249
Governing Body To be held on Thursday 5 December 2019 From 1pm until 4pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ
Governing Body
To be held on Thursday 5 December 2019
From 1pm until 4pm
in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ
Page 1 of 2
GOVERNING BODY To be held on Thursday, 5 December 2019 at 1pm
In Boardroom, Sovereign House A G E N D A
Ref Item Enclosure Led By
Action
Required 1. Apologies for Absence
Verbal Chair For noting
2. Declarations of Interest
Verbal All For noting
3. Minutes of the meeting held on 7 November 2019
Enc A Chair For approval
4. Matters Arising not on the Agenda
Verbal Chair For discussion
5. Notification of Any Other Business
Verbal Chair For discussion
6. Questions from Members of the Public (See our website for how to submit questions – required in advance)
Verbal Chair For discussion
7. Patient Story Verbal Chair For discussion
Strategy
8. Communication & Engagement Strategy 2019/2021
Enc B Head of Communications
& Engagement
For approval
9. Audit Committee Terms of Reference
Enc C Lay Member for Audit & Risk
For approval
Assurance
10. Quality & Performance Report • Spotlight Report on Starting Well
• Children & Young People Future Placements Strategy
Enc D
Enc E
Director of Strategy &
Delivery and Chief Nurse
Acting Assistant
Director, Learning Opportunities:
Children & Young People,
Doncaster Council
For noting
For approval
Page 2 of 2
Ref Item Enclosure Led By
Action Required
11. Finance Report
Enc F Chief Finance Officer
For noting
12. Chair & Chief Officer Report Enc G Chief Officer & Chair
For noting
13. Locality Feedback
Verbal Locality Leads For noting
Items to Note
14.
Procurement Strategy Update
Enc H Chief Finance Officer
For noting
15. Integrated Care System CEO Report
Enc I Chair For noting
Receipt of Minutes
16. Receipt of Minutes • Audit Committee – Minutes of the
meeting held on 12 September 2019 • Quality & Patient Safety Committee –
Minutes of the meeting held on 5 September 2019
• Engagement & Experience Committee – Minutes of the meetings held on 3 October 2019
• Primary Care Commissioning Committee – Minutes of the meeting held on 10 October 2019
Enc J Chair For noting
17. Any Other Business
Verbal Chair
For discussion
18. Date and Time of Next Meeting Thursday 6 February 2020 at 1pm
For noting
Governing Body Quorum is 6 Members: Chair or Vice Chair, at least 3 Clinical Members and Chief Officer or Chief Finance Officer
1
Minutes of the Governing Body Held on Thursday 7 November 2019 at 1pm
In the Boardroom, Sovereign House
Members Present: In attendance:
Dr. D. Crichton Chairman, NHS Doncaster Clinical Commissioning Group (CCG) – Chair (CCG)
J. Pederson Chief Officer, DCCG H. Tingle Chief Finance Officer, DCCG A. Russell Chief Nurse, DCCG L. Tully Lay Member P. Wilkin Lay Member S. Whittle Lay Member Dr E. Jones Secondary Care Doctor Dr M. Pande Locality Lead, South Locality Dr J. Bradley Locality Lead, East Locality Dr M. Pieri Locality Lead, North Locality Dr N. Tupper Locality Lead, Central Locality Dr R. Suckling Director of Public Health Representative L. Devanney Associate Director of HR and Corporate
Services, DCCG A. Leighton Deputy Director of Strategy & Delivery,
DCCG (attending on behalf of A Fitzgerald) A. Goodall Chief Operating Officer, Healthwatch
Doncaster K. Tooley Lead Nurse for Implementation of the Care
Home Strategy, DCCG I. Boldy Deputy Chief Nurse, DCCG T. Thomas Lead Nurse Individual Placements, DCCG P. Hemingway Head of Communications and
Engagement, DCCG J. Telford Engagement Team Manager, Healthwatch
Doncaster K. Connolly Senior Corporate Services Support Officer,
DCCG Action 1. Apologies
Apologies were noted from:
• A. Fitzgerald - Director of Strategy and Delivery, DCCG • P. Holmes - Doncaster Council Representative
2
2. Declarations of Interest Dr D. Crichton reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared.
3. Minutes From Previous Meeting held on 5 September 2019. The minutes of the meeting held on 3 October 2019 were approved as a correct record.
4. Matters Arising not on the Agenda There were no matters arising.
5. Notification of Any other Business
There was no Notification of Any other Business received.
6. Questions from Members of the Public Dr D. Crichton advised of two questions from a member of the public. Unfortunately D. Wright was unable to attend the meeting but was advised the answers would be sent to him. D. Wright raised the following questions: Item 8 - Integrated Care System (ICS) Five Year Long Term Plan (LTP) 1) Can you explain what does total efficiency value mean? If the estimated total
efficiency value figures are achieved, will this still mean that the estimated annual system deficit figures will still be the same?
Our plan for NHS Doncaster CCG means we have to invest £112m over the next four years against an allocation of £75m which leaves a financial gap of
3
£37m, this is the efficiency value to be delivered over the next four years starting in the financial year 2020/2021 ending in 2023/2024. For Doncaster as a place including both health and social care a total efficiency savings value is being refreshed which will quantify what the savings requirement will be across the same four years.
2) Can you tell me the estimated NHS Doncaster CCG figures for 2019/2020 to 2023/2024 for both annual system deficit and total efficiency value?
This is contained in the finance paper presented at the public meeting; the financial gap for Doncaster is £37m.
7. Patient Story – Ageing Well
J. Telford from Healthwatch Doncaster presented the patient story to the Governing Body. Healthwatch Doncaster visited a residential care home situated in the village of Conisborough, Doncaster. The Dale Residential Home is registered as a care home without nursing provision. It provides accommodation for up to 14 older people in single room accommodation. Interviews were conducted with two residents of the home who agreed to have their views recorded and shared at the Governing Body. The main focus of their feedback was:
• How they felt about living there – “nice”, “lovely”, “I’m quite happy”, “visitors are made to feel welcome and like it here”, “ can’t fault it, people want to put their name down”, “don’t get me wrong, it’s that that wonderful that I would not like to be at home”.
• Personal Care – “they take us up to bed”, “I would like a bath everyday but there are a lot of people to get washed”.
• Cleanliness – “the tables are clean”, “everything is spotless”, “cleanliness is in their itinerary”.
• Relationships with staff – “staff listen to what we have to say”, “staff are
very nice, they see to you, get you anything you want”, “you can be honest with staff”.
• Lifestyle – “we have lovely gardens, we sit under umbrellas in the summer”,
“I do word searches, read and knit, I’m not bored”, “we can play bingo, board games and exercise”.
• What the food is like – “we get a drink at 8pm, Horlicks if you want it”, “the
food is very good”, “we had some lovely fruit cake”, “we can be honest with them about the food”.
4
• Meeting their health needs – “they always get someone to see you if you are not well”, “the doctor visits, he is a young fella”, “if he is on duty I think I want be ill”.
The Chair thanked J. Telford for the patient story.
8. Integrated Care System (ICS) 5 Year Long Term Plan (LTP) Dr D. Crichton presented the South Yorkshire and Bassetlaw (SYB) ICS five year LTP to the Governing Body. The key issues were:
• SYB shared its draft plan with the region on 27 September 2019. • Work continued to engage stakeholders including the guiding coalition on 8
October 2019. • Peer to peer process with the four systems in the Yorkshire and Humber
(Y&H) and North East (NE) region took place on 2 October 2019. • Draft plan available for Board, Governing Bodies, Councils and key
stakeholders for discussion and input. • An interim submission was requested from all systems on 1 November
2019. • Final draft due on 15 November 2019.
Dr D. Crichton advised a discussion took place at the Health and Wellbeing Board meeting. It was highlighted that further work to clarify and explain finances is required, this is ongoing and that it is a medically focused document. J. Pederson commented the benefit of ICS is that it has brought services together. The focus is what we can do at place and our Place Plan sits well with this. It is a working document. The Governing Body noted the ICS Five Year LTP.
9. Primary Care Commissioning Committee Terms of Reference L. Tully presented the Primary Care Commissioning (PCC) Committee updated and amended Terms of Reference (TOR) to the Governing Body for approval. The Governing Body approved the amended TOR.
10. Digital Strategy The Chair welcomed K. Dowson to the Governing Body meeting to present the Doncaster Place Digital Strategy 2019/2022 for approval. The purpose of the Doncaster Place Digital Strategy for 2019/2022 is to set out the digital requirements needed to help support the implementation of the refreshed Place Plan and show how digital will help Partners to achieve local ambitions and health and wellbeing objectives. We also document how we intend to meet mandatory national digital targets. The strategy sets out the programmes
5
of work we will implement over a three year roadmap. Our digital vision is: “Digital services will empower Doncaster people to maximise their own health and wellbeing and enable our teams to deliver high quality integrated care”. The strategy describes the programmes and activities that will be implemented across Doncaster over the next three years. They are divided into four key areas. This includes mandatory national programmes but the focus of the strategy is how digital can support and make a positive difference to Doncaster people, our health and care professionals, service managers, commissioners. Supporting Doncaster People
• It will be easier for Doncaster people to interact with Health & Care services and communicate with the professionals who are looking after them.
• Doncaster people will be able to contribute to their own health and care record (NHS LTP).
• There will be Wi-Fi available at all NHS sites to give quick and easy internet access.
• There will be one app to allow Doncaster people to : o Send messages to the health and care professionals who are caring
for them. o View and contribute to their own or a family member’s record. o Access the latest information about the health and care services
available in Doncaster. o Access lifestyle guidance tailored to the individual.
It was recognised that there will be a cohort of individuals who will continue to use other forms of communications.
Supporting Doncaster Health and Care Professionals
• To help health and care professionals in Doncaster work flexibly and seamlessly in any location.
• To work with our colleagues to ensure the technology they are using is making their jobs easier so they can focus on providing the best care at any time of the day.
We will make sure health and care professionals in Doncaster have:
• Fast and safe access to their main IT systems 24/7 from any location through high speed and secure networks.
• Access to relevant and secure information about Doncaster people they are caring for via the integrated Doncaster Care Record.
• Wi-Fi connectivity so that they can communicate with other services more easily.
• The ability to share diary management, address books and transfer large
6
files (true collaborative working). • Easy to use systems so that they can focus on providing the best care for
each individual. S. Whittle queried what engagement has taken place so far. J. Pederson advised there will be an extensive engagement programme when the time is right. Dr D. Crichton advised the Governing Body the Interoperability Group is overseeing the strategy and updates are received at the Partnership Board. The Governing Body reviewed and approved the Doncaster Place Digital Strategy 2019/2022.
11. Quality and Performance Report A. Leighton and A. Russell presented the Quality & Performance Report for noting by the Governing Body. The following key areas were highlighted: NHS Doncaster Clinical Commissioning Group (CCG)
• Patients on incomplete non-emergency referral to treatment pathways (yet to start treatment) should have been waiting no more than 18 weeks – performance increased to 87.0% during September, but remaining below the 92% target.
• 52 week waits – There was one Doncaster patient waiting over 52 weeks for treatment in September at Leeds Teaching Hospital.
• Patients waiting less than six weeks for a diagnostic test – Performance in September improved and met the target at 99.3% against 99%.
• Cancer 31 day waits – Performance during August 2019 met the 96% target at 96.4%.
• Cancer 62 day waits – Performance during August 2019 failed to meet the 85% target at 83.3%.
• Improving Access to Psychological Therapies (IAPT) – The amount of people accessing the service in six week and 18 weeks both met the national targets of 75% and 95% at 93.1% and 99.2% respectively.
Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT)
• Patients on incomplete non-emergency referral to treatment pathways (yet to start treatment) should have been waiting no more than 18 weeks –
performance decreased to 86.4% during September, below the 92% target. • 52 week waits – There were three patients at the Trust waiting over 52
weeks for treatment in September from other CCGs of residence. • Accident and Emergency – Performance deteriorated slightly in September
2019 to 87.2% below the target of 95%. • Cancer 31 day waits – Performance during August 2019 met the 96%
target at 100%. • Cancer 62 day waits – Performance during August 2019 met the 85%
7
target at 87.0%.
Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)
• Care Programme Approach – The proportion of people followed up within 7 days of discharge continues to be 100%.
• IAPT – The amount of people accessing the service was slightly below the 8.08% target at 7.52%.
• Incomplete Attention Deficit Hyperactivity Disorder (ADHD) waits for diagnosis for children – August 2019 performance was 23.9% against the target of 92%.
Other Commissioned Services
• Yorkshire Ambulance Service (YAS) – All measures were met target during September 2019 with the exception of Category Two (Emergency) which achieved an average time of 18 minutes and 26 seconds against a target of less than 18 minutes. Life Stage Strategic Delivery Plan
• Ageing Well - Of the 25 actions within this life stage four have been completed with one overdue
The Governing Body noted the Quality and Performance Report. Spotlight Report on Ageing Well – Care Homes K. Tooley, T. Thomas, D. Hubbard and K. Anderson-Bratt gave a presentation to the Governing Body around Care Homes which focussed on:
• Integrated Quality Management of Services in Doncaster • Quality Issues Log (QIL) • Contracts and Safeguarding (QIL) • Current and Future Developments:
o Joint monitoring with CCG that will improve clinical practise o Piloting electronic audit form – Enable Audit o Reviewing process for obtaining feedback about providers –
questionnaires o Dignity Awards implemented in Doncaster o Oral Health Improvement Group – Workforce looking at
implementing oral health training in care homes • Quality Assurance – New Post Lead Nurse for Individual Placements:
o Co-located with Doncaster Council contract monitoring team two days per week to build relationships & undertake joint quality audits
o Provide dedicated clinical support to individual placements o Developed a quality tool to provide consistent assessment and
reporting approaches o Challenging current care service approaches; interpreting and
8
disseminating national legislation and best practice guidance • New Joint Working Processes:
o Develop and implement the principles of how the joint post will work over the coming months
o Develop a robust process to audit and review all placements within a defined period
o Develop the governance structure to support good quality care provision
o Testing and refining the newly developed Clinical Audit Tool o Build Links with CQC and other partners to ensure good information
sharing processes • What has been achieved so far:
o Induction phase agreed for September/October 2019 o Promoted new role across providers o Multiple Multi-Disciplinary Teams lead professional shadow visits o Establish new ways of working with Doncaster Council :-
IT access; Relationships; understanding of current process and tools
Undertaken several audits and support visits to providers • Raising Quality and Workforce Development • Data Analysis
J. Pederson asked how services engage with care homes, i.e. dental services. K. Anderson-Bratt commented that an Oral Health Group has been established. Managers are also encouraged to be pro-active in regards to providing health services for residents. Care Homes are audited and if health services for residents are not provided this would be picked up and addressed. L. Tully questioned the high turnover of care home staff. K Anderson-Bratt explained staff tend to move from care home to care home and not necessarily on to a different position. Their training passport would then move with them to their next home. Dr D. Crichton thanked the group for attending the Governing Body meeting.
12. Finance Report H. Tingle presented the Finance Report for noting by the Governing Body. The report sets out the financial position as at the end of September 2019. NHS Doncaster CCG is forecasting to achieve all of its financial targets for 2019/2020. Current Position The CCG’s financial position reflects break-even which is in line with the target set by NHS England (NHSE). Key messages and Risks As part of the 2019/2020 Financial Plans, £7.1m of potential risks were identified. The main risk identified was the achievement of the ambitious efficiency plans
9
£2.7m, acute contract over performance £1m, increased costs associated with individual placements £1.4m (including Continuing Healthcare (CHC), Specialist Placement and Section 117 packages) and prescribing £2m. The risks have reduced overall due to the updated Quality, Innovation, Productivity & Prevention (QIPP) position but have increased in relation to CHC due to a forecast overspend against this budget. All risks are being closely monitored in year and mitigating action taken early. Pressures are now being seen in the DBTHFT contract relating to high cost drugs, in prescribing due to Category M pricing and on Individual Placement costs and activity. These are currently being managed within the overall allocation and additional work is underway to understand the pressures and how they can be controlled. DBTHFT Contract As part of the contract negotiation agreements significant additional funding was agreed in the DBTHFT contract in order to improve waiting times, reduce the waiting list size and achieve 92% Referral to Treatment (RTT) targets. It is the CCG’s expectation that the additional funding agreed will be fully utilised by the Trust to deliver the 92% RTT standard, this will be closely monitored as this remains a high risk for the CCG if the additional activity is not delivered by the Trust particularly given the late stage in the year. Efficiency Savings Programme The CCG has set an ambitious efficiency plan equating to £10.1m. The main contracts with DBTHFT and RDaSH NHS FT were negotiated net of the agreed efficiency targets of £3.4m and £0.5m respectively. Further schemes are being identified through the QIPP board to mitigate against any slippage and any other cost pressures that may arise in year. Further Allocations The CCG has received an allocation of £263k for GP Forward View, £47k for Diabetes transformation schemes, £101k for Children and Young People (CYP) Mental Health Trailblazer, £31k for Waiting Time Pilot, £44k for Learning Disabilities (LD) Transformation Support and £126k for additional Better Care Fund (BCF) funding. The Governing Body received the Finance Report and noted any risks and issues highlighted in the report. The Governing Body also approved the financial plans subject to any minor tweaks required before the 15 November 2019 submission.
10
13. Governing Body Board Assurance Framework (BAF) – Quarter Two 2019/2020 L. Devanney presented the Governing Body BAF – Quarter Two 2019/2020 for noting to Governing Body. The key points from the report were as follows:
1. Board Assurance Framework – Key Highlights
- A full review of the BAF has been undertaken by Senior Risk Owners in October 2019.
- Initial, current and target scoring has been reassessed. - Controls, assurances, gaps, actions and progress have been updated. - Corporate objective 2 – 2.2 has been fully reviewed, removing
reference to the quality impact on urgent and emergency care and now considers quality impact on all care.
The Audit Committee is due to receive quarter two BAF at its meeting on 14 November 2019 for consideration and to undertake deep dives in corporate objective 2 - 2.1 and 3 - 3.1, 3.2, 3.3, 3.4. 2. BAF – Dashboard The dashboard can be viewed in Appendix 1, page 2. The outturn for quarter two 2019/2020 illustrates seven risks have achieved against their target score. 3. Next Steps The BAF will continue to be reviewed by the Head of Corporate Governance and Senior Risk Owners on a quarterly basis. The Governing Body noted:
a) the current position and updates to the BAF b) a deep dive of corporate objective 2 – 2.1 and 3 – 3.1, 3.2, 3.3, 3.4 are to
be undertaken at the meeting of the Audit Committee on 14 November 2019.
14. Corporate Assurance Report – Quarter Two 2019/2020 L. Devanney presented the Corporate Assurance Report – Quarter Two 2019/2020 for noting to the Governing Body. The key points from the report were as follows: • BAF: The Head of Corporate Governance has met with each Senior Risk
Owner during Quarter Two.
• Risk Register: At the end of Quarter Two, there were fourteen risks on the risk register, three risks being rated as very high. Dr E. Jones advised one of the high risks, sharps bins, was discussed in the Quality and Patient Safety Committee meeting. A discussion took place and the risk was downgraded.
11
• Incident Reporting: There was one internal information governance breach
which originated at Doncaster CCG in Quarter Two. • External assessments: The Internal Auditors – 360 Assurance have undertaken two internal audits
and one advisory audit. o Governance and Risk Management – Significant Assurance, with five low
recommendations. o Policy Monitoring (Advisory) – one medium and three low
recommendations. • Corporate Governance: The annual full audit has been successfully carried
out for Declarations of Interest and Disclosure of Gifts and Hospitality. The updated register of all decision makers is published on the Doncaster CCG website.
• Health & Safety, Fire and Security: The competent person for Health & Safety at the CCG has confirmed that the CCG is in compliance with legislation.
• Information Governance (IG): Work is underway for the completion of the 2019/2020 Data Security Protection Toolkit. Internal Audit has agreed a two stage review this year. The first stage review will be carried out on an advisory basis and will not contain an audit opinion. A short follow up review will be carried out prior to the final toolkit submission by 31 March 2020.
• Equality and Diversity: An Equality and Diversity six monthly report was presented by the Corporate Governance Manager at the Engagement and Experience Committee in September 2019.
The Governing Body noted the Corporate Assurance Report – Quarter Two 2019/2020.
15. Chair and Chief Officer Report The Governing Body noted the Chair and Chief Officer Report.
16. Locality Feedback Locality Leads gave the following feedback from their Locality meetings:
• Central Locality – Dr N. Tupper had no information to report. • East Locality – Dr J. Bradley had no information to report. • North Locality – Dr M. Pieri had no information to report. • South Locality – Dr M. Pande had no information to report.
The Governing Body noted the feedback from the Locality Leads.
12
17. South Yorkshire and Bassetlaw Joint Committee Clinical Commissioning Groups Progress Report – Quarter One 2019/2020. Dr D. Crichton presented the SYB Joint Committee CCGs Progress Report – Quarter One 2019/2020 to the Governing Body for noting. The Governing Body noted the SYB Joint Committee CCGs Progress Report – Quarter One 2019/2020.
18. Integrated Care System (ICS) Chief Executive Officer (CEO) Report Dr D. Crichton presented the ICS CEO Report to the Governing Body for noting. The Governing Body noted the ICS CEO Report.
19. Receipt of Minutes The following minutes were received and noted by the Governing Body: • Executive Committee – Minutes of the meeting held on 18 September 2019. • Engagement & Experience Committee (EEC) – Minutes of the meeting held on
5 September 2019. • Primary Care Commissioning Committee (PCC) – Minutes of the meeting held
on 12 September 2019. • Joint Committee of Clinical Commissioning Group (JCCCG) – Minutes of the
meeting held on 25 September 2019.
20. Any Other Business Dr D. Crichton advised the Governing Body the scheduled meeting for 2 January 2020 has been cancelled due to the date being so close to the Christmas/New Year period.
21. Date and Time of Next Meeting Thursday 5 December 2019 at 1pm in the Boardroom, Sovereign House.
Page 1 of 3
Meeting name Governing Body Meeting date 5 December 2019
Title of paper
Doncaster Clinical Commissioning Group Communications
and Engagement strategy 2019-21
Executive / Clinical Lead(s) Anthony Fitzgerald, Director of Strategy & Delivery
Author(s) Paul Hemingway, Head of Communications & Engagement Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The purpose of this report is to provide Doncaster CCG Governing Body with a high level overview of the Doncaster CCG Communications and Engagement Strategy, 2019-21 and approve the content and areas of focus for the duration of the strategy. This new strategy takes the previous version much further, reflecting on the progress made in 2019-20 and making best use of all available communications and engagement channels to engage with our partners, stakeholders, patients and members of the public. The strategy includes a focus on:
• Our core functions and duties as a CCG • The importance of communications and engagement and how it supports the
commissioning cycle • Our approaches to communications and engagement • Our Engagement and Experience Committee • 2019-21 Communications and Engagement objectives • Communications and engagement tools • Importance of our brand and identity • Priorities and development for 2019-21
Priorities and development for 2019-21 is focused on: Develop new social media platforms
• LinkedIn – to engage further with our professional groups • Instagram – to engage more regularly and closer with children and young
people • Snapchat – explore the use of Snapchat following period of engagement with
children and young people
X
Page 2 of 3
Develop a suite of e-bulletins for patients and members of the public, linked to the three life stages ‘Starting Well, Living Well and Ageing Well’. We will also start to use a new, interactive email platform which will help determine our reach, open rates, click through rates
• Starting Well – covering all aspects of health and care for children, young people and maternity
• Living Well – typically adults, aged 18 to 65 – covering all aspects of health and care
• Ageing Well – typically adults, aged 65 and over, linking health and social care services together in Doncaster
Review, develop and expand the Doncaster CCG website, linking closer with partner organisations and the wider South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS). Ensure our Patient Participation Groups (PPGs) continue to thrive and flourish, ensuring the views of local people are heard. We will also diversify our approach, working with Healthwatch Doncaster to look at how we can link PPGs into the wider community, proactively supporting and taking part in Primary Care Networks. Recommendation(s) The Governing Body is asked to:
• Read the content of the strategy • Approve the strategy
Report Exempt from Public Disclosure Is the report Exempt from Public Disclosure? Yes No Impact analysis
Quality impact
The strategy will highlight the CCGs approach to communications and engagement and help support improvement in the way we communicate and engage with patients, members of the public, partners and stakeholders.
Equality impact
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.
x
An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
N
Page 3 of 3
Sustainability
impact nil
Financial implications nil
Legal implications nil
Management of Conflicts of
Interest n/a
Consultation / Engagement
(internal departments,
clinical, stakeholder and public/patient)
The communications and engagement team continually engages with patients and members of the public and we check our approaches to ensure we are meeting the needs of our patients and members of the
public.
Report previously
presented at n/a
Risk analysis n/a
Corporative Objective / Assurance Framework
The strategy links to the following corporate objectives: • Ensure an effective, well led, and well governed organisation • Commission high quality, continually improving, cost effective
healthcare which meets the needs of the Doncaster population • Work collaboratively with partners to improve health and reduce
inequalities in well governed and accountable partnerships.
Page 1 of 15
NHS Doncaster Clinical Commissioning Group (CCG)
Communications and Engagement Strategy
2019-2021
October 2019
Page 2 of 15
Contents
Section
Page
Introduction 3
Our core functions and duties 4
How communications and engagement supports the commissioning cycle
6
Our approach to communications and engagement 7
Engagement and Experience Committee 8
Our communications and engagement objectives 9
Our communications and engagement tools 10
Our brand and identity 14
Priorities and development for 2019-21 14
Find out more 15
Page 3 of 15
1. Introduction How we communicate and engage with each other is very important and impacts everything we aim to achieve. At NHS Doncaster Clinical Commissioning Group (CCG), communications and engagement is absolutely vital and informs all our work. The way we communicate and engage, along with our commitment to open and effective communication and engagement reflects our culture, ethos and ambitions – to be forward thinking, ambitious and patient focussed. The aim of this strategy is to highlight the way that we, as a CCG, aim to communicate and engage in ways which are clear, open, transparent and targeted. It is vital that we don’t travel on this journey alone. At Doncaster CCG, our commitment to partnership working is evident in everything we do. Doncaster CCG is a member of many partnership groups and alliances across the borough, including Doncaster Growing Together and Team Doncaster. We also work very closely with a range of voluntary, community and faith sector groups. We are part of a communications and engagement group that meets every two months to plan, review and evaluate our communications and engagement activities. This not only includes health and social care colleagues, but the Council, Children’s Services Trust, Police, Fire and Rescue Service and local housing organisations. We are also a key organisation, operating within the South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS). We have and will continue to share examples of best practice across the ICS, showcasing the innovative, partnership working that is taking place to improve health outcomes and experiences for patients and members of the public. We communicate regularly, every day, to a wide range of audiences and stakeholders. Effective communication is not just about our message out; it is also about listening to patients, the public, staff and our stakeholders. During 2018-19 we made significant strides to improve and enhance our communications and engagement activity approaches – both with staff, stakeholders, patients, members of the public and the voluntary and community sector. We were proud to receive a ‘Green Star’ rating from NHS England (NHS E) for our commitment to patient and public involvement in our commissioning. We could not have done this alone and integral to this rating is how we work with the wider health and care system in Doncaster and beyond. We will continue to strive and further improve our communications and engagement approaches in the coming years and look forward to working with patients and members of the public to scope, design, deliver and evaluate services for the people of Doncaster.
Page 4 of 15
2. Our core functions and duties Our core function as a CCG is to commission high quality, health and social care services for over 320,000 people in Doncaster. Each year, the CCG spends over £500 million in Doncaster and we are committed to ensure our resources are best placed to meet the needs of our local communities. Engaging and communicating with local people, including patients, members of the public and groups such as carers, veterans and hard to reach communities is vital. We do this through conversations, discussions, consultations, engagement exercises and by listening to them. This is helping us to deliver modern, dynamic services, aligned to the needs of local people, helping us to make the best use of our resources. As a CCG, we have a legal duty to involve patients and the public in commissioning, which is included in the Health and Social Care Act 2012. Not only does involving patients and the public in commissioning make good business sense; understanding patient experience will help us to provide better quality services which are more responsive and better able to meet individual needs. Clinical Commissioning Groups (CCGs) are required by law to:
Involve the public in the planning and development of services
Consult on their commissioning plans
Report on public involvement in the annual report
Include ‘lay members’ on the Governing Body to represent the public
Have due regard to the findings from the local Healthwatch
Consult Local Authorities about substantial service change
Have regard to the NHS Constitution in carrying out their functions
Involve patients and members of the public in decisions about their care
Promote patient choice, and
Promote the integration of health and social care.
Statutory guidance for CCGs was published in April 2017 to support the involvement of patients and the public to improve services and provides clear advice on the legal duty to involve. The guidance also links to wider resources on engaging ‘seldom heard’ groups and has been developed alongside statutory guidance for CCGs on involving people in their own health and care. There are 10 key actions for CCGs and NHS E to help embed involvement in their work:
Involve the public in governance
Explain public involvement in commissioning plans
Demonstrate public involvement in annual reports
Page 5 of 15
Promote and publicise public involvement
Assess, plan and take action to involve
Feedback and evaluation
Implement assurance and improvement systems
Advance equality and reduce health inequalities
Provide support for effective involvement
Hold powers to account
These key actions are supported by the ‘principles of participation’ which were developed by NHS E, based on a review of research, best practice and views of stakeholders. Examples of these principles include, but not limited to:
Reaching out to people, rather than expecting them to attend events and ask how they want to be involved
Promote equality and diversity and respect different views
Value people’s lived experience and what they tell you, and
Review and learn from experience, both positive and less so and celebrate the contributions made as a result of people’s involvement.
This communications and engagement strategy outlines how we continue to meet these responsibilities by engaging with patients and members of the public at the right time, right place, using the most effective communication and engagement channels. Our commitment to equality and diversity In addition to the Health and Social Care Act 2012, we are also bound by the Equality Act 2010. This ensures that we promote and prioritise the fair treatment of people regardless of any ‘protected characteristic’ they may have. The NHS defines the nine protected characteristics as:
Age
Disability
Gender re-assignment
Marriage and civil partnership
Pregnancy and maternity
Race including nationality and ethnic origin
Religion or belief
Sex
Sexual orientation When we communicate and engage with people with a protected characteristic, we need to ensure that the methods we use take this into account and enable them to participate fully. We are committed to ensuring that we communicate and engage with all groups effectively, ensuring our commissioning decisions considers all nine protected characteristics.
Page 6 of 15
3. How communications and engagement supports the commissioning cycle
Patients and members of the public are involved in the commissioning of services at Doncaster CCG and we continue to improve and explore other opportunities for people to get involved and have their say. We do this through feedback from their experience of using services, identifying unmet need and analysing data from service users, family and friends to identify areas for improvement. Staff are supported to appreciate the importance of gathering user data and analysing patient experience to improve services and how to best engage patients and members of the public. Colleagues from all areas of the CCG are encouraged to attend an annual training session, led by the NHS E and NHS Improvement (NHS I) patient and public involvement team. The ’10 steps to better patient and public engagement’ course is very well attended and resources are available on the Doncaster CCG staff intranet to ensure all commissioning activity considers patients and members of the public right at all points through the commissioning process.
Page 7 of 15
Our focus on the importance of engagement is also captured through a new engagement database that has been published on the Doncaster CCG staff intranet. This database enables all staff to capture key highlights from engagement activities, supporting all staff to see what engagement has taken place and when. This also supports our ethos of using information, insight and feedback regularly, reducing the chance of duplication. This is enabling CCG commissioning colleagues to focus their engagement activities on key gaps and hard to reach groups.
4. Our approach to communications and engagement Operating within legislative and policy frameworks, Doncaster CCG aims to communicate and engage with all patients, members of the public, stakeholders and the voluntary and community sector in a way which is inclusive, relevant, and open, encouraging dialogue by listening to patient and public views, concerns and providing feedback. By doing so we will ensure that we:
engage effectively with our local communities and build this knowledge into commissioning decisions
are better placed to offer services which are responsive and accountable
build effective relationships and trust with patients and members of the public
are in a position to invest in services which reflect the needs and aspirations of the local community, and
deliver excellent services to patients and service users.
We also use and regularly refer to findings from national insight and engagement research, including the GP Patient Survey, the Adult Inpatient Survey, the Friends and Family Test and the NHS Staff Survey. We carry out a large number of engagement exercises locally and use these, together with any recommendations to improve our on-going communications and engagement.
Page 8 of 15
The ladder of engagement Our work and approaches to communication and engagement acknowledges the work of Sherry Arnstein and the 'Ladder of Engagement and Participation’ to identify different levels of patient and public involvement.
5. Engagement and experience committee The CCG has a Lay Member with responsibility for patient and public engagement and their role is to support and challenge this work. The Engagement and Experience Committee (EEC) meets monthly and includes representatives from Healthwatch Doncaster, the Local Authority, Doncaster’s Health Ambassador network and the voluntary sector.
Page 9 of 15
Our EEC receives a ‘deep dive’ each month which is in line with our Governing Body review of performance across commissioning areas. This includes a report and/or presentation from our commissioning managers on their engagement and involvement with patients and members of the public, as follows: Challenges are made by all representatives to ensure the CCG meets its statutory requirements. The minutes are presented to the Governing Body which provides an overview of patient experience, ‘We Asked, You Said, We Did’ quarterly reports and engagement activity undertaken by Doncaster CCG commissioning leads.
6. Our communications and engagement objectives
Communications and engagement objectives will always be specific to what we are trying to achieve, across the many different programmes and projects that we deliver. Our communications and engagement objectives will always be aligned with and to support delivery of our corporate objectives as a CCG:
Ensure an effective, well led, and well governed organisation
Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population
Ensure that the healthcare system in Doncaster is sustainable
Work collaboratively with partners to improve health and reduce inequalities in well governed and accountable partnerships.
In 2019, we reviewed our current communications and engagement team structure to ensure all service areas had the support they need to ensure all CCG and partnership led work is recognised, as well as ensuring engagement takes place at every possible opportunity. Each service now has a dedicated communications and engagement officer who they go to for all their communications and engagement queries or questions.
Page 10 of 15
They are also responsible for forward planning and evaluation of communications and engagement activities for the areas of the CCG they support. This new way of working not only ensures that we communicate and engage at the right time and right place, it also means that equal weight and consideration to both communication and engagement activities. The new service, support, advice and guidance will continue to support improvement in our approaches to communications and engagement. As a result of the new team structure, this has also strengthened our organisation wide communications and engagement objectives:
Ensuring lived experience has a key place in all commissioning activities
Ensure we work in partnership with all Doncaster health and social care services wherever possible, avoiding duplication of activity
Focussing CCG communications and engagement activity on the priority areas of the CCG, identifying the best engagement option for each priority area, using the Ladder of Engagement.
For 2019-21 a key area of focus for Doncaster CCG is our joint health and social care commissioning strategy, which includes our commissioning priorities with Doncaster Council. The first ever joint health and social care commissioning strategy is aligned with the NHS Long Term Plan and highlights Doncaster’s approach and focus for health and care services over the next few years. We engaged extensively with patients and members of the public in the development phase of the strategy. Almost 800 people gave their views, both online and via forums and focus groups. On social media alone, our messages reached 375,000 people. Using a life stage approach, Doncaster CCG will commission services under starting well, living well and ageing well. It is therefore crucial that our communications and engagement activities align with these life stages, providing opportunities for patients and members of the public to co-design, co-deliver and evaluate health and care services.
7. Our communications and engagement tools We will actively engage our patients, members of the public, staff, partners, stakeholders and the voluntary and community sector through a wide variety of tools and channels. We will always consider that some key audiences have particular communication needs and we will continue to respect these when we engage and communicate with them. We will make best use of the Accessible Information Standard and strive to ensure we use the most appropriate methods and make sure that we use plain English and avoid jargon.
Page 11 of 15
To ensure we maximise all communications and engagement opportunities, it is vital that we consider the different needs of people, as well as the fact that many people may want to engage in different ways, suitable to them. We also appreciate that different groups of people may want to engage with us at different times. We will continue to offer flexibility around the times we engage, including day time, evening and weekends. We use a variety of methods to communicate and engage and these include: Our staff
CCG interactive staff intranet – Connect. Designed to provide the latest, up to date information for all colleagues at Doncaster CCG, including latest updates from all health and social care organisations in Doncaster and the SYB ICS. This includes but not limited to news items, blog posts, forums, dedicated pages for each service area and access to all policies.
All-staff email – a weekly roundup email for all staff, linking to key information, news items and future events.
Colleague Engagement Group – a group led by staff, for staff, supporting the spread of corporate messages and taking the lead on staff health and wellbeing to help sustain and improve health morale.
Monthly all-staff briefing – a dedicated engagement event for all staff, led by the Doncaster CCG Chief Officer, supported by corporate services such
Page 12 of 15
as Communications and Engagement, Corporate Governance, Human Resources and Organisational Development.
Events – a series of events take place across the year to bring all colleagues together, appreciate their work and significant contributions to the Doncaster CCG and the wider health and social care system.
Patients, public and external audiences
The CCG website is our main method of communication and provides a positive online presence for the organisation. The website includes details of the governing body, meetings, news, information, policies and consultations, along with a number of opportunities for people to engage with us. The website also provides information about health and care services across primary care and supports members of the public to learn more about health and find out how to get more involved in their own health and care.
We will continue to use social media extensively to engage with a wide number of groups in Doncaster. Over the past 12 months, we have seen our Twitter following grow by 1,500 followers which includes members of the public, but more so professionals, including GPs, nurses, policy and other officers. Our Facebook community continues to grow from strength to strength, seeing a 20% increase in the number of people that have liked the CCG Facebook page over the last 12 months. This has been driven by targeted engagement activities direct with patients and members of the public.
We will continue to work closely with the local media to promote our work and achievements of the CCG. We will continue to explore opportunities to hold media briefings and meetings to showcase the work taking place at Doncaster CCG, linked and aligned with corporate priorities, programmes and projects.
Throughout the year, we will continue to support local, regional and national health and well-being campaigns, designed to help inform, educate, change behaviour and promote health and well-being key messages. We will utilise all channels of communication to support these campaigns. Our campaign planning takes a very proactive approach, making best use of local data and information to target key groups and audiences.
‘The Bulletin’ GP Newsletter continues to be one of our main tools for communications and engagement with primary care staff, stakeholders and partners. Distributed on a monthly basis, it also includes patient and public information which is published on our website following distribution. In addition, a weekly operational update is issued to Practice Managers, providing local, regional and national information. This has helped reduce email traffic to Practice Managers and includes all key messages and information in one place.
Page 13 of 15
Engagement forums and meetings will continue to be arranged to support key projects, programmes and changes to service provision. Each communication and engagement plan produced to support organisation priorities and projects will always include a dedicated section on the importance of engagement, exploring different opportunities based upon this issue or opportunity.
Engagement groups and networks Our Health Ambassadors play a key role in helping to ensure the CCG has an inclusive approach to patient and public involvement. Ambassadors bring forward the views of marginalised groups. This information is shared at every EEC and fed back to relevant commissioning leads and managers so their comments, views and insight can be taken on board to help with future service planning. From 1 April 2015, it has been a contractual requirement for all GP Practices to form a Patient Participation Group (PPG) and to make reasonable efforts for this to be representative of the practice population. We continue to attend a number of PPGs to talk to patients about key priorities and programmes. More recently, we attended a number of PPGs to speak about the joint health and social care commissioning strategy, seeking their views and feedback on the future direction of travel. Over the next 12 months, we will focus on supporting and strengthening PPGs to ensure they are representative of practice patients, as well as looking at opportunities to ensure they can support the wider Primary Care Networks (PCNs). The CCG supports PPGs through the development of a PPG network, to share good practice and to develop links with these groups across Doncaster. Healthwatch Doncaster is currently supporting the PPG network as part of the CCG’s service specification with Healthwatch to support Doncaster CCG’s proactive engagement with Doncaster patients, carers and the public, especially those who generally are less well heard in commissioning activities, and include the nine protected characteristics.
Page 14 of 15
8. Our brand and identity
Our brand, mission and values underpin everything we do as a CCG. What we do, how we work and our approach always relates back to what we are here for – ensuring we commission high quality, health and care services for patients and members of the public in Doncaster. We will continue to use our brand and encourage our staff to live and breathe our values. It is vital that we all use the correct tools, templates, logos and style to ensure the work of Doncaster CCG is acknowledged. Our corporate identity continues to remain customer focussed, transparent, open and honest. More specifically, our values, linked to our brand and identity ensure we:
Ensure the needs of our patient are paramount
Drive forward continuous improvement
Develop relationships, based on integrity and trust.
Our staff also practice the word TRUST in all we do:
Teamwork – working together
Respect – ensuring we respect each other
Understand – everyone’s needs, opinions and beliefs
Share – information, ideas, network and engage with each other
Trust – we trust and support each other to do the best we can.
9. Priorities and development for 2019-21 Over the next few years, we will continue to review, expand and develop our communications and engagement platforms to ensure we effectively communicate and engage with our key audiences. Some aspects of this work will include:
Develop new social media platforms o LinkedIn – to engage further with our professional groups o Instagram – to engage more regularly and closer with children and
young people o Snapchat – explore the use of Snapchat following period of
engagement with children and young people
Develop a suite of e-bulletins for patients and members of the public, linked to the three life stages ‘Starting Well, Living Well and Ageing Well’ We will also start to use a new, interactive email platform which will help determine our reach, open rates, click through rates
o Starting Well – covering all aspects of health and care for children, young people and maternity
o Living Well – typically adults, aged 18 to 65 – covering all aspects of health and care
o Ageing Well – typically adults, aged 65 and over, linking health and social care services together in Doncaster
Page 15 of 15
Review, develop and expand the Doncaster CCG website, linking closer with partner organisations and the wider SYB ICS
Ensure our PPGs continue to thrive and flourish, ensuring the views of local people are heard. We will also diversify our approach, working with Healthwatch Doncaster to look at how we can link PPGs into the wider community, proactively supporting and taking part in PCNs.
10. Find out more If you would like to find out more about the work of the CCG or would like to get involved in any of our engagement programmes, please contact us: www.doncasterccg.nhs.uk 01302 566300 Email: [email protected] Write to us at: NHS Doncaster Clinical Commissioning Group Sovereign House Heaven’s Walk Doncaster DN4 5HZ
Follow us on Twitter: @doncasterccg Like us on Facebook: nhsdoncasterccg This document is available in other languages and alternative formats. To request this please contact the Communications and Engagement Team using the contact details above.
