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Putting Barnsley People First A meeting of the NHS Barnsley Clinical Commissioning Group Governing Body will be held on Thursday 12 October 2017 at 9.30 am at the Worsbrough Common Community Centre, Warren Quarry Lane, Barnsley, S70 4ND.

AGENDA (Public)

Item Session GB Requested

to

Enclosure Lead

Time

1. Apologies

Note 9.30 am

2. Quoracy

Note

3. Patient Story

Note 9.35 am 10 mins

4. Declarations of Interest relevant to the agenda

Assurance GB/Pu/17/10/04 Nick Balac

9.45 am 5 mins

5. Patient and Public Involvement Activity Report

Information GB/Pu/17/10/05 Lesley Smith

9.50 am 10 mins

6. Questions from the Public on Barnsley Clinical Commissioning Group business

Note Nick Balac 10.00 am 10 mins

7. Minutes of the meeting held on 14 September 2017

Approval GB/Pu/17/10/07 Nick Balac

10.10 am 5 mins

8. Matters Arising Report

Note GB/Pu/17/10/08 Nick Balac

10.15 am 5 mins

Strategy

9. South Yorkshire and Bassetlaw – Local Maternity Services

Information GB/Pu/17/10/09 Brigid Reid

10.20 am 10 mins

10.

GP Forward View Update

Assurance & Information

GB/Pu/17/10/10 Sudhagar

Krishnasamy

10.30 am 10 mins

11. Living with and Beyond Cancer Programme Update

Information GB/Pu/17/10/11 Lesley Smith

10.40 am 10 mins

Quality and Governance

12. Risk & Governance Exception Report Assurance GB/Pu/17/10/12 Richard Walker

10.50 am 10 mins

Page 1 of 3

13. Commissioning of Children’s Services Quarterly Monitoring Report

Information GB/Pu/17/10/13 Brigid Reid

11.00 am 10 mins

Finance and Performance

14. Integrated Performance Report Assurance & Information

GB/Pu/17/10/14 Jamie Wike /

Roxanna Naylor

11.10 am 15 mins

15. QIPP Delivery Update Assurance & Information

GB/Pu/17/10/15 Jamie Wike

11.25 am 10 mins

16. Quality Highlights Report Assurance GB/Pu/17/10/16 Brigid Reid

11.35 am 10 mins

Committee Reports and Minutes

17. Minutes of the Audit Committee Meeting held on 21 September 2017

Assurance GB/Pu/17/10/17 Nigel Bell

11.45 am 5 mins

18. Minutes of the Finance and Performance Committee Meeting held on 7 September 2017

Assurance GB/Pu/17/10/18 Nick Balac

11.50 am 5 mins

19. Minutes of the Membership Council Meeting held on 26 September 2017

Assurance GB/Pu/17/10/19 Mehrban Ghani

11.55 am 5 mins

20. Minutes of the Quality & Patient Safety Committee Meeting held on 3 August 2017

Assurance GB/Pu/17/10/20 Mehrban Ghani

12.00 pm 5 mins

21. Assurance Report of the Primary Care Commissioning Committee held on 28 September 2017

Assurance GB/Pu/17/10/21 Chris Millington

12.05 pm 5 mins

22. Minutes of the South Yorkshire and Bassetlaw Sustainability and Transformation Partnership - Collaborative Partnership Board held on 14 July 2017

Assurance GB/Pu/17/10/22 Lesley Smith

12.10 pm 5 mins

General

23. Date and Time of the Next Meeting: Thursday 9 November 2017 at 9.30am in the Boardroom, Hillder House, 49-51 Gawber Road, Barnsley, S75 2PY

12.15 pm Close

Page 2 of 3

Signed

Dr Nick Balac – Chairman Exclusion of the Public: The CCG Governing Body should consider the following resolution: “That representatives of the press and other members of the public be excluded from the remainder of this meeting due to the confidential nature of the business to be transacted - publicity on which would be prejudicial to the public interest” Section 1 (2) Public Bodies (Admission to meetings) Act 1960

Page 3 of 3

GB/Pu/17/10/04

Putting Barnsley People First

GOVERNING BODY

12 October 2017

Declarations of Interests, Gifts, Hospitality and Sponsorship Report

PART 1A – SUMMARY REPORT 1. THIS PAPER IS FOR

Decision Approval Assurance x Information

2. REPORT OF

Name Designation Executive Lead Richard Walker Head of Governance and

Assurance Author Fran Wickham Governance, Assurance and

Engagement Facilitator

3. EXECUTIVE SUMMARY

Conflicts of interest are defined as a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold. The table below details what interests must be declared:

Type

Description

Financial interests

Where individuals may directly benefit financially from the consequences of a commissioning decision e.g., being a partner in a practice that is commissioned to provide primary care services;

Non-financial professional interests

Where individuals may benefit professionally from the consequences of a commissioning decision e.g., having an unpaid advisory role in a provider organisation that has been commissioned to provide services by the CCG;

Non-financial personal interests

Where individuals may benefit personally (but not professionally or financially) from a commissioning decision e.g., if they suffer from a particular condition that requires individually funded treatment;

Indirect interests

Where there is a close association with an individual who has a financial interest, non-financial professional interest or a non-financial personal interest in a commissioning decision e.g., spouse, close relative (parent, grandparent, child, etc.) close friend or business partner.

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GB/Pu/17/10/04 Appendix 1 to this report details all Governing Body Members’ current declared interests to update and to enable the Chair and Members to foresee any potential conflicts of interests relevant to the agenda. In some circumstances it could be reasonably considered that a conflict exists even when there is no actual conflict. Members should also declare if they have received any Gifts, Hospitality or Sponsorship.

4. THE GOVERNING BODY IS ASKED TO:

• Note the contents of this report and declare if Members have any declarations of interest relevant to the agenda or have received any Gifts, Hospitality or Sponsorship.

5. APPENDICES

• Appendix A – Governing Body Members Declaration of Interest Report

Agenda time allocation for report: 5 minutes.

2

GB/Pu/17/10/04 PART 1B – SUPPORTING INFORMATION

1. Links to the Governing Body Assurance Framework Risk ref(s) This report provides assurance against the following risks on

the Governing Body Assurance Framework:

2. Links to CCG’s Corporate Objectives Y/N To have the highest quality of governance and processes to

support its business Y

To commission high quality health care that meets the needs of individuals and groups

Wherever it makes safe clinical sense to bring care closer to home

To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley

To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.

3. Governance Arrangements Checklist 3.1 Financial Implications

Has a financial evaluation form been completed, signed off by the Finance Lead / CFO, and appended to this report?

NA

3.2 Consultation and Engagement Has Comms & Engagement Checklist been completed? NA

3.3 Equality and Diversity Has an Equality Impact Assessment been completed and appended to this report?

NA

3.4 Information Governance Have potential IG issues been identified in discussion with the IG Lead and included in the report?

NA

Has a Privacy Impact Assessment been completed where appropriate (see IG Lead for details)

NA

3.5 Environmental Sustainability Are any significant (positive or negative) impacts on the environment discussed in the report?

NA

3.6 Human Resources Are any significant HR implications identified through discussion with the HR Business Partner discussed in the report?

NA

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GB/Pu/17/10/04.1

Putting Barnsley People First NHS Barnsley Clinical Commissioning Group Register of Interests This register of interests includes all interests declared by members and employees of Barnsley Clinical Commissioning Group. In accordance with the Clinical Commissioning Group’s Constitution the Clinical Commissioning Group’s Accountable Officer will be informed of any conflict of interest that needs to be included in the register within not more than 28 days of any relevant event (e.g. appointment, change of circumstances) and the register will be updated as a minimum on an annual basis. Register: Governing Body

Name Current position (s) held in the CCG

Declared Interest

Adebowale Adekunle

GP Governing Body Member

• GP Partner at Wombwell Chapelfields Medical Centre

• The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG

• Clinical sessions with Local Care Direct Wakefield

• Clinical sessions at IHeart

• Member of the British Medical Association

• Member Medical Protection Society

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GB/Pu/17/10/04.1


Declared Interest

Nick Balac Chairman • Partner at St Georges Medical Practice (PMS)

• Practice holds AQP Barnsley Clinical Commissioning Group Vasectomy contract

• Member of the Royal College of General Practitioners


• Member of the Medical Protection Society


Nigel Bell Lay Member - Governance

• Lay Advisor at Greater Huddersfield CCG

• Ad hoc provision of Business Advice through Gordons LLP

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GB/Pu/17/10/04.1


Declared Interest

Mehrban Ghani

Medical Director • GP Partner at The Rose Tree Practice trading as the White Rose Medical Practice, Cudworth, Barnsley

• GP Appraiser for NHS England

• Directorship at SAAG Ltd, 15 Newham Road, Rotherham

• The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley

CCG

Madhavi Guntamukkala


• GP partner at The Grove Medical Practice

• Husband is a partner at The Grove Medical Practice and Lakeside Surgery



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GB/Pu/17/10/04.1


Declared Interest


John Harban GP Governing Body Member

• GP Partner at Lundwood Medical Centre and The Kakoty Practice, Barnsley

• AQP contracts with the Barnsley Clinical Commissioning Group to supply Vasectomy, Carpal Tunnels and Nerve Conduction Studies services

• Owner/Director Lundwood Surgical Services

• Wife is Owner/Director of Lundwood Surgical Services


• Member of the faculty of sports and exercise medicine (Edinburgh)


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GB/Pu/17/10/04.1


Declared Interest

James Holloway


• Salaried GP at Dr Mellor and Partners

• Former employee of KPMG LLP

• Former employee of BDO Stoy Hayward

Anne Marie Hoyle

Practice Manager Member

• Business Manager at The Kakoty Practice, Barnsley

• Cllr Alice Cave, BMBC Elected Councillor is related

• Rotarian, Barnsley (Rockley) Rotary Club

• Director Barnsley Enterprise for Living Well (CIC)

• Member of the Institute of Healthcare Management

• Director/ Company Secretary Jaxon’s Gift, Charity Organisation

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GB/Pu/17/10/04.1


Declared Interest


• Board Member for South Yorkshire Credit Union Ltd

M H Kadarsha GP Governing Body Member

• GP Partner in Hollygreen Practice

• Director of FGGP which hold the PMS contract for Dodworth Medical Practice • The practice is a member of Barnsley Healthcare Federation which may provide services to Barnsley

CCG


• Director of YAAOZ Ltd, with wife

Sudhagar Krishnasamy

Associate Medical Director

• GP Partner at Royston Group Practice, Barnsley


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GB/Pu/17/10/04.1


Declared Interest

• GP Appraiser for NHS England

• Executive member of Barnsley Local Medical Committee (ceased July 2017)

• Member of the Medical Defense Union

• Director of SKSJ Medicals Ltd

• Wife is also a Director


• Undertakes sessions for IHeart Barnsley

Chris Millington

Lay Member • Partner Governor Barnsley Hospital NHS Foundation Trust

Roxanna Naylor

Acting Chief Finance Officer

Partner works at NHS Leeds West Clinical Commissioning Group.

7

GB/Pu/17/10/04.1


Declared Interest

Brigid Reid Chief Nurse • Volunteer Registered Nurse, St Gemma’s Hospice, 329 Harrogate Road, Moortown, Leeds LS17 6QD

• Partner works at Leeds Teaching Hospital NHS Trust which provides services to Barnsley patients via Specialised Commissioning and could tender to supply others.

Mike Simms Secondary Care Clinician

• No interests to declare

Mark Smith GP Governing Body Member

• Senior Partner at Victoria Medical Centre also undertaking training and minor surgery roles.

• Director of Janark Medical Ltd

Lesley Smith Governing Body Member

• Husband is Director/Owner of Ben Johnson Ltd a York based business offering office interiors solutions, furniture, equipment and supplies for private and public sector clients potentially including the NHS.

