter plans approved by the Camden Accident and Emergency Care Delivery Board.
Strategic
Objectives Links
Commission the delivery of NHS constitutional rights and pledges Improve the quality and safety of commissioned services
Identified Risks
and Risk
Management
Actions
The winter plan seeks to mitigate the risk of impact to safe, high quality care during the winter period
Resource
Implications
Not applicable for the purpose of this report.
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
Not applicable for the purpose of this report.
Report History
The winter plans have been considered by the Camden Accident and Emergency Care Delivery Board and the integrated Commissioning Committee.
Next Steps
Oversight and monitoring of the winter plans.
Appendices
None
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1 Winter Plans: Camden Accident & Emergency Care Delivery Board
1. Executive Summary
The paper sets out the preparation that has been undertaken to ensure winter resilience across Camden. This includes the preparation of winter plans for the Camden Accident and Emergency Care Delivery Board to maximise hospital and community capacity at times of peak demand.
Given the sustained pressure on the Accident and Emergency waiting time standard during 2017
systems have been asked to:
Co-produce a winter plan to support winter resilience
Develop further contingency plans to manage periods of peak demand.
Alongside overall Accident and Emergency performance the litmus tests for effectiveness of CCG
and Social Care support with regulators will be:
The use of primary care hubs and redirection initiatives away from Accident and Emergency;
The reduction of delayed transfers of care and medically optimised patients to less than 5% of
acute hospital bed base;
Less than 15% of continuing healthcare (CHC) assessments being carried out in hospital beds
(85% carried out in the community).
The Governing Body is therefore asked to note:
The winter plan co-produced by the Camden Accident and Emergency Care Delivery Board
The additional contingencies it has identified that would support systems resilience in periods of
peak demand.
2. Context: Priorities for 2017/18
Guidance from NHS England and NHS Improvement, along with Department of Health and Department for Communities and Local Government, indicates the following priorities for the remainder of 2017/18:
Recovery of the A&E (95%) four-hour waiting time standard by March 2018, with performance over
the winter targeted to be the higher of 90% or performance in winter 2016/17 as part of recovery of
the standard by March 2018;
Extra hospital bed capacity by reducing delayed transfers of care
Reduction in delayed transfers of care (DTOCs)
Meeting financial targets.
The priorities are consistent with the priorities for 2017/18 set out in the refresh of the Five Year Forward View.
3. Camden: Winter Plan
The winter plan agreed by the Camden Accident and Emergency Delivery Board and submitted to NHS England and NHS Improvement in autumn 2017 is summarised below. Final feedback on winter plans, and the readiness checklist, is yet to be received. The plan will require updating for that feedback.
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2 Winter Plans: Camden Accident & Emergency Care Delivery Board
As part of the winter plan, interventions are focused in both community and hospital services to help manage winter pressures, particularly for:
Demand management and admission avoidance,
Flow within hospital units,
Effective discharge of patients back into the community / home to maintain hospital flow, and
Safety and quality of emergency care.
In addition member organisations/ representatives of the Accident and Emergency Delivery Board were asked to submit contingency plans with additional actions to assure winter resilience. Winter resilience monies sit within CCG baselines for use each year. CCGs, and local systems have augmented support for winter pressures, over and above systems resilience allocations in CCG baselines, through:
The Better Care Fund, including the improved Better Care Fund monies allocated to Social Care
in 2017/18;
Historic CCG investment in care outside hospital initiatives including primary care and integrated
care;
Investment in interventions from the Sustainability and Transformation Plan work streams for care
closer to home and urgent and emergency care.
Winter resilience planning and transformational service funding is targeted at University College London Hospitals (UCLH) and surrounding community and mental health services.
Initiative (and explanatory note for initiatives not yet rated green)
Milestone date
RAG rating based on
status from 1 Oct 17
Demand Management and admission avoidance
Primary care streaming through Primary Care @ Front Door service Oct 17
Rapids Response Service (RAPIDs) – in reach provision in emergency department. Explanatory note: Access arrangements currently being finalised.
Oct 17
Integrated Urgent Care – NHS 111 and GP out of hours - *567 facility transformed from pilot status. Threshold capacity for callers to speak directly to clinician.
Primary Care Access – 7 days 8:00 to 8:00 – new provider mobilisation Dec 17
Flow within hospital units
Urgent Treatment Centre – 40% of all attendances streamed directly to UTC
Nov 17
Clinical Navigator at ED streaming – increased care paths for Ambulatory Emergency Care
Nov 17
Additional consultant posts in place of middle grade doctors for increase consultant presence in ED.
UCLH Business case
Oct 17 Recruitment
Nov 17
Protocol for Plus One (Boarding) Explanatory note: Implementation being trialled and assessed at time of writing
Oct 17
Medical & Surgical bed realignment – medicine, surgery and cancer streamed – for improved flow across hospital and reduce delays for ED access to speciality. Explanatory note: Complex initiative with requirement to avoid consequential impacts on RTT and cancer waits.
Dec 17
Develop 48 hour model of care for Acute Medical Unit (AMU). Explanatory note: Date of implementation later than other initiatives. Despite this, need to ensure AMU operates efficiently prior to this.
Jan 18
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3 Winter Plans: Camden Accident & Emergency Care Delivery Board
Mental Health – Psychiatric liaison core 24 hr standard service. Explanatory note: Implementation arrangements being finalised
Nov 17
Clinical Coordination Centre – electronic patient and asset tracking system providing real time bed status. Explanatory note: Key initiative to ensure more efficient use of beds and flow. Will remain ‘amber’ until implemented and functional
Dec 17
Effective discharge of patients back into the community / home
Discharge to Assess (D2A) – operating across levels 1,2 and 3 Oct 17
Criteria Led Discharge – rolled out across acute medical beds Nov 17
Simplified Discharge – patient nurse tracker / trusted assessor to transition patients from acute care to intermediate / rehabilitation services. Explanatory note:
Oct 17
Stroke & neurology services – maintained capacity at St Pancras Hospital
Safety and quality of emergency care
Exemplar Ward Programme within UCLH which incorporates a broader range of matrixes than SAFER principles. SAFER patient flow bundle blends five elements of best practice for:
Senior Review
All patients
Flow
Early discharge
Review
Implemented and ongoing
CQC key elements of safety for:
Ambulance arrivals
First clinical assessment
Use of inappropriate physical spaces
Specialist referrals
Escalation
Deteriorating patients
Patient outcomes
Staff safety and wellbeing
Addressed and ongoing
The additional contingency plans developed, over and above initial winter plans, are summarised
below:
No. Further Support Trigger
1 Use of theatre recovery as a 23 hour stay area
1. Bed capacity does not meet expected elective and non- elective demand
2. Start of day with >5 patients awaiting beds within emergency floor
2 Utilisation of the Emergency Assessment Unit as additional majors capacity at times of unprecedented demand
Emergency department in black escalation and has 3 or more of these triggers: 1. >80 in department 2. Los >5 hours 3. >10 patients waiting for beds 4. >3 ambulance crews unable to offload in next
30 minutes
3 Mobilisation of transition ward space out of hours within UCH (endoscopy, day surgery, surgical or physiotherapy area)
The triggers for #1 have been met and there remains insufficient capacity for elective and non-elective demand
4 Open additional community bed capacity
Trust triggers OPEL level 3 or above and black escalation within Emergency Department
5 Commission additional in-reach Physiotherapy / Occupational Therapy community resource to support early discharge
Trust triggers OPEL level 3 or above and black escalation within Emergency Department
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4 Winter Plans: Camden Accident & Emergency Care Delivery Board
6 Relocation of primary care hub GP resource to work within Urgent Treatment Centre to release Emergency Department staff to Majors
Emergency department in black escalation and has 3 or more of these triggers, plus #2 has already been triggered: 1. >80 in department 2. Los >5 hours 3. >10 patients waiting for beds 4. >3 ambulance crews unable to offload in next
30 minutes
7 Cancel outpatient clinics and redeploy Consultant resource to support the emergency pathway through ward discharge or within the Emergency Department
Triggers #1, #2 and #3 have been met and emergency department in black escalation: 1. >80 in department 2. Los >5 hours 3. >10 patients waiting for beds 4. >3 ambulance crews unable to offload in next
30 minutes
8 Cancel elective activity, with the exception of urgent and cancel electives
Triggers for #1, #2, #3 and #7 have been met and there remains insufficient capacity for elective and non-elective demand
9 Redeployment of resource for increase support in Discharge to Assess (D2A) for DTOCs and external MOs in line with trajectory
1. If total DTOCs exceed current trajectory for UCLH at end of November
2. Bed occupancy above 95% by end of November
10 Consideration for exceptional out of borough placements for mental health patients. Decisions determined on case by case basis
All triggers have been met and defined mitigations are in place. There is an agreed understanding that there are no local bed options to support discharge
Conclusion
The above winter measures have been developed from the NHSE checklist completed in September that indicated our “readiness” for winter and the national “must do” initiatives to deliver the Accident and Emergency waiting time standard. Final feedback from NHSE is awaited on the Accident and Emergency Delivery Board’s plans. Preliminary discussions held in October 2017, suggest that there is a call for providers across NCL to increase the rate of progress on achieving ambulance handover times within 15 minutes and ensure all ambulatory care services within Trusts operate 14 hours a day, seven days a week. While many of the initiatives and programmes are timed to coincide with the beginning of winter, Governing Body members should note that Camden’s plans have been based on the introduction of good practice to absorb pressure throughout the year, with a view to managing demand sustainably. Escalation triggers and additional measures are reflected in this paper to deal with surges of demand as might occur during winter. Capacity modelling for community bed provision for health and adult social care has been completed. In addition, communication and co-ordination arrangements between providers and agencies to expedite flow across the system, based on learning from previous winters, are well-established.
6. Recommendations
The Governing Body is asked to note the winter plan and the escalations to manage surges in demand. _______________________________ Annie Roy Assistant Director Commissioning UEC 25 October 2017
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Camden Better Care Fund (BCF)
Agenda Item 3.4
Date 30/10/2017
Lead Director Richard Lewin Tel/Email [email protected]
Report Author Lucy Flaws Tel/Email [email protected]
GB Sponsor Dr Sarah Morgan Tel/Email [email protected]
Report Summary
The attached Better Care Fund (BCF) Narrative Plan sets out the joint priorities for BCF investment and the delivery plan for 2017-2019. The plan aims to support the delivery of the transformation and vision for health and care in the Local Care Strategy, and ensure continued improvement in service quality and performance Camden has developed a two-year plan building on our achievements in collaborative and integrated planning, commissioning and delivery. The Better Care Fund is investing in the local care strategy model of care, working collaboratively with our communities to improve health and wellbeing, delivering more out-of-hospital services in the community, clustering the workforce that supports residents with complex needs in neighbourhoods, consolidating a seamless approach to admissions avoidance, and continuing to improve discharges from hospital. The final narrative plan was submitted to NHS England in September, following the publication of the delayed national guidance. In accordance with the Governing Body delegation, it has been agreed by the Chair of the Integrated Commissioning Committee and its Vice Chair, the Executive Director for Supporting People, on behalf of the Local Authority. The Governing Body is asked to note the narrative plan (Appendix 1) and the proposed approach set out in this report to ensure Camden makes best use of the Better Care Fund in 2017-19.
Purpose (tick one
box only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to:
NOTE the BCF Narrative Plan
NOTE the process in place to review BCF schemes
Strategic
Objectives Links
The Better Care Fund investment schemes deliver the priorities of the Camden Local Care Strategy.
Identified Risks
and Risk
Management
Actions
N/A
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Conflicts of Interest
None identified.
Finance Content Please see Narrative Plan
Resource
Implications
In line with national requirements, the CCG minimum contribution of £18.048m should be uplifted by 1.79% for 2017/18 to £18.371m. In addition, there is the new recurring allocation of £0.778m Improved Better Care Fund (IBCF) and the non-recurring £5.814 million allocated this year (announced in the Spring Budget 2017). The CCG minimum spend on social care services (excluding the Disabled Facilities Grants and reserves) was set as £12.3m in 2016/17 and draft guidance indicates that that should also be uplifted by 1.79% in 2017/18 to £12.489m.
Engagement
All stakeholders are involved in the implementation and evaluation of BCF schemes throughout the year.
Report History
N/A
Next Steps N/A
Appendices
Appendix 1 – BCF Narrative Plan 2017-19
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1. BACKGROUND
1.1. In 2013, the Department of Health and the Department for Communities and Local Government, NHS
England and the Local Government Association announced the Better Care Fund. The programme
was designed to improve the quality and cost effectiveness of care for people whose needs are met
best when the different parts of the NHS and local authority services work together. The Fund requires
local health bodies and local authorities in each health and wellbeing board area to pool funding, and
produce and agree joint plans for integrated services and reducing demand for hospital services.
1.2. The Fund’s main aim is to drive transformation of local services to ensure that people receive better
and more integrated care and support. The Departments and NHS England sought to do this
principally by reducing demand for hospital services. Both local authorities and CCGs have been given
statutory incentives to consider and implement integration as a priority when planning, developing,
commissioning or delivering services. The Care Act 2014 states that local authorities must carry out
their statutory care and support responsibilities with the aim of promoting greater integration with NHS
and other health-related services. The Health & Social Care Act 2012 imposed a duty on Health &
Wellbeing Boards to encourage integrated working between commissioners of NHS, public health and
social services.
1.3. The Spring 2017 Budget announced additional funding via the Improved Better Care Fund (iBCF)
Grant (£6.59m for Camden in 2017/18). This is provided for the purposes of meeting adult social care
needs; reducing pressures on the NHS, including supporting more people to be discharged from
hospital when they are ready; and ensuring that the local social care provider market is supported.
1.4. There is a long history of partnership and joint commissioning between health and social care in
Camden. The BCF programme seeks to build on the firm foundations of existing integration with
ambitious plans to embed this still further. This is enshrined in the Section 75 agreement, in which
both organisations agreed to establish and maintain a pooled fund to drive closer integration between
and health and social care services and improve outcomes for patients, service users and carers.
2. NARRATIVE PLAN 2017-19
2.1 After considerable delay, the BCF planning requirements for 2017-19 were published on 4 July 17.
The planning requirements detail the conditions for the use of the Better Care Fund (BCF) and the
Improved Better Care Fund (iBCF) monies that local authorities and CCGs are required to describe
locally in a narrative plan. The narrative plan will detail our aims and evidence to support the delivery
of the transformation and vision for health and care in the Local Care Strategy, how we will meet the
four BCF national conditions (please see the attached narrative plan for full conditions), assess and
manage risk and ensure continued improvement in service quality and performance.
2.2 BCF plan approval in 2017 is also contingent upon the LA and CCG agreeing health and social care
related delayed transfers of care (DToC) reduction targets and a credible plan to deliver them with
the support of the local trusts. Camden has set an indicative expectation for DToC performance
consistent with the expectations set by Ministers and will continue to drive improvements in this
regard, as part of our plans to simplify discharge processes and implement the High Impact Change
Model in Camden.
2.3 The use of the Better Care Fund in Camden, as set out in the Narrative Plan, seeks to build upon
the shared history of innovative and collaborative working between the Council and the CCG. The
planning and delivery of Better Care Fund priorities will be orientated to the shared vision of health
and care set out in the Local Care Strategy. This includes:
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Supporting People at Home – delivering joined-up care closer to home. A shared approach to
out-of-hospital services integrating homecare, district nursing and reablement pathways. The
aim of this workstream of the Local Care Strategy is to develop services that prioritise individual
independence, resilience and self-care as the outcomes of care, with a view to reducing the
need for long-term support and the risk of hospital admission.
Supporting People in the Community – investing in prevention and supporting residents to
look after themselves. An asset-based approach with individuals, communities and the voluntary
and community sector to making best use of the resources (whether human, physical, emotional
or intellectual) in Camden, and harness them to improve and maintain the health and wellbeing
of residents.
2.4 The Narrative Plan is also closely aligned to Supporting People, Connecting Communities: the
Living and Ageing better in Camden Strategy and its vision for working with adults who may need
support, their carers and wider communities.
2.5 The attached Narrative Plan (Appendix 1) sets out the proposals in full and how they are aligned
with these priorities.
3. PLANNED REVIEWS OF BCF IN 2017/19
3.1 The Better Care Fund in Camden has had to change over time to align with the changing national
policy and conditions set by NHS England. Furthermore, original allocations of BCF incorporated
existing S256 pooled budgets (transferred funds from the CCG to Local Authority to enable the LA to
perform functions on its behalf) and transferred funds from the PCT, which otherwise did not meet
the criteria of the BCF or relate to delivery against the national metrics. As such, it represents a mix
of pre-existing and new integrated services. The aspiration in Camden is for all schemes to align to
the most recent national metrics and demonstrate impact against them. As such, a rapid review of
schemes took place in May 2017, to consider if further changes and improvements to the use of the
fund were needed.
Schemes were reviewed in order to consider:
- Their alignment with the four national metrics set out in the guidance, with further detail on their
impact on performance where possible,
- Duplication and consolidation –how schemes fit together and align with the wider context of
service provision,
- Greater detail about activity measures against schemes in a more accessible format, including analysis of value for money and benchmarking,
- This analysis was undertaken whilst maintaining sight of the overall aims of the STP, Local Care Strategy and the resultant plans for transformation locally.
It was found that BCF schemes fell within three categories:
- Category 1: These schemes align to the metrics, have no pending reviews and it was recommended that they are approved by the Integrated Commissioning Committee (ICC),
- Category 2: These schemes align to the national metrics but they are part of wider strategic reviews in relation to ongoing work to strengthen admissions avoidance, discharge processes and the Supporting People in the Community Programme.
- Category 3: Schemes, which from a review of available data and evidence, appear not to closely align to the national metrics/provide value for money/demonstrate strong performance or have any data available. As such, two schemes (Safeguarding training and AT Telehealth) will no longer be funded via the BCF and alternative schemes have been recommended.
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3.2 Given this aspiration and the financial pressures facing the CCG and Local Authority, schemes
funded by the Better Care Fund are being further reviewed in 2017/18 to ensure they are having the
required impact on the national metrics and are adding value in regard to health and care
integration. Reviews for BCF schemes within category 2 will be accelerated to ensure that these
resources enable our ability to deliver an ambitious improvement trajectory for delayed transfers of
care in 2017/18 and 2018/19.
4. FINANCIAL MOVEMENTS FOR 2017/18
4.1 Use of Revenue Reserves
4.1.1 Savings realised during 2016/17 when added to the unapplied reserve carried forward from
2015/16, resulted in a 2016/17 year end reserve of £1.450m. This has been apportioned on a non-
recurrent basis as shown in table 1 below.
Use of Revenue Reserves
2017/19
£m
Reserves as at 1 April 2017
1.450
Community Geriatrician (2017/18) 0.122
Nurse Tracker (2017/18) 0.026
CCG funded hospital team (2017/19) 0.288
Social Care spend requirement (2017/18) 0.221
Age UK Dementia Contract (2017/18) Total planned draw down 2017/19
0.120 0.777
Remaining reserve to be used on CCG schemes
0.673
4.2 Scheme and expenditure movement 2017/18
4.2.1 Several schemes planned for 2016/17 were not viable and did not start and the rapid review in
May 2017 of schemes of 2016/17 investments* has resulted in the below summary of scheme and
expenditure movement for 2017/18.
Health schemes
Planned but removed from BCF* in 2016/17 Replacement for 2017/18
Scheme name Change in £000s Scheme name
Change in £000s
Assistive Technology - Medication -121 District Nursing 1,210
Assistive technology - Tele Health -61
Community Clinic for Ambulatory Patients -46
Frailty Programmed Customer Engagement -25
Nursing Homecare training -31
Social Care schemes
Planned but removed from BCF* in 2016/17 Replacement for 2017/18
Scheme name Change in £000s Scheme name
Change in £000s
Access to health worker -44 Integrated Locality teams 207
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Assistive Technology Programme -50 Social Work Virtual Reablement Team 160
Care Act -510
Nursing Homecare training -19
Safeguarding Training -86
Primary Care schemes
Planned but removed from BCF* in 2016/17 Replacement for 2017/18
Scheme name Change in £000s Scheme name
Change in £000s
Additional GP appointments 250 GP Carehome LES 260
4.3 Financial agreement between CCG and LA
4.3.1 An agreement was reached in September 2017 between the CCG and LA regarding maintaining
social care spend in real terms for 2017/18 and funding for plans to simplify discharge processes
and implement the High Impact Change Model in Camden.
4.3.2 This agreement covered the use of £290k unallocated recurrent BCF funding and £221k (as
above) of reserve funding for social care purposes, with the remaining £673k of reserve for CCG
use in 2017/18.
4.3.3 It also states that the savings related to decommissioning the step down beds as part of the
simplifying discharge processes plan will be attributed to the CCG, with the cost of investment to
support this plan and admission avoidance plans to be found from further efficiencies from within the
health portion of the minimum “social care spend” category of the BCF for 17/18 and 18/19.
4.4 Further savings
4.4.1 In reality, this means the reviews of current BCF schemes will need to release funding in year
and next year to cover the planned investment. The BCF has already realised £2.016m of QIPP
savings in 2017/18 out of a planned £2.777m. Work is currently ongoing to realise further savings
and to date a possible £345k has been identified for 2018/19.
5. Delayed Transfers of Care (DToC)
5.1 Included alongside the nationally published BCF planning guidance in July 2017, was the
requirement to submit jointly agreed BCF DToC metrics for 2017-18 and 2018-19 to the Better
Care Support Team. The wording around this expectation was fairly constrictive as it stated:
“BCF plans will only be approved if the relevant LA and CCG(s) have agreed health and
social care related delayed transfers of care reduction targets and a credible plan to
deliver them having consulted with the relevant local trust(s). These reductions need to be
consistent with the expectations set by Ministers, but if local NHS and authority partners
consider that the indicative split for their area is not appropriate, they may agree a
different split. The IBCF funding can be spent as soon as the LA and CCG(s) agree.”
5.2 It was also announced that Government would consider a review, in November, of 2018/19
allocations of the adult social care funding provided at Spring Budget 2017 for councils that are
poorly performing. Please note that Camden recently received a letter advising that at present,
we are not subject to this review.
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5.3 Governing Body members should note that the shift in focus, late in the process, to prioritising
delayed transfers of care and the threat of a review of funding allocations if associated targets are
not met, has been deemed unacceptable by the LGA, who now feel that councils cannot have
confidence to plan for the long-term. They have consequently withdrawn their support for the
published BCF requirements.
5.4 The target setting process was problematic as different expectations were set by NHSE and DoH.
However, it was eventually aligned and Camden’s targets are for the CCG to reduce NHS
attributable delays to 7.59 average daily days delayed (using the 2016 ONS population figure
used to calculate the ASC rate this equates to 3.8 daily days delayed per 100,000 pop.) and the
local authority to reduce ASC attributable delays to 1.9 days delayed per day per 100,000 pop
(appendix B), giving a combined total of 5.7 days delayed per day per 100,000 pop.
5.5 These targets are challenging to achieve. They were set on a baseline of performance in
February 2017, which was a month of particularly strong performance in Camden. Had, for
example, the ASC delay rate in March of 3.1 days delayed per day per 100,000 been used as a
baseline instead of February, ASC would have been required to meet the substantially higher
national target of 2.6, rather the February rate of 1.9. Camden’s most recent data for August 17,
shows bed days delayed due to SC at 4.3 days delayed per day per 100,000 - almost double the
2.2 days delayed per day per 100,000 at the same point last year. This is due to delays in setting
up double handed care packages, nursing placement delays and MH assessment delays. Delays
attributable to the NHS are around the target for August 17 at 3.9 days delayed per day per
100,000, giving a total of 8.2 days delayed per day per 100,000.
5.6 Activity to improve performance includes the work underway to implement the High Impact
Change Model to reduce delays - for example, we have introduced a live DToC reporting
dashboard to flag delay areas. We are also running a discharge to assess pilot and are reviewing
non-acute bedded provision to design a non-medical service model. We have also recently
started holding twice-weekly funding decision panels and can now make urgent out of panel
decisions. Despite significant improvements to practice, we are currently not on track to achieve
the DToC targets set by national government.
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Better Care Fund
Narrative Plan
Camden Health & Well Being Board
2017/19
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CONTENTS
SUMMARY OF PLAN 3 INTRODUCTION
5
VISION FOR HEALTH AND CARE INTEGRATION
6
THE BETTER CARE FUND’S ROLE IN DELIVERING CAMDEN’S VISION
11
THE BCF JOURNEY 2016/17
18
NATIONAL METRICS 21 MEETING THE NATIONAL CONDITIONS
25
FINANCIAL PLAN
30
RISK MANAGEMENT
33
APPENDIX 1 PERFORMANCE LOGIC MODEL
35
APPENDIX 2 HIGH IMPACT CHANGE IMPLEMENTATION PLAN
37
APPENDIX 3 CORPORATE RISK LOG
47
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SUMMARY OF PLAN
Local Authority Camden Council
Clinical Commissioning Group Camden Clinical Commissioning Group
Boundary Differences The Local Authority and the CCG have
coterminous boundaries.
Date agreed at Health and Well-Being
Board:
Delegated authority to sign off the
Camden BCF Plan was passed to the
Chair and Vice Chair of the Integrated
Commissioning Committee, Dr Matthew
Clark and Martin Pratt
Date submitted:
Minimum required value of BCF
pooled budget: 2015/16
£19.314m
2016/17 £18.826m
2017/18 £25.756m
Authorisation and Sign off
Signed on behalf of the Clinical
Commissioning Group
NHS Camden Clinical Commissioning
Group
By
Dr Neel Gupta
Position Chair of the Governing Body
Date 13/09/2017
Signed on behalf of the Council Camden Council
By
Martin Pratt
Position Executive Director Supporting People
Date 13/09/2017
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Signed on behalf of the Health and
Wellbeing Board delegated to the
Integrated Commissioning
Committee Chair and Vice Chair Health and Wellbeing Board
By
Dr Matthew Clark and Martin Pratt
Position Chair and Vice Chair of ICC
Date 13/09/2017
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1. INTRODUCTION
In 2013, the Department of Health and the Department for Communities and Local
Government, NHS England and the Local Government Association announced the
Better Care Fund. The programme was designed to improve the quality and cost
effectiveness of care for people whose needs are met best when the different parts of
the NHS and local authority services work together. The Fund requires local health
bodies and local authorities in each health and wellbeing board area to pool funding,
and produce and agree joint plans for integrated services and reducing demand for
hospital services.
The Fund’s main aim is to drive transformation of local services to ensure that people
receive better and more integrated care and support. The Departments and NHS
England sought to do this principally by reducing demand for hospital services. Both
local authorities and CCGs have been given statutory incentives to consider and
implement integration as a priority when planning, developing, commissioning or
delivering services. The Care Act 2014 states that local authorities must carry out their
statutory care and support responsibilities with the aim of promoting greater integration
with NHS and other health-related services. The Health & Social Care Act 2012
imposed a duty on Health & Wellbeing Boards to encourage integrated working
between commissioners of NHS, public health and social services.
Camden’s plans for BCF were developed jointly between the local authority and the
CCG and submitted in September 2014. This now represents the third year of the BCF
and the Camden Narrative Plan outlines the local BCF journey and key issues and
deliverables for the period 2017-19. The aim of the BCF locally is to build on the
progress made over the previous years of the programme, while addressing some of
the challenges currently facing social care and health and ensuring alignment to the
Sustainability and Transformation Plan (STP), Local Care Strategy and plans for
transformation in regard to adult social care.
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2. CAMDEN VISION FOR INTEGRATION Health Inequality in Camden Camden is a borough of diversity and complexity. While health outcomes in some areas are better than average, there remain significant inequalities that need to be addressed. In addition to this as a health and care economy, we are facing increasing demand due to demographic changes, alongside decreased resources. The key challenges for Camden are three fold:
2.1 . Health and Wellbeing Gap
Camden has a diverse and highly mobile population with people from a range of Black and Minority Ethnic (BME) groups. These groups have differing health needs and health risks. Many do not have English as their main language, which creates challenges for the effective delivery of health and care services, whilst the mobility of our population has a significant impact on access to services and delivery.
Poverty is a crucial determinant of health, and is widespread among both adults and children living in the boroughs that make up North Central London (NCL). Significant inequalities exist, which need to be addressed. For example, men in the most deprived areas of Camden live on average 10 years fewer than those in the least deprived areas.
We face challenges in addressing other wider determinants of health. For example:
• There are high levels of homelessness and households in temporary housing with Camden in the top 10% of boroughs for number of households in temporary accommodation.
• 10% of adults registered with a Camden GP are obese and a further 21% are overweight – that’s equivalent to around 63,000 adults in the borough who are overweight or obese. Around two thirds of those with a chronic illness are overweight or obese.
• A quarter of Camden residents who drink are thought to do so at a level likely to put them at increased or high risk of harm. Camden experiences a higher than average rate of alcohol-specific hospital admissions and alcohol misuse is a significant contributor to health inequalities within the borough.
People living in Camden have higher than average life expectancy, but are ranked lower on healthy life expectancy. The improvements seen over the past few years in life expectancy have not benefitted all equally and now Camden has some of the highest gaps in life expectancy related to inequality.
Although many of our residents are healthy and people are living for longer, good health does not always persist into old age. Our older people are living the last 20 years of their life in worse health than the England average.
Increasingly residents have at least one lifestyle-related clinical problem (e.g. high blood pressure) that is putting their health at risk. However, they have not yet
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developed a long term health condition. Many of these lifestyle-related clinical problems are risk factors for NCL’s biggest killers - circulatory diseases and cancer. These diseases are also the biggest contributors to the differences which exist in life expectancy.
There are high rates of mental illness amongst both adults and children and many conditions go undiagnosed. In NCL 50% of all mental illness in adults begins before 14 years of age and 75% by 18. Children with mothers with mental ill health are much more likely to develop mental health issues themselves. A strong focus on mental health is central to our approach with a clear aim of treating mental and physical ill health in a joined up way and with “parity of esteem.”
2.2. Finance and Resource Gap
Our population is growing and demand is rising: people access health care more often, and are living longer, but often with one or more long term conditions. Meanwhile, costs are rising. The upshot of this is that not only is the system responding to greater demand, but also that the sum cost of activity is growing faster than allocations.
Estimates suggest that there will be a 6-7% increase in demand for services between now and 2020/21, and that without significant transformation and a whole system approach there will be a recurrent financial gap in excess of £100m across commissioning budgets.
There are significant savings targets across health and local authority budgets over the next 5 years. The QIPP target for the CCG is approximately 6%, which equates to £23 million for 2017/18.
2017/18 represent the third year of the Council’s Medium-Term Financial Strategy (MTFS), a three year programme to deliver a budget reduction of £78m. It is anticipated that adult social care will deliver £13.52m of budget reductions by 2017/18. Set against the original £16.2m programme, there remains a financial risk to the Council’s overall budget in 2017/18 of £2.69m. To manage this risk, it is proposed that the delivery of the programme be extended by a further year into 2018/19. To help councils have the option to raise a 2% precept for social care in future years, but this will not be sufficient to close the gap.
In the Spring Budget 2017, the Government announced additional funding for adult social care to be regarded as supplementary funding to the Improved Better Care Fund (iBCF). The Government announced that this funding should be used locally to meet local adult social care needs, stabilise the local care market and address issues related to Delayed Transfers of Care (DToC).The additional funding into adult social care (which has been pooled into the Better Care Fund) will not be sufficient to address both rising demand for services and ongoing funding constraints. Please see section 3.4 for our plans to use the iBCF.
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2.3. Care and Quality Gap
Currently, our system does not sufficiently invest in those people with a life-style related clinical problem, which would help stop them from developing the long term conditions which in aggregate are a huge burden on our health and care system. There is an opportunity in refocusing our efforts towards prevention and making every contact count.
Disease and illness could be detected and managed much earlier, and managed better in community. It is likely that, despite improvements over the last 5 years, people are being treated in hospital for long term conditions (LTCs) when they could be better managed by individuals themselves with the support of professionals in the community. This would help avoid the high levels of hospitalisation we experience for the elderly and those with chronic conditions.
A small cohort of patients (1.1%) account for nearly 20% of A&E attendances. Camden has high rates of mental illness and high usage of mental health services. NHS Right Care analysis indicates that there are opportunities for improved outcomes in musculoskeletal, endocrine and mental health diagnosis, treatment, and prescribing.
Whilst local hospitals have lower than average mortality rates, suggesting people receive effective treatment when admitted, we are using hospital beds for people who could be cared for at home, or in alternative care settings. In NCL 59% of acute bed days are used by people with stays over 10 days, and the majority of these people are elderly. 85% of the mental health bed days in NCL are from patients staying over 30 days.
Delayed discharges in Camden have also risen over the last twelve months and staying longer than necessary in hospital is not good for people’s health, especially the elderly whose health and wellbeing can deteriorate rapidly in an acute environment.29
We face challenges in mental health provision. People do not always have easy access to information and community based support, and community mental health services are under huge pressure. Camden has very high rates of mental illness and high usage of mental health services. A higher than average number of people are detained under the Mental Health Act and mental health patients spend a higher than average number of days in hospital.
For further information on Camden health inequality data, please see the Joint Strategic Needs Assessment available by clicking here
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Camden recognises that the context within which we are working is changing, with an increasing volume and complexity of support needs that our residents are presenting to our health and care services. This requires a fully coordinated and integrated response – not only to make efficient use of reducing resources but also to continue to deliver the best outcomes for residents. The following section describes Camden’s response, progress to date and future plans. Camden’s Local Care Strategy
In 2016, Camden Council and Camden CCG came together to develop the Local Care Strategy (LCS), a vision for a whole system transformation that is needed to deliver sustainable and fit-for-purpose health and social care support services. The LCS will complement and contribute to the transformation occurring at a North Central London level as a result of the NCL Sustainability and Transformation Plan (NCL STP) and inform the transformation of local authority services which is occurring as part of the Adult Social Care Transformation Programme. The principles for developing services consistent with the new model of care established in the Local Care Strategy are:
Accessible – services should be easy to understand and accessed in the right place at the right time
Person-centred - care should be compassionate and offers choice, control and empower people to take responsibility for their own health
Coordinated - where multiple services are involved they should be coordinated around the individual, provide a seamless care experience, and where possible, a continuous relationship with professionals involved in their care
Preventative - at every level of need, care should be focused on early intervention to prevent escalation of need
Effective - services should be based on evidence that results in improved outcomes for the best value.
Supporting People, Connecting Communities: Living and Ageing better in Camden Strategy In December 2016, Camden Council’s Cabinet Members approved the development of a new strategy for working with older and disabled people. Supporting people, connecting communities: living and aging better in Camden is our vision for working with adults who may need support, their carers and wider communities. The draft strategy is closely aligned to the Local Care Strategy and Health and Wellbeing Board
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Strategy and sets out how the council will promote a community approach that focuses on peoples’ strengths and assets, with a view to transforming services to create a sustainable model for the future. The strategy (to be approved by Cabinet in October 2017), is based on the following set of principles (reflected in the Care Act 2014):
Support people to maximise their independence and resilience
Ensure people are in the driving seat
Prevent, delay and reduce the need for statutory services by supporting people to harness community connections Support people to stay safe
Provide high quality, affordable personalised care
Develop a fair and consistent approach to what people contribute to the cost of their care Make the most of digital care technology to help people be as independent as possible.
This approach has been developed in consultation with residents, carers, staff and our partners and aims to further integrate health and social care services to improve outcomes for local people in line with the Camden Local Care Strategy.
The Council will be developing its new overarching strategic plan for the Borough in 2018. The importance of integration and our vision for health and care in Camden will be a key component of that emerging strategic plan for the borough.
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3. THE BETTER CARE FUND’S ROLE IN DELIVERING CAMDEN’S VISION
By recognising our shared ambition, and working across health and care in Camden and with partners as part of the NCL STP, Camden is seeking to maximise opportunities to work at scale and at pace to transform the local care system for our residents – integrating health, housing, social care and the voluntary sector as partners in delivery. The Better Care Fund (BCF) 2017/19 provides us with the foundation to deliver our joint vision across a broad range of strategic programmes. Camden has reviewed the programme of schemes under BCF to achieve alignment with these principles and the wider strategic plans outlined in the LCS, the NCL STP and the ASC Transformation Programme, and is now embarking on the next stage of its ambitious and innovative programme to deliver integrated and sustainable services. As part of these shared programmes, we will jointly focus with our partners on:
Preventative Care – putting support in place earlier to prevent people’s conditions unnecessarily worsening, to support those at the cusp of needing statutory services to have cost effective community support and supporting people to better manage their own health and well-being. The role of the VCS will be essential in supporting us to develop informal networks within local communities.
Developing Neighbourhood Multidisciplinary Teams – health, social care professionals delivering support jointly outside the hospital setting centred around GP practice hubs, working closely with the voluntary sector improving how well information is shared and communicated at a patient level and ensuring consistent practices and common protocols are in place across organisations. Work has already progressed, through BCF investment, on building a more integrated approach between district nursing, therapy and homecare services that seeks to provide a more holistic service for residents and the next stage of this work is being submitted to Camden’s Integrated Commissioning Committee in autumn.
Greater choice and control for residents - fully involving residents in deciding what type and level of support they receive and where they receive it based on personal funding allocation.
Shared business systems – development of shared recording and assessment processes such as CIDR (Camden Integrated Digital Record) that reduce the administrative burden on the workforce and both simplify and improve access to support services for residents by shared information between health and social care.
Camden also recognises that key partners in transforming care are the residents of the borough. Health and social care should be designed around the individual, understanding what is important to them and how they want to access services. Services should empower the individual to take control of their care and make
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informed decisions through information and communication. We will therefore continue to work with them to identify innovative, effective and efficient ways of designing and delivering joined up services across health, social care and housing. This will inform the seamless whole system approach across primary, community, social and acute care services, that is person-centred and responsive, that is the vision of the Local Care Strategy, the NCL STP and the Adult Social Care Transformation Programme.
New ways of working will be evaluated and prioritised based on how well they promote quality of provision, reduce unplanned contact with acute services and assist in meeting the significant financial challenges faced by both the CCG and the Council, whilst improving access to services in order to reduce health inequalities in our local communities.
Camden is maintaining its investment in adult social care in 2017-19 in order to support services in the community and address ongoing budget pressures. The BCF will seek to maintain this investment based on evidence of where programmes are addressing joint priorities of prevention, early intervention and reduce the risk of hospital admission amongst individuals with complex health and care needs.
The CCG minimum contribution to Better Care pooled funds and the required element for adult social care provision, has been increased from the 2016/17 baseline by 1.79% in 2017/18 and a further 1.9% in 2018/19. In addition, Camden has seen an increase through the recurring £0.8m Improved Better Care fund grant with the one-off addition of £5.8million in 2017/18.
The ASC Transformation Programme set out in the Supporting People, Connecting Communities Strategy seeks to improve the communication, collaboration and integration of social care provision and primary care and acute services. This will have wider benefit to the whole system as part of a shared priority to reduce and avoid hospital admissions through prevention and early intervention. The BCF will continue to support these developments through funding hospital social workers and 7-day working to manage potential admissions through proactive care planning and support early discharge from acute settings.
In particular, the intention is to increase the community-based capacity to reduce and avoid admissions to hospital and ensure safe transfers of care falls to the two key programmes of our Local Care Strategy – Supporting People at Home and Supporting People in the Community. To support these priorities, we have aligned the proposed BCF delivery plan activity within each of the LCS strategic programmes as follows:
3.1. Supporting People at Home (SPAH)
This programme focuses on delivering joined up care, closer to home, seeking to support professionals to work together more around the holistic needs of the patient. This includes reviewing the care pathway to ensure that we are focusing on facilitating people to recover their independence.
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In developing the SPAH programme, it was recognised that there existed a wide range of services that were being commissioned separately, each with the intended
objective of supporting people to continue to live in their home environment, either through maintaining a person’s wellbeing or preventing increased deterioration in their health and welfare.
However, the lack of co-ordination between these services has often resulted in duplication of resources being committed to supporting an individual, or gaps in meeting support needs because they had not been specified for a
particular provider to address.
BCF investment is supporting the implementation of an integrated support delivery model, which will be phased in over the next two years with robust workstreams now in place for each workstream. All services in scope will be recommissioned during that period, to form part of an integrated support network that is person-centred and outcome focussed and based within a defined geographical neighbourhood aligned around a GP cluster population.
During 2017/18, we are:
Aligning operational working areas between district nursing and home care and recommission homecare services to deliver enhanced services at a neighbourhood level in partnership with the nursing teams. The services within the local support network will be gradually extended over the next two years to establish by 2020, a comprehensive choice of services available to people to enable them to continue to live at home;
Supporting IT developments to enable shared records and support planning across agencies (this is being developed at a NCL sub-regional level);
Implementing a tiered support response to joint assessments based on a person-centred strength based approach across health and social care. The aim will be to provide a wider response option from low level monitoring to prevent condition deterioration, to high level rapid intervention to prevent hospital admissions for those with more complex health conditions;
Developing an assistive technology strategy to support the change in service delivery model based on a whole system focus on early prevention and supported self-care.
Camden is also strengthening our approach to admissions avoidance as part of the wider Supporting People at Home programme, to help ensure urgent and emergency care services are better able to signpost people to the most appropriate services,
PERSON
District
NursingGP
GP Social
worker
Care
Navigator
Telecare/
ICESThird sector
Pharmacy
Faith Groups
OT/
Physio
Home Care
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prioritising care closer to home. As part of a more aligned provision, patients will be directed to the right service at the right time. More appropriate use of services will reduce the number of unplanned admissions to hospital and support people to return home from hospital as soon as possible, improving people’s experience of the care they receive. The work falls into three broad categories:
Increasing the capacity and improving the performance and effectiveness of
rapid response services that seek to keep people in their homes;
Targeting services at those groups who are most likely to be admitted to
hospital;
Enabling more people to receive a range of services (integrated where
appropriate) in the community.
The BCF investment in admissions avoidance services in the community will therefore be used to increase the efficiency of the current rapid response service and in addition, to expand the service by re-directing resources within the community contract to increase the capacity of the rapid response service.
Reablement A key component of the Supporting People at Home programme is our approach to reablement. In developing effective reablement in Camden, there are a number of services that sit under the umbrella term and aim to support people to maximise their independence following a hospital admission. These are provided by both adult social care and our community health provider with the majority being supporting a safe discharge from hospital. The reablement services are made up of:
Community health provider:
o Early Discharge Service o RAPID Response to avoid a hospital admission o Carelink (health workers/enablers)
Adult Social Care:
o Enhanced Reablement Homecare (providing from point of discharge working with the person for up to ten days in their home)
o Reablement Flats based in an extra care and a sheltered housing scheme where someone is unable to transfer directly home.
Under the BCF programme, the introduction of dedicated officers providing intermediate care across our acute hospitals and aligned to the step down/rehab wards has shown that through good practice and active case management, it is possible to provide cost efficiencies and enhance the quality of the service for the patient.
Further work is needed on the alignment around the level and type(s) of reablement support that is provided to patients across health and social care. A lack of whole system coordination means that a number of patients are effectively being handed
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between acute care, community health and adult social care. The BCF investment is supporting the move to a more integrated reablement service that is person-centred and builds the level of support based on all of a person’s needs. There is also an opportunity to better target the use of reablement in strengthening people’s self-care and resilience to reduce the need for transfer to hospital.
