NEL Joint Commissioning Committee Meeting Part 1 Us... · An alliance of North East London Clinical...

An alliance of North East London Clinical Commissioning Groups City and Hackney, New ham, Tow er Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

Chair: Dr Anw ar Khan I Accountable off icer: Jane Milligan

NEL Joint Commissioning Committee Meeting Part 1

12.30-2.30 Wednesday 9 May 2018 Committee rooms, Unex Tower

5 Station Street, Stratford, E15 1DA

An alliance of North East London Clinical Commissioning Groups City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

NEL Joint Commissioning Committee - Part 1 Date and time: Wednesday 9 May, 12.30am-2.30pm Venue: Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Agenda

No. Time Item Page Action required Owner

1. Welcome

1.1 12.30pm Welcome, introductions, apologies • Declarations of interest

Verbal Chair

1.2 12.35pm Governance update • Terms of reference• Constitutional changes

16 29

Information Approval

S Sanghera

2. Patient and public engagement

2.1 12.45pm Public questions Verbal Discussion Chair

3. Strategy

3.1 1.10pm East London Health and Care Partnership Joint Strategic Needs Assessment

33 Discussion N Gardner

3.2 1.20pm East London Health and Care Partnership Business Plan 42 Discussion N Gardner

4. Performance 4.1 1.30pm NEL Performance update 51 Noting L Eborall

5. Commissioning

5.1 1.40pm North East London Outpatient Transformation overview

53 Discussion S Everington

5.2 2.00pm Strategic Estates Plan update 61 Discussion J John

6 Risk Register

6.1 2.20pm Risk Register 79 Noting Chair

7. Forward planning

7.1 2.25pm Forward plan 85 Discussion Chair

Any other business

Date of next meetings: • 11 July 2018• 12 September 2018

NELCA JCC - Acronyms List

ACRONYM MEANING

A&E Accident & Emergency

APMS Alternative Provider Medical Services (a type of Primary care contract)

AQP Any qualified provider

BAF Board Assurance Framework

Bart's / BHT Barts Health NHS Trust

BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust

BMA British Medical Association

CAS Clinical Assessment Service

CCG Clinical Commissioning Group

CCU Critical Care Unit

CEG Clinical Effectiveness group

CEPN Community Education Provider Network

CHP Community Health Partners

CIL Construction Industry Levy

CPD Continuing Professional Development

CQC Care Quality Commission

CQRM Clinical Quality Review Meeting

CQUINs Commissioning for Quality and Innovation (Payment Framework)

CSU Commissioning Support Unit

CYP Children and Young People

DES Direct Enhanced Service

DoH/ DH Department of Health

DTOC Delayed Transfers of Care

ED Emergency Department

ELFT East London Foundation Trust

ELHCP East London Health and Care Partnership

ELHCP ODG East London Health and Care Partnership Operational Delivery Group


EMIS web Egton Medical Information Systems (System that records patient consults)

EPCS Extended Primary Care Service

EPCT Extended Primary Care Team

EPR Electronic Patient Record

ETTF Estates and Technology Transformation Fund

FOI Freedom of Information

GB Governing Body

GIA Gross internal area

GLA Greater London Authority

GMC General Medical Council

GMS General Medical Services (a type of Primary care contract)

GP General Practitioner

HEE Health Education England

HLP Healthy London Partnership

HMT Her Majesty's Treasury

HUH The Homerton University Hospital NHS Foundation Trust

IAPT Increasing Access to Psychological Therapy

ICP Integrated care partnership

IG Information Governance

IMT Information Management and Technology

IPS Individual placement and support schemes

ITU Intensive Therapy Unit

IUC Integrated urgent care

JCC Joint Commissioning Committee

JSNA Joint Strategic Needs Assessment

KGH King George Hospital

KPI Key Performance Indicator

LAP Local Area Partnership

LAS London Ambulance Service

LAs Local Authorities

LBN London Borough of Newham

LBWF London Borough of Waltham Forest

LCFS Local Counter Fraud Specialist

LD SAF Learning Disability Self-Assessment Framework

LEB London Estates Board


LEDU London Estates Development Unit

LES Local enhanced service

LMC Local Medical Committee

MoLCV Medicines of limited clinical value

MOU Memorandum of Understanding

MPIG Minimum Practice Income Guarantee

NAFO Newham Alternative Funding Option

NCCG Newham Clinical Commissioning Group

NDPP National diabetes prevention programme

NEL North East London

NELCA North East London Commissioning Alliance

NELCSU North East London Commissioning Support Unit

NELFT North East London Foundation Trust

NHS PS NHS Property Services

NHSE NHS England

NHSI NHS Improvement

NICE National Institute of Health and Care Excellence

NUH Newham University Hospital

OOH Out of hours

OPD Outpatient department

OPE One Public Estate

PALS Patient Advice and Liaison Service

PCCC Primary Care Commissioning Committee

PCT Primary Care Trusts

PHE Public Health England

PMS Personal Medical Services (a type of Primary care contract)

PPE Patient and Public Engagement

PPG Patient and Public Group

PREM Patient Reported Experience Measure

PROM Patient Reported Outcome Measures

QIPP Quality, Innovation, Productivity and Prevention

QOF Quality Outcome Framework (Assessor Validation Reports)

R&D Research & Development

RAG Red, Amber, Green

RAID Rapid Assessment Interface Discharge


RICS Royal Institute of Chartered Surveyors

RLH Royal London Hospital

ROI Return on Investment

RTT Referral to treatment

SEP Strategic Estates Plan

SMI Severe mental illness

SPA Single Point of Access

SPR Service Program Review

STP Sustainability and Transformation Plan or Partnership

NHS North East London Commissioning Alliance (City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs)

Voting Members Name Title Name of

organisation and nature of its business

Position Held/Nature of Interest

Type of Interest Date Declared

Date Updated

Financial Non-financial Professional

Non-Financial Personal

Jane Milligan

Accountable Officer –NELCA/NEL STP

NEL CSU Partner is employed substantively by NEL CSU as Director of Business Development and from 2nd January 2018 on secondment to NHSE as London Regional Director for Primary Care

X September 2011 - Present

January 2018

Date 14th March 2018

Edited by Sarah Soan

NHS North East London Commissioning Alliance

Joint Commissioning Committee Register of Interests


Action For Stammering Children

Partner is a Trustee for Action for Stammering Children

X May 2014 – Present

Family Mosaic Housing Association

Non-executive director

X September 2009 – Present

St. Paul’s Way Trust School, Bow

Trust Governing Body Member

X October - 2014

Stonewall Ambassador X January 2017 – Present

Peabody Housing Association Board

Non-Executive Director

X April 2016 – Present

Dr Prakash Chandra

Deputy Chair JCC & Chair Newham CCG

Medical Director, Prime Practice Partnership

Senior GP Partner – Sangam Practice providing primary healthcare including enhanced services, QOF and EPCS. My wife is a partner in the practice

X X

Dr Anil Mehta

Deputy Chair Elect JCC & Chair Redbridge CCG

Fullwell Cross Medical Centre

GP Partner X April 2013 – Present

Metropolitan Police

Forensic examiner X November 2015 - – Present

The Cleaning Company

Sister-in-law is the owner

X 2013 – Present

NHSE GP appraiser X February 2015 - – Present

Healthbridge Direct

Shareholder X September 2014 – Present

Fouress Director X 2015 –


Enterprises Ltd Present Prescon Ad-hoc screening

work X January 2018

– Present

Dr Sam Everington

Chair THCCG

GP Care Group CIC

Partner at Bromley By Bow Health Partnership and part of GP Care Group CIC

X 2012 – Present

Community Health Partnerships

Director of Community Health Partnerships – only shareholder is the department of health

X Present

Kings Fund Trustee X NHS England National Adviser to

the New Models of Care team

X 2014 – Present

BMA Council Member and Vice President

X 1989 – Present

Queens Nursing Institute

Vice President X 2016 – Present

Queen Mary University, London

Honorary Professor X 2016 – Present

Bromley By Bow Charity

X 1998 – Present

Tower Hamlets CCG

Married to Linda Aldous, CCG Practice Nurse Representative

X

Dr Atul Aggarwal

Chair Havering CCG

Maylands Healthcare

GP Partner X April 2013 – Present

Maylands Healthcare Ltd

Director and shareholder in



on-site pharmacy

Parkview Dental Practice

Sister is NHS dentist within Havering

X 1996 – Present

Essex Medicare LLP

Part owner which owns Westland Clinic, Hornchurch. Space rented out to Inhealth (Diagnostic),Nuffield Health (Brentwood), Communitas Clinics (Dermatology & Gynaecology)

X 2014– Present

Havering Health Ltd

Shareholder. GP partner (Dr Kendall) is a director

X September 2014 – Present

Barking, Dagenham and Havering LMC

Co-opted member 2013 – Present

Mark Rickets

Chair C&H CCG

GP Confederation Nightingale Practice is a Member

X

HENCEL I work as a GP appraiser in City and Hackney and Tower Hamlets for HENCEL

X

Homerton University Hospital NHS

CCG Representative on Board of

X


Foundation Trust Governors Nightingale Practice (CCG Member Practice)

Sessional GP X

Kash Pandya

Vice Chair JCC and Lay member B&D CCG

NHS Havering CCG

Lay member, Governance and Audit Chair

X 2013-19

Redbridge CCG a Lay member governance and audit chair

X

University of Essex

Independent Audit Committee member

X 2013-19

Southend-on-Sea Borough Council

Independent Audit Committee member

X 2016-18

Brentwood Citizen's Advice Bureau

General Advisor X 2009 – Present

Essex Ministry of Justice Advisor Committee

Lay member, Governance and Audit Chair

X 2010-19

PriceWaterhouse Cooper

Son is employed as a management Consultant

X 2013-Present

Accenture Son is employed as Legal Counsel

X 2015 – Present

Historic - Her Majesty's Inspector of Constabulary

Associate Inspector

2011 – January 2018

Historic - Hillcroft College for Women (Surbiton)

Council member & honorary treasurer


Historic - Health & Safety Executive

Independent Audit Committee



member Richard Coleman

Lay Member Havering CCG

Richard Coleman Associates

Director/Co-owner. Spouse is also Director/Co-owner


BHR CCGs Brother-in-law is Independent GP on the Primary Care Commissioning Committee

X January 2017- Current

1-2-1 Social Enterprise

Associate X October 2014 – Current

Price Waterhouse Cooper

Nephew is a partner

X August 2013 – Current

Khalil Ali Lay Member Redbridge CCG

Dr Joseph GP practice, Collier Row

Family Doctor X April 2017 – Current

St Francis Hospice Spouse is a regular donor

X April 2017 – Current

Cancer Research UK

Spouse is a regular donor

X April 2017 – Current

Sue Evans

Lay Member C&H CCG

Loughton Youth Project (registered charity)

Trustee and Treasurer

X October 2017 – Current

Barts Health Trust Self and family are potential patients/users of hospital health care services in the local area of the NE London STP.

X October 2017 – Current

Alan Wells Lay Member WFCCG

Capacity Ltd - A policy, research and training body, pledged to promote the needs of young children,

Director X X 2007 – Present


their families and communities The Simplification Centre

Director X 2010 – Present

Alzheimer's Brain Bank UK, Alzheimer's Society

Trustee/Director X 2013- Present

Alzheimer's Society

Nominations and Appointments Committee

X 2013 - Present

Sir George Monoux College

Chair of the Corporation

X 2013 – Present

Noah Curthoys

Lay Member THCCG

Bridgenor Group Ltd

Director

X June 2015 - 16

Northshott Consulting Ltd

Director

X 2011-

The Democratic Society which is a non-profit organisation

Contractor X

July 2016-September 2016

Andrea Lippett

Lay Member Newham CCG

Kwest + Associates Leisure consultancy

Director X March 2017

Barts Health Partner is a Non Exec Director

X March 2017


Non-Voting Members Name Title Name of

organisation and nature of its business

Position Held/Nature of Interest

Type of Interest Date Declared

Date Updated

Financial Non-financial Professional

Non-Financial Personal

Henry Black

Financial Representative JCC & NEL STP

BHRUT Wife works as Deputy Director of Income and Planning at BHRUT

X April 2016-Present

Mark Tyson

Barking & Dagenham Local Authority

NIL

Mark Ansell

Havering Local Authority

NIL

Adrian Loades

Redbridge Local Authority

NIL

Ellie Ward

City of London Corporation

NIL

Gareth Wall

Hackney Local Authority

NIL

Linzie Roberts-Egan

Waltham Forest Local Authority

NIL

Grainne Siggins

Newham Local Authority

ADASS In 2014/15 ADASS received funding via an SLA from NHS England Negotiated by GS on behalf of ADASS

X 2014/15

British Association of Occupational Therapists

Registered Member

X


Health Professions Council as an Occupational Therapist

Registered Member

X

Denise Radley

Tower Hamlets Local Authority

CACI Family member (Marc Radley) is a director of CACI (supplier of information and it systems to public sector)


Hertfordshire Partnership NHS Foundation Trust

Ordinary member



Joint Commissioning Committee Date: 9 May 2018

Title of report Joint Commissioning Committee (JCC) Terms of Reference

Author Alan Steward

Presented by Alan Steward

Contact for further information

Alan Steward Email: [email protected] Tel: 07500 559031

Executive summary Over the last year, NEL CCGs have been developing a more collaborative and joint approach across NEL where it makes sense to do so in the interests of providing better outcomes for local people and making sure services are delivered in the most efficient and effective way. This work was led by the CCG Chairs and (from December) with the Single Accountable Officer.

It is important to stress that the JCC (and North East London Commissioning Alliance) must work within the statutory responsibilities set out for CCGs. It is a collaborative committee of all CCGs and is accountable back to the individual CCG Governing Bodies.

Following considerable engagement over the last six to eight months with CCGs, local councils and wider stakeholders the Terms of Reference of the Committee were agreed through each Governing Body with an associated Scheme of Delegation and Reservation defining the responsibilities of the JCC.

Through the selection process (set out in the terms of reference), it was agreed that the Chair is Dr Anwar Khan the Chair of Waltham Forest CCG. The Vice-Chair is Kash Pandya lay member for Barking and Dagenham CCG. Dr Prakash Chandra, the Chair of Newham CCG, is the clinical deputy Chair.

As this is the first JCC for NEL, it is important that it is kept under review so that it meets both the needs of NEL and the individual CCGs and boroughs. It is planned to do this every six months and then apply any learning or improvements found.

Action required The Joint Commissioning Committee is asked to: 1. Note its Terms of Reference

Where else has this paper been discussed?

The purpose, responsibilities and membership of the JCC have gone through all CCG Governing Bodies for approval.

mailto:[email protected]


Strategic fit • Commissioning

implications • Local

authority/integrated commissioning implications

The JCC will support the delivery of NEL CCGs joint commissioning priorities including aligning strategies and approaches across NEL, the delivery of “once for NEL” services such as integrated urgent care, supporting and enabling the development of integrated care partnerships and providing assurance to regulators such as NHS England.

Impact on finance, performance and quality

The JCC allows the CCGs (with local authority partners) to act collectively to address the health and care challenges in North East London. It also allows strategies and approaches to be aligned across NEL particularly around payment methods, demand and capacity planning and to encourage the sharing of good practice between commissioners.

What does this mean for local people?