• Board Member (Trustee), St Anne’s Community Services, Leeds

Sarah Tyler Lay Member for Accountable Care

Volunteer Governor / Board Member, Northern College

8

GB/Pu/17/10/04.1


Declared Interest

Voluntary trustee / Board Member for Steps (community care provider for early years / nursery)

Interim contract supporting NHS England (ceased July 2017)

Interim Health Improvement Specialist for Wakefield Council

9

GB/Pu/17/10/05


GOVERNING BODY

12 October 2017

Patient and Public Involvement Activity Report 1. THIS PAPER IS FOR

Decision Approval Assurance Information X

2. REPORT OF

Name Designation Executive Lead Lesley Smith

Chief Officer

Author Kirsty Waknell Head of Communications and Engagement


This report gives an overview of patient and public involvement activity over the past month and planned activity for the coming months. Two feedback reports have been published this month, one for diabetes services and one for musculoskeletal assessment and triage. Both reports highlight positive experiences of person centred care and both describe the challenges in communication between services and access/waiting times. Barnsley Patient Council members discussed the most effective ways to involve local people and communities in the work of the Accountable Care Organisation, advising the best route was to bring people together in the neighbourhood or area council areas.


• Consider and note the contents.

Agenda time allocation for report:

10 minutes.

1







Y


N


N


Y



N

Are any financial implications detailed in the report? NA

3.2 Consultation and Engagement Has Comms & Engagement Checklist been completed? NA (general

update report for info)

Is actual or proposed engagement activity set out in the report?

NA


NA


NA


NA


NA


NA

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GB/Pu/17/10/05 PART 2 – DETAILED REPORT 1 INTRODUCTION/ BACKGROUND INFORMATION 1.1 This report gives an overview of our recent and future patient and public

involvement activity in Barnsley CCG.

2 Engagement activity 2.1 How public and patient involvement is influencing the decisions we make.

Recent Activity Outcomes/findings Improving Outcomes for People with Diabetes The feedback report is now available to view on our website. Members of the public who live with diabetes have also been recruited to be part of procurement assessment panel. The final feedback report is now available to download from our website: http://www.barnsleyccg.nhs.uk/get-involved/diabetes.htm

The feedback from people living with diabetes, family, carers and clinicians who have direct experience/ knowledge of the service (and who responded to the survey) praised the following elements:

• Acknowledgment of improvements/ developments made in community diabetes services to date

• Patient centred and tailored care • Professionalism and knowledge of a

number of the staff working in the current services

• Clear advice and information for patients • Continuity of care.

However there were also suggestions highlighted where improvements could be made, mainly in relation to the following areas:

• Access to timely assessment treatment and appointments with less cancellations

• Communication with patients and between services/ teams

• Frustration over waiting times • Referral processes and correct

information • Wider range of services and

appointments ‘out of normal working hours’

• Support, training and education for patients and professionals

• Concern over developments/ improvements being lost in any changes

• Concern that decisions already made.

Musculoskeletal assessment & diagnosis The feedback report is now available to view on our website. Members of the public who

The feedback from people who have used these services, family, carers and clinicians who have direct experience/ knowledge of the service (and who responded to the survey) praised the following elements:

• Patient choice • Patient centred and tailored care

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http://www.barnsleyccg.nhs.uk/get-involved/diabetes.htm



GB/Pu/17/10/05 have experience of musculoskeletal conditions have been recruited to be part of procurement assessment panel. The final feedback report is now available to download from our website: http://www.barnsleyccg.nhs.uk/get-involved/msk.htm

• Professionalism and knowledge of the staff working in the current services

• Clear advice and information for patients • Continuity of care.

However there were also suggestions highlighted where improvements could be made, mainly in relation to the following areas:

• Access to timely assessment treatment and appointments

• Communication with patients and between services

• Waiting times • Referral processes and correct

information • Wider range of services and

appointments ‘out of normal working hours’

• Support for patients and professionals.

Current Activity Outcomes/findings Pain Management treatments We have been reviewing chronic pain management treatments across Barnsley.

The feedback is being analysed and will be published late October 2017.

Primary care support to people in care homes During October and November we are asking for feedback from residents, families and carers on their experience of support from primary care to people in care homes.

Primary care includes the services mainly provided by local GP’s, and practice nurses. They often work closely with community care which includes services such as District Nursing, Community Matrons, Physiotherapy, Specialist Nursing e.g. Dementia, Macmillan, Parkinson’s, Diabetes, Falls Team, Dietician amongst others. In order to develop this work further, we are inviting feedback from care home residents, or family members or carers of someone who does, to help to inform our plans locally and to ensure that services are right for everyone involved - care home residents, care homes and GP practices. Questionnaires will be promoted in care homes and via local groups/networks/forums etc. as well as being promoted online. Further detail will be available on the CCG website in the next few weeks.

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http://www.barnsleyccg.nhs.uk/get-involved/msk.htm

http://www.barnsleyccg.nhs.uk/get-involved/msk.htm

GB/Pu/17/10/05 Accountable Care Partnership in Barnsley We are working with other health and care organisations in Barnsley to improve health through the ways we work together and joining up care more for people. There will be a range of ways patients and the public could or would wish to be involved in the designing and planning of all elements of this work.

To start this work we talked to members of Barnsley Patient Council this month to get their steer on the concept of a Citizens’ Panel for Barnsley. Patient Council members highlighted that there were a number of forums, patient groups and also local community groups, which already existed. Creating a new ‘panel’ wasn’t felt to be an effective way forward; however they did feel that something which reached all parts of our communities was important. The idea of working around the existing area council/neighbourhood areas was really popular and further work is now being done to test this idea out with other groups and partners as well as members of the public.

Getting the best outcome for your condition: Applying a consistent, appropriate approach across Barnsley for GP referrals. We want to ensure people are getting the best clinical outcome for their condition. For some conditions, we know that moving directly to surgery does not always give you the maximum benefit. Sometimes people might think that surgery is the only or best route to take. In fact there is a lot that can and importantly, should be done, before surgery is considered.

Ten procedures were adopted as part of our clinical threshold policy earlier in 2017 and the next set of procedures are planned to be included in December 2017.

Ahead of this, we will be asking people what they think to the approach we have described and the expected benefits. Do they have any concerns and is there anything from the patient information sheet that needs changing or adding?

Full details will be available shortly on the CCG website.

Across South Yorkshire and Bassetlaw Citizen’s panel across South Yorkshire & Bassetlaw

South Yorkshire and Bassetlaw agencies involved in health and social care are starting to work in closer partnership to improve care for you, your family and community. As this work develops, it’s vital that the voice of local people is at the heart of the work. Together we're looking for people who can offer an independent view and critical friendship on matters relating to the work of Health and Care

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GB/Pu/17/10/05 Working Together, which is an Accountable Care System (ACS). Closing date for applications is 13th October. Full details are available http://www.barnsleyccg.nhs.uk/get-involved/ in engagement opportunities.

Independent review of hospital services A piece of work to independently review services within hospitals across our region, to help identify which services would benefit from being provided in a different way, started in August with a pre-engagement workshop of 65 people.

The next engagement phase will start this month with the public, staff and wider stakeholder groups.

Full details of how to get involved will be available on the CCG website and will be circulated to OPEN members and via partners.

Future activity

Barnsley mental health and wellbeing commissioning strategy 2016-2020 We will be carrying out the annual refresh of this strategy, which was published in 2016 following considerable feedback from local people, communities and partners. We have approached members of the Barnsley Mental Health Group Forum at the end of August to ask if they would be willing to work in partnership with us to help shape the communications and engagement work around the refresh.

Update from September: Following discussion with members of the Barnsley Mental Health Group Forum in August, we will be starting the refresh in the next couple of months in order for the forum to be fully involved.

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http://www.barnsleyccg.nhs.uk/get-involved/

GB/Pu/17/10/07

Putting Barnsley People First Minutes of the meeting of the Barnsley Clinical Commissioning Group Governing Body (PUBLIC SESSION) held on Thursday 14 September 2017 at 9.30 am in the Lower Hall at St John’s Community Centre, Church Street, Penistone, S36 6AR. MEMBERS PRESENT Dr Nick Balac Chairman Nigel Bell Lay Member for Governance Dr Mehrban Ghani Medical Director Dr Madhavi Guntamukkala Member Dr James Holloway Member Marie Hoyle Practice Manager Member Dr Sudhagar Krishnasamy Member Chris Millington Lay Member for Patient and Public Engagement &

Primary Care Commissioning Roxanna Naylor Acting Chief Finance Officer Brigid Reid Chief Nurse Mike Simms Secondary Care Clinician Dr Mark Smith Member Sarah Tyler Lay Member for Accountable Care IN ATTENDANCE Jackie Holdich Head of Delivery Kirsty Waknell Head of Communications and Engagement Richard Walker Head of Governance and Assurance Fran Wickham Governance, Assurance & Engagement Facilitator Jamie Wike Head of Planning, Delivery and Performance APOLOGIES Dr Adebowale Adekunle Member Dr John Harban Member Dr M Hussain Kadarsha Member Lesley Smith Chief Officer MEMBERS OF THE PUBLIC Peter Deakin Member of the Public Alan Higgins Member of the Public Margaret Sheard Member of the Public Trevor Smith Member of the Public The Chairman welcomed members of the public to the September Governing Body meeting.

Page 1 of 18

GB/Pu/17/10/07

Agenda Item

Action

Deadline

GB 17/09/01

QUORACY

The Chairman declared the meeting quorate.

GB 17/09/02

PATIENT STORY

The Governing Body heard a Patient Story which reflected the experiences of a person with a learning disability who was a bit overweight, a heavy smoker and suffered with anxiety.

The Governing Body reflected on the Patient Story and the following observations were noted: • Not all patients’ needs are medical based • The sharing of the medical records had made a big

difference as the patient did not have to go over their history at each medical interaction. The Practice Manager Member made it clear however that medical records are not shared with the MY Best Life team; it is for practice champions to identify people who then receive a contact.

• The Practice Manager Member advised that there had been over 400 referrals since the My Best Life launch in April 2017.

• This is a good example of how services support and have a positive impact on the community.

• This is a good example of different agencies and organisations working together for better outcomes for patients.

• Innovative ways of working and decisions about the local health economy can be challenging, however positive stories like this give members confidence in new ways of working and the confidence to be more innovative.

• As commissioners members look for evidence of cost effectiveness of services, which can be difficult when commissioning a new service. However when a scheme is qualitative members need to have the confidence to go forward.

• Anybody’s life can change through unexpected events; it is good that there are services that can be built around that person.

The Governing Body noted the Patient Story.

Page 2 of 18

GB/Pu/17/10/07

Agenda Item

Action

Deadline

GB 17/09/03

DECLARATIONS OF INTEREST, SPONSORSHIP, HOSPITALITY AND GIFTS RELEVANT TO THE AGENDA

The Governing Body considered the Declaration of Interests, Gifts, Hospitality and Sponsorship Report. No new declarations of interests were received.

GB 17/09/04

QUESTIONS FROM THE PUBLIC ON BARNSLEY CLINICAL COMMISSIONING GROUP BUSINESS

The Chairman asked that the public recognise that this is a meeting in public, not a public meeting and he would be very happy to address questions not relating to the agenda outside the meeting.

How will the new ACO communicate effectively and efficiently with the public? The Chairman advised that the Accountable Care Shadow Delivery Board (ACSDB) will be meeting in public from either October or November. However it was recognised that there will be a range of different organisations represented there and the CCG (through the Chief Nurse and Head of Communications & Engagement) are in the process of developing a forum that would be engaging with the public. The Lay Member for Accountable Care advised that there are new people in post to assist with this work and a brief, in plain English, is being developed with Communication Leads across Barnsley for the engagement plan. The Lay Member noted that she will support this work and is happy to be a conduit for ideas and messages to this plan. One of the BHNFT Partner Governor’s noted that he would be happy to be involved in the Accountable Care engagement work. The Chief Nurse noted that this is a great opportunity and the CCG is working with the public to see what ways of engagement are best for them.