The redesign is undertaking ‘step changes’ that aims to move to a fully integrated health and care reablement service by 2020. During 2017/18, the first stage is to:
Establish a dedicated reablement social work team within Adult Social Care, which will manage all reablement cases referred from acute care/hospital social workers, community health and ASC access and response teams.
Create a social work provision at a neighbourhood level to screen GP/Community referrals for alternatives to hospital admissions. This will enable the creation of a joint recovery plan delivered through the neighbourhood MDT approach to the provision of health and social care.
Review the provider element in relation to the accommodation services and reprocure reablement homecare provision. This provides the opportunity to future proof these services to become part of an integrated reablement service pathway
Another key component of this programme is our approach to simplifying discharge, which can be read about in Section 6.
3.2. Supporting People in the Community (SPC)
The Supporting People in the Community (SPC) programme seeks to develop and integrate the wider community support and provision that exists within Camden. Camden recognizes that the voluntary and community sector and values the role it plays in capacity building and ensuring that the Borough has a robust, diverse and capable range of services that address local needs.
SPC is focused on working with local residents, family carers and current service recipients to identify the community services that are important to them to support their quality of life and work across health, care and wider local government services to enable and facilitate communities to deliver these in conjunction with voluntary sector strategic partners. The first phase of the supporting people in the community programme focused on the transformation of care and support to widen access to mainstream and universal employment, education and leisure opportunities. This included the development of our centre for independent living, which will connect people to support or activities which promote independence and wellbeing. The centre for independent living will be a hub for information, guidance and support, which enables disabled people to regain or maintain their independence. It will signpost people with direct payments or self-funders and act as a ‘connector’ to the full range of local services – universal and specialist. As such it will play a vital role in connecting voluntary and commercial sector providers to their target market as well as promote the interests of disabled adults through community engagement.
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Extensive co-production activity has underpinned the development of the centre for independent living and it will be operated by a consortium of local user led organisations. Over time the range of services is expected to grow as the model matures and it will also offer the opportunity to generate income in the future.
The second phase of the supporting people in the community programme has been designed to meet the aims of the Camden Local Care Strategy. The programme focuses on:
Improving the quality of life for Camden residents
Improving health and social care outcomes for Camden residents
Early identification and prevention of health and support needs
Promoting and supporting independence
Developing community resilience
Developing sustainable community assets
The programme focuses on two distinct work streams: prevention and wellbeing and service development. The following areas of work sit within the work streams:
Work-stream 1: Prevention and Wellbeing
Advocacy and Interpreting
Carers’ support services
Dementia
Information and Advice
Prevention and Wellbeing
Social Prescribing
Work-stream 2: Service Development
Developing the Centre for Independent Living
Developing the Greenwood centre, a community asset which will house day services and community resources
Review of Day services
3.3. Digital Enablers
The STP, as part the Local Digital Roadmap (LDR), is providing the direction of travel for the digital transformation of health and social care. Camden’s ambition is to see digital application as an integral part of the way health and social care is delivered on a daily basis.
The North Central London (NCL) Local Digital Roadmap (LDR) sets out five digital themes that underpin our vision and ambition.
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Digitally activated population: We will provide our citizens with the ability to transact with healthcare services digitally, giving them access to their personal health and care information and equipping them with tools which enable them to actively manage their own health and wellbeing
Connected care: We will create and share care records and plans that can be shared across health and care systems seamlessly to enable integrated care delivery across organisations
Insights driven health system : We will use data collected at the point of care to identify populations at risk, to monitor the effectiveness of interventions on patients with established disease and deliver whole systems intelligence so the needs of our entire population can be predicted and met
Digitally enabled workforce: We will support our providers to move away from paper to fully digital care processes and provide infrastructure, which enables our care professionals to work and communicate effectively, anywhere at any time.
Sustainable Care: We will improve efficiency and productivity through consolidation of digital services, applications and projects
These themes support our local prevention, service transformation and productivity objectives and will enable us to meet the national mandate of operating paperless at the point of care. However, this requires significant levels of investment which given the current financial pressures may not be realised within the lifetime of this BCF plan.
An important element of this work will be our continued commitment to invest in a range of assistive technology equipment, providing people with the tools to better manage their wellbeing within their immediate environment to restore a level of much needed independence. During 2016/17 our BCF programme supported two assistive technology initiatives (Telecare and Telehealth), both of which provide residents with equipment that supports them to maintain their independence and to remain in their homes. Over the next two years, we are committed to building on what has been learnt and ensuring assistive technology schemes provide value for money and have a clear impact on residents’ lives.
Through BCF investment, ASC have procured and implemented an advanced new online information and advice portal for people to access information on how social care is delivered in Camden and gives direct access to a range of products and services. Camden Choices went live in November 2016 and comprises enhanced self-directed assessment and support capabilities along with an eMarketplace directory and intelligent information and advice.
During 2017-19, we will review our existing assistive technology strategy as part of the long-term vision around supporting people to live well at home. Market research is being conducted to identify examples of innovative good practice in urban cities to
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inform the case for change in Camden and we are continuing to work collaboratively in looking at areas of development and investment.
3.4. Improved Better Care Fund The use of Improved Better Care Fund will also contribute to our shared ambition in Camden. Camden’s plans for the use of the Improved Better Care Fund (iBCF) are based on the following key areas:
Care Packages: iBCF will be used to support ongoing care commitments, including homecare recommissioning and providing additional stability to the existing adult social care system in the short term whilst our transformation programmes aims to deliver the whole-system change needed to reduce and contain demand in the longer-term.
Simplified Discharge: supporting our plans to reduce delays in the discharge of those awaiting / needing assessment. This will involve developing the right level of community based health and social care resources and activities to shift patient assessment away from being acute hospital based. This is aligned to the High Impact Change Model for Managing Transfer of Care and to our programme of improvements in regard to admissions avoidance including the development of a single point of access. Please see section 5 and Appendix 2 for further details of our plans in regard to the High Impact Change Model.
Development of integrated care teams for adults in neighbourhoods – as set out above in our Supporting People at Home programme this work will create integrated multi-disciplinary and multi-agency teams for adults, bringing together GPs, social workers, home care (with additional investment to the home care model), community nurses, therapists, and palliative care services, aligned with neighbourhoods. This will improve accessibility, co-ordination and communication between services and lead to better coordination of care for individuals, less duplication, fewer emergency admissions and attendances, better quality care and better patient experience.
Funding from iBCF will be used to invest in block contracts to secure support and stabilise the social care market. This will help us to respond to the need to maintain good value nursing provision for existing Camden clients in the short to medium term, whilst attempting to secure flexibility in the longer term to manage future trends.
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4. THE BCF – PROGRESS AND DEVELOPMENTS IN 2016/17
In line with clause 20 of the Section 75 agreement, we conduct an annual review of the operation of the agreement, the pooled funds and provision of services that fall within the BCF. Camden undertook a review of schemes during 2016/17, which provided the basis for considering which services are meeting the broader strategic objectives, where funding can be reduced through reduction in duplication of service provision, and which services are underperforming and may need to be modified, or recommissioned to provide enhanced impact on outcomes for residents well-being. The review of 2016/17 investments (including a £0.5m reduction for Care Act pressures) released £1.2m, which was then reinvested into district nursing services.
Further Reviews and Action for underperforming schemes
New leadership and the desire to further progress our vision for health and social care
in Camden has brought fresh rigour to our approach and use of the Better Care Fund
in Camden. It has been reflected that the Better Care Fund in Camden has had to
change over time to align with the changing national policy and conditions set by NHS
England. Furthermore, original allocations of BCF incorporated existing S256 pooled
budgets (transferred funds from the CCG to Local Authority to enable the LA to perform
functions on its behalf) and transferred funds from the PCT, which otherwise didn’t
meet the criteria of the BCF or relate to delivery against the national metrics. As such,
it represents a mix of pre-existing and new integrated services. The aspiration in
Camden is therefore that all schemes align to the most recent national metrics and
demonstrate impact in regard to these metrics. So as well as the annual reviews of
schemes in the BCF as part of our Section 75 agreement; a rapid review of schemes
took place in May 2017, to consider if further changes and improvements to the use
of the fund were needed.
Schemes were reviewed in order to consider:
- Their alignment with the four national metrics set out in the guidance, with
further detail on their impact on performance where possible,
- Duplication and consolidation –how schemes fit together and align with the
wider context of service provision,
- Greater detail about activity measures against schemes in a more accessible format, including analysis of value for money and benchmarking,
- This analysis was undertaken whilst maintaining sight of the overall aims of the STP, Local Care Strategy and the resultant plans for transformation locally.
It was found that BCF schemes fell within three categories:
- Category 1: These schemes align to the metrics, have no pending reviews and it was recommended that they are approved by the Integrated Commissioning Committee (ICC),
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- Category 2: These schemes align to the national metrics but they are part of wider strategic reviews in relation to ongoing work to strengthen admissions avoidance, discharge processes and the Supporting People in the Community Programme.
- Category 3: Schemes, which from a review of available data and evidence, appear not to closely align to the national metrics/provide value for money/demonstrate strong performance or have any data available. As such, two schemes (Safeguarding training and AT Telehealth) will no longer be funded via the BCF and alternative schemes have been recommended.
Schemes funded by the Better Care Fund are being further reviewed in 2017/18 to ensure they are having the required impact on the national metrics and are adding value in regard to health and care integration and the achievement of the aims of the Local Care Strategy. Reviews for BCF schemes within category 2 will be accelerated to ensure that these resources enable our ability to deliver an ambitious improvement trajectory for delayed transfers of care in 2017/18 and 2018/19.
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5. IMPACT OF THE BETTER CARE FUND ON NATIONAL METRICS
5.1 Performance Management Process Camden has developed a BCF dashboard that reports performance against the four national metrics and includes individual scheme level activity and outcomes measures:
Increasing reablement rates
Reducing permanent admissions to residential and nursing care
Reducing emergency hospital admissions
Reducing delayed transfers of care Further work is underway to continue to refine this dashboard and strengthen our approach to monitoring outcomes and progress against the national metrics.
Complementary to scheme level performance reporting, Camden is now two years into a long-term (5 year) evaluation of the BCF Programme which tracks progress against a system level BCF Programme dashboard and over-arching strategic objectives using a logic model framework, which is attached as Appendix 1. The framework allows for the monitoring of outcomes across the integrated care pathway, including metrics and outcomes over and above the core ones required nationally to provide a wider picture of the impact of BCF in Camden.
The Department for Health, on behalf of a consortium of national bodies, called for the “most ambitious and visionary” local areas to become Integration Pioneers to drive change “at scale and pace, from which the rest of the country can benefit”. Camden Clinical Commissioning Group (CCG) and Camden Council were elected to be a wave 2 Integrated Care pioneer in January 2015. Camden contributes to the scheme by sharing best practice regionally and nationally and benefitting from access to expertise, support and constructive challenge provided via the programme.
The following provides an analysis of performance against the national metrics in 2016/17 and how we intend to build on progress to achieve proposed metric targets for 2017/19. It should be noted that the national metrics aligned to the BCF are affected by many factors in the whole health and care system. Whilst BCF contributes to these outcomes, it can be difficult to assign impact from individual schemes on the overall outcomes.
5.2 Admissions to Residential and Nursing Care
Camden’s rate of long-term admissions to residential and nursing care in 2016/17
has been below or around the upper level target of 43.91 admissions per 100,000
population per month for the majority of 2016/17 with a 2016/17 provisional outturn of
40.14 per 100,000 per month. This is an improved performance on the 2015/16 figures
of 44.94 per 100,000 per month despite significant demographic and financial system
pressures. Placements in care homes are carefully reviewed through a quality
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assurance panel to ensure that they are the most appropriate and effective way of
meeting a person support needs.
BCF funded services that are judged to have a high impact on this performance include
the reablement assessment flats, which support patients with an on-going therapy
programme to maximize their independent living skills before returning home with
assistive technology. This performance is also linked with the range of integrated
community health and care services in the community which support people at home
such as the BCF funded rapid response service, district nursing and enhanced
homecare.
A 5% year on year reduction in permanent residential and nursing admissions on the
2016/17 annual provisional outturn of 481.71 per 100,000 has been set as a target for
2017/19. This target reflects the new out of hospital discharge initiatives starting in
2017/19 such as the dedicated reablement team, discharge to assess and admissions
avoidance activities in contrast to the increased number of requests for residential and
nursing placements from hospitals.
5.3 Reablement Camden’s provisional 2016/17 performance on the effectiveness of reablement (the proportion of older people (over 65) who are still at home 91 days after discharge from hospital into reablement services) is at 86.1% and shows improvement on the 2015/16 rate of 85.6%, hitting our local target. The figure reflects that the service has built on progress made in 2015/16 with the start of the enhanced reablement programme of BCF funded dedicated reablement staff based in hospitals and the duty team. There were 199 patients referred from hospital to the enhanced reablement service in 2016/17, a significant increase from the 92 patients in 2015/16.
Services such as the reablement flats, packages of support, the Nurse Tracker and
Carelink are also judged to have a high impact on Camden’s performance in regard to
reablement. The local authority view is there is scope to improve reablement outcomes
with increased focus on admission avoidance, which forms part of the work underway
as outlined in section 2.
A small increase on the 16/17 provisional outturn of 86.2% has been set as the target
for 2017/18 and 2018/19. Camden already performs above the 2015/16 national
outturn of 85.4% and the London outturn of 82.7%. New activities impacting on the
effectiveness of reablement like the newly formed dedicated reablement team, the
recently commissioned reablement homecare contract and the discharge to assess
pilot are anticipated to take time to bed in before impacting positively on the
effectiveness of reablement rates.
5.4 Non-Elective Admissions
Camden’s performance on non-elective admissions (NEA) fluctuates but overall the
rates have increased. In 2016/17 Camden has seen an average monthly NEA rate of
1,638 admissions per month using Monthly Activity Return (MAR) data, which is over
our target figure of 1,508 admissions per month and the 2015/16 average of 1,564
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admissions per month. This is a challenging metric nationally which requires a system
wide response and it is one of the key areas of transformation in the STP and the local
care strategy.
BCF schemes that contribute reducing admissions include
A 7 day social work service at UCLH and Royal Free Hospital which has
discharged 196 patients direct from A&E (avoiding an emergency admission)
against a projected target of 167 for the year.
199 homecare reablement packages have been set up by A&E social workers during 2016/17, for patients who would otherwise have been admitted to hospital. This is an increase from the previous baseline of 92 care packages.
A CNWL rapid response service, which has reported a total of 682 avoided admissions for the year, against a 2015/16 baseline of 670. 624 acute bed days were saved in 2016/17 as a result.
The Integrated Community Equipment Service has supplied 757 pieces of equipment to help avoid admissions by providing people with the equipment they need to maintain their health and remain independent. This compares to a baseline of 462 purchases.
It is proposed that Camden’s BCF Programme will reduce non-elective admissions to hospital by 2.79% (472), above and beyond plans within the CCG’s operating plan.
This establishes a Risk Sharing Fund equal to £1m, which will be retained by the CCG.
By establishing a Risk-Sharing/Performance agreement Camden is committing £5.22m to a combination of NHS Commissioned Out-of-Hospital services and risk-sharing agreement.
An Enhanced Admissions Avoidance business case proposal currently in development focusses on increasing capacity within the rapid response service to deliver an estimated additional 56 avoided admissions per month. By achieving the targets set out in the risk sharing agreement the programme will contribute to relieving pressure on local A&Es as well as the entire system flow.
The risk share in relation to the BCF Programme is between the CCG and LA in accordance with the Section 75 agreement. Camden CCG has Payment by Results (PBR) contracts with acute Trusts; therefore the commissioner bears the risk of BCF not delivering against non-elective targets.
5.5 Delayed Transfers of Care (DToC)
In 2016/17 Camden has seen an average monthly delayed transfers of care (DTOC) rate
of 183.5 days delayed per 100,000 population, over our target of 139.9 days delayed and the 2015/16 average of 141 days delayed. However, our rate has remained below the London average throughout the year. In Q4 2016/17 the majority of delays are attributable to the NHS for patients waiting for rehabilitation beds and Level 1 neuro rehabilitation due to lack of capacity in the Camden step down allocation. Some long stay patients in this part of
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the system have proved difficult to move on which has had an effect across the whole system. There have also been patients who are self-funders who are awaiting social care funding agreements to bridge funding gaps.
Camden has seen a noticeable increase in delayed transfers of care from the Mental
Health Foundation Trust. These delays are typically lengthy as patients require
alternative living arrangements whether that be via the supported housing pathway or
for mostly older people, a permanent residential or nursing home placement. These
placements can be challenging to identify and take time to put in place, especially
where someone has complex needs, and early discharge planning is a key enabler.
We continue to work with the Trust to improve early discharge planning and support
protocol and policy development and have appointed a Delayed Transfer of Care
Officer who will be able to focus on improving discharge processes and consistent
reporting across the north of the borough which will include the Foundation Trust.
BCF funded services that are linked to Camden’s performance in regard to DTOCs
include the rapid response service, the reablement flats and step down beds, the
hospital social work team, the Nurse Tracker and the Integrated Community
Equipment Service.
Camden HWB DTOC targets for 2017/19 have been set and agreed by all partners as
per the government published ambitions for Camden HWB for reducing social care
and NHS attributable delays and were submitted to NHSE on 21 July 2017.
From an adult social care perspective, the use of snapshot data in February 2017 as
a baseline month of particularly strong performance in Camden is problematic and
makes our indicative expectation particularly ambitious. Pressure in the system has
led to a subsequent rise in our DTOC rate and the trajectory set out may not be
achievable within this timeframe. As partners, we are working very hard within our
local system to better understand our overall performance and to drive significant
improvement for local people in a timely way.
The system in Camden has made strong progress on implementing the High Impact
Change Model, as detailed in Section 6 and we intend to build on this by continuing to
implement discharge to assess, trusted assessor models and working together to
improve delayed transfers of care and to support our local residents to access care
and support closer to home.
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6. MEETING THE NATIONAL CONDITIONS The following sets out how the BCF Programme will continue to meet the National Conditions in 2017/18.
Plans are jointly agreed
This BCF plan builds on approved plans for 2016-17 and demonstrates that local partners have reviewed progress in the first two years of the BCF as the basis for developing plans for 2017-19.
The revised plan for 2017/19 has been signed off by Camden CCG and Camden
Council and has been shared across all local providers and groups. The Chair and
Vice Chair of the Integrated Commissioning Committee (ICC) agreed the plan prior
to the final plan being submitted to NHS England on 11th September 2017.
The ICC review progress and plans in regard to the Better Care Fund and the impact schemes are having on our overall vision for health and care on a regular basis, including quarterly performance management updates. This arrangement will continue in 2017/18.
NHS contribution to social care is maintained in line with inflation
Local areas must include an explanation within their plans of how the use of BCF resources will meet the national condition that the NHS contribution to adult social care is maintained in line with inflation. This condition gives effect to the commitment in the Spending Review to continue to maintain the NHS minimum mandated contribution to adult social care to 2020. This contribution to social care can be used to support existing adult social care services, as well as investment in new services.
In 2015/16, approximately 25% of Camden’s Better Care Fund was pooled from
existing section 256 agreements, which continued as part of the overall transfer. The
section 256 agreements included funding for:
Adaptations and equipment Telecare and Telehealth Reablement services Mental health services Discharge and rehabilitation Care and support
In 2016/17, Camden committed to spending the same level in real terms on social care. In this revised plan, Camden fulfils expectations to commit the same level of
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funding, with the required inflationary uplift, to protect social care services in 2017/19 as in 2016/17 so that the local social and health care system as a whole is not destabilised. We are funding the following services to meet this national condition:
Local authority provided reablement.
Contribution to adult social care packages.
Providing an enhanced reablement resource within the acute setting.
Co-locating social workers within acute hospitals to reduce delayed transfers of care.
Agreement to invest in NHS Commissioned Out-of-Hospital services
Nationally, there is recognition that we need to move away from designing care around individual pathways and conditions, and towards organising care to improve the health of the whole population.
The development of the Camden Local Care Partnership (CLCP) is designed to look at the system as a whole to combine our resources and focus to:
• Prevent the escalation and development of health and care issues. • Provide more joined up consistent health and care support. • Reduce the whole system costs of health and care.
The proposal is that CLCP, who is developing the strategy, will initially focus on increasing the capacity, skills and integration of primary and community care. These activities will increase the ability of community-based services to respond to residents’ needs.
Work is ongoing to agree how Camden’s Better Care Fund can be utilised to support the start-up and delivery of the CLCS itself. In 2016/17, local areas were required to agree how they will use their share of the £1 billion that had previously been used to create the payment for performance fund, for reducing non-elective admissions to hospital. In 2016/17 this ring-fenced figure was £5.129m, which has increased to £5.221m in 2017/18. Locally Camden have agreed to retain the contingency fund (£1m), held from this local allocation for NHS out-of-hospital and additionally have agreed to invest £7.594m in NHS commissioned out-of-hospital services, £2.373m more than the minimum requirement. These include:
CCG commissioned Reablement services (Carelink);
Case Management Project;
Camden’s Rapid Response service;
Co-locating Care Navigators in Primary Care.
Implementing the High Impact Change Model for Managing Transfer of Care to support system-wide improvements in transfers of care.
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In Camden, a number of services are currently commissioned that act as a ‘bridge’ between hospital and home. These services support people who are medically fit for discharge, but require short term nursing, medical, therapy and social care support in the community.
Aiming to help people regain the best possible level of independence following a recent deterioration in function, these services promote recovery from illness, prevent unnecessary admission to hospital, enable timely discharge from hospital and rehabilitation to maximise independent living and the regaining of everyday life skills.
Over the next two years, we are building on progress already made to improve the experience of patients who are medically fit for discharge and implement improvements on a whole system basis through the Local Care Strategy and the emerging Adult Social Care Strategy using BCF and iBCF scheme investment(s). This includes implementation of the High Impact Change Model.
We have a High Impact Change Model Implementation Plan which includes analysis of elements of each of the 8 changes to assess what has been established and the level of maturity and what is yet to be established and the plans to be put in place for this to happen. It also details which elements of the model have already been adopted, for instance how we early discharge plan and use systems to monitor patient flow.
Both the analysis of the elements of each change and the plan for implementation are included with the narrative plan as Appendix 2.
PROGRESS OF FORMER NATIONAL CONDITIONS
The following sets out how we will continue to make progress against these former conditions:
7 Day Services
Please see previous section and Appendix 2 on implementation of the High Impact Change Model.
Data Sharing
Camden has been building on the approach to improved Data Sharing as set out in the 2016/17 Plan.
The NHS Number has been adopted as the primary identifier for all correspondence across health and social care. 97.5% of residents on Framework-I have their NHS number as their primary identifier.
Camden has made progress in developing open Application Programming Interfaces (API) across care settings specifically with GPs, hospitals, social care, community and mental health. In 2017/18, the BCF Programme will continue to support this to include Palliative Care.
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Camden’s Care & Integrated Digital Record (CIDR) has been live in Camden for nearly 18 months with over 1,800 users across health and social care. The Integrated Digital Record was created to enable the delivery of integrated care, thereby overcoming fragmented and uncoordinated care through sharing real time clinical information underpinned by robust information governance. The programme has been clinically led across the partners. Clinicians have shared from a secondary care perspective that using CIDR has reduced the number of repeat diagnostics needed and thereby improved access time to services.
Camden has appropriate information governance controls in place for information sharing in line with the revised Caldicott principles. These are laid out in Schedule 7 – Information Sharing of Camden’s Sec 75 agreement.
A joint approach to assessment and care planning
In 2017/18, a wider transformational service model (the Frail and Elderly Integrated Practice Unit (IPU) commenced, using a patient and clinician developed outcomes based approach.
Patients aged 75 and over, and registered with a Camden GP will be in scope for inclusion on the frailty register. This is approximately 24,000 people over the age of 65 but predicated applicability is between 2,500 and 3,000.
The introduction of an IPU will enable significant upscaling of coordinated care planning, case management through a multidisciplinary service and an overall integrated delivery of services. The integrated delivery service will support case management and provide intervention for patients before they are stepped down to routine integrated care services. These services include existing provision/approaches such as:
- The Hub MDT - Care navigators - Community geriatricians - Complex case management nurses.
The complex care case management service is commissioned to case manage 300 patients per annum and provides an important service to patients whose needs are identified as being complex. This model of care is delivered through a collaborative care planning approach that ensures the most frail and complex patients in Camden are supported to maintain their health, prevents deterioration and avoid crises. The overall aim of case management is to anticipate, co-ordinate and join up health and social care for patients at a high risk of unplanned admissions to hospital. The patient’s GP will remain medically responsible for their patients and will ensure that the nominated named case manager will:
- Actively participate in MDT meetings. - Review the patient’s medication. - Review the patient’s specialist medical input.
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There is a well-established borough wide MDT that coordinates care and enables a collaborative, person-centred approach for older people with the most complex health and social care needs. It manages risk and provides high quality care coordination for patients. The MDT continues to reduce emergency admissions (saving average £23k pcm) and patients experience significantly more time spent at home (an outcome metric patients have devised and prioritised), with 74% spending the same or more days at home following an MDT intervention. A single assessment process (SAP) is used within adult social care that can be completed by any health or social care professional so that assessment, care planning and delivery are person-centred, effective and coordinated. Through the SAP health and social care organisations working closely together with the person themselves and their carer, (if they have one) to enable services or treatment to be received at the right time, through a multi-agency assessment, care plan and review process. This allows assessment information to be shared with staff across health and social care agencies that are involved in providing care or services for the person. This means different professionals contributing to one assessment rather than repeating the process in separate assessments. This work will also progress further as part of plans in regard to Integrated Care Teams.
Care Act (2014) and our responsibilities in regard to Carers The BCF minimum allocation to CCGs includes funding to support the implementation of the Care Act 2014 and other policies. BCF plans should set out how informal or family carers will be supported by LAs and the NHS. Providing care can have a substantial impact on a carer’s current and future quality of life and the importance of recognising the need to support carers in order to sustain them in a caring role is also locally recognised. Carers as a group are at disproportionate risk of experiencing health inequalities and the relationship between poor health and caring becomes more apparent with the duration and intensity of the caring role. The BCF continues to fund two areas in regard to Carers in Camden:
- The Carers Centre, which ensures carers have the right information and advice to enable them to make the best choices for themselves and the person they care for.
- A Care Act compliant approach to assessing and supporting carers. Carers can receive personal budgets to support them to achieve eligible outcomes and improve their wellbeing.
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7. BCF INVESTMENT PLAN IN 2017-18
7.1 Existing Schemes An initial review of schemes of 2016/17 investments (including a £0.5m reduction for Care Act pressures) has released £1.2m for ongoing investment into district nursing services. Further reviews during quarter 1 2017/18 have released an additional £160,000 from mental health schemes, which is available for investment.
7.2 New Funding Sources Two additional sources of revenue contributions are expected to be received into the BCF in 2017/18. Firstly, £0.778m improved better care fund funding announced during the comprehensive spending review and secondly £5.814m enhanced improved BCF announced as part of the March 2017 Spring Budget. Both these contributions will be contributed to the BCF by the Council. These funds will be specific grants to the Council and the conditions for this money are that it be spent on adult social care, including supporting people being discharged from hospital and stabilising, the social care provider market. The expectation from the Government is that this money be used to commission care.
A revenue investment plan for 2017/18 is summarised below:
Funding Source
£m
Revenue Contributions
CCG nationally mandated minimum contribution 18.371
Council improved BCF (CSR) 0.778
Council improved BCF (spring budget) 5.814
subtotal - 2017/18 revenue contributions 24.963
Capital Contributions
Council Disabled Facilities Grant 0.791
BCF minimum pool 25.754 25.754
Reserves
revenue underspend
revenue reserve as at 1st April 2017 (estimated) 1.450
Capital underspend
Capital reserve as at 1st April 2017 (estimated) 0.139
1.589 1.589
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Total BCF pool available 2017/18 27.343
On-going revenue funds 24.963
one off revenue 1.450 26.408
Capital
0.930
Total BCF pool available 2017/18
27.343
7.3 Disabled Facilities Grant It has been confirmed that within Camden’s minimum allocations there is provision of the mandatory funding for Disabled Facilities Grant - £0.791m.The housing options and advice team have responsibility for overseeing the Disabled Facilities Grant in line with Camden’s 2011-2014 Housing Renewal Assistance Policy and have contributed to the development of the BCF plan. Following the approach taken in previous years, Camden continues to pool its Disabled Facilities Grant (DFG) through the BCF. In 2016/17 £728,000 was spent on specialised housing adaptions including level access showers, hoists and stair lifts to allow residents to remain living independently in their own homes. This amount will increase to £791,232 in 2017/18 and £854,926 in 2018/19 with our plans to continue to provide an increasing number of adaptions.
7.4 Reserves A plan for utilising the reserves is summarised below:
Proposed use of Revenue Reserves
2017/19
£m
Reserves as at 1 April 2017
1.450
Community Geriatrician (2017/18) 0.122
Nurse Tracker (2017/18) 0.026
CCG funded hospital team (2017/19) 0.288
Social Care spend requirement (2017/18) 0.221
Age UK Dementia Contract (2017/18)
Total planned draw down 2017/19
0.120
0.777
Remaining reserve to be used on CCG schemes
0.673
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7.5 Minimum Spend Requirements
One of the conditions of the BCF is that the minimum support for adult social care be maintained in real terms. In 2016/17 expenditure identified as adult social care (which in some cases was meeting NHS responsibilities) was £12.3m. Applying the mandated uplift of 1.79% gives, a required minimum spend of £12.5m.
It has been agreed that £1m be retained by the CCG as a risk fund to mitigate against potential cost pressures incurred if improvements in hospital activity are delivered.
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8. RISK MANAGEMENT Our approach to risk management is set out in schedule 4 of the Section 75 agreement between the CCG and LA. The schedule covers arrangements for:
8.1. Financial Risk Management
Covers arrangements for financial risk areas such as:
Virement from other funds established in this agreement to the extent that their budget can be reduced;
That sufficient funds have been set aside to cover any shortfall in the expected outcome so that neither party is required to make any additional contributions;
In the event that BCF schemes overspend, protocols for managing these are outlined.
8.2. Financial Risk Sharing
It is proposed that Camden’s 2017/19 BCF Programme will plan to reduce NEAs to hospital by 2.79% (472) above and beyond plans within the CCG’s operating plan. This establishes a Risk Sharing Fund equal to £1m, which will be retained by the CCG. Please see section 7 for more detail on the risk sharing agreement.
8.3. Operational Risk Management The risk and impact of each individual scheme failing to impact upon BCF national metrics has been mitigated by reviewing each scheme for the appropriateness of inclusion within the BCF and substitution where impact could not be demonstrated.
8.4. Risk Logs
Risk Logs are kept both at programme and scheme level, forming registers to manage risk to the delivery of the service. Risks are reported to the BCF Programme Board, the Integrated Commissioning Committee and Health and Wellbeing Board as necessary. Programme level risks, which reflect significant risks to partners are managed via Camden CCG’s Corporate Risk Register. The relevant section is included below as Appendix 3 and cover the following key themes:
- Ensuring focus on service provision that improves performance against the BCF programme metrics and demonstrates impact against our strategic aims for health and care
- Ensuring appropriate use of reserves.
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Appendix 1: Camden’s Long Term Evaluation: Logic Model
Situation / Challenge The problem that the BCF – overall - aims to address
Goal
What the solution to the problem will look like Outcomes and indicators
- Fragmented services for those who most interact with health & social Care services - Increasing demand for services, e.g. non-elective admissions, avoidable admissions, on a background of austerity. - Services not adequately wrapped around residents’ needs, with patchy patient and carer satisfaction - Changing patterns of health and social care need within changing fabric of society
- Residents will receive personalised health and social care, allowing them to maintain independence and involvement in the community for longer. - Resident’s physical and mental health needs will be treated the same, with a focus on preventing ill health and earlier help for those who need it. - Inequalities in outcomes and healthcare will be reduced, through maximising use of available resources to provide accessible, safe, effective - responsive services. - The health and social care system will be financially sustainable, offering evidence-based care and value for money.
Short Term
Outcomes: April 2015 - October 2016
Medium Term Outcomes: October
2016 - April 2018 Long Term Outcomes: April 2018 - April 2020
If we accomplish our planned activities to the extent we intended, then Camden residents will benefit in these ways. If these benefits to residents are achieved, then these changes in organisations, communities, or systems might be expected to occur. The years indicated are not targets. They are
estimated time frames based on evidence of similar change initiatives. Every effort is being made to deliver change at pace.
Assumptions Inputs Activities Outputs Changes that occur
in near future because of the programme’s
outputs: Usually evident as increased
skills, knowledge, motivation Short
term changes are not usually ends in
themselves, but necessary steps
towards intermediate or long term
outcomes. How would you measure each outcome, and
when would you measure it?
Intermediate
outcomes indicate that long term
outcomes are likely to be met. Intermediate outcomes are often
the result of increased skills or
knowledge, i.e. changes in behaviour
or specific actions taken - they link short
and long term outcomes.
How would you measure each
outcome, and when would you measure
it?
The changes that, together, indicate that the goal has been met.
How would you measure each outcome, and when would you measure it?
The conditions that are believed to already exist that are necessary for the programme to be
successful
Resources Camden has readily available to
ensure the success of the Better Care Fund
programme
Tangible activities and products that
constitute the programme
Measurable, tangible, direct products of the
programme’s inputs and actions (i.e.
activities contribute to these outputs)
We have integrated services already in place for key areas through joint commissioning arrangements.
Funding for BCF programme
1. Day opportunities for advanced dementia
1. Integrated case management approach for high risk patients
We focus on people with the most complex needs, and those at risk of hospital admission, including those with mental health needs.
Staffing from commissioning & provider
2. Reablement services
2. Reactive hospital avoidance
Information and Advice
Information and Advice
Outcomes – Based on National Voices ‘I statements’ for Coordinated Care[1]
Reporting governance structure
3. ASC packages within the social care bill
3. Preventive projects to enable people to live well at home
Residents are able to access information & advice about the types and levels of care that is available to them.
Residents and Health and Social Care professionals are able to access more consistent information and advice.
1. I have systems in place to get help at an early stage to avoid a crisis.
Our vision for personalisation places the customer at the centre of their support and care irrespective of the provider.
Quarterly monitoring to NHSE
4. Preparation for Care Act
4. Effective discharge, reablement and rehabilitation
- Increase in web hits
- Information and Advice is more consistent across partners/care settings
2. All my needs as a person are assessed.
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Joint assessment is established in Camden, and pathways to services are continually under review.
Laws & policies 5. Social Care & mental health in primary care
5. Increased social work offer for complex patients
- Increased use of self-assessment tool
- Increase in whole family assessments
3. My carer/family have their needs recognised and are given support to care for me.
We can learn from other areas by using the opportunities a national programme of integration provides, of sharing and learning best practice, and for forming alliances across traditional boundaries.
6. Enhanced social work discharge team
- Increased self-funding activity
Outcome Achievement
4. I am supported to understand my choices and to set and achieve my goals.
7. 7 day weekend working in social care
- Reduction in overall demand
Residents are able to achieve their health and social care goals. 5. Taken together, my care and support help me live the life I want to the best of my ability.
We will build on our existing preventative services to increasingly shift our services towards prevention and early help, in order to reduce and delay ill health and poor wellbeing and reduce costs to health and social care services.
8. Case management
Control of Care
- Increase in achievement of goals on care Plan
6. I know how to stay as well & healthy as I can and how & where I can seek advice if I do.
9. Camden Community Rapid Intermediate Care Service
Residents have greater control on the type of care they receive and the setting in which they receive it.
- Employment rates of service users
7. I have confidence in the system.
10. Camden Integrated Care Service
- Increase in direct payments
- Admission rates of service users
Indicators
11. Occupational therapy led projects
- Increase personal budgets
7 Day Week Services
1. 8% reductions in avoidable emergency admissions [75+]
12. Care navigation
Discharges
- Residents are able to access the health and social care services they require 7 days a week.
2. 5% reduction in other emergency admissions [75+]
13. Assistive technology
- Residents are discharged in an increasingly safe and timely manner.
- Increase in demand over weekends (GP appointments/Social Care)
3. 4.5% reduction in avoidable emergency admissions [<75]
14. Enhanced home care
- Reductions in DToC (Cases/Days)
- Increase in weekend discharges
4. 2.2% reduction in other emergency admissions [<75]
15. Discharge pathways
- Increase in Bed Days Saved
- Reduction in Hospital Length of Stay
5. Reduce admissions to residential or care home
16. Integrated community equipment service
- Reduction in Readmissions
Prevention
6. Reduction in DTOC
17. Existing Community based Services
Quality of Life
More residents are prevented from accessing Health and Social Care Services too soon.
7. Proportion of older people [65+] still at home 91 days after discharge from hospital into reablement / rehab services
18. Disabled facilities (DFG) & community capacity grant
-Residents/Carers witness an increase in Life Quality.
- Earlier identification of residents at risk of needing health and social care services
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- Carer quality of life - Greater uptake of preventative services
8. Increase proportion of people in receipt of personalised budgets
- Patient quality of life
Self-Management
9. Improved patient and carer experience
Assessments
More residents are able to manage their conditions by themselves or with reduced support.
10. Increased quality of life for carers (ASCOF)
Residents are assessed in a joint manner and have more holistic care plans.
- Increase of services that enable residents to manage conditions at home
[1] http://www.nationalvoices.org.uk/defining-integrated-care
- Increase in Joint Assessments
- Increased supported housing/personal budgets/direct payments
- Increase in Joint Care Plans
- Reduced re-admissions
QIPP
Front Door/Community Services
Services are able to demonstrate Quality, Innovation, Productivity and/or Prevention savings across the Health Economy.
Fewer residents are entering the front door into health and social care settings and more are receiving support through community services.
- Increase in the use of Universal Services
- Reductions in NELs/GP Appointment/A&E Attendances
- Reduced demand for social care services
Appropriate Provision of Care
From the outset residents receive a level of support that is appropriate to their needs.
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Appendix 2 – Analysis of elements of the 8 changes of the High Impact Change Model and implementation plan
Change 1: Early discharge planning. In elective care, planning should begin before admission. In emergency/unscheduled care, robust systems need to be in place to develop plans for management and discharge, and to allow an expected dates of discharge to be set within 48 hours.
Not yet established Plans in place Established Mature Exemplary
Early discharge planning in the community for elective admissions is not yet in place.
CCG and ASC commissioners are discussing how community and primary care coordinate early discharge planning.
Joint pre-admission discharge planning is in place in primary care.
GPs and DNs lead the discussions about early discharge planning for elective admissions.
Early discharge planning occurs for all planned admissions by an integrated community health and social care team.
Discharge planning does not start in A&E.
Plans are in place to develop discharge planning in A&E for emergency admissions.
Emergency admissions have a provisional discharge date set within 48 hours.
Evidence shows n% patients go home on date agreed on admission.
Change 2: Systems to monitor patient flow. Robust patient flow models for health and social care, including electronic patient flow systems, enable teams to identify and manage problems (for example, if capacity is not available to meet demand), and to plan services around the individual.
Not yet established Plans in place Established Mature Exemplary
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No relationship between demand and capacity in care pathways.
Analysis of demand underway to calculate capacity needed for each care pathway.
Policy agreed and plan in place to match capacity in care pathway demand.
Capacity usually matches demand along the care pathway.
Capacity always matches demand along the whole care pathway.
Capacity available not related to current demand.
Analysis of demand variations underway to identify current variations.
Analysis completed and practice change rolled out across Trust and in community.
Capacity usually matches demand 24/7 to match real variation.
Capacity always matches demand 24/7 reflecting real variations.
Bottlenecks occur regularly in the Trust and in the community.
Analysis of causes of bottlenecks underway and practice changes being designed.
Analysis completed and practice changes being put in place and evaluated.
Bottlenecks rarely occur and are quickly tackled when they do.
There are no bottlenecks caused by process or supply failure.
There is no ability to increase capacity when admissions increase -- tipping point reached quickly.
Analysis of admissions variation ongoing with capacity increase plans being developed.
Staff understand the need to increase capacity when admissions increase.
Capacity is usually automatically increased when admissions increase.
Capacity is always automatically increased when admissions increase
Staff do not understand the relationship between poor patient flow and senior clinical decision making and support.
Staff training in place to ensure understanding of the need to increase senior clinical capacity.
Staff understand the need to increase senior clinical support when necessary.
Senior clinical decision making support is usually available and increased when necessary.
Senior clinical decision making support available and increased automatically when necessary to carry out assessment and reviews 24/7
Change 3: Multi-disciplinary/multi-agency discharge teams, including the voluntary and community sector. Coordinated discharge planning based on joint assessment processes and protocols, and on shared and agreed responsibilities, promotes effective discharge and good outcomes for patients.
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Not yet established Plans in place Established Mature Exemplary
Separate discharge planning processes in place.
Discussion ongoing to create integrated health and ASC discharge teams.
Joint NHS and ASC discharge team in place
Joint teams trust each others' assessments and discharge plans.
Integrated teams using single assessment and discharge process.
No daily MDT meeting in place.
Discussion to introduce MDTs on all wards with Trust and community health and ASC.
Daily MDT attended by ASC, voluntary sector and community health.
Integrated teams cover all MDTs including community health provision to pull patients out.
Integrated service supports MDTs using joint assessment and discharge processes.
CHC assessments carried out in hospital and taking 'too' long.
Discussion between CCG and Trust to establish discharge to assess arrangements.
Discharge to assess arrangements in place with care sector and community health providers.
CHC and complex assessments done outside hospital in people's homes/extra care or reablement beds.
Fully integrated discharge to assess arrangements in place for all complex discharges.
Change 4: Home first/discharge to access. Providing short-term care and reablement in people's homes or using 'step down' beds to bridge the gap between hospital and home means that people do no longer need wait unnecessarily for assessments in hospital. In turn, this reduces delayed discharges and improves patient flow.
Not yet established Plans in place Established Mature Exemplary
People are still assessed for care on an acute hospital ward.
Nursing capacity in community being created to do complex assessments in the community.
People usually return home with reablement support for assessment.
People return home with reablement support from integrated team.
All patients return home for assessment and reablement after being declared fit for discharge.
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People enter residential/nursing care too early in their care career.
Systems analysing which people can go home instead of into care - plans for self funder advice.
People usually only enter a care/nursing home when their needs cannot be met through care at home.
Most people return home for assessment before making a decision about future care.
People always return home whenever possible supported by integrated health and social care support.
People wait in hospital to be assessed by care home staff.
Working being done to identify homes less responsive to assess people quickly.
Care homes assess people usually within 48 hours.
Care homes usually assess people in hospital within 24 hours.
Care homes accept previous residents trusting trust/ASC staff assessment and always carry out new assessments within 24 hours.
Change 5: Seven-day service. Successful, joint 24/7 working improves the flow of people through the system and across the interface between health and social care, and means that services are more responsive to people's needs.
Not yet established Plans in place Established Mature Exemplary
Discharge and social care teams assess and organise care during office hours five days a week.
Plan to move to seven day working being drawn up
Health and social care teams working to new seven day working patterns.
Health and social care teams providing seven day working.
Seamless provision of care regardless of time of day or week.
OOHs emergency teams provide non-office hours and weekend support.
New contracts and rotas for health and social care staff being drawn up and negotiated.
New contracts agreed and in place.
New staffing rotas and contracts in place across all disciplines.
New staffing rotas and contracts in place and working seamlessly.