The JCC allows CCGs to act together on those issues that are better addressed at NEL level to improve services and outcomes. This includes specialised commissioning services, integrated urgent care and the London Ambulance Service. It will also improve the commissioning of strategic issues such as workforce, Cancer, Maternity Strategy that need an approach across all CCGs. The JCC will meet in public to ensure transparency and accountability back to CCGs, partners and local people.

Risks

The JCC will help manage and mitigate some of the risks to individual CCGs for the key areas delegated to it. This includes payment reform, demand and capacity planning and variations in the quality of services.


North East London CCGs

Joint Commissioning Committee

Terms of Reference

1. Introduction These Terms of Reference set out the purpose, membership, remit and responsibilities of the North East London Joint Commissioning Committee (JCC).

2. Background The National Health Service (‘NHS’) faces unprecedented financial and clinical challenges including rising demand for services and a significant financial gap. A system-wide solution is required to address these challenges for the benefits of patients.

The following organisations have agreed to work together to meet these challenges and jointly commission services, where it is appropriate to do so:

• NHS Barking & Dagenham Clinical Commissioning Group (‘Barking & Dagenham CCG’) • NHS City & Hackney Clinical Commissioning Group (‘City & Hackney CCG’) • NHS Havering Clinical Commissioning Group (‘Havering CCG’) • NHS Newham Clinical Commissioning Group (‘Newham CCG’) • NHS Redbridge Clinical Commissioning Group (‘Redbridge CCG’) • NHS Tower Hamlets Clinical Commissioning Group (‘Tower Hamlets CCG’) • NHS Waltham Forest Clinical Commissioning Group (‘Waltham Forest CCG’).

The above Clinical Commissioning Groups are collectively referred to as the ‘NEL CCGs.’ The NEL CCGs have a history of collaborative working. The establishment of the JCC, as well as work conducted together as the health commissioners in the North East London STP will formalise collaborative working between all seven CCGs.

3. Purpose of the Joint Commissioning Committee The JCC is comprised of members of the Governing Bodies (GB) from Barking & Dagenham CCG, City & Hackney CCG, Havering CCG, Newham CCG, Redbridge CCG, Tower Hamlets CCG and Waltham Forest CCG to jointly commission goods and services for the residents of the City of London Corporation and London Boroughs of Barking & Dagenham, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest.

4. Role of the Joint Commissioning Committee The role of the JCC is to deliver the delegated functions and powers transferred to it by the seven NEL CCG Governing Bodies. These functions are where the Governing Bodies consider there is additional value in working collaboratively with other CCGs.

At least once each year, the Governing Bodies will receive a recommendation from the JCC of opportunities for collaborative work. The Governing Bodies decide those functions that will be transferred to the JCC. If a single CCG Governing Body does not transfer a function to the JCC then the JCC is unable to take responsibility for that function.

The current list of delegated functions and powers is attached to this document as Schedule 1 (List of delegated functions & powers).

The JCC will retain a strong link between its collaborative work and the individual CCGs commissioning. This will be achieved by each CCG informing the JCC of local care strategies and


undertaking local engagement of the public and key stakeholders, where relevant and appropriate. This may include but is not limited to engagement on service change.

Although all the CCG Chairs and CCG lay representatives will have a particular focus on the interests of their CCG, the decisions they make in the NEL JCC are for whole of North East London. There will be occasions when the interests for a part of a regional commissioning decision are not favourable for one of the CCGs. The representatives from the adversely affected CCG will need to make a judgement call on whether the benefits of the total decision for their CCG outweigh any local unfavourable effects.

The Committee’s role is supported by a statutory framework contained in Section 7 (Statutory Framework) below.

5. Quality and Safety In performing its role, the JCC shall have due regard to any relevant quality and safety issues which may arise as agreed by JCC members.

6. Statutory Framework The main statute is the NHS Act 2006 (as amended) with the key clauses being 13Z, 14Z3 and 14Z9.

Section 13Z provides that: • NHS England’s functions may be exercised jointly with a CCG or CCGs • Functions exercised jointly in accordance with section 13Z may be exercised by a joint

committee of NHS England and each CCG • Arrangements made under section 13Z may be on such terms and conditions as may be

agreed between NHS England and the CCG. Section 14Z3 provides that:

• Two or more CCGs may exercise any of their commissioning functions jointly including by a joint committee of those CCGs

• For the purposes of any arrangements made under this section a CCG may make payments, make the services of its employees or any other resources available to another CCG.

Section 14Z9 provides that: • NHS England and one or more CCGs may make arrangements for any of the functions of

the CCG under section 3 or 3A of the NHS Act or for any functions of the CCG(s) which are related to the exercise of those functions, to be exercised jointly by NHS England and the CCG(s)

• For functions exercised jointly in accordance with the section to be exercised by a Joint Committee of NHS England and the CCG(s)

• Arrangements under that section may be on such terms and conditions as may be agreed between NHS England and the CCG.

7. Membership The JCC’s membership shall meet the requirement of each of the NEL CCG’s constitutions.

The JCC shall comprise of the following voting members: • The Chair of City & Hackney CCG • The Chair of Barking & Dagenham CCG • The Chair of Havering CCG • The Chair of Newham CCG • The Chair of Redbridge CCG


• The Chair of Tower Hamlets CCG • The Chair of Waltham Forest CCG • A lay representative from City & Hackney CCG • A lay representative from Barking & Dagenham CCG • A lay representative from Havering CCG • A lay representative from Newham CCG • A lay representative from Redbridge CCG • A lay representative from Tower Hamlets CCG • A lay representative from Waltham Forest CCG • The NEL Accountable Officer.

Each CCG Board may nominate a deputy to, in the absence of their representative, make decisions on their behalf. The deputy for a Chair will be a clinician from that CCG Board and the deputy for the Lay Member will be a lay member from that CCG Board.

The JCC shall have the following non-voting members: • Financial representative • Two independent clinical advisors (Secondary Care Consultant and Registered Nurse) • A representative from LB Barking & Dagenham • A representative from City of London Corporation • A representative from LB City & Hackney • A representative from LB Havering • A representative from LB Newham • A representative from LB Redbridge • A representative from LB Tower Hamlets • A representative from LB Waltham Forest.

At least once each year, the names of the members will be published in Schedule 2 (List of Members).

8. Chair and Vice Chair The Chair of the JCC shall be elected from amongst the CCG Chairs. An individual may nominate themselves to the AO and in the event that more than one Chair nominates themselves a secret ballot will be held and organised by the AO to determine the Chair on the basis of one CCG one vote. The Chair of the JCC shall be elected for one year but may stand for re-election at the end of their term of office.

The Vice Chair will be elected on the basis of self- nomination to the Chair. The Vice Chair will be a JCC lay member. In the event that more than one member nominates themselves a secret ballot will be held and organised by the Chair to determine the Vice Chair on the basis of one CCG one vote. The Vice Chair shall be elected for one year but may stand again at the end of their term of office.

Where the Chair is unable to participate in a meeting or vote due to absence or a conflict of interest the Vice Chair may chair the meeting.

The Deputy Clinical Chair shall be appointed by the Chair of the JCC from amongst the remaining CCG Chairs.


9. Quorum The quorum of the JCC is 12 voting members (of whom more than 50% must be clinicians) and all CCGs must be present.

If any representative is conflicted on a particular item of business, they will not count towards the quorum for that item of business. If this renders a meeting or part of a meeting inquorate a non-conflicted person may be temporarily appointed or co-opted onto the JCC to satisfy the quorum requirements. If a clinician is conflicted, the person temporarily appointed or co-opted onto the Committee to satisfy the quorum requirements must be a clinician from that CCG.

If a meeting is not quorate, the Chair may adjourn the meeting to permit the appointment or co-option of additional members if necessary. If the conflicted person is a Chair or lay member of a CCG the person temporarily appointed or co-opted onto the Committee must be from the same CCG as the conflicted person. The final decision as to the suitability of any person who is temporarily appointed or co-opted onto the JCC shall be made by the JCC Chair.

In the unlikely event that all the GP JCC members are conflicted and that there are no suitable alternative CCG GPs who are not conflicted, the JCC chair with agree with the other 6 CCG chairs that:

• The vice-chair chairs that part of the meeting for the decision making of that item • any decision making will be made by the non-GP members of the JCC • a clinical majority will be waived for that item • a clear record will be made in the minutes that the decision was made using special

provisions.

10. Voting Members of the JCC have a collective responsibility for the operation of the JCC. They will participate in discussions, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

The seven CCG Chairs (or deputies) must be in agreement to call a vote on a recommendation.

A successful vote on a recommendation occurs when all seven CCGs unanimously vote for the recommendation, using the provisions below. This protects the interests of individual CCGs in matters that concern their operation.

Provisions for JCC voting: • Each member of the JCC has one vote • Each CCG Chair will declare whether their CCG has voted for the recommendation. This is

calculated by a majority of the following votes: • CCG Chair • CCG Lay Member • NEL Accountable Officer

• In exceptional circumstances, the CCG chair may after consulting the Lay member and NEL Accountable Officer declare that their vote solely is the CCG vote on that matter. Where this provision is used, the minutes will include a record of this action.

11. Decisions All decisions of the JCC unanimously agreed by the seven CCGs shall be binding on each of the NEL CCGs.


12. Conflicts of Interest Conflicts of interest shall be dealt with in accordance with the NEL Conflicts of Interest Policy (to be developed).

The NEL Conflicts of Interest Policy is a document which is a master document containing the Conflicts of Interest Policies agreed by all of the NEL CCGs. During the interim, the Newham CCG Conflicts of Interest Policy will be used.

13. Frequency of JCC Meetings The JCC shall meet monthly or as otherwise agreed.

14. Meetings Held in Public Meetings of the JCC shall be held in public unless the JCC resolves to exclude non-voting attendees and/or observers and/or the public from a meeting. In which case the meeting, in whole or part, may be held in private.

Observers and the public may be excluded, following approval of a resolution by the JCC to exclude the public whenever it wishes to go into private session, from all or part of a meeting whenever publicity would be prejudicial to the public interest by reason of:

• The confidential nature of the business to be transacted; or • The matter is commercially sensitive; or • The matter being discussed is part of an on-going investigation; or • Other special reason stated in the resolution and arising from the nature of that business or

of the proceedings; or • Any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as

amended or succeeded from time to time; or • General disturbance.

15. Secretary The JCC shall have secretariat support. The secretariat function will be provided by the office of the NEL Accountable Officer.

16. Standing Orders The Standing Orders for the JCC are contained in Annex 1 (Standing Orders) and form part of these Terms of Reference. The Standing Orders must be adhered to.

17. Sub-Committees The JCC may not delegate any of its powers to a committee or sub-committee. However, it may appoint sub-committees to advise and assist the JCC in carrying out its role. The sub-committee may make recommendations for decision by the JCC. The sub-committee must be chaired by a JCC member but may appoint non-JCC members to the committee.

18. Standards of Business Conduct JCC members and any attendees or observers must maintain the highest standards of personal conduct and in this regard must comply with:

• The law of England and Wales • The NHS Constitution • The Nolan Principles • The standards of behaviour set out in each NEL CCG Constitution • Any additional regulations or codes of practice relevant to the JCC.


19. Review of the Terms of Reference These Terms of Reference shall be kept under review by the JCC to ensure that they meet the needs of the JCC and the NEL CCGs. Any changes to the Terms of Reference must be agreed by the governing bodies of the NEL CCGs in accordance with their Constitutions.

These Terms of Reference shall be reviewed by the NEL CCGs annually in March of each year following the establishment of the JCC.


Schedule 1 Scheme of Reservation and Delegation This Scheme of Reservation and Delegation relates primarily to those functions considered as part of the North East London Commissioning arrangements and provides clarity on some of the other key issues to avoid any misunderstandings. It is not intended to be a comprehensive scheme relating to all CCG functions and responsibilities.

Delegation from Members Practice

CCG Board - Services

Functions Joint Commissioning

Committee - Services

Functions

• Children’s services (NHS and joint)

• Business cases and service change requests

• Needs assessment and demand and capacity planning

• Procurement • Contracting and

contract management

• Joint work with local authorities

• Setting outcomes for providers

• Outcome monitoring • Decommissioning

services • Consultation and

engagement – local people, members, local organisations (providers, councils, voluntary and community sector)

• Specialised commissioning

• Business cases and service change requests

• Needs assessment and demand and capacity planning

• Contracting and contract management

• Joint work with local authorities

• Setting outcomes for providers

• Outcome monitoring • Decommissioning

services • Consultation and

engagement – local people, members, local organisations (providers, councils, voluntary and community sector) – done via local CCG arrangements

• Primary care development, contracting, prescribing

• London Ambulance Service

• Termination of Pregnancy

• Integrated Urgent Care

• Joint Commissioning with LA – Learning Disability / Continuing Health Care / prevention / elderly / Better Care Fund

• Maternity Planning


Delegation from Members Practice

CCG Board - Services

Functions Joint Commissioning

Committee - Services

Functions

• Community Services contracting

• Mental health (acute beds only)

• Mental Health contracting – except inpatients

• NHSE assurance (except through exception done elsewhere eg A&E)

• Acute Commissioning and contracting (local)

• Approve Integrated Care Systems framework

• Borough workforce delivery

• Integrated Care Development


Schedule 2

Joint Commissioning Committee: Membership CCG Chair Lay member LA rep

(non-voting) Barking and Dagenham

Kash Pandya (acting chair until elections complete)

Kash Pandya (Specialty: Audit)

Mark Tyson, Commissioning Director, Adults' Care & Support

City and Hackney

Dr Mark Ricketts Sue Evans (Specialty: Audit)

Ellie Ward, Programme Manager (City of London) Gareth Wall, Head of public health (Hackney)

Havering Dr Atul Aggarwal Richard Coleman (Specialty: PPI)

Mark Ansell, Public health consultant

Newham Dr Prakash Chandra Andrea Lippett (Specialty: Governance)

Grainne Siggins, Executive Director - Strategic Commissioning

Redbridge Dr Anil Mehta Khalil Ali (Specialty: PPI)

Adrian Loades, Corporate Director of People

Tower Hamlets

Dr Sam Everington Noah Curthoys (Specialty: Governance)

Denise Radley, Corporate Director: Health, Adults and Community

Waltham Forest

Dr Anwar Khan Alan Wells (Specialty: PPI)

Linzi Roberts-Egan, Deputy Chief Executive - Families

Single Accountable Officer: Jane Milligan PPI = Patient and Public Involvement

NEL CCG Governance Recommendations vs9

Annex 1: Standing Orders for the North East London Joint Commissioning Committee

1. Introduction These rules and standards apply to the North East London Joint Commissioning Committee (JCC).

2. Meetings of the JCC

2.1. Calling meetings Ordinary meetings of the JCC shall be held at regular intervals at such times and places as agreed by the JCC.

Extraordinary meetings may be called by the Chair at any time.

One third or more members of the JCC may request a meeting in writing. If the Chair refuses, or fails, to call a meeting within seven days of a requisition being presented, the members signing the requisition may forthwith call a meeting.

2.2. Agenda, supporting papers and business to be transacted Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair of the meeting at least seven working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least five working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least five working days before the date the meeting will take place.

2.3. Chair of a meeting At any meeting of the JCC, the Chair if present, shall preside. If the Chair is absent from the meeting, the meeting shall appoint a Chair.

2.4. Chair's ruling The decision of the Chair of the JCC on questions of order, relevancy and regularity and their interpretation at the meeting, shall be final.