How will the CCG engage with younger people, i.e. from 6th Form age, so that we can bring Barnsley people along to improve public health in Barnsley.

Page 3 of 18

GB/Pu/17/10/07

Agenda Item

Action

Deadline

Is there a formal mechanism? The Chief Nurse advised that the Youth Council, supported by Barnsley MBC, links to the People and Young People’s Trust. In November an event is planned where young people will come and work with Councillors and health service staff. In the past this event has worked well and received good feedback. At another recent event students from Darton College were very articulate and well informed. ‘Chillipep’, the Future In Mind Commissioners are involved in Mental Health work.

Time of meeting A member of BSONHS noted that he had tried to get the message out about the Governing Body meeting by putting it on the Penistone Action Group webpage. Feedback he had received suggested that people from the community would like to come but that it is difficult as they work.

Positive Engagement A member of BSONHS noted that in other areas engagement with NHS organisations is not as favourable as Barnsley CCG. Barnsley is in many ways a lot better than anywhere else. The Chairman noted that the CCG must work within a statutory framework; we have integrity and are doing the best we can to put the Barnsley people first.

A member of the public asked if the terminology is ACO or ACS? The Chairman noted that the ‘O’ of ACO refers to organisation and was to develop a structure and form for the ACS, which is the Accountable Care System going forward.

This question was asked at the BHNFT AGM yesterday but we wanted to ask the CCG what it thought about the hospital using private clinics to do weekend procedures? Is this a good use of NHS resources? The Chairman noted that the BHNFT Chairman had

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GB/Pu/17/10/07

Agenda Item

Action

Deadline

given a full explanation at the BHNFT AGM where BSONHS had been present. The CCG would like to see the most resilient and sustainable system, that is free at point of delivery, to patients. Improving outcomes for the people of Barnsley is a high priority for the CCG. Beyond this is political territory.

A member from BSONHS attended a recent event in South Yorkshire regarding the hospital service review. Out of the 66 people there were only 3 from Barnsley. How is this representative? If the patient and participation guidance is not followed local groups across the country will get together to address this. The Chairman drew attention to his earlier comment that a whole range of ways will be used to get people involved. Another member of the public noted that there were more than 3 Barnsley people at the meeting, and it was a very good event. Unfortunately the public found it difficult to speak due to the activists present who had a political point of view. The Chairman summed up that the CCG is exploring ways to involve the public in different ways.

The Chairman thanked the members of the public for their questions.

GB 17/09/05

MINUTES OF THE PREVIOUS MEETING HELD ON 10 AUGUST 2017

The minutes of the previous meeting held on 10 August 2017 were verified as a correct record of the proceedings subject to the following amendment on page 3 regarding Social Prescribing: ‘…Each practice had a social prescribing champion who identifies people to be referred to My Best Life and connect and signpost patients to the most….’

GB 17/09/06

MATTERS ARISING REPORT

The Governing Body considered the Matters Arising Report and the following main points were noted:

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GB/Pu/17/10/07

Agenda Item

Action

Deadline

GB 17/08/11b Risk and Governance Report – it was noted that this item is now complete. The Finance and Performance Committee discussed the Governing Body’s considerations in reducing the risk if sustained improvement for the A&E Performance was seen. The Finance and Performance Committee recommended that the score remains as it is at the present time.

The Governing Body noted the Matters Arising Report.

STRATEGY GB 17/09/07

CARE NAVIGATION REVIEW

The Chief Nurse presented the paper which had been written to share the outcome of the Care Navigation and Telehealth Service Review undertaken between February and July 2017. In July 2017 the decision was made to decommission this service. It was advised that the provider was made aware of the decision straight away. The service will terminate on 31 January 2018 and all patients who are currently on a care navigation and telehealth programme will be given the opportunity to complete their pathway. The Chief Nurse explained the decision had been made due to the following factors:

• Whilst in 2010, when the service was commissioned it was at the leading edge, the service was not using real-time monitoring

• Whilst significant attempts had been made to promote the service it was only used to 50% capacity.

• Since the service was commissioned several new innovative services have been developed.

The Chief Nurse was keen to note that the service was highly valued by patients for the kindness of its staff and the personal approach they took in reducing social isolation. The Lay Member for PPE noted the perception that this service was a lifeline where there were gaps, i.e. GP availability after 6pm. There is a need therefore to

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GB/Pu/17/10/07

Agenda Item

Action

Deadline

ensure that the message goes out that there are other services available and promote these. The Associate Medical Director echoed this and noted that there is a need to support patients with interventions. The Chief Nurse advised that the RightCare Barnsley service was not in place when the Care Navigation service started. In respect of the Recommendations statement on page 2 of the report the Chairman noted that ‘a personalised and tailored approach should embrace a wider range of contact means that suit the induvial and not the service’ where it is safe and cost effective to do so.

The Governing Body noted the report and its recommendations, and the requirement for their utilisation in future work.

GB 17/09/08

OVERVIEW OF ‘STEPPING FORWARD TO 2020/21 THE MENTAL HEALTH WORKFORCE PLAN FOR ENGLAND’

The Chief Nurse advised that this report was prepared following the Government’s announcement that there will be additional numbers of mental health staff by 2021. The emphasis is not just on recruitment but also retraining and retaining staff. The work will look at the current workforce age profile and skill profile. There will be targeted monies available. It was recognised that mental health workers are able to retire earlier and therefore retaining staff will be looked at. It is noted that recruiting to mental health specialities is difficult; there is a need to attract staff and ensure that they feel motivated. The paper sets out the ambition and challenge. The Lay Member for Accountable Care noted that mental health is now receiving a higher profile, would this attract staff to this speciality? Other broader issues that were discussed were international recruitment and specialities/training being located in certain areas.

The Governing Body noted the report.

Page 7 of 18

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Agenda Item

Action

Deadline

GB 17/09/09

DIABETES SERVICE SPECIFICATION

The Diabetes Service Specification came to Governing Body for final sign-off and approval before it goes out for re-procurement. It was noted that following Governing Body comments in August the original specification has been split into two elements; the Specification that is the subject of the procurement and an Appendix which incorporates the elements of the pathway not specifically part of this procurement. The Medical Director asked if a single provider could sub-contract the work. The Acting Chief Finance Officer noted that this was possible but the CCG would only contract to one organisation. The Chairman, for clarity, asked for assurance that this was a single procurement. The Acting Chief Finance Officer confirmed that this is to be tendered to one provider who will be accountable for the delivery of the specification. If they sub-contract we will hold the main contract holder to account. The Practice Manager Member noted that there were a lot of technical terms associated with Diabetes; education and ongoing access to resources to understand the condition should be available to the patient. Is the specification explicit enough? The Associate Medical Director noted that there is a need not to be too prescriptive and part of the procurement is for providers to be innovative.

The Governing Body noted the report and approved the Diabetes Service Specification.

QUALITY AND GOVERNANCE

GB 17/09/10

MSK AND DIABETES PROCUREMENT DECISION MAKING ARRANGEMENTS

The Head of Governance and Assurance presented the proposal that the procurement of the MSK Triage Service and Integrated Diabetes Service decision making is delegated by the Governing Body to the Primary Care Commissioning Committee (PCCC) which has a Lay and Executive majority in order to manage any potential conflicts of interest. It was noted that a

Page 8 of 18

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Agenda Item

Action

Deadline

precedent had been set with the procurement of the GP Out of Hours service. The Medical Director asked if Governing Body could make the decision if enough members were not conflicted. The Head of Governance and Assurance confirmed that this would be possible. A member asked whether there was a timescale issue for decision making. It was advised that the deadline is the end of December 2017 so that a new provider can be in place in April 2018. The Chairman asked whether the three GPs that attend the Primary Care Commissioning Committee, who do not have a vote, would still be able to add their clinical input? It was noted that the clinical input would be received at the evaluation panel by an independent clinical advisor. The Medical Director asked that the decision on whether to delegate to the PCCC could be made after a list of potential bidders is known. The Lay Member for Accountable Care offered her support if needed to look at bidders to see if there were any conflicts of interest. It was agreed that this needs to be looked at further to ensure that there is a clear and fully transparent process. The Lay Member for PPE noted the need for consistency in relation to previous decisions. The Chief Nurse felt that it might be helpful to have a precise outline of the procurement and evaluation process so that members can be confident in the process. The Lay Member for Governance asked what the Terms of Reference of the Primary Care Commissioning Committee stated? The Head of Governance and Assurance noted that it is the Standards of Business Conduct, Managing Conflicts of Interest and Acceptance of Gifts and Hospitality Policy that we are working within. If Governing Body is conflicted then the decision is delegated to the PCCC. Members agreed with this principle and noted that it had been appropriate for the previous GP Out of Hours service as it related to primary care, but questioned whether it was necessary in this case.

Page 9 of 18

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Agenda Item

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Deadline

It was therefore agreed that the decision making would remain with Governing Body, but that if conflicts of interest arose it would be taken to the PCCC in line with CCG Policy. The judgement as to the appropriate decision making route will be made once the bidders are known.

The Governing Body agreed that:

• The procurement decision would be through Governing Body but that if conflicts of interest arose it would be taken to the PCCC

• That a paper outlining the procurement process should be brought back to Governing Body in October.

RW

GB 17/09/11

PATIENT AND PUBLIC INVOLVEMENT ACTIVITY REPORT

The Head of Communications and Engagement presented the above report and highlighted that the full patient and public involvement report for the MSK and Diabetes services will be published so that potential providers are able to make full use of the feedback. It was advised that 6 people (patients who have used the services) have been trained to be part of the evaluation panels. It was advised that the recent event undertaken as part of the independent review of hospital services was the first stage and full engagement will take place later in the year. With respect to the Barnsley Mental Health and Wellbeing Commissioning Strategy 2016-2020, the Chief Nurse advised that she had visited Barnsley Mental Health Forum; they are doing a huge amount of work and the CCG has amended its timetable to fit with theirs to enable engagement. The Lay Member for Accountable Care advised that she will be chairing the Citizens’ Panel for Accountable Care.

The Governing Body thanked the Head of Communications and Engagement for the update.

Page 10 of 18

GB/Pu/17/10/07

Agenda Item

Action

Deadline

GB 17/09/12

RISK AND GOVERNANCE REPORT

The Head of Governance and Assurance introduced the Risk and Governance Report to the Governing Body. Discussion took place and the following main points were noted:

• The Quality and Patient Safety Committee recommended that a new risk ref 17/04 be added to the risk register. As this was a low risk, with a score of 3, the Chairman asked why this was being proposed for inclusion on the register. A discussion followed concerning consistency and to ensure that this is kept in officer’s minds as there are many different interconnections which can affect this risk. The Chief Nurse agreed to review the risk score outside the meeting.

• Risk ref CCG 15/07 – following a query from the Lay Member for PPE and Primary Care Commissioning, the Head of Planning, Delivery and Performance agreed to check if there had been any changes to the Category A Response Standard of 75%.

• The Equality and Engagement Committee Terms of Reference (TOR) have been reviewed and a couple of minor amendments have been made. The Chief Nurse noted that the TOR had been amended earlier in the year but had been revisited to ensure NHS England’s patient and public participation guidance was being met. The Chairman noted that the Committee seemed a large meeting and asked if it was able to undertake its business effectively. It was recognised that two committees had been merged so that this committee covers both the equality and engagement agendas. The Chair of the committee noted that it was a busy agenda but that this was manageable.