Dr David Crichton
– Local GP and
Clinical Chair, NHS
Doncaster CCG
Jackie Pederson
– Chief Officer,
NHS Doncaster
CCG
Sarah Whittle –
Lay Member,
Patient and Public
Involvement, NHS
Doncaster CCG
Paul Hemingway –
Head of
Communications
and Engagement,
NHS Doncaster
CCG
Page 1 of 2
Meeting name Governing Body Meeting date 5 December 2019
Title of paper
Audit Committee Terms of Reference
Executive /
Clinical Lead(s) Paul Wilkin, Chair of the Audit Committee
Author(s) Helen Harris, Head of Corporate Governance Corporate Services Team
Status of the Report To approve To consider / discuss To note
Purpose of Paper - Executive Summary 1. Introduction The Audit Committee reviewed their terms of reference in line with good governance on 14 November 2019. Refer to Appendix 1 for the Terms of Reference. Amendments are highlighted in blue text. Deletions are in red text. 2. Terms of Reference –Amendments The following aspects were discussed and agreed for inclusion to the revised terms of reference: a) Section 5.1 Members: Lay Member – Audit and Governance has been amended
to: Lay Member – Audit, Governance and conflict of interest matters, b) Section 5.1: Locality Lead x 1 (was 2), c) Section 5.1: reworded to: The Chair of the Governing Body, d) Section 5.2: amended to: normally required to attend four out of five, e) Section 5.3: Chief Finance Officer, amended to include: or nominated Deputy, f) Section 7.2: Quorum – now includes a section on meetings by telephone or by the
use of video conferencing. g) Section 8.3: Decisions reached by a process of consensus decision making has
been amended to: In line with the CCG’s Standing Orders, it is expected that decisions will be reached by consensus. Should this not be possible, then a vote of members will be required, the process for which is set out below: • Majority necessary to confirm a decision – simple majority • Casting vote – Chair • Dissenting views – dissenting views must be recorded in the minutes.
3. Conclusion and Recommendation The Audit Committee considered and discussed the proposed amendments, and recommend the terms of reference to the Governing Body for approval.
X
Page 2 of 2
Recommendation(s) The Governing Body is asked to approve the Audit Committee Terms of Reference.
Report Exempt from Public Disclosure Is the report Exempt from Public Disclosure? Yes No
Impact analysis
Quality impact Nil
Equality impact Nil
Sustainability impact Nil
Financial implications Nil
Legal implications Nil
Management of Conflicts of Interest N/A
Consultation / Engagement (internal departments, clinical,
stakeholder & public/patient)
N/A
Report previously presented at Audit Committee
Risk analysis
Oversight of the Risk Management process and scrutiny of the Assurance Framework
Assurance Framework CO1 – 1.1
X
Page 1 of 10
Terms of Reference Audit Committee
1. Introduction 1.1. The Audit Committee (the Committee) is established in accordance with NHS
Doncaster Clinical Commissioning Group’s (CCG) Constitution, Standing Orders, Scheme of Delegation and Prime Financial Policies.
1.2. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution.
1.3. The Committee is responsible for providing assurance to the Governing Body on the processes operating within the organisation for risk, control and governance. It assesses the adequacy of assurances that are available with respect to financial, corporate, clinical and information governance.
1.4. The Committee is able to direct further scrutiny, both internally and externally where appropriate, for those functions or areas where it believes insufficient assurance is being provided to the CCG Board.
2. Accountability
2.1. The Committee is directly accountable to the CCG Constitution for overseeing and providing assurance on the matters detailed under Section 11 (Remit).
3. Authority
3.1. The Committee is authorised by the CCGC to investigate any activity within its
Terms of Reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee.
3.2. Subject to such directions as may be given by the Governing Body, it may establish subcommittees as appropriate and determine the membership and terms of reference of such. The Standing Orders and Prime Financial Policies of the CCG, as far as they are applicable, shall apply to the Committee and its sub-committees.
3.3. The Committee is authorised by the CCG Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.
4. Role of the Committee The Governing Body has delegated the following functions to the Audit Committee.
Page 2 of 10
4.1. Integrated Governance, Risk Management and Internal Control
The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control (both clinical and non-clinical), across the whole of the CCG’s activities that support the achievement of the CCG’s objectives. The Committee’s work will dovetail with that of the Quality & Patient Safety Committee which the CCG has established to seek assurance that robust clinical quality is in place.
In particular, the Committee will review the adequacy and effectiveness of: • All risk and control related disclosure statements (in particular the Annual
Governance Statement (or its equivalent)), together with any appropriate independent assurances, prior to endorsement by the Governing Body of the CCG.
• The underlying assurance processes that indicate the degree of achievement of CCG objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.
• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.
• The policies and procedures for all work related to fraud, bribery and corruption to ensure compliance with NHS Counter Fraud Authority (NHSCFA) formerly NHS Protect’s Standards for Commissioners: fraud, bribery and corruption.
• The Assurance Framework and Corporate Risk Register on a periodic basis as decided by the Committee.
In carrying out this work the Committee will primarily utilise the work of Internal Audit, External Audit, the Local Counter Fraud Specialist, NHSCFA and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from Senior Managers as appropriate, concentrating on the overarching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. This will be evidenced through the Committee’s use of an effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it.
4.2. Internal Audit
The Committee shall ensure that there is an effective Internal Audit function that meets the Public Sector Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Accountable Officer and Governing Body of the CCG. This will be achieved by:
Page 3 of 10
• Consideration of the provision of the Internal Audit service, the cost of the audit and any questions of resignation and dismissal.
• Review and approval of the Internal Audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the Assurance Framework.
• Considering the major findings of Internal Audit work (and management’s response) and ensuring co-ordination between the Internal and External Auditors to optimise audit resources.
• Ensuring that the Internal Audit function is adequately resourced and has appropriate standing within the CCG.
• An annual review of the effectiveness of Internal Audit. 4.3. External Audit
The Committee shall review the work and findings of the External Auditors and consider the implications and management’s responses to their work. This will be achieved by: • Consideration of the performance of the External Auditors.
• Discussion and agreement with the External Auditors, before the audit
commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other External Auditors in the local health economy.
• Discussion with the External Auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee.
• Review of all External Audit reports, including the report to those charged with governance, agreement of the Annual Audit Letter before submission to the Governing Body of the CCG and any work undertaken outside the Annual Audit plan, together with the appropriateness of management responses.
4.4. Other Assurance Functions
The Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications for the governance of the CCG. These will include, but will not be limited to, any reviews by Department of Health, arms’ length bodies or regulators/inspectors (for example, the Care Quality Commission (CQC) and NHS Litigation Authority (LA) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).
Page 4 of 10
In addition, the Committee will review the work of other Committees within the organisation whose work can provide relevant assurance to the Audit Committee’s own scope of work. In reviewing the work of the Quality and Safety Committee, the Committee will wish to satisfy itself on issues around clinical risk management and the assurance gained from clinical audit.
Where a Member who has raised an issue with the Governing Body under the Local Dispute Resolution process is not satisfied by the response, the matter will be delegated to the Committee to advise on the appropriateness of the process followed and the Committee will provide a report back to the Governing Body within one month.
The Committee shall review and approve corporate policies and procedures relevant to the functions of the Committee.
The Committee shall establish and be advised on operational corporate governance issues (including Information Governance and Health & Safety, Fire and Security) by an Information Governance Group.
4.5. Counter Fraud, Bribery and Corruption
The Committee shall provide assurance and advice to the Governing Body on the proper stewardship of resources and assets, including value for money, financial reporting, the effectiveness of audit arrangements (internal and external), compliance with NHSCFA for Commissioners: fraud, bribery and corruption, risk management, and on control and integrated governance arrangements within the CCG.
The Committee shall satisfy itself that the organisation has adequate arrangements in place for countering fraud, bribery and corruption and shall review the outcomes of counter fraud, bribery and corruption work. The Committee will seek assurance regarding the organisation’s compliance with NHSCFA for Commissioners: fraud, bribery and corruption by means including reports from the Counter Fraud Specialist, the CCG’s annual self-assessment (Self Review Tool) submissions to NHSCFA and from NHSCFA inspection reports.
4.6. Oversight of Management Reporting
The Committee shall request and review reports and positive assurances from Senior Managers on the overall arrangements for governance, risk management and internal control.
The Committee may also request specific reports from individual functions within the CCG as they may be appropriate to the overall arrangements.
Page 5 of 10
4.7. Financial Reporting
The Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance.
The Committee shall ensure that the systems for financial reporting to the CCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the CCG.
The Committee shall review schedules of debtor and creditor balances over six months old and over £5,000 and consider explanations and action plans.
The Committee shall review the annual report and financial statements before submission to the Governing Body of the CCG, focusing particularly on: • The wording in the Annual Governance Statement (or its equivalent) and
other disclosures relevant to the terms of reference of the Committee;
• Changes in, and compliance with, accounting policies, practices and estimation techniques;
• Unadjusted mis-statements in the financial statements;
• Significant judgements in preparing of the financial statements;
• Significant adjustments resulting from the audit;
• Letter of Representation; and
• Qualitative aspects of financial reporting. 4.8. Conflict of Interest and Whistleblowing
The Committee shall have oversight and challenge of the management of conflict of interest and whistleblowing procedures by: • Reviewing the Standards of Business Conduct and Conflict of Interest
Policy and Procedures.
• Reviewing the Whistleblowing procedures and the management of confidential whistleblowing in the CCG.
• Supporting the Conflict of Interest Guardian in carrying out their role. 4.9. Risk
The Committee shall:
Page 6 of 10
• Ensure effective risk management systems are in place including, but not limited to, the Board Assurance Framework (BAF); complaints; claims; incidents (including Serious Untoward Incidents (SUIs)); statutory and mandatory training; staff experience; risk assessments and registers, and inspections accreditations;
• Provide a process for scrutiny of high risks identified on the Board Assurance
Framework (BAF) and Risk Register; • Develop and monitor governance policies; • Oversee and monitor the development of Research Governance structures,
systems and processes; • Monitor health, safety and security systems and processes required in order
to deliver sound health, safety and security; • Oversee and monitor the development of information governance structures,
systems and processes required in order to deliver sound information governance;
• Monitor the use of the CCG seal; • Ensure a sound governance process is in place to monitor standards in
relation to independent contractors and providers of healthcare, and • Ensure effective safeguarding systems are in place.
5. Membership 5.1. Members
The Committee shall be appointed by the NHS CCG from amongst those members of the Governing Body who are, or are deemed to be, independent. The Chair of the Governing Body Group shall not be a member of the Committee. The members of the Committee shall comprise:
• Lay Member – Audit, & Governance and conflict of interest matters (Chair) • Lay Member – Patient & Public Involvement • Locality Lead x 12 • Governing Body Secondary Care Doctor Member (Vice-Chair)
5.2. Members are normally required to attend four out of five of scheduled
meetings. Attendance will be monitored throughout the year and any concerns raised with the Chair and relevant Member.
5.3. Attendees
Other individuals may be invited to attend for all or part of any meeting as appropriate. The Committee shall include the following formal attendees:
Page 7 of 10
• Chief Finance Officer (or nominated Deputy) • External Audit representative • Internal Audit representative • Local Counter Fraud representative • Associate Director of HR and Corporate Services • Head of Corporate Governance
5.4. At least once a year the Committee shall meet privately with the External and Internal Auditors.
5.5. Regardless of attendance, external audit, internal audit, local counter fraud and security management providers will have full and unrestricted rights of access to the Audit Committee.
5.6. The Accountable Officer (Chief Officer) has an open invitation to attend meetings, but at least once a year the Accountable Officer will be invited to attend and discuss with the Committee the process for assurance that supports the Annual Governance Statement (or its equivalent) and when the Committee considers the draft Internal Audit Plan and the Annual Accounts.
5.7. Any other Senior Manager may be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that Senior Manager.
5.8. The Chair of the Governing Body will also be invited to attend one meeting each year in order to form a view on, and understanding of, the Committee’s operations.
6. Appointment of Chair
The Lay Member – Audit and Governance shall be the Chair of the Audit Committee. The Vice Chair is appointed by members of the Audit Committee. 7. Meetings and Conduct of Business 7.1. Secretary
The Board Secretary shall provide appropriate advice to the Chair and Committee members and shall make arrangements for the Committee to have an administrator who will arrange meetings, collate and distribute papers, take minutes and keep a record of issues to be carried forward. The Board Secretary will be responsible for supporting the Chair in the management of the Committee’s business and for drawing the Committee’s attention to best practice, national guidance and other relevant documents, as appropriate.
7.2. Quorum
A quorum shall be two members. One member must be a Lay Member.
Page 8 of 10
If a quorum has not been reached, then the meeting may proceed if those attending agree but any record of the meeting should be clearly indicated as notes rather than formal Minutes, and no decisions may be taken by the non-quorate meeting of the Committee. Members of the Committee may participate in meetings by telephone or by the use of video conferencing facilities where they are available. Participation by any of these means shall be deemed to constitute presence in person at the meeting.
7.3. Frequency The Committee will aim to meet at least five times a year at times which are consistent with the audit and reporting cycle and which enable it to efficiently discharge its duties. Extraordinary meetings may be called at the discretion of the Chair. The External Auditors, Head of Internal Audit or Counter Fraud Specialist may request a meeting if they consider that one is necessary.
7.4. Notice of Meetings Items of business for inclusion on the agenda of a meeting shall be notified to the Chair of the meeting at least 10 working days before the meeting takes place. Supporting papers for such items shall be submitted at least six working days before the meeting takes place. The agenda and supporting papers shall be circulated to all Committee members and attendees at least three working days before the date the meeting will take place.
7.5. An Annual Schedule of Meetings shall be agreed at, or before, the last meeting each year in order to circulate the schedule for the following year.
8. Decisions 8.1. The Committee will apply best practice in its decision making processes and
effectively declare and manage all conflicts of interest
8.2. The Committee will make decisions within the bounds of its remit.
8.3. Decisions will aim to be reached by a process of consensus decision-making. In line with the CCG’s Standing Orders, it is expected that decisions will be reached by consensus. Should this not be possible, then a vote of members will be required, the process for which is set out below: • Majority necessary to confirm a decision – simple majority • Casting vote – Chair • Dissenting views – dissenting views must be recorded in the minutes.
8.4. The Committee has full authority to commission any reports it deems necessary to help it fulfil its obligations.
Page 9 of 10
8.5. The Committee may establish Sub-Groups to assist it in discharging responsibilities of the Committee as set out in its Terms of Reference.
8.6. Urgent matters arising between meetings The Chair and Deputy Chair of the Audit Committee in consultation with the Chief Officer or Chief Finance Officer, may also act on urgent matters arising between meetings of the Committee. Any actions taken outside the meeting, will be minuted at the next available meeting of the Committee.
9 Confidentiality and Conflicts of Interest / Standards of Business
Conduct 9.1 All Members are expected to adhere to the CCG Constitution and Standards
of Business Conduct and Conflicts of Interest Policy. 9.2 In circumstances where a potential conflict is identified the Chair of the
Committee will determine the appropriate steps to take in accordance with the CCG’s Conflicts of Interest decision-making matrix. This action may include, but is not restricted to, withdrawal from the meeting for the conflicted item or remaining in the meeting but not voting on the conflicted item.
9.3 All Members shall respect confidentiality requirements as set out in the CCG
Constitution. 9.4 The Committee will conduct its business in accordance with any national
guidance and relevant codes of conduct / good governance practice including the Nolan Principles1.
9. Reporting Arrangements 9.1. The minutes of the Committee meetings shall be formally recorded and
submitted to the Governing Body. The Chair shall also provide a brief written report following each formal Committee meeting drawing to the attention of the Governing Body significant issues of concern that require disclosure and/or senior management action. The report will also contain examples of good practice or positive assurance which are evidenced by the Committee.
9.2. The Committee will report to the Governing Body annually on its work in support of the Annual Governance Statement (or its equivalent), specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and “embeddedness” of risk management in the organisation and the integration of governance arrangements.
9.3. The Committee will annually review and assess its effectiveness and report its
findings to the Governing Body. It will do this by:
• Reviewing its terms of reference; • Reviewing the attendance rate of Committee members;
1 Available at http://www.public-standards.gov.uk/
Page 10 of 10
• Reviewing its work plan; • Reviewing its performance. Any resulting changes to the terms of reference or membership shall be submitted to the Governing Body for approval.
10. Disclosure/Freedom of Information Act (FOI)
The senior officer with responsibility for corporate governance will be responsible for ensuring that FOI requirements in relation to the Committee’s minutes and reports are met. The chair of the committee will seek the advice of the senior officer with responsibility for corporate governance in relation to any matters where an exemption as defined within the Freedom of Information Act 2000 is believed to apply. 11. Links and Interdependencies
The Committee is the primary committee for all strategic risk, control and governance matters of the organisation. It will seek suitable information and assurance from independent sources, such as internal / external audit, as well as from internal sources, such as executive officers / senior managers and other committees of the board, in particular:
• Quality and Patient Safety Committee. • Executive Committee, • Engagement and Experience Committee, and • Remuneration Committee.
12. Review of the Terms of Reference The Terms of Reference will be reviewed not less than annually and submitted to the governing body for approval as necessary. Last reviewed: November 2018 November 2019
Meeting name Governing Body
Meeting date 5th December 2019
Title of paper
Quality & Performance Report
Executive / Clinical Lead(s)
Mr Andrew Russell, Chief Nurse Mr Anthony Fitzgerald, Director of Strategy & Delivery
Author(s) Performance and Intelligence Team Quality Team
Status of the Report
To approve To consider / discuss To note
Purpose of Paper - Executive Summary
This report sets out the key quality and performance issues to be noted by the NHS
Doncaster Clinical Commissioning Group (DCCG) Governing Body which due to reporting restrictions or information potentially identifiable to a patient level have not been included within the main report. This report reflects 2019/20 performance and delivery areas. An update on performance against the Better Care Fund is included in this report at Page 40, with a Starting Well life stage report at Page 48.
Please note all data is validated and quality checked internally within DCCG and with Providers as necessary. Where there is a data quality concern on any of the data or metrics presented in the following report, this will be stated in the narrative accompanying the data. Measures which also form part of the NHS Oversight Framework have been identified as (OF) within this report. The key areas of change, both positive and negative, to note since the last report are: NHS Doncaster Clinical Commissioning Group (DCCG)
Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance improved to 87.6% during October, but remaining below the 92% target (Page 4)
52 week waits – There were no Doncaster patients waiting over 52 weeks for treatment in October (Page 9)
Patients waiting less than 6 weeks for a diagnostic test – Performance in October met the target at 99.2% against 99% (Page 9)
Cancer 31 day waits – Performance during Quarter 2 met the 96% target at 96.1% (Page 13)
Cancer 62 day waits – Performance during Quarter 2 met the 85% target at 85.0% (Page 15). This is the first time the quarterly target has been met since Quarter 4 2017/18.
x
1
Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service in 6 weeks and 18 weeks both met the national targets of 75% and 95% at 93% and 99% respectively (Page 21).
Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT)
Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance improved to 87.1% during October, below the 92% target but in line with the trajectory (Page 4)
52 week waits – There was 1 Bassetlaw CCG patient at the Trust waiting over 52 weeks for treatment in October 2019 (Page 9)
Accident and Emergency – Performance improved in October 2019 to 90.3%, remaining below the target of 95% (Page 11)
Cancer 31 day waits – Performance during August 2019 met the 96% target at 100% (Page 13)
Cancer 62 day waits – Performance during August 2019 met the 85% target at 87.0% (Page 15)
Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)
Care Programme Approach – The proportion of people followed up within 7 days of discharge continues to be 100% (Page 21).
Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service was slightly below the 8.08% target at 7.52% (Page 28)
Incomplete Attention Deficit Hyperactivity Disorder waits for diagnosis (children) – August 2019 performance was 23.9% against the target of 92% (Page 29)
Other Commissioned Services
Yorkshire Ambulance Service – the mean response time for Category 1 calls, both Category 2 measures and the 90th centile for Category 3 calls failed to achieve target during October 2019 (Page 19)
Life Stage Strategic Delivery Plan
Starting Well - Of the 51 actions within this life stage 13 have been completed with 12 overdue (Page 48)
Recommendation(s)
The Governing Body is asked to: Note the Quality and Performance Report
Report Exempt from Public Disclosure
If yes, detail grounds for exemption: Yes No
Impact analysis
x
2
Quality impact Positive quality impact from a consistent focus on quality outcomes.
Specific quality impact as identified in the report.
Equality impact
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x
An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.
An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability impact
Nil
Financial implications
As identified in the report.
Legal implications
Nil
Management of Conflicts of
Interest
The report is for information – no conflicts of interest identified. It should be noted that some Governing Body members may be
employed in secondary employment by organisations referenced in this report: please see Register of Interests for details.
Consultation / Engagement
(internal departments,
clinical, stakeholder and public/patient)
N/A
Report previously
presented at N/A
Risk analysis
Risks are captured in the Executive Summary.
Assurance Framework
2.1, 2.2, 2.3, 2.4, 3.1
3
Section 1: National Frameworks and Measures 1.1: NHS Constitution Measures
1.1.1 Referral To Treatment (RTT) Performance (Oversight Framework Measure - OF)
Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks
Commissioner Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-
19 Jun-19 Jul-19
Aug-19
Sept-19
Oct-19
Doncaster CCG 88.5% 87.6% 86.6% 87.5% 87.7% 89.3% 88.2% 87.2% 86.8% 87.1% 86.5% 87.0% 87.6%
Rightcare Peer Group 88.5% 88.5% 88.0% 88.2% 88.2% 88.0% 88.3% 88.8% 88.6% 88.5% 88.0% 87.8%
Doncaster and Bassetlaw Teaching
Hospitals Foundation Trust (DBTHFT)
88.5% 87.9% 86.6% 87.4% 87.5% 88.8% 87.7% 87.0% 86.6% 86.7% 85.7% 86.4% 87.1%
England 87.1% 87.2% 86.4% 84.3% 86.9% 86.9% 86.4% 86.7% 86.2% 85.7% 84.9% 84.7%
Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%
Recovery Trajectory 86.1% 86.2% 87.1%
4
Performance for Doncaster Clinical Commissioning Group (DCCG) patients at all Trusts remains below target at 87.6% in October 2019.
Performance during the month is within control limits suggesting this performance is what would be expected for the service.
The chart above shows that RTT performance has deteriorated over the last 2 years with 2 clear stages of continual deterioration.
Performance did however improve each month from December 18 to March 2019 given the focus from Doncaster and Bassetlaw
Teaching Hospitals NHS Foundation Trust (DBTHFT) and the financial incentive offered. The DBTHFT waiting list is validated down to 12
weeks which may have a negative impact on reported performance. Twelve specialties are failing to meet the 92% standard for DCCG:
Cardiology (88.2%)
Ear, Nose and Throat (ENT) (83.5%)
General Medicine (77.8%)
General Surgery (88.0%)
Geriatric Medicine (89.3%)
Neurology (91.2%)
Neurosurgery (88.5%)
5
Ophthalmology (87.3%)
Rheumatology (78.1%)
Thoracic Medicine (89.5%)
Trauma and Orthopaedics (T&O) (85.8%)
Urology (84.3%)
The waiting list shape for Doncaster CCG patients at any provider is shown below, highlighting the majority of patients waiting under 18
weeks, and the patients waiting longer, up to 52 weeks. The CCG on a weekly basis continues to monitor our waiting list and is in regular
contact with both DBTHFT and North Lincolnshire and Goole Foundation Trust for most up to date positions on patients waiting over 38
weeks in order to try to reduce long waiters, including those who may breach 52 weeks.
Seventeen specialities failed to meet the standard at DBTHFT in September:
Cardiology (87.6%)
Community Paediatrics (91.2%)
6
Diabetic Medicine (87.8%)
ENT (83.9%)
General Medicine (79.0%)
General Surgery (88.1%)
Geriatric Medicine (89.4%)
Medical Ophthalmology (90.1%)
Ophthalmology (85.8%)
Oral Surgery (90.5%)
Paediatric Cadiology (89.6%)
Podiatric Surgery (64.7%)
Respiratory Medicine (89.6%)
Rheumatology (81.2%)
T&O (84.3%)
Upper Gastrointestinal Surgery (78.3%)
Urology (83.9%)
The Trust has implemented a recovery plan (now reflected in the table above) to get back to the national 92% standard by the end of the financial year. In October the performance was 87.1% against a recovery plan trajectory of 87.1%. This is an improvement on September 2019. The main drivers of the position were:
Commencement of additional activity as per the additional activity RTT action plan
Increase in outsourcing in Ophthalmology and Trauma and Orthopaedics
Increase in service level validation – more timely management of patient pathways
Reduction of typing backlog in some areas Key areas of focus for November include:
Intensive support to Trauma & Orthopaedics, Ophthalmology, ENT, General Medicine & Cardiology to ensure robust plans are put in place to close the gap between current position & trajectory
Mitigate emergent risks in Cardiology and Ophthalmology caused by consultant staffing gaps – review of further opportunities to outsource work
7
Administrative action plan in progress to ensure trained A&C teams support all Divisions and validation is returned to trained Divisional team members (plan underway, to be completed by 31st Dec 2019). This is part of the Trust’s full administrative and elective improvement plan
Delivery of the Urodynamics diagnostic pathway recovery plan (planned for November and December)
Strengthened weekly activity monitoring arrangements at specialty and Trust wide level 1.1.2 Waiting List Size (OF)
Following the achievement of the waiting list size expectation in March 19, the expectation remains to hold the waiting list size to the same
level or less by March 2020. The number of DCCG patients on incomplete RTT pathways has increased in October 2019 by 84 patients to
23,892 and remains above the target. The Trust is aiming to maintain validation of patients at 12 weeks on the PTL going forwards.
8
1.1.3 52 Week Breaches (OF)
52 Week Waits –Incomplete Pathways
Provider Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sept-19 Oct-19
Doncaster CCG 1 0 2 2 3 0 0 1 1 0 0 1 0
DBTHFT 3 2 4 4 3 0 0 1 0 0 0 3 1
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
There were no people who waited over 52 weeks for treatment in October 2019 for DCCG. There was 1 patient who waited over 52 for treatment during the month at the Trust for Bassetlaw CCG. A full breach report has been completed. The patient was not visible on the PTL and was identified via validation due to incorrect clock stop being administered. RTT training will help prevent further similar breaches, however the Trust does acknowledge a continued risk of breaches being identified until the training has been fully rolled out and new practices implemented. This is part of the wider “Improving Processes” Action Plan referred to above. 1.1.4 Diagnostics (OF)
Patients waiting less than 6 weeks for a diagnostic test
Commissioner Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-
19 Jun-19 Jul-19
Aug-
19
Sept-
19 Oct-19
Doncaster CCG 99.5% 99.5% 99.2% 98.9% 98.9% 98.8% 93.7% 97.5% 98.7% 99.3% 98.6% 99.3% 99.2%
Rightcare Peer Group 95.5% 97.9% 97.6% 98.1% 98.8% 98.0% 96.6% 96.7% 97.3% 97.0% 96.0% 95.8%
DBTHFT 99.5% 99.3% 99.3% 99.0% 99.0% 98.8% 93.8% 97.4% 98.7% 99.1% 98.7% 99.3% 99.3%
England 97.7% 97.6% 96.7% 96.4% 97.7% 97.5% 96.6% 96.2% 96.5% 96.8% 96.0% 96.5%
Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%
9
10
Performance for DCCG during October 2019 deteriorated slightly to 99.2% of patients waiting less than 6 weeks for a test (48 breaches), but still met the 99% target. Performance is above the statistical process control limits on the chart above which indicates performance is above normal variation expected for the service. Performance for November and December is not expected to achieve the 99% standard due to an issue discovered in Urodynamics in month and has been raised to the CCG by the Trust. An action plan is in place and performance is expected to recover by January 2020. 1.1.5 A&E attendance to admission, transfer or discharge (OF)
A&E attendances under 4 hours from arrival to admission, transfer or discharge
Provider Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-
19 Jun-19 Jul-19
Aug-
19
Sept-
19 Oct-19
DBTHFT (all
attendances, based on
daily reported figures)
92.2% 92.9% 91.3% 90.3% 91.0% 93.1% 90.6% 92.4% 91.4% 90.4% 88.1% 88.7% 90.3%
DBTHFT (Type 1
attendances) 90.5% 91.4% 89.5% 88.2% 89.0% 91.7% 87.7% 90.2% 88.4% 87.7% 84.2% 83.8% 87.8%
England (all
attendances) 89.1% 87.6% 86.4% 84.4% 84.2% 86.6% 85.1% 86.6% 86.4% 86.5% 96.3% 85.4% 83.6%
Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
Sustainability Fund
trajectory 92.4% 94.6% 94.8% 92.2% 92.6% 93.8% 92.3%
11
Performance improved in October to 90.3% of patients being seen and discharged within 4 hours (1485 breaches), below the 95% national constitution target, and also the 92.3% Sustainability Fund trajectory. October’s performance also falls below the Statistical Process control limits suggesting that this performance is outside of normal parameters for the service. Historically this service does show quite unstable performance though performance has now been below the expected variance of the system for 5 consecutive months. A recovery plan the Trust has developed remains in place to support the department to get back on track with performance and as stated above has shown improvement to the pathway. The key issues identified are considerable growth in attendance (6-8% year on year) and gaps in medical staffing at middle grade level and reliance on locums. Updates from the full Emergency Department (ED) action plan during October include:
The appointment of a new substantive Clinical Director for EDs starting 4th November 2019
Organisational development - awaiting report to discuss next steps of leadership developments
Audit on CDU usage, medium term solutions identified which may support reduction of breaches
Qi stakeholder event completed at Bassetlaw during October 19, focussing on patient flow – pilots agreed include navigation nurse,
Early Senior Assessment, fit to sit & diagnostic tracker
12
Additional ED Staffing – Band 6’s and Advanced Nurse Practitioners now advertised
Development of Mexborough Urgent Treatment Centre in partnership with FCMS - go live planned for 2nd December 2019
1.1.6 Cancer Measures DBTHFT have been accepted to take part in the testing phase of the Clinically-led Review of Standards (CRS) for cancer as 1 of 13 sites nationally. As part of this testing there will be a change in reporting, with 2 week wait and 2 week wait for breast symptomatic reporting no longer provided through this report as part of the requirements of the field test nationally. An additional Faster Diagnosis Standard will be trialed during this period and is defined as a ‘Maximum four weeks (28 days) from receipt of urgent General Practice (General Medical Practitioner, General Dental Practitioner or Optometrist) referral for suspected cancer, breast symptomatic referral or urgent screening referral, to the point at which patient is told they have cancer, or cancer is definitely excluded’. The new Faster Diagnosis Standard has an initial test threshold set by NHS England of 80% which will be monitored internally by the Trust and CCG with NHS England and NHS Improvement until the end of the field testing.
31-day wait from diagnosis to first definitive treatment for all cancers
Commissioner Q3
18/19 Jan-19 Feb-19 Mar-19
Q4
18/19 Apr-19
May-
19 Jun-19
Q1
19/20 Jul-19
Aug-
19 Sep-19
Q2
19/20
Doncaster CCG 96.4% 95.3% 95.7% 95.3% 95.5% 99.3% 97.7% 97.3% 98.1% 96.5% 96.4% 95.9% 96.1%
Rightcare Peer Group 97.1% 96.5% 96.4% 97.3% 96.4% 96.8% 97.6% 95.4% 96.0% 96.2% 96.6% 96.2% 96.3%
Cancer Alliance 95.6% 93.0% 96.4% 97.9% 95.0% 95.4% 94.9% 94.9% 95.0% 97.3% 96.8% 97.2% 97.1%
DBTHFT 99.3% 98.8% 98.6% 98.7% 98.7% 100% 100% 99.4% 99.8% 97.9% 100% 100% 98.8%
England 96.8% 95.4% 96.7% 97.5% 96.2% 96.3% 96.0% 96.0% 96.1% 96.5% 96.1% 95.5% 96.0%
Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%
13
The proportion of patients that were treated within 31 days met target of 96% at 96.1% for Quarter 2 2019. The longest wait during the
quarter was 78 days in July in the Urological tumour group and breached due elective capacity being inadequate.
31 day wait for subsequent treatment
Commissioner Q3
18/19 Jan-19 Feb-19 Mar-19
Q4
18/19 Apr-19
May-
19 Jun-19
Q1
19/20 Jul-19
Aug-
19 Sep-19
Q2
19/20
Surgery - Doncaster
CCG 90.3% 92.3% 100% 81.8% 90.5% 95.8% 94.4% 84.6% 91.2% 100% 95.2% 94.7% 97.0%
Radiotherapy -
Doncaster CCG 92.9% 96.3% 96.4% 100% 97.2% 97.7% 96.0% 94.4% 95.9% 95.7% 92.0% 90.5% 92.8%
Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%
Drug Regimen -
Doncaster CCG 100% 100% 100% 97.1% 99.1% 100% 97.9% 100% 99.1% 100% 100% 100% 100%
Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%
14
The proportion of people receiving Surgery within 31 days was met during Quarter 2 at 97.0% against the 94% target. The proportion of people receiving radiotherapy fell below the 94% target at 92.8% (4 people waited longer than 31 days) during the Quarter which is a reduction from Quarter 1. The longest wait for subsequent treatment was 45 days for a Urological treatment which was delayed due to inadequate elective capacity.
62-day wait from urgent GP referral to first definitive treatment for cancer (OF)
Commissioner Q3
18/19 Jan-19 Feb-19 Mar-19
Q4
18/19 Apr-19
May-
19 Jun-19
Q1
19/20 Jul-19
Aug-
19 Sep-19
Q2
19/20
Doncaster CCG 83.7% 80.0% 86.1% 86.4% 84.5% 87.5% 80.3% 79.0% 81.9% 83.6% 83.3% 88.7% 85.0%
Rightcare Peer Group 79.2% 82.2% 97.8% 87.0% 79.1% 84.1% 80.1% 78.1% 78.3% 78.4% 78.1% 76.6% 77.7%
Cancer Alliance 84.0% 71.8% 81.4% 86.4% 77.7% 81.9% 77.3% 79.1% 79.4% 79.7% 79.1% 80.3% 79.7%
DBTHFT 84.9% 85.4% 90.0% 83.9% 86.6% 89.9% 82.3% 87.9% 83.4% 81.4% 87.0% 95.0% 87.3%
Sheffield Teaching
Hospitals Foundation
Trust (STHFT)
70.7% 60.1% 75.2% 76.5% 69.9% 74.4% 75.1% 71.8% 74.1% 78.0% 74.0% 68.0% 73.4%
England 79.5% 76.2% 76.1% 84.5% 77.4% 79.4% 77.5% 76.7% 77.9% 77.6% 78.5% 76.9% 77.7%
Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%
15
DCCG achieved 62 Day compliance for Quarter 2 of 2019/20 with performance of 85.0% against the 85% target.
The proportion of patients in September that had treatment completed in 62 Days was 88.7%, above the national target. There were a
total of 6 breaches.
Work continues to take place to improve compliance with all cancer standards within DBTHFT – an action plan was presented at Cancer Programme Board in November 2019 which will focus on:
Forward planning for treatment at Multi-Disciplinary Team (MDT) meetings based on Imaging findings
Ensuring MDT Coordinators complete Inter-Provider Transfer (IPT) data fields on NHS Digital system to improve data recording around this point.
Improving diagnostic tracking process at first clinic attendance & the prioritization of typing
Breast – increasing numbers having Chemotherapy as first line treatment based on HER2 histology testing
Head and Neck – forward planning of pathway for inpatient tests date based on histology only results to allow for improved planning for MDT decision making.
Lower Gastrointestinal (GI) – Improve timeframe to enabling treatment (stoma formation) reducing to day 20 and then planning appointment to fall within Day 38 timeframe.
16
Lung – forward planning of pathway for IPT date based on imaging only results to allow improved planning for Oncology appointments
Upper GI - forward planning of pathway for IPT date based on patients travel to STH for Oncology appointments
Urology - forward planning on Medical Imaging investigations (Bone Scans) for patients who do not meet the One Stop Prostate pathway
62-day wait from referral from an NHS screening service or Consultant Upgrade to first definitive treatment for all cancers
Commissioner Q3
18/19 Jan-19 Feb-19 Mar-19
Q4
18/19
Apr-
19
May-
19
Jun-
19
Q1
19/20 Jul-19
Aug-
19 Sep-19
Q2
19/20
Doncaster CCG –
screening service 86.2% 100% 100% 100% 100% 100% 100% 77.8% 91.7% 85.7% 75.0% 78.6% 80.0%
Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
Doncaster CCG –
consultant upgrade 82.7% 83.3% 77.8% 85.0% 82.0% 56.3% 90.9% 76.9% 72.5% 75.0% 73.3% 40.0% 67.4%
The proportion of patients that had a completed 62 Day screening pathway within the required timeframe for September was 78.6% in relation to the 90% target. All 3 breaches were in the Lower GI tumour group and were due to an “other” reason. The longest pathway length in September was 67 days. In quarter 2 of 2019/20, performance was 80%, also below the required 90% target. The proportion of patients that had a completed 62 day upgrade pathway within the required timeframe was 40% for September. There were a total of 6 breaches. The breaches were in the Lung (4), Sarcoma (1) and Skin (1) tumour groups due to Out-patient capacity being inadequate (2), Healthcare Provider initiated delay to diagnostics (2), administrative delay (1) and complex diagnostic pathway (1). The longest time take for a completed pathway in September was 148 days in the lung tumour group due to a complex diagnostic pathway (many, or complex, diagnostic tests required). This particular patient was initially seen/investigated and treated outside our region. In quarter 2, performance was 67.4%.
17
1.1.7 Cancelled Operations – those not rearranged within 28 days Provider
Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19
DBTHFT 0 1 1 1 1 1 3 1 1 0 1 1 1
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
Provider Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19
DBTHFT 1 1 1 1 3 1 1 0 1 1 1 2 1
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
There was 1 patient who wasn’t re-booked within 28 days of cancellation during September 2019 within the Medical Ophthalmology
service. The reason for the cancellation was due to no pre-operation assessment being completed with the booking team then being
unaware of this. Administrative training which includes awareness around the 28 day cancellation measure is now in place.
18
1.2 NHS National Contract Key Performance Indicators 1.2.1 Yorkshire Ambulance Service (YAS)
Feb 19 Mar 19 Apr 19 May 19 June 19 July 19 Aug 19 Sept 19 Oct 19
Category 1 (Life threatening injuries and illness) target of average time less than 7min
00:07:02 00:06:43 00:06:58 00:06:48 00:06:48 00:06:53 00:06:50 00:06:57 00:07:18
Category 1 target 90% of times less than 15 min
00:12:04 00:11:28 00:12:06 00:11:55 00:11:56 00:12:11 00:11:53 00:12:02 00:12:30
Category 2 (Emergency) target of average time less than 18
min 00:20:03 00:17:42 00:19:41 00:18:39 00:18:46 00:18:17 00:17:14 00:18:26 00:21:50
Category 2 target 90% of times less than 40 min
00:41:54 00:35:41 00:40:33 00:38:13 00:38:17 00:37:28 00:34:56 00:37:35 0:45:14
Category 3 (Urgent) target 90% of times below 2 hours
01:53:12 01:29:41 01:49:54 01:42:57 01:49:26 01:42:48 01:27:31 01:33:37 02:09:54
Category 4 (Less urgent) target 90% of times below 3 hours 03:25:14 03:00:07 03:36:40 03:51:12 04:33:48 04:01:00 02:47:12 02:44:08 02:59:54
Category 5 (Lowest acuity) target 90
th centile Target TBC 01:23:35 01:05:29 01:19:58 01:31:08 01:25:51 01:19:40 01:13:43 01:15:28 01:29:49
During October there was some deterioration across all categories with 4 (Category 1 average, both Category 2 measures and Category 3 90th centile) measures failing to meet the respective targets. Representatives from YAS continue to attend meetings around joint pathways within Doncaster to ensure that any issues can be addressed and continue to work closely with DBTHFT.
19
1.2.2 Ambulance Handovers (DBTHFT reported information)
Ambulance handovers
Provider Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-
19 Jun-19 Jul-19
Aug-
19
Sept-
19 Oct-19
DBTHFT handovers 30-
60 min 34 26 66 37 35 13 37 75 43 10 13 17 10
Trajectory 50 45 41 36 32 27 23
DBTHFT handovers over
60 min 2 1 13 1 1 0 5 1 4 1 1 3 2
Target for over 60 mins 0 0 0 0 0 0 0 0 0 0 0 0 0
A total of 3 patients at Doncaster Royal Infirmary and 7 patients at Bassetlaw didn’t achieve the standard of number of patients waiting between 30 to 60 minutes for handovers. 2 patients were waiting over 60 minutes and a root cause analysis has been completed to ensure there was no harm to those patients. Work continues with Yorkshire Ambulance Service and East Midlands Ambulance Service to improve handover times. Recent challenges have been escalated to the appropriate external senior teams by the General Manager requesting support on site at both Emergency Departments. Further details of these actions and updates have been requested from the Trust. 1.2.3 Mixed Sex Accommodation
Mixed Sex Accommodation Breaches
Commissioner
Sep-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19
DCCG 0 0 0 0 0 1 0 0 0 0 0 0 0
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
20
1.2.4 Care Programme Approach (CPA) – Percentage of people followed up within 7 days of discharge
CPA 7 day follow up
Commissioner Sept-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
May-
19 Jun-19 Jul-19
Aug-
19
Sept-
19
DCCG (RDASH figures) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
1.2.5 Improving Access to Psychological Therapies (IAPT) Waiting Times
IAPT referral to treatment within 6 weeks
Commissioner Aug-
18
Sept-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
May-
19 Jun-19 Jul-19
Aug-
19
DCCG 85.0% 87.0% 80.0% 87.0% 88.0% 87.0% 84.0% 87.0% 88.0% 92.0% 87.0% 91.0% 93.0%
Target 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%
IAPT referral to treatment within 18 weeks
Commissioner Aug-
18
Sept-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
May-
19 Jun-19 Jul-19
Aug-
19
DCCG 100% 100% 99.0% 100% 100% 100% 99.0% 100% 100% 99.0% 99.0% 99.0% 99.0%
Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
21
Latest figures released are for August 2019 which shows DCCG performance as 93% (England average 87.3%) of people achieving access within 6 weeks and 99% (England average 98.8%) achieving access within 18 weeks of referral. This indicator is measured on a quarterly basis nationally. 1.2.6 Zero tolerance of methicillin- resistant Staphylococcus aureus (MRSA) – No further information
Cases of MRSA
Commissioner Sept-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
May-
19 Jun-19 Jul-19
Aug-
19
Sept-
19
DCCG 0 4 0 0 0 0 1 0 0 0 0 0 1
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
There was 1 case of MRSA during September 2019. The patient attended the Emergency Department at Doncaster Royal Infirmary with community acquired pneumonia; blood cultures were taken on the following admission (diagnosed with MRSA Blood Stream Infection). A post infection review has been carried out jointly between DBTHFT and DCCG with the outcome as unavoidable with no lapses of care identified. 1.2.7 Incidents of Clostridium Difficile (C-Diff)
Cases of C-Diff
Commissioner Sept-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
May-
19
June-
19
July-
19
Aug-
19
Sept-
19
DCCG (cumulative total) 47 54 59 65 71 76 80 4 7 10 17 24 27
Cumulative Threshold
(84 for 2019/20) 35 42 49 56 63 70 75 80 7 14 21 28 35
22
1.2.8 Venous thromboembolism (VTE) risk assessment data
VTE Risk Assessment
Provider Aug-
18
Sept-
18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
May-
19 Jun-19
Aug-
19
Sept-
19
Percentage of adult
inpatients undergoing
risk assessment
(DBTHFT)
95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
DBTHFT undertake a manual audit of records to enable reporting and therefore cease auditing once sufficient records are reached to achieve target. 1.2.9 Doncaster and Bassetlaw Length of Stay (LOS) Trajectory The LOS position as of 20th October for the number of beds occupied by adult long stay patients is shown below (these are defined as any
patient who is in a hospital bed for 21 days or more).