2.5. Quorum The Quorum for the JCC is 12 voting members (of whom more than 50% must be clinicians).

The JCC must have present either the CCG Chair or lay representative from each CCG to be quorate.

If any representative is conflicted on a particular item of business, they will not count towards the quorum for that item of business. If this renders a meeting or part of a meeting inquorate a non-conflicted person from the same CCG as the conflicted person

NEL CCG Governance Recommendations vs9

may be temporarily appointed or co- opted onto the JCC to satisfy the quorum requirements. If a clinician is conflicted the person temporarily appointed or co- opted onto the JCC to satisfy the quorum requirements must be a clinician.

2.6. Record of Attendance The names of all members of the meeting present at the meeting shall be recorded in the minutes of meetings. The names of all members of the JCC present shall be recorded in the minutes of the JCC meetings.

2.7. Minutes The JCC shall keep records and proper minutes of all meetings, resolutions and business conducted.

3. Attendees and Observers The JCC may call additional experts to attend meetings on a case by case basis to inform discussions.

The JCC may invite or allow additional people to attend JCC meetings as attendees. Attendees may present at JCC meetings and contribute to relevant JCC discussions.

The JCC may invite or allow people to attend meetings as observers. Observers may not present at JCC meetings or contribute to any JCC discussion.

The JCC may invite or allow providers of health care services to attend meetings as attendees or observers on a case by case basis at the JCC’s absolute discretion.

4. Confidentiality Members of the JCC shall respect confidentiality requirements as set out.

Any papers relating to these agenda items will also be excluded from the public domain. For any meeting or any part of a meeting held in private all members and/or attendees must treat the contents of the meeting and any relevant papers as strictly private and confidential.

5. Standards of Business Conduct JCC members and any attendees or observers must maintain the highest standards of personal conduct and in this regard must comply with the spirit of:

• The law of England and Wales • The NHS Constitution • The Nolan Principles • The standards of behaviour set out in each NEL CCG Constitution • Any additional regulations or codes of practice relevant to the JCC.



Date: 9 May 2018

Title of report CCG constitutional changes update

Author Satbinder Sanghera, Director of Partnerships and Governance, NHS Newham CCG

Presented by Satbinder Sanghera, Director of Partnerships and Governance, NHS Newham CCG


Satbinder Sanghera, Director of Partnerships and Governance, NHS Newham CCG – [email protected]

Executive summary This report presents the Committee with an update on governance matters relating to the establishment of the Joint Commissioning Committee (JCC) and the required changes to all CCG constitutions.

Action required The Committee is asked to: • Note the progress made by CCGs to approve the constitutional

changes required to formally establish the JCC and theestablishment of the Single Accountable Officer/Managing Directorposts within the CCG structures.


None

Strategic fit The JCC, the Single Accountable Officer and Managing Directors are key enablers to deliver the NELCA priorities.


The establishment of the JCC and the reflection of the revised management arrangements within each CCGs constitutions enables the CCGs collectively with local authority partners to begin to address the health and care challenges in north east London. In particular it will enable those matters that need to be addressed from a commissioner perspective by seven CCGs acting together, allow the sharing of good practice and the development of strategies for issues that cannot be tackled individually. The JCC will have a significant role in addressing inequalities in health outcomes and inequalities in access to health services across north east London.


This will allow better transparency and accountability to local people and communities to have transparency on key decisions made by the seven CCGs acting together. It will tackle the many issues that need a north east London approach such as specialised commissioning services, London Ambulance Service and strategic issues such as technology, workforce, cancer and maternity.

Risks (link to risk register)

There is a risk that without the required changes to CCG constitutions that the JCC may be acting beyond its powers.



North East London CCGs


1. Introduction The establishment of the Joint Commissioning Committee (JCC) and the appointment of a Single Accountable Officer as well as the introduction of the Managing Director posts required changes to each CCG’s constitutions.

This report updates the JCC on the establishment of the new commissioning arrangements. It builds on the previous reports and discussions and the shadow meetings of the JCC. These new arrangements are vital to deliver north east London’s:

• Strategic alignment with the NHS Five Year Forward View and in particular the commitment to develop Integrated Care Systems (ICS’s)

• Sustainability for the whole system including providers, commissioners and partners • Improvements in outcomes, quality and performance and reducing variation across north

east London.

2. Constitutional changes The detailed recommendations for change to constitutions are set out below. Recommendation 1: The following clause is added to the NEL CCG Constitutions at the section listed below the text:

X.X Joint Appointments with other Organisations The CCG may make joint appointments including joint appointments with other CCGs. Any such joint appointments will be supported by a memorandum of understanding between the organisations that are party to these joint appointments.

Where a Joint Appointment is made, the appointee may choose a named deputy in each of the CCGs. The named deputy must be agreed by the chair of the Governing Body.

Recommendation 2: The following line is added to the NEL CCG Constitutions, where appropriate, at the section listed below the text:

Heading Number Current Joint Arrangements Sub- Heading No. Joint Commissioning Committee The Joint Commissioning Committee has been established to include the seven north east London CCGs. The Committee will exercise such commissioning powers as are delegated to it by the Governing Body and set out in the Scheme of Reservation and Delegation approved by the Governing Body. Any decision must be made unanimously (as described by the Committee Terms of Reference) with the other partner CCGs listed in the Terms of Reference.

Recommendation 3: The following line is added to the NEL CCG Constitutions “Scheme of Reservation and Delegation” at the section listed below the text using one of the formats:


Policy Area Decision Joint Commissioning Committee

COMMISSIONING & CONTRACTING FOR CLINICAL SERVICES

The Committee will exercise such delegated powers as are transferred to it by the Governing Body and set out In the Terms of Reference approved by the Governing Body. Any decision must be made unanimously (as described by the Committee Terms of Reference) with the other partner CCGs listed in the Terms of Reference.

Recommendation 4: The JCC Terms of Reference with its Schedules and Annex are added as an appendix to each of the NEL CCG Constitutions.

Recommendation 5: The following paragraph is added to the NEL CCG Constitutions, where appropriate, at the section listed below the text:

• Committees in Common ArrangementAll Governing Body Committees may meet with similar committees of other CCGs, usingthe “Committees in Common” arrangement, where the committee chair considers there isa value of working collaboratively on one or more specific issues. When the CommitteeChair chooses to meet using a “Committees in Common” arrangement, the additionalTerms of Reference for “Committees in Common” will be applied to the usual Committee’sTerms of Reference.

Recommendation 6: The Terms of Reference Addendum for the use of a “Committees in Common” meeting arrangement is added as an appendix to each of the NEL CCG Constitutions.

Recommendation 7: The following clauses add the requirement for a Conflict of Interest Guardian to the Constitution

The CCG shall appoint a Conflict of Interest Guardian who will normally be the Audit Committee Chair and whose responsibilities shall be to: a) Act as a conduit for GP practice staff, members of the public and healthcare

professionals who have any concerns with regards to conflicts of interest; b) Be a safe point of contact for employees or workers of the CCG to raise any concerns

in relation to this policy; c) Support the rigorous application of conflict of interest principles and policies;d) Provide independent advice and judgment where there is any doubt about how to apply

conflicts of interest policies and principles in an individual situation;e) Provide advice on minimising the risks of conflicts of interest.

Recommendation 8: To approve for recommendation to member practices the draft CCG constitution that sets out all the changes required.

4. Progress to dateChanges to CCG constitutions are required to go through a defined set of steps before approved fully. These are set out below alongside an update on progress:


Requirements Progress

Consideration at CCG Board meeting

All CCG Boards have approved the required changes

Approval by Member Practice Council (or equivalent)

All Member Practice Councils have approved the changes with the exception of Waltham Forest CCG and this will be considered at a meeting on 10th May 2018.

Authorisation by NHS England

NHSE have been notified of the changes requested across all seven CCGs and have agreed to consider and approve the requests as they are submitted. To date City & Hackney’s CCGs changes have been approved and they are currently considering BHR, Newham and Tower Hamlets proposals. Waltham Forest proposals will be submitted following its meeting with members.

5. Next Steps In relation to the remaining vacancies on the Board, it is proposed to recruit for the Board Nurses and Secondary care consultant. This process has started and it is envisaged that the appointments will be made before the next meeting in July.



Date: 9 May 2018

Title of report East London Health and Care Partnership Joint Strategic Needs Assessment

Author Meic Goodyear

Presented by Nichola Gardner, Programme Director, ELHCP


[email protected]

Executive summary

The NEL health profile has been refreshed to use the most recent information available. It is used to inform the ELHCP strategies and priorities. It can also be used by the NEL Commissioning Alliance and others to inform commissioning strategies and priorities. The profile highlights key challenges around population growth, deprivation and health inequalities, obesity, diabetes and cancer.

Action required

The JCC is asked to note the updated profile.


The full refreshed NEL Health Profile has been shared with the NEL Directors of Public Health and discussed at the NELCA senior management team.

Strategic fit � Commissioning

implications � Local


The NEL health profile informs NEL commissioning priorities, as well as the ELHCP priorities.


If the issues highlighted can be addressed through prevention and better self-care, it will improve health outcomes for local people and reduce downstream demand on services.


The profile supports the planning and commissioning of services to meet the needs of local people.

Risks

The profile contributes to mitigating the risk around self-care and demand management (risk 3 on draft risk register).


Bexley

Greenwich

Lewisham

Enfield

Haringey

Camden

Lambeth

Westminster

Islington

HaveringRedbridge

Newham

Southwark

WalthamForest

Hackney

City

Tower Hamlets

Barking &

Dagenham

ELHCP Joint Strategic Needs Assessment

DemographicsThe population in NEL is expected to grow by 120,000 in the next five years and 345,000 over 15 years. This is expected to be particularly high in ethnic groups, which are at increased risk of some health conditions. There are significant health inequalities across NEL and within boroughs for life expectancy and years of life lived with poor health.

WellbeingCombating obesity requires a population-based approach throughout the life course, beginning with breastfeeding, encouraging a healthy diet at pre-school age, and encouraging physical activity at all ages. Cross-organisational management, political and clinical commitment to the necessary resourcing and delivery is critical.

Health inequalitiesHealth inequalities remain a significant issue in NEL with diabetes, dementia and obesity all disproportionately affecting people in poverty.There is significant deprivation with five of the eight NEL boroughs in the bottom 20% for the Index of Multiple Deprivation).

Long-term conditionsNEL faces challenges in diabetes prevention: the biggest components of its expected population rise are in ethnic groups which are at higher risk. Health and local government should continue to work together to implement the national NHS Diabetes Prevention Plan and supplement with local activity – sharing, evaluating and disseminating results.NEL CCGs should consider strategies to increase diagnosis of atrial fibrillation (irregular / fast heartbeat) in primary care.

ELHCP Joint Strategic Needs Assessment

Bexley

Greenwich

Lewisham

Enfield

Haringey

Camden

Lambeth

Westminster

Islington

HaveringRedbridge

Newham

Southwark

WalthamForest

Hackney

City

Tower Hamlets

Barking &

Dagenham

Mental healthData suggests most aspects of mental health in NE London are well-managed. Further local analysis of hospital admissions of people with dementia and for those experiencing psychosis is required.

Sexual healthNEL has high rates of sexually transmitted diseases. More work is needed to promote safe sex and programmes should be considered, to offer HIV tests to those at high risk of HIV.

Potentially avoidable hospital admissionsCCGs in NEL should compare clinical pathways for acute and chronic conditions managed in primary care, with a view to sharing good practice and learning.

CancerVariation in one-year survival rates, combined with average rates of early detection suggests strategies are needed to encourage people to see their GP as soon as symptoms arise. Increased screening rates, awareness-raising and education is required

East London Health and Care Partnership Joint Strategic Needs

Assessment Executive Summary

March 2018

1. Introduction

In 2016 a Public Health Profile for North East London (also referred to as the Joint Strategic Needs Assessment, JSNA) was produced to inform the development of the NEL Sustainability and Transformation Plan (STP).

In light of the rapid population growth, regeneration and housing expansion that is taking place across NEL the profile was refreshed in March 2018 by Meic Goodyear, who produced the original profile.

This document sets out the Executive Summary of key issues.

The full document will be available on the ELHCP website in May 2018 along with public facing communication products. (www.eastlondonhcp.nhs.uk)

2. Priority issues - an overview

It is to be expected that as this update to the NEL STP Profile relates to the position after 2 years, most population-based indicators have not changed a great deal, and therefore the priority concerns remain largely as they were. This section highlights these in summary and section 3 gives further detail.

NE London faces a population growth of about 120,000 people in the next five years. This is expected to be differentially high in ethnic groups at increased risk of some priority health conditions. Over 15 years the increase is expected to be about 345,000 people. Five of the boroughs are in the most deprived quintile of the IMD 2015.

NE London face a stiff challenge in diabetes prevention, as the biggest components of its expected population growth are in ethnic groups at higher risk and which may be harder to reach. NE London is implementing the NHS Diabetes Prevention programme (NHSDPP) across the STP area. It may be beneficial to supplement the national provider’s work with local activity appropriate to the particular demography. The effectiveness of the DPP should be monitored and evaluated.

Combatting obesity needs a population-based approach throughout the life course, beginning with encouraging breastfeeding and creating a breastfeeding-friendly environment, encouraging a healthy diet from pre-school years, and continuing to encourage healthy eating and physical exercise throughout adulthood.

The NHS Health Checks programme is the main tool for identifying people at high risk of CVD, and recommending preventative actions. While the programme is going to plan in NE London rates of

eligible people offered health checks and rates of take-up vary across the area. There is scope to disseminate across NE London locally effective practice.

Such data is publicly available suggest most aspects of mental health in NE London are well managed. There is a shortage of data, and further local analysis of hospital admissions of people with dementia and of acute admission for psychosis should be performed.

NE London has high rates of sexually transmitted diseases, suggesting more work needs to be done locally to promote safe sex.

CCGs in NE London should compare clinical pathways for acute and chronic conditions usually managed in primary care, with a view to spreading local best practice in avoiding unnecessary admissions. There is scope for significant savings in avoiding unnecessary admissions.

NE London has significant variation in the 1 year survival index for all cancers, which combined with average rates of early detection, suggests many of those not detected early may be presenting at a late stage of their disease. NE London has low rates of cancer screening, and work must be done to improve this.

NE London has low rates of childhood immunisation, and everything possible should be done to increase childhood immunisation rates, for the benefit both of individual children and the wider population.

NEL appears to have higher than average percentages of deaths in hospital, lower than average percentages of deaths at the usual place of residence, and a wide range of percentages of deaths in hospices.

3. Summary of Key Issues identified from the Profile

3.1 Population growth from 2016 to 2021 in NE London is expected to be in the region of 6.1% (from 3% Redbridge and Waltham Forest to 13.2% Tower Hamlets), from 1.95 million to 2.07 million. Some BME groups will grow differentially faster, South Asians by 10.5%, but Black groups slightly less than the total, about 5.1%. These groups have higher risks of major, potentially preventable, health conditions. Over 15 years, to 2031, the increase is expected to by around 345,000 or 18%, to 2.3 million people. Five of the boroughs are in the most deprived quintile of the IMD 2015.

Key messages: NE London faces a population growth of about 120,000 people in the next five years. This is expected to be differentially high in ethnic groups at increased risk of some priority health conditions. Over 15 years the increase is expected to be about 345,000 people.

