NHS Nene Clinical Commissioning Group...A G E N D A . NHS Nene CCG Governing Body Meeting in Public...

NHS Nene CCG Governing Body Meeting in Public

Tuesday 20 March 2018

13:30-16:00

Board Room, Francis Crick House, Northampton

1

A G E N D A NHS Nene CCG Governing Body Meeting in Public

Tuesday 20 March 2018 13:30-16:00

Board Room, Francis Crick House, Summerhouse Road, Northampton NN3 6BF

Time Agenda Item Action Presented by Reference

INTRODUCTORY ITEMS 13:30 1. Welcome and Apologies Note Dr Darin Seiger Verbal

2. Declarations of Interest relating to agenda items Members are reminded of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of NHS Nene Clinical Commissioning Group.

Note Dr Darin Seiger Verbal

3. Minutes of Governing Body Meeting in Public held on 30 January 2018

Approve Dr Darin Seiger GB-18-22

4. Matters Arising and Action Log

Note Dr Darin Seiger GB-18-23

13:35 5. GP Chair’s Report

Note Dr Darin Seiger GB-18-24

13:40 6. Accountable Officer’s Report

Note Carole Dehghani GB-18-25

7. Questions from members of the public: Members of the public will be given the opportunity to ask questions which have been submitted in advance. These must relate to items that are on the agenda for this meeting and should not take longer than 3 minutes per person. Responses will be provided under item 8 of the agenda.

Note Dr Darin Seiger Verbal

8. Response to questions raised by the Public Note Dr Darin Seiger Verbal

GOVERNANCE

13:45 9. Board Assurance Framework Assurance Stuart Rees GB-18-26

13:55 10. Conflict of Interest Policy Ratifiy Stuart Rees GB-18-27

11. Terms of Reference • Audit and Risk Committee • Joint Quality Committee

Ratify Kevin Thomas Dr Mathew Davies

GB-18-28

14:00 12. De-establishment of Transformation and Innovation Committee

Approve Dr Matthew Davies GB-18-29

FINANCE AND PERFORMANCE 14:05 13. Performance Report including Strategic Scorecard

Including Thames Ambulance Service Ltd update

Assurance Stuart Rees GB-18-30

14:15 14. 2017-18 Finance, Contracting, Transformation and QiPP Report as at Month 10

Assurance Stuart Rees GB-18-31

14:25 15. 2018/19 Financial Plan, Opening budgets and Transformation and QiPP Plan

Approve Stuart Rees GB-18-32

14:35 16. Urgent and Emergency Care including A&E Delivery Board update and Winter Planning

Assurance Dr Emma Donnelly GB-18-33

2

Time Agenda Item Action Presented by Reference

QUALITY & STRATEGIC

14:45 17. Quality & Safeguarding Report Assurance Dr Matthew Davies GB-18-34

14:55 18. Kettering General Hospital CQC Quality OverviewReport

Assurance Dr Matthew Davies GB-18-35

15:05 19. Public Health Report Note Lucy Wightman GB-18-36

15:10 20. Sustainability and Transformation Partnership BoardUpdate

Note Carole Dehghani GB-18-37

15:15 21 Planning 2018-19 Timeline Note Stuart Rees GB-18-38

COMMITTEE MEETING UPDATES 15:25 22. Highlights from Board of Directors meeting held on

13 March 2018 and approved minutes from 27 February 2018

Note Carole Dehghani Verbal GB-18-39

15:30 23. Highlights from Audit and Risk Committee meetingheld on 8 February 2018 and approved minutes from 30 November 2017

Note Kevin Thomas Verbal GB-18-40

15:35 24. Highlights from Joint Quality Committee held on 13February 2018 and approved minutes from 12 December 2017

Note Dr Matthew Davies Verbal GB-18-41

15:40 25. Highlights from Finance, QIPP & ContractingCommittee meeting held on 1 March 2018 and approved minutes from the 25 January 2018

Note Paul Bevan Verbal GB-18-42

15:45 26. Highlights from Patient Congress meeting held on 25January 2018 and approved minutes from the 30 November 2017

Note Roz Horton Verbal GB-18-43

15:50 27. Highlights from Primary Care Co-Commissioning JointCommittee held on 6 March 2018 and approved minutes from the 2 January 2018

Note Paul Bevan Verbal GB-18-44

FOR INFORMATION 28. Health and Wellbeing Board approved minutes from

18 January 2018Information Dr Darin Seiger GB-18-45

29. Register of Interests for Governing Body Members Note Dr Darin Seiger GB-18-46

15:55 30. Key Messages from the CCG Governing Body Meeting Note Dr Darin Seiger Verbal

DATE OF NEXT MEETING The next Governing Body meeting in Public will be held at 13:30 on Tuesday 15 May 2018 in Board Room, Francis Crick House, Summerhouse Road, Northampton NN3 6BF.

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

3

Report To NHS Nene CCG Governing Body Meeting in Public

Date of Meeting Tuesday 20 March 2018

Title of the Report Minutes of the Governing Body meeting in Public

Agenda Paper Reference No: GB-18-22

Presenter of Report Dr Darin Seiger GP Clinical Chair

Author(s) of Report Governing Body

Executive Director Sponsor Carole Dehghani Accountable Officer NHS Corby CCG and Interim Accountable Officer NHS Nene CCG

Purpose of Report Please select:

☒ Approval ☐ Discussion

☐ Ratification ☐ Information

☐ Assurance ☐ Update

Executive summary

The draft minutes from the Governing Body meeting in public held on 30 January 2018 are presented for approval.

Related Corporate of Strategic objectives

Enter which objective is relevant All

Related CCG Framework Domain N/A

☐ Better Health ☒ Sustainability☐ Better Care ☐ Leadership

Risk and assurance Does the content of the report present any risks or consequently provide assurances on risks? No

Board Assurance Framework N/A Corporate Risk Register N/A Committee Risk Register N/A

4

Conflicts of Interest Please select one of the following: ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in

discussion but not in decision ☐ Conflict noted, conflicted party can remain but not

participate ☐ Conflict noted, conflicted party leave for the discussion and

decision

Quality & Equality Impact Assessment

Please select one of the following: N/A

Patient & Public Engagement

No

Clinical Engagement No

Legal implications / regulatory requirements

No

Recommendations

The Governing Body is asked to:

• Approve the Minutes of the Governing Body meeting in held on 30 January 2018

5

NHS Nene Clinical Commissioning Group

Minutes of the Governing Body in Public Tuesday 30 January 2018 at 13:30

Board Room, Francis Crick House, Summerhouse Road, Moulton Business Park NN3 6BF

Present Dr Darin Seiger GP Chair (Chair) Dr Azhar Ali Clinical Executive Director Mr Paul Bevan Deputy Lay Chair & Lay Member, Primary Care & System Delivery Dr Naomi Caldwell Clinical Executive Director Dr Matthew Davies Medical Director Mrs Carole Dehghani Accountable Officer, NHS Corby CCG and Interim Accountable Officer, NHS Nene CCG Dr Emma Donnelly Clinical Executive Director, (Agenda items 1-17 only) Dr Chris Ellis GP Commissioning & Membership Engagement Executive Ms Aly Hulme Registered Nurse, NHS Corby CCG and NHS Nene CCG Mr Stuart Rees Chief Finance Officer Dr Philip Stevens GP Commissioning & Membership Engagement Executive Mr Kevin Thomas Lay Member for Audit and Financial Management In Attendance Mrs Debbie Abbott Chair of Staff Forum (Agenda item 5.1) Mrs Teresa Dobson Chair of Healthwatch Ms Charlotte Fry Director of Primary Care Transformation Mrs Alison Kemp Director of Partnerships People & Integration Mrs Hayley Mann Vice Chair of Staff Forum (Agenda item 5.1) Mrs Sarah McKenzie Board Secretary, NHS Corby CCG and NHS Nene CCG Mrs Kathryn Moody Director of Contracting & Delivery Mrs Fiona Myers Interim Transition Director, NHS Corby CCG and NHS Nene CCG Mrs Jane Taylor Deputy Director of Urgent Care (Agenda item 11) Mrs Lucy Wightman Director of Public Health, Northamptonshire County Council Apologies Dr Chris Bunch Secondary Care Doctor Ms Roz Horton Lay Member Patient & Public Involvement Dr Tom Howseman GP Commissioning & Membership Engagement Executive

Minute No: Agenda Item

GB17/18 033 Welcome and Apologies Dr Seiger welcomed the Governing Body and members of the public to the meeting and apologies

for absence were noted above. Due notice had been given in line with the Constitution and the meeting was quorate.