BR

JW

12/10/17

12/10/17

The Governing Body:

Reviewed:

• the GBAF for 2017/18, and considered whether the risks on the GBAF were appropriately described and scored, and whether there was sufficient assurance that they were being effectively managed

• the ‘red ‘ risks from the Corporate Risk Register to

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confirm they were appropriately scored and described

Approved: • the reduction of risk 1.1 from 3x5=15 to 3x4=12 • the addition of risk 17/04 to the Risk Register • the increase of risk 15/1(c) to 4x4=16 on the Risk

Register • the reduction of risk 13/31 to 3x4=12 on the Risk

Register • the Terms of Reference for the Equality and

Engagement Committee Agreed:

• the EPRR self-assessment and statement of compliance appended to the report.

GB 17/09/13

CYBER SECURITY ASSURANCE

The Head of Governance and Assurance presented the above paper, noting the arrangements that the CCG has in place to address the risk of a cyber-attack. It was noted that the CCG’s internal audit provider had been asked to undertake a review. It was advised that:

• the CCG is working towards the NHS Data Security Standards

• the IG Toolkit is being re-written • A staff awareness session has been arranged for

20 September 2017 • Work is ongoing to protect the CCG’s key

information assets and to ensure that IT systems are protected

• Work is underway to improve the cascade of messages to all staff through the capture of mobile phone numbers for use in the event of an emergency

• A further report will be brought to Governing Body before the end of the year

• The Practice Manager Member asked whether the ‘Data Security Awareness’ training will be available to practice staff. The Head of Governance and Assurance agreed to confirm this with the Learning and Development Team.

RW


Page 12 of 18

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Agenda Item

Action

Deadline

GB 17/09/14

SECURING PATIENT CHOICE

The Chief Nurse presented this report which shares with Members the CCG’s securing meaningful choice for patients’ self-assessment and action plan. The following paragraph was highlighted: ‘Survey evidence shows that progress towards achieving meaningful choice has stalled. A radical upgrade of choice is now needed across the whole of the NHS in England, and in particular, concerted action is required to improve patient choice in elective services to help deliver the referral-to-Treatment (RTT) waiting times standard.’

Patients are aware of their rights through the Choose and Book system; however it was asked how providers get on the ERS system.

The CCG undertook the self-assessment based on the six enablers. In most areas the minimum requirements have already been embedded, although three areas need further work.

The Chairman asked if the CCG was aware of any dissatisfaction. The Head of Planning, Delivery and Performance noted that there wasn’t and that the guidance is set out in our contracts requiring that patients are aware of their choice. However there is a need to confirm that we are meeting the requirements.

The Practice Manager Member asked that this item be taken to the Practice Managers Group; whilst training for Choose and Book was deployed at the start of its implantation it would be useful to have a refresh.

The Lay Member for Accountable Care advised that she had been involved with this item whilst working with NHS England. She highlighted the emphasis on meaningful choice, promotion with the public and that the availability of resource packs for GPs and Practice Managers was being considered.

The Secondary Care Clinician noted that patients should be helped to make their choices based on quality.

The Governing Body:

• Noted the contents of the self-assessment particularly where the CCG is not rated as fully compliant against the minimum standards

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• Endorsed the Improvement Action Plan and supported the delivery of the improvement actions identified within the plan.

FINANCE AND PERFORMANCE GB 17/09/15

INTEGRATED PERFORMANCE REPORT

Performance The Head of Planning, Delivery and Performance highlighted the following key areas from the Exception Report: 4 hour A&E waiting times – following improved performance in July 2017, there was a dip in August 2017. For September to date performance had again improved to 94% so Quarter 2 performance is currently above 95%. It is noted that we are going into the autumn/winter period and recognised that plans are coming on stream to mitigate waiting times, i.e. primary care streaming to alleviate pressures. IAPT – following an improvement in the June 2017 performance for patients who complete treatment and are moving to recovery, July performance dipped. The percentage of patients waiting 6 weeks or less for treatment continued to reduce in July with 69.87% of patients waiting less than 6 weeks against a target of 75%. The service have attended a Governing Body Development Session and have received initial feedback from the recent IAPT Intensive Support Team visit and have developed an initial action plan aimed at addressing the issues raised. The Chief Officer has also written to the Chief Executive for the provider to seek assurance regarding the timeframe for delivering all IAPT standards. Cancer (2 weeks – breast symptoms) – delivery of this target has been achieved consistently throughout the year however there was a dip in June and the standard was not achieved. For those patients breaching it was noted that in the majority of cases the breach is due to

Page 14 of 18

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Agenda Item

Action

Deadline

patient choice, e.g. a patient being on holiday or a patient cancelling their appointment. The Head of Planning, Delivery and Performance drew Members’ attention to the Improvement and Assessment Framework Checkpoint meeting letter which provided a summary of the meeting with NHS England on 2 August 2017.

Finance The Acting Chief Finance Officer presented the Financial Report. The CCG continues to forecast achievement of financial duties and planning guidance requirements, with an in-year balanced budget position. As previously reported this position is predicated on the delivery on the CCG’s £11.5m efficiency programme. The CCG’s Efficiency Programme Management Office (PMO) monitors and reviews delivery of the CCG’s £11.5m efficiency programme. The report stated that the forecast position on ‘green’ rated schemes shows a £0.9m shortfall against the £11.5m target. However this has now reduced to £0.1m following budget reviews and uncommitted budgets being released against the efficiency programme. Barnsley Hospital NHS Foundation Trust (BHNFT) contract activity data has been received for Month 4, and shows a year to date overspend position of £434k against plan. A robust forecast position is not yet developed, due to ongoing analysis being undertaken and requests for information not yet having been received from the Trust. The Chairman asked whether the CCG was on track to deliver the medicines optimisation scheme; the Acting Chief Finance Officer confirmed that yes the scheme was on track and savings are being recorded.

The Governing Body noted the contents of the report including: • 2017/18 performance to date • projected delivery of all financial duties, predicated

Page 15 of 18

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on the assumptions outlined in this paper • the forecast £0.9m shortfall on the CCG’s efficiency

programme now reduced to £0.1m and the development of schemes being undertaken to ensure delivery of the £11.5m target.

GB 17/09/16

QIPP DELIVERY UPDATE

The Head of Planning, Delivery and Performance presented the QIPP reporting dashboard to the Governing Body. The dashboard provided an overview of progress and performance against the schemes within the CCG QIPP/ Efficiency Programme. The Finance and Performance Committee had provided assurance of the appropriate action being taken to mitigate any risks to the delivery of the QIPP Programme.

The Governing Body noted the contents of this report and the dashboard attached at Appendix 1.

GB 17/09/17

QUALITY HIGHLIGHTS REPORT

The Chief Nurse presented the report noting that there were 5 quality issues being monitored: • Cervical Screening for Learning Disabilities – red • Gram-Negative Blood Stream Infections Reduction

Plan – green • Shared Care (CAMHS) – amber • Improving Quality in Primary Care – green • PHSO complaint – amber These areas were discussed and in particular Members asked that the Practice Manager Group and Membership Council need to think about the first issue above and how the experience can be improved for this vulnerable group. It was noted that there may be the potential for variation across the 33 practices and it may be that one specialised service is the way forward with specially trained staff. The Chief Nurse agreed to give this consideration.

BR


Page 16 of 18

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COMMITTEE REPORTS AND MINUTES GB 17/09/18

COMMITTEE REPORTS AND MINUTES

The Governing Body received and noted the following Committee minutes: • Audit Committee held on 27 July 2017 – the

Chairman drew attention to the reflections on how the meetings were conducted and was encouraged by the comments. The Head of Governance and Assurance noted that a recent internal audit review recommended that every committee has a reflection at the end of the meeting and that this will be taken forward by his department with committee Chairs.

• Finance and Performance Committee held on 3 August 2017

• Equality and Engagement Committee held on 17 August 2017 - this committee receives the minutes from the Patient Council. The Chairman of the committee noted that this forum had changed the way it was delivered and it received valuable input from its members. He noted that there was an open invitation for members of the public to join in. It was noted that Patient Council is an evening meeting which may be easier for some members of the public to attend. It was advised that interpreter services will be delivered by Language Empire going forward.

• Health and Wellbeing Board held on 8 August 2017 –

following a query from the Lay Member for PPE and Primary Care Commissioning, the Chairman advised that this Board is held in public. Questions may be asked in advance in writing and there is a protocol for this which can be shared. The Head of Planning, Delivery and Performance agreed to confirm the process and share with Governing Body Members.

JW

GENERAL GB 17/09/19

QUARTERLY UPDATE OF THE GOVERNING BODY ASSURANCE WORKPLAN / AGENDA TIMETABLE

The quarterly workplan was reviewed. The Head of

Page 17 of 18

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Delivery asked if an update on the progress and implementation of the GP annual review could be added for January 2018. The Lay Member for Accountable Care asked if an item on ACS progress could be added. However it was noted that these updates currently come via the Chief Officer’s Report. As the ACS goes forward the minutes from the Accountable Care Shadow Delivery Board would be received. The Lay Member for Accountable Care also asked if the Governing Body Development Session plan could be shared.

FW

FW

GB 17/09/20

QUESTIONS FROM THE PUBLIC ON BARNSLEY CLINICAL COMMISSIONING GROUP BUSINESS

A member of the public who is a Governor at BHNFT accepted the need to engage more with partners. He thanked the Governing Body for an interesting meeting. The Chairman advised that he held a drop-in session on Friday morning’s at 9.30am for stakeholders to speak to him.

GB 17/09/21

DATE AND TIME OF THE NEXT MEETING

Thursday 12 October 2017 at 9.30 am at Worsbrough Common Community Centre, Warren Quarry Lane, Barnsley, S70 4ND.

Page 18 of 18

GB/Pu/17/10/08


GOVERNING BODY

12 October 2017

MATTERS ARISING REPORT 1. The table below provides an update on actions arising from the previous meeting of the

Governing Body (public session) held on 14 September 2017. Table 1

Minute ref Issue Action Outcome/Action

GB 17/09/10

MSK AND DIABETES PROCUREMENT DECISION MAKING ARRANGEMENTS A paper outlining the procurement process should be brought back to Governing Body in October.

RW

In progress – paper to be brought to November meeting.

GB 17/09/12

RISK AND GOVERNANCE REPORT The Chief Nurse to review the risk score for risk ref: 17/04.

BR

Complete - Q&PSC reviewed the score which has not changed.

GB 17/09/13

CYBER SECURITY ASSURANCE Head of Governance and Assurance to confirm with the Learning and Development Team that ‘Data Security Awareness’ training will be available to practice staff.

RW

Complete – information shared with the Practice Manager Member on how practices can access the training.

GB 17/09/17

QUALITY HIGHLIGHTS REPORT Chief Nurse to give consideration to one specialised service for Cervical Screening for people with Learning Disabilities.

BR

This will be progressed.

GB 17/09/18

HEALTH AND WELLBEING BOARD MINUTES 8 AUGUST 2017 The Head of Planning, Delivery and Performance to confirm the process for asking questions at this Board and share this with members.

JW

Complete - process for public questions at the Health and Wellbeing Board circulated to Governing Body on 29 September 2017

Page 1 of 4

Minute ref Issue Action Outcome/Action

GB 17/09/19a

GOVERNING BODY ASSURANCE WORKPLAN / AGENDA TIMETABLE An update on the progress and implementation of the GP Annual Review to be added to the timetable for January 2018.

FW

Complete – this item has been added to the workplan.

GB 17/09/19b

The Governing Body Development Session plan to be shared with members.

FW In progress – plan being updated.

2. ITEMS FROM PREVIOUS MEETINGS CARRIED FORWARD TO FUTURE

MEETINGS Table 2 provides an update/status indicator on actions arising from earlier Board meetings held in public. Table 2

Minute Ref Issue Action Outcome/Actions

GB 16/252 MATTERS ARISING REPORT Patient Partner – It was agreed that as the service was working well for some practices more than others that Mr Millington and the Practice Manager Member could undertake work to roll out best practice across Barnsley CCG.