Care services only assess and start new care Monday to Friday.
Negotiations with care providers to assess and restart care at weekends.
Staff ask and expect care providers to assess at weekends.
Most care providers assess and restart care at weekends.
All care providers assess and restart care 24/7.
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Diagnostics, pharmacy and patient transport only available Mon-Fri
Hospital departments have plans in place to open in the evenings and at weekends.
Hospital departments open 24/7 whenever possible.
Whole system commitment usually enabling care to restart within 24hrs seven days a week.
Whole system commitment enabling care always to restart within 24hrs seven days a week.
Change 6: Trusted assessors. Using trusted assessors to carry out a holistic assessment of need avoids duplication and speeds up response times so that people can be discharged in a safe and timely way.
Not yet established Plans in place Established Mature Exemplary
Assessments done separately by health and social care.
Plan for training of health and social care staff.
Assessments done by different organisations accepted and resources committed.
Discharge and social care teams assessing on behalf of health and social care.
Integrated assessment teams committing joint pooled resources.
Multiple assessments requested from different professionals.
One assessment form/system being discussed.
One assessment format agreed between organisations/professions.
Single assessment in place. Resources from pooled budget accessed by single assessment without separate organisational sign-off.
Care providers insist on assessing for the service or home.
care providers discussing joint approach of assessing on each other's behalf.
Care providers share responsibility of assessment.
Some care providers asses son each other's behalf and commit to care provision.
Single assessment for care accepted and done by all care providers in the system.
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Change 7: Focus on choice. Early engagement with patients, families and carers is vital. A robust protocol, underpinned by a fair and transparent escalation process is essential so that people can consider their options, the voluntary sector can be a real help to patients in considering their choices and reaching decisions about their future care.
Not yet established Plans in place Established Mature Exemplary
No advice or information available at admission.
Draft pre-admission leaflet and information being prepared.
Admission advice and information leaflets in place and being used.
Patients and relatives aware that they need to make arrangements for discharge quickly.
Patients and relatives planning for discharge from point of admission.
No choice protocol in place. Choice protocol being written up or updated to reduce < seven days.
New choice protocol implemented and understood by staff.
Choice protocol used proactively to challenge people.
All staff understand choice and can discuss discharge proactively.
No voluntary sector provision in place to support self-funders.
Health and social care commissioners co-designing contracts with voluntary sectors.
voluntary sector provision in place in the Trust proving advice and information.
Voluntary sector provision integrated in discharge teams to support people home from hospital.
Voluntary sector fully integrated as part of health and social care team both in the Trust and the community.
Change 8: Enhancing health in care homes. Offering people joined-up, coordinated health and care services, for example by aligning community nurse teams and GP practices with care homes, can help reduce unnecessary admissions to hospital as well as improve hospital discharge.
Not yet established Plans in place Established Mature Exemplary
Care homes unsupported by local community and primary care.
CCG and ASC commissioners working with care providers to identify need.
Community and primary care support provided to care homes on request.
Care homes manage the increased acuity in the care home.
Care homes integrated into the whole health and social care community and primary care support.
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High numbers of referrals to A&E from care homes especially in evenings and at weekends.
Specific high-referring care homes identified and plans in place to address.
Dedicated intensive support to high referring homes in place.
No unnecessary admissions from care homes at weekends.
No variation in the flow of people from care homes into hospital during the week.
Evidence of poor health indicators in CQC inspections.
Analysis of poor care identifies homes where extra support and training needed.
Quality and safeguarding plans in place to support care homes.
Community health and social care teams working proactively to improve quality in care homes.
Care homes CQC rates reflect high quality care.
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High Impact Change/Lead
Commissioner Key Services
Where Are You
What Do You Need to Do
When Will it Be Done By
How Will You Know it is Successful
Early discharge planning.
Camden Adult Social Care Hospital based social work team (BCF) Primary Care (elective admissions) RFH UCLH Hospital MDT's
Plans are in place to develop discharge planning in A+E for emergency admissions. Discussion needed across CHINS re elective admissions
Early discharge planning occurs for all admissions by an integrated community health and social care team approach.
Mar-18 1.Reduction in hospital bed days and residential care admissions 2. Reduction in readmission rates for same condition within 6 months 3. Community support package reviewed to monitor changing needs
Systems to monitor patient flow.
Nurse tracker(UCLH=BCF) Nurse Tracker CNWL SHREWD
Analysis of cause of blockages underway and practice changes being designed to improve patient pathway
The patient flow system is live and multi-agency to include social /community care capacity element. Need to allocate local authority responsibility for updating system
Mar-18 1. Reduced DToCs - meet targets/achieve trajectory
UCLH Clinical utilisation review
2. Reduced readmissions as a result of deterioration 3.Improved patient satisfaction
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Multi-disciplinary multi-agency discharge teams.
MDT Social workers(BCF); GP based social workers(BCF); Reablement(BCF); Enhanced Homecare and DN(BCF & LBC /CCG contracts);Red cross home from hospital(BCF)
MDT hubs hold weekly discussions on complex case management
Fully Integrated health and social care response that makes effective use of community resources available
Mar-18 Patient telling the story once, contributing to a quick and seamless discharge process
Home first/Discharge to assess.
Adult Social Care Complex Assessment beds(BCF) Assessment flats(BCF) Enhanced reablement service(BCF) Carelink(BCF) REDS Single Point of Access
Pilot 'Discharge to assess' model implemented with UCLH from June 2017. 30 patients discharged to date. PDSA approach to learning. Plan roll out all pathways by Nov 1st.
Implement the agreed de-commissioning of BCF funded 10 step down beds with re-investments into D2A Pathways 1 ,2 & 3
Nov-17 Patients return to own home in shorter timeframe with additional community clinical support and GP monitoring as required
Seven-day services.
Hospital based social work team (BCF) St Pancras Rehabilitation Unit Stroke Early Supported Discharge Integrated Community Teams
7 day working from social workers based in RF and UCLH.Home care support packages available with 48 hours notice
Integrated 7 day working from statutory and commissioned services which ensures a timely response to reduce length of hospital stays as a result of reviewing contract specifications
Mar-18 Equity of service response across 7 days/52 weeks per year that is personalised to individual need
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Trusted assessors
Adult Social Care Assessment for transfer into in-patient rehabilitation beds Admission/return to care homes
Assessments done separately by health and social care for restarts of care. Tracker nurses in place at UCLH and St Pancras rehab unit
Trusted assessors assessing for restarts of care packages. Work with NCL sector to develop the role within care homes
Nov-17 Reduced duplication of information , and improved assessment response times and support package implementation
Focus on choice
Care Navigation (BCF) CPPEG
Admissions advice leaflet in place but not used universally
Voluntary sector support available in planning for discharge and patients and relatives fully informed in service options. Choice policy needs updating
Mar-18 Patients feel fully informed and support from point of admission to returning home
Enhancing health in care homes
GP LES (BCF) GP enhanced service providing dedicated advice and assessment in care home settings across Camden
Review effectiveness of provision to ensure availability and quality in all settings
Apr-18 Improved health promotion in residential care and reduced A & E attendances.
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Appendix 3
Corporate Risk Log (CCG)
Risk Controls in place Evidence of
Controls
Consequence (C
urre
nt)
Lik
elih
ood (C
urre
nt)
Ratin
g (C
urre
nt)
Ris
k le
vel (C
urre
nt)
Controls Needed Actions Update on Actions
Consequence (T
arg
et)
Lik
elih
ood (T
arg
et)
Ratin
g (T
arg
et)
Ris
k le
vel (T
arg
et)
BCF Performance (Threat) Cause: If the Better Care Programme is not sufficiently focused on service provision that aims to improve performance against the BCF programme metrics. Effect: There is a risk that programme will fail to meet the targets set in relation to each metric. Impact: This could lead to an impact on the care for patients and potentially NHS England initiating an Escalation Process
C1. The findings from the reviews was reported to the Joint Commissioning Committee in October. C2. Review of the BCF initiatives presented to Commissioning Committee in November. C3. A paper on the BCF was presented to the June Integrated Commissioning Committee. C4. A paper on the BCF was presented to the July Integrated Commissioning Committee. C5. A draft expenditure plan and scheme level performance against metrics was reported to the ICC in August.
C1. Paper for October JCC C2. Paper to November Commissioning Committee C3. Paper and Minutes from the June Integrated Commissioning Committee. C4. Paper and Minutes from the July Integrated Commissioning Committee. C5. Report and minutes from the August Integrated Commissioning Committee
4 3 12
Mo
dera
te
CN1. Future investment - service needs to focus on the metrics (assessment of viability needs to meet the metrics) CN2. Robust business cases that measure the impact and how its going to be measured and monitored are now being developed CN3. Service reviews - each service reflects the delivery of the BCF. A review template has been developed and a programme of reviews scheduled to the ICC.
A1. Planning for BCF in 2017/18 is underway A2. Confirm savings for 2017/18 BCF schemes
As part of the 2017 - 2019 planning round, planning for the BCF submission is underway. Draft expenditure plans for 17/18 which include scheme level performance against national metrics where applicable have been scruntinised by the ICC in May, June and August and the Governing Body in July to date. Schedule of service reviews underway with objective to review suitability for inclusion within BCF of all schemes where impact on national metrics is indirect or not currently evidenced. Findings will be reported to ICC in due course.
4 2
8
Mo
dera
te
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Impact on BCF Finance 2017/18 (Threat) Cause: If the Local Authority and Camden CCG want to use this years reserves to cover their core budgets Effect: There is a risk that this will put pressure on the Better Care Fund Budgets Impact: Which may lead to the programme not being able to achieve its aims and performance targets being missed.
C1. An evaluation of the BCF services took place and was presented to the JCC in June 2016 C2. A BCF evaluation workshop with key stakeholders, led by Nuffield Trust, was held on 01 September 2016 to better understand the impact of BCF schemes. C3. The findings from the reviews was reported to the Joint Commissioning Committee in October. C4. A paper on the BCF was presented to the June Integrated Commissioning Committee. C5. A paper on the BCF was presented to the July Integrated Commissioning Committee.
C1. Reviews presented to JCC C2. Workshop presentation and slides C3. Paper for October JCC C4. Paper and Minutes from the June Integrated Commissioning Committee. C5. Paper and Minutes from the July Integrated Commissioning Committee.
4 3 12
Mo
dera
te
CN1. Proposals for utilising this year's reserves need to be focused on BCF aims and metrics performance improvement. CN2. Proposals need to have evidenced QIPP savings that can release funding from elsewhere in the system. CN3. Recurrent funding, for those proposals that require it, needs to be identified for 2018/19.
A1. List of proposals for new bids is in development. A2. Confirm savings for 2017/18 BCF schemes
Proposals that measure impact against metrics, alignment with interdependent plans and options for CCG funded services that could be legitimately supported by BCF to support the CCG’s QIPP plan will be approved by LB Camden and CCG finance leads prior to ratification by ICC.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Finance Report
Agenda Item 4.1
Date of Report 26/10/2017
Lead Director Becky Booker, Deputy Chief Finance Officer
Tel/Email [email protected]
Report Author Becky Booker, Deputy Chief Finance Officer
Tel/Email [email protected]
Sponsor(s) (where
applicable) Simon Goodwin Chief Finance Officer
Tel/Email [email protected]
Report Summary This report sets out the CCG’s financial position at the end of month 6 and the latest position with regard to QIPP.
Purpose (tick one
only)
Information Approval To note
Decision
Recommendation The Governing Body is asked to note the contents of this report.
Strategic
Objectives Links
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for money services.
Identified Risks
and Risk
Management
Actions
This report sets out the financial risks and opportunities for 2017/18.
Resource
implications
This report sets out the CCG’s financial position at the end of September 2017
together with the forecast spend for the year.
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
Not applicable for the purpose of this report.
Report History The Governing Body receives regular Finance and QIPP updates.
Next Steps Continued oversight by the Finance and Performance Committee.
Appendices None
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Camden Clinical Commissioning Group (CCG)
Finance Report: 1 April 2017 to 30 September 2017 (Month 6)
1. Introduction
1.1 This paper presents to the Governing Body of Camden Clinical Commissioning Group the finance and
performance position as at 30 September 2017.
2. Executive Summary
2.1 The month 6 financial performance can be summarised as follows:
Table 1: Financial Performance Summary
2.2 As at month 6 the CCG is forecast to meet its control total of £407.8m as the end of the 2017-18 financial
year.
2.3 Within the control total of £407.8m the Camden CCG is forecasting a year end position of £5.6m over-
performance. This is due to over-performance of acute £3.6m, non-acute, £1.7m and investments £0.3m.
The year to date financial position is reporting an over-performance of £0.6m. Over-performance is
contained within the control total by use of contingencies and non-recurrent reserves.
2.4 The most significant points to note include:
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2
There has been an improvement of approx. £0.6m in the forecast year-end position in the acute
contracts between the month 6 over-performance of £3.6m compared to the month 5 over-
performance of £4.2m
The main areas of over-performance in the acute sector are Royal Free, £4m and Imperial College
£1m and UCLH £0.6m
The acute forecast position includes adjustments for achievement of QIPP and marginal rate benefits
The non-acute position has an increase in over-performance of approx. £0.8m from between the month
6 position of £1.7m compared to the month 5 position of £0.9m over-performance. This movement is
due to an increase in Continuing Healthcare (CHC) services
At month 6 Camden CCG is reporting a balanced Primary Care commissioning budget. The 2017-18
annual allocation for this service is £36.2m net, with a budget requirement of £38.3m, resulting in an
in-year pressure of £2.1m. This pressure is being managed by a combination of Primary Care non-
recurrent reserve and contingency £0.6m and (subject to Governing Board approval) £1.5m managed
at STP level
Financial risks and mitigations are detailed in section 8. A net financial risk recovery plan of £4.5m is
being developed and implemented to proactively manage potential unmitigated financial over-
performance. This is being monitored through the Finance and Performance Committee
The control total has been met by use of reserves and contingencies that have been released to offset
CCG over-performance. The overheads and contingency budget of £12.5m is reporting an under-
performance of £5.6m
3. Acute Contracts
3.1 Acute contracts are forecast to over-perform by £3.6m at year end. The current year to date over-
performance is approx. £3m. Table 2 below shows the acute spend per provider. Where appropriate the
marginal rate and QIPP on acute contracts has been applied.
Table 2: Acute Expenditure
3.2 As at month 6 the YTD variance on the acute contracts is an over-performance of £3m, this is broadly in
line with the month 5 YTD which would indicate an improvement in the acute financial position. The month 6 reported year-end position is £3.6m, which is an improvement of £0.6m on the month 5 position of £4.2m.
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3
3.3 The over-performance in acute at month 6 are Royal Free £4m, and Imperial College £1m and UCLH £0.6m.
3.4 UCLH – There is over performance at POD level in non-electives £2.7m, outpatients £0.7m, maternity £0.2m which has been offset by under performance in electives £0.8m, diagnostic imaging £0.2m and critical care £0.1m. The underlying over performance has been offset by marginal rate £0.6m and STP QIPP £1.5m.
3.5 Royal Free – The underlying over performance is £9.2m before marginal rate and STP QIPP has been applied. The Royal Free has made significant changes to the POD plans resulting in changes in drivers of in-month movement. Approximately 40% of the over-performance relates to a technical coding change as a result of diagnostic unbundling. Partnership work is underway to manage improve performance.
3.6 Imperial college - The large over performance relates to non-electives particularly within in general medicines and paediatrics.
Table 3: Expenditure at POD Level
3.7 Table 3 above highlights the acute expenditure at point of delivery (POD) level. The main driver of the
over performance at POD level is non-electives £5.8m and diagnostic imaging £1.7m slightly offset by an
under spend in electives of £1.2m. The below table 4 details the main acute providers by POD.
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4
Table 4: Expenditure at POD Level by Trust
4. Non-Acute Contracts
4.1 As at month 6 non-acute is forecasting a year-end over-performance of £1.7m and a year to date over-performance of £0.4m. This is a deterioration of £0.8m on the reported month 5 position of £0.9m. Table 6 below provides a summary of the month 6 non-acute performance.
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5
Table 6: Non-Acute Expenditure
4.2 The reason for this movement is due to an £0.8m increase in Continuing Healthcare. This increase in
costs is in part due to the financial impact of implementing the London Living Wage in the homecare contracts and an increase in fast track placements. In addition to this reported over-performance, there are additional financial risks associated with this service.
4.3 The Primary Care (LCS) budget is reporting an over-performance £150k. This will be resolved during
month 7 when the budget is due to increase.
4.4 There is over-performance in Mental Health services being £0.2m in non-contracted activity (NCA) in the independent sector and Children’s Services, £0.4m in relation to personal health budgets (PHB).
4.5 The other service budget mainly relates to learning disabilities, older people, physical disabilities and
sexual health services. The £0.1m over-performance relates to learning disabilities s.256 service. 4.6 A recovery plan is currently being developed and implemented to address the over-performance in non-
acute contracts.
5. Delegated Primary Care Commissioning
5.1 The 2017-18 Camden CCG allocation for delegated primary care commissioning is £36.8m. The budget
requirement is £38.3m. Table 7 provides a summary of the delegated primary care commissioning
budget to expenditure. As at month 6 this service is reporting a balanced budget. In 2017-18, subject to
Governing Body approval, the financial management of this budget is across the STP footprint to deliver
a balanced budget.
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6
Table 7: Delegated Commissioning
6. Other Budgets
6.1 The investment programme, which includes programmes to support delivery of QIPP and other benefits
to the CCG is forecasting an over-performance of £0.3m against an annual budget is £7.7m. The main driver for this is investment in IT. A recovery plan is being implemented.
6.2 Running costs and overheads are forecast to deliver on target. Included in the running costs are
charges from CSU c£2m, estates charges for the offices £0.2m and staffing cost c£2.4m.
6.3 At month 6 the year to date staffing costs are showing a small over-performance of £0.03m (1%). The
2017-18 agency spend continues to decrease on 2016-17 agency spend.
7. QIPP
7.1 The total net 2017-18 QIPP plan is £18m. As at month 6 the year end performance is estimated to be
£17m, an underperformance on QIPP of £1.2m. There has been no movement in QIPP forecast from
month 5. Work is ongoing to mitigate under-performance.
Table 9: QIPP Summary
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7
8. Risks and mitigations
8.1 The below table 10 provides details of the financial risks and mitigations as at month 6. A recovery plan
is being developed and implemented to proactively manage the net risk position of £4.5m.
Table 10: Risks and Mitigations
Risks - events that may happen which have not been built into expenditure plans
Full risk value
(£’000)
Probability of risk realised
Potential risk value (£’000)
QIPP slippage 4,800 60% 2,880
Continuing Healthcare 1,300 75% 975
Delegated Primary Care commissioning * 2081 100% 2081
Acute contracts over performing 6,796 75% 5,097
LCW contingency 200 100% 200
TOTAL RISKS 15,177 11,233
Opportunities / Mitigations
Full mitigation
value (£,000)
Probability of mitigation success
Expected mitigation
value (£,000)
Non-recurrent reserves** -4,300 100% -4,300
Use of CCG contingency -1,838 100% -1,838
Delegated Primary Care non-recurrent reserve -368 100% -368
Delegated Primary Care contingency -184 100% -184
TOTAL MITIGATION -6,690 -6,690
NET RISK / (HEADROOM) - Forecast likelihood of risks and mitigations being achieved 4,543
BEST CASE - No risks materialise and uncommitted reserves and contingency available -6,690
9. Conclusion
9.1 As at month 6 Camden CCG is reporting to meet its 2017-18 control total of £407.8m. Within this the
CCG is proactively managing potential financial over-performance.
9.2 The most significant areas of risk are QIPP slippage, acute contract over-performance and the
Continuing Healthcare service.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Development of the Operational Plan for 2018/19
Agenda Item 4.2
Date 11 October 2017
Lead Director Rebecca Booker Deputy Chief Finance Officer
Tel/Email [email protected]
Report Authors Nathan Lambert PMO Business Manager
Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Sarah Mansuralli Chief Operating Officer
Tel/Email [email protected]
Report Summary
This paper provides a summary of the progress made with regard to the planning process for 2018/19.
Purpose (tick one
box only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the process in place for developing the 2018/19 operational plans.
Strategic
Objectives Links
Objective A – Commission the delivery of NHS constitutional rights and pledges. Objective G - Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for-money services.
Identified Risks
and Risk
Management
Actions
Risks may arise from differences from the current plan. This risk is mitigated by partnership working across NCL CCGs and by Camden CCG planning arrangements and the review of current activity in order to understand any potential variations.
Conflicts of Interest
No conflicts of interest identified.
Resource
Implications
The financial assumptions will be detailed within the aligned Finance plan for
Camden CCG.
Engagement
The regular Planning meetings allow for wide engagement during the operational planning timetable.
Core Planning Team
NCL Planning Leads meeting
Equality Impact
Analysis
The areas identified within the document have been identified as those that will
deliver the greatest health benefits and tackle inequalities within the borough.
Report History
The Finance and Performance Committee considered the process for
developing the 2018-2019 Operational Plan at their October 2017 meeting.
Next Steps Continue to develop QIPP Plans to inform the Contract discussions, the Finance Plans and to understand any activity reductions.
Undertake a review of Activity and Performance and identify and understand the impact and differences on the current 2018/19 Plans.
Following this work, re-submit the 2018/19 plan if appropriate.
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Development of CCG Operational Plans for 2018/19
Background Following the NCL Planning Leads meeting on 6th October 2017, advise was sought from NHSE (London), to clarify the approach to Planning & Contracting for 2018/19, given we are in a 2-year contracting approach with providers in NCL, as per the NHSE planning & contracting guidance 2017-2019. This report provides an update to the Finance and Performance Committee on the 2018/19 planning assumptions as at October 2017. Please note that these may be subject to change. NHS England / NHS Improvement - NHS Operational Planning and Contracting Guidance for
2017-2019
The national guidance sets out how the NHS operational and planning processes would support delivery of Sustainability and Transformation Plans and financial sustainability in the NHS. The guidance set out the financial and business rules for both 2017/18 and 2018/19. The guidance indicated that:
There needed to be a radical change in the behavioral dynamics of planning and contracting towards a more collaborative process;
This would be underpinned by simplified approaches to contracting and flexibility in implementing strategies;
Partnership working would be incentivised by a number of funding streams available at a Sustainability and Transformation Plan (STP) level;
Local health economies with robust STPs could adopt system control totals for finance, providing transparent opportunities for the sharing of risk.
Work by commissioners and providers on the contract round for 2017 to 2019 made progress on the above. NCL Contract requirements for 2018/19
The two-year contracts for 2017/18 and 2018/19 were signed in December 2016. Whilst there are no major national contract adjustments anticipated at this stage there are key contract terms that will require local negotiation and agreement to underpin the second year of the contract (2018/19). Contracts signed in December 2016 provided for negotiation and agreement of contract baselines for 2018/19. This is built into the planning timetable for developing plans for 2018/19. Contract baselines for 2018/19 will be reflective of the run-rate (outturn) for 2017/18 adjusted for growth and the impact of the Sustainability and Transformation Plan and QIPP interventions. A joint approach between commissioners and providers to the planning round for 2018/19 is being developed through the Finance and Activity Modelling (FAM) group established as an enabler for delivery of the Sustainability and Transformation Plan. It should also be noted that plans for 2018/19 will need to respond to any emerging national policy and associated planning guidance. NHS England (London) Draft Planning & Contracting Principles for 2018/19 NHSE (London) have shared the draft principles for the 2018/19 planning and contracting round which they are working to in London. The draft principles may change subject to input from the national team. These draft principles are:
No re-opening of contract round for 2018/19 – STPs should have agreed a clear and simplified process for aligning 2017/18 activity/ financial forecasts into 2018/19 baselines,
Notified Control totals remain in place,
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STPs should have activity/financial processes in place into which CCGs/ Trusts triangulate. Triangulation should be managed and resolved at STP level,
CEP plans will continue to be needed for those STPs where control, totals are not met in individual organisations- STPs to demonstrate how other organisations can help,
Transparency on normalised/ run rate positions for 2017/18 and 2018/19 and significant progress on resolving triangulation issues expected,
Capability to revise activity baselines for under/ over activity,
Evidence of continuous working through 2-year QIPPs and CIPs with ownership/alignment of these across the STP and impact on commissioning intentions clearly understood,
Clear risk share arrangements in place,
Consideration of enabling criteria to define potential ACS pilots in London and potential “system level” CTs,
Aligned Communications to CCGs and providers critical, The position from NHSE is that we are in a two year planning round so the plans are set for next year and shouldn’t be reopened without significant justification. There are two areas that may lead to a resubmission. These are either a:
significant FOT variance to plan or
change to the contracting model NHSE are working to an end of March 2018 deadline as this will give them a better sense of whether the FOT is significantly different to plan to justify a change to the Operating Plans. Approach for 2018/19 There is concern that due to data issues at RFL and UCLH then there is likely to be a significant FOT variance for 2017/18 both for Camden CCG and the other NCL CCGs. The work underway in developing and aligning Acute QIPP plans informed by the STP workstreams with a focus on UEC, Planned Care and Health and Care Closer to Home could impact on the current plan for 2018/19. The expectation is that there will be changes to the activity reductions in 2018/19, compared to the existing plan assumptions, informed by the work currently being undertaken. In order to ensure NCL CCGs coordinate development of their operational plans 2018/19 it is proposed that the initial assumptions should be consistent across all CCGs. In order to develop a consistent approach, NCL CCGs require the NELCSU BI Team to lead on the production of the activity data for all PODS which will include the following:
Growth (Demographic and Non Demographic)
Forecast Outturn 2017/18
Planned shifts in activity
Service transfers, etc.
Input from contract negotiations
Agreed STP impact on Finance and Activity, including impact of Acute QIPP Plans 18/19 Indicative Timeline for NCL CCGs to develop plans for2018/19 At this stage it is not clear whether we will need to resubmit the Operating Plan but due to the current data issues and all of the work currently taking place regarding 2018/19 QIPP plans this could see differences from the current plan for 2018/19. Below is the indicative timetable for the next 6 months
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DATE ACTION
3rd - 24th October 2017 Development of initial NCL Acute QIPP plans 18/19
25th October - 7th November 2017 Alignment and Triangulation (UEC, Planned Care and HCCH) with NCL CCGs to identify gaps, duplications, opportunities to work at scale
8th– 28th November 2017 Finalise QIPP Plans –align Acute QIPP and CCGs QIPP Plans and incorporate finance, activity and investment modelling
Inform Contract negotiation with NCL providers
Inform NCL CCG’s Draft Operational Plan
29th November -15th December 2017
QIPP Plans sign-off (each CCG and STP workstream boards, HCC, FAM and PDB)
January-March 2018 Review of Activity and Performance and identify and understand the impact and differences on the current 2018/19 Plans.
April 2018 Potential revised Op Plan submission to NHSE
2018/19 Financial Planning As at October 2017 financial planning guidance and has not been issued. Financial planning is underway across the STP with all CCGs using standard planning assumptions. The initial draft has been completed and work is underway to review and update these. Camden CCG’s 2018/19 programme recurrent allocation was confirmed as £355,453 during the five year allocation process announced in 2016-17. The programme allocation reflects a 0.1% increase on 2017/18 recurrent allocation of £355,250. The table below shows the growth the CCG will receive as a result of the Comprehensive Spending Review (CSR) from 2016/17 to 2020/21.
2016-17 2017-18 2018-19 2019-20 2020-21
Allocation £k 354,671 355,250 355,453 355,519 360,786
Allocation per capita £ 1,344 1,329 1,314 1,301 1,308
Growth 1.4% 0.2% 0.1% 0.0% 1.5%
£k change on previous year 4,859 579 203 66 5,267
The following business rules, announced in the 2017/18 planning guidance, have been applied to the CCG’s financial model:
As a minimum, to break-even in-year or achieve a 1% surplus
CCGs need to plan for a 1% non-recurrent reserve
CCGs also have to set aside a 0.5% contingency to manage in-year pressures and risks Camden CCG is working towards the initial allocation of £20m QIPP target for 2018-19. As previously highlighted this is expected to increase. The QIPP target must be achieved to meet the 2018-19 control total.
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Next steps
The next steps in the process are:
Refine the financial plan to revise the QIPP target
Continue to develop QIPP Plans to inform the contract discussions
Undertake a review of Activity and Performance and identify and understand the impact and
differences on the current 2018/19 Plans
Following this work, re-submit the 2018/19 plan if appropriate
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Integrated Performance Report
Agenda
Item
4.3
Date 26/10/2017
Lead Director Charlotte Mullins, Director Sustainable Insights
Tel/
Report Author Richard Cartwright Head of Performance
Tel/
Sponsor(s) (where
applicable) Dr Birgit Curtis Tel/
Report Summary The Integrated Performance Report reports on provider performance against the constitutional targets, financial performance, quality and outcomes. The report also highlights the performance management of CCGs using the CCG Improvement and Assessment Framework which reports on performance against six clinical priority areas.
Purpose (tick one
only)
Information Approval To note
Decision
Recommendation The Governing Body is asked to note the contents of the October 2017 Integrated Performance Report.
Strategic
Objectives Links
Commission the delivery of NHS Constitutional rights and pledges Improve the quality and safety of commissioned services
Identified Risks
and Risk
Management
Actions
These are identified within the report.
Resource
Implications
Not applicable for the purpose of this report.
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
Not applicable for the purpose of this report.
Report History This report is a standing item on the Governing Body agenda.
Next Steps None
Appendices None
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Integrated Performance Report
October 2017
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Contents
DESCRIPTION PAGE
1 Access -
1.1 Operating Plan Targets 3
1.2 Provider Access Targets 4
1.3 UCLH Cancer Vanguard 5
1.4 NCL Winter Planning 6 - 7
1.5 Demand Management 8 - 9
1.6 Delayed Transfers of Care (DTOCs) 10 - 12
1.7 CNWL Access 13
1.8 LAS Access - New Response Time Standards 14
2 Commissioned Services Register Monitoring 15
3 Quality -
3.1 Serious Incidents 16
3.2 Complaints and Friends & Family Test 17
4 Activity -
4.1 Performance against Operating Plan 18
4.2 QIPP Plan 2017/ 19 19 - 20
5 Finance 21
6 Improvement & Assessment Framework -
6.1 2016/17 Year End Rating & Clinical Priority Areas 22
6.2 Dashboard - Four Domains 23
7 Quality Premium -
7.1 2016/17 Quality Premium – internal assessment 24
7.2 2017/18 Quality Premium 25
8 Workforce 26 - 27
9 Glossary 28
Appendices A - Population Health 29 - 30
B - Commissioned Services Register Sep. Attachment10
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Key messages:
• Cancer waiting times and A&E 4 hour waits remain the key areas of concern and focusfor the CCG.
• The CCG did not meet the diagnostics standard in August with 91 patients waiting forover six weeks. Two-thirds of these patients were waiting at Royal Free with CT (28) andEchocardiography (26).
• In September London was ranked 3rd of the four regions for A&E performance for themonth with 16 of 22 Trusts not achieving the 95% standard. In North Central London inAugust Moorfields was the only Trust to achieve the 95% standard. A&E performance atboth UCLH and Royal Free is reflective of the regional and national position.
• Cancer 62 day performance reflects for Camden reflects non-compliance of the standardat UCLH and Royal Free.
• August RTT performance for Camden was impacted by both Royal Free and UCLH notmeeting the standard.
• The CCG is working with acute providers to ensure that sufficient capacity of e-referralslots are made available, and with primary care colleagues to ensure the system is beingutilised where appropriate.
• Camden’s local data shows that the IAPT recovery rate has been delivered in 9 of the last 10 months. Numerous actions are being taken to address the data discrepancies, and the data shows that the difference between local and national data is reducing.
• LAS response time targets will be changing. A summary of the new standards can befound in page 11 of this report.
1. Access
1.1 CCG Operating Plan Targets
Camden CCG 2017/18 Performance Scorecard
Target/
Threshold
RTT Incomplete Pathways within 18 Weeks 92% Aug-17 91.4% 92.5%
RTT 52+ week waiters 0 Aug-17 6 24
Diagnostics Diagnostics - 6+ week waiters 99% Aug-17 98.0% 98.8%
A&E 4 Hour Waits 95% Sep-17 87.0% 89.1%
Delayed Transfers of Care - Acute - Aug-17 303 1797
Delayed Transfers of Care - Non-Acute - Aug-17 220 821
Total delayed days per 100,000 18+ population- Aug-17 245 n/a
2 week wait 93% Aug-17 92.1% 93.2%
2 week wait breast symptomatic 93% Aug-17 94.8% 95.0%
31 day 1st definitive treatment 96% Aug-17 95.3% 94.6%
31 day 1st subsequent treatment - surg. 94% Aug-17 100.0% 97.7%
31 day 1st subsequent treatment - chemo. 98% Aug-17 100.0% 100.0%
31 day 1st subsequent treatment - radio. 94% Aug-17 94.7% 97.4%
62 day standard 85% Aug-17 73.1% 75.3%
62 day standard - screening 90% Aug-17 100.0%
62 day standard - upgrade No Target Aug-17 100.0% 99.0%
Mixed Sex Mixed Sex Accommodation Breaches 0 Aug-17 6 17
MRSA Reported Cases (CCG Assigned) 0 Aug-17 0 1
C.Difficile Reported Cases Aug-17 5 31
Cat A (RED1): Response within 8 Min 75% Aug-17 86.2% 81.8%
Cat A (RED2): Response within 8 Min 75% Aug-17 81.3% 78.8%
Cat A: Response within 19 Min 95% Aug-17 95.3% 94.6%
Cat A (RED1) Trajectory - Aug-17 75% 6%
Cat A (RED1): Response within 8 Min 75% Aug-17 74.4% 74.6%
Cat A (RED2): Response within 8 Min 75% Aug-17 72.0% 71.1%
Cat A: Response within 19 Min 95% Aug-17 94.4% 94.7%
CPA Follow-ups 95% 2017/18 Q1 98.4% 98.4%
IAPT Access 4% 2017/18 Q1 4.4% 4.1%
IAPT Recovery Rates (NB national data presented) 50% 2017/18 Q1 44.0% 43.1%
6 Weeks IAPT Waiting Times 75% Jul-17 89.0% 87.1%
18 Weeks IAPT Waiting Times 95% Jul-17 99.0% 98.5%
Dementia Diagnosis Rate 67% Aug-17 87.6% 87.4%
Psychosis (EIP) - 2 Week Wait, NICE approved package 50% Jul-17 100.0% 89.0%
Eating Disorders Waiting Times (4Wk Routine) 95% 2017/18 Q1 88.0% 88.0%
Eating Disorders Waiting Times (1Wk Urgent) 95% 2017/18 Q1 No activity No activity
New children and young people receiving treatment from
NHS funded community services30% 2017/18 Q1
Await MHSDS
V2 data, tbc
Await MHSDS
V2 data, tbc
Individual children and young people receiving treatment
by NHS funded community services30% 2017/18 Q1
Await MHSDS
V2 data, tbc
Await MHSDS
V2 data, tbc
Utilisation of e-RS booking
50% (April 2017)
80% (Oct 2017)Jun-17 42.0% 43.0%
Wheelchair
ServiceRTT Childrens Wheelchairs within 18 Weeks 100% 2017/18 Q2 90.9% 95.5%
PHBs per 100,000 GP registered pop.11.23 (2017/18 Q1) 2016/17 Q4
12.9
n/a
Camden CCG -
Current monthTrend
Camden CCG -
YTDTrend
e-RS
Personal Health
Budgets
Cancer - 31 day
Cancer - 62 day
HCAIAnnual
RTT
LAS
(Camden)
LAS
(London wide)
Mental Health
A&E
Indicator Type
Camden DTOCs
(days)
Cancer - 2
week
Reporting Period
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RTTUCLH became non-compliant in July against the 18 Weeks RTT standard for the first timesince 2014. Following the development of an RTT recovery plan which has been reviewed bythe CCG, the Trust is currently forecasting compliance with the RTT standard from January2018. Specialty level recovery trajectories will be closely monitored by the CCG and theissue managed inaccordance with the CCG’s performance management framework.Royal Free RTT performance is being managed by Barnet CCG.
DiagnosticsUCLH returned to compliance in the diagnostics standard in July, and is reporting a strongcompliant year to date position.Initial analysis suggests that the Royal Free Diagnostics position is driven by performance atthe Hampstead site, as EnfieldandBarnet CCGs performancehas not been impacted.
A&EA&E performance at UCLH for the year is currently at 89.7% which is below the 90% FYFV standard. This is driven by a combination of factors:• UCLH has the highest proportion of A&E attendances admitted in North East London,
reflecting the complexity of patients seen at the Trust. High attendances, with a high conversion rate for admission are driving bed occupancy.
• The Trust has reopened some of the UCLH tower beds which were closed due to nursing shortages which will had high occupancy rates in cancer and medical beds.
• The Trust is trialling the addition of an additional medial consultant 4-10pm when the department is busiest and most admissions occur. The Trust has vacancies for a number of middle grade ED doctors which has driven delays on some days.
Camden CCG reissued an A&E CPN for 17/18 to UCLH with the aim of improving performance. The urgent and emergency care RAP for UCLH was refreshed and contains various actions aimed at decreasing bed occupancy to 88% - the level at which the Trust would expect to regain compliance with the A&E target.Discharge to assess was launched in August and initially seems extremely positive in improving flow for patients who otherwise would have been in the system for a long time.
CancerThe 62 day standard at UCLH continues to be impacted by late referrals from other Trusts.UCLH is currently meeting the trajectory set in the RAP for internal performance (excludinginter-trust transfers). All Root Cause Analyses of 100+ day breaches will be reviewed byCQRG for any evidence of clinical harm or disease progression, on a monthly basis as per theguidance provided by NHSE. A second robot was brought into service at UCLH at the start ofSeptember which willpositivelyimpact Urology treatments andthe 31 day standard.
1. Access
1.2 Provider Access Targets
London A&E PerformanceIn September 2017 16 of 22 Trusts did not achieve the 95% standard. London was ranked 3rd of the four regions for the month.
UCLH and Royal Free 2017/18 Scorecard Royal Free YTD
Target/
Threshold
Reporting
PeriodPerformance Trend Performance Trend Performance Trend Performance Trend
RTT Incomplete Pathways 92% Aug-17 90.5% 91.3% 87.4% 89.8%
RTT 52+ week waiters 0 Aug-17 3 9 34 44
Diagnostics Diagnostics - 6+ week waiters 99% Aug-17 99.3% 99.4% 98.7% 99.1%
A&E 4 Hour Waits 95% Sep-17 88.0% 89.7% 82.9% 86.0%
A&E 12 Hour Waits 0 Sep-17 0 0 0 0
Delayed Transfers of Care (days) - Trust level - Aug-17 640 3750 757 4865
Delayed days per occupied beds % 2.5% Aug-17 4.9% 5.6% 8.9% 8.8%
2 week wait 93% Aug-17 93.8% 94.2% 92.3% 93.0%
2 week wait breast symptomatic 93% Aug-17 93.9% 92.9% 94.6% 93.7%
31 day 1st definitive treatment 96% Aug-17 93.8% 93.7% 98.3% 97.7%
31 day 1st subsequent treatment - surg. 94% Aug-17 97.8% 94.7% 97.6% 97.6%
31 day 1st subsequent treatment - chemo 98% Aug-17 99.7% 99.9% 100.0% 100.0%
31 day 1st subsequent treatment - radio 94% Aug-17 99.1% 99.4% 100.0% 100.0%
62 day standard 85% Aug-17 67.3% 66.1% 81.1% 81.6%
62 day standard - screening 90% Aug-17 72.7% 69.2% 94.6% 93.0%
62 day standard - upgrade 90% (UCLH) Aug-17 85.7% 83.8% 94.4% 89.8%
Mixed Sex Mixed Sex Accommodation Breaches 0 Aug-17 30 95 32 160
Cancelled Ops for non-clinical reasons rebooked
>28 days100% 2017/18 Q1 92.1% 92.1% 93.7% 93.7%
Urgent operation cancelled for the 2nd time 0 0 0 0 0
MRSA Reported Cases (Trust assigned) 0 Aug-17 0 1 0 2
C.Difficile Reported Cases Aug-17 6 27 5 32
Handover time over 30min of arrival 0 Sep-17 163 1042
Handover time over 60min of arrival 0 Sep-17 97 566
% of Data recorded electronically 90% Sep-17 92.9% 93.1% 89.0% 87.8%
VTE VTE Risk Assessed Admissions 95% Jun-17 95.2% 95.7% 95.7% 96.6%
SHMI Summary Level Hospital Mortality Indicator <100
April 2016 to
March 201677.7 n/a 88.0 n/a
RTT
UCLH UCLH YTD Royal Free
Indicator Type
A&E
DTOCs
Cancer - 2
week
Cancer - 62 day
Cancer - 31 day
Cancelled Ops
HCAI-
Ambulance
Handover
Jul-17 Aug-17 Sep-17
LONDON #REF! 91.1% 91.0% 90.2% 90.7% 89.4% 17.4% 10
North East London 89.9% 89.8% 89.1% 88.9% 88.5% 17.0% 5
BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 88.0% 86.2% 87.0% 84.3% 86.0% 19.7% 0
BARTS HEALTH NHS TRUST 88.4% 88.7% 86.6% 87.2% 85.5% 20.2% 0
HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 97.5% 96.1% 95.6% 94.6% 94.4% 18.2% 0
MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST 98.7% 98.1% 99.4% 97.6% 98.1% 3.0% 0
NORTH EAST LONDON NHS FOUNDATION TRUST 99.6% 99.8% 99.3% 99.1% 99.2% 0.0% 0
NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 81.9% 80.3% 85.8% 77.1% 82.5% 19.6% 2
ROYAL FREE LONDON NHS FOUNDATION TRUST 86.1% 88.7% 84.3% 90.5% 86.1% 20.5% 0
THE WHITTINGTON HOSPITAL NHS TRUST 92.2% 90.5% 89.9% 88.1% 88.9% 17.0% 3
UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 88.2% 88.9% 87.9% 89.0% 88.5% 22.1% 0
North West London 92.5% 91.6% 90.0% 92.6% 90.0% 13.9% 4
CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST 99.2% 99.6% 98.9% 99.9% 99.1% 0.0% 0
CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 95.4% 95.3% 93.7% 94.9% 92.1% 17.3% 0
HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST 99.9% 99.9% 100.0% 100.0% 100.0% 0.0% 0
IMPERIAL COLLEGE HEALTHCARE NHS TRUST 90.5% 88.8% 86.9% 89.3% 88.1% 17.9% 4
LONDON NORTH WEST HEALTHCARE NHS TRUST 88.0% 85.7% 81.4% 89.2% 83.7% 18.9% 0
THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 86.5% 88.2% 88.0% 87.5% 84.6% 15.1% 0
South London 90.9% 91.6% 91.3% 91.0% 89.7% 21.4% 1
CROYDON HEALTH SERVICES NHS TRUST 88.3% 90.1% 90.9% 92.2% 88.1% 21.6% 0
EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 95.2% 94.0% 95.2% 94.0% 95.3% 27.8% 0
GUY'S AND ST THOMAS' NHS FOUNDATION TRUST 83.4% 90.7% 91.9% 90.9% 87.8% 25.1% 0
KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 87.8% 86.2% 85.1% 85.3% 82.9% 20.5% 0
KINGSTON HOSPITAL NHS FOUNDATION TRUST 92.9% 91.3% 91.7% 92.8% 89.1% 24.4% 1
LEWISHAM AND GREENWICH NHS TRUST 91.8% 92.5% 89.9% 86.5% 87.4% 22.9% 0
ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 89.8% 90.0% 90.0% 90.5% 90.3% 32.0% 0
# delays >
12 hrs in
current
month
13 month
performance
Performance
(against 95% standard)
Current 12
month
rolling
perf
% A&E
attendances
admitted (12
month rolling)
Previous
12 month
rolling
perf
Jul-17 Aug-17 Sep-17
LONDON #REF! 91.1% 91.0% 90.2% 90.7% 89.4% 17.4% 10
North East London 89.9% 89.8% 89.1% 88.9% 88.5% 17.0% 5
BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 88.0% 86.2% 87.0% 84.3% 86.0% 19.7% 0
BARTS HEALTH NHS TRUST 88.4% 88.7% 86.6% 87.2% 85.5% 20.2% 0
HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 97.5% 96.1% 95.6% 94.6% 94.4% 18.2% 0
MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST 98.7% 98.1% 99.4% 97.6% 98.1% 3.0% 0
NORTH EAST LONDON NHS FOUNDATION TRUST 99.6% 99.8% 99.3% 99.1% 99.2% 0.0% 0
NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 81.9% 80.3% 85.8% 77.1% 82.5% 19.6% 2
ROYAL FREE LONDON NHS FOUNDATION TRUST 86.1% 88.7% 84.3% 90.5% 86.1% 20.5% 0
THE WHITTINGTON HOSPITAL NHS TRUST 92.2% 90.5% 89.9% 88.1% 88.9% 17.0% 3
UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 88.2% 88.9% 87.9% 89.0% 88.5% 22.1% 0
North West London 92.5% 91.6% 90.0% 92.6% 90.0% 13.9% 4
CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST 99.2% 99.6% 98.9% 99.9% 99.1% 0.0% 0
CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 95.4% 95.3% 93.7% 94.9% 92.1% 17.3% 0
HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST 99.9% 99.9% 100.0% 100.0% 100.0% 0.0% 0
IMPERIAL COLLEGE HEALTHCARE NHS TRUST 90.5% 88.8% 86.9% 89.3% 88.1% 17.9% 4
LONDON NORTH WEST HEALTHCARE NHS TRUST 88.0% 85.7% 81.4% 89.2% 83.7% 18.9% 0
THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 86.5% 88.2% 88.0% 87.5% 84.6% 15.1% 0
South London 90.9% 91.6% 91.3% 91.0% 89.7% 21.4% 1
CROYDON HEALTH SERVICES NHS TRUST 88.3% 90.1% 90.9% 92.2% 88.1% 21.6% 0
EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 95.2% 94.0% 95.2% 94.0% 95.3% 27.8% 0
GUY'S AND ST THOMAS' NHS FOUNDATION TRUST 83.4% 90.7% 91.9% 90.9% 87.8% 25.1% 0
KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 87.8% 86.2% 85.1% 85.3% 82.9% 20.5% 0
KINGSTON HOSPITAL NHS FOUNDATION TRUST 92.9% 91.3% 91.7% 92.8% 89.1% 24.4% 1
LEWISHAM AND GREENWICH NHS TRUST 91.8% 92.5% 89.9% 86.5% 87.4% 22.9% 0
ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 89.8% 90.0% 90.0% 90.5% 90.3% 32.0% 0
# delays >
12 hrs in
current
month
13 month
performance
Performance
(against 95% standard)
Current 12
month
rolling
perf
% A&E
attendances
admitted (12
month rolling)
Previous
12 month
rolling
perf
NCL A&E performance
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Delivering cancer 62 day performance is an absolute priority for UCLH, the Vanguard and North Central and North East London commissioners. The below information sets out to describe the workunderway within UCLH and across the system to deliver performance. This will be overseen by further strengthened commissioner governance, led at an NCL level.