3.2 Diabetes: Black groups and South Asian groups have higher risk of diabetes. Published estimates for Black groups are up to three times that of White groups, for South Asians generally up to four times the rate for white groups, and over five times among Pakistani and Bangladeshi groups. Using the estimated rates published in 2014 by the South Asian Foundation 1 this equates to an estimate additional number of cases of type 2 diabetes of 1300 in Black groups and 8,200 in South Asian groups. Diabetes prevention is clearly an important issue for NE London. It is

1 Type 2 diabetes in the UK South Asian population, South Asian Health Foundation (SAHF),www.sahf.org.uk Date of publication: October 2014

particularly important that interventions are effective in the South Asian group, as trials have previously excluded them.

Right Care analysis identified increased risk of mortality among people with diabetes in NE London CCGs, and that the percentage of people in the National Diabetes Audit (NDA) with Type 1 and Type 2 diabetes who received NICE-recommended care processes was poor. Primary care prescribing costs were high for endocrine conditions (which include diabetes), with potential savings of between £5 and £10 Million perhaps achievable.

An important positive factor for NE London is that the Expression of Interest from a consortium of City & Hackney, Newham, Tower Hamlets, and Waltham Forest was successful in being awarded the joint pilot for the NHS Diabetes Prevention Project (NHSDPP). Further work, beyond the scope of this Profile, is known to be under way in these boroughs. Strong consideration should be given to building on and evaluating the results of the pilot, and implementing the NHSDPP in the remaining boroughs and Barking and Dagenham, Havering and Redbridge CCG group as soon as possible in stage 2.

Key messages: NE London face a stiff challenge in diabetes prevention, as the biggest components of its expected population growth are in ethnic groups at higher risk, which have been excluded from trials, and which may be harder to reach. NE London should continue to implement the NHSDPP across the area, and may need to supplement the national provider’s work with local activity appropriate to the particular demography in NE London. The results should be evaluated and disseminated.

3.3 Obesity: Diabetes is strongly associated with excess weight and obesity. Excess weight was a common theme in the Health and Wellbeing Boards’ priorities for all boroughs in NE London throughout the life course. The position varies in detail from year to year, but in the most recent period, according to the National Child Measurement Programme (NCMP), data three boroughs in NE London have higher rates of excess weight among children starting primary school than the averages for England and London, and none has lower rates, and the average for NE London is about 24%. By the time children are about to leave primary school this average has risen to around 40%, four boroughs have significantly higher rates than London, and all boroughs in NE London have significantly higher rates than England. Evidence suggests that the previous steady rise in childhood obesity may have stabilised, but rates have not started to fall. It may be noted that obesity is generally linked with deprivation, and five of the eight boroughs in NE London have significantly higher proportions of the children living in poverty than the national average, and only the City of London has a lower than average rate.

Perhaps surprisingly, this is not reflected in the statistics for excess weight in adults: Only one borough has significantly higher rates than England, and half have significantly lower rates. NE London has generally higher rates of physically inactive adults, and slightly lower than average proportions of the population eating 5-a-day.

Boroughs vary in their approaches to encouraging physical activity, their corrective programmes for childhood obesity. There is a lack of published evidence of what interventions are effective in this area. Boroughs should consider evaluating their own programmes, sharing the results with each other, and learning from each other’s successes. Boroughs and CCGs should continue to promote the benefits of breast feeding, and encouraging the development of breast feeding friendly environments. Lack of awareness of what constitutes healthy food, what healthy food is cheap to buy, and what skills are needed in cooking it, are barriers to healthy weight programmes. Boroughs may wish to share their experience of such programmes, and co-operate in their further development.

Boroughs vary in their top management’s engagement and willingness to commit resources adequately to the programmes. Although a stated priority, without adequate resources little can be achieved.

Some boroughs describe their circumstance a “obesogenic”, with high numbers of fast (junk) food take-away shops, particularly in proximity to schools, little easy access to green space, a perception of lack of safety when in the open, and other adverse issues. Those boroughs which are not already doing so should consider planning restrictions on fast food take-away shops within 400 metres of schools. While creating safer environments is beyond the scope of the STP, boroughs should feed their concerns in their neighbourhood safety groups.

Key messages: Combatting obesity needs a population-based approach throughout the life course, beginning with encouraging breastfeeding and creating a breastfeeding-friendly environment, encouraging a healthy diet from pre-school years and the knowledge and skills to achieve this affordably, creating an environment where physical activity is seen as natural, affordable, and safe at all ages, and proliferation of undesirable influences such as junk food outlets is controlled in relation to the location of schools. This will not be achieved without top management and political and clinical commitment in both local authorities and CCGs, and long term commitment to the necessary resourcing.

3.4 Circulatory diseases (CVD): South Asian groups have 50% higher risk of ischaemic heart disease than White groups, while Black groups have lower risks of heart disease than the general population. Black groups have double the risk of stroke than the general population, and South Asian groups have rates 50% higher than the general population.

A major risk for circulatory diseases is smoking. NEL has lower than average rates of smoking prevalence at age 15, and approximately the national average smoking prevalence rates for adults.

The principal tool for prevention of CVD is the NHS Health Checks programme. This is proceeding roughly to schedule in NE London, with about 80% the eligible population having been offered a check, and about two thirds having accepted the offer, meaning just over a quarter of the eligible population has been screened to date. Current take-up rates suggest just over half will have been checked by the end of the first round of the programme. Health economies in NE London might consider strategies for increasing take-up rates. There may be scope for transformation in how the health check programme is embedded at a population level.

Prevalence models suggest that boroughs in NE London, in common with the rest of England, have high rates of undiagnosed atrial fibrillation, a marker of high risk of stroke. Strategies for increase diagnosis rates of this in primary care should be considered.

A large proportion of the population has higher risks of CVD, and NE London generally has higher than average rates of preventable mortality from CVD.

Right care analysis of circulatory diseases suggests that savings of between £700,000 and £2.5 Million could be made in elective hospital admissions, and between £4 Million and £7 Million in non-elective admissions when NE London boroughs are compared with their peer groups. Savings of up to £1.8Million are considered possible in primary care prescribing.

Key messages: Tower Hamlets has the highest proportions of their populations who have been offered NHS health checks, and much higher take-up rates (75%) than the NE London average. The other boroughs in NE London should try to learn from this borough to improve their own health check rates. NE London CCGs should consider strategies to increase diagnosis of Atrial Fibrillation in primary care.

3.5 Mental health and learning difficulties: This is an important area though there is a shortage of high quality relevant data. Excess premature mortality rates for adults with serious mental illness are generally lower than the England average, significantly so in three boroughs. Suicide rates are mostly non-significantly lower than the England average. NE London has higher than average rates of mental health clients living independently. The percentage of adults with learning disabilities living independently varies across NE London. Good mental health and mental health services are essential contributors to population wellbeing.

Right care analysis found that standardised mortality ratios (SMR) in people aged 18-74 years in contact with mental health services in NE London, 2012/13 were high (-ve), rates of new cases of psychosis in people aged 18 years and over who received early intervention psychosis (EIP) services were high (+ve), mean percentage achievement scores for physical health checks on people with severe mental illness in NE London were high (+ve), rates of emergency admissions to hospital of people with dementia aged 65 years and over were poor(-ve), ratio of reported to expected prevalence of dementia were better than average (+ve), rates of children and young people aged 0-18 years with three or more admissions to hospital per year for mental health problems were good, and standardised mortality ratio (SMR) in people aged 18-74 years in contact with mental health services were good. Right care analysis did not include savings in the mental health area. The Right Care update packs did not include further analysis of these topics.

Key messages: Taken as a whole, the data suggest most aspects of mental health in NE London are well managed. Further local analysis of hospital admissions of people with dementia, and for psychosis should be performed.

3.6 Sexual health: NE London has high rates of syphilis, gonorrhoea, and HIV compared to the England averages. Late diagnosis rates for HIV are high in three boroughs, and low in two. Boroughs should re-emphasise the importance of safe sex, and consider programmes for testing high risk people for HIV at an early stage.

Chlamydia detection rates are high in Hackney, low in Redbridge and Havering, and fairly similar to the England average elsewhere. Boroughs may benefit from sharing the most effective practices with each other.

All NE London boroughs have low rates of long acting reversible contraception prescriptions.

Right care analysis did not consider savings from sexual health services.

Key messages: NE London has high rates of sexually transmitted diseases, suggesting more work needs to be done locally to promote safe sex. Programmes should be considered to offer testing to people at high risk of HIV (MSM and sub-Saharan Africans). Offering HIV testing at GP registration has been effective in other parts of London.

3.7 Potentially avoidable hospital admissions: Although avoiding unnecessary admissions in the psychiatric area is a theme in the STP programme, there appears to be little in the way of robust published data on this. The data that do exist relate to admission for acute and chronic conditions usually managed in primary care. The rates vary widely across NE London, but are consistent between acute and chronic conditions. Rates for Waltham Forest, Redbridge, Barking & Dagenham, and Havering tend to be higher than those of England, while City of London, Newham, Hackney, and Tower Hamlets tend to be lower than those of England. CCGs in the former group might benefit from studying the management practices in the latter group that enable low admission rates for these conditions to be maintained.

Right Care analysis, comparing NE London CCGs with their peer groups for all aspects of acute care, suggests there may be potential savings of between £6 Million and £17 Million in elective care, and between £10 Million and £ 30 Million in non-elective admissions.

Key messages: CCGs in NE London should compare clinical pathways for acute and chronic conditions usually managed in primary care, with a view to spreading local best practice in avoiding unnecessary admissions. CCGs in NE London should consider instituting a programme of work to compare clinical pathways in each of the Right Care areas with those CCGs identified as Right Care peer groups.

3.8 Cancer: Boroughs and CCGs in NE London have significant variation in the one year cancer survival index, and this has been so since at least 1998 although year on year improvements are being made. Patients with cancers diagnosed at an early stage generally have longer life expectancy, and rates in NE London for early diagnosis (Stage 1 or 2) are similar to or lower than the England and London averages. Premature mortality (age < 75) from cancer among women is similar to that in England, except for one borough, which has a consistently low rate. Among men the same borough has a low rate, four boroughs have high rates, and three have rates similar to that of England.

In cancer screening programmes NE London boroughs consistently have significantly lower coverage rates than the England average which is seen across the capital. Poor screening coverage may be a contributor to lower 1 year survival, and NE London boroughs would do well to seek ways to improve screening coverage across all three screening programmes.

Right care analysis found less than £300,000 could be saved in cancer if the NE London STP area CCGs achieved the score of the best 5 CCGs in the peer group for elective admissions, and over £3 Million pounds could be saved in cancer if the NE London STP area CCGs achieved the score of the best 5 CCGs in the peer group, and £2 Million if they achieved the average score for the peer group for non-elective admissions.

Key messages: Wide variation in one year survival index, combined with average rates of early detection, suggests many of those not detected early may be presenting at a late stage of their disease. This data is not available by ethnic group, but it seems likely that strategies are needed to convince NEL’s population, particularly its BME populations, of the need to see their GP as soon as certain signs and symptoms arise. This may be difficult with some populations, as some African languages, for example, do not have a word for “cancer”. Work must be done to increase cancer screening rates and more generally the signs and symptoms of cancer to prompt the population to seek their GPs opinion. In addition to screening, population awareness and education is required, with clear direction about when and how to present to primary care.

3.9 Childhood immunisations: NEL boroughs have notably low rates of childhood immunisation. For DTap, IPV, Hib at two years, and MMR 1 at 2 years, all boroughs have significantly lower rates than England. For MMR 2 at 5 years, one borough has rates above the England average, while all the others are significantly worse. These rates leave NE London at risk of outbreaks of serious and potentially life threatening diseases, as in none of the conditions has the level required to achieve herd immunity been attained.

Key messages: Everything possible should be done to increase childhood immunisation rates, for the benefit both of individual children and the wider population. Elsewhere in London there has been some success in harnessing GPs’ innate competitiveness to improve performance in this area. Such an approach could be considered in NE London.

End.



Date: 9 May 2018

Title of report East London Health and Care Partnership Business Plan 2018/19

Author Nichola Gardner, STP Programme Director

Presented by Jane Milligan, Single Accountable Officer, NELCA


[email protected]

Executive summary (summary of key points)

This document sets out the East London Health and Care Partnership’s business plan and outlines the key priorities of the partnership for 2018-19:

• Healthy and independent local people • Improving services • Right team, right tech, right place • A well-run partnership.

A number of big ticket priorities including outpatients transformation, payment reform, provider alliance led clinical strategy and development of local integrated care partnerships are also highlighted.

Action required: � Discussion � Approval � Information only/

noting

Information only/noting. The Committee is asked to note the report, including the new governance arrangements for commissioning with the establishment of the JCC.


ELHCP Executive.

Strategic fit � Commissioning

implications � Local


Outlines overarching ELCHP strategy in summary for 2018/19.


N/A


Describes NEL-wide ambitions to improve services and outcomes for people. Please note that an easy read version of this document should be produced for wider circulation to the public.


N/A


East London Health and Care Partnership Business Plan 2018/19

Introduction

The East London Health and Care Partnership (ELHCP) brings together twenty health and care organisations with a col-lective vision to measurably improve health and wellbeing outcomes for the people of east London and ensure sustaina-ble health and social care services, built around local needs.

This document sets out in summary the partnership’s business plan for 2018/19. In October 2016 we agreed an ambi-tious five year sustainability and transformation plan (STP). The first year of the plan focused on scoping, planning and establishing the major collaborative transformation programmes to deliver the partnership’s priorities, as well as building the partnership across the twenty health and social care organisations and with our communities and stakeholders. In 2017/18 we delivered a number of tangible early improvements (see www.eastlondonhcp.ns.uk for highlights). In 2018/19 the transformation programmes and wider work of the partnership moves further into delivering change and supporting the emerging integrated care partnerships (ICPs) across east London.

Our leadership

The leadership of the partnership has an absolute commitment to supporting the health, well-being and independence of the people of east London. It brings together a wealth of experience and expertise: clinical, public health, local govern-ment, health management, educational and scientific.

The focus of our leadership in 2018/19 will be on those big issues where together we can make a real and positive dif-ference to local people’s health, well-being and independence - housing, education and employment, green spaces and clean air, thriving communities, and supporting the local economy. We will be expanding the membership of the partner-ship’s board to reflect this focus.

In addition to strengthening and expanding our civic leadership, our clinical commissioning leaders are matching this by building new collective decision-making arrangements with the formation in April 2018 of a clinically led Joint Commis-sioning Committee (JCC). The JCC is developing its commissioning strategies for the year, aligned to and taking for-ward the partnership’s transformation priorities, which are described in this document.

Our Clinical Senate, which is the forum for our provider and commissioner clinical leaders, is directing its expertise on a major outpatients transformation programme, which will improve patient experience by providing this care in their local practice, reducing the need to go to hospital and speeding up access to care. It will also free-up hospital clinical time which can then be reallocated to both support more work in the community and more acute and specialist work in hospi-tals.

Our year ahead from the independent Chair of the East London Health and Care Partnership, Rob Whiteman 2018/19 will be a pivotal year for the East London Health and Care Partnership as we focus our collective commitment and energy on a bigger, societal agenda of those issues that impact on our local people’s lives every day. We want to tackle those issues that require us to bring together our united expertise, such as housing, air quality, green and safe spaces and healthy lifestyles. Over the past year we have built a solid foundation of transformational programmes that take forward the ambitions of the Five Year Forward View as well as local priorities, and these will continue; and we will support the development of local integrated care

partnerships to deliver these transformations in neighbourhoods and our partner organisations.

http://www.eastlondonhcp.ns.uk/

A number of big ticket developments will draw on the full wealth of our leadership experience and expertise and these are highlighted in the following pages, including: outpatients transformation, developing the provider alliance’s clinical strategy, supporting the development of local integrated care partnerships, and payment reform, amongst others.