CM

10 August Update Noted that integration of the new telephone system for practices and Hillder House would be undertaken during the Autumn until the end of November 2017. 28 June Update Work is currently in progress to replace the end of life analogue phone system. The cut over to the new phone system is scheduled for Tuesday 4 July. The Lay Member for Patient and Public Engagement & Primary Care Commissioning is liaising with the IT Director at BHNFT in relation to the work on hold due to hospital telephone system being delayed, which will impact on LIFT buildings.

Page 2 of 4

GB 17/04/12

YORKSHIRE AND HUMBER FERTILITY POLICY 2017 Chief Nurse to update the Equality Impact Assessment Work with the Smoking Cessation Midwife to develop GP guidance on creating a patient information leaflet

BR

MG

In progress In progress. The issues around the inclusion of an exclusion of women who smoke as part of the Fertility Policy will be brought back to the Governing Body once national specialist advice received.

GB 17/06/04

QUESTIONS FROM THE PUBLIC Statutory Guidance regarding patient and public involvement The CCG was asked whether it will be changing its strategy and constitution documents to read ‘involvement’ instead of ‘engagement’. Agreed that this would be responded to outside the meeting.

KW

Complete - Member of public contacted about meeting. Agreed with them that they will get in touch with the CCG to arrange a time which is convenient for them.

GB 17/07/10

COMMISSIONING OF CHILDREN’S SERVICES QUARTERLY MONITORING REPORT To look at whether referrals to the CAMHS service could be through Map of Medicine.

MGu

Currently under review

GB 17/08/04a

QUESTIONS FROM THE PUBLIC ON BARNSLEY CCG BUSINESS To receive a presentation about Social Prescribing ‘My Best Life’ towards the end of the year.

JHold

In progress – to come to November meeting.

GB 17/08/09

LOCAL MATERNITY SYSTEM UPDATE To seek representation (via Membership Council) to sit on the LMS Board.

NB

In progress - Membership Council Members were asked for expressions of interest at their meeting on 26 September 2017

GB 17/08/11d

To submit a proposal to the Membership Council about the removal of the Standards of Business Conduct, Managing Conflict of Interest and the Acceptance of Gifts and Hospitality

RW Complete – went to Membership Council meeting on 26 September 2017.

Page 3 of 4

form the CCG’s Constitution.

GB 17/08/16b

Member of the public to seek evidence of how other CCG’s manage questions from the public at Board meetings in public and provide feedback to the CCG.

NE

Page 4 of 4

GB/Pu/17/10/09


GOVERNING BODY

12 October 2017

South Yorkshire & Bassetlaw Local Maternity Services

1. THIS PAPER IS FOR

Decision Approval Assurance Information x

2. REPORT OF

Name Designation Executive Lead

Brigid Reid Chief Nurse

Author Patrick Otway Head of Commissioning (Mental Health, Children’s and Maternity and Specialised Services)


The attached presentation provides the Governing Body with a further update on the progress of the South Yorkshire and Bassetlaw Local Maternity Services offer, complementing the update provided in August 2017. The powerpoint was presented by the Senior Responsible Officer, Chris Edwards (Chief Officer of Rotherham CCG) to the NHSE North of England Maternity Transformation Programme Board. A number of presentations were made from several STP / ACS representatives. The South Yorkshire and Bassetlaw LMS plan was positively received.


• Note the progress

5. APPENDICES • Powerpoint Presentation

Agenda time allocation for report: 10 minutes

1

GB/Pu/17/10/09 SUPPORTING INFORMATION


the Governing Body Assurance Framework: 1.1, 1.4, 1.5, 4.1, 5.1




Y


Y


Y


Y



N


3.2 Consultation and Engagement Has Comms & Engagement Checklist been completed? N Is actual or proposed engagement activity set out in the report?

NA


NA


NA


NA


NA


NA

2

South Yorkshire and Bassetlaw Accountable Care System

Chris Edwards SY&B Commissioner SRO

Chair -Y&H Maternity Clinical Network Chair - Y&H Neonatal ODN

South Yorkshire and Bassetlaw

• Population 1.5m • Long track record of working together • One of 9 ‘Accountable Care Systems ‘

selected nationally • Close links to the clinical networks • Strong Programme Manager – Kate

Laurance

South Yorkshire and Bassetlaw

“Better Births” (March 2016) highlighted 7 key themes and recommendations:

– Personalised care – Continuity of care – Safer care – Better postnatal & perinatal mental health – Multi-professional working – Working across boundaries – Payment

The Local Maternity System, that sits alongside the South Yorkshire and Bassetlaw (SYB) Accountable Care System (ACS) will be responsible for transforming maternity services.

What have we done so far? • Developed a working vision with clinicians, providers

and commissioners and shared information on our profile of provision across SYB

• Undertaken stakeholder engagement on our vision and outline plan

• Established our LMS Board and links with our ACS (previously STP) in SYB

• Established 4 task and finish work stream groups to work through the full development and then delivery of our LMS plan

Workstreams of the SYB LMS • Clinical Governance Task and Finish Group (chaired by a Head of Midwifery) This group will focus on

clinical governance structures, processes, culture and challenges faced in working across organisational boundaries.

• Quality Measures Task and Finish Group (chaired by CCG Deputy Chief Nurse) This group has been created to improve the safety of maternity care and continuously measure quality, improve quality outcomes and access to care across SYB.

• Local Maternity Offer Task and Finish Group (Chaired by a Children’s and Maternity Commissioner) This group will review the current choice offer across the footprint and consider whether this meets the recommendation in Better Births and the needs of women, their families and babies. Proposals for transformation will also come from this group following gap analysis.

• Maternity Voices Partnership Task and Finish Group (Chaired by the chair of a Maternity User Group) The group’s main aim is to establish channels for engaging local women and their families, to ensure the views of service users across the footprint are captured in plans and the vision for the future is underpinned by users of maternity care.

• LMS Central Group Payment systems will be explored within this work stream, as will financial planning and sustainability. Baseline assessment and needs assessment will also be produced to support all work streams.

What are the gaps we are working on now? • Development of an accessible version of our plan and

wider engagement of the STP including a fully worked up communications and engagement plan

• Wider engagement on our plan through our collaborative partnership

• Recruitment to clinical leadership to our LMS

• Recruitment to dedicated project management support

• We have no stand alone MLU in SYB

• We need to further develop our model and our joint commissioning arrangements for community hubs

How we will address the gaps? • Use our ACS to support development of

communications and engagement • Recruitment plans are in place for clinical leadership

and project management

• We have engagement from the Yorkshire and Humber maternity clinical lead in our LMS and CN support

• We have engagement and strong links with the ODN.

• We are undertaking a Health Needs Assessment, baseline assessment and gap analysis which will inform future proposals

• The LMS Board is continuing to meet monthly to maintain oversight and progress towards “Better Births”

Risks and Support

• Recruitment to clinical leadership posts to support our transformation

• Recruitment to project management capacity • Challenges in implementing proposals for new care

models due to political pressure. • Resources within local authorities having negative

impact on maternity hub model • Continued support needed with programme

resourcing , engagement and sharing best practice.

Next steps • Finalise and publish our plan

• Complete our HNA, baseline assessment and refreshed gap analysis

• Secure the project support needed including clinical leadership

• Develop proposals for changing provision in line with ‘Better Births’

• Maintain our relationships across SYB clinically, with wider stakeholders and our collaborative partnership

GB/Pu/17/10/10


GOVERNING BODY

12 OCTOBER 2017

GP Forward View Update 1. THIS PAPER IS FOR

Decision Approval Assurance X Information X

2. REPORT OF

Name Designation Executive Lead Jackie Holdich Head of Delivery (Integrated

Primary and Out of Hospital Care)

Author Catherine Wormstone Senior Primary Care Commissioning Manager


To provide the Governing Body with an update on the key issues and headlines relating to Primary Care and implementation of the GP Forward View. 1. GP Forward View – Progress with Implementation

1.1 Assurance Process NHS England is now requesting regular and detailed information from CCGs on the delivery of plans to support GP Forward View. In Barnsley, this first detailed return was submitted on 15 September 2017 and has created a baseline from which to measure progress on the roll out of care navigation, e-consultations, online consultations, access activity and access trajectories. The key areas which are being monitored each have plans attached to them with milestones for achievement and these will be progressed and monitored through Primary Care Development Work stream.

1.2 Investment

a) Practice Delivery Agreement

The Barnsley Practice Delivery Agreement (PDA) was approved by the CCG’s Governing Body on Thursday 13 April 2017. The scheme represents a significant amount of investment (£4.2m) in

1

GB/Pu/17/10/10 General Practice for 2017/18 and will facilitate the resilience and sustainability of primary care in Barnsley. b) GPFV – New Financial Allocations in 2017/18 Financial allocations to support GP Forward View are being distributed and accessed in different ways. Some funding is retained at NHS England (e.g. GP Resilience Fund) and some has already been shared with the CCG (e.g. GP WIFI implementation funding and money to support E-consultation). The priority in Barnsley is that as much of this financial support as possible is secured for primary care services and that maximum benefit is delivered for patients. The Primary Care Teams within the CCG and NHSE work closely together with finance colleagues to track any new funding and ensure that it is invested in primary care within Barnsley. c) GP Resilience Fund

NHS Barnsley CCG has put forward a number of bids against the 2017/18 Resilience Fund. This fund was previously known as the Vulnerable Practice Fund. National guidance for this money was made available in July and practices were able to self-refer as individuals or groups; or the CCG was able to nominate practices (in discussion with the practices) to NHS England. A number of bids were submitted and six practices (or groups of practices) received allocations of non-recurrent support between £5k and £10k. These practices have been supported by the CCG to draft a plan (a Memorandum of Understanding) to spend the money in the current financial year. Unfortunately, three practices have since withdrawn from the scheme, largely due to the non-recurrent and limited nature of the support.

1.3 Workforce

i) Workforce Baselines

As part of the 2017/18 Practice Delivery Agreement, all practices are required to complete the Health Education England Workforce tool on a quarterly baseline. The first data collection period for this task was completed by 31 out of 33 practices on 30 June 2017 and preliminary workforce data has been produced. This will help significantly with planning what is needed across primary care and the wider system in Barnsley and will contribute to the development of a comprehensive Workforce Strategy. The second submission was due on 30 September 2017 but these results are not yet available. ii) Workforce & BEST A CCG wide event was held on 20 September 2017 where the workforce baseline information was shared with member practices. The workforce data was shared as part of the BEST Event and was led by Dr Mark

2

GB/Pu/17/10/10 Purvis from Health Education England. The session also looked at alternative models of skill mix and the benefits of Physicians Associates in supporting the expansion of primary care roles to better meet the increasing demands of patients. In addition to the session for all primary care staff, a further session was held for nurses where the forecasting of retirement ages and the potential future shortfall of nurses was highlighted. iii) Workforce Strategy and Planning A piece of work has commenced, building on the workforce data and the events described above, to build a workforce plan and develop a strategy to address the future requirements of Barnsley practices. This is in conjunction with Barnsley Healthcare Federation and will also build on previous GP FV workforce plans. It was recognised at the BEST event that there are many practices in Barnsley who have already made good progress in re-modelling their workforce and are proactively recruiting to new roles. As a CCG, 15 Clinical Pharmacists have also been recruited and commenced in post between August 2016 and March 2017. These pharmacists work in practices and are having a very positive impact on managing the prescribing workload in practices. A national initiative to expand numbers of the clinical workforce via international recruitment is also underway. It is likely that this work will be progressed by working together across South Yorkshire and Bassetlaw. Barnsley practices and their future needs will form part of this work programme. The CCG is in the second year of an apprenticeship scheme in partnership with Barnsley College. 15 apprentices are currently employed by Barnsley GP practices and they will focus on either Business Administration or Health Care Assistant roles. The scheme was organised, facilitated and part funded by Barnsley CCG. One further apprentice is in the process of being recruited by Barnsley Healthcare Federation.

iv) Practice Manager Leadership Development

The CCG is making good progress in supporting Practice Manager Leadership Development in 2017/18. A coach, Gail Jones, who has a wealth of experience in Practice Manager Development, has commenced a programme which has been co-designed with Barnsley Practice Managers. The programme commenced in August 2017 with a first session on ‘Managing Conflict’. The session was very well attended and evaluated well. Further sessions for the remainder of the year have already been planned into diaries.