DBTHFT is currently achieving their trajectory at 50 patients against the trajectory target of 72 patients.
23
24
Section 2: Provider Exception Report The following section of the report details performance by exception (those measures either rated Red or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH and other commissioned services. Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance as a whole for DBTHFT and Doncaster sites for RDASH, and does not simply relate to services provided to DCCG. The following includes a summary of provider measures and exceptions, which are those causing concern either cumulatively for the year, quarter or in month.
25
2.1 Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) This section only includes measures in the DBTHFT contract currently not meeting target which are not included in the constitution measures in Section 1.
Measure Month Latest
performance Target Trend Update
Stroke: Proportion of patients directly admitted to a stroke unit under 4 hours `
August 2019
54.9% 75%
Trust level performance for direct admission to the Stroke Unit within 4 hours decreased slightly in August 2019 to 54.9% against the 75% target (23 breaches out of 51). The longest wait was 13 days after the patient was admitted to the Intensive Therapy Unit. The increased workforce planned for Hyper Acute Stroke Unit (HASU) implementation will help improve performance as there will be increased clinical nurse specialist/therapist in-reach to ED to see the patients who may be self-presenters or mimics for example. Further work is being explored to improve the patient pathway from ED to the Stroke unit for those who are secondary/late diagnosis of stroke. The Trust is working on increasing the beds on the Stroke Ward and have appointed 2 Stroke Nurse Practitioners who are now in post. The continual review of the pathway from the emergency department and trialling the ring fencing of beds.
26
2.2 Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) This section only includes measures in the RDASH contract currently not meeting target which are not included in the constitution measures in Section 1.
Measure Month Latest
performance Target Trend Update
Memory Service: (from April movement from treatment to initial assessment)
Sept 2019
60.0% 95%
Performance was maintained during September 2019 at 60.0% against the 95% target (34 breaches with an average wait of 8.2 weeks). All breaches have been associated with additional delays within the pathway for patients accessing computerised tomography (CT) scans and electrocardiograms at DBTHFT. There have also been some issues with patients not attending their scans due to appointments allocated in Bassetlaw District General Hospital rather than Doncaster Royal Infirmary. A meeting between RDASH and DBTHFT to upgrade the current Integrated Clinical Environment system to enable RDASH staff to directly refer people for CT scans and electrocardiograms has now been rescheduled for early 2020. Performance Team members continue to meet with the RDASH Team Leaders and are able to provide assurance that the Trust are responding within two weeks from receipt of the scans. This includes recording any delays from DBTHFT so the Trust can raise it at the next joint partnership meeting. Issues have been discussed in the DCCG RDASH Finance, Performance and Information Group around innovative ways to achieve this target and wider pathway considerations for 2020/21.
27
The percentage of eligible people receiving RDASH services receiving a 12 month Section 117 (S117) Review
Sept 2019
87.4% 95%
Performance has decreased during September 2019 to 87.4%, with 77 patients waiting over timescale. A data request has been made with RDASH to identify the longest waiting patient within this measure. A recovery trajectory has been requested by DCCG through the Finance, Information and Performance Group along with details of the longest wait. The impact of delays is discussed through the Clinical Quality Review Group with no adverse issues identified Individual RDASH services are receiving updates from the Trust’s Performance Team to ensure that people requiring reviews are completed. The Performance team also continue to complete data validation checks to ensure that robust recording is completed.
Improving Access to Psychological Therapies (IAPT) – Percentage of people entering treatment as a proportion of people with anxiety or depression (OF)
Sept 2019 (year to date)
9.18% 9.75%
The amount of people accessing the IAPT service was under target cumulatively as at September 2019 at 9.18% against a trajectory of 8.08%; this relates to around 185 people below target. There have been further issues with staffing levels within the service; there are currently five vacancies, one unqualified staff member, one staff member on maternity and two on long term sickness. Due to these capacity issues within the team and the difficulties in recruiting nationally to these roles, a decision has been made to escalate at the next Trust Recruitment and Retention Board. The Team Manager & Service Manager continue to monitor and be proactive in ways to increase access rates whilst also maintaining levels of service. A Trust monthly internal performance clinic and action plan is in place to
28
track progress with performance supporting projection figures for the remainder of the year. This will be monitored on an ongoing basis through the joint RDASH and DCCG Finance, Performance and Information Group (FPIG).
Referral to diagnosis for Attention Deficit Hyperactivity Disorder (ADHD) – Incomplete Pathways for Children
Sept 2019
39.5% 92%
Performance did improve during September by 15.6% to 39.5%. There are 43 children waiting about 18 weeks (23 above 28 weeks) with the longest wait at 54 weeks. This is currently in line with the recovery trajectory agreed between DCCG and RDASH. An advertisement for 2 fixed term members of staff has been placed however recruitment to the senior position is proving challenging. Saturday clinics have resumed however at a reduced capacity and frequency as these are additional to the core service. Although as stated above the recovery trajectory is on track for September it is anticipated that this will fall below the stated ambition from November 2019. A meeting has been arranged to discuss further options to improve the flow through this service during December 2019 as a priority.
Community Nursing – percentage of reviews for complexity completed within the relevant timeframes (annually for lower level complexity at Level 1 to every visit for Level 5)
Sept 2019
Level 1 – 93.9% (77/82) Level 2 – 94.5% (2084/2205) Level 3 – 93.2% (1197/1285) Level 4 – 83.6% (153/183) Level 5 – 100% (3/3)
95%
Complexity reviews for Level 2 and Level 3 deteriorated slightly and remain below target along with Level 1 and 4 reviews. These areas have been raised through the DCCG and RDASH FPIG with the Trust and confirmation received that this issue relates to the recording of information rather than no review being undertaken. Work is being undertaken with the Intelligence Team to understand the required actions around this.
29
50% 50%
Quarter 2 CHC Complaints
Communication
Financial Restitution
2.3 Other Areas 2.3.1 Complaints, Concerns and Compliments There have been a total of 168 contacts made within the Patient Experience Department during quarter two. The percentage and numerical breakdown is shown below.
There have been a total of 2 complaints received and investigated during this reporting period. The percentage and numerical breakdown is shown below.
1
1
Communication
Financial Restitution
0 0.2 0.4 0.6 0.8 1 1.2
Quarter 2 CHC Complaints
1% 3% 1%
57%
4% 5%
29%
Quarter 2 Contacts Complaints
Compliments
Concerns
Enquiries
MP Enquiries
Patient Expereince
Signposted
2
5
1
95
6
8
49
Complaints
Compliments
Concerns
Enquiries
MP Enquiries
Patient Expereince
Signposted
0 50 100
Quarter 2 Contacts
30
100% of complaints were acknowledged within 3 working days as good practice. There have been 2 complaints closed this quarter, both of which were completed within the 25 working day good practice guidance. There have been 5 compliments received during quarter 2.
2.3.2 Primary Care
The Doncaster General Practice Nurse Development Strategy is in the design stage for publication. The action plan is well under way and
The Lead Nurse for Primary Care Quality is meeting with the Clinical Lead (Nurse) at Primary Care Doncaster to see how they can work together to further support and empower General Practice Nurses.
The Lead Nurse for Primary Care Quality has worked with the Primary Care Lead Nurses across the ICS and they have successfully
submitted a bid for funding from NHS England. This funding is to be used to develop a General Practice Nurse Network Ambassador Programme, via ECHO (Extension for Community Healthcare Outcomes), a pioneering tele-mentoring programme. Sessions can be attended by staff without them having to leave their place of work and can join in on their computer, phone or tablet. The process is now to be developed.
This work will support the implementation of the GPN 10 point plan across Doncaster. The GPN 10 point plan is the nurse element of the
Five Year General Practice Forward View (GPFV). The feedback around the four nurses undertaking the General Practice Nurse Vocational Training Scheme has been very positive. The
nurses are settling into their new roles and practices are keen to be involved.
2.3.3 Individual Placements – Coninuing Healthcare
Doncaster CCG provided a quarter two return to NHS England with a substantive report incorporating the below national requirements / measures:
Measure Achieved Assurance Rating
28 Day Referral Process 100% 5
DST’s completed in Hospital 0% 5
31
Checklists completed within 48 hours of CCG receiving
100% 5
Fast Tracks completed within 24 hours of CCG receiving
100% 5
Assurance Rating:
5 – Excellent level of assurance given 4 – High level of assurance given 3 – Assurance is at the expected level 2 – Assurance is below the expected level, more work will be requested as appropriate 1 – Assurance is significantly below the expected level, more work will be requested urgently
2.3.4 Specialist Placements DCCG continues to commission care for 43 individuals. Although this overall number is has changed little, there have been a number of individuals discharged balanced by a number of people needing to be admitted.
There has been significant work undertaken to reduce out of area placements within Acute mental Health Services although there continues to be challenges around capacity for people needing Psychiatric Intensive Care (PICU) type admissions and Doncaster CCG is currently supporting a number of people in PICU placements out of area. Doncaster CCG continues to monitor the care provision and actively works across the clinical teams to discharge people from hospital or move closer to home for ongoing care. 2.3.5 Transformation Care All areas are required to understand and support those individuals that may be at risk of admission into hospital who have been diagnosed with a Learning Disability or an Autistic Spectrum Condition. As at 30th October 2019, Doncaster currently has 24 adults identified on the LTCP Register (Local Transforming Care Partnership). This also now includes those people with a diagnosis of Autistic Spectrum conditions without a diagnosis of LD. The register helps to understand the challenges of care, perceived risk of admission, and support needed to support individuals in order to prevent admission to hospital. The register demonstrates the need and commitment for proactive work which has been very successful in reducing hospital admissions and assisting with earlier than expected discharges from hospital.
32
From the Local Transforming Care Partnership commencing, Doncaster has managed to successfully avoid admissions for a significant number of people through joint working across all partners. There are 9 people currently receiving a care in hospital. Care and Treatment reviews continue to be undertaken for all people within this programme of work to ensure that the current care is appropriate and that there is are clear plans for treatment and discharge. 2.3.6 Care Homes
The Lead Nurse for Individual Placements – Quality has undertaken the induction phase during September and October 2019. The aim of this was to build relationships, gain an understanding of current working practices and establish the new role.
During this phase the Lead Nurse for Individual Placements – Quality has undertaken an number of visits, meetings and audits including shadow visits with Lead professionals within Mental health, Learning Disabilities, Children’s, Primary care, RDASH and Medicines Management.
From these early visits there are some clinical themes and trends identified that will be considered through the quality improvement processes in place.
Discussions have taken place with the Lead Nurse for the Care Home Strategy, Lead Nurse for Primary Care, Medicines Management, RDASH Frailty Team, Continuing HealthCare, Safeguarding, Public Health and Mental Health. The issues above have been evidenced and escalated to improve practice and therefore the quality of care for individuals.
Doncaster currently has two care homes rated inadequate by the CQC. Both care homes have been supported to address the concerns raised by CQC and there is a view that improvements have taken place. Both care homes will be re-inspected in due course and it is hoped that the inspections will confirm the local view that care and quality is improving.
2.3.7 Learning Disabilities Mortality Review (LeDeR) Currently the CCG has 7 cases in process, of the 7, 4 cases are in the process of review, whilst the remaining three are currently suspended due to other investigative processes. The number of cases received into the CCG is manageable due to the allocation of a dedicated ‘reviewer’.
33
During this reporting period, the first LeDeR Learning Group has taken place. The meeting was well attended by professionals, care providers and CCG Staff. The key outcome of the meeting was to establish the group agenda, principles and establish appropriate membership. The meeting will take place bi- monthly and will focus on both local and national learning. Work has started on reviewing all of the Doncaster cases, so that a local report can be developed that ‘mirrors’ the format of the two national reports. This will be presented at the next Quality and Patient Safety Committee meeting. 2.3.8 Never Events There has been a lapse in reporting in relation to Never Events through the performance report process. DBTHFT have now amended their procedures in relation to this to ensure that these are captured within the Performance Reports going forward. There have been 2 Never Events during Quarter 1. It should be noted that the Never Events have been reported to Quality and Patient Safety Committee within the appropriate timeframe with necessary investigation and learning being undertaken by DBTHFT. 2.3.9 Safeguarding – Serious Case Reviews There have been no Serious Case Reviews or Safeguarding Adult Reviews commissioned during this reporting period. There are currently 2 Safeguarding Adult Reviews open and progress within the appropriate timescales. The CCG are fully engaged and contributing accordingly to both of these reviews. There are a further 2 Safeguarding Adult Reviews open to the Doncaster Safeguarding Adult Board. These cases are also open within the Doncaster CCG Serious Incident process therefore; it has been agreed to await receipt of these reports prior to progress further with further investigations. 2.3.10 Lessons Learnt Reviews During this reporting period Doncaster Safeguarding Children Board (DSCB) has not initiated any local lessons learnt reviews.
34
The local lessons learnt review initiated during Q2 2018/2019 has now been received by the Doncaster Safeguarding Children Board Case Review in draft form. It has been established that further family engagement is needed prior to the report being finalised and presented to the Doncaster Safeguarding Partnership. There is currently 1 Lessons Learnt Review open to the Doncaster Safeguarding Adults Board. This review has been commissioned from a single agency perspective however; it have been agreed to extend this review out to wider professionals. A further update will be provided around this case in the quarter three Safeguarding report.
2.3.11 Domestic Homicide Reviews There are currently 2 Domestic Homicide Reviews being considered by the partnership. Agencies are currently at the first stages of information gathering. A further update around these cases will be provided within the quarter three Safeguarding report. 2.3.12 SEND (Special Educational Needs and or Disabilities) Inspection Following the local SEND inspection, a refreshed Doncaster SEND Strategy has been drafted and shared with the CCG for comments. There are currently 6 priority work streams identified with each having a task and finish group. The initial task and finish group meetings were due to take place during November however; due to the recent floods within Doncaster these have been postponed until January 2020. Further updates will be provided in reports to the Quality and Patient Safety Committee and Governing Body as required.
Section 3: NHS Oversight Framework NHS England has a statutory duty to conduct an annual performance assessment of every CCG. The annual assessment of CCGs by NHS England will continue in 2019/20. It is a judgement, reached by considering a CCG’s performance in each of the indicator areas over the full year and balanced against the financial management and qualitative assessment of the leadership of the CCG. Formally NHS England will continue to assess how CCGs work with others (including their local Health and Wellbeing Boards) to improve quality and outcomes for patients. To ensure that the framework is being applied consistently, regional and national moderation takes place. The possible ratings are: Outstanding, Good, Requires Improvement and Inadequate. Doncaster CCG was rated ‘Outstanding’ for 2018-19 – one of only 24 of the 195 CCGs to have achieved this rating. This was the third consecutive year that Doncaster CCG had been rated as ‘Outstanding’
35
The key changes to the previous Improvement and Assessment Framework are: 1. NHS England and NHS Improvement teams speaking with a single voice, setting consistent expectations of systems and their
constituent organisations. 2. Greater emphasis on system performance, alongside the contribution of individual healthcare providers and commissioners to
system goals. 3. Working with and through system leaders, wherever possible, to tackle problems. 4. Matching accountability for results with improvement support, as appropriate 5. Greater autonomy for systems with evidenced capability for collective working and track record of successful delivery of NHS
priorities. The Oversight Framework for 2019-20 covers the following five domains which are aligned to priority areas in the NHS Long Term Plan:
1. New service models. 2. Preventing ill health and reducing inequalities. 3. Quality of care and outcomes. 4. Leadership and Workforce. 5. Finance and use of resources.
Underpinning the five domains in 2019-20 are 59 indicators which are used to inform the ratings.
36
Domain Code Indicator Period Performance Rank (189) Period Performance
Leadership and workforce 109a Reducing low priority prescribing 19-20 Q1 Red
Leadership and workforce 123i MH - Investment standard 19-20 Q1 Green
Leadership and workforce 123k CYP eating disorders investment
Leadership and workforce 141b In-year financial performance 19-20 Q1 Green
Leadership and workforce 145a Expenditure in areas with identified scope for improvement 19-20 Q1 Amber
Leadership and workforce 128d Primary care workforce Sep-18 1.03 85
Leadership and workforce 162a Probity and corporate governance 18-19 Q4 Fully Compliant
Leadership and workforce 163a Staff engagement index 2018 3.71 140
Leadership and workforce 163b Progress against WRES 2018 0.10 46
Leadership and workforce 164a Working relationship effectiveness 2018-19 74.4 54
Leadership and workforce 165a Quality of CCG leadership 19-20 Q1 Green Star
Leadership and workforce 166a
CCG compliance with standards of public and patient
participation (not available)2018 Green Star
New Service Models 105b Personal health budgets 19-20 Q1 39.9 90 19-20 Q2 40.82
New Service Models 127b Emergency admissions for UCS conditions 19-20 Q2 2,513 136
New Service Models 127c A&E admission, transfer, discharge within 4 hours Mar-19 92.54% 26 Oct-19 90.30%
New Service Models 127e Delayed transfers of care per 100,000 population Aug-19 6.48 43 Sep-19 9.43
New Service Models 127f Hospital bed use following emergency admission 18-19 Q2 470.0 67
New Service Models 128b Patient experience of GP services 2019 81% 133
New Service Models 128c Patient experience of getting an appropriate GP appointment
New Service Models 130a 7 DS - achievement of standards 2017-18 2 56
New Service Models 131a
% NHS CHC full assessments taking place in acute hospital
setting19-20 Q1 0% 1 19-20 Q2 0%
New Service Models 144a Utilisation of the NHS e-referral Jul-19 99.94% 106
Preventing ill health and reducing inequalities 102a % 10-11 classified overweight /obese 15/16 to 17/18 34.77% 102
Preventing ill health and reducing inequalities 104a Injuries from falls in people 65yrs + 19-20 Q2 1,992 122
Preventing ill health and reducing inequalities 106a Inequality Chronic - ACS & UCSC 18-19 Q2 2695 148
Preventing ill health and reducing inequalities 107a AMR: appropriate prescribing Jun-19 1.059 148 Aug-19 1.060
Preventing ill health and reducing inequalities 107b AMR: Broad spectrum prescribing Jun-19 5.60% 9 Aug-19 5.60%
Preventing ill health and reducing inequalities 123g MH - Health checks 19-20 Q1 20.50% 134
Preventing ill health and reducing inequalities 125d Maternal smoking at delivery 19-20 Q1 16.58% 164
Latest PerformanceNHSE NHS Oversight Dashboard published Oct 2019
37
Quality of care and outcomes 103a Diabetes patients who achieved NICE targets 2017-18 43.42% 12
Quality of care and outcomes 103b Attendance of structured education course 2017-18 8.12% 91
Quality of care and outcomes 105c
% deaths with 3+ emergency admissions in last 3 months of
life2017 9.28% 157
108a Quality of life of carers 2019 57.80% 91
Quality of care and outcomes 121a High quality care - acute 19-20 Q1 62 70
Quality of care and outcomes 121b High quality care - primary care 19-20 Q1 68 23
Quality of care and outcomes 122a Cancers diagnosed at early stage 2017 48.92% 157
Quality of care and outcomes 122b Cancer 62 days of referral to treatment 18-19 Q4 84.47% 30 Aug-19 83.33%
Quality of care and outcomes 122c One-year survival from all cancers 2016 70.50% 162
Quality of care and outcomes 122d Cancer patient experience 2018 8.90 57
Quality of care and outcomes 123a IAPT recovery rate 19-20 Q1 56.22% 38
Quality of care and outcomes 123b IAPT Access 19-20 Q1 4.54% 107
Quality of care and outcomes 123c EIP 2 week referral Jul-19 88.41% 85 Sep-19 83.87%
Quality of care and outcomes 123f MH - OAP Jun-19 10 47 Jul-19 19.48
Quality of care and outcomes 123j MH - DQMI May-19 79.20% 125 Jul-19 86.10%
Quality of care and outcomes 124a LD - reliance on specialist IP care 18-19 Q4 49 78
Quality of care and outcomes 124b LD - annual health check 2017-18 43.68% 153 2018-19 37.17%
Quality of care and outcomes 124c Completeness of GP LD register 2017-18 0.53% 66 2018-19 0.61%
Quality of care and outcomes 124d LD mortality reviews
Quality of care and outcomes 125a Neonatal mortality and stillbirths 2016 4.23 82
Quality of care and outcomes 125b Experience of maternity services 2018 83.50 74
Quality of care and outcomes 125c Choices in maternity services 2018 57.90 142
Quality of care and outcomes 126a Dementia diagnosis rate Jun-19 71.36% 69 Sep-19 71.16%
Quality of care and outcomes 126b Dementia post diagnostic support 2017-18 74.78% 164 2018-19 77.32%
Quality of care and outcomes 129a 18 week RTT Mar-19 89.30% 73 Oct-19 87.60%
Quality of care and outcomes 129b Overall size of waiting list Aug-19 24115 136 Oct-19 23892
Quality of care and outcomes 129c Patients waiting over 52 weeks Aug-19 0 1 Oct-19 0
Quality of care and outcomes 132a Sepsis awareness 2018 Green
Quality of care and outcomes 133a 6 week diagnostics Aug-19 1.38% 38 Oct-19 0.76%
Quality of care and outcomes 134a Evidence based interventions 19-20 Q1 Amber
CCG in best
performing
quartile in
England
Performance
has improved
CCG in worst
performing
quartile in
England
Performance
has
deteriorated
38
Section 4: South Yorkshire and Bassetlaw Integrated Care System Assurance Report
39
SECTION 5: Better Care Fund 2019-20 Better Care Fund (BCF) Plan Doncaster’s 2019-20 BCF plan was submitted to NHS England on 26th September and was approved by the Yorkshire and Humber BCF Assurance Panel on 17th October. The next step is regional and national calibration of assurance to ensure consistency in application of the Policy Framework and Planning Requirements across England. Calibration is due to be completed and letters of approval sent from the National Team in early December. Year to date
Metric 2019-20 target 2019-20 actual Var. 2018-19 Var.
Reablement 85% 83.33% -2.22% 83.93% -0.71%
Admissions to care homes 185 206 11.65% 192 7.29%
Non -elective admissions 19136 17948 -6.21% 18455 -2.75%
Delayed Transfers 3056 3224 5.49% 2004 60.88%
DTOC NHS 1226 1909 55.76% 1164 64.00%
DTOC ASC 1008 1303 29.25% 518 151.54%
DTOC Joint 822 12 -98.54% 322 -96.27%
40
The percentage of people still at home 91 days following discharge for the 6 months ending 30th Sept 2019 was 83.3% which is below the BCF Target (85%) and marginally below the corresponding period in 2018-19 (83.9%). There is a requirement to build community and homecare capacity to provide additional support to enable people to remain at home post discharge. The 2019-20 BCF Plan includes several schemes to improve reablement including: . Short Term Enablement Programme (STEPs) / Occupational Therapy (OT) service (a 6 week reablement programme to support
people at home). . Positive Steps – support for more complex patients . Community OT Service (specialist service including moving and handling assessments, aids and adaptations) . Community Clinical Services Review (additional community based rehabilitation services)
41
There were 206 admissions to Care Homes for patients aged 65+ in the 6 months ending 30th Sept 2019 which is 12% more than the proposed BCF target (185) and 7% more than in the corresponding period in 2018. Admissions increased in the early months of 2019-20 due to increasing demand for residential care. There is now a strong grip on residential care admissions. All admissions are agreed via a resources panel in conjunction with social care professionals. This ensures that people have their independence considered and access residential care only when all other options for their wellbeing have been exhausted. There has been a significant reduction in admissions over the last 2 years and this has resulted in the lowest number of people in residential care for many years. To sustain this improvement families and communities require additional support to provide better care for elderly persons at home. The vision of the 2019-20 BCF Plan is that no individual is admitted to or will remain in residential care unnecessarily and to reduce the number of people living in residential settings over a period of time by helping them to live safely in their own homes
42
There were 17948 non-elective admissions to acute specialties for Doncaster residents during the 6 months ending 30th Sept 2019 which is 6% fewer than in the corresponding period in 2018 and 3% fewer than the BCF target despite the rising elderly population and increase in volume and acuity of A&E attendances. Patients aged 85+ accounted for 13% of non-elective admissions between April and September 2019 despite only accounting for 2.3% of the population. Pneumonia is the largest contributor to non-elective admissions for patients aged 85+ and many of these involve a long length of stay. There were 1% more avoidable emergency admissions (as defined by the NHS Digital) in the 6 months ending 30th Sept 2019 than in the corresponding period in 2018. - Acute ambulatory care sensitive conditions – 4% fewer than Apr-Sept 2018 - Chronic ambulatory care sensitive conditions – 8% more than Apr-Sept 2018 To continue to control growth in non-elective admissions Doncaster CCG and Doncaster Council have produced an Urgent Care Delivery Plan which includes the development of a community based Single Point Access (SPA) in Doncaster, building on the Integrated Discharge Team and Rapid Response approaches already in place to facilitate admission avoidance and co-ordinate the most appropriate care pathway for patients.
43
There were 3224 delayed days due to delayed transfers of care in the 6 months ending 30th Sept 2019 which is 5.5% more than the BCF target and 61% more than the corresponding period in 2018. The Doncaster health and social care community has taken a system wide approach to managing delayed transfers of care, reducing Length of Stay and implementing the High Impact Change Model. The key priorities in the 2019/20 BCF Plan are: • Early Discharge Planning – there is a need to undertake further work in this area, particularly with primary care and community
services to identify those who will require additional support following elective and unplanned care. Care Homes need to plan in advance for residents who require elective care to ensure timely discharge and to ensure that support is in place in the community.
• Trusted Assessors – partners are prototyping a variation of the trusted assessor model with a strategic local provider for home care support. There is a need to roll out and test the prototype to enable more effective management of transfers of care across the health and social care system. Good progress is being made in Discharge to Assess and Continuing Health Care.
• Enhancing housing pathways • Further enhancements to seven day services • Reviewing bariatric requirements.
44
Almost 25% of delayed days were due to housing, delays for which increased significantly in between November and March but have decreased in recent months.
The Managing Transfers of Care Group has established a Housing Task and Finish Group which is currently focussing on:
- Reviewing and improving existing housing pathways - Developing new approaches including identification of best practice elsewhere
45
There were 1909 NHS attributable delayed days in the 6 months ending 30th Sept which equates to a daily average of 12.5 which is significantly above than the target (6.7). Over 40% were due to housing.
46
There were 1303 Adult Social Care attributable delayed days in the 6 months ending 30th Sept which equates to a daily average of 8.5 which is above the target (5.51). Over 70% were due to patients awaiting either care packages or residential home placements.
There were only 12 delayed days jointly attributable to the NHS and Social Care in the 6 months ending 30th Sept which equates to a daily
average of 0.08 which is significantly below the target (4.49)
47
Meeting name Governing Body
Meeting date 5th December 2019
Title of paper
Starting Well Life Stage
Executive / Clinical Lead(s)
Mr Lee Golze
Author(s) Performance and Intelligence Team
Quality Team
Status of the Report
To approve To consider / discuss To note
Purpose of Paper - Executive Summary
This report sets out the key quality and performance updates to be noted by the
Governing Body from the quarterly updates provided by DCCG and Doncaster
Council staff in relation to the Starting Well Life Stage Strategic Delivery Plan. This
report reflects 2019/20 performance and delivery areas.
Please note all data is validated and quality checked internally within DCCG and
with Providers as necessary. Where there is a data quality concern on any of the
data or metrics presented in the following report, this will be stated in the narrative
accompanying the data.
Of the 51 actions within this life stage 13 have been completed with 12 overdue and
are at the start of each section.
Of the performance indicators within this life stage the following are off track against
target:
Secondary schools persistent absent rate - 15.4% against a target of less than 12.7% during Quarter 2 2019/20 (Page 18)
Primary schools persistent absent rate - 11.1% against a target of less than 9.2% during Quarter 2 2019/20 (Page 19)
Total number of Paediatric assessments taken place at DBTHFT – there were 328 assessments during August 2019 against a target of fewer than 202 (Page 20)
Achievement Gap between disadvantaged pupils and their peers at KS2 - 21.1% against a target of 19.5% (page 22)
L&A LE 03 Fixed Term Exclusions in Primary schools 2.2% against a target of less than 1.4% during Quarter 2 2019/20 (Page 34)
L&A LE 04 Fixed Term Exclusions –in Secondary school were at 57 against a target of less than 10.1 during Quarter 2 2019/10 (Page 35)
There will be fewer babies born by emergency Caesarean (15.2% by march 2020) - 21.8% of babies were born against a target of 15.2% (Page 38)
Reduction in the waiting times for patients with Autism and ADHD of 15% by
x
48
March 2020 - 40% of patients were seen within 18 weeks against a target of 92% during September 2019 (page 43)
93.1% percent of children and young people received non-urgent treatment within 8 weeks of the CAMHS referral against a target of 95% during September 2019 (page 45)
Recommendation(s) The Governing Body is asked to:
Note the key quality performance areas for attention.
Report Exempt from Public Disclosure
If yes, detail grounds for exemption: Yes No
Impact analysis
Quality impact Positive quality impact from a consistent focus on quality outcomes.
Specific quality impact as identified in the report.
Equality impact
Tick
relevant
box
An Equality Impact Analysis/Assessment is not required for this report. x
An Equality Impact Analysis/Assessment has been completed and approved by the
lead Head of Corporate Governance / Corporate Governance Manager. As a result
of performing the analysis/assessment there are no actions arising from the
analysis/assessment.
An Equality Impact Analysis/Assessment has been completed and there are
actions arising from the analysis/assessment and these are included in section xx
in the enclosed report.
Sustainability impact
Nil
Financial implications
As identified in the report.
Legal implications
Nil
Management of Conflicts of
Interest
The report is for information – no conflicts of interest identified. It should be noted that some Governing Body members may be
employed in secondary employment by organisations referenced in this
report: please see Register of Interests for details.
Consultation / Engagement
(internal departments,
clinical, stakeholder and public/patient)
N/A
Report previously
N/A
x
49
presented at
Risk analysis
Risks are captured in the Executive Summary.
Assurance Framework
2.1, 2.2, 2.3, 2.4, 3.1
50
SW 1 - Low Level Interventions Based in Neighbourhoods Title Progress Bar Latest Note Due Date Linked PIs Code
Agree on the non-pay costs for the service to give an understanding of total financial envelope to commission the service for Childrens Community Nursing
13-Nov-2019 Previously agreed model was due to be submitted to CRG and Executive Committee in October, but was discussed and agreed by the working group that the model had lapsed for so long, that it did not reflect the current demand on service, nor was it deemed as being clinically safe anymore. Initial discussions with the service have taken place to assess the current demand under each service area and gain an understanding of the current pathways. Deep dive being undertaken into Children’s Community Nursing services offered across the local boundaries in order to gain best practice ideas for service delivery, linking in with key stakeholders. Forward plan is to bring an updated specification and model of all pathways back to CRG and Executive Committee by December.
31-May-2019 CCG_DP_C&M_01, CCG_DP_C&M_02
Develop new service specification with a focus on out of hospital care, in particular for those with previously avoidable admissions for Childrens Community Nursing
13-Nov-2019 Previously agreed model was due to be submitted to CRG and Executive Committee in October, but was discussed and agreed by the working group that the model had lapsed for so long, that it did not reflect the current demand on service, nor was it deemed as being clinically safe anymore. Initial discussions with the service have taken place to assess the current demand under each service area and gain an understanding of the current pathways. Deep dive being undertaken into Children’s Community Nursing services
30-Aug-2019 CCG_DP_C&M_01, CCG_DP_C&M_02
51
Title Progress Bar Latest Note Due Date Linked PIs Code
offered across the local boundaries in order to gain best practice ideas for service delivery, linking in with key stakeholders. Forward plan is to bring an updated specification and model of all pathways back to CRG and Executive Committee by December.
To evaluate Thrive and Roots of Empathy programmes to check efficacy and if they should be rolled out across the Borough. Both programmes support wellbeing
14-Nov-2019 Thrive evaluation not persuasive of Vfm but agreed to regard as 'committed funding' for Thrive and Roots of Empathy on an interim basis pending outcome of Localities review.
30-Apr-2019 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
To develop the new concept of collaboratives and if they fit into the wider discussions around area based assets and area based commissioning
13-Nov-2019 Given proximity and likely shape of localities review, it was decided to retain the 15 area model. Report to DLT on 13/11/19 and schools Forum in January 2020, highlighting possibilities and requesting steer on future options.
31-Aug-2019 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
To implement the new concept of Collaboratives
13-Nov-2019 Likelihood is that Collaboratives will be captured within the Localities model and a new model for the Collaboratives will be developed within that context.
12-Dec-2019 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
SW 2 - Co-ordinated access to services when needed
Title Progress Bar Latest Note Due Date Linked PIs Code
52
Title Progress Bar Latest Note Due Date Linked PIs Code
Work with colleagues to explore the concept of more area based commissioning and how this fits in with a more community asset based approach, i.e. Doncaster Growing Together Local.
14-Nov-2019 This works sits within the One Council Localities work stream.
31-Aug-2019 EH 3.3, SW 20, SW 24, SW 25
Develop a campaign around children's emotional wellbeing and mental health, that showcases progress to date and what the service offer is, i.e. where to go for support.
13-Nov-2019 Following work through the Mental Health trailblazer scheme, the Young Advisors are working on a campaign film for Secondary aged school children and a story book for primary children. This will signpost young people to the NHS With Me In Mind webpage and the new Mental Health Support Teams in Schools. There will also be a future event / festival that showcases progress to date, although this is in the very early stages of development
31-Aug-2019 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
Oversee the implementation of the local provider's Place Plan & Transformation plan as part of the South Yorkshire and Bassetlaw Integrated Care System: Local Maternity System
13-Nov-2019 Maternity specification completed. Presented at FPIG for sign off. Working to the LMS and Place plan. Completed a smoking Deep Dive with public health and partners. Implementation of smoking training for all community and hospital based midwives in accordance with Saving Babies Lives Care bundle and Nice guidance. Plan to work with SYB project lead and HOM to ensure Doncaster is implementing continuity of carer as per the LMS. Working with the Maternity Transformation Lead and LMS project lead to implement Doncaster Maternity Voice Partnership meeting (TOR, funding etc) to enable this as per guidance Better Births)
31-Mar-2021 SW 06, SW 07, SW 08, SW09, SW 18
53
Title Progress Bar Latest Note Due Date Linked PIs Code
AI - DBTH are currently facing a significant challenge around recruitment of Midwifes, this is at present impacting on their ability to meet the LMS 35% trajectory by March 2020 for Continuity of Care. DCCG have placed LMS as a standing agenda item at the monthly Maternity Quality Sub Group as a means of monitoring continued progress on this. The sub group holds a clear governance and escalation process that will be accessed as required.
Oversee provider service improvement development with a specific focus on Antenatal care & pathways and intrapatum care delivery
13-Nov-2019 Regular Maternity and Neonates sub group meeting. Maternity and Neonates sub group - ensure the implementation of Continuity of Carer (saving Babies Lives Care Bundle V2) . Ensuring Doncaster offer a woman centre approach. AI – DBTH have now completed 2 Quality Improvement (QI) events, Antenatal Care and Intrapartum care. The Postnatal care QI event is currently under way, week beginning 11/11/2019. Each event has been successfully received from which workable and SMART action plans have been established.
31-Mar-2021 SW 06, SW 07, SW 08, SW 09, SW 18
Implement the Local Transformation Plan to secure sustainable improvements in children and young people's emotional wellbeing and mental health
14-Nov-2019 The Local Transformation Plan has been refreshed and submitted to NHS Engalnd at the end of October 2019. For the first time there is a children's version, developed by our Young Mind participation champions.
31-Mar-2020 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
Achieve the 4 week access standards as part of the trailblazer pilot
14-Nov-2019 This work is on-going and the formal launch of the trailblazers begins in December 2019. In Doncaster as per the other trailblazer sites, this will be a phased launch.
31-Mar-2021 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
54
Title Progress Bar Latest Note Due Date Linked PIs Code
New (trailblazer) mental health support teams to provide face to face support for 2,000 children and young people
14-Nov-2019 The core offer is in place and the teams are also in place across the four localities. They have layered over and built upon the exisiitng consultation and advice community CAMHs workers. Senior staff within the teams have completed their training ensuring there is leadership in place. PWP workers will have completed by Feb 2020.
31-Mar-2021 CYPP HH 01, CYPP HH 02, CYPP HH 10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
Review imagination library and develop options paper on new offer to support reading opportunities for young children
14-Nov-2019 Contract has ended. 30-May-2019 19-20 OCF PM45
Provide strategic commissioning support to the development of a school improvement strategy
14-Nov-2019 To support the single offer & Learning Futures, initial discussions have taken place regarding the most suitable commissioning route, to contract with providers of services identified as necessary/desirable by schools. A Dynamic Purchasing System is the current favoured option. Gap analysis information to be provided to allow initial market engagement planning to begin. RF - Secondary improvement partner contract is currently on hold and discussions iunderway with provider to decide a way forwards or whether to decommission due to OA duplication. New Primary Improvement contract (£60k) for the 2019/20 academic year has been developed and signed, with upfront payments authorised - contract/services are now underway to be monitored.
31-Oct-2020 19-20 OCF PM45, CYPP EW 01, CYPP EW 02, L&A LE 03, L&A LE 04
Commission a new school for children with autism so fewer children are placed out of area for this type of
13-Nov-2019 We are currently developing the Service Level Agreement that will outline our relationship with Nexus and the
31-Oct-2020 19-20 OCF PM45, CYPP EW 01, CYPP EW 02, L&A LE 03, L&A LE 04
55
Title Progress Bar Latest Note Due Date Linked PIs Code
educational need Bader School. Opening has been delayed - dates to be confirmed. Discussions with Nexus regarding the initial cohort, including the mapping of eligible children and young people for consultation.
Work with the Department for Education to commissioning services to develop life skills for young people, that will equip them for later life
20-Nov-2019 Essential Life Skills grants ended Summer 2019. Impact is currently being evaluated
31-Oct-2020 19-20 OCF PM45, CYPP EW 01, CYPP EW 02, L&A LE 03, L&A LE 04
Review how Doncaster Children's Trust and Council can collaborate on commissioning and procurement, sharing resources, knowledge and skills where possible, whilst maintaining organisational independence
18-Nov-2019 No update this time 31-Mar-2020 19-20 OCF PM29
19-20 OCF PM33
Doncaster Children's Trust to work with the Council to explore efficiencies from new governance arrangements (ALMO) - e.g. insurance, transport
20-Nov-2019 Completed 31-Dec-2019 19-20 OCF PM29
19-20 OCF PM33
Children's Trust to investigate Residential WRF collaboration with Leeds and other Local Authorities
13-Nov-2019 South Yorkshire Sub Regional Hub Development -We are currently part of the development of a regional approach to ensuring placements in independent fostering, residential and special schools and colleges are of the very best standard. We are part of the hub in our region to become the agents that will work directly with providers to support and challenge them, as well as identify areas of best practice.
31-Jul-2019 19-20 OCF PM29
19-20 OCF PM33
Children's Trust to Review of Matrix agency MSP contract (£10m over 3 years), expires Dec 2019. Procurement process to begin April
20-Nov-2019 Completed
31-Dec-2019 19-20 OCF PM29
19-20 OCF PM33
56
Title Progress Bar Latest Note Due Date Linked PIs Code
2019 - using ESPO MSTAR3 framework
Childrens Trust to implement an Independent Fostering Agency (IFA) engagement event
20-Nov-2019 Completed 31-May-2019 19-20 OCF PM29
19-20 OCF PM33
Effective delivery of Healthy Child Programme 5-19; delivery of Health and Wellbeing clinics in schools; delivery of National Child Measurement Programme; completion of individual and school health plans
14-Nov-2019 NCMP data for 18/19 successfully uploaded and published. Team are now turning their attention to the 19/20 school year upload. Target for delivery of HWB+ clinics for school year 18/19 was met and incentive payment made. Timetable for 19/20 school year has been shared and service set to meet and even exceed number of required clinics. Completion of school health plans for new school year underway.
31-Mar-2020 CYPP HH 21
CYPP HH 23
Uptake of chlamydia screening programme; ensuring care planned interventions resulting in managed agreed positive exits; increase uptake of Long Acting Referable Contraceptive in under 19 population
14-Nov-2019 Chlamydia detection rate in Doncaster for 2018 fell short of the national programme target of 2300/100,000 15-25 year olds (1943/100,000). Partners will meet to discuss potential avenues to improve detection rate. No issues with other target areas
31-Mar-2020
Improved outcomes for the Transforming Care cohort, reduction in admissions to Tier IV, embedding the Care, Education and Treatment Review (CETR) process to align with other statutory functions, decrease in the number of Reviews held
13-Nov-2019 Proactive monitoring & support group continues to case manage children and young people who fall within the remit of Transforming Care. We continue to see a reduction in unplanned Tier 4 Admissions. CETR's only held where necessary as quite often early involvement at PM&S level removes the need.
31-Mar-2020 19-20 OCF PM33, CYPP HH 01, SW 13
Completion of 5 mandated Healthy Child programme checks and reviews;
14-Nov-2019 The smoking in pregnancy service is currently piloting a shopping
31-Mar-2020 PHOF2.02ii
57
Title Progress Bar Latest Note Due Date Linked PIs Code
increased breastfeeding rates at 6-8 weeks; increase CO verified 4 week quits for pregnant smokers
voucher incentive scheme to increase the number of verified quits at 4 weeks and encourge long term quit status. Early data indicates a steady increase in verified quits at 4 weeks. The pilot will run for 6 months. Partners have also come togther to complete a smoking in pregnancy 'deep dive' assessment to idetifiy weaknesses across the system to improve the smoking cessation offer for pregnanct women. An action plan will be shared shortly.