GB17/18 034 Declarations of Interest There were no declarations of interest, relating to items on the agenda, made by those present.

However it was noted that Agenda Item 14 would be chaired by the Lay Vice-Chair, as he chairs the Primary Care Joint Co-Commissioning Committee and to allow Dr Seiger to contribute to the discussions.

GB17/18 035 Minutes of the meeting held on 21 November 2017 The minutes of the Governing Body meeting in public held on 21 November 2017 were presented

and were APPROVED as a true and accurate recording of proceedings.

6

GB17/18 036 Matters Arising and Action Log The action log was considered and noted and would be updated accordingly.

Action: Mrs McKenzie

GB17/18 037 Chair & Accountable Officer’s Report Dr Seiger presented the Chair’s Report and took the report as read but highlighted key areas of

note. Dr Seiger reported that the local health and social care system had seen an unprecedented amount of patients requiring urgent and emergency care over the winter period. This had placed an enormous amount of pressure on all the services provided throughout the county and he wanted to thank all colleagues across the health and social care system who had worked so tirelessly to ensure that patients received the best possible care during this very difficult time. Dr Seiger reported that the CCG was keen to support the Royal College of General Practitioners (RCGP) “three before GP” campaign in order to support patients to make more informed choices before contacting their GP and to free up valuable GP appointments. By supporting this campaign, it was hoped that all patients could be seen in the right place at the right time by the right healthcare professional to deal with their issues. The three questions for everyone to ask themselves before contacting their GP are whether they could: 1. Self-care 2. Use NHS Choices or similar reputable websites/resources (www.nhs.uk) 3. Seek advice/treatment via a pharmacist Mrs Dobson commented that some elderly patients had presented at A&E because they had not taken the advice and been seen at their GP Practice. She suggested that the message for next year for that cohort of patients be reviewed. Mrs Wightman commented that this was the correct message and linked in with self-care. Dr Seiger introduced Debbie Abbott, Chair of the Staff Forum and Hayley Mann, Vice Chair who gave a presentation on the journey and direction of the Staff Forum, highlighting recent work on strengthening culture in the CCG. They informed the Governing Body that the Forum had been refreshed and re-invigorated over the preceding few months and that NHS Corby colleagues and embedded Commissioning Support colleagues had been welcomed and incorporated into the group. Mrs Abbott informed the Governing Body that she was now a member of the Transition Board. She confirmed that a staff market place event would be organised for March with representations from CCGs, North East London Commissioning Support Unit (NEL CSU) and Arden and GEM (AGEM). She commented that the Staff Forum would be identifying future priorities and ways of working along with identifying how the Staff Forum would support the organisations going forward. On behalf of the Governing Body, Dr Seiger thanked Mrs Abbott and Mrs Mann for their presentation and the work that they have achieved. Mrs Dehghani presented the Accountable Officer’s Report and took the report as read. On behalf of the Governing Body she sent condolences to Dave Knight member of the Quality Team whose wife passed away last Friday. The Governing Body NOTED the GP Chair and Accountable Officer’s Report and the Staff Presentation.

GB17/18 038 Question from the Public and Response from the CCG Dr Seiger informed the Governing Body that a question had been received in advance of the

meeting and that the question and response would be read out by Mrs Dehghani.

7

Question from Ron Mendel, Chair of the Northampton Patient Engagement Group and member of the Patient Congress As the Northamptonshire County Council (NCC) is preparing its budget, including cuts in services which could jeopardise the ability of the CCG to implement the STP and thereby adversely affect healthcare in the county, how will the impact of NCC’s cuts be assessed, challenged and if necessary mitigated; and when will the documents related to these assessments be made available to the public? Response from Nene CCG Governing Body We are aware of the challenges faced by our local authority partners over recent years and the requirements to ensure that the resources within the public sector are deployed to achieve value for our local population. Northamptonshire County Council have published their budget position and we continue to work with them through the governance of the STP and our partnership boards to ensure that people’s needs are placed at the centre of planning. There has been progress in areas of performance despite financial challenges in recent months including in the support of good discharge from hospital, which has been jointly approached and managed across partners in health and social care. Supporting our system ensure that the best care is offered to people and patients at the time that care is required is a key part in ensuring sustainability and improve outcomes. The Governing Body NOTED the Question from the Public and response from the CCG.

GB17/18 039 Board Assurance Framework Mr Rees presented the Board Assurance Framework.

Mr Rees reported that the Board of Directors had determined that the CCG’s top risks remained as: 1. Under delivery of current QIPP schemes (FI 009 now BAF 034) 2. Providers & relationships (BAF 021, BAF 029) 3. GP and clinical workforce Recruitment (BAF 028) 4. The Urgent Care system (BAF 029) New BAF Risks He reported that there were no new risks and that BAF 035 identified as potential risk resulting from Accountable Officer vacancy could now be moved and transferred to the Corporate Risk Register. With regard to the Corporate Risk Register he confirmed that a new risk, JCT 034, had been added to the Corporate Risk Register surrounding LPF Lot2b process for Continuing Health care and other clinical staff, this addition had been approved by the Board of Directors. Risk JCT 023 had reduced mental health capacity would now be removed and monitored by the Integrated Commissioning Risk Register. Ms Hulme asked whether the target deadlines were realistic and whether a consistent narrative and articulation of risks could be reviewed to gain clarity and assurance. Ms Fry commented that she would review BAF 15 workforce risk as it needed to be aligned across both CCGs. Mr Thomas commented that a refresh was needed. After discussion the Governing Body requested that an overall audit of the BAF should take place in order for the members to receive assurance. Action: Mr Rees The Governing Body in Common NOTED the Board Assurance Framework.

8

GB17/18 040 Performance Report including Strategic Scorecard Mrs Moody presented the Performance Report including the Strategic Scorecard.

Mrs Moody reported that the Performance Report had changed to a new format which had been proposed through a joint Nene CCG and Corby CCG initiative, in collaboration with NEL CSU. The initiative would deliver a universal reporting format for both CCGs, with the aim to improve consistency and reduce duplication. She reported that the new format aimed to provide more dashboard information and less narrative. She highlighted 4 key performance issues: • Patients waiting 4 hours or less in A&E at both Northampton General Hospital (NGH) and

Kettering General Hospital (KGH) • 62 days, 2 week cancer and 2 week breast symptomatic waiting times standard at NGH • Referral to Treatment (RTT) 18 weeks standard at KGH • The impact of underperformance on the Quality Premium for Nene CCG and Corby CCG She informed the Governing Body of the introduction of new KPIs • Reliance on inpatient care for people with Learning Disability and/or Autism (Nene CCG leads on

this for the county) • Waiting times for urgent and routine referrals to Children and Young People (C&YP) Eating

Disorder Services Mrs Kemp reported that intensive work over the last 6 months had taken place at NGH with regard to Cancer, working on performance and preventative measures. It had been recognised that there had been a level of improvement especially on 62 day waiting times. She reported that there had been a dip in performance during October however November achieved the 62 day target and 9 standards. December’s data was looking very positive however still unvalidated. Mrs Kemp thanked colleagues at the CCG and NGH. Mr Bevan asked if there were any learnings that could be shared. Mrs Kemp responded that the opportunity to work jointly on how performance had been regulated had been beneficial. There were challenges nationally on cancer however working together as a system had been particularly beneficial. Ms Hulme enquired whether the quality impact could be displayed in the report, where there were gaps in IAPT, in order for the Governing Body to gain assurance. Mrs Kemp responded that the IAPT national database and reporting timelines were challenging. She confirmed that the IAPT target had been met locally but challenged around recovery in the measuring of the progress to recovery for a patient. Mrs Dobson asked if assurance could be gained with regard to East Midlands Ambulance Service (EMAS) performance. Mrs Moody responded that new response times had been introduced which had helped especially in ambulance handover times which had improved. Mrs Wightman enquired as to whether there was a recovery plan in place for Planned Care and Cancer waits and were the two acute hospitals working together. Mrs Kemp responded that regular meetings were taking place with clinical input. She confirmed that governance arrangements were now robust and that no cancer operations had been cancelled. Mrs Moody confirmed that both Acutes had insourcing and outsourcing arrangements for elective. Ms Fry commented that detailed daily calls took place explicitly regarding cancelled operations with a review to whether any harm took place. Mrs Moody reported that stakeholders continued to report delays in transporting patients. The current provider Thames Ambulance Service Ltd (TASL) was being managed on a local basis in order to process discharges quickly.

9

She commented that a risk summit had been convened by NHS England (NHSE) across Leicestershire, Lincolnshire and Northamptonshire and she would bring a full report on TASL to the next Governing Body meeting. Action: Mrs Moody The Governing Body NOTED the Performance Report including the Strategic Scorecard.