Our partnership’s purpose

STPs continue to evolve - they were launched in 2016 with the aim of tackling the intractable, systemic challenges that faced all partners and could not be solved by any one organisation on its own but needed a collective endeavour. STPs were also positioned as the means to deliver service transformation through the Five Year Forward View (FYFV) priorities.

Eighteen months later and STPs have evolved to become more than a plan to tackle system-wide challenges and are now being framed as partnerships with the following purpose:

• Supporting health and social care providers to create alliances to provide fully joined-up pathways of care, reducevariations in care across east London and make efficiencies by working together.

• Forming a Commissioning Alliance across the seven Clinical Commissioning Groups (CCGs) in east London tostreamline commissioning processes by doing some things once across the patch.

• Supporting the development of integrated care partnerships across health and social care, which will work together toreduce fragmentation of services by commissioning and providing integrated care locally within and across boroughs.

Looking ahead in 2018/19, with the confirmation of devolution in London, it is expected that the partnership will take on some system development and assurance activities that have to date been exercised by the regulators, NHS England (NHSE) and NHS Improvement (NHSI). This is likely to include a greater level of quality, financial and performance management and also management of transformation funding. This will put the partnership in the driving seat locally.

Our system objectives

The following pages describe the how the transformation programmes and are taking forward the partnership’s strategic objectives in 2018/19.

Healthy and independent local people

Improving services Right team, right tech, right place

A well-run partnership

Case for change

18% population growth over next 5-10 years The quality of some of our

services, access and the outcomes people get are variable

We do not have enough staff now or in the future and our infrastructure needs to keep pace with modern advances and de-mands

The system is frag-mented and there are fi-nancial and sustainability challenges

System ambition

We will support local people to be healthy and independ-ent so that they need to use services less, are more able to take control of their own health and we can contain demand

We will improve services and make sure they are sustainable so that every-one has equal opportunity to the same, consistently high quality services, ac-cess and outcomes

We will make sure we have the right people, technology and estates to support ser-vices

We will make our health and care system sustain-able and affordable by ensuring we have a well-run partnership that inte-grates the system and

deals with the chal-lenges together.

Big tickets for 18/19

• JSNA refresh

• Children & Young Peopletransformation pro-gramme

• Joint work on housing

• Outpatients transfor-mation

• Provider clinical strategy

• EOLC transformation pro-gramme

• Workforce campaigns

• Shared records acrossEast London

• ICP estates strategies

• Service co-design withcommunities

• ICP development

• Payment reform

1. Healthy and independent local people

What we will do in 2018/19

Prevention programme Our prevention programme is led by the Directors of Public Health, who will each be supporting the range of ELHCP transformation programmes to embed prevention strategies. We will refresh the Joint Strategic Needs Assessment (JSNA). We will improve outcomes for local people through the introduction of population health management and out-come based commissioning, working with ICPs to set targets appropriate for local populations. We will work with our partners, Healthy London Partnership and other stakeholders to determine future support arrangements for prevention programmes across the system utilising a quality improvement approach. In 2018/19 the prevention programme will:

• Support people to stop smoking, improving lung and heart health, by ensuring all NHS estates are smoke free.Wider public awareness of smoking cessation support will be generated through a social marketing campaign.

• Reduce Type 2 diabetes by delivering structured education and digital support to people through implementing thenational diabetes prevention programme (NDPP).

• Improve the health of staff by supporting partner organisations to achieve Healthy Workplace accreditation. A pilot isbeing carried and evaluated in primary care and pharmacies to see if the scheme can be extended to them.

Children and young people’s programme We will develop a children’s and young people’s transformation programme to support the east London paediatric alli-ance and continue and embed the work of the Healthy London Partnership (HLP) programme locally, focusing on key health issues such as asthma, mental health and dental care.

Health and housing In October 2017 we held our first Health and Housing conference. This generated new connections across health and housing professionals and organisations and a call to action with ideas on housing to support healthy communities, staff housing needs, etc. In 2018/19 we will follow up with a series of targeted groups and meetings.

Social value We want to harness expertise and resources as widely as possible across the partnership to address the social determi-nants of health. One way we will look to do this through our expand board is to explore adopting the Marmot Principles in our commissioning strategy development and provision of services.

Our challenges

• We have one of the largest and fastest population growth rates in thecountry - 18% over the next five to ten years. This is both growth of ayounger population and also the older population.

• East London also has a transient population and areas of intensehealth inequalities and deprivation. Affordable, quality housing, cleanair, access to healthy food are all challenges.

• People want their whole health and social care needs considered asone and we too often treat and manage people in parts, in particularnot making sure that people’s mental as well as physical health aretreated equally. We have also traditionally focused more on resourcingphysical health needs than mental and well-being needs.

East London system objectives & key messages

• Supporting local people to be healthyand independent by reducing inequalityin expected length of life across EL,increasing prevention & self care,staying independent in their homes,reducing the need for long terminstitutional care

• Managing future demand within currentcapacity & by moving more servicestraditionally provided in hospitals out tothe community

• Improving outcomes for local peoplethrough the introduction of populationhealth management and outcomebased commissioning, working withICPs to set targets appropriate for localpopulations

• Refreshing the Joint Strategic NeedsAssessment to ensure the populationsneeds are understood

• Continue to consider the widerdeterminants of health, proactivelyworking with partners in areas such ashousing

Our system ambition

We will support local people to be healthy and independent so that they need to use services less, are more able to take control of their own health and we can contain demand

2. Improving services


Our transformation programmes to improve services aim to reduce unwarranted variation in access, quality and outcomes, provide more services out of hospital in the community and embed the new models of care from the FYFV. We will continue to develop strong leadership, including clinical leaders to implement service improvements:

Outpatients programme

The major focus of the Clinical Senate will be to transform all outpatient specialties in all hospitals, including mental health services, with a target of 30% of service being delivered in the community. This will build on existing initiatives in all boroughs.

End of Life Care

We will launch a new transformation programme, which will focus on supporting clinicians in early identification, reducing variation in access and outcomes, developing a business case for service gaps and supporting End of Life Care needs in care homes.

Provider clinical strategy

The acute and community/mental health provider Trusts are developing a clinical strategy, which will in the first place develop a plan for elective services to reduce the need to use the private sector by increasing capacity in east London hospitals. This will consider creating hubs of excellence for some specialties and will continue to refine the modelling of the move of acute services into the community.

Our challenge

• Access is too often through A&E, at a point of crisis. The front doorto the system should be people’s own front doors with care providedby multi-disciplinary teams across health and social care, supportedby the voluntary sector and our strong local communities.

• The quality of some of our services and the outcomes people getare variable –and we want the best standard for everyone acrosseast London and we want to keep resources within local services.

• Access to primary care is variable and the Care Quality Commission(CQC)has highlighted services, quality and outcomes across ourproviders that need to improve

• We have a long history of innovation through working with patientsand clinicians to co-design individual components of care, but this

hasn’t been easy to spread more widely.


• All our providers will achieve a ‘good’ or‘outstanding’ score from the CQC

• Expecting all services to reach the sameperformance, levels of access and out-comes as the best in England by transform-ing care models

• Making our local services sustainable bykeeping resources within local services, in-cluding by delivering all elective proceduresby local NHS services

• Bringing services together to ensure theyare sustainable and create centres of excel-lence

• Developing strong leadership including clini-cal leaders to implement service improve-

ments

Our system ambition

We will improve services and make sure they are sustainable so that everyone has equal opportunity to the same consistently high quality services, access and outcomes

Cancer

East London is performing well on cancer improvements. A key outcome is to improve the cancer one year survival rates and increase the number of people diagnosed at stage one and two, with the aim of increasing the one year survival rate to 75% by 2020 across all cancers. Work this year will include: implementation of national optimal pathways starting with radiology front end; screening programme uptake; and preparing for 28 faster diagnosis standards.

Learning Disabilities - Transforming Care

The focus is on continuing the gatekeeping of admissions to hospital through robust dynamic risk registers and the Care and Treatment Review system. In the community prevention strategies with children will be tested. Provision of housing locally for those who will want or need to move in the next two years will be boosted. A strategy around positive behav-iour support will be developed, which will have an impact on commissioning and monitoring of services, supported by a workforce development programme to increase local skills in this area.

Maternity

A comprehensive maternity transformation plan was developed and presented to the ELHCP board in 2017. This plan will be implemented, dependent on the level of national transformation funding secured. Key developments will include: a midwifery workforce rotation scheme to improve recruitment and retention; digital access to maternity records; imple-menting care bundles to reduce rates of still birth, neonatal death, maternal death and brain injury; scoping community midwifery hubs; and working with the third sector to co-deign new models of care and engagement with local women.

Medicines Optimisation

The focus is on delivering plans to reduce the use of ‘medicines of limited clinical value’ (MoLCV) and plans to switch to biosimilars. A methodology and list of MoLCV and the first two biosimilars will be produced for approval by the relevant governance arrangements, supported by public engagement and communication plans. Work will be undertaken to pro-cure a digital solution to support discharge from wards to pharmacy. Initiatives and public campaigns to reduce the inap-propriate requests for antibiotics will be launched.

Mental Health

The mental health programme’s key deliverables will be: increasing the availability of individual placement and support schemes (IPS) to help people with severe mental illness (SMI) into and retaining employment; expansion of Increasing Access to Psychological Therapy (IAPT) services; supporting smoking cessation in mental health services; bidding for funding to develop perinatal services; psychosis pathway redesign; crisis pathway redesign; physical health checks for people with SMI; and developing core mental health competencies for new roles.

Primary Care

The aim is to have all practices undertaking a formal quality improvement programme, with 300 projects in the year and all practices receiving at least a ‘good’ Care Quality Commission rating. In 18/19 a common business intelligence system will be implemented. Work will continue to strengthen the at-scale primary care providers, ensuring that they are fully developed by the end of 18/19. An extensive engagement exercise with the local GP workforce will be undertaken dur-ing Q4 17/18 to understand what would attract and retain GPs to work in east London.

Urgent and Emergency Care (UEC)

The major development will be the new integrated urgent care 111 service and Clinical Assessment Service (CAS) going live by the summer. This will involve direct booking from the 111 service into GP practices. Work is underway to ensure the six urgent treatment centres in east London meet the UEC facility specification guidance. Standardised 24/7 mental health crisis line, linked to the 111 and CAS will be implemented. London Ambulance Service conveyances will be re-duced by continued work to reduce frequent callers and an increase in alternative pathways. All CCGs will offer ex-tended access to GP appointments.

3. Right team, right tech, right place


Digital The east London patient record will connect most of the 20 health and social care organisations in the partnership for record sharing at the individual patient level for clinicians and carers to use in all care with their patients/residents. The Discovery east London data service will pull in all of the data from those 20 organisations into one linked data ware-house. This will also be used for an individual’s care by providing specific utilities to discrete groups of users, e.g. GPs using the ‘Where’s my patient’ utility. It will also be used for local service improvement and research for example allow-ing organisations like Clinical Effectiveness group (CEG) to use it to examine the outcomes from a particular care path-way across all of the care settings that a patient would touch on for their care. Provider digital maturity will be enhanced with expected advances including the implementation of electronic medicines management systems, bedside observa-tions and maternity systems where not already in place.

Estates The ELHCP Estates Board and estates team will be established, supported by a business intelligence system and cen-tralising of information on void spaces and utilisation of estate. A confirmed list of priorities for London capital pipeline will be produced. Support will be given to the ICPs to update their strategic estates plans. A three year capital invest-ment plan will be developed. Based on population growth forecast and potential shift of activity work will be undertaken to anticipate the new capacity requirements and link with the proposed new hubs across east London.

Workforce

The focus will continue to be on recruitment and retention, with local and overseas campaigns, development of appren-ticeships, new roles, talent management strategies and rotations such as the maternity initiatives. Community Education Provider Network (CEPN) and Health Education England (HEE) transformation programmes will be implemented sup-porting new models of working in the community. Primary care workforce schemes such as the physical associate pro-gramme will be rolled out.

Our challenges

• We do not have enough staff now or in the future. We have theopportunity to innovate training, roles and ways of working. It’s about theright care, at the right time, in the right place and most importantly – theright team.

• Community–based working often gives more autonomy to staff andreleases them to innovate and provide whole person care- and this isimportant, as not only is capacity not always in the right part of thesystem, but we need new types of roles, development opportunities andways of working as finding and keeping the workforce these days ischallenging, especially with the cost of living and housing in London.

• Many people live their lives on their smart phones and there is an urgentneed for health and social care services to become more digital friendly.

• We have serious challenges our estates, with some of the best buildings,but also others that are not fit for purpose, such as Whipps CrossHospital. We have estate with old buildings that could be re-purposedand used as one public estate for new integrated health and social carefacilities, creating healthy living campuses.


• We want people to come to work in EastLondon and to stay and we will increasestaff retention by developing joint recruit-ment and retention programmes

• We will utilise digital technology includingconnected patient data (to be accessible byall EL NHS and social care providers)

• We will maximise the contribution of ourcapital asset base articulated through awhole system multi - year estates strategythat describes the service configurationrequired to meet residents needs and canbe used to influence and secure investmentat a London level (insert target)

• We will review and and align enabler

support functions across the system

We will make sure we have the right people, technology and es-tates to support services

4. A well-run partnership


• Engaging with our communities and partners

Co-design of services with patients and communities is key. Continuing development of internet portal and associated

materials promoting jobs and career opportunities across all health and care roles in east London, plus promoting east

London as a place to live. Major public awareness and education programme across east London to signpost people to

correct health and care services, which will be run in partnership with voluntary sector to ensure all communities are

reached.

• Integrated care partnerships development

Support will be given to the integrated care partnerships as they develop across east London, ensuring the benefits of

the London Devolution are maximised at the local level. The Dartmouth Institute Place Based Care programme is sup-

porting five senior teams to develop integrated pathways to underpin their ICP local system.

• Payment reform

In 2017 the ELHCP Board approved the principles for payment reform, and agreed east London should introduce evolu-

tionary changes to payment for April 2018, while working on longer-term payment development options for the system

for testing through 2018. Finance professionals and clinical leads have been working to develop changes to payment for

April 2018 to support outpatient transformation programmes, and to better align incentives in areas where pass through

costs currently exists.

Our challenges

• In recent years the system has become fragmented: causingduplication, not always working to the best advantage for thepatient or local people and putting artificial barriers betweenprofessionals and organisations across health and localgovernment services. We need to make sure we are organised welland working in partnership and that we engage and communicatewith local communities, our partners and stakeholders in ameaningful way, with co-production at the heart of our servicetransformation.

• Individual institutions alone will not be able to address the scale offinancial or quality goals we have, and in order to get the best of ourcollective resources we need to transform how we work togetherusing a partnership approach, rather than working with an individual

organisation focus.


• We will continue to build local relationshipsand co-design services, engaging with ourcommunities and partners

• We will produce a system plan that alignsactivity, finance and workforceassumptions, achieving financialbalance(within a system control total,implement strategic integrated change

• We will allocate resources in the bestinterests of the local system, removing theperverse incentives for individualorganisations.