Business case to be considered at Joint Commissioning Management Board, exploring possibilities of piloting a new way of working
14-Nov-2019 Completed 31-May-2019 SW 06, SW 07, SW 08, SW 09, SW 18
Implement commissioning responsibilities for Starting Well, 1001 Days
14-Nov-2019 No update. 31-Dec-2019 SW 06, SW 07, SW 08, SW 09, SW 18
Business case to be considered at Joint Commissioning Management Board for Starting Well, first 1001 days
14-Nov-2019 Revised model for vulnerable adolescents is going to Clinical Reference Group on 28th November.The revised model will proceed if there is agreement at the Clinical Reference Group.
30-May-2019 SW 17
Implement commissioning responsibilities for starting well and vulnerable adolescents
14-Nov-2019 Revised model for vulnerable adolescents is going to Clinical Reference Group on 28th November.
31-Dec-2019 SW 17
Create a team of young commissioners to support young people's voice
13-Nov-2019 2 x Young Commissioner seats within Youth Council have been set up to link directly with Children’s priorities. Training has been delivered to the young advisors anattended a panel meeting on the 23/10/19 to moderate the latest Short Break Capital Grant. • Young Commissioners completed a UK Youth
31-Aug-2019 SW 20
58
Title Progress Bar Latest Note Due Date Linked PIs Code
Award andd completed 24/4/19. A young commissioner was part of the interview panel for a new Children's Commissioning Officer. A LADDER group Young Commissioner formed part of the evaluation panel for the Short Breaks Capital Grant Fund bids submitted for moderation. 30th October and the 6th November five Young Commissioners moderated Expect Youth small grant applications. A local authority out of area have requested a visit to look at how we run and developed our Young Commissioner project. Date to be arranged.
Develop new service specifications for therapy services including setting new outcome indicator
14-Nov-2019 Ongoing service review including discussions with the services on demand and levels of current resource. Joint area of work between the Council and CCG. Specification update required and wider work may be required at a later stange to consider universal therapy services for children and young people. Doncaster council investment to therapies needs to be reviewed and considered, due to low enagement.
31-Mar-2020 19-20 OCF PM45
To commission good or better child care provisions
14-Nov-2019 The quality and performance of current provision is being recorded through the Children's commissioning dashboard
31-Mar-2020 CYPP HH 16
59
SW 3 - Holistic delivery of care and support
Title Progress Bar Latest Note Due Date Linked PIs Code
Commission services around school improvement at both primary and secondary to support improvements in attendance and attainment.
14-Nov-2019 To support the School Improvement Offer & Learning Futures, initial discussions have taken place regarding the most suitable commissioning route, to contract with providers of services identified as neccessary/desirable by schools. A Dynamic Purchasing System is the current favoured option. Gap analysis information to be provided to allow initial market engagement planning to begin. RF - Secondary improvement partner contract is currently on hold and discussions iunderway with provider to decide a way forwards or whether to decommission due to OA duplication. New Primary Improvement contract (£60k) for the 2019/20 academic year has been developed and signed, with upfront payments authorised - contract/services are now underway to be monitored.
31-Oct-2019 19-20 OCF PM45, L&A LE 03, L&A LE 04
To implement the three agreed test areas of integrated commissioning; a) Vulnerable adolescents placed out of area, b) the first 1,001 days and a new way of working, c) Children with additional needs
19-Nov-2019 Complete 31-Dec-2019 SW 20, SW 24, SW 25
To evaluate the test areas of integrated commissioning
19-Nov-2019 No Update 31-Mar-2020 SW 20
SW 24
SW 25
Oversee the implementation of the
14-Nov-2019 AI - The DCCG led Maternity 31-Jul-2019 SW 06
60
Title Progress Bar Latest Note Due Date Linked PIs Code
provider Maternity action plan to ensure improvements in quality of care
Quality Sub group now meets every month and feeds into the DCCG CQRG process. The group has become an effective senior level working group. The composite action plan developed through the quality concerns identified through the Quality Risk Profile (QRP) undertaken January 2019 is almost completed. A further QRP was undertaken July 2019. Following review of the QRP by NHSE/I and CQC, it is recognised that the standards appropriate to the quality expectations held within the contract are now being met. While DBTH have some further work to do, DCCG and commissioning / monitoring partners are satisfied that they are fully sighted on all remaining issues and continue to put steps in place in order to mitigate any associated risks.
SW 07
SW 08
SW 09
SW 18
Commission services around school improvement at both primary and secondary to support improvements in attendance and attainment.
14-Nov-2019 To support the School Improvement Offer & Learning Futures, initial discussions have taken place regarding the most suitable commissioning route, to contract with providers of services identified as neccessary/desirable by schools. A Dynamic Purchasing System is the current favoured option. Gap analysis information to be provided to allow initial market engagement planning to begin. RF - Secondary improvement partner contract is currently on hold and discussions iunderway with provider to decide a way forwards or whether to decommission due to OA duplication. New Primary Improvement contract (£60k) for the 2019/20 academic year has been
31-Oct-2019 19-20 OCF PM45, L&A LE 03, L&A LE 04
61
Title Progress Bar Latest Note Due Date Linked PIs Code
developed and signed, with upfront payments authorised - contract/services are now underway to be monitored.
SW 4 - Responsive & Accessible Care in Crisis
Title Progress Bar Latest Note Due Date Linked PIs Code
Develop a business case for an enhanced community mental health provision across the Integrated Care System footprint, with the aim of reducing the number of acute in-patient admissions
14-Nov-2019 No Update 31-Jul-2019 CYPP HH 01, CYPP HH 02, CYPP HH
10, CYPP HH 11, CYPP HH 15, CYPP HH 16, LW 19, LW 20, SW 10, SW 19, SW 21, SW 22, SW 23
SW 5 - Person Centered support for complex needs
Generated on: 20 November 2019
Title Progress Bar Latest Note Due Date Linked PIs Code
To standardise the approach for dynamic risk registers across the transforming care partnership footprint, so that all children and young people get the same offer
14-Nov-2019 AI - The work and achievements seen across Doncaster’s all aged Transforming Care Programme continues to be recognised nationally as best practice. The Head of Quality and Transforming Care Specialist alongside the PM&S team have continued to meet with other areas across the local TCP foot print as well as others across the country. DCCG and DMBC continue to share all relevant documents such as Terms of Reference, register templates and fact
30-May-2019 SW 12
SW 13
SW 14
SW 15
62
Title Progress Bar Latest Note Due Date Linked PIs Code
sheets in order to promote replication and standardise approached used across different areas. KF-B. Currently actively involved in the development and implementation of the PM&S (Doncaster's dynamic risk register) in Sheffield. Once embedded, we will offer the same support across the wider partnership.
Commission a new care and treatment review resource to ensure community options are considered prior to admission
14-Nov-2019 First wave of recruitment was unsuccessful. Post has now been confirmed as permanent and will be advertised in due course.
30-May-2019 SW 12
SW 13
SW 14
SW 15
Relaunch the children's commissioning steering group in relation to Transforming Care
14-Nov-2019 There have now been 2 meetings of the relaunched steering group. Terms of Reference and attendees have been updated and confirmed. At the next meeting, the workstreams will be determined.
30-Apr-2019 SW 12
SW 13
SW 14
SW 15
Explore pooled budget arrangements for Future Placements
20-Nov-2019 No Update 30-May-2019 SW 17
Implement the recommendations from the self-evaluation framework that supports the vision of providing the best support possible to children and young people with additional needs
14-Nov-2019 Priorities have been determined following development of the SEND Inspection. The revised strategy contains 6 strategic priorities and there are a series of task groups with partners to strengthen partnership working.
30-Jul-2019 CYPP EW 01, CYPP EW 02, SW 13, SW 14, SW 15
Commission timely initial health assessments for Looked After Children
14-Nov-2019 Specification signed off and approved by CCG's Clinical Reference Group and Executive Committee. Working with procurement to send out a single provider tender for evaluation and award in December and mobilisation by January 2020.
31-Oct-2019 CYPP HH 17
63
Title Progress Bar Latest Note Due Date Linked PIs Code
Reduce the waiting times for Autism pathway
20-Nov-2019 No Update 31-Mar-2020 SW 15
Reduce the waiting times for Attention Deficit/Hyperactivity Disorder (ADHD) pathway
20-Nov-2019 No Update 31-Mar-2020 SW 15
Develop a future placements strategy.
18-Nov-2019 A paper with recommendations will be going to cabinet in January 2020
31-Mar-2020 SW 17
Implement recommendations from future placement strategy
20-Nov-2019 No Update 31-Mar-2020 SW 17
Support the development of a new alternative education offer to ensure all children and young people get fair access to learning
14-Nov-2019 Alternative Provision DPS is live. 3 new providers have been mobilised this month, bringing the current total to 35 and 102 mini competitions to date.
31-Dec-2019 L&A LE 03
L&A LE 04
Development of joint commissioning inline with the code of practice, across health, education and social care for special education needs
14-Nov-2019 This work will be picked up as part of the Joint Commissioning Priority 6
31-Mar-2020 CYPP EW 01
CYPP EW 02
SW 13
SW 14
SW 15
To commission services within the scope of the areas of opportunity to improve education and social mobility
14-Nov-2019 All projects now agreed by Partnership Board. Planning for potential extension now underway. Mobilisation of a small number of projects currently live but majority are in contract management phase.
31-Mar-2020 16/17 PI 64.
19-20 OCF PM48
19-20 OCF PM48a
CYPP EW 01
CYPP EW 02
64
Starting Well PIs – Listed below are the key performance indicators for escalation to the Governing Body. A full list of Starting well indicators are available on request.
19-20 OCF PM48 Secondary schools persistent absent rate (10% Absenteeism)
Current Value
15.4%
Current Target
12.7%
65
16/17 PI 64. Primary schools persistent absent rate (10% absenteeism)
Current Value
11.1%
Current Target
9.2%
66
CCG_DP_C&M_01 Total number of Paediatric assessments taken place at DBTHFT
Current Value
328
Current Target
202
67
CYPP EW 01 Achievement Gap between disadvantaged pupils and their peers at KS2
Current Value
21.1%
Current Target
19.5%
68
CYPP HH 01 Number of young people admitted to an acute mental health bed (tier 4)
Current Value
6
Current Target
6
69
CYPP HH 10 Number of emergency responses seen within 4 hours (CAMHS)
Current Value
100%
Current Target
98%
70
CYPP HH 15 General Acute Hospital Admissions for Self-harm (aged 10 - 24 rate per 100,000)
Current Value
81.79
Current Target
100.9
71
L&A LE 03 Fixed Term Exclusions – Primary school (percentage)
Current Value
2.2%
Current Target
1.4%
72
L&A LE 04 Fixed Term Exclusions – Secondary school (numbers of pupils)
Current Value
57
Current Target
10.1
73
SW 07 There will be fewer babies born by emergency Caesarean (15.2% by march 2020)
Current Value
21.8%
Current Target
15.2%
74
SW 08 Reduction of proportion of women Smoking At Time Of Delivery by 5% with the aim of obtaining the 11% standard by 2022
Current Value
14.4%
Current Target
16%
75
SW 09 Maintain the proportion of women with Normal (include all registerable spontaneous vaginal births) births to 60.9% by March 2020
Current Value
57.9%
Current Target
60.9%
76
SW 15 Reduction in the waiting times for patients with Autism and ADHD of 15% by March 2020
Current Value
40%
Current Target
92%
77
SW 18 10% Reduction in the number of Stillbirths of babies delivered by the end of March 2020
Current Value
4
Current Target
12
78
SW 22 95% of children and young people will receive non-urgent treatment within 8 weeks of the CAMHS referral
Current Value
93.1%
Current Target
95%
79
Page 1 of 4
Meeting name Governing Body Meeting date 5 December 2019
Title of paper
Future Placements Strategy
Executive /
Clinical Lead(s) Anthony Fitzgerald, Director of Strategy and Delivery
Author(s) Lee Golze, Acting Assistant Director Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The purpose of this report is to provide a background of the current provision for Children in Care in-house residential homes, those families who receive an overnight Short Breaks service and the offer for young people leaving care, to stay with their foster carers when they become 18 years old. It sets this within the wider context around foster care provision and semi-independent living arrangements for young people leaving care. The report sets out a series of recommendations that will improve services for children by providing greater opportunities for them to thrive in secure and stable environments akin to family settings within Doncaster. No child will be moved from an existing placement unless it is in their best interests. Recommendation(s) The CCG Board is asked to:
1. Endorse the development of six new, two-bedroom Children’s homes, which will reduce the need for out of authority providers, and ensure Doncaster children are looked after in Doncaster, in secure and stable environments akin to family settings.
2. Approve the purchase and refurbishment of two, two bedroom Children’s homes to the Learning and Opportunities: Children and Young People capital programme and transfer budget of £0.6m from the Investment & Modernisation Fund held in the Corporate Resources capital programme.
3. Approve the increase in the ‘Staying Put’ rate to foster carers, to enable more young people to remain at home with their foster carers once they become 18 years old.
4. Endorse the decision to develop a more modern and improved Short Breaks overnight offer, and to note that a further report will be presented to the Executive following conclusion of a consultation exercise with stakeholders.
5. Support the plan to recruit more in-house foster carers, including specialist foster carers and reduce the number of children in, independent fostering agency
X
Page 2 of 4
placements and out of authority providers.
6. Support the plan to develop a new in-house residential setting, for young people with the most complex needs aged 16years and above.
7. Welcome associated savings arising in the Dedicated Schools Grant High Needs Block and Doncaster Children’s Services Trust cost of service delivery.
8. Acknowledge the level of consultation to date and the commitment to continue to consult throughout subsequent phases.
Report Exempt from Public Disclosure Is the report Exempt from Public Disclosure? Yes No Impact analysis Quality impact -
Equality impact
The proposals would provide greater opportunities for equality, in particular for children with complex needs, as they will be able to stay in services in Doncaster, with specialist foster carers and/ or in a residential setting. They can’t currently, which is not the same for children without complex needs.
Sustainability
impact nil
Financial implications
The proposals outlined in section six of the body of the main report (Appendix A) have been factored into the consideration for the Council’s, Dedicated Schools Grant High Needs Block and Doncaster Children’s Services Trust Medium Term Financial Strategies. The table below summarises net savings totalling £3.3m for financial years 2020/21 to 2022/23 from implementing each proposal.
X
Page 3 of 4
The table below summarises a budgetary pressure of £1.1m by 2022/23 across Social Care, Education and Health that will be avoided for Children with complex needs placements by implementing the proposal for specialist foster carers.
The full narrative of the financials associated to the proposals are outlined in the body of the main report, section 11, page 10.
Legal implications
The proposals contained within this report relating to the future placement of children and young people and, will assist in the Council and the Doncaster Children’s Trust meeting their various statutory duties in relation to Children in Care and Children with complex needs. This includes duties in the Children Act 1989 and the Children and Families Act 2014. When considering the final proposals at a future date, elected members
Proposal
2020/21 Pressure/Savings to
budget (£s)
2021/22 Pressure/Savings to
budget (£s)
2022/23 Pressure/Savings to
budget (£s)
Total Pressure/
Savings (£s)
Children with complex needs: 2 x 2 Bed Homes & Specialist Foster Carers:DMBC General Fund -88,800 7,470 -31,850 -113,180 Dedicated Schools Grant High Needs Block -423,000 103,510 -38,590 -358,080 Doncaster CCG Continuing Health Care Contributions -61,120 25,280 -24,740 -60,580 Children with complex needs: Borrowing costs of £600k capital funding required:DMBC General Fund 31,000 31,000 31,000 93,000Children's Trust 4 x 2 Bed Homes:DCST General Fund 120,920 120,920 0 241,840Dedicated Schools Grant High Needs Block -306,260 -306,260 0 -612,520 Re-profile foster care provision:DCST General Fund -445,420 -731,620 -519,420 -1,696,460 4 Bed Home for 16+ children:DCST General Fund 0 -120,000 0 -120,000 Dedicated Schools Grant High Needs Block 0 -146,260 0 -146,260 Revised Short Breaks offer:DMBC General Fund -600,000 0 0 -600,000 Increase Staying Put rate to £250 p/w:DCST General Fund 70,540 0 0 70,540TOTAL DMBC General Fund -657,800 38,470 -850 -620,180 TOTAL DCST General Fund -253,960 -730,700 -519,420 -1,504,080 TOTAL Dedicated Schools Grant High Needs Block -729,260 -349,010 -38,590 -1,116,860 TOTAL Doncaster CCG Continuing Health Care Contributions -61,120 25,280 -24,740 -60,580 TOTAL Net Savings -1,702,140 -1,015,960 -583,600 -3,301,700
Proposal
2020/21 Cost
Avoidance to budget
(£s)
2021/22 Cost
Avoidance to budget
(£s)
2022/23 Cost
Avoidance to budget
(£s)
Total Cost Avoidance
(£s)Specialist Foster Carers:DMBC General Fund -7,450 -265,230 -109,070 -381,750 Dedicated Schools Grant High Needs Block -98,980 -249,930 -150,930 -499,840 Doncaster CCG Continuing Health Care Contributions -40,750 -122,230 -81,490 -244,470 TOTAL Cost Avoidance -147,180 -637,390 -341,490 -1,126,060
Page 4 of 4
will need to be reminded of their obligations under the public sector equality duty under section 149 of the Equality Act 2010.
Management of Conflicts of
Interest No conflict of interest declarations.
Consultation / Engagement
(internal departments,
clinical, stakeholder
and public/patient)
There has been a significant amount of consultation as part of the initial development of the strategy and subsequently around the development of the proposal. There has been a significant amount of consultation around all aspects of the strategy. This includes with children, parents and carers, front line staff and senior leaders across the system, including agreement on the strategy at the Joint Commissioning Management Board, the Council Joint Leadership Team and Children’s Trust Executive Management Team. Further detail is provided in the main body of the report, section 16, page 13.
Report previously
presented at
Council Extended Leadership Group Council Directors Council Executive Board Children’s Trust Board Joint Commissioning Operations Group Joint Commissioning Management Board CCG QIPP Programme Board Schools Forum
Risk analysis
Risk 1: Unable to source two-bedroom children’s homes – Mitigation: Individuals children’s needs have been assessed and there is a clear specification of requirements for each. Housing colleagues have picked this up. Risk 2: Not able to recruit enough in-house foster carers – Mitigation: Increase in recruitment budget to allow for greater depth of campaign learning from what works in other areas. There is a greater focus on recruiting specific types of carers with particular skills and experiences.
Risk 3: Unable to source a 16 + children’s home – Mitigation: A mixed economy approach where properties are either refurbished or purchased allows for significant scope in obtaining the third property. Risk 4: Not able to recruit enough specialist foster carers - Mitigation: targeted recruitment and support offer akin to the Mockingbird constellation model will ensure prospective carers feel supported and therefore able to offer the placements needed. Risk 5: Staying Put rate not agreed – Mitigation: The increase in the financial offer ensure more of our young people are able to enjoy family life to the age of 25 in line with most families. Further detail is provided in the main body of the report, section 9, page 9.
Corporative Objective / Assurance Framework
CO2, CO4
www.doncaster.gov.uk
Report ____________________________________________________________________
To the Chair and Members of the Governing Body Future Placements Strategy Relevant Cabinet Member(s)
Wards Affected Key Decision
Nuala Fennelly
To be confirmed Yes
1. EXECUTIVE SUMMARY 1.1 The purpose of this report is to provide a background of the current provision for
Children in Care in-house residential homes, those families who receive an overnight Short Breaks service and the offer for young people leaving care, to stay with their foster carers when they become 18 years old. It sets this within the wider context around foster care provision and semi-independent living arrangements for young people leaving care. The report sets out a series of recommendations that will improve services for children by providing greater opportunities for them to thrive in secure and stable environments akin to family settings within Doncaster. No child will be moved from an existing placement unless it is in their best interests. 1.2 Why is it a Key Decision? There are proposals to change the current (in-house) Doncaster residential homes provision; to add six two bed Children ’s homes, to change the financial offer to foster carers for young people to ‘Stay Put’ with their foster carers post age 18years old, and to develop a proposal for a new overnight Short Breaks offer. These changes strengthen the current policy to provide children’s services locally and in family friendly settings. The changes to foster care provision and semi-independent living services are not a key decision, but are included in the report to add context as this is a key part of the strategy to improve support. 1.3 Wards Affected. At the time of writing, it is difficult to know exactly which wards will be affected as there is still further work to be completed on where the new homes will be. The proposed change to the overnight Short Breaks offer potentially affects children and families from all wards. 2. EXEMPT REPORT This report is not exempt. 3. RECOMMENDATIONS Cabinet Members are asked to:
1. Endorse the development of six new, two-bedroom Children’s homes, which will reduce the need for out of authority providers, and ensure Doncaster children are
Date: 5th December 2019
2
looked after in Doncaster, in secure and stable environments akin to family settings.
2. Approve the purchase and refurbishment of two, two bedroom Children’s homes to the Learning and Opportunities: Children and Young People capital programme and transfer budget of £0.6m from the Investment & Modernisation Fund held in the Corporate Resources capital programme.
3. Approve the increase in the ‘Staying Put’ rate to foster carers, to enable more young people to remain at home with their foster carers once they become 18 years old.
4. Endorse the decision to develop a more modern and improved Short Breaks overnight offer, and to note that a further report will be presented to the Executive following conclusion of a consultation exercise with stakeholders.
5. Support the plan to recruit more in-house foster carers, including specialist foster carers and reduce the number of children in, independent fostering agency placements and out of authority providers.
6. Support the plan to develop a new in-house residential setting, for young people with the most complex needs aged 16years and above.
7. Welcome associated savings arising in the Dedicated Schools Grant High Needs Block and Doncaster Children’s Services Trust cost of service delivery.
8. Acknowledge the level of consultation to date and the commitment to continue to consult throughout subsequent phases.
4. WHAT DOES THIS MEAN FOR THE CITIZENS OF DONCASTER? 4.1 Our vision is for all children to have a right to a family life and wherever possible they will be supported to live with their birth parents or family. Where this is not possible, they will live with nurturing and supportive families. If they cannot live in a family home, they will live in a Children’s home, which replicates family life as closely as possible. Every effort will be made either to safely return children to their families or to ensure they have a permanent alternative family as soon as possible. In practice, this means: 4.2 More children will stay at home with their families with systemic support at the earliest possible stage, meaning fewer children entering the care system; continuing the reductions experienced over the last year. 4.3 For those Children in Care, there will be more opportunities for them to live in a setting as close as possible to family life where there is permanence and support. No child will be moved from an existing placement unless it is in their best interests to do so. 4.4 Children will move back into Doncaster into better quality homes more akin to a family setting. Their experiences are likely to be improved with greater opportunities for them to thrive in secure, stable and supportive environments, with local services better able to co-ordinate any wider support, i.e. education and mental health services. 4.5 Increased capacity locally will mean fewer children are placed out of Doncaster in the future over the next three years. 4.6 More Children in Care will live in Doncaster, which means they are able to go to school in the areas where they live, maintaining friendships and contact with their families (where it is safe to do so). They will be able to stay in Doncaster and access local services. 4.7 Services will give better value for money. 4.8 Children will be supported effectively through episodic periods of crisis with the aim of keeping them within the family home. 4.9 More young people would be able to stay with their former foster carers when they turn 18 years old, ensuring placement stability.
3
4.10 The Short Breaks offer will better meet the needs of children and their families. This will give greater independence, help the development of essential life skills and provide opportunities for hobbies and enjoyment whilst providing greater support to families. 5. BACKGROUND 5.1 The definition of looked after children (Children in Care) can be found in the Children Act 1989. A child is deemed to be looked after by a local authority if a Court has granted a Care Order to place a child in care, or a council's children's services department has cared for the child for more than 24 hours. The preference in Doncaster is to use the term Children in Care. 5.2 The agreed definition of a person with complex needs is someone with two or more needs affecting their physical, mental, social or financial wellbeing.' 5.3 Doncaster has experienced higher levels of demand for Children in Care than previously anticipated. This has placed a huge pressure on the system in relation to capacity, quality and cost. Doncaster experienced a growth rate of 11% from 2013 to 2018. Over the last year, we have started to see these reduce, and whilst they remain high in overall terms, it gives confidence moving forward. 5.4 The following chart highlights the demand increase from 2013 to 2018 and respective comparisons.
5.5 The table below shows the care ladder for Children in Care at the end of quarter two (21019), and is provided to demonstrate the range and volume of services currently available.
4
5.6 There are currently four in-house residential homes in Doncaster plus one overnight unit for Short Breaks. All of which are four bedroom homes apart from Oaklands, which has eight bedrooms. The table below shows the breakdown of utilisation across each of the homes and for the overnight provision. Residential
Home Registration
Use Ofsted Rating
Capacity Numbers in
Residence
Average Occupancy
Morrison Drive
Children’s Home
Outstanding 4 4 100%
Cromwell Drive
Children’s Home
Requires Improvement
4 4 100%
Amersall Road
Children’s Home
Good 4 4 100%
Pinewood Avenue
Children’s Home
Good 4 4 100%
Oaklands Short Breaks Overnight Provision
Good 8 Varies 3-5 per night, equates to
approx. 476 nights per
annum
35%
5.7 All four homes are at full occupancy, with all but one rated as good or above. This gives confidence in the Trust’s ability to run and manage in-house residential homes. However full homes of four children can present a challenge to residents and/ or the wider community and does not fit with the vision of having settings akin to a family home. It can also be difficult to match children in residential homes of more than two children. 5.8 Due to matching difficulties, capacity or specific needs that cannot be met by in-house provision, it is at times necessary to place children with independent providers, these maybe in Doncaster and/or out of Borough, these are called out of authority placements. Independent providers do not require the local Council’s authorisation to open and as such can apply to Ofsted for registration in any part of the Borough. The Council does have an opportunity to consider applications through the request for planning process. In February
2019/20Latest
Position
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2
In-house Residential 19 19 19 20 17 16 -4 -20% -3 -16%
Out of Area 29 31 33 35 29 32 -3 -9% 1 3%
Independent fostering agencies 195 206 189 169 172 166 -3 -2% -40 -21%
In-house fostering, incl. family & friends
204 207 198 191 186 208 17 9% 1 0%
Receiving Allowances 102 106 108 111 105 97 -14 -13% -9 -9%
Independent adoption agencies - 'bought in quarter'
3 2 2 4 5 2
Independent adoption agencies - 'sold in quarter'
2 3 2 3 4 1
287 311 320 320 319 324 4 1% 13 5%
163 172 182 174 177 178 4 2% 6 4%
16-17 Transition 27 28 32 26 28 26 0 0% -2 -7%
Supported Independent Living 3 6 5 5 5 5 0 0% -1 -33%
18+ Accommodation 51 40 39 38 42 42 4 11% 2 4%
Asylum seekers 7 4 3 3 2 4 1 33% 0 0%
Leaving Care
TrendMovement since
year endMovement over
12 months
2018/19
Residential care
Fostering
Adoption Services
Special guardianship orders
Child arrangement orders
5
2019, discussions took place around linking relevant professionals in to the planning consultation process for developments relating to independent children’s homes. The protocol dictates that senior leads in key agencies are consulted where planning permission is required, providing them with a 21 day period to view the details supporting a planning proposal and to provide comments to support their stance on the proposed development. Yet whilst there is now a greater opportunity to influence decision-making, the Council is unable to decline applications if they meet key criteria. 5.9 There are currently no in-house residential homes for children with a disability, which means that any child, who is unable to be in the family home, will need to be placed with an out of authority provider. There are ten children currently placed in an out of authority placement. The same challenges apply as raised in the above point. 5.10 There is only one specialist foster carer for children with complex needs, and no in-house residential home for older young people (16 years +) with complex needs. This at times means that children cannot stay within a family environment, which results in out of authority placements. Specialist foster carers are the most skilled and experienced carers who care for the most complex children and young people and there is a need to increase the number of these. 5.11 There are 374 children placed with foster carers with 208 residing with in-house foster carers. The benefits to placing locally as opposed to independent fostering agencies relate to both quality and price. An in-house placement costs approximately £27k per annum less than independent fostering agencies. Children in Care are more likely to stay in an in-house foster care placement longer, achieving better outcomes. 5.12 Short Breaks provide opportunities for disabled children to spend time away from their primary carers. This includes day, evening, overnight or weekend activities and take place in the child's own home, the home of an approved carer or a residential or community setting. Consultation with parents and carers has identified the need to revise our current Short Breaks offer in particular for overnight support. The current overnight offer is an eight bedroom children’s in-house residential home, which is clinical in its setting, being based more on a medical model than a family home. A recent survey of families identified that almost half did not give positive feedback about the residential unit, whilst being clear that they still want an overnight offer. In addition, the home is running below capacity due to the difficulty in matching children with complex health and neuro-developmental needs. Speaking to parents of children with severe complex health needs identified, that they do not want to use overnight residential facilities due to their anxieties around the impact of other children in the same facility, an example being a child with a complex tracheotomy and parental anxiety about this being knocked or pulled out. Recent consultation with families (that use the service the most) identified a very clear message that they want overnight support. There is a commitment to continue to consult with families around a new overnight provision and the development of a proposal. 5.13 Staying-Put is an arrangement where young people remain with their foster carers following their 18th birthday and was endorsed by the Government and formalised in the Children and Families Act 2014. The Staying-Put rate has remained static in Doncaster (£155 per week) since 2014, and is no longer competitive when considering the rate offered by neighbouring authorities (excess of £200 per week). This means that in order to secure staying put arrangements there is a need to pay high rates in line with foster care rates, which can be in excess of £600 per week to independent fostering agencies, with a proportion of the fee going to the agency and not the foster carer. This is placing a financially unsustainable burden on the budget, as there is a need to endorse former fostering rates, which can be in excess of £600 per week for an adult. In some cases, this has, resulted in young people leaving their foster placement. Implementing the new arrangement would see a predicted increase in the number of young people who stay put, around 20 per annum. Currently there are only twelve young people in staying put
6
arrangements, some of these with in-house carers and some with Independent Fostering Agencies. 5.14 For some children with more severe complex issues, aged between 16 and 18 years, traditional residential children’s homes are no longer appropriate, particularly if there is a mix of older and younger children. Many of these children have additional complexities requiring therapeutic interventions, which can mean that semi-independent living providers are unable to meet their needs. This frequently results in these young people moving from provision to provision because of their presenting behaviours. In some cases, this results in children being placed in out of authority placements. Consequently the creation of a bespoke and regulated children’s home, which focusses on preparation for independence, delivered alongside appropriate therapeutic inputs has a far greater chance of success. Currently in Doncaster, there is no such provision, which has indeed resulted in out of authority placements. 5.15 To conclude, the above captures the needs analysis, which to summarise are:
• Average capacity for in-house residential homes is at 100% and there is a need to increase in-house capacity with settings akin to family life.
• No current in-house residential homes for children with complex needs. • Need to recruit more specialist foster carers for children with complex needs. • Plan to recruit more in-house foster carers. • More children placed in out of authority placements than desired. • Short Breaks overnight provision is for some outdated and based on an historic
medical model rather than a family setting. • The Staying Put Rate is too low and is not competitive, hindering recruitment. • There is not an in-house residential unit for young people aged 16 years + that
offers wrap around therapeutic interventions for the most complex young people. 6. PROPOSALS 6.1 The introduction of six new in-house two-bedroom children’s homes, with the first four bedroom homes opening in 2020 and the second two homes opening in 2021, this includes two homes for children with complex needs. The requirements for the homes will reflect the needs of the children, including both single storey and two storey dwellings, to ensure the best environments are provided. The aspiration is for eight children to return to in-house residential provision by the end of 2020, with the second two homes providing four beds to manage future growth, meaning four children would not need to go out of Borough in the future. Detailed discussions have started to explore which children would be best suited to move to these provisions, considering their individual needs, including which educational setting would be best, and GP registration. Any placements would be done in a planned and managed way that has the best interests of the child at heart. Any move will be based on improving a child’s outcomes. Housing colleagues have been made aware of Ofsted requirements for homes and are starting to search for suitable properties. There are no special housing requirements outside of this, which hopefully broadens the scope of potential houses. 6.2 Recruit eight new specialist foster carers for children with complex needs. The Trust have started a targeted recruitment and discussions have taken place around which children would benefit from this type of placement, at the time of writing this report this is one child. The remaining seven places will be taken by assumed growth of three children in 2020/21 then four children over the following financial years. 6.3 Increase the number of in-house foster carers from 191 to 276 by 2023, so that 75% of all foster care placements are in-house. The Trust have a good track record of recruiting and retaining in-house foster carers and have already increased to 208 over the last quarter.
7
6.4 It is proposed that there may be a new Short Breaks offer for children and families who want support overnight. This is based on the outcome of initial consultation sessions with parents and carers, in particular those currently using the current overnight provision, as detailed in section 15. The aspiration is to develop a mixed economy of overnight provision in two settings, a residential unit offering around 500 bed nights per annum and foster cares offering around 100 nights per annum. The residential unit may not be Oaklands, which is the current provision, as this does not have the correct configuration and too many beds. No decision has yet been reached on this issue but it is felt that any new residential offer will include a smaller residential unit offering a setting more akin to family life, with a focus on creating an environment like a sleep over rather than the current more clinical setting. There are some foster carers that have expressed a desire to move away from providing full-time care but would like to continue providing some care, in particular overnights. This is the cohort of potential Short Break foster carers. The next phase is to develop a firm proposal for the new overnight offer and to consult with stakeholders on that proposal. 6.5 Implement a new Staying Put financial framework of £250 per week, which is competitive sub-regionally and encourages foster carers to support young people as they transition into adulthood. It will mean that 20 more young people per annum will get the opportunity achieve permanence. This is particularly important in terms of stability around assuring educational outcomes. 6.6 A new bespoke and regulated four bedroom in-house residential children’s home, which focusses on preparation for independence, delivered alongside appropriate therapeutic inputs. The new home will be managed by the Trust with dedicated wrap around therapeutic support form health services. The aspiration is that this cohort of young people get the intensive support they need in a secure and stable environment. 7. REASONS FOR RECOMMENDED OPTIONS 7.1 The recommended option is to agree the proposals outlined in section six as this will bring around the improvements outlined in section four. 7.2 If the proposals are not agreed then the improvements will not happen and the current arrangements will remain in place. 8. IMPACT ON THE COUNCIL’S KEY OUTCOMES
Outcomes Implications Doncaster Working: Our vision is for
more people to be able to pursue their ambitions through work that gives them and Doncaster a brighter and prosperous future;
• Better access to good fulfilling work • Doncaster businesses are
supported to flourish • Inward Investment
Doncaster Living: Our vision is for Doncaster’s people to live in a borough that is vibrant and full of opportunity, where people enjoy spending time;
8
• The town centres are the beating
heart of Doncaster • More people can live in a good
quality, affordable home • Healthy and Vibrant Communities
through Physical Activity and Sport • Everyone takes responsibility for
keeping Doncaster Clean • Building on our cultural, artistic and
sporting heritage
The Future Placements Strategy will enable several of the outcomes to be realised.
Doncaster Learning: Our vision is for learning that prepares all children, young people and adults for a life that is fulfilling; • Every child has life-changing
learning experiences within and beyond school
• Many more great teachers work in Doncaster Schools that are good or better
• Learning in Doncaster prepares young people for the world of work
Doncaster Caring: Our vision is for a borough that cares together for its most vulnerable residents; • Children have the best start in life • Vulnerable families and individuals
have support from someone they trust
• Older people can live well and independently in their own homes
Connected Council:
• A modern, efficient and flexible workforce
• Modern, accessible customer interactions
• Operating within our resources and delivering value for money
• A co-ordinated, whole person, whole life focus on the needs and aspirations of residents
• Building community resilience and self-reliance by connecting community assets and strengths
• Working with our partners and residents to provide effective
9
leadership and governance
9. RISKS AND ASSUMPTIONS The key strategic risks identified at this stage are as outlined below.
9.1. Risk 1: Unable to source two-bedroom children’s homes – There is a clear understanding of the requirements for the homes but there are potential risks, including the availability of stock, including an acquisition and agreement of capital funding (outlined in 8.1) and inability to secure an educational placement close enough to the home.
Mitigation – Individuals children’s needs have been assessed and there is a clear specification of requirements for each. Housing colleagues have picked this up. There are on-going conversations with the Capital Asset Management Board around securing capital funding. 9.2 Risk 2: Not able to recruit enough in-house foster carers – The Trust have been successful previously in recruiting foster carers however, there are challenges in doing so, including other Local Authorities campaigns and rates and independent fostering agency rates. Mitigation – Increase in recruitment budget to allow for greater depth of campaign learning from what works in other areas. There is a greater focus on recruiting specific types of carers with particular skills and experiences to allow better matching with children. There is a renewed focus on recruitment and as discussions progress around which children would be best suited to foster care provision, a more targeted recruitment is possible.
9.3 Risk 3: Unable to source a 16 + children’s home - There is a clear understanding of the requirements for the homes, but there is a risk that this stock does not exists locally. Mitigation – A mixed economy approach where properties are either refurbished or purchased allows for significant scope in obtaining the property. Likelihood of being unable to purchase a property to meet this need is therefore small. This will be a four-bed home and therefore obtaining the property should be relatively easy within the borough 9.4 Risk 4: Not able to recruit enough specialist foster carers - As this is a specialist area and outside of the mainstream ask and carers feel unable to offer this service Mitigation – targeted recruitment and support offer akin to the Mockingbird constellation model will ensure prospective carers feel supported and therefore able to offer the placements needed. We are actively recruiting over the coming months 9.5 Risk 5: Staying Put rate not agreed – The risk is potentially two-fold. Firstly, foster carers choose not to offer post 18years olds placements and/ or they join independent fostering agencies who offer a higher rate. Mitigation – Request for increase in rate included in this paper. The increase in the financial offer ensure more of our young people are able to enjoy family life to the age of 25 in line with most families. 10. LEGAL IMPLICATIONS [NC 27/11/19] 10.1 The proposals contained within this report relating to the future placement of children and young people and, will assist in the Council and the Doncaster Children’s Trust meeting their various statutory duties in relation to Children in Care and Children with
10
complex needs. This includes duties in the Children Act 1989 and the Children and Families Act 2014. 10.2 In relation to the short breaks offer, in order to comply with the general duty on Council’s to act fairly, prior to a decision to implement any final proposals relevant stakeholders including service users, their parent/carers and staff should be formally consulted. Sufficient reasons must be put forward for the proposals to allow for intelligent consideration and response by the stakeholders; adequate time must be given for consideration and response; and the product of the consultation must be consciously taken into account by elected members before a final decision is made on the proposals. In addition, given this area inevitably involves people with protected characteristics, when considering the final proposals at a future date, elected members will need to be reminded of their obligations under the public sector equality duty under section 149 of the Equality Act 2010. 11. FINANCIAL IMPLICATIONS [Officer Initials: AB 28/11/19] 11.1 The proposals outlined in section six have been factored into the consideration for the Council’s, Dedicated Schools Grant High Needs Block and Doncaster Children’s Services Trust Medium Term Financial Strategies. 11.2 The table below summarises net savings totalling £3.3m for financial years 2020/21 to 2022/23 from implementing each proposal.
Proposal
2020/21 Pressure/Savings to
budget (£s)
2021/22 Pressure/Savings to
budget (£s)
2022/23 Pressure/Savings to
budget (£s)
Total Pressure/
Savings (£s)
Children with complex needs: 2 x 2 Bed Homes & Specialist Foster Carers:DMBC General Fund -88,800 7,470 -31,850 -113,180 Dedicated Schools Grant High Needs Block -423,000 103,510 -38,590 -358,080 Doncaster CCG Continuing Health Care Contributions -61,120 25,280 -24,740 -60,580 Children with complex needs: Borrowing costs of £600k capital funding required:DMBC General Fund 31,000 31,000 31,000 93,000Children's Trust 4 x 2 Bed Homes:DCST General Fund 120,920 120,920 0 241,840Dedicated Schools Grant High Needs Block -306,260 -306,260 0 -612,520 Re-profile foster care provision:DCST General Fund -445,420 -731,620 -519,420 -1,696,460 4 Bed Home for 16+ children:DCST General Fund 0 -120,000 0 -120,000 Dedicated Schools Grant High Needs Block 0 -146,260 0 -146,260 Revised Short Breaks offer:DMBC General Fund -600,000 0 0 -600,000 Increase Staying Put rate to £250 p/w:DCST General Fund 70,540 0 0 70,540TOTAL DMBC General Fund -657,800 38,470 -850 -620,180 TOTAL DCST General Fund -253,960 -730,700 -519,420 -1,504,080 TOTAL Dedicated Schools Grant High Needs Block -729,260 -349,010 -38,590 -1,116,860 TOTAL Doncaster CCG Continuing Health Care Contributions -61,120 25,280 -24,740 -60,580 TOTAL Net Savings -1,702,140 -1,015,960 -583,600 -3,301,700
11
11.3 The table below summarises a budgetary pressure of £1.1m by 2022/23 across Social Care, Education and Health that will be avoided for Children with complex needs placements by implementing the proposal for specialist foster carers.