GB17/18 041 Finance, Contracting, Transformation & Savings Report Mr Rees presented the Finance section of the report and took it as read.

Mr Rees reported on details of the Month 8 Financial which he stated was on plan despite a very difficult year. The report also included details on the individual contracts and the Quality Innovation Productivity and Prevention (QIPP) performance based on activity data from month 7. The recurrent run rate continued to head in the wrong direction and this would impact on the future financial sustainability of the CCG if not addressed in year. The CCG was forecasting that the control total of £15.579m would be achieved at year end but this was only through a series of non-recurrent mitigations. Significant financial risks still remained and all Contingency funds (£3.945m) had been utilised and no other funds were available in 2017/18. Mr Bevan commented that the operational performance of the team had been very good however there would be significant challenges over the new few years. Mr Rees commented that overspends remained in primary care and prescribing and management costs at Month 8. Mrs Moody presented the Contracting section of the report and took it as read and gave an overview of key headlines. Dr Seiger enquired as to the pause of the elective procedures in January and Mrs Moody confirmed that the pause on elective activity had been lifted and that it would be back online within the next 10 days. She confirmed that updates had been provided to the Finance QIPP Contracting Committee and the Board of Directors. The Governing Body were asked to note that Contracting and Procurement were not assured of the commissioning intentions for the following contracts for services:

• Primary Care interventions • A little Help and Hospital Aftercare, Carers Sitting Service • Carers Assessment Service and Dementia Care Advise • Wheelchair Services • New Models of Care

Mr Thomas enquired if there was a timeline as this was important and Mrs Kemp responded that she would be reviewing the timeline. However Mr Rees commented that there were no issues and that the CCG was on track. Ms Hulme enquired about the quality impact and Dr Davies responded that the CCG had a decommissioning and disinvestment policy in place. Mrs Dobson commented that it was very important that procurement was undertaken in a timely manner especially as it was the voluntary sector. Mrs Dehghani also commented that having a timeline was important. The Governing Body NOTED the Finance, Contracting, and Transformation & Savings Report.

GB17/18 042 Urgent and Emergency Care Mrs Moody presented the Urgent and Emergency Care.

Mrs Moody reported on the current performance positions within the acute trusts and the actions that had been taken across the system to support performance and resilience. She commented that the system remained challenged but continued to implement the range of actions/schemes that were supported by the Local A&E Delivery Board and wider system to meet the revised Delayed Transfers of Care (DToC) trajectory, achievement of 3.5% discharge delays by January 2018, and a 1% health attributable target by November.

10

Mrs Moody reported that the focus was now on stranded patients who remained in hospital over 7 days; this required further focus work on discharge and flow. She reported that Emergency Improvement Programme (ECIP) had introduced the Multi Agency Discharge Event (MADE) to NGH which brought together the local health system to support improved patient flow across the system, recognised and unblocked delays, challenged, improved and simplified complex discharge processes. She commented that MADE typically involved senior clinical and operational staff. She reported that in 72 hours discharges had been reduced from 467 to 434. It was hoped to introduce this exercise at KGH. Mrs Taylor reported that the system continued to provide data and assurance on the winter plans to NHSE, daily reporting of Trust pressures through unify and system escalation reporting via the CCG to NHSE. This reporting would continue through to April 2018. NHS England published a new winter framework to support Sustainability and Transformation Partnerships (STP) and their provider organisations during the winter period. The framework would help maximise the appropriate use of care homes and also help identify and care for the cohort of patients who were medically fit for discharge, and therefore contributed to the delayed transfer of care metric in hospitals, with the right therapeutic conditions and appropriate staffing models. Dr Stevens enquired how learning from this year would go into next year. Mrs Moody responded that winter planning was specifically planning for surges and that conversation to plan and address took place. Mrs Dehghani commented that MADE raised a lot of issues. Mrs Dehghani enquired how the CCG was managing the surge in primary care and Ms Fry commented that NHSE had emailed today advising of a workload tool being developed which would be rolled out by the end of March which would enable the CCG to review how to plan and support surges in primary care. Mrs Dehghani commented that this needed to be incorporated in all the plans. Dr Stevens commented that he was very impressed with the medical care undertaken when there were huge pressures and commended the team for their hard work. The Governing Body NOTED the Urgent and Emergency Care

GB17/18 043 Quality & Safeguarding Report Dr Davies presented the Quality & Safeguarding Report.

Dr Davies took the reported as read and highlighted key quality areas and provided an overview of actions taken to mitigate those concerns. He informed the Governing Body that the Quality & Safeguarding report had been presented to, and approved by, the Joint Quality Committee on 12 December 2017. He reported that with regard to KGH the CQC had undertaken a series of inspections to the Trust throughout November and the draft report was expected to be with the Trust by end of this month for factual accuracy checking. The report would be discussed in detail at the next Joint Quality Committee meeting. Dr Davies reported that the Multi Agency Safeguarding Hub (MASH) had been discussed at the Safeguarding Board due to concern from providers that the MASH threshold had increased and referrals had been made which result in no action or single agency involvement. He confirmed that a further detailed update would come to the next Quality and Safeguarding Committee and then the Governing Body. Dr Davies commended the Quality Team on the support given to the Urgent Care Team and their contribution to the Multi Agency Disciplinary Event. The Governing Body NOTED the Quality & Safeguarding Report.

11

GB17/18 044 Kettering General Hospital CQC Quality Overview Report Dr Davies presented the Kettering General Hospital CQC Quality Overview Report.

Dr Davies took the report as read and advised that more information would be available once the CQC report regarding the re-inspection throughout November 2017 had been published. Ms Hulme commented that BAF 19 and BAF 20 would need to be reviewed accordingly. Dr Davies confirmed that the CCG would review progress and challenges subsequent to the outcome of the CQC re-inspection and well-led review. Mr Bevan commented that it would be useful for the lay members to have a briefing and Dr Davies reported that after the Joint Quality Committee meeting which was due to take place on 13 February he would provide an update to the Governing Body. Action: Dr Davies The Governing Body NOTED the Kettering General Hospital CQC Quality Overview Report. Mr Bevan took over from Dr Seiger as Chair of the meeting.

GB17/18 045 Primary Care Commissioning Delegation Ms Fry presented the Primary Care Commissioning Delegation update.

Ms Fry reported that during December and January, the CCG engaged with its member practices on the level of delegation for primary care co-commissioning they wished their membership organisation to undertake from 1st April 2018. NHS Nene CCG submitted an in principle application for primary care delegated commissioning status in November 2017. The application was reviewed by NHSE in parallel with a request to member practices to support the application. She reported that the vote had been conducted through the Electoral Reform Society on the basis of one vote per member practice, to be cast by the named or senior partner of the practice. The vote took place in December 2017 and the outcome of the vote was that out of 45 practices (71% turnout) who voted; 23 vs 22 voted to remain in a joint level of commissioning with NHS England. Of those members that voted the option to move to delegated commissioning status had been narrowly defeated by 1 vote and it was noted that 28.6% of practices had not voted or abstained. The results of the vote had been discussed internally with NHSE at the Primary Care Joint Co-Commissioning Committee and communicated to members. The Governing Body were informed that the next steps proposed were to enter a period of more intense engagement with practices under the umbrella of more formal review of the locality working. To work with NHSE and to maximise the flexibilities available to the CCG under the existing co-commissioning arrangements, and pending the feedback of practices, to explore with them and NHSE whether a form of shadow commissioning would be possible, to demonstrate and build the confidence of the membership in Nene CCG in this commissioning role. Mrs Dobson enquired what the impact would be on patients and Ms Fry responded that it constraints the CCG on its ability to plan for future services. Mr Thomas commented on the importance of building engagement with the member practices and addressing concerns. Dr Davies commented on the need to work effectively with NHSE and develop a reasonable set of plans and assumptions. Ms Fry referred to estates risks and that risks would not be removed but just mitigated. Ms Fry commented that engagement with members continued over delegation arrangements via the Locality Board and through the Commissioning and Membership Engagement Executives and through direct dialogue with Governing Body GP Chair. Dr Seiger commented that surveying the CCG’s stakeholders around engagement would be beneficial. Ms Fry confirmed that a paper would be brought back to a Governing Body meeting with regard to engagement plans once it had been to the Committee. Action: Ms Fry

12

The Governing Body NOTED the Primary Care Commissioning Delegation Report. Dr Seiger resumed his role of Chair of the meeting.

GB17/18 046 Primary Care Workforce Strategy Ms Fry presented the Primary Care Workforce Strategy.