• We will support the development ofIntegrated Care Partnerships and leadingon payment reform (moving away from PBRapproach to capitated funding) andidentification of system wide efficiencies

• We will enhance, streamline and alignsystem governance and decision making

• We will support system learning and

development

We will make our health and care system sustainable and afford-able by ensuring we have a well-run partnership that integrates the system and deals with the challenges together.

• Provider productivity programme

The provider productivity programme will focus on:

HR - Bank & Agency: In 2018, establishment of provider forums covering – e-Rostering, recruitment & retention, equal-

ity & diversity. Plus, implementation of pan-London bank rate caps across east London medical agency staff.

Pathology: Agreement of east London pathology model (one or two hub options) with NHSI. Pathology Hub Transfor-

mation plan to incorporate and embed initiatives as defined previously i.e. test ordering process, materials procurement,

demand & capacity mgmt. and contract reviews.

IT: Benchmarking analysis of cyber security across east London.

Procurement: An options analysis on the potential for east London wide single provider service combinations. An imple-

mentation plan will be developed following the option appraisal.

• Local assurance

As NHSE and NHSI work in closer alignment in 2018 it is anticipated that some of their functions and roles will be dele-

gated to enable locally led assurance of services. ELHCP will work with the regulators to develop a local assurance ap-

proach and framework.

• System leadership development

ELHCP is participating in two integrated care partnership development programmes in 2018. The Dartmouth Institute programme is supporting leadership teams in all five ICPs. The national STP OD programme with Staff College is en-couraging collaborative leadership and projects, working with ELHCP transformation works streams.

To find out more about the East London health and Care Partnership and our transformation programmes, including highlights of last year’s achievements and to follow progress in delivering the 2018/19 operating plan please visit:

www.eastlondonhcp.nhs.uk

http://www.eastlondonhcp.nhs.uk/



Title of report NEL Performance Update

Author Lee Eborall

Presented by Lee Eborall


Lee Eborall

Executive summary

(summary of key points)

The key issues presented in the paper are: • 100% compliance of Primary Care extended access throughout

NEL (8-8, 7 days) • Challenged performance on 4 hour A&E target- Overall

performance was 82.5% in March compared to agreed trajectory of 93%

• NEL has been compliant with the 62-day cancer standard sinceQ2 in 2017/18

Action required • Discussion• Approval• Information only/

noting

The Committee is asked to: • Note the performance report, the performance challenges highlighted

and the actions in place to address them


N/A




Compliance with the performance targets is part of the North East London Commissioning Alliance strategic plans.


• The ongoing deterioration of the A&E performance standard. • The risk of deterioration against the RTT performance target as

opposed to improved compliance.


• This means local people may need to wait longer to be seen at anA&E department and may need to wait longer to receive theirplanned procedure.


• The ongoing national Expert Determination process represents apotential contract and financial risk

• There is a risk if the transformation, QIPP and CIP schemes donot deliver

1

North East London How are we performing?

Risk / Issue RAG Mitigation Owner Date

1 The ongoing deterioration of the A&E performance standard.

Ongoing operationally focussed meetings between Commissioners and Providers.

Archna Mathur Oct 19

2The risk of deterioration against the RTT performance target as opposed to improved compliance.

Monthly contract and RTT specific review groups are in place to monitor compliance.

Les Borratt Oct 19

What are the critical risks in the STP?

Key Graphs• GPs offering extended access throughout NEL (8-8, 7 days) at 100% compliance as City and Hackney are

now live.

• The BHR system is refreshing its recovery plan following a series of support provided by NHSE and I. The system is prioritising a smaller number of high impact interventions, including improving UCC performance and increasing weekday discharges to 120 per day. Alongside this, they are reviewing the resources required to deliver and will need to procure additional support to ensure they can successfully deliver the plan.

• At Barts Health a standardised ambulatory care service specification has been developed across all sites. Contractual discussions are ongoing with Barts to agree consistent ambulatory care coding across all three sites in 2018/19

• Homerton: Overall A&E attendances during February 2018 were 8.6% (755) up on this time last year. The main breach reasons during February 2018 were A&E Assessment delays (47%), clinical reasons (17%), specialty delays excluding mental health (9%) and mental health delays (7%). Homerton's COO chairs a weekly Emergency Care Performance meeting to review progress on actions to support performance/ improvement.

• NEL has been at or above trajectory in 9 months out of the 10 in 2017/18 and compliant with the 62 day standard in Q2 and Q3. Ongoing actions are linked to sustainability of the standard and looking at actions to increase earlier transfer of patients where onward referral is required and then to start preparing for the FDS.

• NEL compliant at 0.5% - Optimisation of radiology and endoscopy services are underway following capacity and demand work by the HLP cancer programme.

• BHRUT have completed associated audits and are in the action planning phase for CT and endoscopy. BH have completed cycle audits in CT at Newham and Whipps cross with feedback sessions in March 2018.

• Latest published data is for Qtr3 2017/18. Cumulative Q1 -Qt3 performance shows that only C&H CCG had achieved their agreed cumulative plan at Qtr3. The other 6 CCGs are below plan although historically most providers report increased activity during Qtr4. Clinical lead practice visits are in place to engage the practices to increase IAPT referral rates.

• Performance continues to be above trajectory; to continue to improve through specialised commissioning surgeries.

Primary Care

Cancer

Mental Health

UEC

Transforming Care

Diagnostics

A&E 4 Hour 111 Clinical Contact

DTOC per day DiagnosticsCancer 62d

RTT IAPT 6 weekIAPT Access

TC: L

engt

h of

St

ay

BHRUT 90.63%

Homerton Univ 96.08%

Barts DNR

Primary Care Access

TC: I

npat

ient

R

educ

tion

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

North East London STP

75.0%

80.0%

85.0%

90.0%

95.0%

North East London STPNorth East London STP Trajectory

0.0%

20.0%

40.0%

60.0%


0

100

200


60.00%

70.00%

80.00%

90.00%

100.00%


0.0%

2.0%

4.0%

Feb-

17

Mar

-17

Apr-1

7

May

-17

Jun-

17

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec

-17

Jan-

18

Feb-

18

Mar

-18


0.00%

5.00%


0.00%

2.00%

4.00%

6.00%


0

50

Q415/16

Q116/17

Q216/17

Q316/17

Q416/17

Q117/18

Q217/18

Q317/18

Q417/18

Q118/19

Q218/19

Q318/19

Q418/19

Inner North East London TCP Inner North East London TCP Trajec tory

0

50

Q415/16

Q116/17

Q216/17

Q316/17

Q416/17

Q117/18

Q217/18

Q317/18

Q417/18

Q118/19

Q218/19

Q318/19

Q418/19

Outer North East London TCP Outer North East London TCP Trajectory

0

20

Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18 Q1 18/19 Q2 18/19 Q3 18/19 Q4 18/19

Inner North East London TCP Inner North East London TCP Trajec tory

0

20

Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18 Q1 18/19 Q2 18/19 Q3 18/19 Q4 18/19

Outer North East London TCP Outer North East London TCP Trajectory



Date: 9 May 2018 Title of report North East London Outpatient Transformation

Overview

Author Les Borrett

Presented by Sam Everington


Les Borrett, Interim Director of Strategic Commissioning, NELCA Email: [email protected] Tel: 07950 841016

Executive summary

The Clinical Senate has developed an Outpatients Transformation delivery plan. The plan promotes new ways of working for commissioners and providers covering referral management in primary care and within hospitals. The required commissioner actions have been discussed in the shadow form of the Joint Commissioning Committee and are outlined here for endorsement.

Action required The Committee is asked to approve the next steps of the Outpatient Delivery Plan as outlined in this report.


Previous versions of this report have been discussed at the NEL Clinical Senate and the shadow NEL JCC.




This is a new commissioning approach to outpatient referrals which will support more appropriate referral activity.


The proposals will support better use of Consultant led outpatient clinics and help reduce the numbers of inappropriate referrals.


The proposals will support better patient experience as referrals will be more appropriate and based on joined up working between primary and acute care.

Risks As the proposals are being implemented there could initially be variation in practice across the NEL patch.


9th May 2018

North East London Outpatient TransformationOverview

Background

• The NEL Clinical senate – with the support of the ELHCP Executive - has decided to focus in the first quarter of 2018 on outpatient transformation with the aim of providing a strategic framework for the outpatient transformation work in each NEL system and pilot one approach to system quality improvement

• The Clinical Senate has developed a delivery plan which was agreed on 14 March. The plan promotes new ways of working for commissioners and providers. The commissioner actions have been discussed in the shadow form of the Joint Commissioning Committee and are outlined here for endorsement

• The key features of the plan are: review of referral management in primary care, referral management within hospitals, a focus on a limited number of pathways to test out the new proposals, and finally the methods and data needed to track the impact of schemes. Local board oversight is required to ensure these elements are progressed.

03/05/2018

5 Elements for delivery of Outpatient Transformation Plan

1 • Systematic peer review of GP referrals

2 • Introduction of consultant triage of some referrals

3 • Programme of system audit of referrals and follow-up practice

4• Introduction of referral and management pathways

5 • Leadership support for leads

1. Systematic peer review of GP referrals

03/05/2018

Each system to have arrangements in place with GP practices to peer review referral practice

Those practices/specialities which are 2 or more standard deviations away from CCG average could be highlighted for review.

Each system to:• Run practice education sessions that include information regards the Referral Assessment Service (RAS)

• Agree any specialties where a RAS model needs to be introduced.

2. Introduction of Consultant Triage

3. System Audit of Referrals & Follow-Up Practice

Each system to introduce: • Secondary care Consultant and Primary care GP pairing to audit -

• GP generated referrals• OPD follow-ups

Targeting those specialties which have seen either the biggest increase in numbers or rates are an outlier when compared to NEL benchmarks

• A programme of at least 6 audits per system during 2018.

4. Referral and Management Pathways

It is recommended that the clinical senate has a facilitated debate to compare and contrast the approaches– looking at it from a GP and consultant perspective.

5. Leadership Support

• NEL Clinical senate to “sponsor” learning set/peer support for • GPs involved in pathway/service redesign work• Patient representatives involved in pathway/service redesign work.

• NEL senate to receive 3 monthly updates during 2018 on work outlined to ensure both shared learning, cross fertilisation of ideas and any issues to unblock.

Recommendations

1. Approve the following proposed key metrics:• Referral rates per 1000 patients benchmarked for each NEL CCG every 6 months showing rolling trends. A >2 standard

deviation from CCG average triggers peer review• OPD waiting times for key specialties• New to follow up ratios at each Trust

2. Commission peer review provider for each system to undertake practice reviews3. Agree that the initial pathways for the outpatient transformation programme are

headaches, hypertension and gastroenterology4. Agree that for the key pathways each system develops agreed protocols for referrals and

discharge including the information passed to primary care and that this is available to patients to inform their decision making

5. Note that further work is required to consider paediatrics and for further development of the outpatient programme and an update report should be received quarterly.

03/05/2018


Title of report Strategic Estates Plan update

Author Carolyn Botfield / Ana Icleanu

Presented by Dr Jagan John Henry Black, Finance Lead, East London Health Care Partnership


Ana Icleanu, Estates manager, ELHCP Email: [email protected] Tel: 07595839727

Executive summary Since the London Devolution MOU was signed the estates work stream has moved to the next gateway requiring London partners to complete a robust London Capital Plan by end of March 2018. (Outline plans submitted 3 April for review to LEB).

This requires STPs to: • Establish a governance structure and set up an Estates Board• Complete an STP wide outline Strategic Estates Plan (SEP)• Produce a detailed, prioritised pipeline of projects• Compile an STP Capital plan to feed into the London Capital

Plan• Produce a detailed 18/19 plan for how the strategy will be

developed to inform the next gateways for devolution.

The outline plan has been produced by the STP Estates Working Group, including all partners, who have been meeting for over a year. It is a summary document of the existing challenges with interim conclusions on work to date. It outlines the ongoing process whereby partners will develop a more robust strategy reflecting the full transformation implications of the STP. This work builds on individual organisation estate strategies and work carried out to date by Local Estate Forums.

Future bidding opportunities for capital will only be accepted via a single STP plan and individual organisations will not be able to bid separately. The next round of wave 4 capital is 16 July requiring a final draft of the Estates Plan and submission of all capital bids.

This is an East London Health Care Partnership plan that covers both NEL commissioners and providers. All commissioners and provider are involved in the development of the plan. The final plan will be signed off through the East London Health and Care Partnership

This report is to approve the outline plan and the work to date so that the views of commissioners can be included within the final plan.



Action required

The JCC is asked to: 1. review the outline plan from a commissioner perspective and

provide any comments on gaps or issues to be addressed in the final plan

2. Receive the final strategy at its July meeting.


Local Estates Forums, ELHCP Estates Working Group, ELHCP Estates Board, ELHCP Clinical Senate, ELHCP Executive, ELHCP STP Board. Outline plan submitted and discussed with London Estate Board.


implications

• Local authority/integrated commissioning implications

This is a key enabler to the wider transformation agenda and priorities for the NEL. This includes:

1. Delivering new models of primary and secondary care at scale will require modern, fit-for-purpose and cost-effective infrastructure

2. Better health and care outcomes through the transformation of health and social care delivery, based in a fit for purpose estate

3. Identify savings opportunities from reduced voids and better utilised space

Emphasis on partnership to commission, contract and deliver services efficiently and safely.


We have agreed a single ELHCP plan for investment and disposals, utilisation and productivity and managing PFI, with a key principle of investing any proceeds from disposals in delivering the STP vision to improve services and health outcomes. It will address the:

• Required investment in primary care premises to support hubs operating at scale

• Required investment in Acute care to support new models of care, population growth and address backlog maintenance. There is value in exploring non-capital and other innovative financing mechanisms

• Connection of Health and Care to the wider economic development, regeneration, inward investment and innovation agenda need to be emphasised and improved. This includes exploring site assembly to facilitate housing such as staff accommodation.


This will: • Provide quality environments people wish to visit and work in to

deliver a range of health and wellbeing services • Measurably improve health and wellbeing outcomes for the

people of ELHCP and ensure sustainable health and social care services

• Improve patient access to a wider range of services for longer through increased utilisation and co-location.

Where there are changes in local services as a result of the estate investment and strategy, ELHCP will undertake engagement and


consultation with local people and stakeholders to ensure their views are taken into account.

Risks

The key risks for this programme are:

• Complexity of the estates system including the number of organisations and the differences in governance, objectives and incentives between each organisation-type

• Affordability: retention of receipts and access to capital investment for re-provision

• Complexity of business cases: getting the right balance of speed and rigour and the different approvals processes facing different organisation types, for example, different capital approval regimes operating across the NHS and local government.


Strategic Estates Plan – Update

Developing the ELHCP Strategy

2

VisionTo develop good quality and cost effective estates infrastructure that meets the complex needs of a growing diverse and relatively transient population. Our estates will need to be flexible, to support the delivery of new models of care over the next 5 – 20 years

Stra

tegi

c O

bjec

tives

Economical efficient estate

Transformed, innovative

estate

Well maintained,

flexible estate

Excellent, quality

environment

Create a costed, consolidated ELCHP Estates Strategy with an enabling programme of work and key milestones

Improving productivity and efficiency of estates usage

Create an overview of the capital programme and projects within ELCHP

Identify savings opportunities from reduced voids, increased util isation and co-locations

Minimising the ongoing revenue cost of property

Maximising commercial opportunities for income generation

Use demand and capacity modelling to develop estimates for future requirements

Use of digital innovation to create efficiency

Acute transformation including significant investment and redevelopment at Whipps Cross, King George A&E, Queens A&E and additional capacity at Homerton and Royal London

The foundation of our model is primary care collaboration at scale with hubs, networks and federations treating populations of up to 70,000 people, accessible 8am-8pm, 7 days a week where appropriate.