11.4 The narrative below describes the financials associated to the proposals outlined in section six. 11.5 Two-bedroom in-house residential children’s homes for children with complex needs has a projected individual bed cost of £173k per annum, which is approximately (£71k) cheaper than the current out of authority placement. The aspiration is for; four children to return to in-house provision and detailed discussions have started around a child’s individual needs and appropriateness of moving placement. The assumption is that two of these children will need an external education placement, which will cost on average £57k per annum. This proposal will require a (provisionally estimated) capital funding figure of £600k to cover the purchase of two homes and the refurbishments required, to make the homes suitable for the children identified. The £600k capital cost will be funded by borrowing through the Investment and Modernisation Fund; this creates a revenue cost of £31k per annum for the repayment of borrowing and interest. The savings are clearly far in excess of the borrowing costs. 11.6 The projected cost of a specialist foster care placement is £50k per annum, which is approximately (£194k) less than the current average cost of an out of authority placement. The Trust have started a targeted recruitment and discussions have taken place around which children would benefit from this type of placement, at the time of writing this report this is one child. A further seven places will be taken by assumed growth of three children in 2020/21 then two children per financial year thereafter which will result in annual cost avoidance of (£1.1m) by 2022/23 across social care, education and health as without this provision the growth of seven children across the next three financial years would have to be placed in an out of authority placement. 11.7 The two proposals for children with complex needs will deliver across financial years 2020/21 to 2022/23 general fund savings of (£113k) included in the Councils Medium Term Financial Strategy, savings to the Dedicated Schools Grant High Needs Block of (£358k), and savings to Doncaster CCG of (£61k) as their continuing health care contributions towards packages will reduce. 11.8 Two-bedroom in-house residential children’s homes has a projected individual bed cost of £135k per annum, which is (£75k) less than an out of authority placement. Out of authority placement are usually funded 50% from the Council’s general fund and 50% from the Dedicated Schools Grant High Needs Block. Future in-house residential placements will be fully funded from general fund at an increased cost of £30k per bed per annum to the general fund. However, the proposal will deliver significant savings of (£612k) per annum to the Dedicated Schools Grant High Needs Block, based on the assumption that 50% of the placements will go to a mainstream school and 50% will require external education to be commissioned. The proposal is included in the Trust’s Medium Term
Proposal
2020/21 Cost
Avoidance to budget
(£s)
2021/22 Cost
Avoidance to budget
(£s)
2022/23 Cost
Avoidance to budget
(£s)
Total Cost Avoidance
(£s)Specialist Foster Carers:DMBC General Fund -7,450 -265,230 -109,070 -381,750 Dedicated Schools Grant High Needs Block -98,980 -249,930 -150,930 -499,840 Doncaster CCG Continuing Health Care Contributions -40,750 -122,230 -81,490 -244,470 TOTAL Cost Avoidance -147,180 -637,390 -341,490 -1,126,060
12
Financial Strategy. The Trust have an allocation of £1.554m in the Council’s Capital Programme, which will be used to fund the purchase of the homes, and any renovation required. 11.9 The cost of an independent fostering agency placement is £27k more than an in-house placement; therefore, the Trust’s aim is by 2023 to have 75% of fostering placements in house with only 25% in an independent fostering agency placement. This proposal included in the Trust’s Medium Term Financial Strategy will deliver savings of (£1.696m) to the general fund across 2020/21 to 2022/23. This proposal does include increasing the support network to in house foster carers and the funding of this has been netted off the savings. 11.10 The Trust are proposing a further four bed children’s home for those children that are not quite ready for semi-independence. These young people will potentially be those who are currently living out of authority and/ or in independent provision. The average cost of the most complex children in an external placement is £260k per annum. The savings from this proposal included in the Trust’s Medium Term Financial Strategy is (£120k) per annum to the General Fund and (£146k) per annum to the Dedicated Schools Grant High Needs Block. The cost of purchasing and renovating the homes is included in the £1.554m in the Council’s Capital Programme. 11.11 There will be a re-profiled budget of £400k to deliver the revised Short Breaks offer. This proposal will deliver a (£600k) general fund saving, which is included in the Council’s Medium Term Financial Strategy. 11.12 The current rate Staying Put rate of £155 per week is less than the neighbouring authorities, the majority of whom are paying in excess of £200 per week. Increasingly independent fostering carers are not prepared to accept the £155 rate to allow young people to Stay Put and are requesting the same level of funding they received to foster often this is £300-£450 per week. The proposal is to increase the standard rate to £250 per week, which at an average activity of 20 Children Staying Put equates to £260k per annum. The Council receives Staying Put grant of £149k, which is paid over to the Trust via the contract, and, it has been assumed that 50% of young people Staying Put will claim Housing Benefit equating to £41k per annum. The net budget pressure from this proposal is £70k, which will be funded from the savings delivered by the other proposals included in the Trust’s Medium Term Financial Strategy. 11.13 In addition, these proposals will have a direct benefit to local employment opportunities and local spend. 11.14 The Trust have an allocation of £1.554 million in the Council’s capital programme as a figure for the development of a semi-independent living home, a further four bed children’s home for those that are not quite ready for semi-independence and four, two-bedroom children’s homes. This existing capital budget will be funded from capital receipts. 12. HUMAN RESOURCES IMPLICATIONS [KW 28/11/19] There are no human resource implications; however, there is an on-going commitment to keep checking this as the work progresses 13. TECHNOLOGY IMPLICATIONS [PW 28/11/19] Where there are technology requirements to support the delivery of the Future Placements Strategy, a proposal would need to be submitted for consideration and prioritisation by the Technology Governance Board (TGB). Full technology implications will be provided as part of the TGB process once the requirements have been clarified. 14. HEALTH IMPLICATIONS [CW 2811/19]
13
The report acknowledges the poor health and wellbeing outcomes that are often associated with a child entering the looked after system. The proposal aims to reduce the number of children entering care and increase the quality of care for those who do. The report outlines how work will be undertaken locally that will reduce inequalities in health and improve health outcomes for those children who experience disadvantage and poorer health outcomes. The reasons children go into care are often complex and multi-faceted. Therefore tackling the issue requires a range of interventions across agencies. A collaborative whole systems approach is likely to be more effective in preventing children going in to care than individual interventions. For children who do end up in care, regardless of where that is, care providers should be equipped to support and promote the health and wellbeing of the children in their care. 15. EQUALITY IMPLICATIONS [LG 26/11/19] The proposals would provide greater opportunities for equality, in particular for children with complex needs, as they will be able to stay in services in Doncaster, with specialist foster carers and/ or in a residential setting. They can’t currently, which is not the same for children without complex needs. There are no further concerns around equality implications at the time of writing the report. 16. CONSULTATION 16.1 There has been a significant amount of consultation as part of the initial development of the strategy and subsequently around the development of the proposal. 16.2 A Short Breaks review began with a questionnaire sent out to all 245 families who use the current respite service, 103 completed and returned the questionnaire (42%), which is a good return rate and gives confidence in that we are actively engaging. Overall families said they wanted overnight respite but almost half not giving positive feedback on the current provision. Building on this there has been consultation around the Short Breaks offer via Doncaster Parents Voice with the development of a working group that will shape and oversee the implementation. This means that residents will be directly shaping the services they need. The information obtained from families will be used to inform the development of the proposals for a new overnight offer. 16.3 There has been two consultation sessions with parents and carers of current service users at Oaklands (19.11.19), to ensure they are central to future decision making. Again, there is an-going commitment to work with this group around the new overnight provision. 16.4 There has been a significant amount of consultation around all aspects of the strategy. This includes with children, parents and carers, front line staff and senior leaders across the system, including agreement on the strategy at the Joint Commissioning Management Board, the Council Joint Leadership Team and Children’s Trust Executive Management Team. 17. BACKGROUND PAPERS 17.1 There are no background papers to submit. REPORT AUTHOR & CONTRIBUTORS Lee Golze Acting Assistant Director Learning and Opportunities – Children & Young People
14
[email protected] Julie Mepham Director for Children ’s Social Care Doncaster Children ’s Services Trust [email protected] Riana Nelson Director of Children’s Services Anthony Fitzgerald Director of Strategy and Delivery
Page 1 of 5
Meeting name Governing Body Meeting date 5 December 2019
Title of paper
Finance Report October 2019 (Month 7)
Executive / Clinical Lead(s) Hayley Tingle, Chief Finance Officer
Author(s) Tracy Wyatt, Deputy Chief Finance Officer Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary This report sets out the financial position as at the end of October 2019 for consideration by the Governing Body. The report also provides details on the CCG’s long term planning for approval. The CCG is forecasting to achieve all of its financial targets for 2019/20. The report also outlines:
• The key risk areas identified for 2019/20 • The CCG’s Operating Cost Statement (Appendix 1) • A summary of the CCG Efficiency Savings for 2019/20 (Appendix 2) • A summary of the CCG’s Resource Allocation (Appendix 3) • A summary of the CCG’s Reserve position (Appendix 4)
Recommendation(s) The Governing Body is asked to:
• Receive the report and note any risks and issues as highlighted in the report.
Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption:
X
X
Page 2 of 5
Impact analysis Quality impact N/A
Equality impact
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.
An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability impact NIL
Financial implications
Forecasting to meet all Financial Targets however QIPP is currently under target and is forecast to slightly under deliver
Legal implications NIL
Management of Conflicts of
Interest N/A
Consultation / Engagement
(internal departments,
clinical, stakeholder and public/patient)
N/A
Report previously
presented at None
Risk analysis
Overall financial risks identified at plan stage of £7.1m. As forecasts are refined the risk is reviewed and now stands at £3.9m. Some pressures
materialising particularly in relation to Individual Placements, prescribing and High Costs Drugs within DBTH contract
Corporative Objective / Assurance Framework
CO3 - maintain spend within allocations overall and specifically for Running Costs. Delivery of QIPP plans and mitigation of overall risk
identified at planning stage.
Page 3 of 5
NHS DONCASTER CCG 2019/20 FINANCE REPORT MONTH 7 – OCTOBER 2019 1. Introduction
This report provides the financial position for NHS Doncaster CCG for 2019/20 as at the end of October 2019 (Month 7). The CCG is forecasting to achieve all of its financial targets for 2019/20. 2. Current Position The following table shows the CCG’s current and forecast position for the key financial targets and statutory duties -
Key Duty Target Month 7 Forecast
Financial Position
NHSE In year reporting - breakeven B/E B/E Achieve cumulative underspend annual target of £13,348k surplus (£7,786k M7)
£7,784k £13,347k
QIPP Achievement Annual Plan £10,121k (£5,333 Month 7) £4,797k £8,793K
BPPC
95% + invoices paid within 30 days (NHS) 98.39% 98%
95% + invoices paid within 30 days (non NHS) 99.12% 98%
95% + invoice values paid within 30 days (NHS) 99.93% 98%
95% + invoice values paid within 30 days (Non NHS) 98.47% 98%
Cash Drawdown
1.25% of monthly drawdown remaining at period end 1.30% 1.25%
Running Costs Maintain spend within annual target of £6,900k (£4,024k M7) £3,003k £5,571k
Delegated Co- Commissioning
Maintain spend within annual target of £44,571k (£24,989k M6) £24,622k £44,556K
Capital Resources
Expenditure not to exceed allocation (N/A) N/A N/A
Key
Red Not achieving and unlikely to be met Amber Not currently achieving but could be
recovered or under- performing Green Achieving and on target to be met
Page 4 of 5
The CCG’s financial position reflects break-even which is in line with the target set by NHS England. The CCG is forecasting to achieve a cumulative surplus of £13,349k which is also in line with expectations. The QIPP achievement is reported as under target at Month 7 by £536k. There is an expectation that all organisations within the SYB footprint will meet their individual control totals and therefore meet the SYB control total. The current and forecast position is summarised in the Operating Cost Statement included at Appendix 1. 3. Key Messages and Risks
As part of the 2019/20 Financial Plans, £7.1m of potential risks were identified. The main risk identified was the achievement of the ambitious efficiency plans £2.7m, acute contract over performance £1m, increased costs associated with individual placements £1.4m (including Continuing Healthcare, Specialist Placement and Section 117 packages) and prescribing £2m. The risks have reduced overall due to the updated QIPP position but have increased in relation to CHC due to a forecast overspend against this budget. All risks are being closely monitored in year and mitigating action taken early. Pressures are now being seen in the DBTH contract relating to high cost drugs, in prescribing due to Cat M pricing and on Individual Placement costs and activity. These are currently being managed within the overall allocation and additional work is underway to understand the pressures and how they can be controlled, In order to mitigate the overall risks identified, the CCG set aside 0.5% of its allocation as a contingency fund, as required by the business rules. This equated to £2.6m, plus there is a small value of funding remaining in the contracting reserve. Due to the reduction in risks now included in the forecast position there is no longer a requirement to identify additional QIPP schemes to achieve financial balance however some new schemes have already been identified and are included in the QIPP monitoring and we will continue to identify new schemes for future delivery. 3.1 DBTH Contract As part of the contract negotiation agreements significant additional funding was agreed in the DBTH contract in order to improve waiting times, reduce the waiting list size and achieve 92% RTT targets. The CCG has been working closely with the Trust to agree a robust and phased activity plan. The Trust has now shared their final plan with the CCG and the CCG are working through the financial implications, although it is within the overall envelope identified. The Trust’s plan is to increase activity from October and complete this by March 2020. It is the CCG’s expectation that the additional funding will be fully utilised by the Trust to deliver the 92% RTT standard, this will be closely monitored as this remains a high risk for the CCG if the additional activity is not delivered particularly given the
Page 5 of 5
late stage in the year. As at this stage only one month of the plan is included in contract monitoring so it is difficult to assess if the increase has happened. This will be closely monitored through Contract Board. 4. Efficiency Savings Programme
The CCG has set an ambitious efficiency plan equating to £10.1m. The main contracts with Doncaster and Bassetlaw Teaching Hospitals NHS FT and Rotherham, Doncaster and South Humber NHS FT were negotiated net of the agreed efficiency targets of £3.4m and £0.5m respectively. Each scheme has been RAG rated in terms of the risk to overall delivery and is being closely monitored through the QIPP board. Information for all schemes is now available and there is a under- performance of £536k year to date with a forecast of £8.8m which is an under performance of £1.3m. The DBTH schemes are slightly under achieving by £83k which is related to referral reductions but offset by overachievements on biosimilar switches. The CHC schemes have not yet delivered any savings due to increase activity and cost of placements, however it is assumed that some savings will be delivered in the latter part of the year which is a risk. Further schemes are being identified through the QIPP board to mitigate against any slippage and any other cost pressures that may arise in year. A summary of progress so far can be found at Appendix 2. 5. Further Allocations The CCG has received an allocation of £25k for Personalisation monies, £152k for Adult and Children’s Palliative Care and End of Life Services, £195k for Mental Health Liaison Transformation Funding and £81k for Enhanced GPIT Infrastructure and Resilience. 6. Capital Resource
The CCG has not received any capital funding in 2019/20. 7. Conclusion and Recommendations The Governing Body is asked to receive the Finance Report for October (Month 7) and note the risks/ issues as outlined in the report.
NHS DONCASTER CLINICAL COMMISSIONING GROUP Appendix 12019/20 FINANCE REPORT OCTOBER 2019
Recurrent Budget £000s
Non Rec Budget £000s
Total Budget £000s
Recurrent Budget £000s
Non Rec Budget £000s
Total Budget £000s
Forecast Outturn £000s
Variance (Under)/ Over
£000s
Recurrent Budget £000s
Non Rec Budget £000s
Total Budget £000s
YTD Actual £000s
Variance (Under)/
Over £000s
Baseline Allocation -475,786 -475,786 -475,786 0 -475,786 -475,786 0Running Cost Allowance -6,900 0 -6,900 -6,900 0 -6,900 -6,900 0Co-Commissioning -44,571 0 -44,571 -44,571 0 -44,571 -44,571 0In year drawdown of prior year surplus 0 -3,000 -3,000 0 -3,000 -3,000 -3,000 0Historic Drawdown 0 -13,348 -13,348 0 -13,348 -13,348 -13,348 0Initial Allocation -527,257 -16,348 -543,605 -527,257 -16,348 -543,605 -543,605 0 0 0 0 0 0
In year changes
Month 12 IR changes 14 0 14 14 0Excess Treatment Costs transfer to NHSE 0 19 19 19 0Diab Transf: DTCN08 MDFT 0 -29 -29 -29 0Diab Transf: DTCN08 DISN 0 -18 -18 -18 0Challenged TCP Funding 19/20 0 -150 -150 -150 0CYP Green Paper Project Initiation Funds 0 -125 -125 -125 0CYP Green Paper MH Support Teams 0 -403 -403 -403 0CYP Green Paper Four week waiting pilot 0 -122 -122 -122 0Improving Access Allocations 19/20 0 -1,958 -1,958 -1,958 019/20 Prior Year FTA Transfer 0 -2,340 -2,340 -2,340 0CYP Rotherham Allocation 0 325 325 325 0ETTF Revenue 0 -638 -638 -638 0Maternity Transformation Funding 0 -154 -154 -154 0Suicide Prevention Funding 0 -90 -90 -90 0MH Liaison TF allocation 0 -390 -390 -390 0GPFV STP funding 0 -263 -263 -263 0Diab Transf: DTCN08 MDFT 0 -29 -29 -29 0Diab Transf: DTCN08 DISN 0 -18 -18 -18 0CYP Green Paper MH Support Teams Trailblazers comm '18/19' 0 -101 -101 -101 04-Week Waiting Time Pilot comm '18/19' 0 -31 -31 -31 0LD transformation funding to TCP 0 -44 -44 -44 0BCF support 0 -126 -126 -126 0Personalisation monies 0 -25 -25 -25 0Non Recurring funding for Adult and Children’s Palliative and End of Life Care 0 -152 -152 -152 0MH Liaison Wave 2 Transformation Funding 0 -195 -195 -195 0Enhanced GP IT infrastructure and resilience arrangements 0 -81 -81 -81 0IR CHANGES 1 0 1 1 0TOTAL ALLOCATIONS -527,257 -16,348 -543,605 -527,242 -23,486 -550,728 -550,728 0 0 0 307,747 307,747 0
Acute Contracts - DBHFT 210,894 0 210,894 212,625 -1,515 211,110 212,478 1,368 123,192 0 123,192 123,990 798Acute Contracts - Other NHS 39,367 3,000 42,367 39,160 2,989 42,149 37,878 -4,270 24,051 0 24,051 21,518 -2,534Acute Contracts - Other Providers Non NHS 5,996 0 5,996 6,929 38 6,967 7,268 301 4,064 0 4,064 4,211 147
Acute Contracts - Urgent Care 6,210 0 6,210 6,209 0 6,209 6,209 0 3,622 0 3,622 3,622 0Acute - Non Contract Activity 4,376 0 4,376 3,572 0 3,572 2,991 -581 2,084 0 2,084 1,750 -333Total Acute Services 266,843 3,000 269,843 268,495 1,512 270,007 266,825 -3,182 157,013 0 157,013 155,092 -1,921
Mental Health Contracts - RDaSH FT 37,004 0 37,004 37,360 973 38,333 38,102 -231 22,485 0 22,485 21,611 -875Mental Health Contracts - Other NHS 574 0 574 1,110 0 1,110 628 -482 647 0 647 386 -262Mental Health Contracts - Other Providers 23,558 0 23,558 22,665 2,857 25,523 25,815 293 12,421 0 12,421 13,860 1,438Mental Health - Non Contract Activity 6 0 6 6 0 6 8 2 4 0 4 5 1Total Mental Health Services 61,142 0 61,142 61,141 3,830 64,972 64,553 -418 35,557 0 35,557 35,861 303
Community Contracts - RDaSH FT 33,541 0 33,541 31,824 1,668 33,492 33,550 58 19,544 0 19,544 19,574 30Community Contracts - Other NHS 391 0 391 391 152 543 543 0 228 0 228 224 -4Community Contracts - Other Providers 11,841 0 11,841 11,721 92 11,813 12,179 365 6,930 0 6,930 7,135 206Total Community Services 45,773 0 45,773 43,936 1,912 45,848 46,272 423 26,702 0 26,702 26,934 232
Prescribing 58,333 0 58,333 58,333 0 58,333 59,515 1,182 34,028 0 34,028 34,729 702Oxygen Services 759 0 759 759 0 759 756 -3 443 0 443 440 -2Other Primary Care Services 3,870 0 3,870 3,533 2,931 6,464 6,229 -234 3,637 0 3,637 3,513 -123GPIT 1,147 0 1,147 1,147 0 1,147 1,147 0 507 0 507 511 4Delegated Co-Commissioning 44,571 0 44,571 44,571 0 44,571 44,556 -15 24,989 0 24,989 24,622 -367Primary Care Services 108,680 0 108,680 108,343 2,931 111,274 112,204 930 63,603 0 63,603 63,816 213
Continuing Healthcare 32,510 0 32,510 32,513 0 32,513 36,071 3,558 18,966 0 18,966 21,283 2,317Continuing Healthcare Services 32,510 0 32,510 32,513 0 32,513 36,071 3,558 18,966 0 18,966 21,283 2,317
Non Recurrent Programmes 0 0 0 0 0 0 0 0 0 0 0 0 0Non Recurrent Programmes 0 0 0 0 0 0 0 0 0 0 0 0 0
Medicines Management 454 0 454 547 -26 521 531 10 310 0 310 309 -1Safeguarding 39 0 39 48 -2 46 70 24 27 0 27 46 20CHC Hosted Retros and PHB 29 0 29 29 0 29 29 0 17 0 17 16 -1Mental Health Assessments 0 0 0 0 0 0 0 0 0 0 0 0 0Quality Team 0 0 0 404 -19 384 384 0 224 0 224 216 -8NHS Property Services Recharge 2,235 0 2,235 2,235 0 2,235 2,221 -14 1,304 0 1,304 1,173 -131Corporate non running costs 2,757 0 2,757 3,263 -47 3,215 3,235 19 1,881 0 1,881 1,760 -122
Chief Pharmacist 82 0 82 82 -4 78 72 -6 45 0 45 40 -6Admin & Business Support 1,123 0 1,123 1,444 98 1,542 314 -1,228 899 0 899 178 -722Contract Management 581 0 581 581 -27 553 521 -32 323 0 323 258 -65Finance 759 0 759 750 -27 722 709 -13 421 0 421 406 -15Corporate Costs & Services 429 0 429 518 0 518 518 0 302 0 302 277 -25Human Resources 84 0 84 106 0 106 106 0 62 0 62 47 -15Health & Safety 11 0 11 12 0 12 12 0 7 0 7 7 0Patient & Public Involvement 154 0 154 154 -7 147 189 42 86 0 86 119 33Communications & PR 5 0 5 5 0 5 5 0 3 0 3 8 5Performance 895 0 895 824 -22 801 818 17 467 0 467 389 -79Quality Assurance 296 0 296 225 -11 215 215 0 125 0 125 123 -2Primary Care Support 261 0 261 249 -12 238 238 0 139 0 139 140 2Strategy & Development 969 0 969 688 70 757 665 -93 442 0 442 374 -68Governing Body 1,252 0 1,252 1,262 -56 1,206 1,190 -16 704 0 704 638 -66Corporate Running Costs 6,900 0 6,900 6,900 0 6,900 5,571 -1,329 4,024 0 4,024 3,003 -1,021
Total Corporate Costs 9,657 0 9,657 10,163 -47 10,115 8,806 -1,310 5,906 0 5,906 4,763 -1,143
CCG Reserves 0 0 0 0 0 0 0 0 0 0 0Contingency Reserve 0.5% 2,652 2,652 2,651 0 2,651 2,651 0 0 0 0 0 0Total Reserves 2,652 0 2,652 2,651 0 2,651 2,651 0 0 0 0 0 0
TOTAL APPLICATION OF FUNDS 527,257 3,000 530,257 527,242 10,138 537,380 537,381 1 307,747 0 307,747 307,750 2
CUMULATIVE SURPLUS REQUIREMENT 13,348 13,348 0 -13,348 7,786 0 -7,786
TOTAL 543,605 550,728 537,381 -13,347 315,533 307,750 -7,784
OPERATING COST STATEMENT
Opening Budget FORECAST YEAR TO DATE
NHS Doncaster CCG QIPP Monitoring Month 7 2019/20
Scheme ContractRecurrent
Target £000M7
Target M6 YTDM7
estimateTotal YTD Variance Forecast
Forecast Variance
RAG rating
Risk of Slippage
£000 CommentsOpthalmology Community procurement DBTH 129 56 0 0 0 -56 73 -56 73 May need review as part of overall contract agreementNew Pathway - Faecal Calprotectin DBTH 97 56 16 3 19 -37 34 -63 SY&B negotiated price reductionEvidence Based interventions- Phase 1 DBTH 336 196 68 11 79 -117 134 -202 90% reduction in activity assumedCommissioning for outcomes/EBI Phase 2 DBTH 1,352 791 735 123 858 67 1,473 121 Mainly impact of T&O procedures linked to audit findings and FYE'sAcupuncture full year affect DBTH 125 73 96 16 112 39 192 67 Needs audit reviewFIT testing- reduction in diagnostics DBTH 157 91 26 4 30 -61 51 -106 50% of ICS reduction assumedAdalimumab Biosimalar switch savings DBTH 1,037 470 503 84 587 117 1,007 -30 Based on reference priceReferral reductions/follow up reductions DBTH 123 70 0 0 0 -70 0 -123Contract Challenges DBTH 0 0 30 5 35 35 62 62DBTH Total 3,356 1,803 1,474 246 1,720 -83 3,027 -329 73
RDASH contract savings RDASH 483 282 242 40 282 0 483 0 Demographic growth £100k
Prescribing - identified schemes Prescribing 2,800 1,616 1,086 155 1,241 -375 2,128 -672 £2.8m of schemes identified, £194k from EPACT and switch data£720k based on Meds Mgmt estimate of workplans
Prescribing - schemes being developed Prescribing 700 408 0 783 783 375 988 288 205 Schemes being developed for remaining balance. Estimate based onreported budgetary position
Evidence Based Interventions Other providers including non NHS TBD TBD
Continuing Healthcare CHC 2,000 892 0 0 0 -892 1,108 -892 1,108 Further work required, phased Q2 onwards, Forecast reflects under
Intermediate Care Beds Reductions 0 0 63 10 73 73 125 125
Out of Hours cessation Primary Care 282 164 141 23 164 0 282 0 Cessation of 8-8 at Flying Scotsman
Primary care Primary care 300 50 405 12 417 367 452 152 Phased Q3 onwards
Other minor schemes 200 117 100 17 117 0 200 0
Total QIPP Plans 10,121 5,333 3,511 1,287 4,797 -536 8,793 -1,328 1,386
Potential New Schemes 87%QUIT ProgrammeMental Health impact on Acute CareChildrens Individual Placement StrategyRightcare - Frailty
RAG ratings
Likely to achieve in fullMay be some slippage but likely to achieve > 50%High Risk, may achieve less than 50% of target
In Financial Plans risk of non achievment of QIPP was estimated at £2.9m, this has reduced to £1.4m as forecasts are refreshed. This has been mitigated in plans with reserves and contingency
NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 3
SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 7 OCTOBER 2019
Recurrent Non Recurrent Total£000's £000's £000's
Baseline Allocation -475,786 0 -475,786Running Cost Allowance -6,900 0 -6,900Co-Commissioning -44,571 0 -44,571In year drawdown of prior year surplus 0 -3,000 -3,000Historic Drawdown 0 -13,348 -13,348Total Resources Available at Plan Stage -527,257 -16,348 -543,605
Adjustments to the Resource Limit:
Month 01 AprilNo adjustments 0 0 0
0 0 0
Month 02 MayNo adjustments 0 0 0
0 0 0
Month 03 JuneIR changes 14 0 14Excess Treatment Costs transfer to NHSE 0 19 19Diab Transf: DTCN08 MDFT 0 -29 -29Diab Transf: DTCN08 DISN 0 -18 -18Challenged TCP Funding 19/20 0 -150 -150CYP Green Paper Project Initiation Funds 0 -125 -125CYP Green Paper MH Support Teams 0 -403 -403CYP Green Paper Four week waiting pilot 0 -122 -122Improving Access Allocations 19/20 0 -1,958 -1,95819/20 Prior Year FTA Transfer 0 -2,340 -2,340
14 -5,126 -5,112Month 04 JulyCYP transfer to Rotherham CCG 0 325 325ETTF Funding Workforce Tool 0 -638 -638
0 -313 -313Month 05 AugustMaternity Transformatoin Funding 0 -154 -154Suicide Prevention 0 -90 -90MH Liaison 0 -390 -390
0 -634 -634Month 06 SeptemberGPFV STP funding 0 -263 -263Diab Transf: DTCN08 MDFT 0 -29 -29Diab Transf: DTCN08 DISN 0 -18 -18CYP Green Paper MH Support Teams Trailblazers comm '18/19' 0 -101 -1014-Week Waiting Time Pilot comm '18/19' 0 -31 -31LD transformation funding to TCP ref Claire Swithenbank 0 -44 -44BCF support 0 -126 -126
0 -612 -612Month 07 OctoberPersonalisation monies 0 -25 -25Non Recurring funding for Adult and Children’s Palliative and End of Life Care Services 0 -152 -152MH Liaison Wave 2 Transformation Funding 0 -195 -195Enhanced GP IT infrastructure and resilience arrangements 0 -81 -81IR Changes 1 0 1
00 -453 -452
Revised Resources available as at Month 7 October 2019 -527,243 -23,486 -550,728
NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 4SUMMARY OF RESERVES AS AT MONTH 7 OCTOBER 2019
RESERVES Recurrent Non TotalRecurrent
£000's £000's £000's
RISK RESERVES AND CONTINGENCIES
0.5% ContingencyInitial Plan 2,651 0 2,651Budget TransfersNo transfers as at Month 7 0
2,651 0 2,651
Total Reserves 2,651 0 2,651Cross Check to Operating Cost Statement 2,651 0 2,651
Page 1 of 7
Meeting name Governing Body Meeting date 5 December 2019
Title of paper
Chair and Chief Officer Report
Executive / Clinical Lead(s)
Dr David Crichton, Clinical Chair Jackie Pederson, Chief Officer
Author(s) Helen Harris, Head of Corporate Governance Paul Hemingway, Head of Communications and Engagement
Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary 1. Introduction The purpose of this report is to update the Governing Body on issues relating to the activity of the Doncaster Clinical Commissioning Group (DCCG) of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. 2. This month the paper includes updates on the following areas: CCG:
• Doncaster and Bassetlaw Place Review by Integrated Care System – Quarter Two
• East Locality Lead Appointment • Director of Digital • CAMHS – Working Together to Avoid Admissions • International Men’s Day 2019: It’s okay to talk • Doncaster CCG shortlisted for prestigious national award • Help us help you stay well this winter – Doncaster winter campaign • Launch of Health and Care professionals element of primary care campaign • Nominate your primary care shining star! • NHS in Doncaster Christmas Carol Service – 12 December 2019
National Update:
• NHS – Winter Readiness • Reducing single-use plastics in the NHS • Inpatients with Learning Disabilities or Autism to be given Case Reviews • £26 million to help Hospitals Introduce Digital Prescriptions • General Election Guidance
X
Page 2 of 7
Recommendation(s) The Governing Body is asked to note the report. Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption: Impact analysis Quality impact Neutral
Equality impact
Neutral
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. X An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.
An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability impact Nil
Financial implications Nil
Legal implications Nil
Management of Conflicts of
Interest Paper is for information. No relevant interests.
Consultation / Engagement
(internal departments,
clinical, stakeholder & public/patient)
N/A
Report previously
presented at None
Risk analysis Nil
Assurance Framework CO1 - 1.1
X
Page 3 of 7
Chair and Chief Officer Report 5 December 2019
1. CCG News
1.1 Doncaster and Bassetlaw Place Review by Integrated Care System – Quarter Two The Doncaster and Bassetlaw Place Quarter Two Review took place on 12 September 2019. The focus was on the delivery of elective care, referral to treatment times, elective pathway transformation and the Doncaster Royal Infirmary estate. The letter can be viewed in Appendix A. 1.2 Appointment of East Locality Lead Dr Rao Kalusu has been successful in being appointed as East Locality Lead, commencing in January 2020. 1.3 Director of Digital The CCG has appointed a Director of Digital to lead the digital agenda for the CCG and across the Doncaster Place. The post holder will develop the CCG Digital strategy for Primary Care ensuring it supports new ways of working and integrated IT services. The post holder will also support the partnership to deliver the Doncaster Place Digital Strategy that was agreed at Governing Body in November. The strategy has been developed in partnership with patients and frontline staff and will work with IT Leads across the partnership and this approach will continue into implementation. 1.4 Children and Adolescent Mental Health Services (CAMHS) - Working Together to Avoid Admissions The Chief Officer attended a North East and Yorkshire and Humber regional event on 20 November and presented Doncaster’s partnership approach to working together to avoid tier 4 CAMHS admissions. In 2016/17 the partnership involvement was limited, with a system that had a high volume of admissions via A&E, a financial cost of circa £3m and extended lengths of stay in hospital. Four key actions to improve systems and processes were: strategic buy in, a support database, proactive management and support and investment in to a CAMHS intensive support team. In 2019/20 there is now a collaborative proactive approach across Place, with self-harm admissions via A&E reduced from 150/100,000 to 82/100,000, a 77% reduction into tier 4 CAMHS services and significant reductions in length of stay. The model is also working for adults, with testing of this model on neighbourhoods.
Page 4 of 7
1.5 International Men’s Day 2019: It’s okay to talk On 19 November every year, International Men’s Day is commemorated worldwide to shine a spotlight on men who are making a positive difference and to raise awareness of issues that men face on a global scale. With male suicide being the biggest killer of men under the age of 45, according to charity Calm, encouraging people to have open conversations about topics such as men’s mental health and male suicide is essential. Doncaster CCG supported the awareness day, calling for organisations and individuals to encourage men, their friends and families to talk about issues that may affect their physical and emotional health. 1.6 Doncaster CCG shortlisted for prestigious national award An innovative system led by NHS Doncaster Clinical Commissioning Group (CCG) to better understand differences in healthcare has been shortlisted for a top national award. One of its kind, the Primary Care Matrix helps local practices better understand how they compare to other similar organisations across the borough. 1.7 Help us help you stay well this winter – Doncaster winter campaign Local health and care organisations have launched Doncaster’s Borough wide winter campaign to help people in Doncaster stay as well as they possibly can during the cold months. This year’s campaign focuses on four key areas to support people to stay well, take control over their own health and provide information to enable people to choose the right services for their needs. 1.8 Launch of Health and Care professionals element of primary care campaign In Doncaster, there’s a range of health and care professionals working across primary care that can provide help, information, advice and ensure you receive the care you need. Whether you see a GP, nurse, practice nurse, advanced nurse practitioner, clinical pharmacist or health care assistant, you will always receive the care you need, from the most appropriate person. As part of our Primary Care campaign in Doncaster, we want to ensure that everyone is aware of who works in primary care and what they do.
Page 5 of 7
1.9 Nominate your primary care shining star! The annual Doncaster General Practice Nurse and Health Care Assistant awards are back and open for nominations. And this year, we’re keen to recognise the fantastic work and care provided by all other practice staff so an additional award has been added; our Doncaster Pride of Primary Care award. Local practices, health and care staff, patients and members of the public are asked to nominate an individual that has provided fantastic care. 1.10 Christmas Carol Service – 12 December 2019 A special Christmas carol service is taking place on Thursday 12 December, 2019, 5.30pm at St George’s Minster in Doncaster to give thanks for the NHS. This event is open to anyone and everyone who wants to attend and say a special ‘thank you’ to the NHS in Doncaster, including NHS staff and volunteers, patients, members of the public and local voluntary and community organisations. This is a free service and open to everyone. Further information can be viewed on NHS Doncaster CCG website: Doncaster-christmas-carol-service 2. National News 2.1 NHS – Winter Readiness The NHS has developed a local ‘Winter Delivery Agreement’ which has been issued to Trust Chairs and Chief Executives, CCG Chairs and Accountable Officers, and STP/ICS Chairs and STP/ICS Leads. There have been a number of national “defaults” identified, being:
• More general and acute hospitals beds open, • Work with Local Authorities in relation to care packages and nursing /
residential beds, • GP Out of Hours services from 8.00pm-8.00am seven days a week, • Mental Health Services to respond quickly, • Community Health Services to be as responsive as acute emergency
services, • Improving uptake of the flu vaccine.
Refer to Appendix B for the letter from the NHS.
Page 6 of 7
2.2 Reducing Single-Use Plastics in the NHS The Chief Nursing Officer, NHS England / NHS Improvement, Ruth May calls on organisations to sign up to the NHS Plastic Reduction Pledge. ‘Across the NHS, nurses, midwives and other frontline staff are providing great leadership on environmental issues and championing sustainability where they work. ‘Support from local NHS organisations to sign the pledge and cut use of catering plastics will need all NHS staff to take action in their own areas and encourage their employers to go further faster.’ The deadline to sign the pledge has been extended to Friday 20 December. (Reference NHS England / NHS Improvement bulletin, issue 303, 21 November 2019). 2.3 Inpatients with Learning Disabilities or Autism to be given Case Reviews All 2,250 patients with learning disabilities and autism who are inpatients in a mental health hospital will have their care reviewed over the next 12 months. The government will commit to providing each patient with a date for discharge, or where this is not appropriate, a clear explanation of why and a plan to move them closer towards being ready for discharge into the community. The announcement builds on statistics which show that there has already been a 22% reduction of inpatient numbers since March 2015. The government has committed to a further reduction of up to 400 inpatients to be discharged by the end of March 2020. For those in long-term segregation, an independent panel, chaired by Baroness Sheila Hollins, will be established to oversee their case reviews to further improve their care and support them to be discharged back to the community as quickly as possible. The panel will monitor, challenge and advise on the progress of case reviews of those in the most restrictive settings, with the aim of supporting more people to be discharged. The panel will expect a clear plan towards a discharge date or an explanation for how providers are making progress towards discharging the individual. This is a direct response to the recommendation of the Care Quality Commission’s review of restrictive practices. In addition, the government will ensure that all inpatients have a case review focused on how to discharge them into the community. A further measure will see the government commit to greater transparency in this area, by agreeing to publish data on inpatients in mental health settings who have a learning disability or are autistic. This will take the form of an information dashboard, which will include data on inpatient rates in different regions, so areas can learn and share good practice. The government is also confirming today that every NHS and social care worker will receive mandatory training relevant to their role. The full story can be viewed on the Government website: All-inpatients-with-learning-disability-or-autism-to-be-given-case-reviews
Page 7 of 7
2.4 £26 million to help Hospitals Introduce Digital Prescriptions The digital prescription technology will see hospitals move away from handwritten prescriptions. The upgrade to more efficient systems will save the NHS time and benefit patients. The funding will support them to fulfil the NHS Long Term Plan commitment to introduce electronic prescribing systems across all providers. The full story can be viewed on the Government website: 26-million-to-help-hospitals-introduce-digital-prescriptions 2.5 General Election Guidance NHS England and NHS Improvement have submitted ‘Purdah’ guidance (Appendix C) to the NHS in the run-up0 to the general election. The guidance is effective from 6 November to 13 December. The day to day operations of the NHS must continue unimpeded and resources must not be used for party political purposes. Parliamentary visits by candidates to NHS Providers and CCGs are able to decide whether to agree to a visit.
South Yorkshire & Bassetlaw Integrated Care System 722 Prince of Wales Road
Sheffield S9 4EU
Programme Office: 0114 3051905
21 November 2019
To: Jackie Pederson, Accountable Officer, Doncaster CCG Idris Griffiths, Accountable Officer, Bassetlaw CCG Richard Parker, Chief Executive, D&BTHFT Kathryn Singh, Chief Executive, RD&SHFT Rupert Suckling, Director of Public Health, Doncaster MBC
Dear Colleagues
QUARTER TWO DONCASTER & BASSETLAW PLACE REVIEW
Thank you for participating in the Quarter 2 place review meeting on 12 September 2019. It was very helpful to focus on the delivery of elective care and consider progress in the implementation of your improvement plan. Apologies for the delay in circulating this letter, you will have had a draft for comment in October but there has been a delay in confirming and agreeing a final version. In future, we will send a draft within a week of the meeting, request your comments within the following week and then be able to send an agreed letter within three weeks.
Elective Care and Referral to Treatment Times We discussed current RTT performance, and our shared disappointment in the distance between the current and planned positions. RTT achievement has deteriorated over time, and delivery in Doncaster and Bassetlaw – and consequently the overall SYB ICS - is not assured. Thank you for sharing a discussion paper which had been prepared by Rebecca Joyce, Chief Operating Officer. We considered the work programme undertaken recently to cleanse waiting lists and identify next steps in the development and implementation of
a sustainable improvement plan. Data quality has improved significantly, and you have secured ongoing Intensive Support Team support. You explained that the timeframe for improvement and recovery to the NHS Constitution Standard of 92%, has moved from the original plan of Q2 2019/20. The Trust is now committed to securing sustainable delivery of the standard from Q4 2019/20 onwards. We noted several risks inherent in the improvement plan:
(i) the impact of ongoing waiting list validation and the potential identification of long-wait pathways;
(ii) the availability of timely, appropriate alternative capacity (compounded by the ongoing pensions issue); and
(iii) resolving residual contractual and funding arrangements, although we consider this risk to have diminished significantly.
Our collective endeavour is to deliver on NHS Constitution standards and our Operating Plans. I would be grateful if you could continue to work closely with Alison Knowles, Locality Director NHSE/I, to ensure through mitigation and assure your improvement plan.
Elective Pathway Transformation You provided an update on elective care transformation plans in Doncaster and Bassetlaw. We heard about your approach to demand management and pathway redesign; your ambition to enhance utilisation of the Electronic Referral System; and further Commissioning for Outcome plans. These initiatives, combined with Dr Doctor, Capacity Alerts and Choice at 26 weeks are integral to the place vision for reformed elective care. Estate We turned our discussion to the capital expenditure required to address backlog maintenance works at Doncaster Royal Infirmary. There are several planning options to consider, including the feasibility of a replacement hospital building. The Trust is developing a proposal for a new building, potentially on an alternative site. We agreed that it was vital that the Doncaster place and SYB ICS worked together in the exploration and development of options: both in the development of the proposition; and the implementation plan. When an initial proposition has been developed, I would like us to set aside some time to visit the DRI site, review the proposition and agreed next steps.
Thank you for taking the time to meet for the Quarter 2 place review, and for all you are doing for the people of the Doncaster and Bassetlaw places. Yours sincerely,
Sir Andrew Cash System Leader South Yorkshire & Bassetlaw Integrated Care System
OFFICIAL
1
Skipton House
80 London Road
London
SE1 6LH
Publishing Approval Number: 001239 5th November 2019
To
• Trust Chairs and Chief Executives
• CCG Chairs and Accountable Officers
• STP/ICS chairs and STP/ICS leads
Dear Colleague,
On behalf of the NHS, thank you for your leadership and the extraordinary dedication of your
staff as the NHS looks after record numbers of patients.
During recent weeks, we have worked with you to complete a national stocktake of winter
readiness and talked to many of you directly about how we can deliver for patients for the
rest of this year.
It is clear from your feedback that local partnership working has further developed over the
past year, providing the opportunity to jointly tackle challenges more effectively, with mutual
assistance and accountability. It has been suggested that individual organisations would find
it helpful if these arrangements were now confirmed locally in a ‘Winter Delivery Agreement’.
To support your work we have set out in Appendix 1 an approach you may find useful.
We have, as part of the stocktake discussions, been asked to set out what the expected
national “defaults” now are on several important elements. They are:
Enclosure B (i)
OFFICIAL
2
1. This winter the goal should, wherever possible locally, be more General and
Acute (G&A) hospital beds open, to reflect increased levels of patient need and
admissions.
2. Work with Local Authorities to ensure the same or more care packages and
nursing/residential home beds are available over the winter period than last year,
with the same level of visibility and dual sign-off on these plans.
3. GP Out of Hours services should be expected to deliver services from 8pm to
8am 7 days per week and, critically, over bank holidays.