Ms Fry reported that the Primary Care Workforce Strategy described workforce baseline data, strategic approach and actions to achieve the GP Forward View (GPFV) workforce targets that had been agreed through the Joint CCG Primary Care Workforce Steering Group. She reported that workforce was one of the CCG’s highest BAF risks. It was noted that NHS England would continue to seek assurance of the CCG’ delivery of the GPFV programme, of which workforce was a component, through regular assurance meetings. The Joint CCG Primary Care Workforce Committee had a dual line of reporting to Local Workforce Advisory Board (LWAB) and the Primary Care Joint/Commissioning Committees of each CCG. Ms Fry circulated to the Governing Body members a slide detailing the countywide GP and Primary Care Workforce Development Strategy which illustrated the multi-faceted approach to GP and Primary Care Workforce Development. Dr Cauldwell explained in detail each section to the Governing Body and commented that she would arrange for the circulation of the Practice nurse Development 10 point plan. Action: Mrs McKenzie The Governing Body discussed the Workforce Development Programme and Ms Fry commented that Workforce would be discussed in more detail at the next Governing Body OD session. The Governing Body NOTED the Primary Care Workforce Strategy.

GB17/18 047 Sustainability and Transformation Partnership (STP) Board Update Mrs Dehghani gave a verbal update from the STP Board meeting held on 18 January 2018

Mrs Dehghani reported that the STP Board discussed next steps in the development of the STP Programme in 2018 and confirmed changes in the management of New Models of Care workstreams. The STP Board were updated on the procurement of the resources required to support the programme. Reports were received on key changes in performance and highlights for discussion principles and process underpinning the development of a robust monitoring and reporting regime. She confirmed that an updated dashboard had been developed. A summary on the progress in the development of the Collaborative Stakeholder Forum had been received by the STP Board. An event in March to bring stakeholders up-to-date with STP was planned to develop processes that ensured two way engagement in order that colleagues, professionals and members of the public could be assured that their input counted. Mrs Dehghani also reported that ten business cases would be presented to the STP Board and they collectively represented a significant recasting of the service and management models that supported the organisation and delivery of health and social care in Northamptonshire. Mrs Dehghani reported that a generic STP Board update would be presented to Governing Bodies in the future. The Governing Body NOTED the Sustainability and Transformation Partnership Board Update.

13

GB17/18 048 Sustainability and Transformation Partnership (STP) Governance Framework Mrs Dehghani presented the STP Governance Framework.

Mrs Dehghani reported that the STP Governance Framework described arrangements intended to provide a foundation of good corporate governance, enabling the Northamptonshire Sustainability and Transformation Partnership to implement changes in the way that NHS services would be planned, delivered and experienced in Northamptonshire. She reported that she would be happy to take feedback to the STP Board and that once the Framework had been to most Trust Boards and Governing Bodies a revised document would be presented to the STP Board in March. Mr Thomas commented that it had been considered at the November Audit and Risk Committee and that the main point which arose was around conflict of interest and how it would be managed. He commented that clarity was needed on where the independent oversight and scrutiny would be. Dr Davies commented that senior nurse leadership had been identified and would be inserted in the updated version. Mrs Kemp commented that the organogram was not up-to-date and Mr Bevan commented that the Memorandum of Understanding was out of date. Dr Donnelly left the meeting at 16:09 After discussion the Governing Body members felt they were NOT able to approve the Framework. Mrs Dehghani would feedback to the STP Board the Governing Body’s decision and feedback. Action: Mrs Dehghani The Governing Body NOTED the STP Governance Framework.

GB17/18 049 Board of Directors Report

The Governing Body NOTED the Board of Directors Report.

GB17/18 050 Audit and Risk Committee Report

The Governing Body NOTED the Audit and Risk Committee Report.

GB17/18 051 Joint Quality Committee Report

The Governing Body NOTED the Joint Quality Committee Report.

GB17/18 052 Finance, QIPP & Contracting Committee Report

The Governing Body NOTED the Finance, QIPP and Contracting Report.

GB17/18 053 Patient Congress Report

The Governing Body NOTED the Patient Congress Report.

GB17/18 054 Primary Care Co-Commissioning Joint Committee Report

The Governing Body NOTED the Primary Care Co-Commissioning Joint Committee Report.

GB17/18 055 Transformation & Innovation Committee Report

The Governing Body NOTED the Transformation and Innovation Committee Report.

14

GB17/18 056 Health and Wellbeing Board Minutes 9 November 2017 Meeting

The Governing Body NOTED the Health and Wellbeing Board Minutes.

GB17/18 057 Key Messages Dr Seiger summarised three Key Messages:

• Improvement in DTOC and noted considerable amount of work undertaken by the Urgent

Care Team and wider system as a whole • The serious financial position that will take system ownership to tackle together and

acknowledgement of hard work by Finance Team • Well received Primary Care Workforce Strategy

The Governing Body NOTED the Key Messages.

GB17/18 058 Register of Interests for NHS Nene CCG Governing Body Members The Governing Body noted the contents of the Register of Interests for NHS Nene CCG Governing

Body Members. The Governing Body NOTED the Register of Interests NHS Nene CCG Governing Body Members.

Date and Time of the next meeting The next Governing Body meeting in public would be held at 13:30 on Tuesday 20 March 2018 in the Board Room, Francis Crick House, Summerhouse Road, Moulton Business Park NN3 6BF. Dr Seiger brought the meeting to a close at 16:10

15

Report To


Date of Meeting


Title of the Report

Action Log of the Governing Body meeting in Public

Agenda Paper Reference No:

GB-18-23

Presenter of Report Dr Darin Seiger GP Clinical Chair

Author(s) of Report

Governing Body

Executive Director Sponsor

Carole Dehghani Accountable Officer NHS Corby CCG and Interim Accountable Officer NHS Nene CCG

Purpose of Report

Please select:

☐ Approval ☐ Discussion

☐ Ratification ☐ Information

☒ Assurance ☐ Update

Executive summary To note the contents of the Action Log from the Governing Body meeting in public held on 30 January 2018. Related Corporate of Strategic objectives

Enter which objective is relevant All

Related CCG Framework Domain

N/A ☐ Better Health ☒ Sustainability ☐ Better Care ☐ Leadership

Risk and assurance

Does the content of the report present any risks or consequently provide assurances on risks? No

Board Assurance Framework N/A Corporate Risk Register N/A Committee Risk Register N/A

16




decision




No



No

Recommendations


• Note the contents of the Action Log from the Governing Body meeting in public on 30 January 2018

17

NHS Nene Clinical Commissioning Group

Action Log from Governing Body Meeting in Public Updated 23 February 2018

AgendaNumber

Minute No: Agenda Item Action Lead Status/Update Timescale RAG

30 January 2018 GB17/18 48 STP Governance Framework. Feedback to STP Board regarding non-approval of STP

Governance Framework by Governing Body.

Carole Dehghani Feedback provided to STP Board February 2018

GB17/18 46 Primary Care Workforce Strategy

Practice nurse Development 10 point plan to be circulated to the Governing Body.

Dr Naomi Cauldwell Circulated by Sarah McKenzie February 2018

GB17/18 45 Primary Care Commissioning Delegation update

Engagement Plans to be brought back to the Governing Body.

Charlotte Fry Scheduled for May Governing Body meeting May 2018

GB17/18 44 Kettering General Hospital CQC Quality Overview Report.

Briefing to lay members to be circulated after February Joint Quality Committee.

Dr Matthew Davies Actioned. Circulated by Sarah McKenzie February 2018

GB17/18 40 Performance Report Detailed report on Thames Ambulance Service Ltd to next Governing Body meeting.

Kathryn Moody On March Agenda March 2018

GB17/18 39 Board Assurance Framework An overall audit of the BAF to take place. Stuart Rees Corby CCG and Nene CCG are reviewing and aligning their BAFs, with all risks being reviewed and updated, including transition support from the auditors.

April 2018

30 November 2017 GB17/18 10 Performance Report Cancer section from Northampton General Hospital

Assurance meeting to be circulated.

Alison Kemp Addressed under performance section of the agenda 30 January 3018 meeting

December 2017

19 September 2017 7 Board Assurance Framework Delay in meeting target score for BAF24 to be reflected;

and the need for a single story to be told to be added to BAF31.