Better health and care outcomes through the transformation of health and social care delivery, based in a fit for purpose estate

Delivering new models of primary and secondary care at scale will require modern, fit-for-purpose and cost-effective infrastructure

Improve patient access to a wider range of services for longer through increased util isation and co-location

Identify savings opportunities from reduced voids and better util ised space

Measurably improve health and wellbeing outcomes for the people of ELHCP and ensure sustainable health and social care services

Emphasis on partnership to commission, contract and deliver services efficiently and safely

Provide quality environments people wish to visit and work in to deliver a range of health and wellbeing services

3

Context - REGIONAL AND STRATEGIC

Key London Themes

• Strategic framework to redress the under-funding in primary care and improve issues with workforce, workload, infrastructure, care design and sustainability in general practiceNHS England General Practice Forward View (April 2016)

• Framework to redress the lack of house building in London, where the annual supply is far outstripped by need and demand resulting in an affordability crisisLondon Housing Strategy (Sep 2017)

• Targets have been set for each borough, including the redevelopment of surplus or under-utilised public sector owned sitesDraft London Plan (Jan 2018)

• 50% of all homes should be affordable. £3.15 billion of affordable housing investment has been committed through to 2021Homes for Londoners; Supplementary Planning Guidance (Aug 2017)

• A target of 160,000 homes has been set to be delivered between 2015 and 2020 on Government landDisposal of Public Land for New Homes, the Department for Communities and Local Government (Jan 2016)

• £2bn of assets to be released for reinvestment and to deliver land for 26,000 new homesDepartment of Health (Jan 2016)

Naylor Review

• 17 Recommendations across 3 Key Themes:

1. Strategic Capability2. Incentives for providers and STPs3. Funding and national planning

• Department of Health (DH) & Her Majesty's Treasury (HMT) should provide robust assurance that sale receipts will not be recovered centrally provided the disposal is in agreement with the STP’s plans

• Noted demand for affordable housing especially among lower paid staff and recommended surplus NHS land should be prioritised for the development of residential homes for NHS staff.

4

London DevolutionMemorandum of Understanding (MoU)

Since the London Devolution MoU was signed mid-November 2017, the estates work stream has moved to the next gateway requiring London partners to complete a robust London Capital Plan by end of June 2018. This requires STPs to:

1. Establish a governance structure and set up an Estates Board

2. Complete an STP wide Strategic Estates Plan (SEP)3. Produce a detailed, prioritised pipeline of projects4. Compile an STP Capital plan to feed into the London

Capital Plan

The completion of this work requires each Integrated Care System to produce local level information to feed into the STP Plan. This document forms the BHR Integrated Care Partnership contribution to the ELCHP STP Plan.

Devolution Opportunities

A new national £2.6bn capital fund was announced in the budget with the first 10% being given to the most mature STP plans.

Future access to this fund will be via a single STP estates strategy and capital plan. Individual organisations will not be allowed to bid for money for individual schemes.

The STP capital plan must demonstrate an outline clinical strategy and outline all available disposal opportunities.

Devolution offers the opportunity to argue for capital receipts to be recycled locally, noting that London will expect all receipts to be recycled within London as part of the agreement.

GRO

WTH

REGE

NER

ATIO

N

CURR

ENT

ESTA

TE

5

5% WardsAccount for over 35% of

growth

6New housing zones

16New Crossrail Stations

35 minsDirect train Havering to City

Isle of Dogs has hyper-dense housing, denser than Tokyo similar to Hong Kong

126k in 5 YrsEquivalent to size of Eastbourne

262k in 10 Yrsthe size of Plymouth

384k in 15 Yrsthe size of Middlesbrough

Over 384k population growth

£197m Backlog Maintenance

76%Acute (£88m Whipps Cross)

16%Community

8%Primary Care

10%Built in last 12 years

1 in 3of our estate predates the

1,000,000+ m²GIA space

6GLA Opportunity Areas

Key Challenges

• Our boroughs are currently undergoing unprecedented growth and change with an additional 384,000 residents adding pressure to an already overloaded health and social care system.

• Regeneration also brings the opportunity to redesign integrated buildings for the future as part of major new developments.1 GLA 2016 Housing led projections © GLA 2016-based Demographic Projections2 https://www.citypopulation.de/UK-EnglandUA.html

Challenges - Highest growth in London – do nothing not an optionLarge growth in both Homes and Jobs as London grows eastwards

GLA Housing ZonesBlackhorse Lane &Northern Olympic Park 2,477 homesIlford 2,189 homesBarking Town Centre 2,295 homesRainham and Beam Park 3,457 homesPoplar Riverside 6,404 homesTotal 16, 822 homes

GLA Opportunity Areas

*Figures adjusted proportionate to area of opportunity area that is in ELHCP

Area (Ha)

IndicativeEmploym

entCapacity

Min Housing

City Fringe 900 50,000 15,000Ilford 85 800 5,000

Isle of Dogs 485 110,000 30,000London Riverside 3,000 16,000 26,500Lower Lea Valley 1,400 50,000 32,000

Royal Docks & Beckton Riverside

1,380 60,000 25,500

Upper Lea Valley* 1,170 4,500 6,000Total 8,420 291,300 140,030

6

7

Where do we need to be in 15 years time?

AS IS POSITION

• Fragmented ownership• Wide variations in use and

condition• Fixed core estate• Opportunities for

consolidation• Lack of capacity in some

growth areas• High estate and Void costs• Inefficient use of space• Incomplete data

DRIVERS FOR CHANGE

• Service transformation• Population growth• Estate utilisation and

condition• Digital innovation• Workforce pressures• Financial pressures

DESTINATION

• Place-based care• Primary care ‘at scale’• Reduced estate costs (voids)• Improved estate utilisation

(75% – 85%)• Reduction in non-clinical

space• Improved quality and

condition• Disposal of surplus sites• Efficient use of resources

8

Our clinical vision drives our estates priorities

Our ChallengesHealth and wellbeing challenges:• Population growth of 18% over next fifteen years• Five out of our eight boroughs are in the lowest

quintile for deprivation in the UK.• Health inequalities are high, with many residents

challenged by poor physical and mental health driven by factors such as smoking and childhood obesity.

• Particular challenges from a growing elderly population in outer NEL.

Care and quality challenges:• Performance against CQC standards in both acute and

primary care is highly variable.• Variable performance against key performance targets• Poor quality estate in some areas – not purpose built,

or suitable for modern healthcare• Substantial backlog maintenance requirementsSustainability challenges:• Poor utilisation for some sites• Void (unused) space in some buildings• Workforce shortages• Availability of funds for improvement• Need to reduce operational costs

Delivering our vision Health and wellbeing :• Develop sufficient capacity for population growth

and changes to models of care:• Primary care - more operating at scale required to

provide out of hospital care• Elective surgery to reflect population growth and

change• Maternity care, and delivery of Better Births

programmeCare and quality:• Increased integration across primary and secondary

care pathways• Increased capacity to provide out of hospital care• Ensuring sustainability of emergency services• Ensure better access to specialised services• Develop new care models for older peoples services Sustainability :• Improve utilisation of facilities • Reduce void space• Improve productivity and provide more flexibility for

mental health services

Estates prioritiesHealth and wellbeing :• Investment in primary care premises to support hubs

operating at scale• Major health and wellbeing community facilities at St

George’s, Whipps Cross, Mile End and St Leonard’s sites.• Elective care hubs including surgical centres of excellence

with increased capacity at Newham and Homerton• Shape maternity facilities around the Better Births agenda• New models of care at Whipps Cross and KGH to reflect

changing population need specifically services for older people

Care and quality:• Redevelopment of the Whipps Cross Hospital site• Development of urgent and emergency care facilities –

Queen’s Hospital and Royal London Hospital (RLH) as major emergency hubs

• Whipps Cross, Newham Homerton, King George’s Hospital (KGH) as spokes – with investment at Whipps Cross and KGH required

• Reduce out of area flows for specialised services by investing at RLH, St Barts and Queen’s

Sustainability :• Review the location of acute inpatient mental health

services to improve productivity and flexibility

Better use of our Infrastructure

Estates are a crucial enabler for our system-wide delivery model. We need to deliver care in modern, fit for purpose buildings and to meet the capacity challenges produced by a growing population. We have developed a common estates strategy for ELHCP which has identified priorities from 2017/18 onwards.

We have agreed a single ELHCP plan for investment and disposals, utilisation and productivity and managing PFI, with a key principle of investing any proceeds from disposals in delivering the STP vision. This was developed by the ELH&CP Infrastructure Steering Group and agreed by the STP Board in November 2017

9

The principles underpinning our estates strategy are:

• Better health and care outcomes assisted by delivering health and social care delivery from a fit for purpose estate

• Partnership between commissioners, providers, and other public sector organisations to align incentives for estate release and support the delivery of new models of care. Alongside the estate currently used for health service delivery, there are significant opportunities for out of hospital services to be delivered using local authority estate, such as children’s centres and libraries, e.g. BHR CCGs; Waltham Forest Council, ELHCPFT and Waltham Forest CCG have mapped the health estate against the wider local authority estate, and are using this to develop local opportunities. Across ELHCP we want to undertake similar mapping to facilitate the delivery of our strategic aims for the health and care estate.

• Provide expertise and resource for the development of infrastructure programmes for ELHCP

• Respond to clinical requirements and other changes in demand to put in place a fit for purpose estate

• Increase the operational efficiency of the estate and maximise utilisation of the core estate

• Enhance capability to deliver a portfolio of estates transformation projects

10

Our principles for transforming the estate

Better Utilisation Principles

1. Reduction of ‘void’ space and more efficient use of buildings through improved space utilisation.

2. Opportunities to rationalise the healthcare estate through co-location and/or consolidation of healthcare services

3. One Public Estate programme - Opportunities to co-locate healthcare services with other public sector bodies and services; notably Local Authorities, to achieve more efficient use of the public sector estate.

4. Moving non-clinical activity away from the clinical estate and co-locating this across ELHCP in suitable logistics hubs

Investment Principles

1. Investment will be prioritised to support areas of growth where there area inadequate existing facilities

2. Investment will be prioritised where supportive of clinical transformation and service delivery

3. Inefficient or functionally unsuitable buildings will be disposed of in conjunction with estates rationalisation

4. Innovative approaches to the delivery of healthcare services reducing demands on the healthcare estate, e.g. use of technology

5. Only undertaking new build where opportunities to rationalise and/or maximise use and efficiency of the existing estate have been realised.

Progress to DateWork to date Next Steps

1 GovernanceSTP Estates Board established (quarterly) w ith a monthly Operational Working Group already meeting for over a year to date. Membership includes all STP partners. New structure mirrors the LEB/LEDU structure. All local CCGs/systems have Local Estates Forums in place.First formal STP Estates Board meeting 10th AprilOutline STP Estates plan submitted to LEB on 3rd of April.

1. To be refined in line w ith London Devolution progress to Gatew ay 3

2. Submission of plans to LEB 6th July – Communication team supporting w ith the review of the plan to be consistent w ith the language, font and formatting

2 Strategic Planning CCGs have kept 2015 SEP submissions up to date and these have been consolidated w ith provider and clinical strategies into single STP SEP. We have been w orking on this for a year so the document contains all current, sense checked data on estates. We have run a robust prioritisation methodology to create one prioritised project pipeline for the STP.Current data, prioritised pipeline and investment plan f inalised for end of March.

1. Drafting (w ith SEP assistance) detailed STP programme plan and methodology w ith associated resource plan.

2. Wave 4 Capital bidding due 6th of July.3. Producing detailed 18/19 plan for how SEP w ill be taken from outline to full plan.4. Continue close w orking w ith digital and productivity w ork streams and set up a new w orking group to

review key w orker housing opportunities in new housing developments w ith LA partners.

3 Work streams: Utilisation Agreed STP Utilisation strategy. Database of all empty ‘void’ space has been produced covering all NHS PS and CHP community buildings. Action plan per building is being produced for STP assurance and local QIPP targets for 18/19. Specif ic live projects are addressing buildings w ith biggest issues e.g. Kenw orthy and St Leonards. Meetings have been held NHS PS (aw aiting CHP) to agree principles of how buildings w ill be used/let to tenants.

1. Very poor data held by property companies has meant w e have had to do a lot of the w ork ourselves (w ith SEP assistance). Data needs further due diligence to ensure it is correct.

2. Add provider voids to the database.3. Finalise action plan per building for 18/19 and set savings targets.4. Liaise w ith NHS E regarding their voids and how this can be better managed jointly w ith STP.5. Link into commissioning procurement process to ensure estate is considered in line w ith our strategy

before contracts are let.

4 Work streams: New capacityDetailed capacity plans w ere produced in 2017 at locality level modelling population grow th, current estate condition and future requirements. This identif ied w here new buildings may be needed in the future and has informed the SEP update, OPE and ETTF bids and detailed STP programme.

1. Continue w orking w ith all LA partners to get our detailed plans into their new Local Plans.2. Agree consistent form of w ords/approach to new planning applications (S106/CIL) contributions to

ensure w e are maximising benefits from housing developments.3. Review ing any cross-border opportunities for more joined up STP planning.4. Strong link to utilisation w ork stream to ensure no new capacity is taken w here there are voids locally.

5 Work streams: DisposalsCurrent disposal opportunities included in SEP and investment plan. These have been captured in the detailed STP programme, OPE bids and prioritised pipeline.

1. Lack of NHS PS property data including site values makes identifying w here to prioritise opportunities diff icult.

2. Future w ork w ill identify w here further value and housing units can be released from active core sites w here land or building massing has not been maximised.

6 One Public EstateWe have successfully bid for partnerships in Barking & Dagenham, Havering, New ham and Waltham Forest.

1. Review ing prioritised projects to see if there are OPE opportunities for Phase 7 bidding.2. Review ing w hether remaining boroughs w ish to join the programme to get full STP coverage.

7 Resources CCGs have appointed single joint AO and w ork is ongoing to review consolidated resource across 7 CCGs (including estates). SEP team have provided a lot of useful support to date w hich w e w ould like to continue utilising.

1. Proposed new structure w ith project delivery at a local level but reporting into centralised STP estates team.

2. We w ill require continued SEP support and have requested additional support to help cover maternity leave for 18/19.

11

Phased Investment Plan

• Detailed programme of all prioritised projects being completed across ELHCP to indicate high level phasing and funding required by year (90% complete).

• We are working on a funding strategy which maximises alternative funding sources particularly where we can enter into partnerships with local stakeholders such as local authorities.

• We have two example alternative funding models which reduce the net capital:• Tower Hamlets S106 investment new health and social care hubs• Newham AFO proposal investment new health and social care hubs

12Indicative phasing plan for project pipeline and investment plan

13

Big Ticket Issues and Proposed Solutions

Big Ticket Issues Proposed Solutions

Access to bidding for infrastructure and estates funding is dependent on a robust 5 year plan and ROI capital plan for

ELHCP

Retention of capital receipts for local investment

Clarifying how evolving clinical models including digital access will impact on current and future demand for space and infrastructure.