4. Ensure mental health services can respond quickly and comprehensively,
particularly in relation to ED presentations.
5. Community health services able to operate to the same ‘clock speed’ of
responsiveness as acute emergency services, e.g. 2 hour home response where
that would avoid hospital admissions or speed discharges.
6. Improving uptake of the flu vaccine:
o A further increase in staff vaccinated to 80% or above, including through the
‘buddy’ arrangements in place to support trusts that struggled with this last
year;
o Achieving maximum levels of vaccination for eligible patients in community,
general practice and pharmacy settings.
We also heard clearly from the stocktake process that our most significant shared challenge
relates to workforce availability – particularly nursing – and also the continuing impact of
pensions taxes on doctors.
The Government’s second consultation on reform of the NHS Pension Scheme closed on 1
November and they have agreed to review the tapered allowance.
In the meantime, NHS Employers have published guidance on the options available to trusts
to support staff and service delivery in dealing with the pension tax. Many trusts have
already put in place schemes with a positive impact on clinical workforce supply, but a
OFFICIAL
3
number of provider board members have requested clarification on what the national
‘default’ should now be. We can confirm that of the options set out by NHS Employers,
among the most effective have been local policies on the payment of employer contributions
foregone as additional salary where scheme members have elected to opt out of the scheme
due to tax arrangements (see in particular section 3b of the September 2019 guidance from
NHS Employers). We are now signalling our expectation that trusts that have not done so
already should make immediate use of the flexibilities available (unless they are
demonstrably not experiencing any issues with medical staff availability). We can provide
examples of guidance and Board papers used by trusts that have already implemented
schemes if that would be helpful.
We would find it very helpful if chairs or chief executives confirm in the next fortnight the
arrangements they have in place or intend to put in place, through Regional Directors. Given
the urgency, where Remuneration Committee approval is considered necessary we would
ask that these meetings are arranged on an extraordinary basis.
In the coming weeks Regional Directors will work with you to support the development of
Winter Delivery Agreements and implementation of pension flexibilities. Please let them
know if there is any further information or practical support we can provide, to understand
the progress you are able to make and how we can best support you.
Yours Sincerely
Pauline Philip DBE
National Director of Emergency and Elective Care NHS England and NHS Improvement
Richard Barker Regional Director (North East and Yorkshire) NHS England and NHS Improvement
OFFICIAL
4
OFFICIAL
5
Appendix 1: Developing a delivery agreement
From the feedback we have received we suggest that it would be helpful for each system to
develop a ‘Winter Delivery Agreement’. The agreement would build on the work that has
taken place on winter planning at STP/ICS level. The focus of the Agreement would be to set
out how organisations in the STP/ICS will work together to maximise capacity, both in
hospitals and in the community during winter.
Systems are likely to want to:
• Discuss the progress of current winter planning and the extent to which it delivers
additional capacity across key service components
• Discuss the outcomes of the stocktake exercise for all organisations in the system
and the expectations for mutual support and support from programmes and corporate
teams
• Agree what further can be done to increase capacity this winter to deliver the six
priority expectations set out in this letter
You may also find it helpful to use the following list to help explore opportunities:
• GP Streaming – Increasing the proportion of patients who are streamed to primary care if
they don’t require A&E
• Same Day Emergency Care (SDEC) – Increasing the proportion of patients who can be
treated without requiring an overnight hospital admission, and establishing an acute
frailty team for 70 hours per week by the end of December 2019
• Increasing the proportion of patients discharged over weekends to reduce pressures on
inpatient beds and patient flow at the start of the week
OFFICIAL
6
• Reducing the number of patients with a long length of stay to ensure inpatient spells are
no longer than is clinically appropriate, in order to improve patient experience and to
increase the available bed stock
• Continuing the increase of the number of people accessing support and bookable
services through NHS 111
• Continuing to expand the availability of Urgent Treatment Centres to ensure that type 1
Emergency Departments are not the default for patients with minor injury and minor
illness
• Escalation – Hospital supported by systems put measures in place including the use of
full capacity protocols to minimise ambulance queues and improve patient flow out of
EDs.
• Primary Care – ensuring GP OOHs provision have planned for activity peaks and that
extended access hubs are well sign-posted
• Intermediate care – local community services should be assured that step-up/step-down
beds and workforce capacity are sufficiently resourced for increased winter demand
• Elective care – capacity for elective treatment should be delivered so that elective
treatment volumes agreed at the start of the year between commissioners and providers
are delivered
OFFICIAL
7
• Cancer care – ensuring capacity for delivering and managing cancer diagnosis and
treatment achieves improvements in the number of patients whose treatment starts in
less than 62 days from urgent referral
• Diagnostic services – increasing capacity for diagnostic services to significantly reduce
waits of over six weeks and in targeted service areas to reduce the lengths of wait for
elective and cancer care
• Directory of Services and MiDOs – local partners should be assured that all information
with the local DoS is up to date and well connected to the relevant ambulance service(s)
• Bank holiday capacity planning – as in previous years, a more detailed exercise will be
run on planned bank holiday capacity to ensure gaps are avoided and sufficient capacity
is planned for ahead of potential activity surge. This exercise will be run closer to the
Christmas/NYE period once local demand and capacity planning has advanced and
rostering is underway.
Our intention is that a Winter Delivery Agreement belongs to the system locally and we are
not suggesting that it needs to be shared nationally. However, we are asking that you share
with your Regional Director what additional capacity in terms of beds, out of hospital care,
etc that you have been able to identify.
NHS England and NHS Improvement
To: Chairs and Chief Executives of NHS Foundation Trusts and NHS Trusts Chairs and Accountable Officers of CCGs STP and ICS leads
Cc: NHS Regional Directors
5th November 2019
Dear Colleague,
GENERAL ELECTION GUIDANCE – FOR ACTION
Please find attached the usual ‘Purdah’ guidance, which always applies to the NHS in the run-up to a general election. This guidance takes effect from 00:01 hours tomorrow, Wednesday 6th November 2019, until Friday 13th December 2019 or the date at which a new government is formed.
The principles underpinning the guidance are that:
- the day to day operations of the NHS must continue unimpeded;- as always, the NHS must act and be seen to act with political impartiality, and its
resources must not be used for party political purposes; and- during the election period, democratic debate between candidates and parties should
not be overshadowed by public controversy originating from NHS bodies themselves.
Please therefore follow the attached guidance carefully, and in case of doubt please consult your Regional Director ahead of time.
In respect of campaign visits to NHS services and premises, NHS providers and Clinical Commissioning Groups are able to decide whether to agree a visit by a parliamentary candidate. But there should be no disruption to services; the same opportunity should be offered to other candidates in an even-handed way; and election meetings should not be permitted on NHS premises.
With best wishes,
Yours sincerely,
Simon Stevens NHS Chief Executive
NHS England & NHS Improvement Skipton House
80 London Road London SE1 6LH
Enclosure B (ii)
Pre-election guidance for NHS organisations
A general election will take place in the UK on 12 December. This note sets out longstanding guidance which always applies to the NHS during the run-up to an election. Communication activities during a general election should avoid competing with parliamentary candidates for the attention of the public. This note gives guidance to NHS organisations (NHS providers, clinical commissioning groups, STPs and ICS) on:
• the handling of requests for information and other enquiries during a general election campaign;
• briefing of MPs, prospective parliamentary candidates and ministers during the election period;
• carrying out business as usual activities during an election campaign.
Please contact your regional NHS England and NHS Improvement communications team if you need any further advice (contact details can be found below).
What is the pre-election period?
During the pre-election period, also referred to as ‘purdah’, specific restrictions are placed on the use of public resources and the communication activities of public bodies, civil servants and local government officials.
The pre-election period is designed to avoid the actions of public bodies detracting from or influencing election campaigns.
The pre-election period has implications for all NHS organisations (although it is worth remembering that the NHS should remain politically impartial at all times).
When does it start?
The start of the pre-election period is 00:01 hours on Wednesday 6th November 2019. The pre-election period will end once a government has been formed, on or after 13th December 2019.
Key considerations
You should ensure your organisation and staff behave impartially towards all candidates and political parties, and do not influence the election outcomes, whether inadvertently or intentionally.
The Cabinet Office has issued guidance, which also applies to NHS England and NHS Improvement. You are also asked to abide by the principles set out there.
As always during a pre-election period, there should be:
• no new decisions or announcements of policy or strategy; • no decisions on large and/or contentious procurement contracts; • no participation by official NHS representatives in debates and events that may be
politically controversial, whether at national or local level.
These restrictions apply in all cases other than where postponement would be detrimental to the effective running of the local NHS, or wasteful of public money.
You should consider:
• Requests for information from prospective parliamentary candidates (PPCs): These should always be handled in an impartial manner so that information is made available to all candidates. Information should be factual, and candidates should be responded to in a timely manner.
• Briefing and meeting prospective parliamentary candidates and ministers: Once Parliament is dissolved, every seat in the House of Commons becomes vacant. All business in the House comes to an end and MPs stop representing their constituencies so there will be no MPs until after the general election. Any briefing provided to former MPs should be available to all prospective parliamentary candidates. During an election, the Government retains its responsibility to govern, and ministers remain in charge of their departments. Essential business must carry on. Any briefings for ministers should be handled as per the usual process, ensuring any information shared is factual and provided promptly.
• Consultations: No consultations should be launched during the pre-election period unless they are considered essential. Ongoing consultations should continue but should not be promoted. Consultation periods can be extended if it is expected that the pre-election period will impact negatively on the quality of the consultation. Consultation responses should not be published until after the pre-election period has ended. If you have an issue or any questions about if something should or should not go ahead during this period, your regional NHS England and NHS Improvement communications team will be able to advise you.
• Media handling: Avoid proactive media work on issues that may be contentious. Reactive lines should be factual and, where possible, in line with previous lines. Any appearances on local or national media (TV, radio) should follow the same principles.
• Events: Avoid attending events where you may be asked to respond to questions about policy or on matters of public controversy. This may mean withdrawing from previously agreed engagements.
• Visits from politicians: Visits are permitted, but the decision to host visits is at your discretion. The same approach must be applied to all visit requests from candidates/parties to avoid any question of bias. Any visits should not interfere with the day to day running of your service and you should be mindful of patient privacy and dignity.
• Social media and web: Nothing contentious should be posted on your website or social media accounts. Updates/posts, including blogs, should only convey essential factual information.
• Campaigns: Do not undertake major publicity campaigns unless time critical (i.e. a public health emergency). However, ongoing business as usual campaigns such as the ‘Help us Help You’ or ‘We are the NHS’ can continue as planned.
• Board meetings: Board meetings should be confined to discussing matters that need a board decision or require board oversight. Matters of future strategy should be deferred.
• EU Exit: NHS organisations are expected to continue preparations for EU Exit, and existing guidance can be found here. If you have any questions about this, please contact your regional EU Exit Lead.
• Appointments of board members and non-executive directors: Appointments can continue as per the usual process unless you are concerned appointments may result in local political sensitivities, in which case, you may wish to postpone until after the elections. Exercise sensitivity over the timing of any announcements.
• Foundation trust governor elections: There is nothing to prevent foundation trust governor elections taking place. As above, exercise caution if there are concerns these may become political. Again, any announcements should be carefully considered during this period.
• Marketing: Printed materials, such as posters and leaflets, promoting contentious policy or proposed policy should not be given fresh circulation, but can be retained and issued in small numbers on request. Films and other media produced by the NHS, including the NHS logo, should not be made available for use by candidates/parties.
• Staff activism: NHS employees are free to undertake political activism in a personal capacity but should not involve their organisation or create the impression of their organisation’s involvement.
Useful resources
Cabinet Office Guidance for December 2019 Elections
Electoral Commission Local Election Updates
Electoral Commission Twitter
Contact details
Please contact your regional NHS England and NHS Improvement communications team if you need any further advice:
• North East and Yorkshire: [email protected] • North West: [email protected] • Midlands: [email protected] • East of England: [email protected] • South East: [email protected] • South West: [email protected] • London: [email protected]
Page 1 of 2
Meeting name Governing Body Meeting date 5 December 2019
Title of paper
Procurement Strategy update
Executive / Clinical Lead(s) Hayley Tingle, Chief Finance Officer
Author(s) Claire Burns, Head of Procurement Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The Procurement Strategy has been reviewed in line with the review date specified. The only amendment required at this time is the updated Single Quote Waiver document contained in the Standing Financial Instructions and approved at Audit Committee in November 2019. Recommendation(s) The Governing Body Committee is asked to note the update to the Procurement Strategy.
Report Exempt from Public Disclosure Is the report Exempt from Public Disclosure? Yes No
X
X
Page 2 of 2
Impact analysis Quality impact N/A
Equality impact
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.
X
An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability impact Nil
Financial implications Nil
Legal implications Improved adherence to Procurement Legislation
Management of Conflicts of
Interest Nil
Consultation / Engagement
(internal departments,
clinical, stakeholder and public/patient)
Nil
Report previously
presented at N/A
Risk analysis
Risks are associated with an outdated strategy which doesn’t reflect current policy and legislation and could lead to challenge from the market.
Corporative Objective / Assurance Framework
CO3
Page 1 of 27
Doncaster Clinical Commissioning Group
Procurement Strategy
Last Review Date 1st November 2018 Approving Body Governing Body Date of Approval Date of Implementation Next Review Date November 2021 Review Responsibility Head of Healthcare Procurement Version 4.0
Page 2 of 27
REVISIONS/AMENDMENTS SINCE LAST VERSION Date of Review Amendment Details May 2014 The document has been revised to reflect the Scheme of
Delegation (Page 20) October 2018 The document has been revised to reflect policy and legislation
changes including procurement thresholds in the Standing Financial Instructions. Amendments: Local Context - updated to reflect current policy and legislation (Page 4) Procurement Principles – updated to reflect current policy and legislation (Page 6) Grant Funding – updated links (Page 6) EU Procurement Legislation – updated to reflect current legislation (Page 7) Integration Choice and Competition – removed and replaced with NHS Procurement Patient Choice Regulations 2013 (Page 8) Social Value Act – updated to reflect current process (Page 9) Procurement Process update to reflect the revised procurement thresholds from the SFIs.(Page 11) Waiver Process Revised to reflect the revised SFIs – Waiver document attached as Appendix 2.(Page 14) Conflicts of Interest Process – detail removed and Standards for Business and Conflicts of Interest referenced. (Page 15) Procurement Planning – Addition of quarterly submission and sign off at Executive Committee (Page 16) Dispute Avoidance Policy Reference removed – no longer current Framework information updated to reflect current legislation and frameworks available. (Page 19) External Advice Section removed – CSU no longer a resource (Page 20) Sustainable Procurement – Updated to reflect current policy (Page 20) Monitor references removed and replaced with NHS Improvement Diagrams removed and replaced by revised process – added in Appendix 1
November 2019 This document has been revised to reflect the recommendation from Audit Committee in November 2019 to amend the Single Quote Waiver document to include Conflict of Interest. (Page 24)
Page 3 of 27
Contents 1. Introduction .............................................................................................. 4
2. Principles and Practice ............................................................................. 6
3. Legislation ................................................................................................ 7
4. Deciding whether to use the Competitive Tender Process. .....................10
5. Procurement Process ..............................................................................11
6. Avoidance of procurement rules..............................................................14
7. CCG Process for Managing Major Procurements ...................................15
8. Role of the CCG Governing Body in the Procurement Process ..............15
9. Confidentiality and Conflicts of Interest ...................................................15
10. Procurement Planning .............................................................................15
11 Most Economically Advantageous Tender (MEAT) .................................18
12 Framework Agreements ..........................................................................19
13 Any Qualified Provider (AQP) .................................................................19
14 Pilot Projects ...........................................................................................20
15. Sustainable Procurement ........................................................................20
16. Third Sector/SME Support ......................................................................21
Annex A - Glossary ........................................................................................22
Appendix 1 Process for Procurement .............................................................23
Appendix 2 Single Quote/Tender Waiver Request Form . Error! Bookmark not
defined.
Page 4 of 27
1. Introduction
1.1 Local and National Context NHS Doncaster Clinical Commissioning Group (CCG) comprises of 40 GP practices and is fully authorised as the statutory organisation with responsibility for commissioning (buying) many of the healthcare services for the Doncaster population of approximately 300,000 people. To maximise our ability to commission the highest quality services within the available resource allocation we work jointly with a range of partners which include, NHS England, Doncaster Metropolitan Borough Council, local health providers and the Voluntary Sector. As a CCG we are working to deliver an NHS that is fair, personalised, effective, and safe and provides effective choices for the population of Doncaster.
1.2 Background
With the introduction of the Health and Social Care Act 2012, Clinical Commissioning Groups (CCGs) were established with numerous:
• key statutory duties – the “must dos” that CCGs are legally responsible for delivering; and
• key statutory powers – things that CCGs have the freedom to do, if they wish, to help meet those duties.
There are clearly significant reputational and legal consequences of non-compliance with legislation. All organisations should have arrangements in place to identify existing, amended and new legislation and a mechanism to provide assurance that timely and appropriate action is being taken. Procurement of NHS services is now governed by the following regulations:
• NHS Procurement, Patient Choice and Competition (PPCC) (No 2) Regulations 2013 (SI2013 No.500) which came in to force on 1 April 2013 (PPCC Regulations). The PPCC Regulations were produced to help ensure commissioners’ decisions to buy clinical services are transparent and fair, and that they improve the quality and efficiency of health care services for patients. They provide guidance in a number of areas including:
− advertisements and expressions of interest; − award of a new contract without competition; − conflict of interests in purchasing health care services and supplying such
services; − anti-competitive behaviour; and
• The “Light Touch Regime” set out in the Public Contracts Regulations 2015 (PCR 2015) which came in to force on 18 April 2016. The Regulations apply to services being commissioned with a value in excess of £615,278 (from January 2018, £589,148 previously) and have removed the distinction between Part A and Part B services, which previously existed under the Public Contracts Regulations 2006. The Crown Commercial Service has issued guidance on how to design a procurement regime compliant with the PCR 2015 regulations.
Page 5 of 27
The increased emphasis on commissioning integrated care has arguably heightened procurement risks facing CCGs. A recent report of the Health and Social Care Committee (“Integrated Care: organisations, partnerships and systems”, June 2018) recognised that;
• “procurement regulations covering the tendering of NHS contracts…. were designed to facilitate choice and competition”;
• “there are aspects of the legislation, particularly competition and procurement regulations, that local bodies are working around”; and
• “legislative change may need to be considered, including… changes to legislation covering procurement and competition”.
In the context of this, and recognising significant improvements already made to delivery, service quality and outcomes, a ‘business as usual’ approach to the commissioning of healthcare services will fail to secure better outcomes and value for money. Changes to the roles of hospitals, and a shift to primary care leading and delivering more services in a community based setting, requires the CCG to work closely with all providers, including new providers and the voluntary sector. Once the decision is taken to procure by competitive tender the CCG will need to establish an agreed process which sets out the principles, rules and methods the CCG will work to. This strategy clearly outlines how and when it is appropriate to seek to introduce contestability and competition as methods to help to define the most beneficial and cost effective modes of delivery. Generating momentum, delivery of completed projects, and stakeholder engagement is key. Rigorous and transparent processes will deliver affordable services within defined timescales. The CCG will develop the local health economy in Doncaster by encouraging new providers and supporting local and existing providers so they can participate fully. A vibrant market place for healthcare provision will encourage innovation, drive up quality, and allow the CCG to clearly demonstrate value for money. This strategy aims to identify the direction and scope of procurement over the short, medium and long term to achieve advantage for the CCG through the configuration of resources within a challenging environment to fulfil stakeholder expectations. The aims of this strategy are three-fold. 1. To provides an overview of how the CCG will operate and the ethos that will be applied to all procurement activity while ensuring compliance with statutory procurement guidelines. 2. To provide advice and guidance for all staff working within the CCG who procure any goods or services by setting out the procurement principles, rules and methods that the CCG will work within. 3. To set out a summary of expected procurement activity to be undertaken by the CCG in the short term and medium term
Page 6 of 27
This strategy reflects existing national guidance, in particular the requirements of the NHS Procurement, Patient Choice and Competition Regulations 2013 (2) and the Procurement Guide for Commissioners of NHS Funded Services.
2. Principles and Practice To ensure we commission services fairly and transparently NHS Doncaster CCG will comply with regulations governing best practice in procurement, protecting and promoting patient choice, and anti-competitive conduct.
2.1 Doncaster CCG Procurement Principles Doncaster CCG will conduct its procurement activities in compliance with the following principles as set out in legislation and national guidance.
In relation to each procurement decision Doncaster CCG will:
• Consider the extent to which any form of competition is required and consider the most appropriate process and procedure for awarding the relevant contract or contracts;
• In that regard, give consideration to whether the use of a framework agreement, including the use of approved lists, is the most appropriate means of appointing providers. Doncaster CCG will appoint the provider offering the best value for money bid taking the quality and affordability criteria agreed;
• Ensure that they take heed of applicable guidance and at all times comply with legislation (including when there is a joint procurement with Local Authorities);
• Ensure that clinical procurement decisions take into account clinical needs, clinical quality and measurable improvement in outcomes, with their demonstrable inclusion in any evaluative criteria and supported by clear clinical advice informed by gathering patient needs from the outset.
2.2 Grant or Procurement
The rules on when a grant can be used and when procurement should be used mean that there are many situations when the CCG can use either. The following factors should be considered when deciding:
• State of the market
• Desired future state of the market
• Capacity building
• Enforceability
Further information regarding the appropriateness of Grant funding can be found on the NHS England:
Page 7 of 27
https://www.england.nhs.uk/wp-content/uploads/2015/02/nhs-bitesize-grants.rb-170215.pdf 3. Legislation
3.1 EU Procurement Legislation When procuring goods, services and works, Doncaster CCG will ensure compliance with EU procurement law and the UK’s implementing regulations to the extent that these are applicable to the goods, services or works being procured. In particular it will ensure compliance with the requirements of:
• The Public Contracts Regulations (PCR) 2015 (as amended); and • The EU Treaty Principles; • Procurement, Patient Choice and Competition Regulations (No 2) 2013 • Relevant EU and UK procurement case law.
Together the EU Procurement Rules include any updated European and/or UK Legislation and case law which updates, amends or replaces them. As well as applying to the procurement of goods, non-clinical services and works, the EU Procurement Rules will apply where Doncaster CCG proposes to enter in to a legally enforceable, written contract for clinical services which has an estimated whole-life cost above the relevant financial threshold. At the date of publication of this document, the Public Contracts Regulations (2015) stipulates the following thresholds applicable to Doncaster CCG Procurement:
• Procurement of Goods and Services (non-clinical services): to which the full extent of the EU Procurement Rules apply to all such contracts valued at or above £181,302 (excluding VAT)
• Procurement of clinical healthcare services under the Light Touch Regime (LTR) to which the EU Rules only apply in part. The LTR Rules apply to all clinical healthcare services valued at or above the higher threshold of £615,278 (excluding VAT)
• Procurement of Works. The EU Regulations apply to works contracts valued at or above the threshold of £4,551,413 (excluding VAT)
It is the responsibility of Doncaster CCG to seek advice as to whether the above thresholds have changed since the publication of this Strategy. The services to which the LTR applies are set out in Schedule 3 of the PCR 2015 and the rules governing this procedure are set out in Regulations 74 – 78 of the PCR. The obligations applicable to clinical LTR services and with which Doncaster CCG will ensure they comply, include:
• Treating providers equally and in a non- discriminatory way; • Acting transparently (including the duty to advertise above-threshold
contracts); • Complying with the rules on technical specifications, including that these do
not favour particular providers or present unjustified obstacles to competition;
Page 8 of 27
• Publishing a contract advertisement and an award notice in the Official Journal of the European Union (OJEU);
• The provision of statistical and other reports; • Even where a clinical service contract falls under the LTR, there are only a
limited range of steps required under the PCR 2015. Under the LTR, Doncaster CCG is not obliged to follow the detailed rules set out in the PCR 2015 to the word: it may tailor and adapt them where necessary, as long as it adheres to the main rules governing the LTR, and do not have to use one of the standard procedures (i.e. open, restricted, competitive dialogue, competition with negotiation, dynamic purchasing system, etc.)
3.2 Health and Social Care Act (2012)
The Health and Social Care Act describes the responsibilities of the commissioning organisations with the NHS and wider UK healthcare landscape.
3.3 NHS Procurement, Patient Choice and Competition Regulations 2013
The NHS Internal market has continued through the 1990s, but accelerated at the turn of the century with a series of reforms, including the introduction of PBR in 2002, the establishment of foundation trusts in 2003 and the introduction of primary care trusts. This period also saw an extended role for the private sector in the NHS, under successive governments. A key feature of the Health and Social Care Act is the emphasis on Integrated Care. The Act saw the creation of NHS Clinical Commissioning Groups responsible for commissioning services for their local populations. The reforms were designed to support a diverse and competitive landscape of public and non-statutory provision, with an extended role of NHS Improvement. Section 75 of the Act became the Procurement, Patient Choice and Competition Regulations 2013 (No 2.) and this requires commissioners to consider how they can procure services in a more integrated fashion to consider other Healthcare services, Healthcare related services and Social services. The Regulations ask commissioners to consider when procuring services the impact on the patient who may have multiple healthcare needs and hence may traditionally have had to –
• Receive treatment from a number of different healthcare teams across a range of disciplines,
• Receive treatment over a number of different sites,
• Receive treatment from a number of different healthcare providers,
No direct solution is given to address the issue other than to ensure that when procuring services they interface in a way which gives the patient a seamless service. NHS Improvement may test a commissioner’s effectiveness in this by asking providers how they will co-operate in the delivery of a patients care with other providers.
Page 9 of 27
The NHS (Procurement, Patient Choice and Competition)(No 2) Regulations PPCCR 2013 provides that :
• Must act with a view to securing patient’s needs and improving the quality and efficiency of the service;
• Must act in a transparent and proportionate way and treat bidders equally and in a non- discriminatory way;
• Where third parties, assist or support a commissioner in their procurement activity, the commissioner must ensure that they follow the requirements of the Regulations in the same way the commissioner must do itself;
• Must maintain and publish a record of each contract awarded for the provision of healthcare through the development of a Procurement Register. In addition, Regulation 9(1) of the PPCCR 2013 requires DCCG to maintain and publish a record for all contracts that they award on the website maintained by NHS England. This is currently https://www.gov.uk/contracts-finder
• must not engage in anticompetitive behaviour unless in the interest of patients • must maintain a record of how any conflicts of interest between
commissioners and providers are managed; • must maintain a record of how, in awarding the contract, Doncaster CCG
complies with duties under the NHS Act 2006; • provide thorough justification if competition not required where services are
only capable of being provided by a particular provider; • must publish contract notices (if applicable) and facilitate expressions of
interest; and • consider improving quality and efficiency of services through providing
services in an integrated way, enabling providers to compete and allowing patients a choice of provider.
The PPCCR 2013 also governs the circumstances when Doncaster CCG may award a new contract for clinical services without a competition (Regulation 5). They provide that the CCG:
“may award a new contract for the provision of healthcare services for the purposes of the NHS to a single provider without advertising an intention to seek offers from providers in relation to that contract where the relevant body is satisfied that the services to which the contract relates are capable of being provided only by that provider”
The PPCCR 2013 requires that the CCG publishes a contract notice on Contracts Finder
The notice must include:
• a description of the services to be provided; and • the criteria against which bids will be evaluated.
3.4 Public Services (Social Value) Act 2012 (UK)
Page 10 of 27
Commissioners must consider their responsibilities under the Public Services (Social Values) Act (2012)1 for all healthcare (clinical) procurements conducted. Consideration should be proportional and equitable whilst ensuring that the economic, social and environmental needs of the local community are met. Doncaster Clinical Commissioning Group will embed the values of the Act into any tender documentation to ensure adherence to the principles described within.
3.5 Equality Act 2010 (UK)
Commissioners must consider their responsibilities under the Equality Act 20102 for all procurements conducted. Potential Providers must not be discriminated against, in compliance with the requirements of the act, during the term of contract or the procurement process itself.
3.6 Freedom of Information 2000 (UK)
Commissioners must consider their responsibilities under the Freedom of Information Act 200 (FOI)3 for all healthcare (clinical) procurements conducted. Care must be taken to ensure the rights of individuals and the rights of all organisations associated with the procurement process are protected during all correspondence and associated actions. Potential bidders must be made aware of the commissioner’s responsibilities as a public sector organisation under the act during the preliminary stages of any procurement process. 4. Deciding whether to use the Competitive Tender Process. The following criteria should be considered:
Estimated Value of the contract
• The greater the value, the stronger the case for advertising the competitive tender. The process is shown in Diagram 1.
Level of market interest and capability
• The larger the number of potential providers the stronger the case for advertising the tender. This could override considerations based on the value of the contract.
Securing New Contracts
• Procurement must be used where the commissioner is seeking to secure new contracts to deliver a new service, existing services delivered in a completely different way or an enhanced service (primary care).
1 http://www.legislation.gov.uk/ukpga/2012/3/enacted 2 http://www.legislation.gov.uk/ukpga/2010/15/contents/enacted 3 http://www.legislation.gov.uk/ukpga/2000/36/contents
Page 11 of 27
• Procurement must also be used where the commissioner is seeking investment in significant, additional capacity to supplement existing services.
Expiry of existing contracts
• When evaluating options upon termination or expiry of an existing contract, the decision making process and key factors to be considered will be broadly similar to securing new service models or additional capacity.
Government Policy on Protected services
• Where the CCG can demonstrate that using a particular provider protects the public interest then a tender is unlikely to be necessary. (This must not be used to protect providers that are not best placed to deliver the needs of their patients and population).
Is competition appropriate?
• Is there only one supplier capable of providing the service due to technical reasons or special or exclusive rights?
• Do urgency considerations, due to factors beyond the CCG’s control, preclude an advertised tender?
• Are the services protected by monopoly rights in accordance with a legal or administrative instrument?
Where appropriate the CCG will work collaboratively across the wider health economy to jointly commission and procure services. The CCG will actively participate with initiatives wherever there are benefits to the Doncaster population, including reduction of procurement costs and increased leverage with providers, by acting regionally.
5. Procurement Process The transparency principle imposes an obligation to carry out a sufficient level of advertising, but does not necessarily imply an obligation to conduct a formal tender procedure in full accordance with procurement rules. The CCG will assess local context and each circumstance, and decide whether a formal procurement is desirable on the grounds of demonstrating best value, maintaining some element of competitive tension and complying with the public procurement rules. Use of single tender actions and urgency exemptions will be avoided except where robust reasons can be given. The CCG will take account of the Department of Health’s recommendation that all public services, including foundation trusts should use Contracts Finder4, the Government’s single portal for publishing tender and contract documentation for contracts valued over £10,000. 4 https://www.gov.uk/contracts-finder
Page 12 of 27
5.1 Contracts below £5,000
• Where the estimated value or amount of a proposed Contract does not exceed £5,000 the CCG shall ensure that value for money is achieved
• Where the estimated value or amount of a proposed Contract does not exceed £5,000 at least 1 verbal quotation from suitable suppliers should be obtained followed up by written confirmation (including email). Wherever possible the quotation should be sought from a Doncaster based business.
• Whilst there is only a requirement for one quotation the CCG must consider whether additional quotations are in the CCGs best interest.
5.2 Contracts between £5,000 and £25,000
• Where there is an estimated contract value of between £5,000 and
£25,000 the CCG should seek three verbal quotations followed up by written confirmation. Where possible at least one quotation should be from a Doncaster business.
• Written confirmation of any verbal quotation must be obtained prior to placing a purchase order. This should include:
o Details of the contract o Full name and address of the contractor o The person who verbally supplied the quotation o The submitted price.
5.3 Contracts between £25,000 and current EU threshold
• Where there is an estimated contract value of between £25,000 and the relevant EU Threshold the CCG must seek three written quotations. Where possible at least one quotation should be from a Doncaster business.
• The contract must be procured using the procurement portal using a unique reference number which will be applied to all stages of the process including on the purchase order.
• Procurements need not be advertised using the procurement portal
where alternative arrangements are in place e.g. Crown Commercial Services Framework, LPP Frameworks, SBS Frameworks.
5.4 Contracts over EU Procurement Thresholds.
Page 13 of 27
• Where there is an estimated contract value above the relevant EU Procurement Threshold the CCG shall seek tenders through advertising in Contracts Finder and utilise the procedure proportionate to the value, complexity and a risk of the contract opportunity.
• The procurement must be run using the procurement portal using a unique reference number which will be applied to all stages of the process.
Total Contract Value
Type of Procurement Required
Procurement Options
Timescales
Up to £5k 1 quotation required use standard requisition process. For audit purposes and to demonstrate that value for money has been considered, wherever possible staff should ensure that a quotation is attached to the requisition for both single and multiple items if this is not already available via an existing contract.
Adhere to local/national contracts
1 week
Between £5k and £25k
3 verbal quotations required (waiver required if 3 quotes can’t be obtained)
Telephone quotations followed up in written of selected quote
1-2 weeks
Over £25k 3 written quotations (waiver required if 3 quotes can’t be obtained)
Mini competition through framework agreement
1-4 weeks
Selection of 3 providers – RFQ undertaken
Page 14 of 27
Over EU Thresholdstender process required
EU tender process to be undertaken for contracts for goods and service (Non Clinical) over £181,302.
Local Tendering process for contracts for services (Clinical) below LTR Threshold.
LTR Process to be followed for contracts for services (Clinical) above the LTR Threshold.
Mini competition through framework agreement
Typically between 4 – 6 months
Advertised tender published on e-tendering procurement portal
5.5 Single Quotation/Tender Waiver
Where a decision is made not to undertake a quotation or tender exercise a waiver will be completed to provide evidence to the Audit Committee as to the reasons for that ‘no tender’ decision. All waiver decisions must be documented and should represent the decision of the organisation rather than an individual. The waiver document used to present this evidence is attached in Appendix 2. Advice should be sought from the Head of Procurement if there is any doubt as to whether a tender should be conducted. 6. Avoidance of procurement rules The UK courts take a strict line when they perceive that public contracts have been awarded without taking the necessary steps to ensure competition rules have been adhered to. Commissioners should be aware of several forms of avoidance that have been commonplace within the NHS:
a) Pilot Projects – Awarding a contract through the guise of a ‘pilot project’ without following the correct procedure:
• Pilot Projects have been awarded as a stop-gap measure when the commissioner has no intention to enter into a competitive process in the future. These contracts are often extended without competition,
• Projects have been labelled as a pilot when the previous contract lapses and a procurement hasn’t taken place,
Page 15 of 27
b) Contract lengths are reduced (i.e. a 3 year contract is awarded as a 1 year contract) to artificially alter the contract value to avoid the compulsory OJEU thresholds5,
c) Using negotiation with existing providers as a mechanism to improve services when the contract lapses (for clarification, negotiation is a viable method within the contract term but shouldn’t be used to renew/extend a contract),
The UK courts have the authority to award damages to providers who have been unfairly excluded from the market through the use of such tactics
7. CCG Process for Managing Major Procurements This section seeks to establish an agreed process for managing service procurements undertaken by Doncaster CCG. The process will seek to ensure that there is a clear, consistent, fair and transparent approach to the process of procurement and contract award. Where appropriate the CCG will work collaboratively across the wider health economy to jointly commission and procure services. The CCG will actively participate with initiatives wherever there are benefits to the Doncaster population, including reduction of procurement costs and increased leverage with providers, by acting regionally. 8. Role of the CCG Governing Body in the Procurement Process The Governing Body has the ultimate responsibility for ensuring that the CCG meets its statutory requirements as described in the 2012 Health Act when procuring healthcare services. The Governing Body will be transparent when making decisions to procure services and be the authorising body for awarding contract once a formal tender process has been completed. At all times when considering options for procurement the Governing Body will work with the guidelines and legislation set out in this document.
8.1 Delegation and sign off Decisions to procure and decisions to award will operate at the levels shown in Doncaster CCGs Scheme of Delegation (Standing Financial Instructions/Standing Orders). 9. Confidentiality and Conflicts of Interest The CCGs Policy of Standards of Business Conduct and Conflicts of Interest applies at all stages of the process. All tenders must comply with the Standing Financial Instructions of Doncaster CCG. 10. Procurement Planning
5OJEU Thresholds
Page 16 of 27
A procurement plan will be maintained which will be linked to the contracts database and will be informed by and overlay the current delivery plans of the CCG. The plan will list all current and potential procurements. The plan will also take account of the requirements of the annual operating framework, and nationally mandated procurements. Not every priority on the procurement plan will result in procurement, but indicates the intention of the CCG to review the service or activity which may result in procurement. This plan will be presented at approved by the DCCG Executive and shared at DCCG Managers Meeting on a quarterly basis. Through transparent and open processes, the CCG will actively encourage provider engagement at an early stage of any procurement, particularly in the case of review of existing services with existing providers. The procurement plan will consider the issues in Table 1:
Page 17 of 27
Table 1 - Considerations in Procurement Planning Assess relevant markets What is the need?
Are new services required in terms of new treatments or additional and discrete new provision?
Market Structure
Assess local, regional and national markets in terms of where services are provided along current or desired patient pathways (vertical market structure). Assess the number of local and regional provider organisations and understand current market structure (horizontal market structure).
Competition Assess behaviours that demonstrate competitive tension and responsiveness to patients and commissioner needs. Is there a case for introducing (more) competition to address choice, quality, efficiency or responsiveness?
Innovation Assess developments in the market in other regions and international benchmarks.
Interest Assess market interest in opportunities, transparently and without discrimination, including whether a contract may be of interest to a provider from a member state.
Evaluate existing contracts Performance Analyse current provider’s performance – are they meeting
expectations and seeking quality improvements? Will a re-tender/new tender have a positive impact on the end user?
Efficiency Are services being delivered efficiently? Is productivity in line with services delivered elsewhere including internationally?
Demand Is demand being managed effectively?
Fitness Are current contracts fit for purpose in light of future need and requirements?
Evaluate procurement options (especially in relation to market structure) Outcomes Review outcomes from previous procurements, particularly
of similar services and with regards to the
Page 18 of 27
size/structure/number of contracts and contract lots.
Attractiveness Based on the market assessment and proposed risk-sharing arrangements. Determine the scale and attractiveness of the opportunity to providers (existing providers, existing or potential market).
‘lots’ Assess whether the needs of the population would be best served by single or multiple contracts (Separate ‘lots’ are required in multiple tenders), and approaches to achieving seamless pathways of care.
Multi-source The multi-sourcing approach offers a number of potential benefits including: providing scope for continuing to exert a degree of
competitive pressure between providers; access to a wider range of resources and approaches
than might otherwise be possible, and to pilot or run with different approaches in parallel; and
Continuous improvement.
Single-sources
The potential benefits of a single provider approach include: flexibility in bringing about business change; potential for servicing the entire requirement at a lower
total cost than with multiple providers, through economies of scale; and
Reduced contract management overheads.
Evaluate procurement routes Advice Seek external advice) for help on the procurement routes.
Other Determine other routes that are proportionate for the scale,
complexity and risk associated with the services to be purchased and the market to be manager.
The procurement route decision making process is shown in Appendix 1 11. Most Economically Advantageous Tender (MEAT)
The CCG will ensure that all procurements undertaken will be done using MEAT criteria where appropriate rather than solely on a lowest cost basis. This approach
Page 19 of 27
allows commissioners to consider the whole life cost of bids and takes into account the quality of the deliverable elements. It will be for the commissioner of the service to determine the priorities when setting out the bid evaluation criteria.
12. Framework Agreements
A framework is a pretendered agreement which is established in compliance with the EU Procurement Regulations and sets out the terms on which the CCG and the provider(s) will enter into contracts. These agreements can be established on both a national or regional level and are constituted by a number of pre-approved providers who supply a similar range of goods from which a purchase can be made relatively quickly and easily. Various framework agreements are available e.g.:
• Crown Commercial Services6,
• NHS Shared Business Services (SBS)7,
• NHS Supplychain8,
• NHS London Procurement Partnership9 ,
There are two options available to purchase from a framework agreement:
i. Direct Award:
This option would apply when the terms and conditions of a direct award purchase are set out in the original procurement process. No competition is required.
ii. Hold a mini-competition:
Where direct award is not acceptable in the terms and conditions, the specification must be sent to all capable providers for quotes (e.g. Providers competing for an IT implementation project).
The purchaser can be assured that the providers on a framework are financially stable and that the goods and/or services on offer are of a high quality because the suppliers have already been approved and rigorously assessed. Any purchase made through a framework is also compliant with procurement legislation, provided that the rules to engage providers have been followed.
13. Any Qualified Provider (AQP)
6 http://gps.cabinetoffice.gov.uk/ 7 http://www.sbs.nhs.uk/ 8 http://www.supplychain.nhs.uk/ 9 http://www.lpp.nhs.uk/
Page 20 of 27
The use of AQP should be determined at a local level where increasing the role of competition and patient choice can be proven to improve quality and patient care. Providers must be Care Quality Commission (CQC) registered (or, where CQC registration is not required to deliver the service, an appropriate registration body) or licensed by NHS Improvement to take part in this truncated selection process, and all providers will be required to operate within the same pricing structure. 14. Pilot Projects
In order to identify new working practices through the use of pilot projects, the CCG must establish that a project is in fact a pilot via the following definitions:
• There is a specific goal,
• The timetable is clearly laid out with defined periods for:
o Start date,
o End date,
o Period for lessons to be learnt,
• Clear and signed contract with the pilot service provider,
• Robust plan/process for evaluation,
• Right to terminate a pilot must be included if it is found to be unsafe or the outcomes cannot be met.
It is important for commissioners to use pilot projects only in circumstances where the clinical outputs are not known or cannot be accurately predicted. The CCG should contact the Head of Procurement for specialist advice before embarking on a pilot project to ensure compliance with EU legislation. 15. Sustainable Procurement Sustainable procurement means:
• Buying what is needed, and seeking innovative, lower impact products and services.
• Understanding demand to ensure most efficient delivery of outcomes.
• Specifying environmental and social standards through the procurement process to influence supply chains and drive innovation.
• Basing procurement decisions on whole life rather than short-term costs and benefits.
• Providing business opportunities and supporting skills development amongst supplier communities.
• Making sure procurement supports and facilitates a reduction in resource use and waste.