Tony Ferrari Target extended to end of March 2018 March 2018

Completed On Track Overdue No further action

18

Report To


Date of Meeting


Title of the Report

GP Chair’s Report


GB-18-24

Presenter of Report Dr Darin Seiger GP Chair NHS Nene CCG

Author(s) of Report

Hannah Cruickshank Senior Communications Lead North East London Commissioning Support Unit


Dr Darin Seiger GP Chair NHS Nene CCG

Purpose of Report

Please select:


☐ Ratification ☒Information

☐ Assurance ☒Update

Executive summary A general overview of local NHS activity including meetings attended by the GP Chair. Related Corporate of Strategic objectives

Enter which objective is relevant Nene CCG: All of them


Please select: ☐ Better Health ☐ Sustainability ☐ Better Care ☒Leadership

Risk and assurance


19

Board Assurance Framework N/A

Corporate Risk Register N/A

Committee Risk Register N/A Conflicts of Interest Please select one of the following:

☒ No conflict identified ☐ Conflict noted, conflicted party can participate in



decision




No



No

Recommendations


• Note the GP Chair’s report

20

GP Chair’s Report IPSOS Mori 360 Stakeholder survey We wanted to thank all of our member practices and stakeholders who completed our IPSOS Mori 360 Stakeholder survey. The survey closed on 23 February 2018 and we expect the results to be available in June. We will share this and the key action points for us that will enable us to strengthen our organisation as soon as the feedback is available. Primary Care Update Newsletter We appreciate that communication is integral to our work and continue to try different ways to meet the differing ways our member practices and key stakeholders have feedback to us. We continue to provide short videos and at the beginning of the year we trialled a Primary Care Update (PCU), which is a more concise newsletter with hyperlinks for those who would like to know more detail about a particular issue. PCU contains information on key areas of work and achievements for the CCG and practices, and invites comments from member practices. It has been designed as a tool to improve our engagement with them. The newsletter has been largely well received and will be rolled out on a monthly basis. If anyone wants more information about Primary Care Update, please contact Kelly West. MSK Referral Management NHS Nene & Corby CCGs have commissioned Circle Health to manage the referral management triage of musculoskeletal services across Northamptonshire for the next year. The new system went live on 5 March 2018 and will provide a single point of access for patient referrals. It will direct them to the most appropriate clinical teams first time and reduce the need for repeat visits to different services which patients find frustrating. All patients registered with a GP in Nene or Corby with conditions that require Orthopaedic, Rheumatology, Pain or Spinal interventions will be referred into the service. Patients requiring an operation will receive their treatment at the same hospital as they would have previously and patient choice will still apply. Improving quality of care Dr James Findlay, Dr Emma Donnelly and Megan Fielding have been reviewing the current feedback process and developed a revised template and process, designed to ease both reporting and analysis in order to strengthen and improve the quality of care between primary and secondary care that we jointly provide to our patients.. The feedback is discussed at joint quality meetings between the CCG and trusts and the aim of this improved process is to ensure that all relevant information is captured. In order that all issues are identified and a plan put in place to resolve them through a quality review process. A trial of the new form is due to start soon in three practices, supported by the LMC. If successful it will be rolled out across the county in stages.

21

Help for Heroes Pat Haslam, our Armed Forces Covenant lead, will be staffing a Help for Heroes stand at Debenhams in Northampton on Saturday and Sunday 17 and 18 March 2018 and I am pleased to announce that we have been awarded the Defence Employer Recognition Scheme bronze award that recognises how employers support their staff veterans. Improving Quality of Care for Patients with Unexplained weight loss Dr Az Ali, Clinical Executive Director for planned care will provide a patient story on a new pathway for patients with unexplained weight loss. Meetings Attended since last Governing Body

• January 2018 – Meeting with Health Chairs & Sustainability and Transformation Plan (STP) Lead

• February 2018 – STP Engagement Event on Last Years of Life • February 2018 – Governing Body Organisational Development Session • February 2018 - STP Clinical Advisory Group • March 2018 – STP – Health and Wellbeing workstream • March 2018 – Meeting with PML-DocMed federation • March 2018 – Local Government Association & NHS Clinical Commissioners; Political and

Clinical Leaders in Health and Care Annual Summit • March 2018 – Northamptonshire Health & Wellbeing Board meeting • March 2018 – STP Partnership Board Meeting

22

Report To


Date of Meeting


Title of the Report

Accountable Officer’s Report


GB-18-25

Presenter of Report Carole Dehghani Accountable Officer for NHS Corby CCG and Interim Accountable Officer for NHS Nene CCG

Author(s) of Report

Hannah Cruickshank Senior Communications Manager, NEL CSU


Carole Dehghani Accountable Officer for NHS Corby CCG and Interim Accountable Officer for NHS Nene CCG

Purpose of Report

Please select:


☐ Ratification ☒ Information

☐ Assurance ☒Update

Executive summary A general overview of CCG, provider and wider NHS activity. Related Corporate of Strategic objectives

Enter which objective is relevant Nene CCG: All of them


Please select: ☐ Better Health ☐ Sustainability ☐ Better Care ☒Leadership

Risk and assurance


Board Assurance Framework N/A Corporate Risk Register N/A

23

Committee Risk Register N/A Conflicts of Interest Please select one of the following:

☒ No conflict identified ☐ Conflict noted, conflicted party can participate in



decision


Please select one of the following: NA


No



No

Recommendations


• Note the Accountable Officer’s report

24

Accountable Officer’s Report In the year ahead, I hope you will join me in looking forward to both CCGs continuing to build on existing close collaboration, and further focusing on integrating commissioning. This will mean us all working even closer together and harnessing the benefits of shared management teams.Our staff may find themselves working as part of a multi-disciplinary/organisational team to ensure implementation of the Sustainability and Transformation Partnership, which I hope will be welcomed in these transformational times. Stuart Rees Appointed as interim Chief Finance Officer/SIRO for Corby CCG Following Mike Alexander’s plans to retire from his role as Chief Finance Officer (CFO) for NHS Corby CCG, Stuart Rees has accepted the interim position of Chief Finance Officer/SIRO for Corby CCG. This will be in addition to Stuart’s portfolio with effect from 1st April 2018. I would like to take the opportunity to wish Mike all the best for the future and thank Stuart for his continued support. Celebrated in the News Following a prolonged period of cold weather local and NHS services experiencing extreme pressure, messages were issued via the media urging people in Northamptonshire to use services wisely. https://www.northamptonchron.co.uk/news/patients-in-northamptonshire-urged-to-use-nhs-services-wisely-to-ease-pressure-on-county-hospitals-1-8390209 The communications team supported the promotion of the Whose Shoes workshop, which took place on 12 March. The interactive event provided parents and maternity service health professionals the opportunity to discuss how maternity and neonatal services could be improved. Further workshops are planned in Kettering and Corby during May. CCG Fundraisers Congratulations to our CCG fundraisers. Peter Watson, Head of Programme Delivery ran the Brighton Half Marathon on 25th February in aid of the BacZac charity. The charity is raising funds to work in partnership with Teenage Cancer Trust, providing vouchers for both in and out patients to buy a holiday home on the coast so young adults who have fought or are fighting Cancer can have some respite. And congratulations to Emma Baross, Learning Disability Strategic Health Facilitator who ran the Barcelona Marathon on Sunday 11 March to raise funds for the Epilepsy Society. She chose the charity after being diagnosed with epilepsy in 2010 and the son of a friend being diagnosed with the condition at the age of four. Emma’s accomplishment is even more remarkable considering she tore her calf in June and only started running again in September. Northampton General Hospital Update: Maternity Survey Results The Care Quality Commission has published the results of a national maternity survey. A total of 144 responses were received from patients at Northampton General Hospital.

25

https://www.northamptonchron.co.uk/news/patients-in-northamptonshire-urged-to-use-nhs-services-wisely-to-ease-pressure-on-county-hospitals-1-8390209https://www.northamptonchron.co.uk/news/patients-in-northamptonshire-urged-to-use-nhs-services-wisely-to-ease-pressure-on-county-hospitals-1-8390209

Areas where the trust performed better than the majority of trusts included:

• Receiving appropriate advice and support at the start of labour • If attention was needed during labour and birth, a member of staff helped the

mother within a reasonable amount of time • Staff introduce themselves before examination or treatment • Being treated with kindness and understanding by staff after the birth • Thinking the hospital room or ward was clean

Kettering General Hospital Update: New CQC Rating The Care Quality Commission published a report on 27 February 2018 following inspections that took place in November 2017. Between 7 and 10 November, the CQC inspected urgent and emergency care, surgery, maternity, children and young people, outpatients and diagnostic imaging. The overall rating for the trust improved from a rating of inadequate to requires improvement. Main findings are:

• Are services safe? Requires improvement • Are services effective? Requires improvement • Are services caring? Good • Are services responsive Requires improvement • Are services well led? Requires improvement

Northamptonshire County Council’s On-going Financial Challenges As you may be are aware Northamptonshire County Council is experiencing on-going financial challenges. Last month it announced details of how it will be tightening its spending controls after its director of finance issued a section 114 notice. This means no new expenditure is permitted with the exception of safeguarding vulnerable people and statutory services, although commitments to existing contracts will be honoured. Following concerns raised by its auditors about an over-reliance on the use of capital receipts, the county council was required to present a second budget. The second budget proposed a further £9.9 million of savings, including library closures, removing bus subsidies, reducing the Trading Standards budget, reducing the highways maintenance budget and a pay freeze for staff during 2018/19. The budget was approved at a full council meeting on 27 February 2018. We are in regular dialogue with county council colleagues and other key partners to ensure any impact on health and social care services are kept to a minimum and ensure that people across Northamptonshire continue to receive the care they need. We will keep the Governing Body fully informed as the situation develops.