Internal performance at UCLHUCLH have a recovery action plan (RAP) in place for cancer that is being actively managed by CCG and Trust. The plan was refreshed at the start of the financial year and signed off by Camden CCG. TheCCG and Trust undertook a pageturn of the plan with NHSI, TCST and IST colleagues in May 2017 in order to provide assurance that it was comprehensive.An external, clinically led review of cancer waiting times in the trust is currently underway. This will provide insight into the drivers of performance and give a set of recommendations pertaining toboth governance and operational delivery which will be built in to the existing RAP.
System performance and the role of the Vanguard and commissionersUCLH have not seen improvements in external performance owing to continued poor performance of 38 and 24 day pathways across the sector. The improvement work done to date through theVanguard, overseen by commissioning structures, has delivered notable improvements including delivery of urology and GI one-stop clinics at most NCL trusts. There is however more required todeliver performance improvements at the necessary pace.
Commissioners have strengthened leadership with the appointment of an NCL-wide director of performance who will have oversight of the wider system including an increased commissioner input intothe monitoring and scrutiny of PTLs and ITTs through weekly system monitoring. Commissioners will also take an active role in ensuring that the revised recovery plans are robust, and includedemandand capacity analysis and learning from breach root cause analysis.NCL and NEL systems have cancer performance Leadership groups in place and include dedicated senior support from commissioners and the Vanguard. These have been a positive vehicle to developsystem management with providers, backlog clearance and performance recovery. These meetings have just been escalated from fortnightly to weekly with an enhanced focus on return to compliancedates.The Vanguard is now working with NCL and NEL commissioners to take a much more strengthened and focused approach to ITT pathways. NCL commissioners will hold a series of focused meetingsbetween trusts involved in those pathways that are showing the most system breaches. Detailed action plans and trajectories will be developed from these, covering actions to deliver 38 and 24 dayperformance at each respective trust. The Vanguard will be able to support delivery of these and commissioners will hold trusts to account for delivery, and this will be done at a granular pathwaylevel. These will be key to UCLH’s recovery plan and compliance trajectory. Regulatory oversight of delivery on individual trust actions inthe plans has been sought from NHSI.The Vanguard has also taken steps to review governance, taking learning from other regions.
Recovery trajectory and return to complianceUCLH will revise the recovery action plan following receipt of the reports from the review. Alongside this, commissioners and UCLH will undertake the focused work on ITT referral pathways. On thebasis of these important pieces of work, a clear trajectory back to compliance and this is likely to be ready by mid-November.
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1.3 UCLH Cancer Vanguard
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Preparation has been undertaken to manage winter pressures across North Central London. This includes thepreparation of winter plans for each A&E Delivery Board to maximise hospital and community capacity at timesof peak demand. Within the winter plan for each A&E Delivery Board partner organisations have developedtheir own local escalation frameworks, triggers and action cards. The escalation frameworks cover both internalescalationwithin each organisation and across the A&E Delivery Boardaidat times of system surge.
Given the sustained pressure on the A&E waiting time standard during 2017 systems have been asked to:Develop further contingencyplans to manage periods of peak demand;Develop mutual aid proposals that work across A&E DeliveryBoards
Responseto this andincludes:- Flexing elective beds (not cancer) to provide more medicalbed capacity at times of escalation;- Converting medical consultant sessions in outpatients into inpatient sessions to provide additional seniorsupport to improve discharge as well as increasing senior medical capacity to respond to specialty referralsfrom the emergency department (ED);- At times of severe pressure surge to obtain support from registered nurses in the community for ED and alsoto have rapid response nurses being based inED;- The transfer of GP capacity from extended access hubs into local emergency departments. This could beconsidered to meet peaks indemandafter the bank holidays for Christmas and New Year;- The transfer of staff across hospital sites.
Alongside overall A&E performance the litmus tests for effectiveness of CCG and Social Care support withregulators will be:- The use of primary care hubs andredirectioninitiatives awayfrom A&E;- The reduction of delayed transfers of care and medically optimised patients to less than 5% of acute hospitalbed base;- Less than 15% of continuing healthcare (CHC) assessments being carried out in hospital beds (85% carried outin the community).
Priorities for 2017/18Guidance from NHS England and NHS Improvement indicates the following priorities for the remainder of2017/18:- Recovery of the A&E (95%) four-hour waiting time standard by March 2018, with performance over the wintertargeted to be the higher of 90% or performance in winter 2016/17 as part of recovery of the standard byMarch 2018;- Recovery of the cancer 62-daywaiting time standard(85%of treatments within 62 days of GP referral).- Performance andthe recoveryplan are covered inthe acute commissioning report by September 2017;- Meeting financial targets.
The priorities are consistent with the priorities for 2017/18 set out inthe refreshof the Five Year ForwardView.
1. Access
1.4 NCL Winter Planning
Current PerformanceHospital Trusts, with their aligned health and care community services, have been risk-rated by NHS England and NHS Improvement for resilience in delivering the A&E waiting time standard. The categorisation for North Central London is summarised below:
Interventions, and focus on performance and recovery plans, from NHSE and NHSI increase with each category. Escalation involves the A&E Delivery Board as performance is seen as a health and care system issue.
Urgent and emergency care structures in North Central LondonThe North Central London Urgent and Emergency Care Board and local A&E Delivery Boards are in place to manage and improve urgent and emergency care pathways in North Central London:
The NCL Urgent and Emergency Board has a strategic focus taking an overview of:- Delivery of service transformation interventions in the Sustainability and Transformation Plan workstream for urgent and emergency care;- System escalation - opportunities for broader system support across A&E Delivery Boards when particular hospital emergency departments are under extreme pressure;- High-level performance overview including delivery against High Impact Changes priorities in winter planning guidance.
National winter planning guidanceNHS England and NHS Improvement have been working together on the planning, preparations and management of winter. Dedicated teams are being established at a national and regional (for us London) level to co-ordinate delivery of winter plans and systems resilience. For London, a single winter team has been established across NHS England and NHS Improvement.
In North Central London The Surge Hub provided by Northeast London Commissioning Support Unit (NELCSU) co-ordinates escalation actions on behalf of the A&E Delivery Boards, including daily and escalation reports required by NHS England and NHS Improvement.
In addition senior CCG and NELCSU staff participate in an on-call rota to co-ordinate responses as pressure in an urgent and emergency care system is escalated. Providers have on-call rotas to do the same.
Category Trusts
1. Organisations delivering the A&E waiting time standards Moorfields Eye Hospital
UCLH
Whittington Health
3. Moderate concern in escalation Royal Free London
4. Highest level of escalation NMUH
2. Minor to moderate concern about delivery. No escalation
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Winter operating modelIt is expected that the winter operating model will be in place from 1 October 2017 to the end of April 2018.This involves the day-to-day management of the urgent and emergency care systems, and will include daily internal calls for North Central London co-ordinated by the NELCSU Surge Hub with participation from local A&E Delivery Boards. These internal calls are then followed by a call with NHS England and NHS Improvement to provide an overview of performance and pressure in the system that is informed by daily situation reports (see below) and the internal call.
Data information and intelligenceThe daily situation report (SITREPs) provides a snapshot of performance and pressure in the system. The report provides an update for each emergency department but considers performance of the whole health and care system.SITREPs provides the snaphot of performance and pressure that determines if a system will go into escalation over performance with NHS England and NHS Improvement. At times of peak pressure additional escalation calls are held with the regulators. The information is updated each day with comparisons made for all metrics to the same time in the previous week and the average over the last six weeks to provide a barometer of performance and pressures.
Bank Holiday and weekend assuranceExperience from previous years indicates the following dates for peak demand pressure over the winter period:The Friday before Christmas (22 December in 2017) with a surge in alcohol related attendances and admissions;The first working day after the Christmas Bank Holiday (27 December in 2017);The first working day after the New Year (2 January in 2018) followed by sustained pressure through January and February.
Over the winter existing plans will therefore be supplemented with bank holiday and weekend assurance plans to ensure that the system maintains flow with both hospital and community capacity in place. This is particularly the case for the above dates.
The early weeks of the new year are the time that the urgent and emergency care system comes under the most pressure, so assurance plans in the run up to Christmas will focus on:Reducing hospital bed occupancy to 90% or below to create capacity for admissions;Ensuring that beds taken up by people medically fit for discharge take up less than 5% of bed stock;Ensure staff rotas are up to establishment in both hospitals and the community;Ensure that capacity in the community is maintained for both admission avoidance and establishing community packages of care.
1. Access
1.4 NCL Winter Planning
EscalationEscalations will follow a process that is outlined in the Department of Health winter 2017/18 operational arrangements document. Escalation is a response to rising pressure in an urgent and emergency care system and sustained under performance in a system. Under these circumstances internal co-ordination through the Surge Hub and with NHS England and NHS Improvement increases form the scheduled daily calls.
Escalation framework for North Central London An escalation framework for North Central London has been established for winter 2017/18 building on the experience from previous years. Within each A&E Delivery Board partner organisations have developed their own local escalation frameworks, triggers and action cards. The escalation frameworks cover both internal escalation within each organisation and for mutual across the A&E Delivery Board aid at times of system surge.
All of the escalation plans, and supporting triggers for action, are based on the national Operational Pressure Level Escalation (OPEL) Framework published by NHSE in November 2016. The framework is an operational plan, closely l inked to business continuity, major incident, pandemic influenza and other contingency plans. It contains procedures for communicating between organisations within a flexible framework based on escalation triggers and actions. Part of the ongoing work of using the framework is for each partner to ensure that these are familiar to those who may need to use the procedures during times of escalation.
Mutual AidEscalation frameworks have historically focused on mutual support within A&E Delivery Boards. For winter 2017/18 frameworks are being developed for mutual aid across A&E Delivery Boards in NCL, in line with the development of the Sustainability and Transformation Plan (STP) and new commissioning arrangements.Some mutual aid is already provided locally and includes:- The Royal Free and Barnet sites regularly do treat and transfer at times of high bed occupancy or lack of beds on one or other sites. The same is true of sharing staff in relation to at times of escalation;- The STP now has one agreed referral form for accessing any intermediate care or rehabilitation facility across
the STP This means that if there are capacity and escalation issues in the South of the STP, referrals could be made to facilities in the North of the STP.
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1.5 Demand ManagementThe following two pages focus on demand management in terms of admission avoidance. Further information on demand, including referrals can be found on page 14 of this
report.
Extended Access Extended access in primary care (08:00 - 20:00, seven days a week) is in place in Camden.
Primary care streaming continues at UCLHas a 10:00 - 22:00 service.
Utilisation
Comparative data suggests that Camden does not use extended access as extensively as other NCL CCGs. Utilisation rates have been discussed with Haverstock Health and various actions are underway to improve utilisation, including patient awareness of the service. The Integrated Care Team business case to redesign community services was taken to the
Integrated Commissioning Committee on 27/09/17.
AT Medics will take over the full contract from 1st December 2017 and are in the process of mobilisation.
2016/17
The current provision of weekends across all hubs and weekdays at the
South hub was mobilised by Nov 16.
Utilisation improved as the service became embedded.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North South West North South West North South West North South West North South West
Nov-16 Dec-16 Jan-17 Feb-17 Mar-17
Current EA Service: Utilisation 2016/17
YTD 2017/18
The West hub continues to have better utilisation than North or South
In Jul 17, the South hub is at its second highest point since service
commencement (the South hub has been subcontracted since 1 Jul 17)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North South West North South West North South West North South West
Apr-17 May-17 Jun-17 Jul-17
Current EA Service: YTD
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1.5 Demand Management
Simplified Discharge - Discharge to Assess Progress
This is part of the wider Supporting People Programme, building onCamden’s integrated commissioning arrangements and includes
admissions avoidance as well as simplified discharge. D2A Pathway 0 - agreement with Adult Social Care on hospital restart of
pre-existing care packages. D2A Pathway 1 - is in place with UCLH as a Planned, Do, Study, Act
(PDSA) pilot using real live cases - 30 to date - to help design the pathwaycollaboratively.
D2A pathway 2 & 3 - for patients unable to immediately return home. Muchof the system, such as rehabilitation beds and trusted assessor
arrangements are in place. A review of the bed capacity is beingundertaken to support assessment at home as the preferred option.
D2A targets - reduced delayed transfers of care from 15 a day to 10.72,which will go towards achieving the £799k QIPP in 2018/19, facilitating
patient flowout of the acute hospital.
RAPIDS
The chart (right) shows admission avoidance from the Rapid Response service plus the out of hours nursing service.
Rapids accounts for approximately two-thirds of these admission avoidance episodes per month.
Implementation of the Rapid Response Admission Avoidance business case has commenced and includes:
- The development of a communication plan to promote the service in Primary care
- Re-provisioning of nursing resources into the Rapids service - Discussion with London Ambulance Service to re-direct potential Admission
Avoidance patients. 0
20
40
60
80
100
120
140
April 2016 May 2016 June 2016 July 2016 August 2016 September2016
October 2016 November2016
December2016
January 2017 February2017
March 2017 April 2017 May 2017 June 2017
RAPIDS activity
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1.6 Delayed Transfer Of Care (DTOCs)
The most recent benchmarking data available suggests thatCamden performs better than both England and London,however Q1 2017/18 has seen a pressure on DTOCperformance and this largely relates to the successfulcompletion of social care assessments.
The Integrated Commissioning Team have been workingclosely with the Adult Social Care Team to address thispressure and the improved position for June 2017 appears toreflect the impact of this work.
The increase in delays due to patients waiting for a residential
home is a known issue and the integrated commissioning
team are working with ASC colleagues to address this. There
is an issue where information on some patients’ funding is not
being received quickly enough. The ASC are working on this.
NHS England gives a list of 10 reasons for a DTOC.Nationally the fastest growing reason is ‘awaiting carepackage in own home’. In England in May 2017 there wereover three times as many delayed days due to patientsawaiting a care package in their own home compared to April2014, although significantly this does not appear to be anissue in Camden.
- England
0
50
100
150
200
250Camden Local Authority Delayed Discharge reasons (Number of delayed days)
A) COMPLETION OF ASSESSMENT B) PUBLIC FUNDING
C) WAITING FURTHER NHS NON-ACUTE CARE DI) AWAITING RESIDENTIAL HOME PLACEMENT OR AVAILABILITY
DII) AWAITING NURSING HOME PLACEMENT OR AVAILABILITY E) AWAITING CARE PACKAGE IN OWN HOME
F) AWAITING COMMUNITY EQUIPMENT AND ADAPTIONS G) PATIENT OR FAMILY CHOICE
H) DISPUTES I) HOUSING - PATIENTS NOT COVERED BY NHS AND COMMUNITY CARE ACT
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1.6 Delayed Transfer Of Care (DTOCs)
Camden CCG and UCLH continue to work closely on a daily basis to ensure numbers of
DTOC’s and MO’s are kept within acceptable limits.
Barnet CCG continue to lead on DTOC meetings for Royal Free, which are held twice each
day to expedite early discharges and free up bed capacity in acute setting. The PMO structure is being established by Barnet CCG and the Recovery Action Plan has
been refreshed to help the trust meet the 4 hour A&E target.
0
200
400
600
800
1000
1200
Ju
l-14
Au
g-1
4
Sep
-14
Oc
t-14
No
v-1
4
De
c-1
4
Ja
n-1
5
Feb
-15
Mar-1
5
Ap
r-1
5
May
-15
Ju
n-1
5
Ju
l-15
Au
g-1
5
Sep
-15
Oc
t-15
No
v-1
5
De
c-1
5
Ja
n-1
6
Feb
-16
Mar-1
6
Ap
r-1
6
May
-16
Ju
n-1
6
Ju
l-16
Au
g-1
6
Sep
-16
Oc
t-16
No
v-1
6
De
c-1
6
Ja
n-1
7
Feb
-17
Mar-1
7
Ap
r-1
7
May
-17
Ju
n-1
7
Ju
l-17
Au
g-1
7
UCLH Delayed Days by Type of care
Acute
Non-Acute
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1.6 DTOCs and CHC performance against trajectory
The DToC target for Camden is an average of 10.73 delays per day over the month for both health and adult social care, and the performance for September was 13.83 .
The CHC Target is for 85% of assessments to be carried out outside of an acute setting and the performance for September was 61.1%.
Future reports will include a full dashboard that will provide more detail around the reasons for delays. The latest weekly data (week ending 28th September) is shown
below.
Red Flags for the week ending 28th September 2017
49 days delay this week for patients waiting social care
funded care home placements. (3 mental health & 4ASC)
19 days delay during the week for patients waiting
funding agreement from QAP. 125 total days delayed for one patient in CIFT. This
patient is expected to wait until a disabled roombecomes available at Tile House. This has been
followed up and this placement remains the best
discharge option for the patient. Delays waiting for rehab beds at St Pancras are
increasing. There are currently 6 Camden patients
delayed waiting discharge from the rehab beds (4placement delays & 2 QAP delays).
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1.7 CNWL Access
CNWL community services access targets
6 week wait performanceCNWL are monitoring and reporting waiting times on a weekly basis with services targeting patients with apparently long waits and identifying any potential data quality issues. As many of the services see patients within very short timeframes (e.g. District nursing, Rapid response) these are largely excluded from this KPI as it only measures patients who are on an open wait at month end. CNWL have now reached a fairly consistent performance level (92%-93%) over the last three months but with further actions are forecasting to achieve this target in October.
Urgent Out Of Hours referrals responded to within 2 hoursThe OOH response performance has been identified as a data entry issue where the contact was being made however wasn’t being recorded correctly on the system.A new process was implemented by the service in the middle of May and the target has been achieved since June. The year to da te performance is below target mainly due to the very low performance in April (37%) which is impacting the overall figure. As the service is expected to continue to meet or exceed the 80% target this YTD figure should continue to increase gradually to achieve a YTD performance on or above target.
District nursing referrals responded to within 48 hoursThis has also been identified as a data quality issue rather than a genuine performance issue and the service has worked with the performance team and SystmOne configuration team to identify and address the issues. CNWL are regularly reviewing these waits, with the service receiving a daily report to identify and correct any apparent breaches. This led to steady incremental improvements throughout the past six months and ultimately resulted in the service achieving and exceeding the target in September, which is expected to be maintained. The year to date performance will not reach 95% this year due to the lower performance levels earlier in the year.
Performance across all indicators is discussed and managed at the regular CNWL CRG meetings, attended by the Integrated Commi ssioning team and CSU.
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1.8 LAS Access - New Response Time Standards The current national 8 minutes response standards are being replaced by a new call prioritisation system which sets the standards for all 999 calls to ambulance services including those passed to ambulance services via 111. The new national standards were established under an initiative called the Ambulance Response Programme (ARP) led by NHS England. The aim of ARP is to ensure that: - The sickest patients receive the fastest response - All patients get the best response allocated to them first time - No one is left waiting for an unacceptably long time for an ambulance to arrive.
The development of ARP focused on: - Giving call handlers a new set of questions to help them work out which patients are the most seriously i ll and need the fastest response. - More time for call handlers to assess 999 calls so that patients in non-life threatening situations can get the right care first time. - Introduction of a new set of codes to make describing the patient care better.
Ambulances services across England are expected to transition into ARP between 13th July and end of November 2017 and should introduced ARP by the national deadline of 30th November with the exception of Isle of Wight. The new national response times are set out below:
Implications for LAS - The new standards will mean that the number of calls requiring an 8mins response will l ikely reduce daily from approx. 1500 to around 250. (this will be patients requiring a response within 7 minutes). - Fleet reconfiguration and frontline staff rota changes
London Ambulance Service (LAS) Readiness LAS has been involved with the ARP development and the Trust is planning to ‘go live’ with ARP on 31st October 2017. Key areas of activity that must be completed by 31st October are: - Upgrading of the LAS triage tool and implementation of the ARP categories and new response profiles. - Further upgrading of the Trust dispatch system to ensure that it can interface with the triage tool. - Work to switch on key internal and external reports from the go-live date which reflect the new model. - Changes to fleet management to ensure flexibility to respond to new operational requirements. - Ensuring all relevant operating policies are updated to reflect the ARP requirements and that all required staff training is completed. - Completion of NHS England readiness checklist and assurance process
NHS 111 Progress - The codes used by NHS 111 providers and the codes used by LAS have been cross referenced to ensure that patients receive an equal response regardless of which route they choose to access urgent and emergency care. - 111 providers need to upgrade their systems by 24 November 2017 to recognise the new ARP codes. There will be a transition period from when LAS move to ARP and all 111 providers across London complete their upgrade. - There is a national agreement that all 999 services will manage the transition for all calls until all 111 providers have completed their upgrade.
Other implications - CCG commissioners will need review of current Appropriate Care Pathways (ACP) to ensure suitable functionality. - Acute trusts - currently no change anticipated to activity for Emergency Departments however overtime there is potential for reduced conveyances.
Performance reporting Due to the nature of the technical changes required to introduce the new operating model, there is no opportunity for a period of dual reporting on the existing and new performance regimes. The following actions have been agreed to mitigate this position: - Minimum national dataset submitted to UNIFY will be used for reporting and monitoring performance from 31st October to early January 2018 to give an opportunity to establish the baseline for a performance trajectory. - Performance will also be monitored via benchmarking of LAS against other ambulance providers using the national UNIFY data. - Achieving the required response time for the sickest patients i.e. within an average of 7mins will be priority.
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2. Commissioned Services Register Monitoring
SummaryThe Commissioned Services Register is comprised of a list of contracts that Camden CCG wholly or partly funds. The Register provides monthly oversight of these contracts, broken down into spend and performance, for the purposes of contract monitoring and informed decision-making regarding their future or maintenance.
This month (Oct ’17) the focus is on those contracts with a high and low attention level whose overall RAG status is Red or Amber.
Highlights• UCLH – Acute Hospital Services: There is an over-performance of £0.6m, with the largest pressures in non-elective, outpatients and drugs & devices. This is offset by under-performance in elective,
critical care and diagnostic imaging. The FOT deteriorated by £70k from the previous month driven by reduction in projected QIPP delivery.• Royal Free – Acute Hospital Services: There is an over-performance of £4.1m, driven largely in diagnostic imaging, non-elective, outpatients and other. This is a £2.1m positive in month movement,
driven by positive movements in elective, outpatients, maternity, critical care and non-elective. The movement in elective & outpatients suggests the plan has not been phased correctly to reflect summer holiday period – NELCSU will raise at CTG to confirm phasing is correct.
• UCLH – MSK Services: Due to the continued issues around implementation of contracting and reporting arrangements, quality & safety and activity & finance reporting a meeting with the CCG Local Executive Director & GB Chair takes place on 18 Oct to determine what form of escalation is necessary.
• Whittington Hospital – Acute Hospital Services: The contract is forecast to over perform by £22k – this does not include an adjustment for 50% marginal rate. Over-performance is driven by maternity and elective (predominantly T&O) whilst under-performance is seen across majority of PODs, particularly critical care.
• Whittington Health – Children Community Services: Following the agreed improvement plan from 22 Sept targets have been put in place to be met before Dec ’17 including establishing a shared understanding of the current funding situation to mitigate the £220k cost pressure for personal health budgets, establishing cross charging arrangements with Haringey and Islington, updating bladder & bowel specification, and reviewing and codesigning SLT.
• Whittington Health – Adult Community Services: Following the agreed improvement plan from 22 Sept targets have been put in placeto be met before Dec ’17 including updating specifications for bladder & bowel, nutrition & dietetics and tissue viability, improving activity data, and codesigning nutrition & dietetics service and wound care pathway.
• North Middlesex University Hospital – Acute Hospital Services: The under-performance is being driven by lower than planned critical care and emergency activity. The FOT improved by £28k for M6• Royal Free Hospital – Community Dermatology Service: The CCG met with RFH to discuss the closure of the service in Dec ‘ 17 and agree next steps including absorbing all existing patients into
another clinic and liaise with CCAS to ensure redirection of patients into appropriate settings. Work continues on the redesign of the new Dermatology Service through NCL wide workshops including the development of a business case.
A data assurance workstream has been developed in partnership with the CSU to assure Camden of its acute position.
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3. Quality
3.1 Serious Incidents (SIs)
UCLHSerious Incidents(SI)Assurances regarding organisational wide learning following SI investigations, was reported to theClinical Quality Review Group (CQRG) meeting on 03 October 2017.
Royal Free LondonSerious Incidents (SI)
SI’s and Never Events are discussed each month at CQRG, as part of the Trusts Safer Surgeryprogramme.
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3. Quality
3.2 Complaints and Friends & Family Test
UCLHComplaintsWork continues across all Divisions to sustain compliancefor responding to complaints as reported to CQRG on 03October 2017.Friends and Family Test (FFT)The In-patient Patient Experience team are monitoringscores and feedback following the implementation of theSMS automated data collection system in May 2017.
Royal Free LondonComplaintsClinical treatment and communication remain theprimary focus of complaints received by the Trust, asreported to CQRG on 27 September 2017.
Friends and Family TestFFT reporting remains steady across the Trust.
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4. Activity
4.1 Performance Against Operating Plan
Referrals – The plan was based on the data that was flowing at the point of planning. Camden's deepdive data assurance work continues to review referral data and the CCG is working with the Royal Freeand the CSU to understand the volume of follow-up attendances included within the referral data. Forfuture submissions assurance is being sought through technical meetings to ensure that future planningcan be completed accurately. This impacts commissioners differently due to different sites within theprovider being util ised by different commissioners.
First Outpatient Attendances – There has been a significant change in the recording of diagnostic imagingat UCLH, impacting Camden (approximately 3,500 attendances) and Islington CCGs. With this taken intoaccount Camden is below plan.
Follow-up Outpatient Attendances - There has been a fall in the volume of follow up attendances relatingto Diagnostic Imaging (approximately 6,000 fewer attendances). The deep dive assurance piece of work isreviewing inconsistent reporting of activity between years in order to understand the true levels ofgrowth within activity.
Total Elective - Lower volumes of elective activity is being reported across providers. This is beinginvestigated by the CSU to be assured that this is a true reflection of activity and whether there will beimpact on other areas of performance.
A&E Attendances – CLCH missed the month 5 submission and therefore activity is understated byapproximately 655 attendances. This brings performance to 4.8% under plan. During the rebasingexercise in July the Camden plan was increased significantly, driven by the inclusion of overseas visitors.Discussions have taken place with NHSE as to whether the plan should be resubmitted to reflect the flowof data coming through, and Camden were advised not to resubmit the plan.
The CCG is required to submit an Operating Plan to NHS England on an annual basis. The plan takes into account expected demographic and non-demographic growth along withany increases expected due to new guidance. The performance against Plan is monitored by NHS England throughout the year, historically via a monthly return from the CCG andthen additionally in 2017/18 via an NCL wide teleconference to review activity and QIPP across the system.
2016/17 saw unprecedented over performance on Royal Free and UCLH contracts, but not on the CCG’s Operating Plan. Although measured on different data sources (Contract =SLAM, Operating Plan = SUS SEM), the direction of travel should be similar in both. The CCG is currently undertaking a forensic deep dive of all data sources to ensure that activity isbeing reported accurately, and that data issues are not affecting the CCG’s financial position.
Activity variance -5% to +5% above plan
Criteria Measured by NHSE
YTD Plan YTD Actual Variance % Variance
All Referrals 46514 42338 -4176 -8.98
Outpatient First
Attendance 49186 50591 1405 2.9
Outpatient Follow Up
Attendances85485 76629 -8856 -10.36
Total Outpatients* 134671 127220 -7451 -5.5
Total Elective 10182 9473 -709 -6.96
Non- Elective 7803 7824 21 0.3
Total Inpatient* 17985 17297 -688 -3.8
A&E 54047 50781 -3266 -6.0
Operating Plan Performance 2017/18 Month 5
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4. Activity
4.2 QIPP Plan 2017/19 - Executive Summary
Non-IFSE Return Summary
The CCG submitted its month 6 QIPP position to NHSE with a YTD position of £5.53m representinga negative variance of £670k. This is an increase of £400k adverse effect against plan highlightingslippage in transformation projects vs the QIPP profile.
Overall Camden is reporting a FOT position of £16.93m with a negative variance of £1.21m,unchanged from month 5. The following slide includes a variance report highlighting movementssince the previous month.
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4. Activity
4.2 QIPP Plan 2017/19 - Status
Month 6 Variance Report
The following table highlights FOT movements between M5 and M6. Overall negative and positivemovements results in an unchanged position of £1.21m negative variance against plan.
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5. Finance
Overview As at month 6 the CCG continue to forecast to achieve its control total at the end of the year. The
CCG is forecasting expenditure overspends of £5.6m, due to pressures in the acute spend of £3.6m,
Non-Acute spend of £1.7m and investment spend of £0.3m. This is a deterioration of £0.5m from the
month 5 position of £5.1m.
This movement is mainly due to the improvement in acute contracts and an emerging FOT pressure
in Continuing Care (CHC) services in Non-Acute contracts.
The expenditure overspend is offset by use of contingencies and non-recurrent reserves to achieve
a balanced control budget.
Risks QIPP slippageCHC Delegated Primary Care commissioningAcute contract over-performing LCW contingency
MitigationsNon-recurrent reservesUse of CCG contingency
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Jul 2016 Jan 2017
Camden England
Better Care 122a Cancers diagnosed at early stage 45.8% 45.8% 54.2% 61/ 209 H
Better Care 122b People with urgent GP referral having first
definitive treatment for cancer within 62 days
of referral
67.1% 78.5% 82.2% 97/ 209 H
Better Care 122c One year survival from all cancers 72.0% 72.0% 71.1% 50/ 209 H
Better Care 122d Cancer patient experience 88.6% 8.8 8.8 41/ 209 H
Better Care 126a Estimated diagnosis rate for people with
dementia
68.7% 73.0% 75.4% 43/ 209 H
Better Care 126b Dementia care planning and post-diagnostic
support
79.4% 80.0% 80.0% 68/ 209 H
Better Health 103a Diabetes patients that have achieved all the
NICE recommended treatment targets
43.5% 43.5% 42.4% 37/ 209 H
Better Health 103b People with diabetes diagnosed less than a
year who attend a structured education course
14.3% 14.3% 19.1% 17/ 209 H
Better Care 124a Reliance on specialist inpatient care for
people with learning disability and/or autism
67 59 59 112/ 209 L
Better Care 124b Proportion of people with a learning disability
on the GP register receiving an annual health
54.0% 54.9% 54.9% 10/ 209 H
Better Care 125a Neonatal mortality and stillbirths 4.8 4.8 7.0 117/ 209 L
Better Care 125b Women's experience of maternity services 76.4 76.4 76.4 171/ 209 H
Better Care 125c Choices in maternity services 67.7 67.7 67.7 53/ 209 H
Better Health 101a Maternal smoking at delivery 2.8% 2.1% 3.6% 11/ 209 L
Better Care 123a Improving Access to Psychological
Therapies recovery rate
40.8% 41.4% 46.4% 154/ 209 H
Better Care 123b People with first episode of psychosis
starting treatment with a NICE recommended
package of care treated within 2 weeks of
referral
81.8% 86.2% 83.6% 52/ 209 H
MATERNITY TBC
MENTAL
HEALTHGood
Better
is
DIABETES TBC
LEARNING
DISABILITIESTBC
CANCERRequires
Improvement
DEMENTIA Outstanding
CLINICAL
PRIORITY
2016/ 17
RATING
(JULY 2017)
Performing
Well
Needs
Improvement
Jul 2017INDICATOR
Camden
2015/ 16
RATING
(JUNE 2016)
Needs
Improvement
Performing
Well
Top
Performing
Needs
Improvement
DOMAIN Camden CCG’s headline rating has been
announced as Good for 2016/17.
NHSE have released ratings for three of thesix clinical priority areas for 2016/17 - Cancer,
Dementia, Mental Health.
Ratings positively improved for Dementiaand Mental Health.
The rating for Cancer remained unchanged,
and is reflective of the wider system issuesrelating to the 62 day cancer target. The
significant improvements to earlydiagnosis should be noted.
Ratings for Diabetes, Learning Disabilities and
Maternity are expected to follow later in theyear, as is a refreshed 2017/18 IAF
dashboard.
Further changes are expected to NHSE’sassurance processes going forward, with an
increased focus on monitoring and reportingvia the STP.
6. Improvement & Assessment Framework
6.1 2016/ 17 Year End Rating & Clinical Priority Areas
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6. Improvement & Assessment Framework
6.2 Dashboard - Four Domains
The IAF dashboard, published at the end of July
2017, covers indicators located in four domains:Better Health, Better Care, Sustainability and
Leadership.
Work has commenced to analyse the detail of
the indicators within the dashboard, with relevant
leads across the CCG to:
- obtain assurance on Camden’s performance,particularly for those indicators where
Camden is in the worst quartile or
performance has declined.
- to identify what is required to achieve‘outstanding’. The output of this work will be
reported via the IPR.
Maternity
- 125a, occurrences will fluctuate throughout a
given period (monthly/ quarterly), and only
become relevant if such changes aresustained.
- 125b and c a national survey has recently
been completed, the findings of which will be
available later in the year. Much of NCL’sBetter Births work relates to choice and
personalised care with the intention of
increasing women’s experience of choice and
continuity of care.- 101a, noted that Trusts are now accurately
measuring CO levels and identifying more
pregnant smokers.
Falls 104a, three pieces of work have
commenced to drive improved performance -
prevention work initiated by Public Health,admissions avoidance post falls in the
community, and the care home LES.
NHS Camden CCG
Better Health Period CCG Peers England Trend Better Care Period CCG Peers England Trend
R 101a ✔ Maternal smoking at delivery 16-17 Q3 3.6% 2/11 11/209 R 121a n/a High quality care - acute 16-17 Q4 56 6/11 134/209
R 102a n/d % 10-11 classified overweight /obese12/13 to 14/15 35.0% 4/11 142/209 R 121b n/a High quality care - primary care16-17 Q4 64 4/11 116/209
R 103a n/d Patients who achieved NICE targets2015-16 42.4% 1/11 37/209 R 121c n/a High quality care - adult social care16-17 Q4 64 1/11 12/209
R 103b n/d Attendance of structured education course2014 19.1% 1/11 17/209 R 122a n/d Cancers diagnosed at early stage2015 54.2% 3/11 61/209
R 104a n/d Injuries from falls in people 65yrs +16-17 Q3 2,367 7/11 170/209 R 122b ✘ Cancer 62 days of referral to treatment16-17 Q4 82.2% 4/11 97/209
R 105a n/a Utilisation of the NHS e-referral2017 03 41.3% 6/11 #DIV/0! R 122c n/d One-year survival from all cancers2014 71.1% 4/11 50/209
R 105b n/a Personal health budgets 16-17 Q4 13 6/11 94/209 122d n/d Cancer patient experience 2015 8.8 3/11 41/209
R 105c n/a % of deaths in hospital 16-17 Q2 47.5% 8/11 109/209 R 123a n/d IAPT recovery rate 2017 01 46.4% 7/11 154/209
105d n/d LTC feeling supported 2016 03 62.4% 7/11 148/209 R 123b ✔ EIP 2 week referral 2017 03 83.6% 4/11 52/209
R 106a n/d Inequality Chronic - ACS 16-17 Q3 964 6/11 119/209 R 123c n/a MH - CYP mental health 16-17 Q4 95% 1/11 13/209
R 106b n/d Inequality - UCS 16-17 Q3 1,830 4/11 100/209 R 123d n/a MH - Crisis care and liaison 16-17 Q4 57.5% 9/11 155/209
R 107a ✘ AMR: appropriate prescribing 2017 02 0.62 1/11 1/209 R 123e n/a MH - OAP 16-17 Q4 75.0% 8/11 158/209
R 107b ✘ AMR: Broad spectrum prescribing2017 02 9.3% 5/11 120/209 R 124a n/d LD - reliance on specialist IP care16-17 Q4 59 9/11 112/209
108a n/a Quality of life of carers 2016 03 0.78 7/11 137/209 124b ✘ LD - annual health check 2015-16 54.9% 1/11 10/209
Sustainability Period CCG Peers England Trend R 125a n/d Neonatal mortality and stillbirths2015 7.0 6/11 117/209
R 141a n/a Financial plan 2016 Green 1/11 1/209 125b n/a Experience of maternity services2015 76.4 7/11 171/209
R 141b n/a In-year financial performance 16-17 Q4 Green 1/11 1/209 125c n/a Choices in maternity services 2015 67.7 4/11 53/209
R 142a n/a Improvement area: Outcomes 16-17 Q3 ########## 1/11 1/209 R 126a n/a Dementia diagnosis rate 2017 03 75.4% 5/11 43/209
R 142b n/a Improvement area: Expenditure16-17 Q3 ########## 1/11 1/209 126b n/d Dementia post diagnostic support2015-16 80.0% 5/11 68/209
R 143a n/a New models of care 16-17 Q4 N #VALUE! R 127a n/a Delivery of an integrated urgent care service2017 01 7 1/11 1/209
R 144a n/a Local digital roadmap in place 16-17 Q4 Y #VALUE! R 127b n/d Emergency admissions for UCS conditions16-17 Q3 2,250 5/11 88/209
R 144b n/a Digital interactions 16-17 Q4 54.7% 10/11 183/209 R 127c ✘ A&E admission, transfer, discharge within 4 hours2017 03 88.9% 7/11 111/209
R 145a n/a SEP in place 2016-17 Y ##### #VALUE! R 127e n/d Delayed transfers of care per 100,000 population2017 03 8.3 3/11 47/209
Well Led Period CCG Peers England Trend R 127f n/d Hospital bed use following emerg admission16-17 Q3 446.2 3/11 33/209
R 161a n/a STP 2016-17 Green 1/11 1/209 R 128a n/d Management of LTCs 16-17 Q3 872 6/11 99/209
R 162a n/a Probity and corporate governance16-17 Q4 Fully Compliant 1/11 1/209 R 128b n/d Patient experience of GP services2016 03 83.5% 7/11 149/209
R 163a n/a Staff engagement index 2016 3.83 4/11 48/209 R 128c n/a Primary care access 2017 03 80.0% 4/11 15/209
R 163b n/a Progress against WRES 2016 0.20 11/11 208/209 R 128d n/d Primary care workforce 2016 09 0.97 2/11 107/209
R 164a n/a Working relationship effectiveness16-17 59.80 11/11 188/209 R 129a ✔ 18 week RTT 2017 03 93.4% 3/11 44/209
R 165a n/a Quality of CCG leadership 16-17 Q4 Green 1/11 31/209 R 130a n/a 7 DS - achievement of standards2016-17 0.0% 1/11 #N/A
Key R 131a n/a People eligible for standard NHS CHC16-17 Q3 27.1 10/11 179/209
Worst quartile in England Best quartile in England
Interquartile range
Good
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7. Quality Premium
7.1 2016/17 Quality Premium – internal assessment
In January 2017 the CCG received£492k of the available QP for2015/16.
Based on the CCG’s internalassessment of the 2016/17 qualitypremium, it is estimated that the CCGwill receive £146,750 for the 16/17quality premium. This is subject tofinal data and validation by NHSE.
This is based on achieving all of thequality elements with the exceptionof:- E-referrals- Experience of making a GP appointment- Complication for stoke among people with diabetes
The QP is heavily weighted towardsachievement of the constitutionalstandards (25% each for 62 daycancer, A&E, RTT, ambulance), andthe CCG would then receive 25% ofthe money available for achievingRTT.
The CCG expects to receive the2016/17 monies in January 2018.
Target Latest Data % AllocationMaximum *
Available
Performance
Risk Rating
1
Improvement in the proportion of cancers (specific cancer sites, morphologies and
behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year compared to
the 2015 calendar year.