Page 21 of 27
Doncaster CCG recognises the impact of its purchasing and procurement decisions on the regional economy, and the positive contribution it can make to economic and social regeneration of Doncaster. The CCG is committed to the development of innovative local and regional solutions, and will deliver a range of activities as part of its market development plan to support this commitment. Wherever it is possible, and does not contradict or contravene the CCG’s procurement principles, the CCG will work to develop and support a sustainable local health economy, working with other public sector organisations to deliver innovative projects to the local population whilst developing the local supplier base. 16. Third Sector/SME Support Doncaster CCG aims to support and encourage Small & Medium sized Enterprise (SME) suppliers, Third Sector/Voluntary organisations and local enterprises in bidding for contracts. NHS Doncaster CCG will ensure that procurement processes promote equality and do not discriminate on the grounds of age, race, gender, culture, religion, sexual orientation or disability. Doncaster CCG will aim to support Government initiatives seeking the optimal involvement of SME’s and the Third Sector in public service delivery without acting in contravention of public sector procurement legislation and guidance. The NHS is keen to encourage innovative approaches that could be offered by new providers – including independent sector, voluntary and third sector providers. NHS Doncaster CCG is committed to the development of local providers that understand the needs of local communities. It is vital to ensure that the Organisation’s approach to procurement is open and transparent and that it does not act as a barrier to new providers.
Page 22 of 27
Annex A - Glossary AQP Any Qualified Provider
DCCG NHS Doncaster Clinical Commissioning Group
EXECUTIVE DIRECTOR A Member excluding Non-Officers or Locality Leads as defined in the DCCGs Standing Financial Instructions
LTR Light Touch Regime (under Public Contract Regulations 2015)
OJEU Official Journal of the European Union
PbR Payment by Results
RFQ Request for Quotation
SFIs Standing Financial Instructions
VfM Value for Money
Page 23 of 27
Appendix 1 Process for Procurement
Business case developed for approval at relevant committee (in line with the Scheme of Delegation**).
Complete requisition and raise purchase order via Purchasing and
Supply function. Obtain 3 verbal quotes. Select quote that delivers best value
for money NO
NO
NO
NO
YES
Waiver signed off by Chief Finance Officer
N.B. The values stated are for the total value for the full term of the agreement and include VAT where appropriate. If an agreement is for more than one term/year and the full term value exceeds the stated value, the relevant process would apply
YES
NO
Are goods and services < £5,000
Are goods and services < £25,000
Are the goods and services expected to be under OJEU
thresholds*?
Obtain 3 written quotes as per SFIs and select quote that
delivers best value for money
Do conditions for waiver apply?
Do conditions for waiver apply?
Carry out OJEU Procurement/Tender Process
YES
YES
Page 24 of 27
Appendix 2
SINGLE QUOTE/TENDER WAIVER REQUEST FORM
NOTES FOR COMPLETION: Please refer to Section 17.5.4 of the current CCG Standing Orders & Standing Financial Instructions and give details of the relevant sub section which supports the request. Please also complete the table in Appendix 1 with relevant exception. NB Approval must be sought in advance of any commitments being made and is not automatic.
Completed by: Department: Date:
Reference:
Supplier: Value £ £ Product/Service: Single Quote/Tender Request is made for the following reason(s)
Manager Name: (PRINT NAME) …………………………………………………………….. Manager Approval:………………………………………Date: …………… Have all conflicts and potential conflicts of interest been appropriately declared and entered in registers which are publicly available? Please record how you have managed any conflict or potential conflict below:
Head of Procurement Comments: Signature: Date: Approval by Chief Finance Officer (all Requests): YES / NO Signature: Date: Approval by Chief Officer (Tenders): YES / NO Signature: Date: Reason for Refusal: Copy to: Deputy CFO for notification to Audit Committee
Page 25 of 27
Single Quote / Tender Waiver Request Checklist
Exceptions and instances where formal tendering procedures need not be applied (SFI, Section 17.5.4)
Where a contract opportunity is required to have competition under SFI 17.5.1, procedures need not be applied where: (Please complete):
Considerations
Yes / No / NA
(a) the estimated expenditure or income: (i) for a contract opportunity (for goods and non healthcare services) does not, or is not reasonably expected to, exceed £5,000 (incl. VAT); or (ii) for any contract opportunity (for healthcare services) does not, or is not reasonably expected to meet OJEU limits.
(b) any disposal falls within SFI 17.12.1 and/or within SFI 25.1.3
(c) the requirement can be met under an existing contract without infringing Procurement Legislation
(d) the CCG is entitled to call off from a Framework Agreement and the requirements of SFI 17.6 (Use of Framework Agreements) have been followed
(e) a consortium arrangement is in place and a lead organisation has been appointed to carry out tendering activity on behalf of the CCG; or
(f) an exception permitting the use of the negotiated procedure without notice validly applies under Article 32 of the Regulations.
Formal tendering procedures may be waived in the following circumstances (g) in very exceptional circumstances where the Chief Officer decides that formal tendering procedures would not be practicable or the estimated expenditure or income would not warrant formal tendering procedures, and the circumstances are detailed in an appropriate CCG record.
(h) where the timescale genuinely precludes competitive tendering for reasons of extreme urgency brought about by events unforeseeable by the CCG and not attributable to the CCG. Failure to plan work properly is not a justification for waiving the requirement to tender.
Page 26 of 27
(i) where the works, services or supply required are available from only one source for technical or artistic reasons or for reasons connected with the protection of exclusive rights.
(j) when the goods required by the CCG are a partial replacement for, or in addition to, existing goods and to obtain the goods from a supplier other than the supplier who supplied the existing goods would oblige the CCG to acquire goods with different technical characteristics and this would result in: - incompatibility with the existing goods; or - disproportionate technical difficulty in the operation and maintenance of the existing goods; but no such contract may be entered in for a duration of more than three years.
(k) when works or services required by the CCG are additional to works or services already contracted for but for unforeseen circumstances such additional works or services have become necessary and that such additional works or services: - cannot for technical or economic reasons be carried out separately from the works or services under the original contract without major inconvenience to the CCG; or - can be carried out or provided separately from the works or services under the original contract but are strictly necessary to the latest stages of performance of the original contract; provided that the value of such additional works or services does not exceed 50% of the value of the original contract.
(l) for the provision of legal advice and/or services provided that any provider of legal advice and/or services commissioned by the CCG is regulated by the Solicitors Regulation Authority for the conduct of their business (or by the Bar Council for England and Wales in relation to the obtaining of Counsel’s opinion) and are generally recognised as having sufficient expertise in the area of work for which they are commissioned. The Chief Finance Officer will ensure that any fees paid are reasonable and within commonly accepted rates for the costing of such work.
(m) when the services required by the CCG are to be commissioned to support the local health economy in line with national policy and guidance e.g. ICS and Place Plan.
Page 27 of 27
DCCG must evidence that this complies with the NHS Procurement, Patient Choice and Competition Regulations which includes the need to: • ensure that commissioners secure high-quality, efficient NHS health care services that meet the needs of people who use those services; • protect the rights of patients to choose who provides their health care in certain circumstances; and • prevent anti-competitive behaviour by commissioners unless this is in the interests of patients. The NHS Procurement, Patient Choice and Competition Regulations are intended to enable commissioners to decide for individual services what is best for patients. They adopt a principles-based approach and do not generally include prescriptive rules on how commissioners must carry out their procurement activities. It is for commissioners to decide what services to procure and how best to secure them in the interests of patients, within the framework of the regulations. Where it is decided that a competitive procurement process need not be applied or should be waived, the fact of the non application or waiver and the reasons for it should be documented and recorded in an appropriate CCG record and reported to the Audit Committee at each meeting. Where the CCG proposes not to conduct a procurement process in relation to a contract opportunity for a new health care service or a significantly changed health care service then the CCG shall consider such proposals in line with the Procurement Regulations, the Scheme of Delegation and Procurement Strategy.
1
South Yorkshire and Bassetlaw Integrated Care System CEO Report
SOUTH YORKSHIRE AND BASSETLAW INTEGRATED CARE SYSTEM
12 November 2019
Author(s) Andrew Cash, Chief Executive, South Yorkshire and Bassetlaw Integrated Care System
Sponsor
Is your report for Approval / Consideration / Noting
For noting and discussion
Links to the STP (please tick)
Reduce inequalities
Join up health
and care
Invest and grow primary and
community care
Treat the whole person, mental
and physical
Standardise acute hospital
care
Simplify urgent
and emergency
care
Develop our workforce
Use the best technology
Create financial sustainability
Work with patients and the
public to do this
Are there any resource implications (including Financial, Staffing etc)?
N/A
Summary of key issues
This monthly paper from the South Yorkshire and Bassetlaw Chief Executive provides a summary update on the work of the South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) for the month of November 2019.
Recommendations
The SYB Collaborative Partnership Board (CPB) and SYB ICS Health Executive Group (HEG) partners are asked to note the update and Chief Executives and Accountable Officers are asked to share the paper with their individual Boards, Governing Bodies and Committees.
Enclosure B
2
South Yorkshire and Bassetlaw Integrated Care System CEO Report
SOUTH YORKSHIRE AND BASSETLAW
INTEGRATED CARE SYSTEM
12 November 2019 1. Purpose
This paper from the South Yorkshire and Bassetlaw Integrated Care System Chief Executive provides an update on the work of the South Yorkshire and Bassetlaw Integrated Care System for the month of October 2019. 2. Summary update for activity during October 2019 2.1 Collaborative Partnership Board The October Collaborative Partnership Board received updates on the priorities of joint working for the local authorities (physical activity and complex lives) and the ICS Five Year Plan. In addition, the Board was joined by the Sheffield City Region team to provide an update on Working Win, the Health Led Employment Trial. The Trial has been hugely successful with 4306 participants, 273 having found employment and 317 staying in work (August 2019 data). Members also discussed the importance of developing our relationship with the voluntary and community sector and agreed a series of next steps including establishing an exploratory task group to bring together VCS and ICS stakeholders and lead a programme of work specifically to embed the VCS in the ICS at every level of the system. 2.2 ICS Guiding Coalition and Five Year Plan Our Guiding Coalition met on Tuesday 8th October at the Keep Moat Stadium in Doncaster to discuss and feed back on the draft refreshed vision of our Five Year Plan. We had some very helpful and informative discussions at the event, the themes from which have been added to the final version which will be submitted to NHS England and Improvement on November 15th 2019. At the Health Executive Group on Tuesday 12th November, members will receive a near final strategic narrative, along with the finance and workforce data and metrics trajectory. Boards and Governing Bodies meeting before the 15th November submission should use the draft version and those meeting after the submission should use the final version. Publication of the final Plan is now subject to Purdah during the General Election campaign period. While we await guidance on when we can publish, the draft version will remain on our website. Alongside the final version, we will publish a Plain English version, an easy read version and a version that uses audio/subtitles. 2.3 Focus meeting with NHS England and Improvement Our quarterly focus meeting with NHS England and Improvement took place on 31 October. The review concentrated on operational and financial performance, progress with our Five Year Plan and its alignment and how the ICS partners are working together. Good progress was noted on our performance and the development of our Plan. In respect of ICS governance, we described how in 2020/21 we will take account of the work coming out of the Establishing ICSs programme, led by Amanda Prichard, to focus our system at Place and whole system to deliver the LTP. As with previous focus meetings, when I receive a formal letter from Regional Director Richard Barker in due course I will forward on to colleagues.
3
2.4 National ICS Leaders Update
The next national STP/ICS Leaders Development event, which I have been asked to chair, takes place on 7 November. The agenda includes a panel discussion with Simon Stevens and discussions on the role of STPs and ICSs in supporting development of Primary Care Networks and also system-wide quality improvement. There will also be the opportunity to join breakout discussions on tackling race inequalities in the workforce, quality engagement and communications to support system working, local government and the NHS working together as ‘anchor institutions’, population health approaches and system-wide metrics. I will update colleagues on the session at the Health Executive Group meeting. 2.5 Allocate Awards I am pleased to report that we won a national industry award in recognition of our joined-up work on the e-rostering workforce project. The Allocate Awards 2019 ceremony took place on Wednesday, October 16th in Manchester and was collected by attending members of the eRoster group within the ICS. This award was particularly impressive as it recognised our achievement of ‘working inclusively across boundaries’. The partnership has been coming together regularly and has successfully developed a shared approach to eRostering (an electronic way of efficiently managing when staff are needed to work). This is an excellent example of the innovative project work taking place within the ICS at the moment. I have said previously that we need to ensure continuity of improvement if we want to be the best delivery System in the country. 2.6 Performance Scorecard The attached scorecards show our collective position at October 2019 (using predominantly August and September 2019 data) as compared with other areas in the North of England and also with the other nine advanced ICSs in the country.
You will see we are green across the board for six week diagnostics, two week cancer waits, two week cancer breast waits and 31 day cancer waits. Our A and E performance as a System, while still below the constitutional standard, has also improved. This is important progress as we head into winter and we obviously need to try and keep up the improvement if we want to be the best delivery System in the country. The amount of work and leadership taking place at the moment to make and then sustain these improvements is hugely appreciated. At month 6 all organisations are on plan and are forecasting to achieve plan; although there remain some risks to full year delivery. 2.7 Establishing ICSs As part of the commitment in the NHS Long Term Plan for ICSs to be formed and covering the country by April 2021, there have been a number of discussions with stakeholders to hear their feedback on supporting systems. ICSs are not statutory entities, nor is there any specific legislation governing how they operate and therefore it is important for local systems to work together with regional teams to establish a new way of working.
4
There have been a number of key themes emerging which focus on the role of the ICS and its collective model of accountability. Stakeholders are keen to see greater clarity and we can expect to learn more about the themes and next steps when more details are published shortly. 2.8 General Election and Purdah We are now under six weeks before a general election, and are therefore in ‘purdah’ or the pre-election period of sensitivity. Purdah continues until a new government is in place – if the election results are close, this could continue for some time. This is a time of sensitivity, and specific restrictions are placed on the use of public resources and the communication activities of public bodies, civil servants and local government officials. The ICS will consider both the guidance and impact on other organisations and colleagues and ensure that we remain politically impartial. Andrew Cash Chief Executive, South Yorkshire and Bassetlaw Integrated Care System Date 5 November 2019
1
Minutes of the Audit Committee Meeting
Held on Thursday 12 September 2019 at 9.00 am In Meeting Room 3, Sovereign House
Committee Members Present:
P Wilkin (Chair) Lay Member for Audit and Governance
Dr E Jones (Vice Chair)
Secondary Care Doctor Lead
S Whittle Lay Member For Engagement and Experience
Dr N Tupper Locality Lead Formal Committee Members Present:
H Tingle Chief Finance Officer
K Meats Client Manager – 360 Assurance
C Partridge External Auditor, KPMG
H Harris Head of Corporate Governance
A Smith Anti-Crime Specialist, 360 Assurance
In attendance: J Whittaker
J Lawson C Burns (arrived 9.35 am)
Senior Corporate Services Support Officer (Minutes) Senior Finance Manager Head of Healthcare Procurement (Item 10 – Contract Management Plan/Purchase Card Policy)
Action 1. Welcome and Introductions
The Chair welcomed everyone to the meeting.
2. Apologies
Apologies were noted from:
• T Wyatt, Deputy Chief Finance Officer • L Devanney, Associate Director of HR and Corporate Services
2
3. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: It was agreed that C.Partridge had a conflict of interest in relation to the review of External Audit appointment. It was therefore agreed she would leave the room during this discussion.
4. Minutes From Previous Meeting held on 11 July 2019 The minutes of the meeting held on Thursday 11 July 2019 were approved as a correct record with the following amendment: Amended to read: Internal Audit Progress Report – K.Meats advised a piece of work has been undertaken for Rotherham and Bassetlaw so they would be able to share specific reports if required and further system guidance will be produced by the Integrated Care System (ICS) in Autumn.
5. Action Log Update The Audit Committee Action Tracker was updated accordingly.
6. Matters Arising not on the Agenda C.Partridge left the meeting at 9.05 am
Review appointment of External Auditor– further to the last Audit Committee Meeting, H.Tingle advised we are now in receipt of the increasing fees from KPMG, and that this represents an increase of around 23-24%. C.Partridge will be attending a future Chief Finance Officers (CFO) meeting to give a detailed rationale as to why the fees have increased. Once the meeting has taken place, H.Tingle will share the feedback with the Audit Committee for virtual comments and highlight the position of the other South Yorkshire and Bassetlaw (SYB) Clinical Commissioning Groups (CCG’s). C.Partridge returned to the meeting at 9.15 am
H.Tingle
3
7. Notification of Any other Business The following item was noted and the Committee agreed to pick this up at today’s meeting:
• The Audit Chairs meeting with other Audit Chairs for Doncaster and Bassetlaw.
8. External Audit External Audit Technical Report/Progress Report C.Partridge presented the report and the key highlights were as follows: Department of Health and Social Care (DHSC) Group Accounting Manual 2019-2020 – there has been an update to this and the main changes from the 2018/2019 version include:
• The adoption of International Financial Reporting Interpretations Committee (IFRIC) 23 (Uncertainty over Income Tax Treatments), which now applies in full;
• The inclusion of more information to confirm the deferral of International Financial Reporting Standards, (IFRS) 16 – Leases until the 1 April 2020 and
• Additional detail around the treatment of investment property within a group where the entity occupying a property does so under a lease from a parent or subsidiary entity.
C.Partridge advised that the changes from the prior year will not have a significant impact to audit here. Better Care Fund 2019/2020 – P.Wilkin asked for an update in terms of where we are in regards to guidance. J.Lawson advised work is on-going and T.Wyatt is linking in with Doncaster Council. Following a discussion, P. Wilkin asked if a briefing could be added, moving forward, within the Finance Exception Report regarding the Better Care Fund (BCF). A discussion was held around Referral to Treatment (RTT) and that we have commissioned the Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust (DBTHFT) to achieve 92% RTT standard in 2019/20, however, they are struggling to get additional capacity due to the impact on pensions. H.Tingle advised a letter has been sent to DBTHFT regarding this and an ICS Meeting is being held today, the focus of which is RTT. This is currently on the CCG Risk Register. The Audit Committee noted the reports and the contents within. Mental Health Investment Standard Update The Audit Committee received the draft Accountable officer declaration in relation to the Mental Health Investment Standard (MHIS). The CCG have met with KPMG in early August to outline the processes followed and shared all relevant information. KPMG have since been on site to undertake the detailed testing and this has now concluded. The
T.Wyatt
4
CCG are now awaiting formal feedback from KPMG as to their findings. The CCG is required to publish a compliance statement on its website by 30 September 2019 or sooner if possible. A draft statement indicating the CCG’s compliance with the standard has been produced and shared with the members and will be published once KPMG report their findings. Once the audit is complete, the outcome will be brought back to Audit Committee in November 2019 for formal review by the Committee. The Audit Committee noted the update and the proposed compliance statement and that this will be published once the outcome of the audit is received from KPMG.
9. Internal Audit and Counter Fraud Internal Audit Progress Report – K.Meats presented the report which identifies progress made in relation to completion of work from the CCG’s 2019/20 Internal Audit Plan. This progress report covers the work carried out during the period 4 July to 3 September 2019. K.Meats highlighted the key messages and advised they have issued two final reports since the last meeting, which were Governance and Risk Management and Policy Monitoring. Significant assurance opinion has been given in respect of both the Governance and Risk Management elements. The Audit Committee noted the report along with the key messages and progress made against the plan since the last meeting. Governance and Risk Management Draft Report – K.Meats advised that a review has recently been completed in respect of the overarching Governance and Risk Management arrangements in place within the CCG.
A summary of the findings and recommendations made by Internal Audit are detailed in the report, which has been shared with the members, and these are being addressed accordingly by the CCG. For noting is that the recommendations made were rated as low and significant assurance has been given in regards to governance and risk management. The Audit Committee noted the report and key messages and felt this was a positive report. Counter Fraud Progress Report – A.Smith provided an update of the activity that has taken place during the period 1 April to 31 July 2019. The key messages include:
• Counter Fraud Specialist (CFS) concluded a pro-active detection exercise in relation to declarations of interest;
• NHS Counter Fraud Authority (NHSCFA) guidance and fraud prevention instructions were issued to the CCG;
• The CFS undertook a comprehensive review of the CCG’s Conflicts of Interest Policy Including Standards of Business Conduct and Gifts and Hospitality; and
5
• The CFS provided a counter fraud awareness session to 35 CCG staff.
A.Smith advised that clarity has been sought from the NHSCFA regarding updates to standard 1.4 which now requires the CCG to manage identified fraud risks in line with risk management policies. It has been confirmed by NHSCFA that the fraud risk assessment should be owned and managed internally by the CCG rather than by CFS on the CCG’s behalf and dependent on the risk, will sit under the Manager of that department. A.Smith and H.Harris will be meeting to look at how we manage the risk register moving forward. In response to emerging fraud risks, specifically associated with Personal Health Budgets (PHBs), A.Smith advised that a range of awareness initiatives are being developed which will include webinar/face to face training, e-learning package aimed at staff who work with PHBs and PHB fraud awareness information for patients and their representatives and this will be put on to the 360 Assurance website. The Audit Committee noted the comprehensive report and the key messages and progress made against the Counter Fraud Work Plan. Conflict of Interest Report – A.Smith advised the Committee that a proactive exercise has been undertaken to review whether the CCG had robust processes in place to capture Conflict of Interest and if staff are following the policy. A.Smith stated that all recommendations have been implemented at the CCG and any findings have been responded to. Overall, it was felt the report was positive and demonstrates the robust processes that are in place at the CCG. It was also agreed at the last Audit Committee Meeting for this to be removed from the risk register which provides further assurance regarding this. In regards to policy reviews, A.Smith requested for any policies that are being reviewed by the CCG to be forwarded on to her. The Committee noted the report and contents within and agreed it was very informative. A.Smith left the meeting at this point.
10. Financial Reporting Finance Exception Reports J.Lawson provided a brief overview of the report the purpose of which is to provide assurance on the following issues by exception:
• Losses and special payments; • Waiver of Standing Orders and Standing Financial Instructions
(tenders and quotes procedures); • Schedule of Debtor and Creditor balances including specifically
6
balances with Doncaster Council. The report identifies any losses and special payments, debtors or creditor balances over six months old and over £5,000 waived as per standing orders or Standing Financial Instructions (SFI’s). The following points were highlighted:
• There have been no losses or special payments. • There have been two new applications to waive the tenders and
quotes procedures since the last meeting and these were circulated to the members.
• The number of outstanding debtor balances over 6 months old and £5,000 is nil.
• The number of outstanding creditor invoices over 6 months old and £5,000 has reduced from £1,515,810 to £1,344,344. Issues to the value of £709k have been resolved and paid since the last report and £537k of new issues have gone past the 6 month date of which £404k relate to Doncaster Council.
• The largest balance is with Doncaster Council at £800k and the CCG is actively pursuing these and liaising with colleagues to resolve issues. The next largest balance relates to FM charges for the Flying Scotsman practice (£89,000) which has recently been discussed at Primary Committee and is now being followed up with the practice. A meeting has taken place with the provider and they have now been given a final deadline of 20 September 2019 to agree to the CCG’s proposal.
• The remaining balances mainly relate to Continuing Healthcare (CHC) recharges due to queries with the charges or awaiting further information relating to special observation and these are being followed up with the CHC Team and Senior Contracts Manager.
• In regards to Doncaster Council Debtor and Creditors, it has been requested that detailed information is shared in relation to the outstanding debtor and creditor balances with DMBC due to the increasing nature of the balances so that Audit Committee can be sighted on any risks.
• As at 2 September 2019, Doncaster Council owe the CCG £2,666,134 which is an increase of £1.1m since July. However £1.3m of this is current and relates to invoices still within the 30 day payment period.
• The remaining balances are undergoing review with a view to agreeing to clear these debts as soon as possible. It should be noted that the majority of the values are agreed but there are minor disputes over specific packages of care which are in discussion with the Local Authority and as the CCG is unable to part pay invoices the full invoice remains outstanding unless a credit note is raised.
• A monthly reconciliation will then take place and be jointly agreed and any variances will be invoiced on a quarterly basis. Work is underway to process the reconciliation for July and August and this will be shared by mid-September. The new process will help to minimise delays in paying invoices and will be closely monitored through a joint monthly meeting.
7
The Committee noted the report and were happy to approve the two Single Quote Waivers. H.Tingle left the meeting at this point Contract Management Plan (CMP) C.Burns presented her report and advised we are taking a more proactive approach as to how we manage our contracts. The plan identifies services for development in current delivery plans (categorised using the life stages) plus contracts that are expiring over the next twenty four months and non-recurrent funded services. The plan is RAG rated to provide a transparent and central mechanism for the CCG to prioritise and forward plan contracting and procurement decisions making in line with its governance and delivery plan obligations. The plan also identifies milestones for decisions to help manage risk, and provides a focus for the CCG over the coming quarter identifying progress, risks and potential savings. The updated plan is to be shared with Quality, Innovation, Productivity and Prevention (QIPP) and Executive Committee quarterly, and Audit Committee and Governing Body bi-annually. Dr Jones raised that a number of the contracts do have clinical implications and are taken to Clinical Reference Group (CRG) for discussion/consideration. The suggestion was therefore put forward that it would be beneficial to add a column on to the CMP of the date when contracts are taken to CRG to which C.Burns was in agreement and will make the necessary amendments. The Audit Committee noted the report and felt this was informative. Purchase Card Policy J.Lawson and C.Burns explained the purchase card policy, which is for the use of the CCG credit card for limited products and services. C.Burns advised the process is the same and the policy reflects how we currently operate. The purchase card will be used by exception when buying goods and services from any supplier who operates a purchasing card facility and will be subject to the following principles:
• Goods and Services when the only option is ‘on-line’ ordering. For all other goods and services the usual procedure for requisitioning should apply.
• Train travel. Train tickets at a cost of £20 or less should be claimed back through the Easy expenses system.
• Train Travel. Purchase Card should be used for ad-hoc purchases only. Where a department require regular travel a purchase ‘call-off’ order should be established and authorised in line with the Scheme of Delegation and procedure for requisitioning.
• Conferences – Ad Hoc on-line bookings and prepayment requirements (within 10 days) or where this option provides the best
8
value for money i.e. when invoicing incurs excessive additional charges.
• Hotel Bookings – Ad Hoc on-line bookings and prepayment requirements (within 10 days) or where this option provides the best value for money i.e. when invoicing incurs excessive additional charges.
• Mobile Phones and SIMS – Only when Pay As You Go is the required option. All other Mobile phone contracts should be raised using the procedure for requisitioning.
It was raised by the members that this process could potentially introduce further counter fraud risks. However, the purchasing card may only be used in accordance with this policy and by designated purchasing card holders. Monthly credit limits have been agreed in line with the limits contained within the scheme of delegation. The suggestion of undertaking a future audit on this was put forward to see how this is working and to also pick up in Fraud Awareness Training. A detailed discussion was held and the Committee felt that due to the sensitivity around this, the recommendation would be for the policy to be approved by the Governing Body and for the Governing body to delegate overall responsibility of the policy to the Audit Committee for them to ensure the right controls are in place and recommend any future changes to the Governing Body members. The Chair will present this to the Governing Body Meeting in October. C.Burns left the meeting at this point.
P.Wilkin
11. Integrated Governance, Risk Management and Internal Control Integrated Risk Issues from Other Committees;
• Quality and Patient Safety – Sharps bins continue to remain on the risk register and concern was raised in relation to the lack of progress. No other issues to report.
• Primary Care Commissioning Committee - No issues or risks to report.
• Engagement and Experience Committee - No issues or risks to report.
• Executive Committee – No issues or risks to report. • Clinical Reference Group - No issues or risks to report. • Governing Body – No issues or risks to report.
Audit Committee Self-Assessment Report 2018-19 – H.Harris presented the key points from the 2018/19 self-assessment, which were as follows:
• 100% response rate (excluding the Chair due to the change-over); • A work-plan has been developed, the terms of reference have been
reviewed and clearly define the role of the committee; • The key achievements for 2018/19 are, reviewed internal audit
reports, annual accounts, corporate assurance report, policies, terms of reference and deep dives into the board assurance
9
framework; • Ensure education / training and development for new committee
members; • One person was dissatisfied with the papers being circulated in time
and minutes not being received after the meeting in a timely manner.
Overall the self-assessment of the Audit Committee has demonstrated that members are satisfied with its effectiveness. The 2017/18 self-assessment key points have been actioned, as members of staff responded promptly to updates requested by Internal Audit during 2018/19. It was felt by the Committee that future assessments should be circulated wider and so H. Harris advised this will be sent to all members and attendees moving forward and that she will be able to differentiate responses from formal/ non-formal members The Committee noted the report and key points and were in agreement to new Committee members receiving training and development where applicable. The Committee further agreed that the self-assessment for 2019/20 would be extended to include all regular attendees as well as members. Standing Financial Instructions (SFIs) & Scheme of Delegation – this was last reviewed in 2018 and now sits in the Committee Handbook. Following discussion, it was agreed by the members that it would be good practice to review SFI’s annually and it was agreed for J.Lawson to undertake a review and produce a summary of changes to be presented to the Committee. General Data Protection Regulation (GDPR) Update – H.Harris explained at the last meeting a recommendation was made for the closure of this risk. However, a paper was requested by members as they felt further assurance was required before a decision could be made. H.Harris therefore presented a report, which provides evidence of some of the controls and assurances in place and explained that the GDPR risk delegated to the Audit Committee is as follows: CO1-CO13 - On 25 May 2018, the Data Protection Act 1998 will be replaced by the new European Union (EU) GDPR. There will be process and cost implications for the organisation which is unknown at the present time. GDPR is embedded in Doncaster Clinical Commissioning Groups (DCCGs) daily business and there are robust systems and processes in place. Information governance and data protection are managed within the Corporate Governance Team. H.Harris advised that a corporate assurance report is produced every quarter which is taken to Governing Body. The Audit Committee noted the report and were in agreement to the closure of the risk as they felt the report offered assurance and that there
J.Lawson
10
were robust mechanisms in place. The Committee further discussed further guidance that would make the CCG responsible for GDPR within GP practices and it was agreed that this should be assessed as a new risk. Audit Report to Governing Body It was agreed by the Committee today to raise the following items in October:
• Mental Health Investment Standard (MHIS) Update • Governance and Risk Report • Finance Exception Report • Contract Management Plan (CMP) • Purchase Card Policy • Conflict of Interest (COI) • Sharps Bins • Change of Meetings for Audit Committee • Audit Self-Assessment Results
12. Governance Audit Committee Meetings 2020/21 – P.Wilkin put forward a paper for consideration to review the number of Audit Committee meetings per year. A discussion was held and the Committee were in agreement to the following:
• Trial five meetings (reducing from 7 meetings) a year initially and review this 6 months into the year;
• To cancel the meeting in January 2020; • To only have one meeting in May. This will be moved from the 14th
to 21st May 2019 to accommodate the year-end process. The meeting schedule would therefore be as follows for 2020:
• March • May(annual accounts) • July • September • December
A discussion was also held around moving the meeting in November 2019 to December 2019, however due to other meeting commitments, this was not possible.
13. Forward Plan This was reviewed and no additional items were added.
14. Any Other Business
Assurance Framework Deep Dive on Strategic Objectives – due to an ICS Meeting taking place today, it was agreed by the Committee to defer
11
this item to the next meeting in November 2019 and to ask both L.Devanney (HR) and A.Russell (Quality) to attend.
Doncaster Audit Chairs – P.Wilkin made the Committee aware that he has made contact with other Doncaster and Bassetlaw Audit Chairs and will be attending a meeting next Thursday19 September 2019 to discuss how things are developing in regards to the ICS. P.Wilkin advised he will provide feedback at the next Audit Committee Meeting in November.
P.Wilkin
15. Date and Time of Next Meeting: Thursday 14 November 2019 from 9.00 am to 12.00 midday in Meeting Room 3, Sovereign House
1
Minutes of the Quality & Patient Safety Committee
Held on Thursday 5 September 2019 at 9.30 am – 12.00 midday In Boardroom, Sovereign House
Present: Dr E Jones (Chair) Secondary Care Doctor
A Russell Chief Nurse Z Head Lead Nurse Primary Care Quality Dr J Bradley GP Governing Body Member T Thomas (arrived 10.15 am)
Quality Assurance Nurse Individual Placements
L Denman (arrived 10.15 am) Lead Nurse for All Age Individual Placements and Safeguarding Adults
A Johnson Court of Protection/Personal Health Budgets Lead Practitioner
S Evans Transforming Care Specialist Placements Case Manager
W Feirn Senior Nurse – Quality & Patient Safety A Ibbeson Head of Quality & Designated Nurse for
Children’s Safeguarding & LAC K Fenn CHC Team Leader J Rayner Senior Officer for Quality V-Lin Cheong Deputy Head of Medicines Management
In attendance: J Whittaker Senior Corporate Services Support Officer
(Minutes) J Pederson Chief Officer
Action
1. Welcome, Introductions and Housekeeping The Chair welcomed everyone to the meeting and introductions were made.
2. Apologies
Apologies were noted from: • A Stothard, Quality and Patient Safety Manager • I Boldy, Deputy Chief Nurse • Dr V Joseph, Consultant in Public Health • H Joerning, Patient Experience Manager • A Molyneux, Head of Medicines Management
3. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
2
Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared.
4. Minutes From Previous Meeting held on 4 July 2019 The minutes of the meeting held on 04 July 2019 were approved as a correct record.
5. Action Log Update The Quality & Patient Safety Committee Action Tracker was updated accordingly.
6. Matters Arising not on the Agenda There were no items raised.
7. Notification of Any Other Business
There were no items raised.
8. Specialist Placements Update Report
Mr Russell provided an update to the Committee and advised for noting is that the use of out of area Psychiatric Intensive Care Units (PICU) services has increased gradually over the past three years and currently there are four out of area placements. A working party has been established to examine new commissioning principles and to develop ways of commissioning PICU provision from both local and regional NHS providers in a more effective manner. In regards to Coral Lodge, in-patient provision at Rotherham Doncaster and South Humber NHS Foundation Trusts (RDaSH’s) male locked rehab facility has been commissioned on a spot purchase basis, aside from a block contract for four beds. This block funding arrangement has now been increased to eight beds, following analysis of usage over the past three years. There are currently eight Doncaster Clinical Commissioning Group (DCCG) patients at Coral Lodge, and three active referrals. The Committee noted the report and the contents within.
9. Care Home Report Mrs Denman and Mrs Thomas presented the report and provided the Committee with an update on the progress made in the Care Home work
3
streams. In regards to Quality Assurance for Individual Placements, Mrs Thomas advised the Committee that the Local Authority have completed the Quality Audits for Doncaster CCG for a number of years and as part of improved integrated working a dedicated Nursing position has been developed within the CCG as a result of increased clinical assurance requirements, and Mrs Thomas commenced in this role on 19 August 2019. The intention is that requirements are communicated to the placement, in order to develop an action plan. The immediate route of escalation will continue to be the existing Quality and Risk Meeting. The methodology utilised is a Clinical Audit Tool to work alongside the Infection Prevention Control (IPC) and Local Authority tool and this will provide a consistent approach across multiple assessments. The tool itself remains under development with the aim that it will identify themes and trends and provide qualitative and quantative data to provide assurance.
From the audit that was undertaken for the four care homes, issues were highlighted around medication and Mrs Thomas advised she is working to support the care homes around this. Mrs Thomas provided feedback from the bi-weekly Care Home Quality and Risk Meeting. Details were provided on the rag rating for the Care Homes and there are still a number of homes that require improvement and these are being supported accordingly. Mrs Thomas explained that joint work is being undertaken with Doncaster Council around improving the systems and processes in regards to rag ratings. The aim in the next 3 months is to work closely with Care Quality Commission (CQC) and the Local Authority Contracts Monitoring Team to establish the number of placements and their ratings. The intention over the coming year is then to build up relationships with placements in a co-ordinated approach, prioritising the “at risk” category. Also when someone is supported at distance from home, we will make sure that arrangements are adequately supervised, with the aim of introducing stronger oversight arrangements The Committee noted the report and updates will continue to be provided at this meeting.
10. LeDeR Report Mr Russell provided the group with an update on the progress of the Learning Disabilities Mortality Review (LeDeR) at a local, regional and national level. The second LeDeR National Report was released in Quarter One and provided an oversight of activity, along with themes and trends in this area. This has been taken through both Clinical Quality Review Group Meetings (CQRG) for any immediate learning to take place from the national report. LeDeR is also taken through the Incident Management Group (IMG).
To date, throughout the local reviews, there have been no significant
4
concerns identified in terms of the care delivered to individuals prior to death. However, one of the areas of development that has not taken place has been the establishing of a local ‘learning’ group. This has been addressed and the first meeting is due to take place in early September with the group representation coming from a wide range of providers. Communication of this work will also be reported into the Learning Disability and Autism Partnership Boards. From a Primary care perspective, it was raised that we need to ensure General Practitioners (GPs) and Practice Nurses are aware of LeDeR and their roles within this. A discussion took place and it was agreed for both Mr Russell and Mr Boldy to share information with the Coroner and ensure that the Coroner’s office is aware of the LeDeR process. The Committee noted the report and it was agreed for LeDeR to be raised at every Quality and Patient Safety (Q&PS) Committee Meeting until an established working group is formed and until such time that the Committee is confident all learning networks are in place and are taken forward appropriately.
Mr Russell/Mr Boldy
11. Continuing Health Care Mrs Denman went through the report and provided a substantive overview of the work undertaken by the Continuing Healthcare Team (CHC). Doncaster CCG provides a quarterly return to NHS England (NHSE) with a substantive report incorporating the national requirements/measures and the CHC Team continue to meet these targets and achieved 100% on the 28 Day Referral Process. July has seen an increase in the number of fully funded individuals open to CHC although outstanding reviews for fully funded have decreased significantly. Mrs Denman advised the Committee a review is being undertaken around reviewing our new processes through an Individual Placements Board and we are also doing an internal review of our processes and outcomes to provide reassurance that these are robust and are not impacting on both quality and outcomes. There has been a slight increase since May 2019 in the number of new appeals, however, there is still a significant decrease in the number of open appeals over the last twelve months. The Committee noted the report and felt it was very comprehensive and easy to read.
12. Deprivation of Liberty Safeguards (DoLS) Report Mrs Johnson provided an update on progress in relation to Deprivation of Liberty Safeguards (DoLS). Suitable preparations are being made for the
5
new legislation, which will be implemented next year, by setting up a partnership group around the development of Liberty Protection Safeguards (LPS) and the first meeting is in September 2019. Mrs Johnson advised that following the meeting in September, the delivery plan will be brought to this meeting in November for monitoring and assurance.
An Option appraisal paper on implementation of LPS has been written by Mrs Johnson and will be presented at Governing Body and Strategy and Organisational Development Forum. The question was raised in regards to training on the new legislation in order for staff to gain an understanding/awareness on what the changes mean for us as a CCG, and Mrs Johnson advised she will facilitate a session for this.
The Committee noted the report and the progress in relation to DoLs and this will continue to be a standing agenda item.
Mrs Johnson
13. Transforming Care Programme Report Mr Evans updated the Committee around the on-going quality engagement in the Doncaster Transforming Care Programme (TCP). The report highlights progress and challenges set against the NHS England (NHSE) quality audit submission, March 2019. This provides current assurance to NHSE against their six national standards. We currently have nine patients in hospital, for which we have potential discharge plans for eight of these patients already in place. Mr Evans discussed some of the challenges around discharge planning but provided assurance that the relevant people were engaged to progress with discharge plans. Mr Evans provided information in relation to a number of patients in acute settings and provided assurance around Care and Treatment reviews being undertaken.
On-going work also continues with various CCG’s around commissioner guidance and disputes over responsibility for patients who have been placed in Doncaster from other areas and then require hospital due to placement breakdown. There are a number of these cases currently being examined. The Committee noted the report and commended the team for the amount of good work that is being undertaken.
14. Transition Risk & Current Challenges Update Ms Ibbeson advised that concerns were raised at the last Committee in July around the co-ordination of transitions and ensuring this happens in a timely manner. Following discussions with Doncaster Council, a Transition Board has been formed with three workstreams sitting underneath this. The
6
Transition Board met last month where Ms Ibbeson was keen to ensure that progress was happening within the workstreams. A new Chair is now in place and there is recognition that time is needed to mobilise the workstreams and so this will be monitored over the next three months and escalated accordingly. The Committee noted the update and the concerns raised.
15. DBTHFT Quality Report Ms Ibbeson presented the report and the key highlights were as follows: CQC Inspection – for noting is that CQC inspections are taking place this week at the Acute Trust which will be covering outpatients, Emergency Department (ED), Maternity and diagnostic imaging.
Ophthalmology - as previously reported, DCCG CQRG have raised concerns in respect of the review list in Ophthalmology, and the increased numbers of patients on it and Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust (DBTHFT) acknowledge and share this concern. CQRG have requested a clear understanding of the current issue along with assurance that a planned resolution is in place that will address these issues and mitigate any possible impact on patient care and safety. In addition, DBTHFT have agreed to submit details of the work already completed by the Trust in order to address any delays from the list, this will offer a better understanding of how patients are prioritised in order to prevent incidences of harm. Work is being undertaken around validating appointment outcomes, as it has been identified that there are a number of appointments that are not currently documented on the system from various specialities and this should be completed prior to the next Quality meeting and so an update will be provided. Ms Ibbeson advised this will continue to be monitored at CQRG and there has been good engagement with the Trust.
Maternity - Mrs Ibbeson explained that a further Quality Risk Profile (QRP)
was completed in August 2019 has now been populated, finalised and submitted to the NHSE Quality Risk Meeting (QRM). This second risk profile shows a reduction in surrounding concern and offers clear evidence that risks are being managed and mitigated with improvements progressing at pace. The QRM members agree that it is now appropriate to stand down the QRM with the understanding that the CQRG Maternity Sub group will continue to meet and monitor any arising concerns and escalate if required. Tetanus Immunoglobulin – following concerns around the implementation of the pathway in and out of DBTHFT from the community/primary care, a review of the guidance has taken place. This ensures that national guidance is aligned to current pathways on a local level. The guidelines are due to go through the Trusts Drugs and Therapeutics Committee in September and will also be reviewed through the relevant safety and effectiveness groups.
7
The Committee noted the report and concerns raised.
16. RDaSH Quality Report The report was presented by Ms Ibbeson and the key highlights were as follows: Safer Staffing – this risk has recently been reduced from Extreme to High from an RDaSH Quality Committee and Board point of view. A letter was formally sent to Mr Hackett by Mrs Tingle, from which a response has been received and acknowledges the concerns identified by the CCG. Ms Ibbeson stated we feel the letter offers assurance and that RDaSH are mitigating risks. The emerging situation in relation to Pensions and the impact on medical staff has also being raised at CQRG as this is impacting on services at both the Acute Trust and Primary Care. Jubilee Close – Ms Ibbeson advised the action plan has been completed and additional site visits have been undertaken which has shown an improvement in both risk assessment and care planning. A sub group was set up in regards to Jubilee Close, which attendees have found really informative and would like for this to continue and develop. Ms Ibbeson therefore asked the Contract Board if they were happy to support the further development of this group and the suggestion was put forward for the group to be closed if the concerns have been resolved regarding Jubilee Close and for Ms Ibbeson to produce a new Terms of Reference for the new development of the group, take through CQRG and inform the Contract Board as needed. Ms Ibbeson therefore asked the Committee if they support the development of the group moving forward to which they welcome the invitation provided this is done in an agreed and formal way and reports to the Contract Board as required.