3

GB/Pu/17/10/10 2. Workload & Care Redesign

Project plans are in place and being monitored against the 10 high impact actions described within GPFV. Many of these are linked to workforce and expanding the primary healthcare team (see section above). Brief highlights from other key areas of progress are described below: a) Active Signposting – In Barnsley, active signposting (or care

navigation) is delivered through a programme called First Port of Call Plus. Barnsley Healthcare Federation has been commissioned to deliver bespoke care navigation training for Barnsley practices and this programme of work is underway. The training comprises two visits and builds on the structure and services which each practice has. The first visits have had very positive feedback and a further 8 practices have sessions booked over the next few months. Work will take place to encourage the remaining practices to take up the training package

b) Social Prescribing – My Best Life is a borough wide Social Prescribing service which was commenced in April 2017 to enable adults to access non-medical sources of support in the community and have a holistic approach to health. The service has been commissioned by Barnsley CCG and the provider is South Yorkshire Housing Association. 460 referrals have been made up to the end of August since the service commenced in April 2017. A referral target for the first year has been set at 600 so this is likely to be exceeded based on quarter 1 data. This is a very positive outcome and is making a real difference to the patients who have been referred to the service.

c) Supporting Self Care – People need to be at the heart of their own health and wellbeing and person centred care is a priority area that is broad ranging and needs promoting widely across Barnsley. We need to find different ways of communicating and how to empower patients to take control over their own care and treatment. Dr Ollie Hart, a GP in Sheffield has recently spoken at the BEST event and the Practice Nurse forum about the importance of person centred care and the benefits for clinicians and patients. He has described the Patient Activation Measure (PAM) and how this can be used to manage practice workload to best support patients

d) Develop Quality Improvement Expertise - A cohort of ten colleagues

from NHS Barnsley CCG, Barnsley Healthcare Federation and member practices has recently completed the General Practice Improvement Leaders programme. This is a national programme arranged by NHS England which is designed to equip primary care leaders with improvement techniques and methodologies. The course was beneficial and those who attended have practiced skills in process re-design, facilitation and change management.

e) Releasing Time for Care – 10 High Impact Actions - Dr Robert Varnam, Director of General Practice Development for NHS England,

4

GB/Pu/17/10/10 is leading a number of showcase events to promote the 10 High Impact Actions. Plans are underway to host a showcase event for clinicians and managers in Barnsley during January 2018. This will also promote the work Barnsley has done to date and link up a number of local initiatives (e.g. My Best Life and iHeart 365) with the 10 High Impact Actions.

f) Promotion of GP Forward View - NHS England have released a GP

Forward View ‘Animation’ (https://www.england.nhs.uk/gp/gpfv/ )

General practice is at the heart of the care provided by the NHS. The need to invest in general practice has never felt more important for the long term sustainability of the NHS.

This animation explains the changes and additional support that are being rolled out as part of the GP Forward View and is a helpful summary for patients and practices alike.

3. Infrastructure - Estates & Technology Transformation Fund (ETTF)

Following submission of 7 bids against the ETTF fund in June 2016, 4 premises bids remain ‘live’ and are included in cohort 2 (due for completion by 31 March 2019). Nationally, it is recognised that investment from this fund has been slow to reach General Practice and CCGs have recently been approached to check that the schemes are still required and in what priority order they might be considered. Barnsley CCG is working with Community Ventures who have been procured by Community Health Partnerships (CHP) to complete “strategy light” documents. This is a sense check on the proposals submitted and may facilitate further investment to work up Project Initiation Documents (PIDs). As with workforce planning, a piece of work has also commenced to work up a more detailed strategy, based on emerging localities, for Estates. Where practices have completed bids for extensions or work, it is recommended that the PIDs are worked up at pace, ideally with additional financial support. Where practices had bid for feasibility studies, it may be that these are pended until the strategic work has been completed. A further bid was submitted for ‘mobile working’ and this was considered under the ‘technology’ part of the process. Where previously this work had not been prioritised, it is likely that this will be re-focussed with a view to utilising the national allocation effectively. A Task and Finish Group has been planned to progress this work at pace.

4. Primary Care Charter

The triple aim of the NHS’s strategic Five Year Forward View is: to improve the health of populations; to improve care patients receive and their experience of it; while delivering the best value possible for

5

https://www.england.nhs.uk/gp/gpfv/

GB/Pu/17/10/10 taxpayers. These aims are set against a backdrop of pressures, particularly those of rising demand and limited resources. These challenges require the health service to evolve and adapt to changing needs and innovations in treatment and to work in very different ways. Nationally providers and commissioners of health and care services are coming together by region to form and implement system Sustainability and Transformation Plans. The South Yorkshire and Bassetlaw footprint incorporates 5 localities: Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield. The SY&B ACS Primary Care programme is an overarching work stream that brings together key enabling work streams of Workforce, Estates and Digital as they relate to primary care and in the context of delivering the GP Forward View. Through combining existing plans to deliver the GP Forward View, the South Yorkshire and Bassetlaw footprint is working together to collate a ‘Primary Care Charter’. This document will describe the collective responses to the challenges facing primary care and how some will be delivered at “place” and some will be addressed across the wider footprint.

5. Locality Working and GP Forward View – “Next Steps”

Committee members will recollect an update in June on the publication. https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/ This document set out a clear vision to: “Encourage practices to work together in ‘hubs’ or networks. Most GP surgeries will increasingly work together in primary care networks or hubs. This is because a combined patient population of at least 30,000-50,000 allows practices to share community nursing, mental health, and clinical pharmacy teams, expand diagnostic facilities, and pool responsibility for urgent care and extended access. They also involve working more closely with community pharmacists, to make fuller use of the contribution they make. NHS Barnsley CCG has incentivised and encouraged practices to work together around existing locality structures through the 2017/18 Practice Delivery Agreement (PDA). Through the Demand Management scheme, practices are now meeting together in six geographical localities to facilitate peer review of referrals and to consider how locality working can offer benefits and resilience in the future. The first locality meetings took place on 16 August 2017 and a further 4 meetings have been scheduled before the 31 March 2018. Whilst it was recognised that practices were experiencing some difficulties with the software used to support the scheme, all localities reported that they could see benefits in working together. A clinical lead from the Governing Body has been identified for each locality, together with a lead Practice

6

https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/

https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/

GB/Pu/17/10/10 Manager. Work is also underway to develop nurse leadership along the same model. The next locality meeting will be held on 18 October 2017.

4. THE GOVERNING IS ASKED TO:

• Note the content of the report.


10 minutes.

7

GB/Pu/17/10/10 PART 1B – SUPPORTING INFORMATION 1. Links to the Governing Body Assurance Framework Risk ref(s) This report provides assurance against the following risks on

the Governing Body Assurance Framework: .

1.4 and 5.2




Y


Y



Y



NA



NA


NA


NA


NA

8

GB/Pu/17/10/11


GOVERNING BODY

12 October 2017

LIVING WITH AND BEYOND CANCER PROGRAMME UPDATE



2. REPORT OF

Name Designation Executive Lead Lesley Smith

Chief Officer


The attached paper is to highlight the progress of the Living with and beyond Cancer programme to date.


• Note the progress of the programme.

5. APPENDICES

• Living with and Beyond Cancer Programme Update


10 mins

1

South Yorkshire, Bassetlaw and North Derbyshire Cancer Alliance Board

1. Background

In November 2015 agreement was reached with Macmillan and the Commissioners Working

Together programme to work in a programme approach to implement Living with and

beyond cancer (LWABC) over five years, across the eight CWT localities. Along with

Macmillan’s experience in this field and our joint experience of working together regionally,

Macmillan committed up to £6.4m during the life of the programme to support the

transformation required to implement the programme.

The programme aim is to enable every adult living with breast, colorectal or prostate cancer

in each of the eight localities to have access to the LWABC model of care from diagnosis

onwards by 2020.

The programme was launched in April 2016, at the same time we saw NHSE launch the first

guidance “Commissioning person centred care for people affected by cancer”.

Title

Living with and Beyond Cancer programme - update for boards August 2017

Sponsor Lesley Smith, Chair of the South Yorkshire, Bassetlaw and North Derbyshire Cancer Alliance, Chair of the LWABC Programme Board and Accountable officer Barnsley CCG

Author Richard Metcalfe, Cancer Alliance lead/Macmillan Living with and Beyond Cancer Programme lead

Purpose The purpose of this paper is to highlight progress of the Living with and beyond Cancer programme to date, which can be shared with Cancer Alliance member organisation boards.

Recommendation The Board is asked to NOTE the progress of the programme and members are asked to SUPPORT by sharing this update with their own organisations board.

2

The guidance is based on:

In November 2016 the newly formed South Yorkshire, Bassetlaw & North Derbyshire Cancer

Alliance agreed Living With and Beyond Cancer as one of the four priority work streams of

the Cancer Alliance.

In December the 2017/18 and 2018/19 NHS planning guidance confirmed Living with and

beyond cancer and specifically Stratified pathways of care and the Recovery package as

a ‘must do’ in Cancer care.

In January 2017 the programme was confirmed within the Cancer Alliance delivery plan and

Cancer Alliance bid for transformation funding specifically to support the implementation of

eHNA (as part of the Recovery Package).

This funding has now been agreed meaning the total additional funding for our region to

implement Living With and Beyond Cancer is up to £6.8m.

• The Cancer Taskforce strategy (2015)

recommending the implementation of:

A. Stratified pathways of care for Breast,

Colorectal & Prostate cancer

B. The Recovery package a set of essential interventions designed to deliver a person centred approach to care for people affected by cancer.

• Whole person, whole pathway approach

• Long term condition management of Cancer

• Commissioning for the individual rather than

cancer in isolation

• Services need not be cancer specific

• Follow the principles of PERSON CENTRED

CARE

3

2. Progress to Date

It is important to emphasise there has been excellent work already in our region to progress

our understanding of cancer survivorship. The programme aims to adopt this learning along

with what is happening nationally, at scale across our programme footprint. There some

great services already in place, with committed people working to deliver support for people

affected by cancer.

Since the programme launch in April 2016 we have initiated the following governance

structure.

We are working through a locality approach, working as local place based systems with

service providers, commissioners, community and voluntary sector and with people affected

by cancer in locality teams.

To date we have approved additional funding in Bassetlaw and Rotherham with significant

progress in each of the localities.

Whilst each locality is working on how to the implement the LWABC model in their context at

‘place’, localities are also testing different approaches to the implementation (see below).

Advisory board of people affected by

cancer

Prioritisation

Panel

Programme work streams

Programme board

Learning &

development

Engagement with people affected by

cancer

Evaluation &

Intelligence

Clinical

Engagement

Communication & stakeholder

engagement

Locality teams

Barnsley Hardwick Bassetlaw Doncaster

North

Derbyshire Wakefield Rotherham Sheffield

4

Essentially the approaches are either acute or community based or a combination of both.

This learning is key to not only informing our learning across the programme as we progress

implementation, but also learning in Macmillan and nationally as part of the NHSE national

cancer transformation programme.

Our Clinical Engagement model is essential to enabling the Risk Stratification. We have

been working at a tumour site level in three groups (Breast, Colorectal & Prostate) ‘Clinical

Delivery Groups’. To date this work has involved over 150 clinicians & managers from both

providers and commissioners agreeing how to implement the new regional High value

pathways, specifically around their follow up arrangements. These pathways stratify patients

into cohorts based on clinical complexity and patients suitability for either earlier discharge,

remote follow up or shared care.