4% point improvement
OR
At least 60% diagnosed at stage 1 & 2
2013 (44.1%)
2014 (45.8%)
2015 (54.2%)
20% £234,800
2 Increase in the proportion of GP referrals made by e-referrals
80% by March 2017 & year-on-year
increase
OR
20% point increase between March
2016 and March 2017
March 2016 (39.9%)
March 2017 (41%)20% £234,800
3 Improvement in overall experience of making a GP appointment85% OR 3% point increase between
July 2016 to July 2017 publications
2014 (83.5%)
2015 (79.4%)
2016 (83.0%)
2017 (71%)
20% £234,800
a) Reduction in number of antibiotics prescribed in primary care
4% reduction on 2013/14
OR
England average (1.161)
2013/14 (0.687), 2014/15 (0.672),
Q1 2016/17 (0.626), Q2 2016/17
(0.628)
5% £58,700
b) Reduction in number of co-amoxiclav, cephalosporins and quinolones as a
proportion of the total number of selected antibiotics prescribed in primary care.
10%
OR
20% reduction on 2014/15 value
2013/14 (11.5%), 2014/15 (11.2%),
Q1 2016/17 (10.0%), Q2 2016/17
(9.7%)
5% £58,700
5Endocrine - Additional risk of complication for stroke among people with diabetes
(%)80 patients (2015/16 baseline 89) TBC 10% £117,400
6Mental Health - Mental Health - Reported numbers of dementia on GP registers as
a % of estimated prevalence71.56% Dementia Diagnosis Rate 75.4% March 2017 10% £117,400
7 Mental Health - % of people aged 18-69 on Care Program Approach in employment5% of people aged 18-69 on Care
Program Approach in employment5% 16/17 CIFT Camden data 10% £117,400
£1,174,000
Target Latest Data Weighting Weight ValuePerformance
Risk Rating
STF/ Op Plans for Q4 16/17 93% 2016/17 25% £293,500
STF/ Op Plans for Q4 16/17 89.1% 2016/17 25% £293,500
STF/ Op Plans for Q4 16/17 80.6% 2016/17 25% £293,500
STF/ Op Plans for Q4 16/17 69.2% 2016/17 25% £293,500
Measures
A&E waits (CCG mapped from HES provider data)
Cancer waits - 62- Day Standard (Urgent GP referral to 1st definitive treatment for cancer)
Cat A red 1 ambulance calls (LAS performance)
Nat
ion
alLo
cal
Constitutional Measures
18 Week RTT - Incomplete Pathway
4
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CCG leads are assigned to each of the QualityPremium indicators and actions in place to assistwith delivery of the targets.
To gain access to Quality Premium funds, CCGsmust also pass the following two gateways:
1. Quality Gateway - no cases of seriousquality failures at a local provider whereCCG is not considered to have madeappropriate, proportionate response with itspartners to resolve failures. Payments will bediscretionary and subject to CCG assuranceprocess criteria in relation to quality failureswhere gateway is not achieved.
2. Financial Gateway - operate in a mannerconsistent with Managing Public Money;does not incur unplanned deficit in 2017/18,or require unplanned support to avoidunplanned deficit; and does not incur aqualified audit report in respect of 2017/18.
Measure Target Latest Data
Quality
Premium
allocation
Maximum
Available
Performance
Risk Rating
Early Cancer Diagnosis 4% point improvement
OR
At least 60% diagnosed at stage 1 & 2
44.1% (2013)
45.8% (2014)
54.2% (2015)
17% £227,165
GP Access and Experience 85% of respondents who said they had a good experience of making
an appointment
OR
3 percentage point increase from July 2017
79.4% (2015)
83.0% (2016)
71% (2017)
17% £227,165
Continuing Healthcare Part a) in more than 80% of cases with a positive NHS CHC Checklist,
the NHS CHC eligibility decision is made by the CCG within 28 days
from receipt of the Checklist
Part b) less than 15% of all full NHS CHC assessments take place in an
acute hospital setting.
Part a) 91%
(Q1 2017/18)
Part b) 68%
(Q1 2017/18)
17% £227,165
Mental Health Total number of bed days relating to out of area placements to have
reduced by 33%
tbc 17% £227,165
Bloodstream Infections 2017/18 Part a) 10% reduction (or greater) in all E coli BSI
Part b)
b1 - 10% reduction (or greater) in the Trimethoprim: Nitrofurantoin
prescribing ratio
b2 - 10% reduction (or greater) in the number of trimethoprim items
prescribed to patients aged 70 years or greater
Part c)
items per STAR-PU must be equal to or below 1.161 items per STAR-PU
Part a) 185
(Jan - Dec 2016)
Part b1) 0.954
(Jun 15 -May 16)
Part b2) 1936
(Jan - Dec 2016)
Part c) 0.61
(Mar 2017)
17% £227,165
Local indicator: The percentage of people waiting 6
or more weeks for a colonoscopy.
93.2% 96% (July 2017) 15% £200,440
NHS Constitution requirement Target Latest Data WeightingWeight
Value
Performance
Risk RatingMaximum 18 weeks from referral to treatment –
incomplete standard.
STF/ Op Plans for Q4 17/18 - 92% 92.7%
(Jul 2017 YTD)
25% £334,066
Maximum four hour waits in A&E departments -
standard.
STF/ Op Plans for Q4 17/18 - 95% 90.2%
(Aug 2017 YTD)
25% £334,066
Maximum two month (62-day) wait from urgent GP
referral to first definitive treatment for cancer.
STF/ Op Plans for Q4 17/18 - 85% 78.6%
(Jul 2017 YTD)
25% £334,066
Maximum 8 minute response for Category A (Red 1)
ambulance calls.
STF/ Op Plans for Q4 17/18 - 75% 80.5%
(Jul 2017 YTD)
25% £334,066
Pe
na
lty
ind
ica
tors
Ach
ieve
me
nt
ind
ica
tors
7. Quality Premium
7.2 2017/18 Quality Premium
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8. Workforce
HR Data Table
* Head count at 30 June 2017
** The sickness absence rate is based on the FTE (Full Time Equivalent) hours lost each month and has been
averaged for the reporting period
*** Number of vacancies over the quarter
As 24/07/17, we have 21 interims in the following Directorates. All IR35 have beenreceived and on file.
Sickness Absence
The following graph shows the overall monthly sickness absence rates for the period 01June 2016 to 31 May 2017 (sickness data is reported 6 weeks in arrears):
The overall short term sickness absence has reduced over the past 12 months from 2.30%
in June 2016 to 1.31% May 2017. Compared to Q4 there has been a slight increase inlong term during March 2017 of 0.98%. Over the past 12 months, sickness absence has
cost the CCG an estimated £85,680 (based on the FTE lost over 12 months due tosickness).
The following table shows the average Directorate sickness absence rate for the period
01/06/2016 - 31/05/2017. The arrows show the movement from the previous quarter’s data:
Q1 2016/17
Q2 016/2017
Q3 2016/17
Q4 2016/17
Q1 2017/18
Headcount 114 110* 104* 111* 110*
Starters 13 6 10 12 11
Leavers 7 15 6 12 8
% Sickness 2.34%* 1.96%** 1.47% 1.14%* 1.58%
Interims 27 26 27 22 21
Live vacancies 1 3 18 17 14***
Directorate Interims in Post (No.)
Transformation 0
Corporate Services 3
Finance 4
Quality & Clinical Effectiveness 0
Sustainable Insights 6
Other
Primary Care 0
Acute 5
CCAS 3
CCG Directorate Q4 2016-17 Sickness
Absence Rate Q1 2017-18 Sickness
Absence Rate1
Commissioning 0.84% 1.36%
Corporate Services 3.58% 3.24%
Finance 11.73% 2.61%
Quality & Clinical Effectiveness 1.90% 0.78%
Sustainable Insights P/ships 2.37% 1.19%
Transformation 0.15% 0.29%
1 The sickness absence rate is based on the FTE (Full Time Equivalent) days lost over the reporting period.
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8. Workforce
Occupational Health & Employee Assistance Programme
AXA, the CCG’s occupational health provider has reported the following occupationalhealth and employee assistance programme usage for the period 01/04/2016 - 31/03/2017.
Employee Relations CasesThere have been the following formal employee relations cases for the period 01/07/16 -
30/06/17:
Whistle Blowing
No reported incidents.
Appraisals
The CCG rolled out a new Appraisal Policy and Procedure in May 2017. All managers andstaff were given a deadline to complete review meetings (for the 2016/2017 period) and set
objectives for 2017/2018 by mid July 2017. This deadline has been extended to August2017, as a number of appraisals had not taken place. Following the revised deadline,
another audit will take place to confirm the compliance rate across the CCG.
Mandatory Training
The following table highlights the mandatory training compliance by Camden CCGemployees (based on the total number of employees at 21/04/17 – 112): the previous
quarter’s figure is in brackets ().
There were reported technical issues with the safeguarding modules during the period
which have now been resolved. The overall statutory training compliance for the CCG is80%.
Directorate breakdown (date as at 21/07/17):
Statutory & Mandatory training is undertaken and monitored via the NHS Online Learning
Management (OLM) system. The HR team have been and will continue to liaise withDirectors and managers to ensure all employees are undertaking their statutory training.
The OLM lead will be providing regular drop in sessions at Stephenson House to supportwith any technical/ login support.
AXA OH Service Number of Employees utilising the service
Q3 Q4 Q1
Occupational Health 7 3 5
Employee Assistance Programme
7 5 3
Employee Relations Matter
Number of cases
Q3 Q4 Q1
Change Management 1 - -
Concerns during Probation Period
1 2 1
Long Term Sickness Absence
1 - 1
Mandatory Training Compliance
Equality, Diversity and Human Rights - 3 Years 85% (83%)
Fire Safety - 1 Year 78% (78% )
Health, Safety and Welfare - 3 Years 85% (79%)
Information Governance - 1 Year 75% (79%)
Safeguarding Adults - Level 1 - 3 Years 75% (84%)
Safeguarding Children - Level 1 - 3 Years 79% (84%)
Directorate Statutory Compliance
Commissioning Directorate 75%
Corporate Services Directorate 90%
Finance Directorate 83%
Sustainable Insights Partnerships Directorate 81%
Transformation Directorate 93%
Quality & Clinical Effectiveness Directorate 76%
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9. Glossary
Abbreviation Full Term Description
2WW Two Week Wait cancer standard Cancer waiting times standard
A&E Accident and Emergency Hospital emergency department
CCAS Camden Clinical Assessment Service CCG referral management service
CSU Commissioning Support Unit Provides commissioning support functions to CCGs
CWT Cancer Waiting Times Set of indicators measuring cancer performance
DTOC Delayed Transfer of Care When an adult inpatient is ready to be discharged from hospital but this is delayed
EIP Early Intervention in Psychosis Access standard - 50% of patients should be treated within 2 weeks of referral
IAF Improvement and Assessment Framework Set of indicators on which CCG performance is assessed
IAPT Improving Access to Psychological Therapies Programme for treating people with depression and anxiety disorders.
MAR Monthly Activity Return Central activity data return
QIPP Quality, Innovation, Productivity and Prevention Programme to improve quality of care while making efficiency savings
RAG Red, Amber Green Colour coded rating based on performance
RAP Remedial Action Plan Recovery plan to bring performance back to compliance
RTT Referral to Treatment target NHS constitution target to start consultant-led non-emergency treatment within 18 weeks of referral
SI Serious Incident A serious event that warrants using additional resources to mount a comprehensive response
STF Sustainability and Transformation Fund Funding to acute trusts based on delivery of quarterly milestones
SUS Secondary Uses Service Repository for healthcare data
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The population health tool segments the Camden population using utilisation as a
proxy for need.
The complexity of the people within the segments increase from left to right.
The latest information shows that 1.36% of the Camden population fall within the mostcomplex segment. Although a small proportion of the population, they account for
19% of the CCGs total spend on acute.
Whilst shaping solutions to improve the outcomes for patients and reducing spend onthe most complex, there remains significant spend on the people falling within
healthier segments. This spend is driven by high volume rather than high cost.
Insights from this tool is being shared with neighbourhoods to understand which
areas, population groups and geography should be targeted for the greatest impact.
The tool now includes community data which allows the CCG to understand whetherthe right services within CNWL are being accessed to add value to the patient
pathway.
The following slide shows an example of how the population health tool helpsunderstand the different solutions required for different populations for ambulatory
care conditions.
The CCG has received CNWL and CIFT data and will be refreshing the segmentsbased on a whole system view (conversations have also begun with social care).
10. Appendices
A. Population Health
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Ambulatory Care Sensitive Conditions are often considered as a single problem to solve, however looking at ACSs
through a population health lens it shows different needs driving the issue and therefore multiple responsesare required.
People admitted for ACS conditions fall within 3 population health segments.
Main SegmentPopulation
in this
segment
Number of
patients who
had at least
one
emergency
admission to
ACS
Number of
Emergency
admissions
to ACS
conditions
Total Cost of
Emergency ACS
Conditions
Admissions
per patient
Cost ACS
admissions
per person in
the segment
Acute/Maternity patients
without LTCs with limited
potential to use secondary care
50,903 7,545 13,339 35,862,151£ 1.8 705£
LTC patients who need regular
management and /or
monitoring
4,609 1,256 1,504 2,036,278£ 1.2 442£
Patients with LTCs and have high
potential to use secondary care
3,001 2,233 6,013 17,395,263£ 2.7 5,796£
High volume – low complexity & cost
Response: • GP at the front door• Extended hours • 8-8 Saturday Service
Low volume – high complexity & cost
Response: • Reablement, rehabilitation and recovery• MDT
Low volume –growing complexity
Response: Universal Offer
Achieving the most effective healthcare outcomes for each segment requires tailored approaches
10. Appendices
A. Population Health
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Business Plan Report Agenda Item 4.4
Date 30/10/17
Lead Director Sarah Mansuralli, Chief Operating Officer
Email [email protected]
Report Author Debbie Hawkins, Head of PMO and Reena George, PMO Business Manager
Email [email protected] [email protected]
GB Sponsor(s) (where applicable)
Sarah Mansuralli, Chief Operating Officer
Email [email protected]
Report Summary
The Business Plan was refreshed to include Camden CCG’s 17/18 key priorities aligning with Local Care Strategy and the STP. This is the first report since the refresh of the Business Plan and change to six monthly reporting to the Governing Body. This is primarily an exception report focusing on those initiatives which have a RAG status of either red or amber whilst also highlighting some key updates. Overall progress
Progress continues to be made across all eight objectives. Of the 40 initiatives, 26 are progressing to plan (RAG status green); 13 have some risks and issues which require action (RAG status amber) and one initiative has a significant issue which is being actively managed (RAG status red).
The attached Business Plan Update Report provides detail of the actions being taken to address issues relating to initiatives with an amber or red RAG status. Key issues / risks
There are a number of risks on the Board Assurance Framework relating to the Business Plan, summarised below. Further information is provided in the separate Board Assurance Framework paper to Governing Body.
Delivery of Cancer 62-day waiting time standard (Threat) o relates to initiative ‘A1 related to Constitutional standards and
targets’
Increased costs due to acute over-performance (Threat) o relates to initiative ‘G1 Financial Strategy and QIPP’
PMS Review (Threat) o relates to initiative ‘D.4 PMS review’
Failure to produce a deliverable and robust QIPP plan for 17/18 (Threat) o relates to initiative ‘G1 Financial Strategy and QIPP’
Purpose (tick one box only)
Information
Approval
To note
Decision
Recommendations The Governing Body is asked to:
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1. Note the contents of this report 2. Note that the next update on the Business Plan will be the end of year
report
Strategic Objectives Links
The Business Plan makes a contribution to all of the CCG Strategic Objectives. The majority of the initiatives are in objectives C and D which are:
Objective C: Improve health outcomes, address inequalities and achieve parity of esteem.
Objective D: Integrate and enable local services to deliver the right care in the right setting at the right time.
Identified Risks and Risk Management Actions
Issues and risks for each objective are included in the main report and the key risks are noted above in the report summary. Relevant risks relating to Business Plan initiatives are monitored through the Board Assurance Framework and Integrated Commissioning Committee Risk Registers.
Conflicts of Interest
Where conflicts of interest arise in relation to specific Business Plan initiatives, these will be addressed accordingly.
Resource Implications
Resource implications of the Business Plan are addressed as part of implementation planning and mobilisation.
Engagement
This report has been prepared with the involvement of the CCG Executive Team and senior managers involved in delivering the Business Plan.
Equality Impact Analysis
There are no equality issues arising from this report.
Report History
Updates are presented every six months to Governing Body, following review by the Executive Team.
Next Steps The CCG will continue to prioritise the implementation of the Business Plan and provide regular updates to Executive Management Team and Governing Body.
Appendices None
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Business Plan Update Report
Governing Body – 8th November 2017
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Title Slide No.
Business Plan Objectives 3
Overview of Business Plan Initiatives 4 – 5
Key Updates 6
Objective A: Commission the delivery of NHS constitutional rights and
pledges
7
Objective B: Improve the quality and safety of commissioned services 8
Objective C: Improve health outcomes, address inequalities and achieve
parity of esteem
9 – 10
Objective D: Integrate and enable local services to deliver the right care in
the right setting at the right time
11 – 12
Objective G: Maintain financial stability and ensure sustainability through
robust planning and commissioning of value-for-money services
13
Table of Contents
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Commission the delivery of NHS constitutional rights and pledges
Improve the quality and safety of commissioned services
Improve health outcomes, address inequalities and achieve parity of esteem
Integrate and enable local services to deliver the right care in the right setting at the right time
Work jointly with the people and patients of Camden to shape the services we commission
Involve member practices and commissioning partners in key commissioning decisions
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for-money services
Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce
Population segment addressed
Enablers
Children Adults Mental Health
Learning Disabilities
Eight Objectives in Camden CCG Business Plan
A
B
C
D
E
F
G
H
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Overview of Business Plan Initiatives
Summary
Of the 40 initiatives
• 26 are progressing to plan (RAG status - green)
• 13 have some risks or issues requiring action (RAG status – amber)
• 1 initiative has a significant issue which is being actively managed (RAG status – red)
The subsequent slides focus primarily on the status of the ‘amber’ and ‘red’ RAG initiatives, whilst also highlighting key updates.
All initiatives in the following objectives are green and are therefore not featured in this report:
• E (Work jointly with the people and patients of Camden to shape the services we commission). Please see Patient Voice report for further information
• F (Involve member practices and commissioning partners in key commissioning decisions) and
• H (Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce)
4
1
13
26
Summary of RAG Status - Nov'17
KeyRed – Significant risks/issues have arisen that require action immediately
Amber – There are risks/issues that require action in the near future
Green – No Issues, progressing according to plan
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Objectives Key
Objective A: Commission the delivery of NHS constitutional rights and pledgesObjective B: Improve the quality and safety of commissioned servicesObjective C: Improve health outcomes, address inequalities and achieve parity of esteemObjective D: Integrate and enable local services to deliver the right care in the right setting at the right timeObjective E: Work jointly with the people and patients of Camden to shape the services we commission.Objective F: Involve member practices and commissioning partners in key commissioning decisions Objective G: Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for-money services.Objective H: Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce.
Overview of Business Plan Initiatives (cont’d)
5
12
1
54
1
12
6
2 2
2
2
5
10
15
20
Obj A Obj B Obj C Obj D Obj E Obj F Obj G Obj H
RAG Status of Initiatives by Objective
KeyRed – Significant risks/issues have arisen that require action immediately
Amber – There are risks/issues that require action in the near future
Green – No Issues, progressing according to plan
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Key Updates on Business Plan initiatives
Objective A: Commission the delivery of NHS constitutional rights and pledges
• Diagnostics target is currently being met for Camden and UCLH
• UCLH has achieved the internal performance trajectory in the Remedial Action Plan for 62 day cancer
• Cancer 2WW (week wait) is currently being met for Camden, and UCLH
• The cancer RAP was refreshed and is having a positive impact on the Trust's internal performance.
Objective C: Improve health outcomes, address inequalities and achieve parity of esteem
Children’s
• Children and Adolescent Mental Health Service (CAMHS) waiting times have reduced to below the target of 8 weeks
Adults
• Homecare and reablement tender is underway
Mental Health
• The psychiatric liaison service went live in July
• There has been an increase in learning disabilities health checks to 62% and plans are being developed to work to the new target of 79%
Objective D: Integrate and enable local services to deliver the right care in the right setting at the right time
• Camden CCG’s draft PMS service specification received positive feedback at the NCL PMS Oversight Group in October. Work is now progressing to a
full service specification, aiming for approval from NHSE in December.
Objective E: Work jointly with the people and patients of Camden to shape the services we commission
• 2017-18 CCG Key Achievements document was produced
• The annual stakeholder survey results have been analysed and an action plan from the results is being implemented
• Over 500 tweets and 75 Facebook items were posted
Objective G: Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for-money services
• Robust systems and processes are in place which includes focus on mitigations and under-delivery to support the delivery of QIPP – QIPP Challenge
Panel, clinical QIPP workshops, Finance, Performance and QIPP Committee
Objective H: Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce
• A number of different events were held during the Health and Wellbeing (HWB) week, which received positive feedback. Survey shows that 80% of staff
would participate in HWB week in future.
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Objective A: Commission the delivery of NHS constitutional rights and pledges
Initiative Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
A1 Achievement of remedial
action plans, improvement
trajectories and maintenance
of compliance with
standards
Through the NCL Joint
Committee, improve the
delivery of constitutional
standards and pledges, where
required. This includes, for
UCLH, achievement of
remedial action plans and
improvement trajectories for:
• cancer 62-day waits
• the A&E 4-hour standard and
maintenance of compliance of
the following standards;
• cancer 14 day waits
• diagnostic targets
• improvement of specialty-
specific Referral to Treatment
(RTT) delivery challenges
• UCLH has not met the A&E trajectory in the
RAP (remedial action plan). The Trust has not
met the 90% threshold in Q2 set out in the
FYFV (five year forward view).
• UCLH did not meet the RTT target (referral to
treatment) in July, and is currently forecasting
a return to compliance in January 2018. It is
likely that this will impact on Camden CCG’s
performance.
• Trust performance is being managed in line with
the CCG’s performance management
framework.
• Camden CCG reissued CPNs for 17/18 to
UCLH for A&E and 62 day cancer with the aim
of improving performance.
• The urgent and emergency care RAP for UCLH
was refreshed and contains various actions
aimed at decreasing bed occupancy to 88% -
the level at which the Trust would expect to
regain compliance with the A&E target.
• The cancer RAP was refreshed and is having a
positive impact on the Trust's internal
performance.
• System wide cancer issues, including high
volumes of late referrals from referring providers
is being managed at the NCEL Cancer
Leadership Forum.
• An RTT recovery plan has been created,
including specialty level trajectories. The plan
will be monitored in detail at the monthly
performance meeting with escalation to CRG
where necessary, and GB updated via the
Integrated Performance Report and at F&P.
Chief Operating
Officer
NCL Director of
Performance
and Acute
Commissioning
A2 Local Care Delivery
Improve the delivery of
constitutional standards and
pledges using the following
STP and LCS work streams as
an enabler to improving
performance:
• Urgent and Emergency Care
(including admissions
avoidance)
• Care Closer to Home
• Planned Care
• Prevention
The initiative is Amber – transformation initiatives
are moving at pace, and several of the priority
projects are now moving into implementation.
However, there has been significant slippage
against the original STP timescales, and
validation of the original investment targets have
meant that the scale of some transformation
initiatives has had to be reduced, or phased over
a longer period. This means that the anticipated
benefits may also be reduced or delivered over a
longer timescale.
The agreed approach is to remodel current
services, rather than ‘invest to save’.
The programme is being closely monitored to avoid
slippage on timescales and ensure benefits are
realised.
Transformation team is supporting the
commissioners who are developing business cases
for the key initiatives.
Transformation team are also looking at
implementation/Performance Improvement (PI)
methodologies that can support robust
implementation of the initiatives.
Director of
Transformation
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Objective B: Improve the quality and safety of commissioned services
Initiative Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
B1 NCL Quality & Safety
collaboration
Optimise the new North
London CCGs collaboration
to enable improved quality
and safety of jointly
commissioned contracts
The initiative is currently being scoped by the NCL
CCG Directors of Quality (DoQ). The scope
includes a quality strategy across NCL, care
homes and A&E as the first set of priorities to be
further developed.
The lead DoQ for each of the three priorities have
been agreed. Progress will be reported on a
quarterly basis to the NCL SMT.
Director Quality
and Safety
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Objective C: Improve health outcomes, address inequalities and achieve parity of esteem
Initiative Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
Adults - Acute
C4. Planned Care -
Dermatology,
Gastroenterology
Develop new pathways,
models and commissioning
arrangements with a view to
implement these in the first
half of 2018
The Amber RAG reflects the considerable work
still to be done to implement the dermatology
changes and gastroenterology pathway
improvement.
Dermatology - There has been a series
of NLP workshops to agree the pathway
for the service model. A business case,
based on this process, is being
developed for consideration by the ICC
(Integrated Commissioning Committee)
in October.
Gastroenterology -- there has been initial
discussion with Secondary Care on
pathways.
This represents significant progress
since previous reporting.
Director of
Commissioning
& Contracting
C4.2 Planned care -
PoLCE, IVF, Integrated
Medicine
Address PoLCE
(Procedures of Limited
Clinical Evidence)
compliance, and implement
IVF (In Vitro Fertilisation)
policy changes informed
through consultation
IVF policy - ICC agreed in August to proceed to
public consultation on revising Camden CCG's
IVF offer, in line with NICE guidance.
Consultation is expected to last early into the new
year. This initiative is flagged as amber as the
consultation requires great care in its planning
and management.
IVF policy - Acute resource has been
assigned to progress the consultation,
working with Comms and Engagement
team. Detailed timetable is being
discussed.
PoLCE – A compliance audit has been
agreed and commenced with UCLH, for
reporting by the end of November.
Integrated medicine -- The team are
finalising decommissioning of
homeopathic remedy prescribing, by
Royal London Hospital of Integrated
Medicine. Drug costs (approx. £50k) will
be saved but the service implications are
still being worked through with clinicians
from the CCG and UCLH.
Director of
Commissioning
& Contracting
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Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
Adults – Community
C4.3 Planned care –
MSK
Ensure the integrated
MSK service is fully
implemented by March
2018
Six-months in to the arrangement, UCLH has not
progressed the integrated MSK service as quickly
and comprehensively as required. The formalising
of contracts with acute and referral management
providers is taking longer than anticipated.
The reasons for this are primarily resource-related
rather than any issues of dispute or principle.
We continue our efforts to support UCLH
in rolling out this contract so that full
benefits can be realised as soon as
possible. Progress is being monitored by
the CSU contract manager and CCG’s
clinical lead via UCLH’s Strategic Board
and Operational Delivery meeting.
Director of
Commissioning
& Contracting
C5.2 Supporting People
at Home – Integrated
Care Teams (ICT)
Develop and implement a
new model for Integrated
Care teams aligned with
Primary Care
neighbourhoods to
achieve better and more
integrated support for
people in the home
The Amber RAG is because of the challenges in
meeting the timeline for implementation of the new
ICT model as it is in its early stages of development.
District nursing and homecare
neighbourhoods have been agreed and
will align with GP neighbourhoods.
Business case detailing the ICT model
was taken in September and will be taken
again in December for approval.
Director of
Integrated
Commissioning
Mental Health
C9 Crisis Care (Core 24
Liaison Services)
Scale up 24/7
comprehensive liaison
service to UCLH. To
support University College
London Hospital (UCLH)
to develop mental health
liaison services that meet
Core 24 NHSE bid
criteria.
NHS funding for extra staff in the psychiatric liaison
team is until March 2018 only, with the expectation
that it will produce cashable savings that UCLH will
reinvest in the team going forward. There is a risk
that these savings are not realised and/or that
UCLH does not fund services in the future, which
would cause a £0.5M cost pressure to the CCG.
Work is progressing through the STP
Liaison group to consider an independent
evaluation of the service to help identify
the impact of additional funding in terms
of length of stay.
This has been added to the ICC risk
register to stimulate discussion and
possible solutions at senior management
level or through the urgent & emergency
STP workstream.
Director of
Integrated
Commissioning
Objective C (cont’d): Improve health outcomes, address inequalities and achieve parity of esteem
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Objective D: Integrate and enable local services to deliver the right care in the right setting at the right time
Initiative Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
D1.1 Neighbourhoods -
Service Delivery
Gain approval for two service
delivery proposals, and
ensure service delivery is fully
underway
Further work is required to finalise the
neighbourhood service proposals.
The paper and proposals are being further refined
with the aim of being approved at the October
Integrated Commissioning Committee. Adjustments
to mobilisation plans and delivery schedules will be
agreed between neighbourhoods and the Primary
Care and Transformation teams.
Assistant
Director
Primary Care
D1.2 Neighbourhoods –
QISTs
Develop and agreed the
QISTs business case, and
deliver quality improvement
support to practices, linked to
the Universal Offer
The status of the initiative is amber because the
savings target (from the STP) will not be delivered
in 2017/18.
However, the planned work relating to the delivery
of the initiative in 2017/18 is on track. Each
neighbourhood is delivering the foundation QIST
linked to delivery of the Universal Offer. Work to
develop a business case for further QIST
development in Camden will be submitted to ICC
in December.
Develop the business case for QISTs in Camden
for delivery in 2018/19 – to be submitted to ICC in
December.
Other areas are being explored to mitigate the
savings gap.
Assistant
Director
Primary Care
D2 Universal offer
Ensure all practices
successfully deliver the
Universal Offer, and refine for
2018/19
This initiative is broadly on schedule, however, the
delivery RAG is Amber to reflect that the target
savings against the Universal Offer services will
not be fully delivered in 2017/18. Delivery of the
anticoagulation service is slightly behind schedule
due to a delay with training on DOAC initiation and
the deadline for practices to offer this service has
been moved back from 1st October to 1st
November 2017. This is however one service out
of 10 within the Universal Offer. The collaborative
pathway for IUCD/IUS has been agreed in line
with the expected plan for all services to be offered
by 1st October 2017.
Primary Care team to report any Universal Offer
forecast underspend to the QIPP Challenge Panel
each month.
Ensure practices have booked onto DOAC training
and are preparing for service delivery.
Other areas are being explored to mitigate the
savings gap.
Assistant
Director
Primary Care
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Objective D (cont’d): Integrate and enable local services to deliver the right care in the right setting at the right time
Initiative Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
D8 Digital programme
Implement the following
workstreams of the ‘Towards
Digital’ strategy, to enable
LCS:
• CIDR enhancements for
111, radiology,
documentation, and single
sign-on between secondary
and council IT systems
• Enabling other key LCS
work streams such as Tele-
Dermatology pilot
• 111/OOH services
integration with GP Hubs and
GPs
• Produce monthly digital
dashboards on the activity
and quality of primary care
services, for GP services and
the CCG, for assurance and
information purposes
• Enable patients to be able to
book & access GP/primary
care professionals through
alternative means such as
through e-consultation,
telephone triage and Patient
Online
CIDR - Ongoing delays to the release of the ULCH
ADT interface with CIDR, due to infrastructure
issues at UCLH.
All other workstreams are going to plan:
• Enabling access to clinical alerts within CIDR
for hospital admissions, discharges and deaths
• Working closely with urgent care team on
enabling flags within 111 call systems for
patients with care plans for faster access to
records
• Developing radiology reports in CIDR from
Royal Free
• Tele Dermatology: working closely with STP
lead and local providers on staring Camden
pilot using e-referrals and practice based
cameras
• Working with NHSE and Healthy London
Partnership to enable the first NHS pilot for e-
booking and e-consultation, by end of this year.
The governance has been signed off by ICC.
Continue to offer support and apply pressure to
UCLH, exploring all opportunities for leverage.
Director of
Sustainable
Insights
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Objective G: Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for-money services
Initiative Reason for Amber and Red Status Red or
Amber
Key Actions being taken (and by when) Accountable
G1 Financial Strategy
and QIPP
Develop and implement
Camden’s medium-term
financial strategy in line
with the revised financial
allocation, taking into
account cost pressures,
investment plans, QIPP
plans, demographic growth
and other adjustments,
and deliver 17/18 QIPP
and develop plans for
18/19 QIPP
As at month 6 (September) the CCG is
forecasting a balanced budget to the 17/18
MTFS financial plan. Robust financial
monitoring is in place for managing the
MTFS, including the identification of cost
pressures, financial risks and mitigations,
monitoring of investment and QIPP.
In line with national trends the CCG continues
to face increasing costs and higher demand
for services which may impact on the MTFS.
As at month 6 financial risks have emerged
that require a recovery plan to be
implemented with immediate effect.
The 18-19 QIPP planning is underway with
initial targets being allocated and plans being
worked up
Continuing robust monthly financial
monitoring. Camden CCG continues to face
increasing 2017-18 financial pressure. A
recovery plan is being implemented to
mitigate in year financial risks.
2018-19 financial planning process started.
QIPP planning is underway, plan due
November 2017.
Deputy
Director of
Finance
G2 Alternative
contracting forms
Through the NL Joint
Committee, work with
providers to further
develop system incentives
and options for alternative
contract forms that better
support the new models of
care in the STP and
ensure financial
sustainability
Discussions regarding further changes to
contract form are at an early stage of option
appraisal. Significant changes are already in
place for 17-19, with a move away from PbR
(payment by results) towards marginal rates,
and a revised set of contract incentives.
Royal Free and NMUH (North Middlesex
University Hospital) have agreed to trial an
alternative method of setting contract value,
with discussions taking place as to the
information required to support this. These
are centred around variations on an ‘aligned
incentives’ model, which seeks to understand
where the inefficiencies are in the current
system, and agree system wide solutions to
reducing these. This would be closely linked
to the priorities already identified as part of
the STP. There is an aim to implement
shadow arrangements prior to 2019/20, when
the current contractual agreements expire.
NCL Director of
Performance
and Acute
Commissioning
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Board Assurance Framework
Agenda Item 5.1
Date 30th October 2017
Lead Director Ian Porter, Director of Corporate Services
Tel/Email [email protected]
Report Author Michael Wuestefeld-Gray, Governance Lead (interim)
Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Richard Strang, Lay Member Tel/Email [email protected]
Report Summary
The Board Assurance Framework (‘BAF’) captures the most serious risks identified as threatening the achievement of the CCG’s eight strategic objectives. Number of risks There are 13 risks on the BAF. Since the BAF was presented to the Governing Body in September 2017 6 risks have been escalated to the BAF. Three of these risks are from the NCL Joint Commissioning Committee and three are from Camden CCG only committees. Aside from risk 363 risk ratings remain unchanged. One risk has been removed and closed. Risks from the NCL Joint Commissioning Committee are from the perspective of cross-NCL work. These risk are identified as ‘JCC’ risks. The other risks are from a Camden CCG only perspective. Therefore, there may be a degree of natural overlap between some of the risks. Closed risks Risk 242- Poor Performance Against Constitutional Targets (Threat) has been removed from the risk register and closed. It has been replaced with two new risks that better cover the key elements of risk 242. One of these risks is Temp 1- Delivery of 62 Day Waiting Time Standard (Threat). This risk has a current risk score of 16 so meets the threshold for escalation to the BAF. This risk appears on the BAF as a new risk. The other new risk has not met the escalation threshold so does not appear on the BAF. Risks Risk 362- System Resilience (Threat): Full Community was due to be completed by end September 2017. Weekend Hub Access is currently in place and a re-provision exercise has been completed to enhance utilisation. Extended hours access is also in place and re-provision exercise has been completed to enhance utilisation. Risk 363 - PMS Review (Threat): Local Project Plan for developing local proposals and managing contract transition has been agreed and a Proposal Prioritisation Workshop date agreed. Concerns around lack of financial baseline information and financial support from the Commissioning Support Unit (‘CSU’) has been raised with Director of Primary Care at NHS England (London). Next steps include obtaining an external review of the outcome of these actions.
215 of 291
Please note the current risk rating has decreased from 20 to 15, due to the likelihood reducing from 5 to 3, while consequence rating has increased from 4 to 5. Risk 382 - Failure to produce a deliverable and robust QIPP Plan for 2017/18 (Threat): The QIPP Challenge Panel has been established to oversee operational delivery of QIPP. The QIPP programme has now identified £22.4m of schemes, on a risk rated basis there is £4.8m considered at risk of being delivered. NCL Joint Commissioning Committee Risks JCC 1 - Delivery of Cancer 62-day waiting time standard (Threat): There is a risk that the system may be unable to cope with the level of demand and has limited resilience to unexpected events, due to insufficient capacity within the system, and inefficiencies along pathways in particular for inter-provider transfers. JCC 2 - Delivery of four-hour waiting time standard for A&E (Threat): There may be insufficient capacity across hospital and community services to meet peaks in emergency care demand. There is a risk that people will spend more than four hours within emergency departments before receiving definitive treatment or be located in the wrong part of the system due to pressures along the emergency care pathway. JCC 10 - Mobilisation of STP and QIPP plans (Threat): There is a risk that contracts will not be delivered within resource envelopes for 2017/18 if it is not ensured that STP and QIPP plans are delivered in accordance with planning assumptions. JCC 11 - Managing acute contracts within contract baselines (Threat): There is a risk that CCGs will not meet their financial duties and/or investment is withheld to support delivery of the STP if expenditure on acute contracts exceeds planned contract baselines. New Risks Temp 1- Delivery of Cancer 62 Day Waiting Time Standard (Threat): The Performance Team continues to work with providers to meet the standard. UCL Hospital is predicting recovery of the standard by the end of March 2018 and is consistent with system recovery by the end of September 2017. 431 - Increased costs due to acute over-performance (Threat): if expenditure on acute contracts exceeds planned contract baselines this increased expenditure could lead to a requirement for additional in-year and future QIPP delivery, This may impact on delivering a balanced control total; and may increase baseline acute costs in 18-19 432 - Failure to produce a deliverable and robust QIPP plan for 2018/19 (Threat): This risk complements risk 382. If the CCG fails to produce and deliver a robust QIPP plan for 2018/19 that meets NHS mandated control totals there is a risk that the CCG may not have a balanced budget for 2018-19 and not meet NHS England control totals. This may result in the CCG being placed into directions/special measures by NHS England, destabilisation of the CCG, destabilisation of local providers, a wider negative impact on the NCL health economy and loss of influence of quality of patient care.
216 of 291
JCC 13 - Winter Pressures and Non-Elective Flows (Threat): There is a risk that patients may receive sub-optimal care and long waiting times leading to the local system missing waiting time standards for A&E and referral-to-treatment. Historically capacity to meet cancer waiting time standards has been successfully ring-fenced. JCC 14 - STP and local plans target the shift of care from hospital into community settings, to reduce the overall system financial deficit this needs to be done in a way that allows hospital providers to reduce capacity and costs. This risk follows on from the initial risk of mobilising STP and local plans in JCC10 (Threat): There is a risk that hospital providers are left with stranded costs and we do not reduce overall system costs JCC 18 - NCL is a system in deficit. One of the aims of our Sustainability and Transformation Plan is to deliver financial recovery and maintain and sustainable health and care system. The STP sets out the challenges to financial recovery from demographic and demand trends. (Threat): There is a risk that additional savings plans will need to be developed that have a greater impact on service delivery and access than current plans, and the local system comes under greater scrutiny from regulators.
Purpose
Information
Approval To note
Decision
Recommendation The Governing Body is asked to review the risks and provide feedback on the updated BAF.
Strategic
Objectives Links
The BAF focuses on risks relating to the strategic objectives of the CCG:
Commission the delivery of NHS constitutional rights and pledges
Improve the quality and safety of commissioned services
Improve health outcomes, address inequalities and achieve parity of esteem
Integrate and enable local services to deliver the right care in the right setting at the right time
Work jointly with the people and patients of Camden to shape the services we commission
Involve member practices and commissioning partners in key commissioning decisions
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for- money services Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce.
Identified Risks
and Risk
Management
Actions
The BAF is a risk management document which is presented at every Governing Body report. It is available to members of the public on the CCG’s website.
Conflicts of Interest
None identified
Resource
Implications
Updating of the BAF is the responsibility of each risk owner and their respective directorates. The Governance Team helps to support this by providing monitoring, guidance and advice.
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
This report was written in accordance with the provisions of the Equality Act 2010.
217 of 291
Report History
The BAF was last reviewed by the Governing Body at its September meeting and by the Executive Team on 25 October 2017. Risks are kept under review by committees of the Governing Body and risk owners.
Next Steps To continue to manage risk across the organisation in a robust way.
Appendices
The following is attached: 1. BAF; 2. BAF Heat Map; 3. Risk Scoring Key.
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ID Director Objectives Risk Controls in Place Evidence of ControlsOverall Effectiveness of
Controls in Place
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Actions Update on Actions Action Competion Date
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362
Trevor Myers, Interim
Director of Commissioning
and Contracts
Commission the delivery of
NHS Constitutional rights
and pledges
TITLE: System Resilience (Threat)
CAUSE: There may be insufficient capacity within
the system
EFFECT: Which may lead to the risk that the
system may be unable to cope with changes and
increases of activity at times of high demand,
such as the winter time.
IMPACT: This may lead to performance issues in
A&E (UCLH), referral to treatment targets, and
elective care which may impact on patient care.
The CCG may also suffer reputational damage.
C1. An A&E delivery board has been established which has executive level
representation from key providers in the system.
C2. A&E Delivery Board has developed a 'Heat Map' dashboard which
monitors key parts of the system to highlight any issues in terms of capacity
and/or performance.
C3. With key providers, and using funding available to the A&E Delivery Board,
agreed which parts of the system would benefit from increased capacity or
efficiency changes.
C4. Continued monitoring of the action plan (RAP) against agreed outcome
measures.
C5. A North Central London ('NCL') wide review of how winter went across
NCL took place on 6th April 2017 to share lessons learned.
C6. The A&E Delivery Board submitted plans to NHS England for winter
2017/18 based on experiences and pressures in 2016/17.
C1. A&E Delivery Board papers (meets
monthly)
C2. Heat Map discussed at each A&E
Delivery Board meeting
C3. Bids submitted and considered at
the A&E Delivery Board
C4. Monitored through the monthly
UCLH performance meeting
C5. Notes from the workshop.
C6. Winter plan
AVERAGE: The controls
have a 61 – 79% chance of
successfully controlling the
risk
4 4 16
Very H
igh
A1. Community Bed Review.
A2. Have in place Weekend Hub
Access to give increased access to
GP services.
A3. Access to Extended Hours
service.
A1. The 'Full Community Bed' review is
underway and is scheduled to be completed by
the end of September 2017. The ambition of
this review is to identify further resources
required to support Winter Resillience
A2. Currently in place, reprovision exercise has
been completed to enhance utilisation.
A3.Currently in place, reprovision exercise has
been completed to enhance utilisation.
A1. 31.10.2017.
A2. Completed.
A3. 31/12/2017.
4 2 8
High
Temp 1
Trevor Myers, Interim
Director of Commissioning
and Contracts
Commission the delivery of
NHS constitutional rights
and pledges
TITLE: Delivery of Cancer 62-day waiting time
standard (Threat)
Cause: Performance against the 62 day waiting
time standard at UCLH is impacted by whole
system performance, particularly late inter-trust
transfers.
Effect: There is a risk that the Trust may be
unable to cope with the level of demand.
Impact: This may result in patients not receiving
treatment within 62 days.
C1. Regular performance meetings with providers and strengthened CCG
performance management process in place.