Attention Deficit Hyperactivity Disorder (ADHD) - Children & Young Peoples Services - it has been identified through both the CCG, CQRG and Finance, Performance, and Information Group (FPIG) meetings that the waiting times for children accessing RDaSH, ADHD services is lengthy and currently goes beyond expected and appropriate timescales. This had been escalated as an area of concern to the DCCG Contract Board and will continue to be monitored via this forum. Since the last reporting period the CCG has formally agreed to financially support additional clinics along with two fixed term staffing posts in order to clear any outstanding waiting lists over the next twelve months, however, for noting is that RDaSH are struggling to recruit into posts. It was agreed for this to be raised at Governing Body by Mr Russell in regards to the waiting times. The Committee noted the report and the concerns raised.
Mr Russell
17. Medicines Management Report Ms Cheong presented information on the current safety and quality issues within Doncaster Clinical Commissioning Group (DCCG) and the key
8
highlights were as follows: Controlled Drugs (CD) Update – a proposal for Pregabalin and Gabapentin monitoring to be undertaken across South Yorkshire and Bassetlaw by Medicines Management Teams in 2019/20 has been approved. Reviews of patients identified will take place via controlled drugs monitoring and letters will be sent to individual GP Practices regarding this. SYB Integrated Care System (SYB ICS) – Medicines Management - the polypharmacy ‘safer prescribing in frailty’ is a new workstream within the South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS). All CCGs within the ICS will be reviewing five patients per practice who are aged seventy five and over, and taking ten medications or more. The higher risk patients will be identified systematically and will be reviewed with the view to reduce their medication load. Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) – Lithium monitoring audit was carried out by RDaSH which overall showed a good result with close monitoring of patients taking Lithium at the Doncaster Lithium Clinic. The audit however, highlighted a lack of monitoring of serum calcium with Lithium, but this was flagged up as needing improvement, and assurances will be put in place to ensure better monitoring of serum calcium. A new policy around suspected Urinary Tract Infection (UTI) and appropriate diagnostics was discussed at the RDaSH Medicines Management Committee (MMC) meeting. It was noted that the document was in line with national Public Health England document, where routine dipstick is not recommended. This is also in line with documents/policies being developed for the care homes in Doncaster. The Committee noted the report and contents within.
18. Medicines Management Antibiotic Audit Review Ms Cheong presented the results of the Urinary Tract Infection (UTI) antibiotic prescribing audit that was undertaken within a two week period in both December 2018 and February 2019. The audit indicated mixed levels of improvement from baseline to re-audit of the prescribing of antibiotic for the treatment of UTI. Improvements were observed from baseline to re-audit in the areas of:
• Number of practices which participated in the audit: from 26 to 30 practices
• Antibiotic for the prophylaxis of UTI: this reduced from 8% to 5% across Doncaster
• Antibiotic treatment initiated in patients where antibiotic was needed: from 86% to 87% across Doncaster
• Nitrofurantoin used as first-line antibiotic for the treatment of UTI: increased from 62% to 71% across Doncaster
• Trimethoprim used as first line antibiotic for the treatment of UTI: reduced from 27% to 21%.
9
Poor results were observed with deterioration from baseline in the following areas:
• Appropriate dose of antibiotic used: deteriorated from 97% to 93% across Doncaster
• The use of delayed antibiotics in non-pregnant women (<65 years) with mild symptoms
• To update the local antibiotic formulary to reflect PHE recommendations. • Prescribers to be updated once local antibiotic formulary has been
updated.
The antibiotic formulary requires updating to reflect Public Health England (PHE) recommendations and Prescribers will be updated once this has been completed. The Committee noted the report and the results of the audit and would encourage a re-audit of the prescribing to be undertaken in the future.
19. Rebate Schemes Ms Cheong explained the scheme and that this was taken to the Quality Innovation, Productivity and Prevention (QIPP) Programme Board in August 2019 for sign off and has been brought today for information. The Committee noted the three specific Rebate Schemes and were happy this would have no adverse impact on the quality of patient care.
20. Primary Care Quality Report Mrs Head presented the report and the key highlights were as follows: Workforce – Mrs Head advised she has been pulling together information gathered from Nurses and the Doncaster General Practice Nurse Development Strategy is now in draft. This will set the direction of development for General Practice Nursing across Doncaster. There has been an event held to gather information and two nurse TARGET sessions to engage with General Practice Nurses (GPNs). GPNs were also given anonymous questionnaires to complete with a return rate of 97%. This work will support the implementation of the GPN 10 point plan across Doncaster. The GPN 10 point plan is the nurse element of the Five Year General Practice Forward View (GPFV). It was agreed to report here by exception and the draft Doncaster General Practice Nurse Development Strategy will go to the Primary Care Committee Meeting on 12 September 2019. For noting is that in red on the GPN 10 point plan is: Improve access to return to practice programmes, and support nurses who need to return to the NMC register. Wound Care Service – at the request of the Wound Care Alliance, the service will now go live on 1 December 2019 and not the 1 October 2019, in order to allow more time for staff competencies to be measured and training needs to be identified. Training of primary care staff has commenced, led by the Lead Nurse of Skin Integrity Team at DBTHFT to enable staff to be skilled and proficient to provide this service and Practice
10
staff are attending a suite of training complete with competency assessments. Good feedback has been received from Practice Nurses regarding the Wound Care education. Care Quality Commission (CQC) – inspections have taken place, however, no reports have been published since the last meeting in July. No serious concerns have been raised from the inspections.
21. Fylde Coast Medical Services (FCMS) Update Report The purpose of the paper is to provide an update and overview of the quality and patient safety update in relation to FCMS. Due to staffing issues in management, FCMS Doncaster have received support from the Blackpool team. They have started to pull together a new quality report that provides assurance on the safety and effectiveness of the service. For noting is that both Mr Russell and Ms Ibbeson did a walk-through of front door access and streaming service at Doncaster and Bassetlaw Teaching Hospital Foundation Trust (DBTHFT) in terms of their triage processes and through this, a good understanding and confidence of the service has been gained. The Committee noted the report and contents within.
22. IPC Report Mrs Feirn presented her report to the Committee which contained an update on:
1. The national requirement to reduce Healthcare Associated Infections
2. Data relating to outbreak of infection during the preceding 8 weeks (PLACE)
3. Report on the current and (future) position regarding the Sharps Bins contract
4. Exception report –pressure ulcers 5. Exception report - Immunisation & Vaccination
Methicillin-Resistant Staphylococcus Aureus (MRSA) 2019-20 - this trajectory remains as zero tolerance. Group A Streptococcus - a national group has been set up by Public Health England (PHE) to investigate both invasive and non-invasive Group A Streptococcal infections. There have been thirty four cases since April and for Doncaster these are predominantly within the Doncaster Prisons. Influenza – planning has begun for the 2019/20 Influenza season, the main objective being an increased uptake of Influenza vaccine particularly by at risk groups, healthcare staff and carers within care homes and domiciliary workers.
11
Sharps Bins Contracts – this remains on the CCG risk register. Legal opinion has been sought by Doncaster Council and a response is still awaited. Mr Russell is due to Mr Garrett to look at the next steps. The Committee noted the report and contents within.
23. Safeguarding Quarter One Report 2019/2020 Ms Ibbeson presented the Quarter 1 (Q1) report which sets out Doncaster Clinical Commissioning Groups (DCCG) safeguarding arrangements and activity within commissioning and provider services across the Doncaster health economy for Q1. The report provides the Quality and Patient Safety Committee (Q&PSC) with assurance that DCCG is meeting its statutory duties and requirements for safeguarding children and adults demonstrating the activity carried out and plans for the year ahead. Ms Ibbeson advised for noting is that due to the unexpected time delay in relation to the revised Performance Framework being developed by the Doncaster Safeguarding Children Board, the Q1 data in relation to Child Protection plans is not available. Doncaster CCG have discussed this with the Doncaster Safeguarding Children Board and expressed their concerns in relation to this extended delay and so Q1 data will be reported to the Quality and Patient Safety Committee in November 2019. The Committee noted the report and contents within.
Ms Ibbeson
24. Doncaster SEND Inspection The Committee received a paper that sets out key findings and the next steps required following a joint inspection in May 2019 that was conducted across Doncaster by Office for Standards in Education, Children's Services and Skills (Ofsted) and the Care Quality Commission (CQC) to judge the effectiveness of the area in implementing the special educational needs and disability (SEND) reforms as set out in the Children and Families Act 2014. Doncaster CCG will be working jointly with Doncaster Council to develop an action plan and ensure this is effectively actioned and that improvements are made going forward. The report was brought to the Committee to offer assurance and will come to every meeting by exception as well as to Executive Committee and Governing Body. The Committee noted the report and the findings from the SEND Inspection. It was also noted that the outcome of the inspection was that Doncaster were not required to produce a Statement of Action.
25. Quality in Contracts and Safeguarding Children Work Plan 2019-20 Ms Ibbeson presented the report and provided the group with an update on the work plan in relation to Quality in Contracts and Safeguarding Children.
12
The group were sighted on the Quality in Contracts & Children’s Safeguarding Team Structure and workstreams for 2019/20, which sets out the responsibilities for Ms Ibbeson’s team. The Committee noted the report.
26. Patient Experience update Mr Russell advised the report provides staff with more of an in-depth review of the complaints/compliments received, demonstrates responsiveness and evidences we are managing complaints/concerns in an active way. The report will also be shared at DCCG Managers Meeting on a quarterly basis, which will allow for open discussions. The Committee noted the report and the contents within.
27. Caldicott Log & Caldicott Work Plan (Exceptions) No issues to raise.
28. Doncaster Serious Incident (SI) Themes Report 2018/2019 & Q1 2019/20 Mrs Rayner presented the report and advised this provides the annual reported serious incident themes and trends for 2018/19 and also the Q1 2019/20 figures. Additionally, it also provides data on the other commissioned services from Q1 2019/20 which will be developed in year and also provides data and work that is taking place around the identified themes and trends. Mrs Rayner advised they are going to work with Mr Empson to look at reviewing the database and how we monitor actions as we need to ensure appropriate action is taken by the CCG and so the report will evolve as necessary and will also be shared more widely at a future DCCG Managers to see if it is meeting people’s needs. The Committee noted the report and felt it was good and easy to read.
29. Corporate Risk Register and Escalation of Risks It was noted by the Committee that Sharps Bins remains a risk and will continue to remain on the Risk Register. It was agreed that there were no additional risks to be added following today’s meeting.
30. Quality and Patient Safety Committee Effectiveness Review 2018-19 The CCG as part of its Annual Governance Statement, contained within its Annual Report, has conducted a self-assessment of its Committees performance as good principles of corporate governance. Overall the self-assessment of the Quality and Patient Safety Committee has demonstrated that members are satisfied with its effectiveness however, for noting is the 54% response rate.
13
The key improvements and learning for the committee for 2019-20 are: • Time allocation for each paper so the Committee functions
effectively; • A standard format for reports; • Evolving data and information flows to respond to emergency
structures and circumstances. • Development and training for new committee members to be
implemented by Members.
The Committee noted the report, the response rate and the key improvements and learning for 2019-20.
31. Quality & Patient Safety Committee Reporting Matrix It was agreed that there were no items to add.
32. Items to escalate to Governing Body/Executive Committee It was agreed there were no items for escalation from today’s meeting.
33. Minutes of Meetings The following sets of minutes were noted by the Committee:
• Medicines Management Group (MMG) – 13.06.19 • Area Prescribing Committee (APC) – 30.05.19, 25.07.19 • Incident Management Group (IMG) – 26.06.19, 10.07.19, 24.07.19 • Acute Clinical Quality Review Group (ACQRG) 11.06.19, 09.07.19 • RDaSH Clinical Quality Review Group (CQRG) – 19.06.19, 17.07.19
34. Any Other Business There were no items raised.
35. Date and Time of Next Meeting
Thursday 7 November 2019 at 9.30 am, Boardroom, Sovereign House
1
Engagement & Experience Committee (EEC) Meeting Thursday 3rd October 2019 at 10am – 12pm
In Meeting Room 3, Sovereign House
Present : S. Whittle - Chair Lay Member for Patient & Public
Involvement, DCCG A. Fitzgerald (from 10.30am) Director of Strategy & Delivery, DCCG H. Joerning Patient Experience Manager, DCCG A. Smith Senior Communications & Engagement
Officer, DCCG A. Goodall Healthwatch Doncaster D. Atkin S. Hodges
Doncaster Health Ambassador Group Chair Health Analyst , Trainee - NHS England (NHSE)
In attendance:
K. Connolly
Senior Corporate Support Officer (taking minutes)
Agenda Ref
Subject Action Required By
1. Welcome and Introductions The Chair welcomed everyone to the meeting and introductions were made. The Chair also welcomed Sophie Hodges to the meeting, a trainee from NHS England, shadowing within the Performance team. The Chair informed the Committee members Debbie Hilditch has stood down as Vice Chair for Healthwatch Doncaster and will no longer attend EEC meetings. Mr Goodall from Healthwatch Doncaster will attend meetings in place of Mrs. Hilditch. The Chair expressed her appreciation and thanks to Mrs Hilditch for all her engagement work through Healthwatch Doncaster for EEC. Mr Atkin advised EEC Health Ambassador meetings are being rescheduled so he can attend EEC meetings. Mr Atkin also informed the Committee minutes from Health Ambassador meetings will be shared with the Committee members.
DA
2. Apologies for Absence The Chair noted apologies of absence from the following :
• Paul Hemingway - Head of Communications & Engagement, DCCG
2
• Amy Coggan – Head of Performance and Intelligence, DCCG • Alison Edwards - Corporate Governance Manager, DCCG • Rachael Mather - Senior Communications & Engagement Officer,
DCCG • Victor Joseph - Public Health Representative • Louise Robson - Public Health Theme Lead • Manjushree Pande – Locality Lead, South
3. Declarations of Interest
The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared.
4. Minutes From Previous Meeting The minutes from the previous Committee meeting held on 5th September 2019 were approved as a correct record with the following amendment : • Add Dr. M. Pande to apologies list
5. Action Log Update Both the open & closed action logs have been updated :
• 9 actions closed • 3 actions remain open • 6 new actions
The updated open and closed action logs will be circulated with the minutes of this meeting.
6. Notification of Any Other Business There was no notification of any further business for discussion.
3
7. Complaints Update Quarterly Report Mrs. Joerning provided the Committee members with a verbal update on Complaints for the last quarter and highlighted the following points:
• 4 complaints received • 174 contacts made • 2 concerns received • Survey Monkey link almost ready – will be on website • Equality & Diversity forms are ready to go out • Complaints Policy currently being reviewed
Mrs. Joerning explained enquiries are being signposted to the correct person / organisation, this is making a big difference to the concern/complaint being dealt with efficiently. The quarterly report will be presented at the next EEC meeting in November by Mrs. McGuire. Mrs. Joerning advised EEC members the recent external audit had one recommendation, the word ’annual’ was missed off the annual report. Overall a good complaints system is in place and it is working very well.
The Chair thanked Mrs. Joerning for the update.
8. Healthwatch Monthly Update Mr. Goodall provided the Committee members with a verbal monthly update on Healthwatch Doncaster and highlighted the following points: Health Ambassadors
• 3 new Health Ambassador (HA) representatives have been recruited for the following communities:
o Deaf o Young People with Autism o Mental Health
• Young Carer representative to be recruited • DMBC representative attended HA meeting to discuss ‘Doncaster
Talks’ • Continuing to help support seldom heard communities have their
issues raised where appropriate
Patient Participation Group Network
• Cheryl Watkinson to join the PPG network as a representative of primary care Doncaster and as a patient participation group member as well.
• Julie Magee is set to visit the PPG network in October as another locality representative within her integrated neighbourhood co-ordinator role.
4
• Tina Hope from Primary Care Doncaster now has a regular agenda item where she shares information primarily on how the extended access to GP services is developing and she also relays information on behalf of the PPG network back to Primary Care Doncaster.
• New members have joined the Network from Scawsby Health Centre, they felt they required some further support in order to help their PPG grow so thought it would be highly beneficial to join the network. They have already connected with other members of how they can work together outside of network meetings to make positive steps forward.
• Future meetings will see a representative from NHS Doncaster CCG to attend meetings to share relevant information with the group.
• PCN Clinical Lead – Ben Scott –will be attending October’s meeting to share his vision for his locality within the primary care network.
• Later on in the year the newly appointed Health and Wellbeing Manager from Doncaster Culture and Leisure Trust will be attending a network meeting to gain insight on what the network’s opinion is of an exercise referral programme through your local GP practice.
• Healthwatch Doncaster and NHS Doncaster CCG working on some guidance and support for PPGs to share best practice – developing more effective PPGS to strengthen Patient Voice in Primary Care.
Healthwatch Doncaster Projects NHS Long Term Plan
• Presentation to SYB ICS Guiding Coalition on the NHS Long Term Plan report based on the voices of 1300 people across South Yorkshire and Bassetlaw.
• Response to the NHS Long Term Plan from SYB ICS being discussed at next Guiding Coalition on 9 October 2019.
• Work done by all local Healthwatch in South Yorkshire and Bassetlaw and co-ordinated by Healthwatch Doncaster was awarded an Outstanding Achievement Award by Healthwatch England at the Annual Conference in October 2019.
Miss Smith to upload a copy of the press release relating to the national Achievement Award on the CCG website.
Recovery Games and Pride A qualitative experience project focussed on emotional health and well-being has been developed by the Healthwatch Doncaster Engagement Team and Sophie Hodges – NHS Graduate Management Trainee from NHS Doncaster CCG. The project has been delivered through conversations and then thematic analysis of the information shared. Access to GP Services
AS
5
Nearly 1300 people were engaged in this project with coverage from across the Borough. The report is being written and finalised with some additional time being spent on data analysis. Healthwatch Doncaster Micro-Grants 2019 Micro-Grants celebration event took place on 19 September 2019. 23 organisations have been funded up to £500 to deliver community-based engagement and involvement projects. Young Healthwatch First Young Healthwatch session took place on 26 September 2019. The group is focussing on growing and developing and links have been made with Ladder Group, Doncaster College and Young Commissioners. Hypermobility Report A Yorkshire and The Humber wide report on Hypermobility Syndrome has been published and shared locally. NHS Doncaster CCG Primary Care team have received the report and agreed to share the recommendations and outcomes across Primary Care. 24 Hours in Urgent and Emergency Care Healthwatch Doncaster volunteers have developed a project gathering qualitative experiences of people using Urgent and Emergency Care services across a 24 hour period. The outcomes of this work will feed in the proposals and discussions for Urgent and Emergency Care being developed by DBTH. Future Planned Activities
• Patient Clinical Information Boards (DBTH – engagement session)
• Cancer (referral to diagnosis – 28 days) • Supported Living • Social Capital (1000 voices – linked to Community Led Support) • Supporting people to share their stories and experiences with
NHS Doncaster CCG’s Governing Body • Airing Your Views (qualitative patient experiences)
The Engagement and Experience Committee :
• Noted the updates on work that has taken place through the Healthwatch Doncaster and Engagement in health and wellbeing grant-funded activity
• Discussed future planned activities and identified any areas for additional partnership working
• Discussed any other areas of activities which EEC may wish to see considered
Mr Goodall to send report to Mrs Connolly for distribution to the Committee members.
AG
9. Primary Care Communications and Engagement Strategy
6
Mr Fitzgerald presented a report to Engagement and Experience Committee with an overview of the planned communications and engagement activities that will take place across Primary Care in 2019 - 20. Based on communications and engagement activity which has taken place over the last 18 months in Doncaster, this strategy brings all that feedback into one place and includes a focus on six key themes:
• Choosing the right service for health and care needs • Primary Care Networks and More choice, more appointments
service • Improving the use of digital tools and platforms across primary
care • Raising awareness of the different health and care professionals
working across primary care • Harnessing the importance of self-care • Improving the buildings and facilities primary care services
operate from The strategy includes an action plan which is split into activities by month. It also includes costings which are within the communications and engagement budget allocated for primary care for 2019-20. The allocation is £10,000 and the proposals can all take place within the allocated budget. The following objectives will be the focus of our communications and engagement activity across primary care. We will work with patients, members of the public, health care professionals and staff to:
• Ensure key primary care messages are articulated consistently and in a timely manner
• Ensure members of the public and patients are aware of the services available to them across primary care to help them choose well
• Ensure the key benefits of Primary Care Networks and Extended Access are clear and transparent
• Help encourage the use of digital apps and platforms for patients and staff – improving access and choice
• Maximise the use of case studies to highlight what services are available across primary care and how people can recognise their symptoms and take appropriate early action to reduce unnecessary hospital admission
• Maintain and nurture relationships with partners, stakeholders and staff.
Over the next 12 months, engagement opportunities will be discussed, explored and utilised to reach hard to reach groups and encourage onwards discussions with their friends and families. Mr Fitzgerald informed the members the report has been to Primary care
7
Committee and it has been brought to EEC for noting. The report is a ‘live’ document that can be updated regularly. The Chair suggested any input would be helpful. The Engagement and Experience Committee noted the Primary Care communications and engagement strategy for 2019-20.
10. Place Plan Refresh Launch Event Mr Fitzgerald advised the Committee members of the Place Plan Refresh Launch Event being held on Wednesday, 16th October from 4.30pm – 7pm at the High Speed Rail College, Doncaster. At the moment 60 delegates have registered with spaces for at least 20 more. Mr Goodall requested details of the event to be sent to him for Healthwatch Doncaster. The Chair requested her registration for the event. The official launch of the Refreshed Place Plan is 17th October 2019.
AS
11. Any Other Business Mr. Atkin advised Committee members an engagement officer for the Cancer community for all of Yorkshire has been funded for 1 year. Mr Atkin to email Mr Goodall with details. The Priority Area for this meeting Ageing Well – Care Homes will be presented at November’s meeting.
DA
12. Date & Time of Next Meeting Thursday 7th November 2019 at 10am – 12pm in Meeting Room 3, Sovereign House
Enc A
1
Minutes of the Primary Care Commissioning Committee (Public)
Held on Thursday 10 October 2019 at 12.30pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ
Voting Members Present:
Mrs Linda Tully Lay Member (Chair) Mrs Jackie Pederson Chief Officer Mrs Hayley Tingle Chief Finance Officer Mr Anthony Fitzgerald Director of Strategy and Delivery Mr Andrew Russell Chief Nurse
Non-Voting Members Present:
Mrs Carolyn Ogle Associate Director of Primary Care & Commissioning
Mr Karl Roberts Primary Care Manager Mrs Andrea Ibbeson Head of Quality & Designated Nurse for
Children’s Safeguarding & LAC Mr Paul Barringer NHS England Representative Dr Dean Eggitt Local Medical Committee Representative Mrs Zara Head Lead Nurse Primary Care Quality
In Attendance:
Mrs Kelly Smith Primary Care Support Officer - Commissioning
Mrs Karen Tooley Lead Nurse for Implementation of Care Home Strategy
Mr Alex Molyneux Head of Medicines Management Mrs Lisa Frisby Finance Manager
One member of public in attendance.
Action
1. Apologies for Absence Apologies for absence were received from:
• Dr Manjushree Pande – Locality Lead GP • Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term
Conditions • Mrs Sarah Whittle – Lay Member
The Primary Care Commissioning Committee noted that Mr Anthony Fitzgerald would arrive late.
2. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the
Enc A
2
CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared.
3. Notifications of Any Other Business
• TARGET.
4. Minutes From Previous Meeting held 12 September 2019 The minutes of the last meeting held on 12 September 2019 were approved as an accurate record with the following amendment:
• To remove track changes The minutes were signed by the Chair.
5. Matters Arising not on the Agenda No matters arising.
6. Action Tracker The Committee discussed and updated each item on the Action Tracker. The latest updates can be viewed on the Action Tracker. The following updates were also noted in relation to action plan references:
• AP50 and AP51 - Communications and Engagement Campaign: The first phase of the campaign will focus on Primary Care Networks and More Choice, More Appointments. The campaign will go live next week. All GPs and practice managers will receive a briefing note along with other stakeholders and groups of how they can get involved and support. In November/December the campaign will raise awareness of the different health and social care professionals working across primary care including pharmacy (November) and choosing the right service (December) which will focus on pharmacy
Enc A
3
for minor ailments.
7. Finance and Contracting 7.1 Interim Exception Report No items to report. 7.2 Quality Toolkit for Care Homes The Quality Toolkit for Care Homes was shared as a paper, ahead of the meeting. As part of the work to raise the quality of work in Care Homes, a Quality Toolkit has been developed to collate best practice principles supporting care homes including;
• A guide for care homes to support self-care for selected conditions by purchasing over the counter treatments along with using the Homely Remedy Scheme,
• Good practice guidance for Care Homes to use the ‘When required Medicines’ (PRN)
• Good practice guidance around the use of ‘Covert Medicines’ and good administration.
The Toolkit will sit on the CCG’s intranet for Care Homes to access and will be updated regularly in line with National Institute for Health and Care Excellence (NICE) and Care Quality Commission (CQC) guidance. The Committee questioned whether the role out included domiciliary care, Mrs Tooley confirmed that a meeting is being arranged with the Local Authority for endorsement to include domiciliary care and Learning Disability (LD) providers. The Committee questioned whether the CCG will know which Care Homes are using the toolkit and whether they will achieve a higher quality of care. Mrs Tooley confirmed that the CCG has undertaken lots of engagement with Care Homes and all have been in support of the Toolkit. If Care Homes choose not to use the Toolkit it is likely that it would be evident which are not as the CCG would expect to see a reduction in issues. Mrs Tooley also confirmed that engagement with Primary Care is planned at both November TARGET sessions. The disclaimer at the bottom of the Toolkit advises Care Homes to refer to the online copy for the latest version, the Committee asked how Care Homes will be notified of any changes, Mrs Tooley confirmed that the CCG is currently in the process of providing all Care Homes with NHS.net email addresses, all regular communications will be sent via this route. It was noted that the bullet points listed under Covert Medication on page 38 may be confusing; Mrs Tooley agreed to amend the points to make
Mrs Tooley
Enc A
4
them clearer. Along with approval at today’s Primary Care Commissioning Committee, the Toolkit will be taken to the Medicines Management Group for approval also. Dr Eggitt questioned whether this will be discussed with the LMC, it was confirmed that the Toolkit will be shared with the LMC pending approval. It was noted that training requirements and engagement would be picked up through routine meetings including locality meetings. Mr Fitzgerald joined the Meeting. The Primary Care Commissioning Committee approved the Quality Toolkit for Care Homes and requested an update in six months. 7.3 doctorlink Demonstration NHS England stated that all Practices must offer an Online Consultation platform for all patients from 1 April 2020, Doncaster CCG, along with Barnsley, Bassetlaw and Sheffield undertook a procurement exercise and doctorlink were the successful bidders for the contract to provide the service. In Doncaster, it was proposed that five to six Practices would be set up as early adopters of the service, feedback from those early adopters would be collected and a roll out to all remaining Practices would follow. Mr Roberts gave a demonstration of the system for the patient’s view. doctorlink can be accessed via an app. When a patient registers to use doctorlink, the patient’s details will be checked against those held on the spine. The patient must register themselves and the Practice will not be required to register patients. doctorlink offers the following functions:
• Check Symptoms (and book an appointment if necessary) • Book an appointment • BMI Checker • Repeat Prescriptions
The ‘Check Symptoms’ functions allows patients to be triaged via an online chat. The chat is run by algorithms and looks to rule out any red flags. The patient will then be given their results with recommendations these may include advice for self-care or to book an appointment within a time frame. The function will then allow the Patient to book a slot with their Practice online. The notes from the Online Consultation will be inserted into the patient’s medical notes. If the Practice chooses not to allow patients to directly book into the appointment slots, an email will be sent to the Practice’s nominated inbox requesting the Practice to contact the patient to arrange an appointment within the recommended timeframe.
Enc A
5
It was noted that this function will be connected to the local Directory of Services (DOS) by 1 April 2020. This function is also indemnified by doctorlink. It was noted that the ‘Book an appointment’ function was for non-urgent appointments and the function is optional and can be switched off as default if the Practices wishes. Practices are concerned that Online Consultation may result in more patients being directed to Accident and Emergency (A&E). Mr Roberts has engaged with Doncaster & Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) and Fylde Coast Medical Services (FCMS) to inform them of doctorlink. The initial plan was to have a two week pause following the rollout to early adopters before rolling out to all other Practices, however due to time constraints, this has not been possible. The feedback from the early adopters has been taken on board by doctorlink, and built in to the implementation plan ready to be rolled out to the remaining Practices. It is anticipated that doctorlink will roll out to up to ten Practices per month between now and the end of March 2020. A letter will be sent from the Primary Care team to all Practices to advise that doctorlink will be making contact in the coming weeks to arrange installation and to talk through the programme. Mr Roberts also advised that the CCG have been successful in appointing project support for the implementation of Digital Primary Care, including doctorlink on a 12 month Secondment basis. The Primary Care Commissioning Committee noted the doctorlink demonstration.
Mr Roberts
8. Quality 8.1 Interim Exception Report Tetanus and Immunoglobulins work was presented at the October TARGET session, the Primary Care Commissioning Committee acknowledged the large amount of work that has been undertaken and agreed to write to Dr Kirby in recognition of the amount of work undertaken by the practice. CQC Report A paper, including Primary Care Doncaster’s CQC inspection report was shared ahead of the meeting. Primary Care Doncaster had their first CQC inspection on 12 June 2019; the inspection report was published 16 September 2019. The service was rated as requires improvement overall.
Mrs Ogle/Mrs
Head
Enc A
6
Areas highlighted included: • Recruitment procedures: The Committee noted that the system
used to hold staff data, failed on the day of inspection and therefore, they were not able to provide evidence such as Disclosure and Barring Service (DBS) checks. The issue has now been resolved; however was a breach of regulation.
An action plan was issued and Primary Care Doncaster fully engaged and has now completed the plan. All staff now have clear evidence of documents. The Primary Care Commissioning Committee discussed the breach of regulation and noted that a remedial notice would usually be issued, however due to the approach taken by the service; the Primary Care Commissioning Committee agreed that the breach had been remedied and agreed for this to be noted at the next Contracting Meeting. The Committee were assured the Quality and Patient Safety Committee would ensure quality requirements are being met. Primary Care Doncaster Ltd are currently part of Doncaster’s Emergency Contractor Framework, Mrs Ogle agreed to inform Mrs Burns of the new CQC status. The Committee noted that Primary Care Doncaster were registered under the name Devonshire House, Mrs Head advised the Committee that Primary Care Doncaster have requested a change, the Committee felt this may cause confusion for patients and affect the Same Day Health Centre, Mrs Ogle agreed to discuss this with the Communication and Engagement Team. The Primary Care Commissioning Committee noted the report.
Mrs Ogle
Mrs Ogle
Mrs Ogle
Any Other Business – TARGET Due to time constraints, it was agreed to move this item up the Agenda. Doncaster CCG pays for backfill cover for TARGET from 12pm up until 6pm, the Committee discussed a number of letters which had been shared with Practices that did not attend the TARGET sessions requesting practices to pay back the funds for backfill cover. It was questioned whether communications were shared with Practices prior to the letters, Mrs Ogle confirmed that initial letters were sent by the Chair of the CCG in March 2019 advising Practices that funds will be recouped if they do not attend as it had become apparent through the attendance registers that many Practices were leaving before the 4pm session. Those Practices that did regularly attend raised concerns with the CCG that not all Practices were staying and stated that they felt this was unfair.
Enc A
7
Dr Eggitt raised concerns and questioned if a signed agreement was in place with Practices stating that funds could be recouped and stated that LMC advice to Practices would be not to pay the costs. Dr Eggitt felt that a change in process needed to be made, the Primary Care Commissioning Committee agreed for Mr Fitzgerald and Mrs Ogle to discuss this in further detail with the LMC, outside of the meeting. Dr Eggitt left the meeting.
Mr Fitzgerald / Mrs Ogle
9.
Access 9.1 GP Patient Survey Results The July 2019 GP Patient Survey results were presented to the Committee, the Committee noted that Healthwatch Doncaster have undertaken a local engagement exercise and the results of this will follow at a future meeting. 12,484 GP Patient Surveys were distributed, 4,342 Surveys were returned, giving a response rate of 35%. The Committee noted the survey limitations including sample sizes at Practice level being relatively small and the survey does not include qualitative data. The questions within the Survey changed in 2018; therefore there is no comparative data that can be used prior to 2018. The Primary Care Commissioning Committee noted the following results:
• Overall experience of GP Practice: Doncaster CCG was rated lower than the national average for ‘good’ when asked ‘How would you describe your experience of your GP Practice?’ and were rated slightly lower than in 2018.
• Local GP Services: Doncaster CCG was rated lower than the national average for ‘good’ for ‘how easily it is to get through to someone at your GP Practice on the phone’ and rated slightly lower than in 2018. Doncaster CCG was rated lower than the national average for ‘good’ when patients were asked ‘How helpful do you find the receptionists at your GP Practice?’ And were rated slightly lower than in 2018.
• Access to online services: Doncaster CCG were rated lower than the national average for patients ‘Understanding what online services their GP practice offers’ and scored higher for ‘don’t know what online services their GP offers’. The CCG scored lower than national average for patients using online services. Doncaster CCG were rated the same as the national average when patients were asked ‘How easy is it to use your GP Practice’s website to look for information or access services?’ And received better ratings when ranked ‘easy’ than in 2018.
• Making an appointment: Doncaster CCG were rated lower than the national average when patients were asked ‘When they last tried to make an appointment, were you offered a choice of
Enc A
8
appointment?’ And were slightly lower than in 2018. The CCG scored slightly lower than the national average when patients were asked ‘Whether they were satisfied with the type of appointment offered’ and were rated the same as in 2018. The Committee noted what patients do when they are not satisfied with the appointment offered and do not take it. Doncaster CCG was rated slightly lower than the nation average when patients were asked ‘How they would describe their experience of making an appointment’ and were slightly lower than in 2018.
• Mental health needs recognised and understood: Doncaster CCG were rated lower than the national average when patients were asked ‘During your last appointment, did you feel that the healthcare professional recognised and/or understood any mental health needs that you might have had?’ And were lower than in 2018.
• Managing health conditions: Doncaster CCG were rated lower than the national average when patients were asked ‘In the last 12 months, have you had enough support from local services or organisations to help you to manage your conditions?’ And were lower than in 2018.
• Satisfaction with general practice appointment times: Doncaster CCG were rated slighted lower than national average when patients were asked ‘How satisfied are you with the general practice appointment times that are available to you?’ And were lower than in 2018.
• Services when GP Practice is closed: The Committee noted the services that patients contact when their GP Practice was closed and noted that contacting an NHS service by telephone was the most popular service and was higher than the national average. The Committee also noted that fewer patients said they attended A&E than the national average. Doncaster CCG rated higher than the national average when patients were asked ‘How do you feel about how quickly you received care and advice on that occasion?’ And was rated higher than in 2018. The CCG was rated the same as the national average when patients were asked ‘Considering all of the people that you saw or spoke to on that occasion, did you have confidence and trust in them?’ however, were rated slightly lower than in 2018. The CCG was rated higher than national average when patients were asked ’Overall, how would you describe your last experience of NHS services when you wanted to see a GP but your GP Practice was closed?’ and rated higher than in 2018.
The Primary Care Commissioning Committee noted the Survey Results. It was agreed that the results would be triangulated along with the Healthwatch local engagement exercise findings and any areas of focus would be discussed alongside other data at future Primary Care Information Sub Group meetings. Mr Roberts agreed to share the full GP Patient Survey Results with all
Mr Roberts
Enc A
9
Committee members. 9.2 Patient Registration Issues A paper outlining patient registration issues identified in practice visits was shared ahead of the meeting. Two Practices had raised concerns where other Practices appear to not be meeting their contractual obligations in terms of registering and removal of patients off their Practice list. One Practice alleged that a neighbouring Practice is directing patients with a learning disability to their Practice where patients required a home visit. Another Practice alleged that Care Home patients have been asked to re-register with the Practice despite the patient already being registered with another Practice in the area. The Primary Care Commissioning Committee discussed each in turn and agreed for a reminder of contractual obligations to be shared with all Practices, Mrs Ogle agreed to draft the letter and share this with the LMC.
Mrs Ogle
10. Strategy and Planning 10.1 Primary Care Delivery Plan The September update of the Primary Care Delivery Plan was shared as a paper, ahead of the meeting. The Committee noted that a more robust process has been put in place for updates via a SharePoint folder accessible via the CCG intranet. The Primary Care Delivery Plan is discussed each month at the Primary Care Delivery Group; a number of items were discussed and updated at the September Delivery Group meeting. The Primary Care Delivery Plan will also be in focus at the January 2020 Governing Body. Highlights included:
• Item 1.5 ‘Ensure the findings of the 360 Assurance Audit on effective Primary Care Commissioning are embedded across Doncaster’. – Will be marked as complete at the October Primary Care Delivery Group.
• Item 1.6 ‘ A full review of alternative provider medical services (A-PMS) GP contracts to ensure a better equity across GP Primary Care’ – Will be marked as complete at the October Primary Care Delivery Group.
• Item 2.1 ‘Enable more patients in Doncaster to use online services to increase the ease in making appointments and ordering repeat prescriptions as well as having repeat medications dispensed directly where appropriate’ – Mrs Ogle advised that monitoring repeat dispensing continues to be a problem and is being looked at currently.
• Item 3.1 ‘Update and improve all Doncaster GP and Pharmacy
Enc A
10
local enhanced services by implementing robust monitoring and collections processes as well as clear and detailed specifications’ – The service specifications are currently being updated and should be completed by November.
• Item 3.3 ‘Increase the appropriate use of secondary care by analysing five key local enhanced services to ensure activity is delivered in the correct clinical setting’ – Will be discussed at the October Primary Care Delivery Group with the intention to amend the deadline.
• Item 4.1 ‘Develop a Doncaster Cardio Vascular Disease (CVD) prevention programme as the annual clinical priority for population health management – This has been discussed at the CCG Manager’s Meeting as currently there is no CCG lead, the item will be discussed in focus at a future meeting.
• Item 4.4 ‘Development of a Primary Care focussed estates implementation plan to enable the Clinical Commissioning Group to make informative and robust decisions regarding Primary Care estates and support access to relevant sources of capital funding – The Primary Care Commissioning Committee agreed to mark the item as complete.
• Item 5.4 ‘Monitor, evaluate and support GP Practices in understanding the workforce and appointment utilisation to create more capacity in GP Primary Care by implementing the Apex and Insight software applications’ – The Primary Care Commissioning Committee noted that the Apex Tool is still not in use due to delays, it is expected to roll out imminently.
The Primary Care Commissioning Committee considered and noted the Primary Care Delivery Plan. 10.2 Primary Care Commissioning Committee Terms of Reference The Primary Care Commissioning Committee Terms of Reference proposed amendments were shared as a paper, ahead of the meeting. The Terms of Reference are regularly reviewed to ensure strong governance and that the Committee fulfils all requirements. The Primary Care Commissioning Committee reviewed all of the amendments in turn and approved all. The Terms of Reference will be submitted to the Governing Body and will be reviewed again in 12 months. 10.3 Primary Care Networks Update The Primary Care Networks (PCN) update was shared as a paper, ahead of the meeting. Highlights included:
• Central PCN - The Practice Group Ltd has not yet signed up to the network agreement due to internal governance. A letter of intent was received in June 2019; NHS England has advised that a deadline should be set for the network agreement to be received.
Enc A
11
The Primary Care Commissioning Committee agreed to request the agreement is received no later than 31 October 2019, if the agreement is not received within the timeframe, the CCG will look to recoup the funding for July, August, September and October 2019.
• Regent Square Group Practice - As of the 1 October 2019, the Practice is now providing Proactive Care.
• East PCN – It has now been confirmed that the East PCN are now providing Extended Hours. As discussed at the September 2019 meeting, it has been confirmed that both Practices within the East PCN are not providing Proactive Care; therefore option three is being taken forward.
• North PCN – Following discussions at the September 2019 meeting, the request for the North PCN to appoint 2 Clinical Pharmacists was denied subject to clarification and a letter sent to the PCN, a response had not been received at the time of writing the paper however subsequently it had been confirmed that the North PCN did not have access to a full time Social Prescribing Link Worker, therefore the Committee confirmed its initial response to deny the recruitment to two clinical pharmacists as an alternative..
• Primary Care Network Development Plans – An event is being held on 19 November 2019 where it is expected CCG’s will have the opportunity to look at development plans and the maturity matrix. The Committee questioned whether evidence has been provided from the Networks on the spend of £1.50 per head; Mrs Ogle agreed to request the information. It was also suggested that this is also discussed at the Integrated Care System (ICS) Primary Care Leads and ICS Primary Care Finance Leads meetings to ensure consistency.
10.4 DRAFT Primary Care Delivery Group Minutes – 25 September 2019 The draft Primary Care Delivery Group Minutes were shared as a paper, ahead of the meeting. Mrs Ogle highlighted the Primary Care Event that is due to be held 19 November 2019; all members are invited to attend. The Primary Care Commissioning Committee noted the draft Primary Care Delivery Group minutes. The Chair requested that acronyms were not used in the minutes in future. 10.5 ICS Update The ICS Update was shared as a paper, ahead of the meeting. The Primary Care Commissioning Committee noted that the date of the Primary Care Workshop detailed in the paper was incorrect; the Workshop was actually held on 18 October 2019. The slides from the Workshop were included within the paper. The objectives of the Workshop included:
• Developing an ICS Strategy with the caveat to be aware of the five Place Plans.
Mrs Ogle /
Mrs Pederson
Mrs Ogle
Mrs Ogle
Enc A
12
• To test an earlier thinking. • Reviewing the vision and guidance principles • Agree the outcomes of the day • Update on the Prime Minister’s Capital Funding.
The Primary Care Commissioning Committee noted the update.
11. Forward Planner The Primary Care Commissioning Committee noted the Forward Planner.
12. Risk Register The Primary Care Commissioning Committee noted the Risk Register. No new risks were raised.
13. Any Other Business No further business.
14. Date and Time of Next Meeting Thursday 14 November 2019, 12.30pm in the Boardroom at Sovereign House.
All