26

CQC Review The Care Quality Commission will be undertaking a countywide review of health and social care. The Secretary of State has requested Northamptonshire is included in the next round of reviews for areas challenged around Delayed Transfers of Care. The week long assessment will begin on Monday 9 April 2018 and will review how organisations across the county work together to deliver health and social care services. The review team will meet people who use services, front line staff and local health and care leaders. They will also observe care and meet local groups. The review team will include CQC reviewers, senior NHS and local authority leaders, and people with experience of using service. At this stage we don’t know if this will include a visit to Francis Crick House but are preparing staff accordingly. The Yellow Bracelet Pilot Scheme The yellow bracelet scheme is a pilot being run across Northamptonshire. Patients participating in the pilot who have a care package will have a yellow sticker placed on the inside of their front door, which indicates a yellow folder containing details of the package is inside their home. If EMAS attend and the person requires taking to hospital, they will notice the yellow sticker and take the folder information. A yellow bracelet will be put onto the patient’s wrist so that A&E staff will be immediately recognise a current package of care is in place and follow the information in the folder. The initiative’s aim is to reduce avoidable admissions and length of hospital stay.

27

Report To


Date of Meeting


Title of the Report

Board Assurance Framework and Corporate Risk Assessment


GB-18-26

Presenter of Report Stuart Rees Chief Finance Officer

Author(s) of Report

Tony Ferrari Governance & Risk Manager


Stuart Rees Chief Finance Officer

Purpose of Report

Please select:

☐ Approval ☒ Discussion

☐ Ratification ☒ Information

☐ Assurance ☐ Update

Executive summary The Board Assurance Framework (BAF) represents the highest level risks that the CCG is facing. The Board Assurance Framework and corporate risk register is presented to the Governing Body for assurance and to ensure that all the key risks facing the CCG have been identified, that risks are being effectively mitigated and to identify any key actions. The Board of Directors have determined that the CCG’s top risks are:

1. Under delivery of current QIPP schemes (FI 009 now BAF 034) given the recurring challenge of meeting QiPP targets: Financial performance (BAF 025), mitigated by a financial recovery plan, regular updates to the Board of Directors including the introduction of weekly financial sustainability meetings.

2. Providers & relationships (BAF 021, BAF 029), mitigated through the enhanced contract/commissioning meetings, programme of practice visits and adoption of communications and engagement plan following the audit of engagement.

3. GP and clinical workforce Recruitment (BAF 028), mitigated by the GP five year forward view, Local Workforce Action Board (LWAB) and production of an STP Workforce and OD Strategy.

4. The Urgent Care system (BAF 029). The Department of Health has emphasised to all CCGs that

28

the Urgent Care system and Winter Planning are a top priority; ii) the risk remains red-flagged with an increased risk score of twenty.

BAF 029 - The urgent care system is struggling to provide an effective, timely and appropriate level of service. As noted above in “top risks” due to the extreme pressures on the system the risk score has increased from sixteen to twenty.

There are no new risks for the BAF and two risks are recommended for removal (see below).

BAF 033 - CQC Inspection identified areas of concern relating to patient safety and quality at Kettering General Hospital. Although Kettering General Hospital remains under special measures, the situation has improved sufficiently that the risk score has reduced from sixteen to twelve.

BAF 025 - Not fulfilling our statutory financial duties for future years has a reduced score from sixteen to twelve.

BAF 020 - Key Performance Targets. Has a reduced score to twelve, as this means the risk has reached its target score, it is recommended for removal from the BAF to the Healthcare Performance and Market Management Risk Register (formerly the Contracts and Procurement Risk Register).

BAF 32 - Not fulfilling our statutory involvement duties. This Risk reduced to a risk score of eight in January 2018 and has remained at this score. As this is below the threshold risk score of twelve for inclusion on both the Board Assurance Framework and the Corporate Risk Register it is recommended that this risk be removed to the Joint Commissioning Risk Register and continue to be monitored there

There are no new risks for the Corporate Risk Register other than FI 014 “Failure to achieve statutory financial duties 2017/18” has been replaced by FI 018 “Failure to achieve statutory financial duties 2018/19”. FI 014 is therefore to be recommended to be removed from the Corporate Risk Register, in addition

Risk CS 015 “A successful Cyber Security Attack could result in the CCG staff and GP Practices being unable to carry out significant elements of their work” is recommended for removal as it has achieved its target score, it will continue to be monitored via the Corporate Services Risk Register.

One other risk on the Corporate Risk register FIN 003 Lack of Capacity or Capability in Finance Team has reduced in score from 20 to 15.

As a result of the realignment of portfolios it has been decided to review and rescore some of the risks on the Joint Commissioning Risk Register that appear on the Corporate Risk Register. These will be added as appropriate after this review is complete.

Related Corporate of Strategic objectives

Enter which objective is relevant Each risk on the Board Assurance Framework is matched to the relevant Corporate Objective(s)

29


Please select:

☐ Better Health ☐ Sustainability ☐ Better Care ☒ Leadership

Risk and assurance

The Business Assurance Framework sets out all of the high level risks to Nene CCG.

Board Assurance Framework BAF: N/A

Corporate Risk Register CRR: N/A

Committee Risk Register RR: N/A




decision


Please select one of the following: ☒ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be

addressed ☐ Continue regardless: Benefits outweigh risks and continuing

would not constitute unlawful discrimination ☐ Stop: Risks outweigh the benefits, including being open to

legal challenge


No



None, bar where highlighted on the register

Recommendations

The Governing Body is asked to: • Review the BAF and Corporate Risk Register, including the top risks identified are correct, and

feedback any improvements. • Approve recommendations for removal of risks from the Board Assurance Framework or

Corporate Risk Register as appropriate • To identify any additional actions that are needed to mitigate key risks

30

12345

NHS Nene CCG - Board Assurance Framework - Summary Version 18-03-2.0

Corp

orat

e O

bjec

tive

Refe

renc

e

Risk Dire

ctor

Com

mitt

ee

MAR

CH

MAY

JUN

E

SEPT

EMBE

R

NO

VEM

BER

JAN

UAR

Y

MAR

CH

MAY

JULY

SEPT

EMBE

R

NO

VEM

BER

TARG

ET

TARGET DATE KEY CHANGES

STRATEGIC RISKS

1BAF 024

Not developing a Sustainable Health Economy for Northamptonshire through the STP process caused by insufficient resources, lack of capacity or planning at a granular level could lead a non sustainable economy, inequality of services and poor patient experience

SR

FQCC 4x4

=164x4 =16

4x4 =16

4x5 =20

4x4 =16

4x4 =16

4x4 =16

3x3 =9

31/03/19

1BAF 021

The ability of CCG commissioned providers to respond to commissioner requirements due to insufficient capability and capacity and lack of engagement resulting in a failure to meet CCG objectives, potential patient harm and pressure on other providers.

KM TC

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

2x4 =8

31/03/18

1,2,3BAF 019

The CCG is unable to discharge its commissioning responsibilities due to poor planning and analysis of information leading to suboptimal commissioning decisions and poor patient experience

KM

FQCC 3x4

=123x4 =12

3x4 =12

3x4 =12

3x4 =12

3x4 =12

3x4 =12

3x3 =9

31/03/18

2BAF 029

The urgent care system is struggling to provide an effective, timely and appropriate level of service to patients as a result of insufficient capacity and capability, increased DToC numbers and inability to discharge patients effectively resulting in poor service levels, increased pressure on the health economy, increased costs, poor patient experience and decreased staff morale.

KM

Q&

PC 4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

5x4 =20

3x4 =12

31/03/18

Increase in risk score

2BAF 033

CQC Inspection identified areas of concern relating to patient safety and quality at Kettering General Hospital following their inspection in October 2016 resulting in a Section 29A warning notice, leading to a risk of an overarching concern regarding the Trust articulation and reporting of risk especially as winter pressures are contributing to potential risks to patient care.