C2. Use of contractual leavers where applicable.
C3. RAPs being implemented and monitored.
C4. North Central London ('NCL') cancer governance arrangements
established to cover both performance and transformation.
C5. Improvement trajectory agreed with NHS England and NHS Improvement.
C6. 38 day transfer protocol in place for inter-provider transfers from district
general hospitals to tertiary services with the 38 day standard compatible with
treatment commencing within 62 days.
C1. Meeting papers and notes.
C2. CPN issued.
C3. RAPs monitored at the monthly
performance meeting
C4. Transfer protocol document.
C5. Trajectory
C6. Transfer protocol.
AVERAGE: The controls
have a 61 – 79% chance of
successfully controlling the
risk
4 4 16
Very H
igh
A1. Continue to work with
providers on delivering the
trajectories.
A2. Continue to work with
providers to ensure sustainable
delivery and includes work through
the cancer vanguard.
A3. UCLH recovery of the 62 day
standard by end of March 2018 and
is consistent with system recovery
by end of September 2017.
A1. Meeting with providers on a monthly basis
and ensuring their plans are consistent with
agreed trajectories.
A2. Meeting with providers on a monthly basis.
A3. Currently on track for delivery.
A1. Meetings are held
continuously on a monthly
basis.
A2. Meetings are held
continuously on a monthly
basis.
A3. 31.03.2018
4 3 12
High
363Sally MacKinnon- Director
of Transformation
Improve health outcomes,
address inequalities and
achieve parity of esteem
TITLE: PMS Review (Threat)
CAUSE: If Camden CCG fails to successfully
complete the PMS Review.
EFFECT: There is a risk that the funding required
to deliver an equitable offer in general practice
will not be available.
IMPACT: This may result in the CCG being unable
to deliver the Primary Care Mandate
commitment - a consistent offer for patients in
general practice in Camden.
C1. On-going communication with PMS Negotiating Team
C2. On-going communication with NHS England
C3. On-going communication with LMC
C4. GP Forward View returns to NHS England
C5. Local PMS Review Group established
C6. Governing Body Paper outlining approach for reinvestment plans
C7. Final submission to NHS England of local PMS reinvestment plans
C8. Financial position for 2017-18 received from NHS England and information
has been distributed to practices to support baseline modelling.
C9. External review information from 2015-16 held.
C10. Local Reinvestment Forum established and running.
C11. Local Project Plan outlining approach to developing reinvestment
proposals and contract process in plan
C12. Regular meetings of NCL Reinvestment Group
C1. Email communication documenting
meetings with PMS Negotiating Team.
C2. Formal minutes of communication
between NCL CCG's and NHS England.
C3. Formal minutes of communication
between Camden CCG and London wide
LMC
C4. Completed Forward View template.
C5. PMS Review Group documentation.
C6. Copy of the Governing Body paper
outlining approach to reinvestment
plans.
C7. Copy of final NHS England
submission.
C8. Spreadsheets and e-mails.
C9. Spreadsheet.
C10. Minutes/ notes of meetings.
C11. Copy of Project Plan
C12. Minutes/ notes of meetings.
AVERAGE: The controls
have a 61 – 79% chance of
successfully controlling the
risk
5 3 15
Very H
igh
A1. Letter to practices to confirm
outcome of dialogue around
transition.
A2. First local reinvestment
meeting held.
A3. Shaping local service
specification with support from
Sustainable Insights.
A4. Local Project Plan for
developing local proposals and
managing contract transition
agreed
A5. Proposal prioritisation
workshop date agreed.
A6. Concerns around lack of
financial baseline information and
financial support from CSU raised
with NHSE Director of Primary
Care.
A7. Updated Financial Baseline
information shared with practices
A8. Practice meetings held
A9. Commissioning Intentions
discussed at NCL Oversight Group
A10. Commissioning Intentions
assured by NHS England / LMC
A1. Letter to practices sent.
A2. Meeting on PMS review held on 4.05.2017.
A3. Currently being shaped.
A4. Discussed at local group
A5. Discussed and agreed at local group
A6. Emailed to NHSE Director of Primary Care
A7. Sent to practices
A8. Practice meetings complete
A9. Discussed at October meeting
A10. Service specification developed, awaiting
sign off and completion of assurance
A1. 05.05.2017
A2. 04.05.2017
A3. 31.08.2017
A4. 23.08.2017
A5. 23.08.2017
A6. 18.08.2017
A7. 30.9.2017
A8. 27.10.2017
A9. 17.10.2017
A10. 10.11.2017
17.1 2 4
Mo
derate
1219 of 291
ID Director Objectives Risk Controls in Place Evidence of ControlsOverall Effectiveness of
Controls in Place
Co
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(cu
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Like
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(cu
rre
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Rat
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(cu
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Ris
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(cu
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Actions Update on Actions Action Competion Date
Co
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432
Trevor Myers, Interim
Director of Commissioning
and Contracts
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value-
for- money services
TITLE: Increased costs due to acute over-
performance (Threat)
Cause: if expenditure on acute contracts exceeds
planned contract baselines
Effect: Increased acute expenditure leading to
requirement for additional in-year and future
QIPP delivery
Impact: recovery plan and additional in-year
and future QIPP requirements. may impact on
delivering a balanced control total. May increase
baseline acute costs in 18-19
C1. Signed contracts in place for 2017/18 and 2018/19
C2. Contracts include marginal rate payments/deductions for variances from
plan and 3% growth (higher than historic growth trends)
C3. Contract management framework in place with providers
C4. Issue of contract notices in line with contact provisions
C5.. Mobilisation of STP and QIPP plans (see JCC10)
C6. North Central London Finance and Activity Modelling (FAM) Group, with
commissioner and provider membership. that oversees system financial
position
C7. Work on alternative contract forms to support the Sustainability and
Transformation Plan (STP) through the Acute Contract Modelling Group (with
commissioner and provider membership)
C8. Monthly finance and performance monitoring of acute contracts
C1. Signed contracts
C2. Signed contracts
C3. Meeting minutes and papers
C4. Contract documentation and
correspondence including remedial
action plans
C5. See JCC10
C6. Meeting minutes and papers
C7. Meeting minutes and papers
C8. Finance & Performance reporting
AVERAGE: The controls
have a 61 – 79% chance of
successfully controlling the
risk
5 4 20
Very H
igh
A1. Develop, in co-production, with
providers, proposals for alternative
contract forms for hospital
providers
A2. Pursue all contractual remedies
for inappropriate charging beyond
standard challenges. These include
PoLCE (incorporating RLHIM), 30-
day readmission threshold at local
trust, application of access policy,
and coding notification issues at a
neighbouring trust.
A3. Conduct independent analysis
of reconciliation between data
sources to validate charging in
specific areas
A1. Consideration of models used elsewhere -
Aligned Incentive Contract in Bolton;
Accountable Care models
A2. This work has commenced for finalisation
prior to end of calendar year
A3. This work is being reported to Finance &
Performance committee 25th October 2017
A3. 25/10/17
4 4 16
Very H
igh
431Rebecca Booker- Deputy
CFO
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value
for money services
TITLE: Failure to produce a deliverable and
robust QIPP plan for 2018/19 (Threat)
CAUSE: If the CCG fails to produce and deliver a
robust QIPP plan for 2018/19 that meets NHS
mandated control totals.
EFFECT: There is a risk that the CCG may not
have a balanced budget for 2018-19 and not
meet NHS England control totals.
IMPACT: This may result in the CCG being placed
into directions/special measures by NHS England,
destabilisation of the CCG, destabilisation of local
providers, a wider negative impact on the NCL
health economy and loss of influence of quality
of patient care.
C1. QIPP Workshop is overseeing the development of the 2018/19 QIPP plan.
C2. Finance and Performance Committee reviews and approves the overall
financial plan including QIPP.
C3 Currently going through a review of avoidable spend, assigning priorities to
spend areas with a view to reducing or ceasing low priority spend.
C4. QIPP Manager to support the QIPP Programme is in role.
C5. QIPP Planning started in September 2017.
C6. Obtained from Governing Body direction on lower priority spend areas for
savings.
C7. Root and branch review of all spend across the organisation completed.
C8. Consistent NCL approach to planning .
C9. PMO taking a strengthened role in QIPP.
C10. Governing Body direction on lower priority spend areas obtained.
C11. Contractual arrangements with acute providers in place.
C12. Clinical and manager leads in place for each area of QIPP.
C13. QIPP Challenge Panel established to oversee operational delivery of QIPP.
C14. Camden CCG is part of the NCL STP which has shared responsibility to
ensure financial stability. This includes commissioners and providers.
C1. Minutes and papers of the QIPP
cabinet;
C2. Minutes and papers of the Finance
and Performance Committee;
C3. Minutes and papers of the QIPP
Cabinet and Finance and Performance
Committee.
C4. Contract of Service.
C5. Minutes of meetings and meeting
reports.
C6. Governing Body forum note.
C7. Updated financial assessment.
C8. NCL QIPP & planning meetings.
C9. PMO reports.
C10. Minutes of workshop.
C11. Contracts with acute providers.
C12. QIPP register
C13. Meeting notes and papers.
C14. A NCL STP Finance and Activity
Modelling meeting occurs every two
weeks to ensure NCL remains on track
with QIPP delivery.
AVERAGE: The controls
have a 61 – 79% chance of
successfully controlling the
risk
5 4 20
Very H
igh
A1. Review of all existing 18-19
QIPP schemes and identification of
new schemes
A2. 18-19 QIPP target identifed and
planning underway (on-gofng from
Sept 2017)
A3. 18-19 initial QIPP plans due at
NHSE 30/10/17
A4. 18-19 refresh of QIPP target
and plan
A1. Review of all existing 18-19 QIPP schemes
and identification of new schemes to meet
initial 18-19 QIPP target. All existing QIPp
schemes have been reviewed and (if required)
updated. Additional QIPP scoping documents to
identify new schemes submitted and reviewed
A2. Planning and actions under-way, being
reported to NCL QIPP Planning Meeting, QIPP
Challenge Panel and Finance and Performance
Committee
A3. In line with requirements initial QIPP plan
being submitted to NHSE for review
A4. Initial QIPP target being refreshed to reflect
most up to date financial position and to
support NCL consistency. Additional schemes
identified if required
A1. 20/10/17
A2. 29/09/17
A3. 30/10/17
A4. 30/11/17
4 4 16
Very H
igh
A1. 15/09/2017
Very H
igh
16
Very H
igh
44
A1. Develop PIDs/Project plans for
all QIPP schemes in line with NCL
STP plans and continue to
participate in the Capped
Expenditure Process.
A1. Finance plans were revised in May 2017 in
accordance with NHS England's requirements
and to recognise the devolvement of primary
care commissioning to CCGs. The unidentified
QIPP in the most recent plan was reduced down
to zero, leaving a £22.4m gross QIPP savings
required for 2017-18. A NCL wide capped
expenditure process summit was held on 24th
April 2017 to identify opportunities for
additional savings through difficult decisions.
Both commissioners and providers are seeking
to identify the locality solutions jointly.
The QIPP programme has now identified
£22.4m of schemes, on a risk rated basis there
is £4.8m considered at risk of being delivered. A
deep dive into all QIPP schemes is to be
undertaken in late August to identify and
quantify the risks to the QIPP programme.
382Rebecca Booker- Deputy
CFO
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value
for money services
TITLE: Failure to produce a deliverable and
robust QIPP plan for 2017/18 (Threat)
CAUSE: If the CCG fails to produce and deliver a
robust QIPP plan for 2017/18 that meets NHS
mandated control totals.
EFFECT: There is a risk that the CCG will not have
a balanced budget for 2017-18 and not meet
NHS England control totals.
IMPACT: This may result in the CCCG being
placed into Directions/special measures by NHS
England, destabilisation of the CCG,
destabilisation of local providers, a wider
negative impact on the NCL health economy and
loss of influence of quality of patient care.
C1. QIPP cabinet is overseeing the development of the 2017/18 QIPP plan.
C2. Finance and Performance Committee reviews and approves the overall
financial plan including QIPP.
C3 Currently going through a review of avoidable spend, assigning priorities to
spend areas with a view to reducing or ceasing low priority spend.
C4. QIPP Manager to support the QIPP Programme is in role.
C5. QIPP Planning started in September 2016.
C6. Obtained from Governing Body direction on lower priority spend areas for
savings.
C7. Root and branch review of all spend across the organisation completed.
C8. Deloitte review of QIPP completed.
C9. PMO taking a strengthened role in QIPP.
C10. Governing Body direction on lower priority spend areas obtained.
C11. Contractual arrangements with acute providers in place.
C12. Clinical and manager leads in place for each area of QIPP.
C13. QIPP Challenge Panel established to oversee operational delivery of QIPP.
C14. Camden CCG is part of the NCL STP which has shared responsibility to
ensure financial stability. This includes commissioners and providers.
C1. Minutes and papers of the QIPP
cabinet;
C2. Minutes and papers of the Finance
and Performance Committee;
C3. Minutes and papers of the QIPP
Cabinet and Finance and Performance
Committee.
C4. Contract of Service.
C5. Minutes of meetings and meeting
reports.
C6. Governing Body forum note.
C7. Updated financial assessment.
C8. Deloitte feedback.
C9. PMO reports.
C10. Minutes of workshop.
C11. Contracts with acute providers.
C12. QIPP register
C13. Meeting notes and papers.
C14. A NCL STP Finance and Activity
Modelling meeting occurs every two
weeks to ensure NCL remains on track
with QIPP delivery.
AVERAGE: The controls
have a 61 – 79% chance of
successfully controlling the
risk
5 4 20
2220 of 291
ID Director Objectives Risk Controls in Place Evidence of ControlsOverall Effectiveness of
Controls in Place
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(cu
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Rat
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(cu
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(cu
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Actions Update on Actions Action Competion Date
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(Tar
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JCC 1
Paul Sinden- NCL Director
of Performance and Acute
Commissioning
Commission the delivery of
NHS constitutional rights
and pledges
TITLE: Delivery of Cancer 62-day waiting time
standard (Threat)
Cause: There may be insufficient capacity within
the system, and inefficiencies along pathways in
particular for inter-provider transfers.
Effect: There is a risk that the system may be
unable to cope with the level of demand and has
limited resilience to unexpected events.
Impact: This may result in people not receiving
treatment within 62 days with potential adverse
impact on their health outcome.
C1. North Central London ('NCL') cancer governance arrangements
established to cover both performance and transformation.
C2. Improvement trajectory agreed with NHS England and NHS Improvement.
C3. Remedial Action Plans in place with providers that are not meeting the 62
day standard.
C4. 38 day transfer protocol in place for inter-provider transfers from district
general hospitals to tertiary services with the 38 day standard compatible with
treatment commencing within 62 days.
C1. Meeting papers and notes.
C2. Plans and trajectories in place with
each provider to allow NCL to meet the
standard overall.
C3. Plans.
C4. transfer protocol document.
Weak
4 4 16
Hvery H
igh
A1. Continue to work with
providers on delivering the
trajectories.
A2. Continue to work with
providers to ensure sustainable
delivery and includes work through
the cancer vanguard.
A3. NCL recovery of the 62 day
standard by end of September
2017.
A4. UCLH recovery of the 62 day
standard by end of March 2018 and
is consistent with system recovery
by end of September 2017.
A1. Meeting with providers on a monthly basis
and ensuring their plans are consistent with
agreed trajectories.
A2. Meeting with providers on a monthly basis.
A3. Currently on track for delivery.
A4. Currently on track for delivery.
A1. 31.07.2017
A2. 31.07.2017
A3. 30.09.2017
A4. 31.03.2018
3 4 12
High
JCC 2
Paul Sinden- NCL Director
of Performance and Acute
Commissioning
Commission the delivery of
NHS constitutional rights
and pledges
TITLE: Delivery of four-hour waiting time
standard for A&E (Threat)
Cause: There may be insufficient capacity across
hospital and community services to meet peaks
in emergency care demand.
Effect: There is a risk that people will spend
more than four hours within emergency
departments before receiving definitive
treatment or be located in the wrong part of the
system due to pressures along the emergency
care pathway.
Impact: This may result in people experiencing
delays in treatment, admission to a hospital bed
and/or discharge back into the community.
C1. A&E Delivery Boards established and meet monthly which have executive
level representation from key providers and commissioners in the system
C2. A&E Delivery Boards are informed by dashboards that monitor key parts
of the system to highlight any issues in terms of capacity and/or performance.
C3. With key providers, and using resilience funding available A&E Delivery
Boards have agreed which parts of the system would benefit from increased
capacity or efficiency changes.
C4. Continued monitoring of the plan (i.e. initiatives) against agreed outcome
measures by A&E Delivery Boards.
C5. Funding is targeted to support the remedial action plans (RAPs) agreed
with UCLH.
C6. A North Central London (NCL) wide review of how winter went across NCL
took place on 6th April 2017 to share lessons learnt.
C7. All A&E Delivery Boards submitted plans to NHS England for winter
2017/18 based on experiences and pressures in 2016/17
C1. Meeting papers and notes.
C2. Meeting papers and dashboards.
C3. Remedial Action Plans, meeting
papers and notes.
C4. Meeting papers, notes and
dashboards.
C5. Plans to utilise winter resilience
monies.
C6. Report.
C7. Plans
Weak
4 4 16
Very H
igh
A1 . Develop a demand and
capacity plan for both hospital and
community services.
A2. Implement STP initiatives.
A1. A&E Delivery Boards are developing system
wide demand and capacity plans.
A2. STP initiatives are being implemented in
accordance with individual plans. Progress on
implementation is reviewed in CCGs and STP
workstreams monthly.
A1. 30.08.2017
A2. 31.07.2017
3 4 12
High
JCC 10
Paul Sinden, NCL Director
of Performance and Acute
Commissioning
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value-
for- money services
TITLE: Mobilisation of STP and QIPP plans
(Threat)
Cause: if we do not ensure that STP and QIPP
plans are delivered in accordance with planning
assumptions
Effect: There is a risk that contracts will not be
delivered within resource envelopes for 2017/18
Impact: This may result in delays to service
changes, higher contract baselines for 2018/19
than anticipated in financial plans for CCGs, and a
wider system financial gap.
C1. Signed contracts in place for 2017/18 and 2018/19
C2. Contract frameworks in place with each provider including Local Delivery
Teams to support the STP
C3. In-year contract variances subject to marginal rates rather than full tariff
adjustments
C4. Collaborative arrangements in place through Finance and Activity
Modelling (FAM) Group as part of STP governance framework
C5. Sustainability and Transformation Plan governance and supporting
workstreams with commissioner and provider membership in place
C1. Signed contracts
C2. Meeting minutes and papers
C3. Signed contracts
C4. Meeting minutes and papers
C5. Meeting papers
Average
4 4 16
Very H
igh
A1. Finalise proposals to increase
support for STP workstreams
A2. Progress the work of the acute
contract modelling group to
consider alternative contract forms
A1. To discuss the approach to this at SMT.
A2. To include the ambition to change system
incentives in system intentions
A1. 31.07.2017.
A2. 30.09.2017
4 3 12
High
JCC 11
Paul Sinden, NCL Director
of Performance and Acute
Commissioning
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value-
for- money services
TITLE: Managing acute contracts within contract
baselines (Threat)
Cause: if expenditure on acute contracts exceeds
planned contract baselines
Effect: There is a risk that CCGs will not meet
their financial duties and/or investment is
withheld to support delivery of the Sustainability
and Transformation Plan
Impact: This may result in delays to investing in
primary care and community capacity and
perpetuate the risk over performance on acute
hospital contracts
C1. Signed contracts in place for 2017/18 and 2018/19
C2. Contracts include marginal rate payments/deductions for variances from
plan and 3% growth (higher than historic growth trends)
C3. Contract management framework in place with providers
C4. Issue of contract notices in line with contact provisions
C5.. Mobilisation of STP and QIPP plans (see JCC10)
C6. North Central London Finance and Activity Modelling (FAM) Group, with
commissioner and provider membership. that oversees system financial
position
C7. Work on alternative contract forms to support the Sustainability and
Transformation Plan (STP) through the Acute Contract Modelling Group (with
commissioner and provider membership)
C1. Signed contracts
C2. Signed contracts
C3. Meeting minutes and papers
C4. Contract documentation and
correspondence including remedial
action plans
C5. See JCC10
C6. Meeting minutes and papers
C7. Meeting minutes and papers
Average
4 4 16
Very H
igh
A1. Develop and sign-off system
intentions for 2018/19
A2. Develop, in co-production, with
providers, proposals for alternative
contract forms for hospital
providers
A1. First draft to be considered at Joint
Commissioning Committee on 3 August 2017
A2. Consideration of models used elsewhere -
Aligned Incentive Contract in Bolton;
Accountable Care models
A1. 30.09.2017
A2. 31.10.2017
4 3 12
High
3221 of 291
ID Director Objectives Risk Controls in Place Evidence of ControlsOverall Effectiveness of
Controls in Place
Co
nse
qu
en
ce
(cu
rre
nt)
Like
liho
od
(cu
rre
nt)
Rat
ing
(cu
rre
nt)
Ris
k le
vel
(cu
rre
nt)
Actions Update on Actions Action Competion Date
Co
nse
qu
en
ce
(Tar
get)
Like
liho
od
(Tar
get)
Rat
ing
(Tar
get)
Ris
k le
vel (
Tar
get)
JCC 13
Paul Sinden- NCL Director
of Performance and Acute
Commissioning
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value-
for- money services
Winter Pressures and Non-Elective Flows
(Threat)
Cause: if we are unable to manage non-elective
flows within planned hospital and community
capacity to meet winter pressures
Effect: There is a risk that patients may receive
sub-optimal care and long waiting times leading
to the local system missing waiting time
standards for A&E and referral-to-treatment.
Historically capacity to meet cancer waiting time
standards has been successfully ring-fenced.
Impact: Patients may remain in inpatient
placements longer than anticipated as
community care packages are developed.
C1. Establishment of A&E Delivery Boards with representation across health
and care system
C2. Establishment of NCL Urgent and Emergency Care (UEC) Board
C3. STP workstreams for urgent and emergency care established for long-term
sustainability.
C4. Winter plans for 2017/18 prepared by each A&E Delivery Board
C5. Recovery plans submitted by each A&E Delivery Board to regain A&E four-
hour waiting time standard
C6. See JCC2 - recovery of A&E four-hour waiting time standard
C1. Meeting papers and minutes from
A&E Delivery Boards
C2. Meeting papers and minutes from
UEC Board .
C3. Workstreams plans and QIPP
monitoring reports
C4. Plans submitted and
reports/dashboards monitoring
progress.
C5. Plans submitted and
reports/dashboards monitoring
progress.
C6. See JCC2
Average
5 4 20
Very H
igh
A1. Agree escalation process for
NCL with NHS England and NHS
Improvement
A2. Hold winter workshop on 27
September 2017;
A3. Identification of further
recover plans through winter
workshop and A&E Delivery Boards
A1. NCL approach to escalation agreed in
principle with NHS England
A2. Actions from winter workshop will be
actioned through A&E Delivery Boards
A3. Response from regulators to winter plans
will specify further actions to be taken to
alleviate winter pressures
A1. 13.10.2017
A2. 30.09.2017 - write up
of actions
A3. 31.10.2017
4 4 16
Vey H
igh
JCC 14
Paul Sinden- NCL Director
of Performance and Acute
Commissioning
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value-
for- money services
STP and local plans target the shift of care from
hospital into community settings, to reduce the
overall system financial deficit this needs to be
done in a way that allows hospital providers to
reduce capacity and costs (Threat)
Cause: if we are unable to shift care from
hospital to community settings that allow
providers to make a step-change in capacity
Effect: There is a risk that hospital providers are
left with stranded costs and we do not reduce
overall system costs
Impact: STP and local interventions do not help
reduce the system financial deficit in the
anticipated way.
C1. Signed contracts for 2017/18 and 2018/19 that include the impact of STP
interventions
C2. System intentions for 2018/19 that seek to align intentions across CCGS so
we commission at scale
C3. Agreement of approach to planning round for 2018/19 with providers
through STP finance meetings. Contract baselines for 2018/19 to include the
impact of STP interventions.
C4. Work with providers on alternative contract forms to support STP delivery,
with the work informed by provider cost profiles.
C5. STP Finance meetings with commissioners and providers that has a
common understanding of financial position in NCL system
C1. Contract documentation
C2. NCL Systems Intentions letter
C3. Meeting paper and notes.
C4. Meeting papers and notes.
C5. Meeting papers and notes
Average
4 4 16
Very H
igh
A1. Workstreams development of
STP plans for 2018/19.
A2. Agree option for setting
contract baselines for 2018/19.
A3. Negotiation of contract
baselines for 2018/19 incorporating
2017/18 plan/outturn, growth and
impact of interventions.
A4. Agree models for alternative
contract forms to be shadow run in
2018/19
A5. Create finance and activity
schedules that support the shadow
running od the alternative contract
forms.
A1. STP workstreams notified on planning
timetable and working to identify interventions.
A2. Options for setting contract baselines went
to STP finance meeting on 01.09.2017 and will
go to meeting on 29.09.2017 for decision.
A3. To follow on from finance STP decision (see
A2)
A4. Acute contract modelling group established
A5. Open book approach to provider cost
profiles agreed
A1. 30.11.2017
A2. 13.10.2017
A3. 31.12.2017
A4. 31.12.2017
A5. 01.01.2018
3 3 9
High
JCC 18
Paul Sinden- NCL Director
of Performance and Acute
Commissioning
Maintain financial stability
and ensure sustainability
through robust planning
and commissioning of value-
for- money services
NCL is a system in deficit. One of the aims of our
Sustainability and Transformation Plan is to
deliver financial recovery and maintain and
sustainable health and care system. The STP
sets out the challenges to financial recovery
from demographic and demand trends. (Threat)
Cause: if our plans do not deliver financial
balance
Effect: There is a risk that additional savings
plans will need to be developed that have a
greater impact on service delivery and access
than current plans, and the local system comes
under greater scrutiny from regulators.
Impact: Delivery of our STP developments is
slowed down and impact reduced. Greater local
resource is taken up with assurance processes
C1. STP finance meeting established that has a common view of system deficit
C2. Collaborative approach to contracting round for 2017/18 and 2018/19
C3. Work on alternative contract forms for future years to support cost
reduction
C4. Monthly reporting cycle and monitoring
C5. working groups established for areas of pressure and with scope for cost
reduction - estates, continuing healthcare, demand management etc.
C6. Iterative CCG QIPP plans
C1. Meeting papers and minutes from
STP finance group
C2. Contract documentation; notes from
STP finance group.
C3. Notes from acute contract modelling
group
C4. Reports
C5. Meeting notes
C6. Reports
Average
4 5 20
Very H
igh
A1. Finalise quarter one
reconciliation process to identify
opportunities for year-end
settlements
A2. Continue to identify further
savings opportunities
A3. 2081/19 planning round to set
contract baselines for 2018/19
A1. Quarter one reconciliation process
underway
A2. Opportunities being developed through STP
finance group and locally by CCGs
A3. Process for planning round agreed through
STP finance group
A1. 30.10.2017
A2. 31.01.2018
A3. 31.12.2017
4 4 16
Very H
igh
4222 of 291
BAF Risk Heat Map
2 3 4 5
3
4
5
Consequence
Likelihood
2
1
1
Temp 1
Temp 1
382
Current Risk Score: Target Risk Score:x x
382
363
363
362362
JCC 1
JCC 1
JCC 2
JCC 2
JCC 10
JCC 10
JCC 11
JCC 11
JCC 13JCC 13
JCC 14
JCC 14
JCC 18
JCC 18
432
431
431
432
223 of 291
Risk Scoring Key This document sets out the key scoring methodology for risks and risk management.
1. Overall Strength of Controls in Place There are four levels of effectiveness:
Level Criteria
Zero The controls have no effect on controlling the risk.
Weak The controls have a 1- 60% chance of successfully controlling the risk.
Average The controls have a 61 – 79% chance of successfully controlling the risk
Strong The controls have a 80%+ chance or higher of successfully controlling the risk
2. Risk Scoring
This is separated into Consequence and Likelihood. Consequence Scale:
Level of Impact on the Objective
Descriptor of Level of Impact on the Objective
Consequence for the Objective
Consequence Score
0 - 5% Very low impact Very Low 1
6 - 25% Low impact Low 2
26-50% Moderate impact Medium 3
51 – 75% High impact High 4
76%+ Very high impact Very High 5
Likelihood Scale:
Level of Likelihood the Risk will Occur
Descriptor of Level of Likelihood the Risk will Occur
Likelihood the Risk will Occur
Likelihood Score
0 - 5% Highly unlikely to occur
Very Low 1
6 - 25% Unlikely to occur Low 2
26-50% Fairly likely to occur Medium 3
51 – 75% More likely to occur than not
High 4
76%+ Almost certainly will occur
Very High 5
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3. Level of Risk and Priority Chart
This chart shows the level of risk a risk represents and sets out the priority which should be
given to each risk:
LIKELIHOOD
CONSEQUENCE
Very Low
(1)
Low (2)
Medium (3)
High (4)
Very High
(5)
Very Low (1)
1 2 3 4 5
Low (2)
2 4 6 8 10
Medium (3)
3 6 9 12 15
High (4)
4 8 12 16 20
Very High (5)
5 10 15 20 25
1-3
Low Priority
4-6
Moderate Priority
8-10
High Priority
15-25
Very High Priority
225 of 291
226 of 291
Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Camden CCG 2016/17 Safeguarding Adults Annual Report
Agenda Item 5.2
Date 25 October 2017
Lead Director Neeshma Shah Tel/Email [email protected]
Report Author Vikki Gray Tel/Email [email protected]
GB Sponsor(s) Charlotte Cooley Tel/Email [email protected]
Report Summary
This report sets out how Camden CCG has delivered its statutory responsibilities for safeguarding adults over 2016-17. The report includes:
Camden CCG governance arrangements for safeguarding adults
Camden CCG contribution to the Safeguarding Adults Partnership Board whose annual report has shown that self-neglect and financial abuse are most reported in Camden and most prevalent in the home
Contribution and learning from statutory reviews with actions to date
Provider assurance mechanisms that highlight improvements in learning disability care, prevention and management of pressure ulcers
Challenges for providers around the delivery of the Prevent Duty and the application of the Mental Capacity Act in practice
Safeguarding adults priorities for 2017-18 and the links to CCG strategic objectives
Purpose (tick one
box only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked:
To note arrangements for the CCG to deliver its statutory responsibilities for safeguarding adults in Camden
To note the achievements and challenges to date for safeguarding adults
To note and use the report for appropriate challenge to safeguarding adults arrangements to support continuous improvements in this area
Strategic
Objectives Links
Improve the quality and safety of commissioned services Improve health outcomes, address inequalities and achieve parity of esteem
Identified Risks
and Risk
Management
Actions
Areas of challenge are highlighted on page 10 of the report.
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
Not applicable for the purpose of this report.
Report History
Presented to the September 2017 Quality and Safety Committee.
Next Steps To publish on the Camden CCG website
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Safeguarding Adults Annual Report
2016/17
228 of 291
2
Contents
1. Introduction ..................................................................................................................... 3
2. Key Professionals in Post .............................................................................................. 3
3. Accountability and Structure ......................................................................................... 4
4. Governance Arrangements ............................................................................................ 4
4.1 Safeguarding Adults Training Camden CCG ........................................................... 4
5. Camden Safeguarding Adults Partnership Board (Camden SAPB) ............................ 5
6. Statutory and Mandatory Reviews ................................................................................. 6
6.1 Safeguarding Adult Review ...................................................................................... 6
6.2 Domestic Homicide Reviews (DHR) ......................................................................... 7
6.3 The Learning Disability Mortality Review Programme (LeDeR) ............................. 8
7. Camden Community Safety Partnership Board (CSPB) ............................................... 8
8. Camden Prevent and Channel ....................................................................................... 9
9. London Safeguarding Networks ................................................................................... 9
10. Safeguarding Supervision ......................................................................................... 10
11. Monitoring of Provider Safeguarding Arrangements and Performance................. 10
11.1 Areas of Achievement and Challenge .................................................................. 10
12. CCG Safeguarding Adults Priorities for 2017-18 ..................................................... 11
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3
1. Introduction
NHS Camden CCG serves the London Borough of Camden with a diverse population of over
230,000, which is expected to increase by 9% (21,000)1 over the next ten years. The current
population live generally healthy lives but some have needs that are more complex and with an
ageing population, we can expect to see more people living with long-term conditions and dementia2.
Complex and long-term conditions as well as ageing can all increase vulnerability to abuse and
neglect for which health services play a key role in recognition, response and prevention. Adult
safeguarding practice is underpinned by the following six key principles for all agencies to adhere
to:
Empowerment
People being supported and encouraged to make their own decisions and informed
consent.
Prevention
It is better to take action before harm occurs.
Proportionality
The least intrusive response appropriate to the risk presented.
Protection
Support and representation for those in greatest need.
Partnership
Local solutions through services working with their communities. Communities have a part
to play in preventing, detecting and reporting neglect and abuse.
Accountability
Accountability and transparency in safeguarding practice.
This annual safeguarding report for Camden CCG (CCCG) brings together the safeguarding
activities for 2016-17, providing assurance to Camden’s CCG Governing Body that the CCG is
fulfilling its statutory responsibilities for Safeguarding Adults. This report sets out how CCCG has
worked with partner agencies to safeguard adults with care and support needs during 2016/17 and
will illustrate how CCCG has continued to improve outcomes for adults at risk through governance
and assurance processes. It also provides an update in regards to developments and delivery
against the objectives set for 2016/17.
2. Key Professionals in Post
The CCG secured appropriate safeguarding posts - in 2016/17 the following posts are in place and
shown in Figure 1 to ensure that safeguarding adults’ duty is discharged across the health
economy:
Executive Lead for Safeguarding
Elected Governing Body Clinical Lead for Safeguarding
Head of Quality and Safeguarding
1 http://www.camdenccg.nhs.uk/downloads/our-work/local-care-strategy/NHS-Camden-CCG-Camden-local-care-strategy-In-depth-v2.pdf 2 http://www.camdenccg.nhs.uk/downloads/our-work/local-care-strategy/NHS-Camden-CCG-Camden-local-care-strategy-In-depth-v2.pdf
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4
Quality Assurance Lead (Safeguarding Adults)
Figure 1. Camden CCG Governance Structure for Safeguarding Adults
3. Accountability and Structure
Camden CCG has clear safeguarding adults’ accountability and reporting structures and
arrangements, which aligned to the NHS England document Safeguarding Vulnerable People in the
NHS Accountability and Assurance Framework (2015). The accountability for safeguarding sits with
the Chief Officer who is responsible for ensuring that health service contribution to safeguarding and
promoting the wellbeing of adults with care and support needs is delivered effectively across the
health economy.
There is robust accountability within the safeguarding team, demonstrated through the reporting line
of the Head of Quality and Safeguarding Adults to the Executive Lead for Safeguarding. The internal
monitoring of safeguarding takes place through the Quality and Safety Committee, and ensures that
any risks to delivery of the CCG statutory duties are reported to the Chief Officer and Governing
Body.
4. Governance Arrangements
Safeguarding governance arrangements are in place through reporting by the Head of Quality and
Adult Safeguarding to the Quality & Safety Committee. The Committee also receives quarterly and
annual reports from the Camden Safeguarding Adults Partnership Board and the annual
safeguarding adults report to NHS Camden’s Governing Body.
4.1 Safeguarding Adults Training Camden CCG
Governing Body
Governing Body members are required to complete safeguarding adult training commensurate
with the commissioning role they hold. The Governing Body received this training, which must
be refreshed every three years and took place in July 2017.
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5
CCG Staff
Safeguarding adults’ E-learning is part of mandatory training for all staff employed by Camden
CCG. This year ending the compliance figure for this training was at 89%.
5. Camden Safeguarding Adults Partnership Board (Camden SAPB)
The Camden Safeguarding Adults Partnership Board is a statutory body that provides leadership for adult safeguarding arrangements across the borough. The SAPB oversees, coordinates the safeguarding work of its member and partner agencies and holds them to account over the effectiveness of that work. 2016 saw the appointment of a new Independent Chair who is also the Chair of the Islington Safeguarding Adults Board creating opportunities for closer working between to the two boroughs.
Camden CCG is one of three statutory partners of the SAPB along with the local authority and Police.
In discharging this responsibility, representation and membership of the Board is at executive and
strategic level, the Director of Quality and Clinical Effectiveness is the vice-chair of the SAPB. The
CCG provides membership to the Quality and Performance and Learning and Communication sub
groups, which drive the work of the Board, this includes the CCG Governing Body safeguarding lead
chairing the Quality and Performance sub-group. As a Board partner, the CCG achieved 100%
SAPB attendance and submitted a report of key achievements to support the work of the Board for
2016-17 and priorities for 2017-18.
The SAPB is committed to Making Safeguarding Personal3, which aims to develop an outcomes
focus to safeguarding work, and a range of responses to support people to improve or resolve their
circumstances. It is about engaging with people about the outcomes they want at the beginning and
middle of working with them, and then ascertaining the extent to which those outcomes were realised
at the end. The CCG is an active member of the Making Safeguarding Personal working group and
has prioritised work for the coming year to ensure the voice of service users and carers informs
safeguarding practice.
Data received by the SAPB for the year, illustrated in Figure 2, shows that neglect, including self-
neglect and acts of omission, is the largest reported category of abuse followed by financial abuse.
Both areas have seen an increase in reporting over the last year.
Figure 3 shows most allegations of abuse are occurring within the homes of adults with care and
support needs, which is in line with previous years. Allegations of Self-neglect and financial abuse
occur most often in the home. A CCG priority for 2017-18 is to develop a GP safeguarding leads
network to support GP leads to be equipped to cascade knowledge through their practices to
recognise, prevent and respond to adult abuse and neglect of individuals in their own homes. This
is particularly significant as, coupled with the current safeguarding adults data, the NHS Five Year
Forward View and Local Care Strategy is striving to achieve more care out of hospital and in to
primary care/community settings.
3 https://www.adass.org.uk/media/5151/making-safeguarding-personal-2012-13-full-report.pdf
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6
Figure2:
Figure3
6. Statutory and Mandatory Reviews
6.1 Safeguarding Adult Review
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Under the Care Act 2014, a Safeguarding Adult Review (SAR) must be commissioned by the
Safeguarding Adults Partnership Board for every case where an adult has died from, or
experienced serious abuse or neglect, and there is reasonable cause for concern about how
agencies and service providers involved worked together to safeguard the person. A SAR was
commissioned by the SAPB in January 2017 following the death of an individual who declined
treatment for his complex illnesses and pressure ulcers. The CCG has provided panel
membership and Chair to the SAR, which will be presented to the SAPB for approval in October.
In 2015, the SAPB commissioned a SAR following the death of a 79-year-old individual who
died after they were discovered with very poor hygiene, pressure ulcers, malnutrition and
confusion while in receipt of a care package. The review made recommendations which the
SAPB has received assurance from partner agencies have been implemented. Key areas of
recommended improvements relevant to the health economy were around the application of the
Mental Capacity Act 2005 and the management of pressure ulcers.
The following assurances have been provided:
The revised NHS Serious Incident Framework https://www.england.nhs.uk/patientsafety/wp-
content/uploads/sites/32/2016/03/serious-incdnt-framwrk-faqs-mar16.pdf advises that ‘any
pressure ulcer that meets, or potentially meets, the threshold of a Serious Incident should be
thoroughly investigated to ensure any problems in care are identified, understood and resolved
to prevent the likelihood of future recurrence’. The fundamental purpose and principles of
Serious Incident management is to learn from incidents to prevent the likelihood of recurrence
of harm. The health services commissioned by Camden CCG report Grade 3 and 4 pressure
ulcers as serious incidents as well as reporting all pressure ulcers on their internal systems and
as safeguarding referrals, when appropriate to do so. Providers have established internal
pressure ulcers boards that scrutinise each report and root cause analysis to ensure learning is
disseminated and embedded to mitigate against similar occurrences. Provider services have
also produced leaflets for service users and carers on the prevention and management of
pressure ulcers with contact details for specialist advice from the Tissue Viability Nurses.
Camden CCG have secured expertise within the Quality and Clinical Effectiveness Directorate
to gain assurance on the effectiveness of these processes and provide support and appropriate
challenge where required.
The CCG and the services it commissions are required to have a Mental Capacity Act (MCA)
Lead. The CCG lead is the head of Quality and safeguarding and is normally within the
Safeguarding Adults Lead role in the provider. The CCG monitors provider MCA training levels
and audit activity in this area. The Learning Disability Mortality Reviews, detailed in this section
6.3 of this report, also provide information on how the MCA is applied in practice.
6.2 Domestic Homicide Reviews (DHR)
DHRs are multi-agency reviews introduced by section 9 of the Domestic Violence, Crime and
Victims Act 2004 (DVCA 2004) and came into force on 13 April 2011. Under this legislation,
Community Safety Partnership Boards (CSPBs) are responsible for commissioning DHRs where
the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse or
neglect by a relative, household member or someone he or she has been in an intimate
relationship with. In June 2016, the CSPB commissioned a DHR following the murder of a
Camden resident by her partner.
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8
The Director of Quality and Clinical Effectiveness and Head of Quality and Adult Safeguarding
provided panel membership. The CCG submitted an action plan for member practices based on
the following recommendations from the review:
All agencies will develop a domestic abuse identification and referral pathway, including
potential signs that someone is experiencing domestic abuse or witnessing domestic
abuse (for services to children).
All agencies will encourage and support staff to use their professional curiosity to explore
possible indicators of domestic abuse and refer clients on appropriately.
All agencies will ensure that public-facing staff have sufficient training to be able to
explore, recognise and respond to domestic abuse appropriately.
The actions have been completed through the commissioning of the IRIS project, which has had
a positive impact after the tragic death reviewed in this case. The actions will be subject to on-
going audit as part of the project specification. The DHR report must be sent to the Home Office
for scrutiny and approval prior to its publication.
6.3 The Learning Disability Mortality Review Programme (LeDeR)
The LeDeR Programme supports local reviews by health and social care professionals of deaths
of people with learning disabilities aged 4-74 years of age across England. In London, the
review period for all deaths is from December 2016-April 2018. The Head of Quality and
Safeguarding Adults chairs the Camden steering group for this work at local level. To date, five
deaths have been reported locally for review in this annual reporting period with one completed
and others in progress. The CCG, UCHL, RFLFT and CNWL all have reviewers who have
completed the required training. Camden is one of the few areas in London to have successfully
completed a review. Challenges for reviews are around time to gather records from partner
agencies, respectfully approaching bereaved families for their involvement and capacity of
professionals to undertake reviews in addition to their main roles, all of which have been
discussed with the NHSE Regional Coordinator.
7. Camden Community Safety Partnership Board (CSPB)
The Community Safety Partnership Board (CSPB) is a bi-monthly multi-agency committee that works
on initiatives across statutory and non-government agencies to reduce crime and anti-social
behaviour in the community. One of the key priorities of the CSPB is tackling domestic and sexual
violence. Camden CCG has re-commissioning the IRIS project. This service increases identification
and support for individuals accessing their GP who are at risk of, or experiencing, domestic abuse.
Service users benefitting from this support has increased from under 10 in 2013 (Pre IRIS training)
to over 200 in 2016. Funding has also been provided for an Independent Domestic and Sexual
Violence Advocate (IDSVA) to support service users of both the Royal Free and University College
Hospitals who are at risk of, or experiencing, domestic abuse. The CSPB commissioned one
Domestic Homicide Review for a Camden resident murdered by her husband which is detailed in
the Statutory Review section 6 of this report.