As one of the four interventions in the Recovery Package we are testing the implementation

of e-Holistic Needs Assessment across our acute trusts. There are two systems being

tested across the programme; a Macmillan web based stand-alone system and a system

which is integrated into the trusts patient management system for cancer.

The Doncaster & Bassetlaw system are leading on testing the standalone system with

Barnsley testing the integrated system approach. Both systems enable patients to either

remotely complete their own assessment prior to attending clinic or on a tablet device in

clinic; either whilst they are waiting for an appointment or with a member of the clinical team.

Based on the information provided the system identifies the patient needs, enables the

patient to score/rank their needs and generates a care plan based on those needs.

LWABC model Programme priorities

Programme management across acute &

community services,

testing the use of PAM with PABC

(Sheffield)

eHNA/ treatment summary/PROMS

(Barnsley)

Cancer Support

Worker roles, Community; Cancer Care

review, Education & Expert Pts.

(North Derbyshire &

Hardwick)

‘Opt out’ acute to

community model, whole

‘system’ (Doncaster &

Bassetlaw)

Cancer Support

Worker role, Education,

H&WB, ‘Universal

door’. Community

(Rotherham)

5

The evaluation of the impact of the programme is critical not only to enable us to

effectively implement the programme, but also to support learning in Macmillan and

nationally as part of the NHSE national Cancer transformation programme.

The way we have approached our evaluation with the Macmillan evidence team is by

developing ‘Theories of change’. Theories of change go further than logic models to

include key real life factors in systems including most fundamentally our ‘assumptions’

about how and why systems should work. Theory of change aims to:

• provide clarity about what we think a programme will achieve and how (emphasis on causality and explicit assumptions)

• enables stronger programme design, monitoring and evaluation. • should be revised over time as programmes evolve and evidence becomes

available • is ideally developed at design stage but adds value at any stage of the programme

cycle

Following a procurement process we have appointed the Tavistock institute to work with us

over the life of the programme to facilitate and support the evaluation of the programme

considering our four theories of change:

• Theory 1 - why work in a programme approach

• Theory 2 – how to bring about implementation of LWABC model

• Theory 3 – the LWABC model itself and changes it brings about

• Theory 4 – how the benefits will be sustained over time

Fundamentally this process has enabled us to ‘unpack’ the Recovery Package, to ask the

“so what?” question; by implementing the Recovery package what is the impact for people

affected by cancer and those who are working to support them, the “so what?” question.

For example when we consider Holistic Needs Assessment as just one element of the

Recovery Package. We know that one of our huge challenges is how we link people

affected by cancer to the support in their local community. Therefore being able to identify

those people with additional needs utilising a standardised assessment process sounds like

a good idea …. however

• There is a real risk of HNA being a ‘tick box’ exercise, where we introduce a process

with a target such as “70% of people have a HNA by day 31 & day 62”, with no

understanding of the benefit for people affected by cancer.

6

• At this stage there we have heard lots of ‘Person centred’ language and rhetoric, with

limited evidence of implementation.

• The system has previous experience of promoting person centred planning for

example for people with Learning Disabilities over the past 30 years. From this

wealth of experience we know that the plan is simply the first step, therefore avoiding

seeing the HNA as a process measure is critical. The HNA is simply a tool on which

to capture a conversation.

• Therefore by ‘unpacking’ the Recovery Package we know we need to focus on

‘Having ‘Conversations’ …. person centred conversations with a meaningful

shared care plan … and the elements of the Recovery Package (eg: HNA,

Treatment summary, Cancer Care review) are simply tools or enablers.

• Through testing the locality approaches we are trying to understand Who should

initiate the conversation? When and Where? should conversations happen. For

example we know from audits of existing HNA conversations in patients with multiple

needs identified:

• if conversations happen in a hospital – the uptake of support services can be as low as 0%.

• however if conversations happen in a community setting, the uptake of support services can be as high as 92%.

Engagement with People affected by cancer is key ensuring the changes we make are

grounded in the real experiences of people affected by cancer. So far the programme is:

• Utilising existing intelligence in localities and by building on what we already know

from the national, regional and local engagement work

• We have Principles for engagement with people affected by cancer – which we

consulted with the public during summer of 2016

• Building on co-production experience and skills across the footprint with up to 60

people affected by cancer per locality involved in co-designing solutions.

• Testing specific work via the voluntary and community sector organisations to

engage reach/seldom heard groups.

• Using intelligence from conversations with people affected by cancer to inform a

decision making framework at the Prioritisation panel.

• Established an Advisory board of people affected by cancer – with 11 people

affected by Cancer representing all the localities. This Advisory board is helping us

make decisions about how the programme is working.

A high level summary of progress by programme projects and locality teams can be found in

Appendix 1.

7

3. Timetable A snap shot of the high level Milestones from the programme plan can be found in Appendix 2. Our priority next steps for the remainder of 2017 include:

Progressing the agreement and modelling of follow up care through the three tumour site clinical delivery groups.

Begin testing both approaches to the use of eHNA.

Working with Bassetlaw & Rotherham on evaluation work to understand the impact of the early changes being made.

Embed the Advisory board’s role into our decision making process.

Supporting localities to agree their plans with initial investment.

Development of medium and long term learning and development offer to support changes being made across localities.

4. Recommendations The Board is asked to NOTE the progress of the programme and SUPPORT by sharing this update with their own organisations board or governing body.

8

Project/Scheme Name

Ref

Project Lead

Planned

Completion

Date

Progress

(RAG)

Comments

(Include reasons for Amber and Red assessments)

Clinical Engagement model

Hayley Williams

Ongoing

G

Lead CNS now meeting regularly. Clinical delivery groups - next meetings in August. CDGs well attended/ agreed HVP/ meet again to refine and agree risk stratification and follow up.

e-HNA/treatment summary

Hayley Williams

Ongoing

A

Funding agreed, initial meetings with partners including Barnsley as first test site to use Infoflex in May. Further testing using the Macmillan web based eHNA across Doncaster & Bassetlaw, with interest from Chesterfield & Rotherham.

Programme Evaluation

Richard Metcalfe/Sarah Allen

Ongoing

G

Tavistock Institute appointed, initial implementation meeting held, planning to start conversations with Bassetlaw & Rotherham.

Communications

Laura Boyd

Ongoing

G

Ongoing work plan, looking to develop ‘meaningful conversations’ film by December.

Engagement with PABC

Richard Metcalfe/ Ian Margerison

Ongoing

G First Advisory board 26

th July 2017.

Barnsley

Richard Metcalfe

Ongoing

G

PDD submitted following locality group support for panel conversation in August.

Bassetlaw

Richard Metcalfe

Ongoing

G

Implementation phase this quarter and evaluation conversations are starting. Exploring use of stand alone eHNA across the Doncaster & Bassetlaw system.

Doncaster

Richard Metcalfe

Ongoing

A

Locality group working toward PDD in September. Exploring use of stand alone eHNA across the Doncaster & Bassetlaw system.

Hardwick & North Derbyshire

Richard Metcalfe

Ongoing

A Follow up conversations post PDD panel approval, return to panel following locality conversations

Rotherham

Richard Metcalfe

Ongoing

G PDD 2 phase approach signed off at May Panel, now entering implementation phase.

Appendix 1

9

Sheffield Richard Metcalfe

Ongoing

A

PDD in early draft support by STHFT. Potential for initial panel conversation in September.

Wakefield Richard Metcalfe

Ongoing

G

PDD underdevelopment.

10

Phase 3 Programme

2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 Milestones Status Date Q1/2 Q3/4 Q1/2 Q3/4 Q1/2 Q3/4 Q1/2 Q3/4 Q1/2 Q3/4 Q1/2 Q3/4

Engagement on LWABC programme approach Complete Jan-16

Macmillan internal funding bid submission Complete Aug-15

Phase 3 Programme initiation document completed Complete Sep-15

Macmillan funding approval Complete Sep-15

Macmillan funding approval years 4 & 5 Mar-19

LWABC programme agreed by Working Together Complete Nov-15

LWABC launched Complete Apr-16

Programme Board and governance structure operating Complete Mar-16

Local Implementation teams in place Complete Sep-16

Local implementation plans developed Sep-17

Locality & programme testing

Proposals around Risk stratification

Case for change/business case development

Pre consultation/Consultation

Pre-implementation work & transition

Commissioning - Final specification

Full implementation

Appendix 2

GB/Pu/17/10/12


GOVERNING BODY

12 October 2017

RISK AND GOVERNANCE EXCEPTION REPORT PART 1A – SUMMARY REPORT 1. THIS PAPER IS FOR

Decision Approval Assurance Information

2. REPORT OF

Name Designation Executive Lead Richard Walker Head of Governance &

Assurance Author Kay Morgan

Governance & Assurance Manager


Introduction The Governing Body receives the full Assurance Framework (GBAF) on a quarterly basis and full Risk Register twice a year with exception reports brought to intervening meetings. In accordance with timescales the full Assurance Framework and Corporate Risk Register are presented to the Governing Body. Governing Body Assurance Framework The Governing Body Assurance Framework (GBAF) facilitates the Governing Body in assuring the delivery of the CCG’s annual strategic objectives. The GBAF is reported to every meeting of the Governing Body as part of the Risk & Governance Exception Report. Appendix 1 provides the full GBAF for members’ consideration. Corporate Risk Register The Corporate Risk Register is a mechanism to effectively manage the current risks to the organisation. This report provides the Governing Body with the full Corporate Risk Register (Appendix 2). Red (extreme) risks There are currently eight extreme risks on the CCG’s Risk Register which have been escalated to the Assurance Framework as gaps in assurance against risks on the Assurance Framework. The risks are:

1

GB/Pu/17/10/12 • Ref 13/3 (rated score 20 ‘extreme’) - BHNFT’s under performance against the

target that 95% of A&E patients are treated or discharged within 4 hours • Ref CCG 14/10 (rated score 16 ‘extreme’) – Risks resulting from the lack of

GPs in Barnsley compared with the national average • Ref CCG 14/15 (rated score 15 ‘extreme’) – Potential impact on quality &

patient safety of incomplete D1 discharge letters • Ref CCG 15/07 (rated score 15 ‘extreme’) – Quality & patient safety risks

relating to Yorkshire Ambulance Service (YAS) under achieving against the Category A response standard of 75% within 8 minutes

• Ref CCG 15/14a (rated score 16 ‘extreme’) - In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes) there is a risk that there is a risk that the service quality and safeguarding provided for the 0-19 population will be adversely affected

• Ref CCG 15/14b (rated score 16 ‘extreme’) - In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes) there is a risk that there will be a negative impact on primary care workforce and capacity.

• CCG 13/31(rated score 16 ‘extreme’) There is a risk that if the CCG does not develop a clear and robust QIPP programme, then it will not achieve its statutory financial duties.

Additions / Removals No new risks have been added or removed from the Corporate Risk Register since the September 2017 meeting of the Governing Body. The Quality and Patient Safety Committee have requested a potential new risk around the IAPT service and quality perspective is developed for inclusion on the Risk Register and that the Finance and Performance Committee to review financial aspects of continued risk of underperformance and reflect this in their own risk register.


• Review the GBAF for 2017/18, and consider whether the risks on the GBAF are appropriately described and scored, and whether there is sufficient assurance that they are being effectively managed as at 12 October 2017

• Identify any positive assurances relevant to the risks on the GBAF • Review the Corporate Risk Register to confirm all risks are appropriately

scored and described. • Identify any potential new risks.

5. APPENDICES

• Appendix 1 – GBAF 2017/18 (full)

• Appendix 2 - Corporate Risk Register (full)

Agenda time allocation for report: 10 mins

2

GB/Pu/17/10/12 1. Links to the Governing Body Assurance Framework Risk ref(s) This report provides assurance against the following risks on

the Governing Body Assurance Framework: All




Y


Y


Y


Y



NA


3.2 Consultation and Engagement Has Comms & Engagement Checklist been completed? NA Is actual or proposed engagement activity set out in the report?