AJ QC 4x4

=164x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

3x4 =12

3x3 =9

31/03/18

3BAF 031

Inability to effectively engage with key stakeholders including members due to poor communication and lack of capacity resulting in potential for inequalities, poor working relationship and the potential for reputational damage.

CF BoD 5x4

=205x4 =20

5x4 =20

4x3 =12

4x3 =12

4x3 =12

4x3 =12

2x4 =8

31/03/19

4BAF 028

Meeting the STP Workforce Challenges including the ability to recruit and retain GPs and other clinical staff that may lead to insufficient provision to meet patient need, increased pressure on A&E departments and poor patient experience and patient outcomes

CF BoD 5x4

=204x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

31/12/20

4BAF 015

Nene CCG capacity and capability is insufficient to deliver its Operational and Strategic Plans due to lack of appropriate skills, lack of organisational memory and need to develop new ways of working leading to strategic objectives not being met, a lack of effective leadership and poor staff morale.

CF BoD 2x3

=62x3 =6

2x3 =6

2x3 =6

2x3 =6

2x3 =6

2x3 =6

2x3 =6

31/05/18

5BAF 025

Not fulfilling our statutory financial duties for future years due to pressures, changes in CCG Structure/LPF and an unbalanced/unmitigated plan resulting in these financial pressures and lack of investment which could impact on the quality and safety of patient care

SR

FQCC 4x4

=164x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

3x4 =12

2x3 =6

31/07/18

5BAF 026

Better Care Fund (BCF) does not support the transformation to deliver improved quality or mitigate financial risk in the system leading to overspend, breakdown of relationships between organisations.

AK ICB 3x4

=124x4 =16

3x4 =12

3x4 =12

3x4 =12

4x4 =16

4x4 =16

2x3 =6

31/03/18

5BAF 034

Under delivery of current QIPP schemes and non recurrent nature of QIPP Schemes and lack of future transformation will lead to increased costs for the CCG, unrealistic QIPP savings target for future years and failure to deliver STP and achieve STF.

SR

FQCC N/A N/A 5x4

=205x4 =20

5x4 =20

5x4 =20

5x4 =20

3x3 =9

31/07/18

RISKS PROPOSED FOR REMOVAL FROM THE BAF

5BAF 020

Key performance targets are not achieved by providers serving our population due to insufficient capability and capacity, poor planning and services not fit for purpose causing service levels below standard, reduced income from Quality Premiums and potentially harmful impacts on patients

KM

Q&

PC 4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

3x4 =12

3x4 =12

31/03/18

To be monitored on the Healthcare Performance and Market Management Risk Register

5, 1 BAF 032Not fulfilling our statutory involvement duties may mean service changes are halted or delayed, leading to reputational damage to the CCG and financial shortfall

AK TC3x4 =12

3x4 =12

2x4 =8

2x4 =8

2x4 =8

2x4 =8

2x4 =8

2x3 =6

30/12/18

Mar-18

Communication & Engagement - We will proactively support local people, seldom heard communities, member practices and partners to achieve better health outcomes for everyone in Northamptonshire, through effective collaboration, communication and timely engagement

Workforce and Culture - We will build and support a motivated workforce equipped with the required capabilities, culture and competencies to meet the evolving needs of primary care and commissioning.

Statutory Duties - We will drive the Financial Strategy for the whole Health Economy that efficiently and effectively delivers health services that achieve the constitutional standards, value for money and innovation.

CORPORATE OBJECTIVESTransformation - We will create the environment to enable the commissioning and delivery of high quality services to reduce health inequalities and improve health outcomes and resilient communities

Clinical Commissioning - We will ensure clinically led commissioning of personalised, safe and effective care from high performing providers

31

NHS Nene CCG - Board Assurance Framework - Summary Version 18-03-2.0Co

rpor

ate

Obj

ectiv

e

Refe

renc

e

Risk Dire

ctor

Com

mitt

ee

MAR

CH

MAY

JUN

E

SEPT

EMBE

R

NO

VEM

BER

JAN

UAR

Y

MAR

CH

MAY

JULY

SEPT

EMBE

R

NO

VEM

BER

TARG

ET

TARGET DATE KEY CHANGES

Mar-18

CORPORATE RISKS

2 JCT 034The LPF process was suspended for Lot 2b due to lack of competition. Currently there is a negotiated solution for both care service, however the risk is that this will not be sustainable following the providers stated desire to exit the market

AK

BoD/

FQCC

N/A N/A N/A N/A N/A4x4 =16

4x4 =16

2x3 =6

30/09/18

4 PCCC 14

Inability to appropriately support the Co-Commissioning Agenda due to lack of resource in Primary Care and no funding from NHS England causing an Inability to progress delegated commissioning status and the need for CCGs to identify additional funding CF

PCJC

C 4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

2x4 =8

31/3/19

4FI

005Lack of Medium Term Financial stability due to a failure to produce a Medium Term Financial Plan supporting STP, poor financial performance, a failure to deliver transformation under STP and lack of robust 5 year plan for CCG leading to a failure to meet future financial targets and an inability to meet future qualitative standards

SR

FQCC 4x4

=164x4 =16

3x4 =12

4x4 =16

4x4 =16

4x4 =16

4x4 =16

1x4 =4

31/07/18

4FI

007Partner Organisations Financial Position SR

FQCC N/A N/A 4x4

=164x4 =16

4x4 =16

4x4 =16

5x4 =20

3x4 =12

31/03/20

4FI

003Lack of Capacity or Capability in Finance Team due to vacancies, reliance on CSU leading to a failure to support business planning and development, meet financial targets and a lack of business continuity SR FQ

CC 5x4 =20

4x4 =16

3x4 =12

4x4 =16

4x4 =16

5x4 =20

5x3 =15

2x4 =8

30/6/17

5,2FI

008 The number of patient records and subsequent workload for RTT backlog clearance are unknown leading to an increased costs to the CCG beyond current assumptions.SR

FQCC 4x4

=164x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x4 =16

4x2 =8

31/03/19

5, 1FI

009Under delivery of current QIPP schemes and non recurrent nature of QIPP Schemes and lack of future transformation will lead to increased costs for the CCG, unrealistic QIPP savings target for future years and failure to deliver STP and achieve STF. SR FQ

CC 5x4 =20

5x4 =20

5x4 =20

5x4 =20

4x4 =16

4x4 =16

4x4 =16

3x3 =9

31/03/18

5CP

005 Kettering General Hospital Trust (KGH) fail to deliver against the Referral to treatment target of 18 weeks. KM

FQCC 5x3

=155x3 =15

5x3 =15

5x3 =15

5x3 =15

5x3 =15

5x3 =15

1x2 =2

31/03/18 Revised risk description

5FI

018Failure to achieve statutory financial duties 2018/19 SR

FQCC N/A N/A N/A N/A N/A N/A 4x4

=162x3 =6

31/03/19 New risk for 2018/19

5CP

006NGH and KGH fail to deliver against the Accident and Emergency 4 Hr Transit Time target. KM

FQCC 5x3

=155x3 =15

5x3 =15

5x3 =15

5x3 =15

3x4 =12

3x4 =12

2x2 =4

31/03/18

RISKS PROPOSED FOR REMOVAL FROM THE CORPORATE RISK REGISTER

5FI

014Failure to achieve statutory financial duties 2017/18 - Performance SR

FQCC N/A N/A 4x4

=165x4 =20

4x4 =16

3x4 =12

2x3 =6

2x3 =6

31/03/18On Target for financial year, replaced by new risk for 18/19 - FI 018

5 CS 015A successful Cyber Security Attack could result in the CCG staff and GP Practices being unable to carry out significant elements of their work for a sustained period which could result in harm to patients, stolen sensitive patient data, financial loss and reduced reputation.