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9
8. Camden Prevent and Channel
Prevent is part of the Government’s work to reduce the risk of radicalisation to terrorist activity, and
seek to support children and adults who are being, or at risk of being recruited into violent extremism.
The Prevent Duty Guidance and updated Counter Terrorism Act, published in 2015, gave a clear
direction and guidance to health professionals; putting Prevent within the framework of safeguarding
practice. Channel Panel, where a group of multi-agency professionals assess referred cases
regarding consenting individuals, for appropriate support and monitoring. The CCG Head of Quality
and Safeguarding represents the CCG on both Prevent network meetings and Channel. Mental
health services must be represented on Channel; this is achieved through membership from Camden
and Islington Foundation Trust.
Camden remains a high priority area for the Government requiring providers to report compliance figures quarterly to NHSE as part of the London Prevent region. NHS Trusts and Foundation Trusts are included in the statutory Prevent Duty, which requires them to have an identified Prevent Lead, and delivery plans to ensure systems are in place along with staff training, to identify and support individuals at risk of becoming involved in terrorism. The provider Trusts have all submitted evidence that they have the statutory requirements in place through the quarterly return. The Basic Prevent Awareness training requirements are met or on target to be met by 2018. The Workshop to Raise Awareness of Prevent (WRAP) training is presenting significant challenges to providers as demonstrated in the data. The WRAP training is a DVD-based product requiring staff to be away from practice for one hour. Trusts are working with CCG and NHSE Prevent Leads to increase their figures and NHSE are exploring other training options for health staff to provide some flexibility in delivery. Table 1: Provider Prevent Compliance Data
Provider Prevent Lead In Post
Basic Prevent Awareness
WRAP
UCHL Yes 77% 20%
RFH Yes 87% 9.9%
T&P Yes 90% 2%
CIFT Yes 85% 47.5%
9. London Safeguarding Networks
There are a number of quarterly professional networks and steering groups across London that
support and develop best practice frameworks and guidance, provide consultation responses to, and
dissemination of, new guidance and legislation. These are particularly vital given the rapidly evolving
safeguarding agenda and Camden CCG is an active participant in the following groups:
Safeguarding Adult CCG Network
London Prevent CCG Network
London MCA and DoLS Network
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10. Safeguarding Supervision
The Head of Quality and Safeguarding attends a bi-monthly peer supervision session with leads
from Islington, Haringey and Barnet. All Trust Safeguarding Adults Leads in commissioned services
have demonstrated supervision arrangements within their organisations. Safeguarding adults
supervision is available to Trust leads from the CCG should this become a preferred option.
11. Monitoring of Provider Safeguarding Arrangements and Performance
The delivery of safeguarding adult’s responsibilities in commissioned services is monitored through
a range of mechanisms:
Monitoring of Service Level Agreements and Contract Schedules through Contract Review
Groups (CRG)
Monitoring actions arising from statutory reviews
Serious Untoward Incident reporting and monitoring.
Site visits
Pan London Safeguarding Adults Multi-agency Policy and Procedures
The Head of Safeguarding and Quality attending internal health provider Safeguarding
meetings and receiving the organisation annual and quarterly reports
CQC inspection reports
In order to meet the CCG responsibilities in gaining assurance on effective safeguarding
arrangements, the SAPB developed and introduced an Integrated Safeguarding Performance
Dashboard. Reporting on the dashboard is now quarterly to both the SAPB and the CCG Quality
and Safety Committee. Provider reporting includes quantitative and qualitative data on areas such
as referrals, DoLS applications and authorisations and training. The dashboard is in its infancy and
subject to development to reflect continuous improvements within provider organisations. Further
work through the Quality and Performance subgroup of the SAPB and the Quality and Safety
Committee will continue over the year and is one of the CCG safeguarding adult’s priorities for 2017-
18.
11.1 Areas of Achievement and Challenge
Of particular note, University College London Hospital Foundation Trust (UCLH) and the Royal Free London Foundation Trust (RFH) have evidenced improvements in the care of individuals with a learning disability within their annual safeguarding reports. The hospitals have secured the expertise of learning disability nurses to provide training, support and to increase the use of hospital passports and flagging systems for patients with a learning disability. The Royal Free web page for learning disability patients was highlighted as an example of good practice to other Trusts during an international webinar on End of Life and Learning Disability Care www.royalfree.nhs.uk/learningdisability. UCLH saw non-attendance of outpatient appointments fall from 22.57% to 12.5% for learning disability patients following the implementation of a system for contacting patients directly about their appointment.
Safeguarding adults and Mental Capacity Act training remains an area of challenge for provider services. The safeguarding adults’ agenda is rapidly evolving with new and complex forms of abuse and neglect emerging that staff require training on. Providers have published training strategies to set out their arrangements for meeting training requirements using a mixture of e-learning and face-to-face sessions. These will be monitored and reported on a quarterly basis to the Quality and Safety Committee.
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The Law Commission published a draft Bill in March 2017. There are two main themes to the
proposals: changes to the wider Mental Capacity Act (MCA), and a complete replacement of the
Deprivation of Liberty Safeguards (DoLS) with a new scheme, the Liberty Protection Safeguards
(LPS). The main changes affecting the health economy from these proposals include:
Local authorities will no longer be responsible for issuing authorisations in respect of hospital detentions, as these should now fall to the responsibility of the relevant NHS body
The responsible body would then carry out an internal review of the proposed arrangements. Where the patient objects to the arrangements or if detention is mainly for the protection of other individuals, the responsible body would have to refer its decision to an Approved Mental Capacity Professional for an independent assessment.
Where the Professional decides to uphold the arrangements that would deprive the patient of their liberty, the patient would have rights to further scrutiny and challenge of their situation. These safeguards would be a right to access advocacy, regular reviews of the arrangements, and ultimately a right to make an application to court
LPS would also apply to young people aged 16 and over to ensure they can access the same safeguards
Health providers and CCGs are engaging in initial discussions in response to these proposed
changes and monitoring the progress of the draft bill.
12. CCG Safeguarding Adults Priorities for 2017-18
CCG Strategic Aim Safeguarding Priorities
Improve the quality and safety of commissioned services
Embedding of the Integrated Safeguarding Adults Dashboard within commissioned services
Improve health outcomes, address inequalities and achieve parity of esteem
To contribute to and have oversight of delivery of the Prevent agenda
Involve member practices and commissioning partners in key commissioning decisions
To develop a safeguarding adults network across GP practices to ensure GPs are involved and influencing safeguarding work
Work jointly with the people and patients of Camden to shape the services we commission
The promotion of Making Safeguarding Personal
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for-money services
To work as part of multi-agency safeguarding initiatives to ensure resources are improving outcomes for adults with care and support needs
Progress updates on the priorities will be provided through quarterly safeguarding adults reports to the Quality and Safety Committee.
Author: Vikki Gray Designated Nurse Safeguarding Adults
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Primary Care Co-Commissioning Committee in Common Terms of Reference
Agenda Item 5.3
Date 23rd October
2017
Lead Director Paul Sinden, NCL Director of Performance and Acute Commissioning
Email [email protected]
Report Author Andrew Spicer, NCL Head of Governance and Risk
Email [email protected]
GB Sponsor(s)
(where applicable) Helen Pettersen Accountable Officer
Email [email protected]
Report Summary
This report sets out proposed minor amendments to the North Central London Primary Care Co-Commissioning Committee in Common Terms of Reference.
Purpose (tick one box
only) Information
Approval
To note Decision
Recommendation The Governing Body is asked to approve the amendments to the NCL Primary Care Co-Commissioning Committee in Common Terms of Reference.
Strategic
Objectives Links
This paper links to the following strategic objectives:
Commission the delivery of NHS constitutional rights and pledges;
Improve the quality and safety of commissioned services;
Improve health outcomes, address inequalities and achieve parity of esteem;
Integrate and enable local services to deliver the right care in the right setting at the right time;
Involve member practices and commissioning partners in key commissioning decisions;
Maintain financial stability and ensure sustainability through robust planning and commissioning of value for money services.
Identified Risks
and Risk
Management
Actions
This report helps to maximise the opportunities for effective decision-making for primary care medical budgets delegated to the CCGs from NHS England in April 2017.
Conflicts of Interest
Conflicts of interest are dealt with robustly and in accordance with the NCL Conflicts of Interest Policy.
Resource
Implications
This report helps to increase the efficient use of resources by streamlining decision making in a proportionate and appropriate way.
Engagement
This report was considered by the members of the NCL Primary Care Co-Commissioning Committee in Common which includes elected clinicians, lay members and officers from each of the five NCL CCGs.
Equality Impact
Analysis
This report was drafted in accordance with the provisions of the Equality Act
2010.
Report History
The Terms of Reference for the Primary Care Co-Commissioning Committee in
Common were approved by Barnet, Enfield, Haringey and Islington CCG
Governing Bodies in November 2016 and by Camden CCG Governing Body in
January 2017.
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Next Steps None.
Appendices
Appendix 1: Primary Care Co-Commissioning Committee in Common Terms of Reference with proposed amendments.
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Primary Care Co-Commissioning Terms of Reference
Introduction At the September 2017 Governing Body meetings the five North Central London (‘NCL’) Clinical Commissioning Groups (‘CCGs’) were asked to approve some revisions to the governance arrangements for primary care co-commissioning. One of the revisions was the establishment of a process for making low level, non-contentious, low risk decisions outside of scheduled NCL Primary Care Co-Commissioning Committee in Common (‘Committee’) meetings. Due to the pressing need to put this process into place quickly to ensure the smooth operation of primary care services and preserve continuity of care for patients there was insufficient time to present the proposed process to the Committee before the process was presented to Governing Bodies for approval. To ensure the Committee had the opportunity to review the process and provide their feedback the process was presented at the Committee meeting on Friday 22nd September 2017. The Committee recommended the following amendments to the process:
A clinician be added as a decision maker; and
Clarify that decision making would be by the relevant CCG lay member rather than any lay member.
Terms of Reference To reflect the Committee’s feedback the following amendments to the Committee’s Terms of Reference are proposed:
Clause Amendment Reason
11.6 Removed references to people that can approve low level, non-contentious decisions
Amended to reflect the feedback of the Committee
New section 11.7 Added references to the people that that can approve low level, non-contentious decisions as per Committee feedback.
Amended to reflect the feedback of the Committee
11.3 and 11.8 Renumbered parts of clauses to take account of the above amendments.
To ensure the Terms of Reference are appropriately numbered.
The proposed revised Terms of Reference are attached. Recommendation The Governing Body is asked to approve the proposed amendments to the Committee’s Terms of Reference.
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NCL Primary Care Co-Commissioning Committee in Common
Terms of Reference
1. Introduction and Background
1.1 Simon Stevens, the Chief Executive of NHS England, announced on 1st May 2014 that NHS
England was inviting Clinical Commissioning Groups to expand their role in primary care commissioning. Each Clinical Commissioning Group (‘CCG’) was invited to submit an expression of interest setting out its preference for how it would like to exercise expanded primary medical care commissioning functions.
1.2 One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to individual CCGs. Accordingly, in October 2016 each of the five CCGs in North Central London (‘NCL’) submitted separate applications to NHS England to exercise these commissioning functions for each of their own geographical areas.
1.3 The five North Central London CCGs (‘NCL CCGs’) are NHS Barnet CCG, NHS Camden CCG, NHS Enfield CCG, NHS Haringey CCG and NHS Islington CCG.
1.4 In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended) (‘NHS Act 2006’), NHS England subsequently delegated the exercise of the functions specified in section 4 below to each of the NCL CCGs for their own geographical areas.
1.5 Each CCG has established its own individual Primary Care Commissioning Committee as a committee of its Governing Body. The purpose of each committee is to be a corporate decision making body for the management of the delegated functions and the exercise of the delegated powers.
1.6 To promote cross NCL understanding, collaborative and integrated working, information sharing, benchmarking, greater transparency, openness and help manage conflicts of interest each of the NCL CCGs have agreed to hold their Primary Care Commissioning Committee meetings in the same time, in the same place, as a committee in common with a common Terms of Reference. This committee in common is known as the NCL Primary Care Commissioning Committee (‘Committee’).
1.7 These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee.
2. Committees in Common
2.1 The following committees form the Committee:
NHS Barnet CCG Primary Care Commissioning Committee;
NHS Camden CCG Primary Care Commissioning Committee;
NHS Enfield CCG Primary Care Commissioning Committee;
NHS Haringey CCG Primary Care Commissioning Committee;
NHS Islington CCG Primary Care Commissioning Committee.
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3. Statutory Framework
3.1 NHS England has delegated to each of the NCL CCGs the authority to exercise the primary care commissioning functions set out in section 4 below for their own geographical areas in accordance with section 13Z of the NHS Act 2006.
3.2 Arrangements made under section 13Z of the NHS Act 2006 may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and each CCG.
3.3 Arrangements made under section 13Z of the NHS Act 2006 do not affect the liability of NHS England for the exercise of its functions. However, each CCG acknowledges that in exercising its functions (including those delegated to it) it must comply with the statutory duties set out in Chapter A2 of the NHS Act 2006 and including:
No. Statutory Duty Section of NHS Act 2006
1. Management of Conflicts of Interest 14O
2. Duty to promote the NHS Constitution 14P
3. Duty to exercise its functions effectively, efficiently and economically
14Q
4. Duty as to improvement in quality of services 14R
5. Duty in relation to quality of primary medical services
14S
6. Duties as to reducing inequalities 14T
7. Duty to promote the involvement of each patients 14U
8. Duty as to patient choice 14V
9. Duty as to promoting integration 14Z1
10. Public involvement and consultation 14Z2
3.4 In respect of the delegated functions from NHS England the CCG will need to exercise those
functions in accordance with the relevant provisions of section 13 of the NHS Act 2006 including:
No. Statutory Duty Section of NHS Act 2006
1. Duty to have regard to impact on services in certain areas
13O
2. Duty as respects variation in provision of health services
13P
3.5 Each of the individual Primary Care Commissioning Committees which form the Committee is
established by their respective Governing Bodies in accordance with Schedule 1A of the NHS Act 2006.
3.6 The members of the Committee acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.
4. Role of the Committee 4.1 The role of the Committee is to carry out the function relating to the commissioning of primary
medical services under section 83 of the NHS Act 2006. This includes the following:
Decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities:
o Decisions in relation to Enhanced Services;
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o Decisions in relation to Local Incentive Schemes (including the design of such schemes)
o Decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices;
o Decisions about ‘discretionary’ payments; o Decisions about commissioning urgent care (including home visits as required) for
out of area registered patients; o The approval of practice mergers; o Planning primary medical care services in the area, including carrying out needs
assessments; o Undertaking reviews of primary medical care services; o Decisions in relation to the management of poorly performing GP practices and
including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list);
o Management of delegated funds; o Premises costs directions functions; o Co-ordinating a common approach to the commissioning of primary care services
with other commissioners in NCL where appropriate; and o Such other ancillary activities that are necessary in order to exercise the Delegated
Functions.
4.2 In performing its role the Committee will exercise its management of the functions in accordance with the Delegation and the Delegation Agreement that each CCG entered into with NHS England. The Delegation and the Delegation Agreement sit alongside these Terms of Reference. The Delegation is contained in Schedule 2.
4.3 The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity, value for money and remove administrative barriers.
4.4 The Committee will have due regard to any relevant Quality and Safety issues which may
arise as agreed by Committee members. 4.5 In performing its role each Primary Care Commissioning Committee will act within the powers
delegated to it by NHS England. 4.6 Decisions made by each individual Primary Care Commissioning Committee will be binding
on NHS England as long as decisions are made within the scope of the powers delegated to it.
4.7 In performing its role Committee members will act in good faith towards each other, work
collaboratively, review evidence, share information, provide objective expert input and endeavour to reach a consensus and collective view.
5. Geographical Coverage 5.1 Each individual CCG has responsibility for carrying out the functions for their own geographical
areas as set out below:
Committee Geographical Area
NHS Barnet CCG Primary Care Commissioning Committee
London Borough of Barnet
NHS Camden CCG Primary Care Commissioning Committee
London Borough of Camden
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NHS Enfield CCG Primary Care Commissioning Committee
London Borough of Enfield
NHS Haringey CCG Primary Care Commissioning Committee
London Borough of Haringey
NHS Islington CCG Primary Care Commissioning Committee
London Borough of Islington
6. No Double Delegation 6.1 The Committee operates under the principle of no double delegation. This means that each
CCG may only carry out the functions and make decisions for its own geographical area. No CCG has the power or authority to carry out the functions or make decisions for other any other CCG or its geographical area.
7. Pooling Budgets 7.1 The individual CCG Primary Care Commissioning Committees comprising the Committee
have no authority to pool budgets with each other. 7.2 Each individual CCG Primary Care Commissioning Committee is responsible for the
delegated funds in their respective geographical areas.
8. Membership 8.1 The membership of each of the individual Primary Care Commissioning Committees will meet
the requirement of their respective Constitutions. 8.2 The Committee and each of the individual Primary Care Commissioning Committees shall
have a lay and executive majority. 8.3 The Committee shall have the following non-voting attendees who will sit at non-voting
attendees in common across all five NCL Primary Care Commissioning Committees:
A Practice Nurse representative;
NHS England representative(s);
Health and Wellbeing Board representative(s);
Healthwatch Representative(s);
LMC Representative(s);
Non-conflicted external clinicians.
8.4 The list of members and non-voting attendees is set out in Schedule 1. 8.5 Committee members may nominate deputies to represent them in their absence and make
decisions on their behalf. Non-voting attendees may nominate deputies to represent them in their absence.
8.6 The Committee may call additional experts to attend meetings on a case by case basis to
inform discussion. 8.7 The Committee may invite or allow additional people to attend meetings as attendees.
Attendees may present at Committee meetings and contribute to the relevant Committee discussions but are not allowed to participate in any formal vote.
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8.8 The Committee may invite or allow people to attend meetings as observers. Observers may not present at Committee meetings, contribute to any Committee discussion or participate in any formal vote.
9. Chair and Vice Chair of the Committee 9.1 The Chair of the Committee shall be a Lay Member from an NCL CCG. The Committee Chair
shall not be the Chair of an NCL CCG Audit Committee nor a Conflict of Interest Guardian. 9.2 The Vice Chair of the Committee shall be a Lay Member from an NCL CCG. The Committee
Vice Chair shall not be the Chair of an NCL CCG Audit Committee nor a Conflict of Interest Guardian.
10. Voting 10.1 Each individual Primary Care Commissioning Committee shall vote and make decisions for
their own geographical area only. A vote of one Primary Care Commissioning Committee will not be binding on any other Primary Care Commissioning Committee.
10.2 Each voting member of each Primary Care Commissioning Committee shall have one vote
with resolutions passing by simple majority.
10.3 Each Primary Care Commissioning Committee shall nominate a Lay Member from its own CCG to have the casting vote.
10.4 The Chair of the Committee may not vote on any resolution other than on those resolutions from his or her own CCG’s geographical area.
10.5 The Vice Chair of the Committee may not vote on any resolution other than on those resolutions from his or her own CCG’s geographical area.
10.6 Where there is a pan NCL resolution each of the five NCL Primary Care Commissioning Committees must vote in favour of the resolution for it to pass.
10.7 Each Primary Care Commissioning Committee can only invest their own delegated funds in their own geographic area. However, where there are new or additional funds available that are not delegated funds such as new transformation monies all decisions on how such money is invested will be treated as a pan NCL resolution.
11. Decisions 11.1 The Committee and each individual NCL Primary Care Commissioning Committee will make
decisions within the bounds of their remit. 11.2 Decisions of the Committee and each individual Primary Care Commissioning Committee will
be binding on NHS England. 11.3 Due to the nature of primary care commissioning the Committee recognises that some urgent
and immediate decisions may need to be made outside of Committee meetings. Each individual NCL Primary Care Commissioning Committee may therefore delegate urgent and immediate decisions that need to be made outside of Committee timescales in accordance with clauses 11.4 – 11.5 and 11.87 below.
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11.4 Urgent decisions requiring a response within 24 hours will be made by the following people or their nominated deputies:
The relevant Chair of the CCG;
The relevant CCG Chief Operating Officer/Local Executive Director;
The relevant CCG lay representative. 11.5 Immediate decisions requiring a response within 2 weeks will be made at a Committee
meeting where practicable. Where this is not practicable the following people or their nominated deputies will make the decision:
The relevant Chair of the CCG;
The relevant CCG Chief Operating Officer
The relevant CCG lay representative.
11.6 Due to the nature of primary care commissioning the Committee recognises that the following non-contentious, low risk, decisions may be made outside of Committee meetings by those listed in clause 11.7 below: a Committee lay representative and the NCL Director of Performance and Acute Commissioning acting together:
Requests to add or remove a partner;
Retirement of a partner and adding of a new partner;
Partnership changes- 24 hour retirement;
Opening of a patient list;
Increases in practice boundaries.
11.7 The following people or their nominated deputies may make the non-contentious, low risk decisions set out in clause 11.6 above:
The relevant CCG lay representative;
The relevant CCG clinician;
The NCL Director of Performance and Acute Commissioning.
11.87 Decisions made outside of Committee meetings will be reported to the Committee at the next Committee meeting. This may be in a public or private part of the meeting depending on the nature of the business and the decision(s) made.
12. Quorum 12.1 Each individual Primary Care Commissioning Committee must have a lay and executive
majority to be quorate. The following members must also be present:
One lay representative;
One officer representative;
One clinical representative.
12.2 If the clinical representative referred to in clause 12.1 above is conflicted on a particular item of business they will not count towards the quorum for that item of business and a non-conflicted clinician will be appointed or co-opted in their place.
12.3 If any representative is conflicted on a particular item of business they will not count towards
the quorum for that item of business. If this renders a meeting or part of a meeting inquorate a non-conflicted person may be temporarily appointed or co-opted to satisfy the quorum requirements.
12.4 For the Committee to be quorate all five NCL Primary Care Commissioning Committees must be quorate. If a Committee meeting is not quorate the Chair may permit the appointment or co-option of additional members if necessary.
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12.5 In some very rare circumstances all clinicians may be conflicted and therefore it may not be possible to co-opt or appoint a non-conflicted clinician to satisfy the quorum requirements. In this case the Chair may dis-apply the requirement to have a clinical representative present in clause 12.1 above and deem the meeting quorate upon the agreement of all of the lay representatives on the Committee.
13. Secretariat 13.1 The Secretariat to the Committee shall be provided by Islington CCG. 14. Frequency of Meetings 14.1 The Committee shall meet bimonthly or as otherwise agreed by the Committee. 15. Notice of Meetings 15.1 Notice of a Committee meeting shall be sent to all Committee members no less than 7 days
in advance of the meeting. 15.2 The meeting shall contain the date, time and location of the meeting. 15.3 Where Committee meetings are to be held in public the date, times and location of the
meetings will be published on each CCG’s website. 16. Agendas and Circulation of Papers 16.1 Before each Committee meeting an agenda setting out the business of the meeting will be
sent to every Committee member no less than 7 days in advance of the meeting. 16.2 Before each Committee meeting the papers of the meeting will be sent to every Committee
member no less than 7 days in advance of the meeting. 16.3 If a Committee member wishes to include an item on the agenda they must notify the Chair
via the Committee’s Secretariat no later than 7 days prior to the meeting. The decision as to whether to include the agenda item is at the absolute discretion of the Chair.
17. Minutes and Reporting 17.1 The minutes of the proceedings of a meeting shall be prepared by the Committee’s Secretariat
and submitted for agreement at the following Committee meeting. 17.2 The approved minutes will be presented to the NHS England area team. They will also be
presented to each individual NCL CCG Governing Body as per their local requirements. 17.3 Each individual CCG will comply with their own Governing Body’s reporting requirements. 18. Conflicts of Interest 18.1 Conflicts of Interest shall be dealt with in accordance with the NCL Conflicts of Interest Policy
and NHS England statutory guidance for managing conflicts of interest. The NCL Conflicts of Interest Policy is a master document containing the single conflicts of interest policy agreed by each of the NCL CCGs together with a schedule setting out each CCG’s local variations to that policy.
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18.2 Each CCG shall ensure appropriate local safeguards are in place to maintain the integrity of the role of Conflicts of Interest Guardian.
18.3 The Committee shall have a Conflicts of Interest Register that will be presented as a standing
item on the Committee’s agenda. 19. Gifts and Hospitality 19.1 Gifts and Hospitality shall be dealt with in accordance with the NCL Conflicts of Interest Policy
and NHS England statutory guidance for managing conflicts of interest. 19.2 The Committee shall have a Gifts and Hospitality Register that will be presented as a standing
item on the Committee’s agenda.
20. Meetings Held in Public 20.1 Meetings of the Committee shall be held in public unless the Committee resolves to exclude
the public from a meeting. In which case the meeting, in whole or in part, may be held in private. The Committee may also exclude non-voting attendees and observers. Meetings or parts of meetings held in public will be referred to as ‘Meeting Part 1’. Meetings or parts of meetings held in private will be referred to as ‘Meeting Part 2.’
20.2 Non-voting attendees, observers and the public may be excluded from all or part of a meeting
at the Committee’s absolute discretion whenever publicity would be prejudicial to the public interest by reason of:
The confidential nature of the business to be transacted; or
The matter is commercially sensitive or confidential; or
The matter being discussed is part of an on-going investigation; or
The matter to be discussed contains information about individual patients or other individuals which includes sensitive personal data; or
Information in respect of which a claim to legal professional privilege could be maintained in legal proceedings is to be discussed;
Other special reason stated in the resolution and arising from the nature of that business or of the proceedings; or
Any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time; or
To allow the meeting to proceed without interruption, disruption and/or general disturbance.
21. Confidentiality 21.1 Members of the Committee shall respect the confidentiality requirements set out in these
Terms of Reference unless separate confidentiality requirements are set out for the Committee in which event these shall be observed.
21.2 Committee meetings may in whole or in part be held in private as per section 20 above. Any
papers relating to these agenda items will be excluded from the public domain. For any meeting or any part of a meeting held in private all members and/or attendees must treat the contents of the meeting and any relevant papers as strictly private and confidential.
21.3 Decisions of the Committee will be published by Committee members except where matters
under consideration or when decisions have been made in private and so excluded from the public domain in accordance with section 20 above.
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22. Standards of Business Conduct 22.1 Committee members, attendees and/or observers must maintain the highest standards of
personal conduct and in this regard must comply with:
The law of England and Wales;
The NHS Constitution;
The Nolan Principles;
The standards of behaviour set out in each NCL CCG Constitution;
Any additional regulations or codes of practice relevant to the Committee.
23. Training and Information 23.1 It is the responsibility of each organisation referred to in section 1.3 above to ensure that their
representatives at the Committee are provided with appropriate training and information to allow them to exercise their responsibilities effectively.
24. Sub-Committees 24.1 The Committee and each individual Primary Care Commissioning Committee may not
delegate any of its powers to a committee or sub-committee but it may appoint sub-committees and/or working groups to advise and assist it in carrying out its functions.
24.2 Any sub-committees or working groups must abide by the NCL Conflicts of Interest Policy and
NHS England statutory guidance for managing conflicts of interest.
25. Review of Terms of Reference 25.1 These Terms of Reference will be reviewed from time to time, reflecting experience of the
Committee in fulfilling its functions and the wider experience of CCGs in primary medical services co-commissioning.
25.2 These Terms of Reference will be formally reviewed in April each year following the
establishment of the Committee. These Terms of Reference may be changed or amended by mutual agreement of the Committee and on being approved by each of the Governing Bodies of the NCL CCG’s in accordance with their Constitutions.
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Schedule 1 - List of Members This schedule sets out the membership, attendees, Chair and Vice Chair of each individual Primary Care Commissioning Committee and the Committee.
NHS Barnet Primary Care Commissioning Committee The voting members of the NHS Barnet Primary Care Commissioning Committee are as follows:
Position Name Title
Clinical representative Dr Tal Helbitz Governing Body GP Representative
Lay representative
Ms Bernadette Conroy Lay Member
Officer representative Mr Leigh Griffin Director of Strategic Development
Member with casting vote
Ms Bernadette Conroy Lay Member
NHS Camden Primary Care Commissioning Committee The voting members of the NHS Camden Primary Care Commissioning Committee are as follows:
Position Name Title
Clinical representative Dr Kevan Ritchie Governing Body GP Representative
Lay representative Ms Kathy Elliott Lay Member Public and Patient Engagement and CCG Vice Chair
Officer representative Ms Sarah Mansuralli Chief Operating Officer
Member with casting vote Ms Kathy Elliott Lay Member Public and Patient Engagement and CCG Vice Chair
NHS Enfield Primary Care Commissioning Committee The voting members of the NHS Enfield Primary Care Commissioning Committee are as follows:
Position Name Title
Clinical representative Dr Jahan Mahmoodi Governing Body GP Representative
Lay representative
Ms Karen Trew Lay Member
Officer representative
Ms Deborah McBeal Deputy Chief Officer
Member with casting vote
Ms Karen Trew Lay Member
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NHS Haringey Primary Care Commissioning Committee The voting members of the NHS Haringey Primary Care Commissioning Committee are as follows:
Position Name Title
Clinical representative Dr Dina Dhorajiwala Governing Body GP Representative
Lay representative Ms Cathy Herman Lay Member for Public and Patient Engagement and CCG Vice Chair (Non-Clinical)
Officer representative Ms Jennie Williams Executive Nurse & Director of Quality, Haringey CCG
Member with casting vote Ms Cathy Herman Lay Member for Public and Patient Engagement and CCG Vice Chair (Non-Clinical)
NHS Islington Primary Care Commissioning Committee The voting members of the NHS Islington Primary Care Commissioning Committee are as follows:
Position Name Title
Clinical representative Dr Dominic Roberts Clinical Director, GP Representative
Lay representative Ms Sorrel Brooks Lay Member for Public and Patient Engagement
Officer representative Mr Paul Sinden NCL Director of Performance and Acute Commissioning
Member with casting vote Ms Sorrel Brooks Lay Member for Public and Patient Engagement
Non-Voting Attendees The following non-voting attendees sit as non-voting attendees on all of the NCL Primary Care Co-Commissioning Committees as attendees in common:
Position Name Title
Practice Nurse representative Vacant
Health and Wellbeing Board representative(s)
TBC
Healthwatch representative(s) Ms Emma Whitby Chief Executive, Islington Healthwatch
LMC Representative Mr Greg Cairns Director of Primary Care Strategy
LMC Representative Dr Manish Kumar Chair, Enfield LMC
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NHS England Representative Liz Wise Director Primary Care Commissioning, London
External Clinician TBC TBC
External Clinician TBC TBC
External Clinician TBC TBC
The roles referred to in the list of voting members and non-voting attendees above describe the members’ and non-voting attendees’ substantive roles and/or any successor equivalent roles only and not the individual title or titles of any member. Names and job titles are provided for information purposes only and may be updated as required without the need to formally amend the Terms of Reference. Chair and Vice of the Committee in Common The Chair and Vice Chair of the Committee are as follows:
Position Name Title CCG Geographical Area
Chair Ms Cathy Herman (from Haringey CCG)
Lay Member for Public and Patient Engagement and CCG Vice Chair (Non-Clinical)
Haringey
Vice Chair Ms Sorrel Brooks
Lay Member for Public and Patient Engagement
Islington
Schedule 2 - Template Delegation
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Annual General Meeting Minutes
Agenda Item 5.4
Date 30/10/2017
Lead Director Sarah Mansuralli Chief Operating Officer
Tel/Email [email protected]
Report Author Tyrieana Long, Board Secretary
Tel/Email [email protected]
Sponsor(s) (where
applicable) Dr Neel Gupta Tel/Email [email protected]
Report Summary The Governing Body is asked to note the minutes of the Annual General Meeting (AGM) held on 21 September 2017.
Purpose (tick one
only) Information Approval To note
Decision
Recommendation To note the Annual General Meeting minutes prior to approval at the next AGM in 2018.
Strategic
Objectives Links
Commission the delivery of NHS constitutional rights and pledges
Improve the quality and safety of commissioned services
Improve health outcomes, address inequalities and achieve parity of esteem
Integrate and enable local services to deliver the right care in the right setting at the right time
Work jointly with the people and patients of Camden to shape the services we commission
Involve member practices and commissioning partners in key commissioning decisions
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for- money services
Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce
Identified Risks
and Risk
Management
Actions
Not applicable for the purpose of this report
Conflicts of Interest
There are no conflicts of interest arising from this report.
Resource
Implications
Not applicable for the purpose of this report
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
There are no equality impacts from this report.
Report History None.
Next Steps
The minutes of the AGM will be presented for approval at the next AGM in 2018.
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1
CAMDEN CLINICAL COMMISSIONING GROUP
Minutes of the Annual General Meeting, held on Thursday 21 September 2017 Royal College of General Practitioners, 30 Euston Square, London NW1 2FB
Present:
Elected Voting Members
Charlotte Cooley Elected Practice Nurse
Dr Birgit Curtis Elected GP Representative
Dr Neel Gupta Chair
Dr Jonathan Levy Elected GP Representative
Dr Sarah Morgan Elected GP Representative
Dr Kevan Ritchie Elected GP Representative
Dr Philip Taylor Elected GP Representative
Appointed Voting Members
Jane Davis, OBE Registered Nurse Kathy Elliott Lay Member and Vice Chair
Simon Goodwin Chief Finance Officer, North Central London CCGs
Non-Voting Members
Simone Hensby Voluntary Action Camden
Hilary Lance Patient Representative
Richard Lewin Local Authority Representative, London Borough of Camden In Attendance:
Sally MacKinnon Transformation Programme Director Sarah Mansuralli Chief Operating Officer Charlotte Mullins Director of Sustainable Insights and Partnerships Tyrieana Long Board Secretary (Minutes) Trevor Myers Interim Director of Commissioning and Contracting Ian Porter Director of Corporate Services Neeshma Shah Director of Quality and Clinical Effectiveness
Also present were representatives from our member practices, partner and provider organisations, voluntary organisations, other CCGs and members of the public.
Apologies:
Dr Martin Abbas Elected GP Representative
Julie Billett Director Public Health, London Borough of Camden
Dr Matthew Clark Secondary Care Doctor
Mike Cooke Chief Executive, London Borough of Camden
Jonathan Duffy Elected Practice Manager
Dr Farah Jameel LMC Representative
Cllr Richard Olszewski Health and Wellbeing Board Observer
Helen Pettersen Accountable Officer, North Central London CCGs
Richard Strang Lay Member Saloni Thakrar Healthwatch Representative Glenys Thornton Lay Member
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1. Introduction
1.1 Welcome Dr Neel Gupta introduced himself as the new Chair of Camden CCG from July 2017 and
welcomed all those present at the Annual General Meeting (AGM).
1.2 Notice of Meeting The Chair confirmed that a quorum was present and that the notice convening the meeting
had been served on members for the prescribed period of 14 days.
1.3 Minutes of the 2016 AGM Meeting The minutes of the Annual General Meeting held on 22 September 2016 were approved as
an accurate record. 1.4 Opening Remarks 1.4.1 Dr Neel Gupta briefly shared some reflections on the last 12 months, to provide some context
for the presentations that were to be delivered. 1.4.2 One of the key themes over the last year was transition, with a number of personnel changes
involving both executive and non-executive leadership. The Chair thanked colleagues who were no longer with the organisation, for their contribution to the development of the CCG and its successes since its inception in 2011. In particular he thanked his predecessor, Dr Caz Sayer and also Dorothy Blundell who was the Chief Officer until May 2017. He followed on with a warm welcome to the new Governing Body members and Sarah Mansuralli the newly appointed Chief Operating Officer that were attending their first AGM.
1.4.3 The Chair confirmed that Camden CCG had entered into collaborative commissioning
arrangements with the other four North Central London CCGs and a central North Central Leadership team had been established. He welcomed the members of the new management team and in particular Helen Pettersen, the Accountable Officer and Simon Goodwin the Chief Finance Officer.
1.4.4 With regard to the changes in personnel, the Chair announced that Kathy Elliott had been
appointed as the Governing Body Vice Chair and Dr Kevin Ritchie as the Clinical Vice Chair and they were introduced to the audience.
1.4.5 In addition to the above changes, the Chair advised that the Sustainability and Transformation
Plan and been developed which will bring together commissioners, providers and local authorities, with the aim of delivering new models of care. There had also been a significant change to the CCG’s financial position which will mean a greater emphasis on delivering value for money and efficiency.
1.4.6 Given the amount of change for a relatively small organisation and in such a short space of
time, the Chair offered reassurance that that there had been no change to the CCG’s vision, values or culture. Camden CCG remains a clinically led membership organisation which is fully committed to working with the people of Camden to deliver the best health for all. In spite of all the changes the CCG had been able to deliver against its aims and objectives and discharge its statutory responsibilities.
1.4.7 Finally, the Chair said that he was hopeful that some of the changes would enable the CCG to
deliver the longer-term vision of a sustainable health and care system which works for all, and which was underway through the implementation of the Local Care Strategy.
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2. Camden CCG Performance and North Central London Activity in 2016/17
2.1 Vision and Aims 2.1.1 Sarah Mansuralli began by saying how pleased she was to be in Camden and in the role of
Chief Operating Officer for Camden CCG. She welcomed the opportunity to look back at what had been achieved over the last year, what had worked well and not so well, where lessons needed to be learned and to take stock of the CCG’s overall performance.
2.1.2 As the Chair had outlined earlier, the CCG’s vision and aims had remained broadly consistent
throughout the period of transition in the last 12 months, and were reflective of an organisation that was striving to achieve the best health outcomes for residents by working in partnership with a range of different partners, stakeholders and providers. The role of member practices in the development and delivery of the CCG’s goals was highlighted in recognition of the CCG’s role as a membership organisation.
2.2 Organisational Context 2.2.1 The key elements of the 2016/17 period of transition were:
a) Delegated primary care commissioning b) Election of new Governing Body members c) Changing Camden CCG senior leadership d) North Central London commissioning arrangements e) Development and delivery of the Camden Local Care Strategy
2.2.2 Delegated primary care commissioning formally began on 1 April 2017, although much
preparatory work had been carried out across the North Central London CCGs to ensure the smooth transition of the delegated primary care commissioning functions.
2.2.3 Some new partnership collaborations had been formed over the last year to develop
strategies and different work streams to achieve better health outcomes for patients. The collaboration with Camden Council was now embedded and together with the collaboration that had been achieved with other partners in the development of the Local Care Strategy, it was anticipated that the fruits of the development work was expected to be seen in 2017/18.
2.2.4 With regard to the North Central London collaboration of CCGs the senior management team
had been in place since May 2017. A structure chart was presented which revealed that the majority of roles were dedicated to local CCG work in recognition that development and implementation of commissioning needed to be achieved at a local level with partners, providers, member practices and patients.
2.2.5 The North Central London CCG collaboration will facilitate working across a wider geography
and two committees had been established to oversee commissioning at a North Central London (NCL) level. These were the:
1. NCL Joint Commissioning Committee which had delegated commissioning responsibility for acute hospital contracts, integrated urgent care (NHS 111 and GP out of hours service), transforming care for learning disabilities and specialist services not commissioned by NHS England.
2. NCL Primary Care Committee in Common which had delegated authority for North Central London GP core contracts.
2.2.6 Both committees enabled consistency of approach and with the benefit of a single decision
making body for the five NCL CCGs.
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2.3 2016/17 Key Achievements 2.3.1 Sarah Mansuralli advised that NHS England had assessed Camden CCG’s performance as
‘good’ overall in relation to clinical priorities. Tangible outcomes for patients had been achieved which had brought improvements to health outcomes and patient experience.
2.3.2 Ratings for 2016/17 had been released in relation to Cancer, Dementia and Mental Health
performance. Positive improvement had been achieved in relation to dementia and mental health with the rates of early diagnosis for dementia rated as outstanding. Official ratings for the remaining clinical priority indicators, namely diabetes, learning disabilities and maternity were expected to be published later in the year.
2.3.3 With regard to patient experience and patient outcomes, in 2016/17 the key achievements
were: a) A focus on early diagnosis and early intervention resulting in an improvement of 8% in
early stage cancer diagnosis. b) The creation of the Diabetes Integrated Practice Unit (IPU) which delivers services
through a single team, focused on the patient rather than organisational boundaries or professional disciplines. The numbers of patients on the diabetes register has increased by 9%, enabling earlier and more proactive care.
c) A continued focus on mental health services to support the 1 in 6 adults in Camden with mental health needs. A new mental health employment service is being developed and closer working with communities to reach out to residents that are less likely to use services and also to encourage them to seek help sooner. Following on from the example of the Diabetes IPU, a Psychosis IPU has opened to deliver a holistic package of care for patients.
d) Developing services to support older people to lead independent and active lives; including the establishment of a Care Navigation service to help older residents’ access available services and continued support for the Carers Centre to help carers maintain their health and wellbeing.
e) For children and young people work, work with Camden Council and other local partners has resulted in reduced waiting times from 8 to 6 weeks in Children’s and Adolescent mental health services.
f) Significant investment in primary care in recognition of the GP surgery as the first point of contact for the majority of people when they are unwell. This has resulted in extended access to primary care services throughout the borough from 8:00am to 8:00pm Monday to Sunday and increased funding for patients with long term health conditions and serious mental health illness.
g) The roll out of the Care Integrated Digital Record to all Camden practices to allow joined up access to patient records for GPs and other health professionals.
h) Work to develop GP Neighbourhoods with the aim of creating greater capacity and resilience in primary care and also to reduce variation in service delivery.
2.4 Looking Ahead 2.4.1 Looking ahead towards 2017/18 and beyond, Sarah Mansuralli said that there were many
opportunities to work differently across North Central London and within the framework of the Sustainability and Transformation Plan (STP) with providers and partners to achieve the best outcomes for patients.
2.4.2 The key priorities for Camden CCG in 2017/18 were:
a) Working as a collaboration of CCGs across North Central London through shared
management structures. b) Continued implementation of the Local Care Strategy as part of Camden’s
contribution to the North Central London STP.
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c) Continued development of the primary care infrastructure as the foundation of delivering the Local Care Strategy.
d) Ensuring that the CCG maintains financial stability while commissioning high quality, cost effective services for residents.
e) Continued collaboration with partners and stakeholders to improve the quality of local health and care services.
2.4.3 In conclusion, Sarah Mansuralli highlighted the CCG’s partnership and engagement work with
providers, partner organisations, member practices, patients and Camden residents. Although there were challenges ahead, maintaining constructive dialogue with all the CCG’s stakeholders was highlighted as vital in achieving the best health for the people of Camden.
3. Camden CCG 2016/17 Financial Accounts
3.1 Simon Goodwin introduced the CCG’s 2016/17 Financial Accounts. He advised that the CCG
has three statutory financial duties set by the Department of Health which were to: 1. Operate within its financial allocation. 2. Deliver a surplus 3. Deliver within a running cost total.
Camden CCG had met all those duties in 2016/17 and Simon Goodwin thanked his predecessors, Ian Boyle and Carl Pettitt for achieving all the financial obligations agreed with NHS England.
3.1.1 Simon Goodwin highlighted that:
a) Camden had delivered a £0.4m in year surplus b) The total spend was £371.7m c) Running costs were £5.5m d) The majority of the CCG’s commissioning budget is allocated to acute trusts. Acute
spend had increased by £16.4m and non-acute spend had increased by £2.4m in 2016/17.