Focus on maximising clinical utilisation across the entire estate, thereby supporting seven-day working whilst releasing savings through disposal and increasing efficiency

Develop a ELHCP wide Estates Strategy -provide a fit for purpose, cost-effective, integrated, accessible estate which enables the delivery of high quality health and social care services for local residents.

Seek London wide agreement to recycle the proceeds of sales. We are working as part of the London devolution programme

to pilot devolved powers in relation to the health and care estate.

Input into development of ELHCP wide Joint Clinical Strategy to be able to respond to clinical requirements and other

changes in demand to put in place a fit for purpose estate

Agree common benchmarks and metrics, respond to Carter metrics, strategy for current void-spaces, agree system wide principles of occupancy. Improve utilisation to 85% based on

RICS standards.

Identification of opportunities for shared use of accommodation – which could include office and back office functions, agile working, new ways of working, eg shared booking systems. etc

Respond to changes in ways of working arising from STP productivity workstream. NHSPS/CHP support in developing the options appraisal for providers and commissioners office

base solutions.

14

ELHCP Estates Board

London Devolution MoU has been approved requiring specific governance arrangements to be put in place for each STP in relation to devolved activities, to ensure appropriate, transparent and robust decision-making authority within the ELHCP context (including taking account of the constitutions of providers and links through to finance).

The Executive level governance gateway between the local working groups and the London Estates Board for review of all estates business cases and capital bids

The Estates Board aims to facilitate more joined-up strategic decision-making for NEL and to enhance effectiveness, efficiency, quality and transparency of process and decisions

First met on the 10th of April reviewing first draft of the outline Estates Plan to be submitted to London Estates Board

ELHCP to continue to work to produce a strategic estates plan, built up from a clear clinical strategy, which will feed into the London capital plan.

15

Clinical Senate At the last Clinical Senate meeting the system wide estates plan was reviewed.

1. Positive feedback received for work done to date

2. One outcome of the meeting was for a workshop to be organised between Clinical Senate members, Estates and stakeholders in order to help review and define what is meant by a community hub across NEL.

This would include considering what co-located care services should be present within a ‘hub’, how many co-located services define a hub, are virtual hubs a possibility, where should they be located versus where can they be located within the community, will they be staffed by current care service employees rotating or will new staff be required. These would need further exploration and scoping.

3. Another focus was around the need to more joined up approach between IT and Estates integrated in an infrastructure ask for the system, using IT innovations to use less physical space.

4. Ensure there was a good discussion between primary and the secondary care about setting up the principles

16

DHSC/HMT confirmed support for the Naylor Review in November 2017.

STPs £2,600m

Carter – efficiency & technology £200m

Existing estate and infrastructure issues included QSM and backlog £738m

Total Announced in Autumn Budget £3,538m

Announced in Spring Statement £425m

Total £3,963m

£3.96bn of new capital funding announced for the NHS (see table below). Rest of the £10bn to be achieved through land disposals and private finance. So far the QSM/backlog funding is effectively committed, the Carter bidding process will be announced shortly and

approximately £1.4bn has been committed on 77 STP schemes). This leaves £1.6bn for STP capital. SoS expects to announce approx. one large scheme annually (£100m+)

All STPs to submit their latest draft estates strategy and prioritised capital plans by 16 July 2018. Announcements of further schemes anticipated November.

STP capital available must be targeted at the schemes for which it will demonstrably deliver the greatest clinical and financial sustainability

London has a deadline of 6th of July to be reviewed by LEB before submission to national team.

Role of the STP:1) Estates Strategy as a core overarching submission2) STPs asked to take a prioritising role for the Capital Schemes 3) STP to coordinate the submission of all bids

Next steps on the development of your STP estate strategy and next wave STP capital bidding process


Title of report Joint Commissioning Committee Risk Register

Author Alan Steward, System Transition and OD, BHR CCGs



Alan Steward

Email: [email protected] Tel: 07500 559031

Executive summary

The report presents the draft NELCA Joint Commissioning Committee (JCC) risk register for review. Good governance requires each committee to hold a risk register for its responsibilities. The paper identifies eight risks held by the NELCA JCC and indicates the mitigating action. These cover: 1. Reputational risk from the perception that the JCC is removing

responsibilities from local decisionmaking 2. Robust demand and capacity planning across NEL 3. Improving self care and demand management and increasing

care closer to home 4. Securing the future of NEL health and social care providers and

commissioners 5. Improving the commissioning of specialised care 6. Streamlined and robust assurance on system transformation and

improvement plans 7. Mobilisation of the new Integrated Urgent Care contract 8. Enabling programmes of workforce, digital and estates.

The risk review uses the standard NHS methodology that considers the likelihood of the risk alongside its severity. Both measures are scored out of 5 (with 5 being the most likely and worst impact). The risk score takes account of the mitigating action proposed. This then gives a risk score and categorisation of:

The CCGs are in the process of agreeing their corporate objectives for 18/19. Once these are agreed, the risk register will be organised under these headings.

Risk rating Risk Score

Low 1 – 3 Medium 4 – 6 High 8 – 12 Severe 15 - 25


9 May 2018



The JCC has set out its forward plan that includes updates on its key strategies and programmes. The risk register will be updated each time to reflect the progress being made, as well as identifying any new risks from the consideration of any business. As the JCC is a collaborative committee of all CCGs, each Governing Body must own the risk and associated mitigating action through its risk management arrangements. The risk assessment and mitigation are set out in appendix 1. For risks that are red-rated (scored 15 or greater), CCGs should ensure that these are covered in their own risk registers and Board Assurance Frameworks.

Action required

The JCC is asked to: • Review the risks and mitigating action and advise on any gaps or

concerns for further action • Note the risk register.


None.




The risk register notes the main risks and mitigating actions to deliver the NELCA priorities. The risks should be considered and integrated into local CCG Board Assurance Frameworks where required.


The risk register sets out the key actions being implemented to address any finance, performance or quality risks.


This report highlights the main risks to deliver the NELCA priorities and the actions taken to minimise the impact of those risks. It is part of making sure the work of the JCC is transparent and accountable to local people.

Risks Not applicable.

9 May 2018, item 6.1 - Appendix 1 Joint Commissioning Committee – Draft Risk Register

Ref Category Date added Description Prev.

rating

Current risk rating Risk

owner (SRO)

Escalated to CCG GBAFs

Mitigating actions Target Target date Likelihood

(1-5) Severity

(1-5) TotalScore (1-25)

1 Reputation May-18 NELCA and JCC seen as removing power and responsibilities from local systems with an impact on NEL NHS reputation and a withdrawal of engagement and participation.

4 3 12 JM N

• Open and accountable meetings • Regular communications on purpose, progress and

issues • Stakeholder engagement to improve communication • Regular liaison with key stakeholders including local

authorities, Healthwatch and others.

4

30/09/18

2 Strategy May-18 Unless there is robust demand and capacity planning and approaches across NEL, the quality of services, health outcomes and the sustainability of both commissioners and providers will be affected negatively.

4 4 16 LB N

• STP reviewed and refreshed with transformation programmes to deliver on key priorities including maternity, outpatients, mental health and others. NEL focus on enablers around workforce, digital and estates

• Operating Plan submitted on 30 April • Operating Plan reviewed and monitored through

Operational Delivery Group.

8

31/09/18

3 Strategy May-18 Unless self care and demand management is improved and high quality care offered closer to home, the pressure on services will continue with a consequent effect on performance, quality and outcomes.

3 4 12 TBC N

• STP reviewed and refreshed with transformation programmes to deliver on key priorities including maternity, outpatients, mental health and others. NEL focus on enablers around workforce, digital and estates

• NEL JSNA refreshed with recommendations to improve prevention

• Integrated Urgent Care to provide better clinical advice and signposting to reduce pressure at ED

• Clinical Senate programme on Outpatients supported across NEL - good practice being shared with proposed local system alignment

• Primary care improvement strategy to enhance capacity and quality.

8

31/12/18

4 Strategy May-18 Unless the future of NEL health and social care providers and commissioners is secured financially there may need to be significant reductions in services with a consequent impact on health outcomes.

4 5 20 HB Y

• Payment reform engagement and proposals to consider contract payment mechanisms

• Risk share mechanisms being agreed across NEL • JCC ICS Support Framework in development to be

considered at July meeting • NEL Transformation programmes to address

demand and capacity issues • Local systems aligning QIPP and CIP plans to

support transformation • Monthly monitoring at ODG meeting to consider risk

and mitigation • Financial Strategy Committee manages payment

reform and other STP wide finance issues.

12

30/09/18

Ref Category Date added Description Prev.

rating Current risk rating Risk owner (SRO)

Escalated to CCG GBAF

Mitigating actions Target Target date

5 Strategy May-18 Unless specialised services are aligned with current CCG commissioned services, there is a risk of duplication and inefficiencies, as well as financial pressure on NEL commissioners and providers.

3 3 9 LB N

• Delegation of Specialised Commissioning anticipated for 19/20

• Ongoing SAO engagement with NHSE to influence • LD review underway with improvement plan being

developed.

6

31/12/18

6 Assurance and Delivery

May-18 Unless the assurance process with NHS England is streamlined, it will be difficult to release capacity to support delivery of local priorities and the Sustainability and Transformation Plan. Unless NEL delivers robust assurance on its improvement plans to regulators, it may lead to additional costs and a lack of control and influence over local services.

3 3 9 JM N

• Discussion with regulators for new assurance mechanisms

• Self assurance proposals in development with aim to introduce in 2018/19.

6

30/09/18

7 Assurance and Delivery

May-18 Unless the new Integrated Urgent Care service is mobilised for August 2018, there will be excessive pressure in the UEC system with a consequent impact on performance and quality.

3 4 12 AM N

• Expert led 111 mobilisation plans with new provider • Oversight and governance via IUC Programme

Board • Passing of NHSE Gateway required prior to service

Go-Live.

6

30/09/18

8 Enablers May-18 Unless the large scale enabling programmes around workforce, technology and estates are delivered through all providers being aligned and understanding the implications of the new models of care, local transformation and the drive towards integration of services will not be delivered.

3 4 12 JM

(HB / LR / JM)

N

• STP refresh of deliverables - Digital / Estates • Estates Board established to oversee NEL strategy

under London Devolution • IT digital bid underway to DH to secure additional

resources • Digital embedded in primary care plans • Workforce strategy being refreshed and aligned to

the resources available in each system • Maternity recruitment and retention programme

underway.

6

30/09/18

Risk grading matrix

Likelihood

Rating 1 2 3 4 5 Description Rare Unlikely Possible Likely Certain

Probability <10% 10% - 24%

25% to 45% 50% - 74% >75%

Seve

rity

Rating Description

A Objectives/

projects

B Harm/injury to patients, staff

visitors & others

C Actual/potential complaints &

claims

D Service

disruption

E Staffing &

competence F

Financial

G Inspection/

Audit

H Adverse media

1 Insignificant

Insignificant cost

increase/time slippage.

Barely noticeable

reduction in scope or quality

Incident was prevented or

incident occurred and there was no

harm

Locally resolved complaint

Loss/ interruption more than 1

hour

Short term low staffing leading to

reduction in quality (less than 1 day)

Small loss <£1000

Minor recommendations Rumours 1 1 2 3 4 5

2 Minor

Less than 5% cost or time

increase. Minor

reduction in quality or

scope

Individual(s) required first

aid. Staff needed <3

days off work or normal

duties

Justified complaint

peripheral to clinical care

Loss of one whole

working day

On-going low staffing levels

reducing service quality

Loss of 0.1% budget.

<£10,000

Recommendations given. Non-

compliance with standards

Local media column

2 2 4 6 8 10

3 Moderate

5-10% cost or time increase.

Moderate reduction in

scope or quality

Individual(s) require

moderate increase in care. Staff needed >3

days off work or normal

duties

Below excess claim. Justified

complaint involving

inappropriate care

Loss of more than one

working day

Late delivery of key objectives/service

due to lack of staff. On-going unsafe

staff levels. Small error owing to

insufficient training

Loss of more than 0.25% of budget. <£100,000

Reduced rating. Challenging

recommendations. Non-compliance with standards

Local media front page story

3 3 6 9 12 15

4 Major

10-25% cost or time increase. Failure to meet

secondary objectives

Individual(s) appear to have

suffered permanent harm. Staff

have sustained a "major injury" as defined by

the HSE

Claim above excess level.

Multiple justified complaints

Loss of more than one working week

Uncertain delivery of services due to lack of staff. Large

error owing to insufficient

training

Loss of more than 0.5% of

budget. <£500,000

Enforcement action. Low rating.

Critical report. Major non-

compliance with core standards

Local media

short term 4 4 8 12 16 20

5 Severe

>25% cost or time increase. Failure to meet

primary objective

Individual(s) died as a result of the incident

Multiple claims or single major

claims

Permanent loss of

premises or facility

No delivery of service. Critical error owing to

insufficient training

Loss of more than 1% of

budget. >£500,000

Prosecution. Zero rating. Severely critical report.

National media

more than 3 days. MP

concern

5 5 10 15 20 25

Risk Category Severe High Medium Low



Date: 9 May 2018

Title of report Forward Plan 2018/19

Author Alan Steward, System Transition and OD, BHR CCGs



Alan Steward Email: [email protected] Tel: 07500 559031

Executive summary The forward plan sets out the key items that will be considered at the Joint Commissioning Committee (JCC) meetings in 2018/19. This supports transparency and accountability back to CCGs, stakeholders and local people. It will be subject to change as new priorities emerge. The report will be reviewed at each meeting of the JCC.

Action required The Joint Commissioning Committee is asked to: 1. Discuss the forward plan and suggest any additions and

revisions2. Approve the forward plan.


NEL Senior Management Team – 1 May 2018


implications• Local

authority/integratedcommissioningimplications

The forward plan sets out the key strategies and priorities for NEL agreement that will inform commissioning and delivery across all CCGs.


Not applicable


The Forward plan contributes to making sure that the JCC is transparent and accountable back to local people, communities, partners and stakeholder, as it sets out the key decisions and business that the JCC will consider in 2018/19

Risks Reputational risk to the work of NELCA and JCC if the running of the committee and its business is not transparent.



Joint Commissioning Committee Forward Plan 2018/19

Month Items

9 May • East London Health and Care Partnership – Joint Strategic Needs Assessment Refresh

• Outpatient transformation programme • Strategic Estates Plan

11 July • Integrated Care Partnership Framework • Urgent and Emergency Care Strategy including Integrated Care

mobilisation, Urgent Treatment Centres and Ambulatory Care • LAS performance • Primary Care Strategy

12 September • Mental Health Strategy including crises intervention, suicide and veterans and Early Intervention in Psychosis

• Elective Care Strategy • Workforce Strategy • Diabetes Prevention • Commissioning Intentions 19/20

14 November • Medicines Optimisation strategy • Integrated Urgent Care delivery • Cancer diagnostic hub case for change • JCC Review

9 January 2019 • Financial Strategy • Maternity Planning 19/20 • Outpatient transformation programme update

13 March 2019 • Operating Plan 19/20 • JCC Review and 19/20 programme

Regular items • Minutes / Action Log • Patient Story • Questions from Public • Finance, quality and performance report • Risk register • Forward Plan

Date post:	07-Jul-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

NEL Joint Commissioning Committee Meeting Part 1 Us... · An alliance of North East London Clinical...

Documents