KM A&R

N/A N/A5x4 =20

4x4 =16

4x4 =16

3x4 =12

3x4 =12

3x4 =12

31/1/18Target score achieved - to be monitored on Corporate Services Risk Register

32

12345

NHS Nene Clinical Commissioning Group Board Assurance Framework Mar-18 Version 18-03-2.0

Dire

ctor

, Co

mm

ittee

&

Clin

ical

Lea

d(s)

Corp

orat

e ob

ject

ive

Refe

renc

e

Risk description Including cause and effect(s) In

itial

Sco

re

Last

Rep

orte

d

Key ControlsControls must be realistic measures to mitigate the risk,

commentary on current performance is not a key control Gaps in Controls Curr

ent

Scor

e Assurance for controls

Green = fully assuredAmber = partially assured

Red = not assuredGaps in

Assurance

Future Actions (must include completion date and owner if not

named risk lead)

Progress against Future Actions Ta

rget

Sco

re

Targ

et d

ate

STRATEGIC RISKS

Stua

rt R

ees

Fina

nce,

QIP

P &

Con

trac

ting

Com

mitt

eeDr

Mat

thew

Dav

ies

1BAF 024

Not developing a Sustainable Health Economy for Northamptonshire leading to:• Staff not being engaged• Lack of consistent clear leadership and understanding of the change management process• Political reaction to proposals• Lack of financial sustainability 4

x4 =

16

4x4

=16

• New Governance arrangements• Sustainability and Transformation Plan (STP)• CCG Role as system leader

• STP refocused on 5YFV priorities• CCG as system leader not matched to clinical & financial sustainability 4

x4 =

16

• Partnership Board• Strategic Executives Meeting• Enabling Boards• Portfolio Boards• Delivery Boards

N/A • Development of project plans for 5YFV priorities TBC• OD link to system leadership (ACS/ACO)• STP Governance arrangements to be reset April 2018

• STP Governance arrangements reset• Development of project plans for 5YFV priorities completed

3x3

=9

30/0

3/19

Kath

ryn

Moo

dy

Tran

sfor

mat

ion

Com

mitt

eeDr

Em

ma

Donn

elly

/Dr A

z Ali/

Dr N

aom

i Cal

dwel

l

1BAF 021

The ability of CCG commissioned providers to respond to commissioner requirements due to insufficient capability and capacity and lack of engagement resulting in a failure to meet CCG objectives, potential patient harm and pressure on other providers.

4x4

=16

4x4

=16

• Standard contracts in place with all providers• Provider Schedule trackers and quality and performance reports• Continuous review of the CCG performance via GB and QC reporting• Section 75 Agreement for 2015/16 rolled forward• Contract and Performance Meetings• Clinical Quality Review Meetings• A&E Delivery Boards• Agreed commissioning framework and timetable • Development and embedding of Commissioning Intentions • Provider regulators meet with NHS England and CCG• STP Board and underpinning work stream governance • Contractual levers enacted as required

N/A

4x4

=16

•Minutes of Health & Social Care Executive Committee• Minutes of Health & Wellbeing Board• Minutes of Contract Performance meetings• Minutes of Clinical Quality Review Meetings• Regulator correspondence and feedback from reviews• Minutes of Co-Commissioning Committee•Minutes of STB Board• Assurance letters from tripartite mtgs

• 2017-19 Contract performance below required levels• STP implementation plan not sufficiently developed for contractual purposes• BCF not approved without conditions• Trusts stating that they do not have capacity to respond to challenge process

• Enhanced contract / commissioning meetings from June - ongoing• Nene CCG and NEL CSU working together to refine contract challenge process by 31/03/18• Nene CCG providing support in relation to current urgent care pressures - ongoing• MSK Review underway to address issues and build trust - ongoing

3x4

=12

30/0

3/18

Workforce and Culture - We will build and support a motivated workforce equipped with the required capabilities, culture and competencies to meet the evolving needs of primary care and commissioning.Statutory Duties - We will drive the Financial Strategy for the whole Health Economy that efficiently and effectively delivers health services that achieve the constitutional standards, value for money and innovation.

CORPORATE OBJECTIVESTransformation - We will create the environment to enable the commissioning and delivery of high quality services to reduce health inequalities and improve health outcomes and resilient communitiesClinical Commissioning - We will ensure clinically led commissioning of personalised, safe and effective care from high performing providersCommunication & Engagement - We will proactively support local people, seldom heard communities, member practices and partners to achieve better health outcomes for everyone in Northamptonshire, through effective collaboration,

33


Dire

ctor

, Co

mm

ittee

&

Clin

ical

Lea

d(s)

Corp

orat

e ob

ject

ive

Refe

renc

eRisk description

Including cause and effect(s) Initi

al S

core

Last

Rep

orte

d



ent

Scor




Assurance


named risk lead)


rget

Sco

re

Targ

et d

ate

Kath

ryn

Moo

dy

Fina

nce,

QIP

P &

Con

trac

ting

Com

mitt

eeDr

Mat

thew

Dav

ies

1,2,3BAF 019

The CCG is unable to discharge its commissioning responsibilities due to poor planning and analysis of information leading to suboptimal commissioning decisions and poor patient experience

5x4

=20

3x4

=12

• Revisions to information sharing protocols now incorporated in 17-19 contracts• Data sharing agreement in place across health and social care (BCF) system• Closer linkages between information flows and commissioning activities to support analysis of cause and effect and confirm issues to be resolved• Escalation of information issues through Executive where not supplied in a timely manner and contractual levers applied• Capacity and demand planning improved to support decision making• Revised information schedules developed• KGH recovery phase re: RTT completed• 2 year operational plan• Reporting pack in development to improve focus and evidence based commissioning• Reinstatement of weekly meetings• CFO/DoCD meeting with NELCSU to improve systems re information • Additional BI staff • CCG reporting pack finalised

N/A

3x4

=12

• Minutes of Information Meetings• Minutes of Contract Meetings• 17-19 Standard Contract

• Staff ability to articulate and respond to issues highlighted by information• countywide meetings no longer held consistently• Reduction in BI staff through CSU remains a concern

• Finalisation of CCG reporting pack by 15/02/18• Additional Business Intelligence and Performance staff in place in NEL CSU by 31/01/18• Nene CCG and NEL CSU working together to refine contract challenge process by 31/03/18• CCG working with trusts to deliver agreed challenge process by 15.04.18

• Weekly meetings reinstated• Additional BI Staff now in place

2x4

=8

30/0

4/18

34


Dire

ctor

, Co

mm

ittee

&

Clin

ical

Lea

d(s)

Corp

orat

e ob

ject

ive

Refe

renc

eRisk description


al S

core

Last

Rep

orte

d



ent

Scor




Assurance


named risk lead)


rget

Sco

re

Targ

et d

ate

Kath

ryn

Moo

dy

Qua

lity

and

Perf

orm

ance

Com

mitt

eeDr

Em

ma

Donn

elly

2BAF 029

The urgent care system is struggling to provide an effective, timely and appropriate level of service to patients as a result of insufficient capacity and capability, increased DToC numbers and inability to discharge patients effectively resulting in poor service levels, increased pressure on the health economy, increased costs, poor patient experience and decreased staff morale.

5x5

=25

4x4

=16

• Joint NHS Nene and Corby CCGs Quality and Performance Committee.• A&E Delivery Boards• Emergency Care Improvement Team supporting system• Contract performance notices raised where appropriate• Discharge to assess home first option in place for CHC, Dementia home based model awaiting approval • Updated surge and escalation plan • Additional pathway plans in place to prevent attendance at A&E • Action plan to ECIP recommendations for KGH • Revised UCWG and sub group structure in place.• Crisis pathway commissioned via NHFT I• Ambulatory care usage increased to reduce pressures on A&E• Single Point of Access (SPA) for discharge management • Fortnightly inflow, internal flow, outflow and surge/escalation meetings to focus on delivery of action plans• Revised reporting to A&E Delivery Boards• COOs meeting weekly to assess progress against Urgent Care plan• Escalation at Regional level - fortnightly meetings• DTOC trajectory in place and monitored to achieve national requirements• Regional Winter room and Winter Director in discussion• weekly meetings in place • Risk Share in place allowing additional activity and spot purchase• improved DTOC reporting in place

• NCC activity remains a risk due to uncertainty over financial position• recruitment to UC post unsuccessful

5x4

=20

• Minutes of Joint NHS Nene and Corby CCGs Quality and Performance Committee.• Minutes of System Resilience Groups• Minutes of Urgent Care Working Group• Escalation meetings with regulators• Feedback from National Escalation Exercise

• A&E performance & DTOC delivery remain challenged

• further work on existing key controls 31/03/18• STP for Urgent Care to be refined through system workshop 31/03/18• Recruitment to Urgent Care posts to enhance support to system by 28/02/18• Implementation of coding and counting review of DToCs to enhance accuracy of reporting by 31/01/18• Revised escalation triggers and processes in place and being monitored 31.03.18• CQC Review taking place April 2018

3x4

=12

30/0

4/18

35


Dire

ctor

, Co

mm

ittee

&

Clin

ical

Lea

d(s)

Corp

orat

e ob

ject

ive

Refe

renc

eRisk description


al S

core

Last

Rep

orte

d


commentary on current performan

Date post:	03-Aug-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

NHS Nene Clinical Commissioning Group...A G E N D A . NHS Nene CCG Governing Body Meeting in Public...

Documents