3.1.2 In setting out the financial picture for 2017/18, Simon Goodwin advised that there was almost
zero growth in funding for the next three years for Camden which meant that the CCG’s income did not increase in spite of inflation and growth in demand across the health system. As a result there was increased pressure on the CCG’s budget.
3.1.3 To keep within budget for 2017/18 a savings target of 5.5% of the total CCG budget had been
set. This was significantly more than what the CCG had previously delivered and was especially challenging for the CCG.
3.1.4 A strong strategic and financial framework had been established with North Central London
partners to manage funding reductions. Patient care and continued delivery of improved health outcomes remained a top priority.
3.1.5 Simon Goodwin acknowledged the difficult financial climate and emphasised the need to
deliver services within allocated budgets.
4. Panel Questions
4.1 Dr Neel Gupta invited questions from the audience which were answered by members of the
Governing Body. A number of questions were asked on a range of subjects, including:
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a) Access to primary care services and also primary care patient forums for deaf people. In response the Chair requested that the Patient Engagement Team work on what tangible things could be done to improve the specific issues that had been raised for deaf people.
b) Cancer waiting times of over 62 days from first diagnosis to receiving treatment. Sarah Mansuralli confirmed that the CCG was working with the University College London Hospital (UCLH) to improve performance and that recovery action plans were in place and were being monitored closely with the provider and regulator. Dr Kevin Ritchie, Governing Body sponsor for UCLH commissioning added that a clinical audit had been carried out which confirmed that there were no cases of clinical harm as a result of the delays to treatment.
c) The STP focus on finance rather than the needs of patients, and the CCG’s engagement role to ensure feedback was received from a wide range of people on how public money should be spent given the financial position. The Chair confirmed that STP was about NHS organisations coming together to build a sustainable health system and was not focused on opening the market up to competition and privatisation.
d) The difficulties of attending engagement meetings for disabled people and in particular those set up for the purposes of public consultation. Martin Emery, Deputy Head of Patient confirmed that guidance was in place to support travel to public consultation meetings for disabled people. He agreed to follow-up in person after the meeting.
e) The establishment of a Patient Participation Group at Somers Town and thanks to the CCG for their support for patient engagement within the local community.
f) Unclear responsibility for the funding of a new drug between primary care and secondary. This matter was followed up in person after the meeting because of its specialist nature.
4.2 The Chair welcomed the questions that had been raised and offered to address any further
questions outside of the meeting. He thanked the audience for their active participation and for taking the time to attend.
5. Close
5.1 Finally, Dr Neel Gupta thanked the CCG’s partners and in particular member practices and
residents for their support over the last 12 months. . 5.2 The Annual General Meeting closed at 15:05pm.
These minutes are agreed to be a correct record of the Annual General Meeting of Camden Clinical Commissioning Group held on 21 September 2017
Signed ………………………………………….. Date …………………………………
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Report of the Audit Committee
Agenda Item 6.1
Date 01/11/2017
Lead Director Rebecca Booker Deputy Chief Finance Officer
Tel/Email [email protected]
Report Author Tyrieana Long Board Secretary
Tel/Email [email protected]
GB Sponsor(s) (where applicable)
Richard Strang Lay Member
Tel/Email
Report Summary
This report provides a summary of the key topics discussed at the 27 September 2017 Audit Committee meeting.
Purpose (tick one
box only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the Audit Committee Report.
Strategic
Objectives Links
Commission the delivery of NHS constitutional rights and pledges
Maintain financial stability and ensure sustainability though robust planning and commissioning of value for money services
Identified Risks
and Risk
Management
Actions
Audit Committees have a crucial role to play in the governance of NHS organisations. They report on the relevance and rigour of underlying structures and processes and on the assurances that the Governing Body receives.
Conflicts of Interest
Not applicable for the purpose of this report.
Resource
Implications
None identified.
Engagement
Not applicable for the purpose of this report.
Equality Impact
Analysis
There are no equality impacts arising from this report.
Report History
The Audit Committee reports to the Governing Body at regular intervals.
Next Steps None
Appendices
Appendix 1, summary of the September 2017 meeting of the Audit Committee.
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Appendix 1 This report provides a summary of the items considered by the Audit Committee on 27 September 2017. Internal Audit Internal Audit Progress Report The Committee considered the Internal Audit Internal Progress Report which contained a progress update against the CCG’s and CSU Quality Assurance 2017/18 work plan. The following reviews were in progress:
CSU Contract Monitoring
Primary Care Delegated Commissioning
Provider Performance Management
Procurement (all CCGs)
Cybersecurity (all CCGs)
Recruitment (all CCGs) The Committee noted the current status regarding management actions that has been raised. LCFS Counter Fraud Report The Committee considered the summary report on counter fraud work against the 2017/18 work plan. Targeted communications and training for staff was being planned for November 2017. The Committee also received the Fraud Benchmarking Report which was an annual report which provided information on reactive fraud investigative work across the NHS. External Audit The Committee noted the progress report and Technical Update. Plans for next year’s CCG audits were being prepared. The External Audit 2016/17 Annual Audit Letter was noted, confirming the completion of the work carried out for Camden CCG. Governance, Risk Management and Internal Control The Committee approved the NCL Conflicts of Interest and Gifts, Hospitality and Sponsorship policies which had been revised in line with NHS England statutory guidance. CCG Governance and Risk Assurance In response to a request from the Chair, the Committee discussed the CCG’s arrangements in place in respect of:
a) The Sustainability and Transformation Plan b) Risk Management and Assurance c) Contract Management and Performance
The Committee agreed to consider a detailed paper on contract management and the underlying processes in place at the next meeting. The Audit Committee is next due to meet in January 2018.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Finance and Performance Committee Report
Agenda Item 6.2
Date 26 October 2017
Lead Director Simon Goodwin, NCL Chief Finance Officer
Tel/Email [email protected]
Report Author Michael Wuestefeld-Gray, Governance Lead (interim)
Tel/Email [email protected]
GB Sponsor(s)
Dr Birgit Curtis Tel/Email [email protected]
Report Summary
The main change to report since the last Governing Body meeting is that the QIPP Cabinet, which reported to the Committee, has been disestablished and replaced with QIPP workshops open to all Governing Body members and executive directors to attend This change introduces a greater clinical focus to QIPP as well as providing all Governing Body members a chance to become more familiar with the CCG’s QIPP activity. It also reduces duplication as there was some overlap between the terms of reference of the QIPP Cabinet and the Committee, and both had a role in overseeing QIPP Challenge Panels. In summary:
The Finance and Performance Committee will now be the Finance, Performance and QIPP Committee;
The QIPP Cabinet will be disestablished in its current form and instead become a series of workshops whereby the PMO and QIPP project managers can present specific QIPP projects;
QIPP Challenge Panels will continue to report to the F&P (now FPQ) Committee.
These new arrangements will provide both greater focus and greater engagement with QIPP as the CCG moves into planning and successful delivery of a challenging QIPP target for 2018/19. A summary report of the meetings of 27 September and 25 October is attached.
Purpose
Information
Approval To note
Decision
Recommendation The Governing Body is asked to approve the change in the Committee’s name from Finance and Performance to Finance, Performance and QIPP and to note the summary reports of the September and October 2017 meetings.
Strategic
Objectives Links
This report links with the following strategic objectives:
Commission the delivery of NHS constitutional rights and pledges;
Improve health outcomes, address inequalities and achieve parity of esteem;
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for- money services.
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Identified Risks
and Risk
Management
Actions
The Committee oversees performance and finance risks rated 12 or higher in line with the CCG’s standard risk management processes
Conflicts of Interest
There are no conflicts of interests arising from this report. The Committee identifies and manages conflicts of interests in line with CCG processes.
Resource
Implications
None
Engagement
This summary report is shared with the Camden Public and Patient Engagement Group.
Equality Impact
Analysis
There are no equality impacts arising from this work
Report History
The Finance and Performance Committee reports to each Governing Body
Meeting.
Next Steps The Committee and QIPP Workshops will continue to meet as planned
Appendices
None
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Name of committee: Finance and Performance Committee Date of meeting: 27 September 2017 Issues discussed Finance Report: Month 5
A balanced budget is forecast, but there are risks around primary care delegated budgets, QIPP and over-performance at Royal Free London;
Pressures are offset by underspend from overheads, contingencies and QIPP;
All budgets have been reviewed and there is assurance they are allocated correctly;
The key risk is QIPP, which is now showing a £1.6 million variance. STP schemes are due to support QIPP delivery in quarter 4.
Integrated Performance Report
University College London Hospitals (UCLH) did not meet the 18 week Referral to Treatment (RTT) standard, for the first time since July 2014. The Trust has committed to bring that back to the Clinical Quality Review Group (CQRG) in October, and the expectation is that the Trust should return to achieving the standard by January 2018.
NCL is delivering work on performance in winter around A&E and the 62 day target.
It was noted RTT issues are site specific at UCLH, and the underlying reasons for RTT performance issues may vary by specialty.
It was also noted that UCLH is now meeting the diagnostics performance standard. Procedures of Limited Clinical Effectiveness (PoLCE) Audit
The Committee approved the proposal to undertake an audit of PoLCE at UCLH QIPP Planning Update: Month 5
The year to date position is £300k variation from plan with a forecast outturn of £1.2 million below plan.
66% of the QIPP plan is closed off or green rated and from month 4 to month 5 £0.5 million of new schemes have been identified.
The forecast outturn is largely due to acute care and business cases are being developed for Q4 2017/18 to tackle this area
There is a focus also on delivering PoLCE QIPP, the planned care LCS and the universal offer scheme.
Spending on stroke had increased by 200% and heart failure by 300% compared with last year. The data is being examined and if they are robust then further work is needed to explore the causes of this.
QIPP 2018/19
£4 million of additional QIPP was being added in 2018/19, bringing the total to £20 million.
Projects will be prioritised with a focus on delivery and a paper set out the process for this.
There will be fewer QIPP lines and they will be developed from the bottom up allowing greater clarity of the targets.
Commissioning directorates will submit scoping documents to the QIPP Challenge Panel. This is also an opportunity to submit new schemes.
The aim is to have by the end of October a consolidated QIPP plan with gaps identified, to be addressed for final submission in December.
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Mental Health Performance Update The key issues noted were:
Referrals to AAT have increased, especially via the Police, but not all of these are appropriate.
Actions have been agreed with the Police to mitigate these as well as the work of the AAR to cope with demand.
A granular review of the block contract for the service has begun to examine value for money.
Readmission data shows a significant reduction in Q1 compared to Q4
Camden Integrated Musculoskeletal Service
UCLH has agreed subcontracts with Connect and Royal Free London.
GP pilots had started in two practices and there was also now a named care coordinator. Feedback on the pilot will go to the single point of access.
Rules around activity adjustment have been agreed with providers.
Work needs to be done on outcome measures and data quality assurance. Insights around 2016/17 over performance at RFL and UCLH The Committee considered the findings of a deep dive into over performance at Royal Free London and UCLH. The report was a more detailed follow-up to the report to the Committee at its August meeting. Key themes were that contract negotiation and management have historically only focussed on finance, and finance decisions haven’t always focussed on performance data. Also, contract performance management has solely focused on finance to the detriment of the underlying activity data. This has enabled data anomalies to remain unchallenged. The impact of this is a disconnect between contract performance and operating plan performance. Given the complexity of the data and the changes to counting and coding rules in 16/17 the team had worked with CCAS to understand whether demand for elective services increased, as suggested by the contract over performance of this Point of Delivery at UCLH and Royal Free for outpatients. The joint work with CCAS concluded that elective demand did not increase significantly in 16/17, hence the scrutiny of this data.
Issues for the Governing Body None.
Decisions for the Governing Body None
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Name of committee: Finance and Performance Committee Date of meeting: 25 October 2017 Issues discussed Finance Report: Month 6
A balanced budget is forecast, but there is a year to date pressure of £600 thousand.
Acute overperformance has reduced from £4.2 million to £3.6 million
There is overall an unmitigated risk of £4.5 million and a mitigation plan is being pulled together.
The greatest budget pressure is due to non-elective activity and the CCG is exploring the reasons for this. Royal Free, UCLH and Imperial between them have overperformance in non-elective care of around £6 million.
Financial Risk Register
A new risk was proposed for inclusion on the Board Assurance Framework relating to acute overperformance and this was agreed.
Risk Sharing Arrangements
Existing known risk sharing arrangements had been reviewed. These are marginal rate, Section 75 and Section 256 agreements.
It was noted that there is no risk share arrangement around delegated primary care commissioning budgets.
Mitigation of Financial Risk in Continuing Healthcare The committee received a report that there has been an increase of 62% in patients eligible for continuing healthcare (CHC). This is partly due to patients at the end of life being fast-tracked so that they can be discharged from hospital and return home. Governance arrangements around the award of and eligibility for CHCare being strengthened, and also data are being cleansed to remove duplicate patients. In addition the assessment team and the commissioning team are being co-located. Additional budget pressures have arisen from the increase in the London Living Wage, which has added £900 thousand. It was noted there has been a similar increase in CHC eligibility across North Central London and discussions have been had on a more consistent decision making process and on the consistent application of existing eligibility criteria. Some of the reasons for the increase are the high acuity and complexity of patients, and that they are living longer. A greater focus on admissions avoidance can mean round the clock care, and some packages can be greater in cost than a care home. It was noted Camden is a high performer in terms of the number of patients dying at home. QIPP Planning Update: Month 6
The year to date position is £670k variation from plan with a forecast outturn of £1.2 million below plan. This is due to slippage in expected savings.
There is a push to move forward with Primary Care at the Front Door, which is a national initiative and progress is expected shortly. It was noted Barnet’s model may be more cost efficient than others and it was agreed to explore this.
The scoping documents for 2018/19 QIPP have been submitted and so far 16 million has been identified, with a target of £20 million.
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The Committee noted the need to identify opportunities for savings and investments across the STP area and the need to align local plans.
QIPP Cabinet
The Committee agreed to change the QIPP Cabinet to a QIPP workshop where project and programme managers could present and seek both clinical and executive input and challenge to help drive and deliver more robust plans.
The Committee will be known as Finance, Performance and QIPP (FPQ) going forward.
Issues for the Governing Body The Governing Body is asked to agree the change in the Committee’s name from Finance and Performance to Finance, Performance and QIPP.
Decisions for the Governing Body None
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Camden Health and Wellbeing Board Report
Agenda Item 6.3
Date 30/10/2017
Lead Director Julie Billett, Director of Public Health
Tel/Email [email protected]
Report Author Daisy Beserve, Programme Manager
Tel/Email [email protected]
GB Sponsor(s)
(where applicable)
Julie Billett, Director of Public Health
Tel/Email [email protected]
Report Summary
This report provides a summary of the most recent meeting of Camden’s Health and Wellbeing Board held in October 2017.
Purpose (tick one
box only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the contents of the report.
Strategic
Objectives Links
This paper links to the following strategic objectives:-
Improve the quality and safety of commissioned services
Improve health outcomes, address inequalities and achieve parity of esteem
Identified Risks
and Risk
Management
Actions
N/A
Resource
Implications
N/A
Engagement
N/A
Equality Impact
Analysis
No equality impact assessment is required for this report.
Report History
This report provides the Governing Body with an overview of the Camden Health and Wellbeing Board’s agenda, discussions and decisions. The intention is to provide these reports to the Governing Body four times a year, aligned to the Health and Wellbeing Board’s schedule of quarterly meetings.
Next Steps N/A
Appendices
None
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Camden Health and Wellbeing Board Summary Report of October 2017 Meeting
1. Background The purpose of this report is to provide the Governing Body with a summary of the agenda items, discussions and actions agreed at the Camden Health and Wellbeing Board (HWBB) meeting on 10th October 2017. 2. Update on the Healthy Weight, Healthy Lives Priority The Board received an update on the implementation of the Healthy Weight, Healthy Lives priority within the Health and Wellbeing Strategy 2016-19. Following the previous update on this priority to the Board in December 2016, two partnerships have been established to help drive a whole systems approach to promoting healthy weight: a borough wide Healthy Weight, Healthy Lives Partnership and at ward level, the St Pancras and Somers Town Partnership. The Board discussed the work of these two partnerships and welcomed the progress made, including the launch of Camden Can - an overarching campaign brand to bring a coherent identity to the full range of activities and interventions focused on supporting residents to maintain a healthy weight in Camden. It also noted the insights gained from community engagement activities with local residents to identify barriers to increased physical activity and healthy eating, and to develop potential local solutions, such as the revival of Charlton Street Market and extending the network of ward-level school Health Champions. The Board commented on the next steps, particularly the need to ensure that mechanisms are in place to continue capturing and sharing ongoing insights with partners and make connections with similar initiatives taking place at regional and national levels. The Board noted the linkages between the range of interventions, services and programmes focused on supporting residents to make healthy choices, and the opportunities presented through social prescribing, and discussed how it could support closer working with local general practitioners and primary care more broadly to improve awareness, uptake and referral into the support on offer. The Board also agreed that all its constituent member organisations would consider what Camden Pledges they might make, in order to promote and remove the barriers for residents making healthier choices. 3. Better Care Fund (BCF) Narrative Plan The Director of Integrated Commissioning presented the Better Care Fund Narrative Plan, which sets out the joint priorities for BCF investment and the delivery plan for 2017-19. The plan aims to support the implementation of the whole system transformation of health and care articulated in the Local Care Strategy, as well as ongoing improvements in service quality and performance. The plan was submitted to NHS England in September. The Board noted that, overall, performance of initiatives within the fund was good and agreed that more work was need to continue to improve performance. It welcomed the streamlined, consolidated approach outlined in the report to ensure better alignment of BCF funded schemes with the national metrics and local priorities, to minimise duplication, and focus on performance management and maximising value for money. The Board also discussed the further planned review of BCF schemes in 2017/18 in light of the financial pressures facing the Clinical Commissioning Group and Local Authority. It noted that the BCF is a relatively small part of the entire integrated commissioning system and discussed the importance of targeting all resources towards realising better outcomes for residents.
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4. Pharmaceutical Needs Assessment Consultation As noted in the update to the Governing Body meeting in July, Health and Wellbeing Boards in England have a statutory responsibility to publish a statement of needs for pharmaceutical services for the population in its area every three years, referred to as a Pharmaceutical Needs Assessment (PNA). Camden’s last PNA was published in 2015, with the next PNA due to be published in April 2018. The draft PNA includes a comprehensive analysis of the health needs of the population at locality level, qualitative research with residents and an assessment of each pharmacy’s services. The overall conclusion of the assessment is that there is sufficient provision of pharmaceutical services to meet the health needs of the borough’s population. The Board considered and commented on the findings of the assessment. In particular, it noted that more needed to be done to promote and maximise the preventative role of local pharmacies in improving people’s health and reducing the pressure on other parts of the healthcare system. The Board also discussed the availability of late night pharmacies for people in the last stages of life and the as yet unknown impact of online prescribing on community pharmacies. The Board approved the final draft PNA for 60-days public consultation ending on 23rd December, and delegated to the Chair approval of the final PNA in February 2018. 5. Developing the Camden Health and Wellbeing Board The Board considered the proposed plan for a development away day, agreed at its meeting in July. The Board discussed the suggested areas of focus, including shared strategic priorities – in light of the development of the new Camden Plan and with a view to inform a new Health and Wellbeing Strategy; membership and composition of the Board; whole system, place-shaping leadership; and resident and community engagement. The Board agreed on an initial half-day session on 9th November, facilitated by Shared Intelligence who have produced a number of evaluative reports on health and wellbeing boards across the country. The session will focus on the Board’s shared vision and outcomes for tackling health inequalities, learning from other health and wellbeing boards and emerging good practice, and understanding the statutory duties and responsibilities of the Board. The Board also noted the potential for a subsequent session to be held with attendance from a wider group of stakeholders, including providers. 6. Date of next meeting The next Camden Health and Wellbeing Board meeting is scheduled to take place on 16th January 2018.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Integrated Commissioning Committee Report
Agenda Item 6.4
Date 27/10/2017
Lead Director Richard Lewin, Director of Integrated Commissioning
Tel/
Report Author Tyrieana Long Board Secretary
Tel/
GB Sponsor(s) (where applicable)
Dr Matthew Clark Tel/
Report Summary This paper presents a summary of the Integrated Commissioning Committee meetings held on 27 September and 25 October 2017.
Purpose
Information Approval
To note
Decision
Recommendation The Governing Body is asked to note the Integrated Commissioning Committee Report.
Strategic
Objectives Links
Commission the delivery of NHS constitutional rights and pledges
Improve health outcomes, address inequalities and achieve parity of esteem
Identified Risks
and Risk
Management
actions
Any major risks are highlighted as part of this report.
Conflicts of Interest
There are no conflicts of interest arising from this report.
Resource
Implications
None
Engagement
This summary report is shared with the Camden Public and Patient Engagement Group.
Equality Impact
Analysis
There are no equality impacts arising from this report.
Report History The Committee reports to each Governing Body meeting.
Next Steps None
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Name of Committee: Integrated Commissioning
Date of meeting: 27 September and 25 October 2017
Issues discussed
Supporting People, Connecting Communities, a plan for living and ageing better in Camden
Integrated Care Teams
Minding the Gap Services
Long Term Conditions Community Services
Carers Business Case
NHS First App
Neighbourhood Development
Dermatology
Latent TB Infection Testing
CAMHS Local Transformation Plan
2017/18 Winter Resilience Planning
Adult Family Conferences
Annual Health Checks for Patients with Learning Disabilities
Camden Integrated MSK Service
Decisions Made: Integrated Care Teams The Committee approved a business case to develop integrated care teams in neighbourhoods by building on good practice already in place. The plan is to create integrated multi-disciplinary teams in neighbourhoods that will bring together GPs, social workers, homecare workers, care navigators and community nursing. Minding the Gap Services The Committee approved a business case which recommended a continuation of the existing contracts with providers to deliver Minding the Gap services for a period of 2 years, and with some variation in the financial model to allow financial savings to be made. Long Term Conditions (LTC) Community Services The Committee considered Camden’s investment in LTC community services and in particular recurrent funding for diabetes, chronic kidney disease (CKD) and hypertension. The Committee agreed to extend the chronic kidney disease pilot and hypertension by 3 months to 30.6.2018 and to extend the diabetes IPU contract by 12 months to 31.3.2019. The Committee will re-visit the business case again in three months’ time. Carers Business Case The Committee agreed to approve the procurement of a carer support service, led by the London Borough of Camden for 3 years. Neighbourhood Development The Committee agreed to approve the introduction of a GP Frailty service in the NW3 / NW5 /
South neighbourhoods until September 2018, with funding to be dependent on the development
of robust outcomes and an evaluation framework by the end of December 2017.
Dermatology The Committee agreed to approve the introduction of teledermatology with triaging as a unified service with local providers, subject to adequate management and mitigation of risks, and also a 3 year QIPP savings target for the new dermatology pathway.
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Latent TB Infection The Committee agreed to approve the implementation of Latent TB Infection testing in Camden, funded by NHS England until 2020 in line with all areas in North Central London.
Issues for the Governing Body: None to report.
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title Locality Committees Report
Agenda Item 6.5
Date 24/10/2017
Lead Director Ian Porter, Director of Corporate Services
Tel/ Email
Report Author Francesca McNeil, Head of Communications and Engagement
Tel/ Email
Report Summary
This paper is a summary report of Locality Committees held in September and October 2017.
Purpose (tick one box only)
Information
Approval To note
Decision
Recommendation The Governing Body is asked to note the contents of this report.
Strategic Objectives Links
Involve member practices and commissioning partners in key commissioning decisions.
Identified Risks and Risk Management Actions
There are no risks associated with this report.
Conflicts of Interest
None
Resource Implications
None
Engagement Not applicable for the purpose of this report
Equality Impact Analysis
Not applicable for the purpose of this report
Report History The Locality Committees Report is presented at every Governing Body meeting
Next Steps None
Appendices None
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Camden CCG Locality Committees Report: September – October 2017 1. Introduction
One of the key ways that Camden CCG engages with its members is through Locality Committees. The South Locality Committee is chaired by Dr Jonathan Levy, the North by Dr Martin Abbas and the West by Dr Birgit Curtis. This report summarises the September and October 2017 Locality Committees.
2. September 2017 Locality Committees
The following commissioning items were brought to all three Committees in September:
2.1 Ratification of the Locality Committee Chairs Following the completion of the 2017 Governing Body elections, member practices approved the retention of Drs Abbas, Curtis and Levy as their Locality Governing Body representatives. 2.2 GP Engagement on Adult Social Care (ASC) Transformation Strategy Sarah McClinton (SMC), Director of Adult Social Care, updated members on ASC transformation plans and sought member feedback. Opportunities to build links between ASC services and GP Neighbourhoods were highlighted e.g. via Home Care service recommissioning. It was agreed that if the new ASC strategy inadvertently increases GP workload, practices should feedback to SMC and to Dr Sarah Morgan, Governing Body GP. 2.3 PMS Review Sally MacKinnon, Transformation Director, attended to discuss the PMS review. Sally confirmed the final proposal needs to meet national and local strategic aims, and not duplicate core or existing local contract activity. The assumption is full PMS monies will stay in general practice, monitored in a light touch way through some form of specification. Member comments / queries included:
The importance PMS and GMS practice involvement in funding reallocation decisions
The need for practices to have sufficient time to manage staffing changes etc.
Risk assessment and mitigation plans will be required, supported by the CCG
The risk for practices with challenging demographics and practices with smaller revenue streams.
2.4 Tissue viability services and wound care Dr Sarah Morgan and Amanda Rimington attended to discuss issues raised by members at previous Locality Committees re: current tissue viability and wound care services, and options for the future – including funding practices to deliver this care. Member comments / queries included:
The need for a clearer wound care treatment pathway in Camden
The importance of any PMS reinvestment being distributed equal across all practices
The option of funding activity per practice, with flexibility to deliver in Neighbourhoods
A request for light touch specifications for practice funding
The need to ensure there is sufficient primary care nurse capacity to deliver wound care. 2.5 NCL Procedures of Limited Clinical Effectiveness (PoLCE) Dr Neel Gupta attended to discuss plans to review the current NCL PoLCE policy. Members:
Highlighted the importance of the right language being used avoid public alarm
Welcomed the opportunity to reduce inappropriate secondary care referrals back to GPs
Flagged the need to avoid: o Reducing appropriate clinician to clinician referrals o Introducing additional unnecessary steps for referring patients o Additional administrative burden with limited clinical or financial benefit.
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2.6 Camden Patient and Public Engagement Group (CPPEG) representative update CPPEG representatives at each Locality Committee updated practices on recent public engagement work, including:
Presentations on Extended GP Hours and CIDR at the August CPPEG open meeting
Discussions on Neighbourhood development, Universal Offer and the annual commissioning process at the CPPEG operational meeting in September.
3. October 2017 Locality Committees
The following commissioning items were brought to the three October Locality Committees: 3.1 QIPP 2017-18 planning Harrison Spencer attended to update members on QIPP 2017-18 planning and sought member ideas to consider in the planning process. Members requested more information on Camden CCG investment linked to services’ performance to help them understand where efficiencies could be found. Additional member comments / ideas included:
Any services moved into primary care must come with appropriate funding attached
Exploring efficiencies via improving communication between Trusts (data sharing, IT etc.)
Funding sufficient practice time/capacity for time consuming, complex admissions avoidance work
Planned Care services: recommissioning the community COPD service
Reducing community pharmacy prescribing wastage
A review of A&E behaviours (e.g. inappropriate referrals back to GPs)
Rebranding Urgent Care services as part of primary care, funded at the primary care tariff
Tracking unintended cost pressures linked to full utilisation of extended hour appointments.
3.2 Rapids Service plans CCG commissioners and Rapids Service representatives attended to flag the recent investment in additional capacity and discuss increasing practice referrals. Overall, feedback from practices was positive re: recent improvements in the flexibility of the service. The Service has offered to visit each practice to discuss any individual issues, to remove barriers to referral.
3.3 Update on the Universal Offer Vanessa Cooke (VC) attended to discuss Universal Offer roll out with members. VC highlighted the QIPP savings identified against Universal Offer are not being delivered in 2017-18, and the specification is being reviewed for 2018-19. VC confirmed any proposed changes would be discussed with members and sufficient notice would be given. Members noted concern that any reduction in Universal Offer funding would impact practices.
3.4 Medicines Management Team update EY Chung attended to provide a quarterly medicines management update. It was noted that Camden practices are the best performing nationally re: antibiotic prescribing targets. 3.5 Annual Health Checks and Accessible Information for Patients with Learning Disabilities Dulwinder Jandu and Dr Meena Anand facilitated a discussion about increasing annual health checks and accessible information for patients with Learning Disabilities in Camden practices. The CCG has invested in producing a wide range of templates available on the GP website.
3.6 Camden Patient and Public Engagement Group (CPPEG) representative update CPPEG representatives at each Locality Committee updated practices on recent public engagement work, including:
Patient representative inclusion on the Long Term Conditions strategy development work
Updates on the Childrens Integrated Paediatric Service and Musculoskeletal Service roll out at the September CPPEG open meeting
4. Forward look
Practice visits are underway by Dr Neel Gupta and Sarah Mansuralli across Q3 2017-18
November Locality Committees: South: Wednesday 15th / North/West: Thursday 16th
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Meeting in Public of the Camden CCG Governing Body Wednesday 17 January 2018, 14:00 Venue tbc
PART I AGENDA
Item Title Presenter Action Paper Time Page
1. Introduction
1.1 Apologies for Absence Dr Neel Gupta Note Verbal -
1.2 Declarations of Interest Dr Neel Gupta Note 1.2
1.3 Declarations of Gifts and Hospitality Dr Neel Gupta Note 1.3
1.4 Minutes of the Previous Meeting Dr Neel Gupta Approve 1.4
1.5 Action Log
Dr Neel Gupta Note 1.5
2. Chair, Accountable Officer, Patient and Quality Reports
2.1 Chair’s Report
Dr Neel Gupta Note 2.1
2.2 Accountable Officer’s Report Helen Pettersen
Note 2.2
2.3 The Patient Voice Report
Kathy Elliott Note 2.3
2.4 Quality and Clinical Effectiveness Report
Charlotte Cooley
Note 2.4
3. Strategy
3.1 North London Partners in Health & Care Sustainability and Transformation Plan
Will Huxter Note 3.1
3.2 North Central London Digital Solution Dr Neel Gupta Note 3.2
4. Finance and Performance
4.1 Finance Report
Simon Goodwin
Note 4.1
4.2 Draft QIPP Plan 2018/19 Simon Goodwin
Note 4.2
4.3 2017/19 Operating Plan Rebecca Booker
Note 4.3
4.4 Integrated Performance Report Charlotte Mullins
Note
4.4
5. Governance
5.1 Board Assurance Framework Richard Strang Note 5.1
5.2 NCL Individual Funding Requests Helen Pettersen
Note 5.2
6. Committee Reports – For information
6.1 Finance and Performance Committee
Dr Birgit Curtis Note 6.1
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6.2 Integrated Commissioning Committee
Dr Matthew Clark
Note 6.2
6.3 Localities Report
Dr Jonathan Levy
Note 6.3
7. Any other Business
7.1 Draft Agenda March 2018 Meeting Dr Neel Gupta Note 7.1
8. Questions from the Public Verbal -
Members of the public have the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should take no longer than three minutes per person.
9. Date of Future Meetings
14 March 2018
REGISTER OF INTERESTS
A register of members’ interests is available on the Camden CCG website http://www.camdenccg.nhs.uk/publications/camden-ccg-board-register-of-interests
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Camden Clinical Commissioning Group Governing Body Meeting 8 November 2017
Report Title 2018 Governing Body Meeting Dates
Agenda Item
7.2
Date 24/10/2017
Lead Director Sarah Mansuralli Chief Operating Officer
Tel/Email [email protected]
Report Author Tyrieana Long, Board Secretary
Tel/Email [email protected]
Sponsor(s) (where
applicable)
Dr Neel Gupta Tel/Email
Report Summary To notify members of the 2018 Governing Body meeting and workshop dates. We propose that the cycle of committee meetings continues to follow the same pattern.
Governing Body meetings in public: Governing Body Workshops
17 January 14 February 14 March 11 April 9 May 13 June 11 July 8 August 12 September 10 October 14 November 12 December Annual General Meeting: 10 October (pm)
Purpose (tick one
only) Information Approval
To note
Decision
Recommendation The Governing Body is asked to note the 2018 meeting dates.
Strategic Objectives Links
Commission the delivery of NHS constitutional rights and pledges
Identified Risks and Risk Management Actions
Not applicable for the purpose of this report.
Conflicts of Interest
There are no conflicts of interest.
Resource Implications
None
Engagement
Early notification of the CCG’s Governing Body meetings facilitates engagement activity with Camden’s population.
Report History The Governing Body meeting dates are approved on an annual basis.
Equality Impact Analysis
No Equality Impact Assessment is required for the report
Next Steps The agreed dates will be incorporated into the Secretariat calendar.
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GLOSSARY
Acronym Meaning
A
A&E Accident and Emergency
ACHS Adult Community Health Services
ADHD Attention Deficit Hyperactivity Disorder
AHSNC Academic Health Science Networks and Centres
ALB Arms’ Length Body
AMR Anti-Microbial Resistance
AMS Ancillary Medical Services
AoMRC Academy of Medical Royal College
APE Accountable Provider Entity
APMS Any Provider Medical Services
AQP Any Qualified Provider
ASC Adult Social Care
AWP Any Willing Provider
B
BAU Business As Usual
BC Business Continuity
BCDR Business Continuity and Disaster Recovery
BCF Better Care Fund
BEHMHT Barnet, Enfield and Haringey Mental Health Trust
BMA British Medical Association
BME Black and Minority Ethnic
BNF British National Formulary
C
C2C Clinician to Clinician
CAF Common Assessment Framework
CAMHS Child and Adolescent Mental Health Services
CAP Common Assurance Process
CBT Cognitive Behavioural Therapy
CC2H Care Closer to Home
CCAS Camden Clinical Assessment Service
CCG Clinical Commissioning Group
CCU Critical Care Unit
CDiff Clostridium Difficile
CDF Cancer Drugs Fund
CDS Commissioning Data Set
CDU Clinical Decision Unit
CEPN Community Education Provider Network
CG Caldicott Guardian
CHC Continuing Health Care
CHP Camden Health Partnership
CICS Camden Integrated Care Service
CIDR Camden Integrated Digital Record
CIFT Camden and Islington Foundation Trust
CIP Cost Improvement Plans
CIT Clinical Information Technology
CKD Chronic Kidney Disease
CLD Chronic Liver Disease
CMHT Community Mental Health Team
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CMT Controlled Medical Terminology
CNWL Central and North West London NHS Foundation Trust
COPD Chronic Obstructive Pulmonary Disease
CPPEG Camden Patient and Public Engagement Group
CPRD Clinical Practice Research Datalink
CQC Care Quality Commission
CQN Contract Query Notice
CQRG Clinical Quality Review Group
CQUIN Commissioning for Quality and Innovation
CSIPS Continuous Service Improvement Plans
CSU Commissioning Support Unit
D
DBS Disclosure and Barring Service
DES Directed Enhanced Service
DH or DoH Department of Health
DNA Did not attend
DOAC Direct Oral Anticoagulants
DOLS Deprivation of Liberty Safeguards
DR Disaster Recovery
DTOC Delayed Transfer Of Care (where patients are ready to return home or transfer to another form of care but still occupy a hospital bed)
DVA Domestic Violence and Abuse
E
EA Equality Analysis
E&D Equality and Diversity
ED Emergency Department
EDS Early Discharge Service (was REDS) / Equality Delivery System
EMIS Electronic Management Information System
EMT Executive Management Team
EOLC End of Life Care
EPR Electronic Patient Record
ERR Enhanced Rapid Response (Lambeth)
F
F2F Face to Face
F&P Finance & Performance
FBC Full Business Case
FE Frail and Elderly
FFT Friends and Family Test
FNC Funded Nursing Care
FoI Freedom of Information
FT Foundation Trust
G
GB Governing Body
GDP Gross Domestic Product
GMS General Medical Services
GP General Practice (or General Practitioner)
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GPSU General Practice Support Unit
H
HASU Hyper Acute Stroke Unit
HCA Health Care Assistant
HCC Health Care Commission
HEE Health Education England
HHC/HHL Haverstock Healthcare Ltd
HLP Healthy Living Pharmacy (Programme)
HPA Health Protection Agency
HPSS Health and Personal Social Services
HSC Health Scrutiny Committee
HSCIC Health and Social Care Information Centre
HSSI Higher Severity Service Incident
HVS Home Visiting Service
HWBB Health and Wellbeing Board
I
IAPT Improving Access to Psychological Therapies
ICAS Independent Complaints Advocacy Service
ICAT Integrated Community Ageing Team (Islington)
ICO Information Commissioner's Office
iCOPE Camden and Islington Psychological Therapies
ICP Integrated Care Pathway
ICT Information and Communication Technology
IDSVA Independent Domestic and Sexual Violence Adviser
IFR Individual Funding Request
IG Information Governance
IHM Institute of Healthcare Management
INR International Normalised Ratio
IPC Integrated Personal Commissioning
IPU Integrated Practice Unit
IRIS Identification and Referral to Improve Safety
ISBHaSC Information Standards Board for Health and Social Care
ISIP Integrated Service Improvement Programme
ISTC Independent Sector Treatment Centre
ITF Integrated Transformational Fund
ITT Invitation to Tender
J
JCC Joint Commissioning Committee
JGPITC Joint GP IT Committee
JSNA Joint Strategy Needs Assessment
K
KPI Key Performance Indicator
L
LAs Local Authority
LAS London Ambulance Service
LCS Locally Commissioned Service
LES Locally Enhanced Service
LGA Local Government Association
LHB Local Health Board
LHS Local Hospital Strategy
LMC Local Medical Committee
LSOA Lower Safer Output Access
LSP Local Service Provider
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LTC Long Term Conditions
M
MARSG Multi-Agency Reablement Steering Group
MASH Multi-Agency Safeguarding Hub
MBSR Mindfulness Based Stress Reduction
MCA Mental Capacity Act
MCP Multispecialty Community Providers
MDT Multi-Disciplinary Team
MHAAT Mental Health Assessment and Advice Team
MHRA Medicines and Healthcare products Regulatory Agency
MRSA Methicillin Resistant Staphylococcus Aureus
MSA Mixed Sex Accommodation
MSK Musculoskeletal
N
N.A.P.P. National Association for Patient Participation
NCL North Central London
NCL JFC North Central London Joint Formulary Committee
NCL MON North Central London Medicines Optimisation Network
NCEL North Central and East London
NE Never Event
NEL CSU North East London Commissioning Support Unit
NES National Enhanced Service
NHSE National Health Service England
NHS IQ NHS Improving Quality
NIB National Information Board
NICA National Integration Centre and Assurance
NICE National Institute for Health and Care Excellence
NIHR National Institute for Health Research
NMP Non-Medical Prescribing
NMUH North Middlesex University Hospital
NP Nurse Practitioner
NPSA National Patient Safety Agency
NQB National Quality Board
NRLS National Reporting & Learning System
NSF National Service Framework
O
OBC Outline Business Case
OBR Office for Budget Responsibility
OCD Obsessional Compulsive Disorder
OOH Out of Hours
P
PACE Post-Acute Care Enablement
PACS Primary and Acute Care Systems
PALS Patient Advice and Liaison Service
PAS Patient Administration System
PASA Purchasing and Supply Agency
PBC Practice-Based Commissioning
PC Primary Care
PCT Primary Care Trust
PCTF Primary Care Transition Fund
PD Personality Disorder
PDT Programme Delivery Team
PGD Patient Group Directions
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PH Public Health
PHB Personal Health Budget
PHE Public Health England
PID Person Identifiable Data/ Project Initiation Document
PIL Patient Information Leaflet
PIRU Policy Innovation Research Unit
PM Practice Manager
PMO Project Management Office
PMS Primary Medical Services
PN Practice Nurse
PNA Pharmaceutical Needs Assessment
PPE Patient and Public Engagement
PPG Patient Participation Group
PPI Patient and Public Involvement
PQQ Pre-Qualification Questionnaire
PQS Prescribing Quality Scheme
PRC Programme Review Committee
PREMS Patient Related Experience Measures
PREVENT Part of the government’s counter-terrorism strategy
PROMS Patient Related Outcome Measures
PTL Patient Tracking List
PTSD Post-Traumatic Stress Disorder
Q
Q&S Quality and Safety
QAS Quality Alerts System
QGG Quality Governance Group
QIPP Quality, Innovation, Productivity and Prevention
QM Quality Matters Newsletter
QOF Quality Outcome Framework (Assessor Validation Reports)
QP Quality Premium
QP(I) Quality Performance (Indicators)
R
R&R Rehabilitation and Recovery
RACI Responsible Accountable Consulted Informed
RAG Red Amber Green (a rating system for indicating the risk status using the traffic light colours)
RAID Rapid Assessment, Intervention and Discharge Service (a mental health service)
RAPIDS Rapid Response Admission Avoidance Service (a mental health service)
RAS Rapid Access Service
RCP Royal College of Physicians
RCGP Royal College of General Practitioners
RCT Randomised Controlled Trials
REDS Rapid Early Supported Discharge
RFL Royal Free London NHS Foundation Trust consisting of Barnet, Chase Farm and Royal Free Hospitals
RFL DTC RFL - Drugs & Therapeutics Committee
RNTNEH Royal National Throat Nose and Ear Hospital
RRP Responsible Respiratory Prescribing Subgroup
RTT Referral to Treatment
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S
SBS Shared Business Services
SCAS Assessment Service for Children with Autism
SCG Shared Care Guideline
SCR Serious Case Review
SEND Special Educational Needs and Disabilities
SFI Standing Financial Instructions
SHA Strategic Health Authority
SHMI Summary Hospital-level Mortality Indicator
SHOT Serious Hazards of Transfusion
SIGN Scottish Intercollegiate Guidelines Network
SIs Statutory Instruments
SI Serious Incident
SLA Service Level Agreement
SMI Service Measurement Index or Supplier Management Inventory
SMT Senior Management Team
SOC Single Overriding Contract
SPA Single Point of Access
SPC Summary of Product Characteristics
SPG Strategic Planning Group
SPOR Single Point of Referral
STEIS Strategic Executive Information System
STP Sustainable Transformation Plan
T
TAP (Mental Health) Team Around the (GP) Practice
TDA NHS Trust Development Authority
TFT Thyroid Function Test
TIA Transient ischaemic attack
TOPS Termination of Pregnancy Service
ToR Terms of Reference
TREAT Triage and Rapid Elderly Assessment Team
TSDO Transformation Strategy Delivery Office
TTA Tablets to Take Away
TUPE Transfer of undertaking protection of employment regulations
TWR Two-week referral
U
UCC Urgent Care Centre
UCLH University College London Hospital
UCLH UMC UCLH - Use of Medicines Committee
UTC Urgent Treatment Centre
V
VBC Values Based Commissioning
VSNAG Voluntary Sector National Advisory Group
VTE Venous Thromboembolism
W
WEMWMS Warwick-Edinburgh Mental Health Wellbeing Scale
WHO World Health Organisation
WRAP An interactive workshop undertaken by healthcare staff to raise awareness of PREVENT
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