NA


NA


NA


NA


NA


NA

3

05/10/2017 NHS Barnsley CCG Governing Body Assurance Framework 2017-18

FPC JW SKRisk rating Likelihood Consequence TotalInitial 3 5 15Current 3 4 12Appetite 3 4 12Approach

Rec'd?May-17

Ongoing

Ongoing

To be kept under review

To be kept under review

Ongoing

PRIORITY AREA 1: URGENT & EMERGENCY CARE Delivery supports these CCG objectives: PRINCIPAL THREATS TO DELIVERY• Front door clinical streaming• Improved patient flow• Free up hospital beds • Urgent Treatment Centres• More GP appointments evenings & weekends• Increased clinical assessment of calls to NHS 111

Highest quality governance If partners locally and across the STP do not engage constructively together, to develop a model for urgent care at a South Yorkshire and Bassetlaw and Barnsley level, in line with best practice and national guidance there is a risk that urgent care services are unable to meet the growing demand, constitution standards for urgent care are not achieved and the quality of patient care is negatively impacted

High quality health care

Care closer to home

Safe & sustainable local services

Strong partnerships, effective use of £

Links to SYB STP MOU

8.4. Urgent and Emergency Care

Committee Providing Assurance Executive Lead Clinical LeadDate reviewed Oct-17Rationale: Likelihood currently judged to be 'possible' given current pressures and challeges across the urgent care system and the developing nature of plans to deliver outcomes of the national urgent care review. Consequence is judged as major due to the potential impact on patient care.Treat

Key controls to mitigate threat: Sources of assurance Operational planning templates 2017-2019 were submitted to NHSE in December 2016 along with a planning narrative setting out plans to deliver agreed activity reductions, standards and targets.

Plan submitted to NHSE in line with required deadlines and the CCG have worked with NHSE on the final assurance of plans following initial feedback received in January 2017. received confirmation as part of CCG 2016-17 Annual Review that plans have been approved by NHSE.

A&E Board established, with representation from the CCG, to ensure oversight of performance and planning for urgent care locally and ensure delivery of urgent care standards

CCG Associate Medical Director and Head of Planning Delivery and Performance represent the CCG as members of the local delivey board.A&E Delivery Board plans assured by NHS England - October 2017

Urgent and Care Network established across South Yorkshire and Bassetlaw.Representation in place for the A&E Delivery Board partners on the Network, Steering Group and Commissioner Reference Group.

CCG Delivery of Integrated Care collection template reported by SYB Urgent and Emergency Care Network to NHS England to demonstrate progress of the Network.Oversight by the SYB UECN and locally through the A&E Delivery Board.

Developing Integrated extended hours and out of hours primary care services (IHEART 365) though contracts for both elements of service delivered by Barnsley Healthcare Federation from July 2017

A contract and contract management arrangements are in place for BHF services. The contract is being finalised to incorporate the Out of Hours specification requirements and national standards. Monitoring arrangements are in place and being refined on an ongoing basis to ensure that the CCG have a clear understanding of delivery and performance against all national standards and requirements and local specifications for all services including extended hours and out of hours. Monthy IHEART Performance Reports received by the CCG - This has been revised to reflect the changes to the service following commencement of delivery of the OOH service from July 2017.

Developing Streaming Services & remodelling A&E (UTT) in line with national guidelines and best practice through the A&E Delivery Board.

Oversight by the A&E Delivery BoardJoint workshop held between BHNFT/BCCG/BHF on development of proposals to inform final delivery model.Task and finish group in place with CCG and primary care input along with BHNFT and BHF. The group are meeting on a weekly basis through the development and mobilisation.BHF commence provision of streaming on 4th September 2017, this will be within A&E initially with a GP providing streaming. Building works are expected to be complete by October to enable the full extended streaming model, adjacent to A&E to commence.

Gaps in assurance Positive assurances received

Performance reports to Governing Body on the delivery of constitution standards and CCG Improvement and Assessment Framework.

Monthly reporting through the Integrated Performance Report to Finance and Performance Committee and Governing Body

Gaps in control Actions being taken to address gaps in control / assurance(risk ref 13/3) Failure to deliver 4 hour A&E waits target in 2016/17. October 2017 - BHNFT still not achieving the the 95% standard however performance is in line

with the agreed Sustainability and Transformation Fund trajectory for Q2. A&E Board continue to have oversight of system wide performance and delivery of A&E Improvement Plans.

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1

A

0

5

10

15

20

A M J J A S O N D J F M


PCCC JH NBRisk rating Likelihood Consequence TotalInitial 3 4 12Current 3 4 12Appetite 3 4 12Approach

Rec'd?

PRIORITY AREA 2: PRIMARY CARE Delivery supports these CCG objectives: PRINCIPAL THREATS TO DELIVERYDelivery of 'GP Forward View' and 'Forward View - Next Steps for Primary Care' to: a) deliver investment into Primary Care b) improve Infrastructure c) ensure recruitment/retention/development of workforce d) Address workload issues using 10 high impact actions e) Improve access particularly during the working week, more bookable appointments at evening and weekends.

Highest quality governance


Care closer to home




8.3. General Practice and primary care

Committee Providing Assurance Executive Lead Clinical LeadDate reviewed Oct-17Rationale: Likelihood has been scored at 3 (possible) but will be kept under review. Consequence has been scored at 4 (major) because there is a risk of significant variations in quality of and access to care for patients if the priorities are not delivered.TOLERATE

There is a risk to the delivery of Primary Care priorities if the following threat(s) are not successfully managed and mitigated by the CCG:• Engagement with primary care workforce• Workforce and capacity shortage, recruitment and retention• Under development of opportunities of primary care at scale, including new models of care• Not having quality monitoring arrangements embedded in practice• Inadequate investment in primary care • Independent contractor status of General Practice.

Key controls to mitigate threat: Sources of assurance 1. Incentivise practices to complete HEE Workforce Analysis tool 31/33 practices submitted baseline information for 30 June 2017. The workforce data will be

2. Additional investment above core contracts through PDA delivers £4.2 to Barnsley practices

Ongoing monitoring of PDA (contractual / QIPP aspects via FPC, outcomes via PCCC)3. Optimum use of BEST sessions BEST programme and Programme co-ordination4. Development of locality working GP Clinical Leads and PMs allocated to each locality. First meeting 16 August 2017.5. BHF - Existence of strong federation BHF contract monitoring, oversight by PCCC

9. Engagement and consultation with Primary Care (Membership Council, Practice Managers etc)

360 Stakeholder Survey results reported to Governing Body

6. Practices increasingly engaging with voluntary and social care providers (e.g. My Best Life) Monitor through PDA (contractual / QIPP aspects via FPC, outcomes via PCCC)

7. Progamme Management Approach of GPFV & Forward View Next steps Assurance through Primary Care Development Workstream and GPFV returns to NHSE 8. Care Navigation roll out - First Port of Call Plus BHF contract monitoring, oversight by PCCC

Gaps in assurance Positive assurances receivedNone identified

Gaps in control Actions being taken to address gaps in control / assuranceRR 15/14(b): In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes) there is a risk that there will be a negative impact on primary care workforce and capacity

October 2016CCG Chair & Chief Nurse met with colleagues from the LA. CCG Chair is part of the transition Board, meeting fortnightly overseeing the change.

RR 14/10: If the Barnsley area continues to experience a lack of GPs in comparison with the national average, due to GP retirements, inability to recruit etc there is a risk that:(a) Some practices may not be viable, (b) Take up of PDA or other initiatives could be inconsistent (c) The people of Barnsley will receive poorer quality healthcare services(d) Patients services could be further away from their home.

Aug 17BCCG now has a baseline of the Primary Care workforce following the 30 June 2017 submission for baseline data via the HEE Tool. The next step is for the CCG to present the data at a BEST event supported by Mark Purvis from HEE to interpret what the data means. The CCG will then work with member practices to address any gaps/ variance and to develop a workforce plan going forward.

Primary and Community Workforce Shortages to deliver out of hospital strategy SY Workforce Group in place; STP has a workforce chapter developed in collaboration with CCG's, HEE, providers and Universities.

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1

2

A0

10

20



FPC JH Dr H Kadarsha

Risk rating Likelihood Consequence TotalInitial 3 4 12Current 3 4 12Appetite 3 4 12Approach

Rec'd?

Sep-17

Aug-17

Jul-17

Aug-17

Cancer services are have detailed and copious volumes of data from a variety of areas including Dr Foster, PHE and NHSE, as well as local BI and Provider data in Open Exeter. Whilst we do not believe that additional information will be required to identify compliance additional information will be brought to bear as appropriate and necessary to interrogate specific areas.

62 performance compliant in June 2017.

Gaps in control Actions being taken to address gaps in control / assurance

Drive LWABC in Barnsley to deliver Survivorship program Delivery of LWABC Delivery Plan monitored by CAT team and reported via FPC Subject to Combined strategy with Primary Care and inclusion in PDA PDA delivery monitored by F&PC Subject to agreement to include in PDA in 2018/19


2. Early diagnosisComms / Public Health Strategy to reach affected communities Evidence of effective engagement (reduced screening inequalities, reduced late / A&E

diagnosis, Primary Care Audit of late / A&E diagnosed cancers)

Routine monitoring of performance in respect of early cancer diagnosis Via Intergrated Performance Report to FPC and by exception to GB, and via NHSE IAF clinical priorities published on MyNHS

3. LWABC

1. 62 Day wait targetRecovery plans (if necessary) in place with local providers Barnsley Acute Trust and CCG are delivering against 62 day target. Contributed to Alliance 62

day recovery plan

Sign off and mobilise inter Trust transfer policy Acute Trust and CCG agreed the Inter Provider Tranfer Policy. Policy to be included in contract.

Routine monitoring of performance against 62 day wait NHS Constitution target Barnsley is compliant against the 62 day standard

Key controls to mitigate threat: Sources of assurance Overall arrangementsDevelopment of delivery programme and bids to deliver prevention, early diagnosis, and LWABC

Secure cancer transformation funding (TBC) for prevention, early diagnosis, and LWABC Bid Reporting arrangements for delivery of cancer priorities - Barnsley Cancer Steering Group

Chaired by Clinical Lead and responsible for providing assurance through SSDG


8.6. Cancer

Committee Providing Assurance Executive Lead Clinical Lead

Date reviewed Oct-17Likelihood has been scored at 3 (possible) because, while the CCG met the 62 day target in 2016/17 Barnsley's performance in respect of early diagnosis is lower quartile compared with other Y&H CCGs. Consequence scored at 4 (major) because of the potential negative impact on the quality of services for the people of Barnsley if the risks are not managed and mitigated.

Tolerate

PRIORITY AREA 3: CANCER Delivery supports these CCG objectives: PRINCIPAL THREATS TO DELIVERY• Reduced Inequalities • Better cancer survival • Speed up and improve diagnosis • Faster test results • Access to the most modern cancer treatment in all parts of the country • Improve Patient Experience • Deliver Survivorship Program (LWABC)• Commissioning for Value

Highest quality governance 1. Risk to delivery of the 62 day wait NHS Constitution standard if clear pathways from cancer diagnosis to treatment are not developed and shared by partner 2. Risk to delivery of early diagnosis if:(a) the CCG does not effectively promote to the people of Barnsley the national screening programme(b) Practices do not consistently apply NICE guidance for cancer diagnosis and referral. 3. Risk that, if the CCG does not have a clear local strategy for delivering cancer priorities, the CCG may not get access to cancer transformation funding which would impact negatively on securing improvements to services for people Living With and Beyond Cancer (LWABC).4. Risk that the incidence of cancer is not reduced, and of poorer outcomes post treatment, if steps to promote healthy lifestyles for Barnsley people are not successful.


Care closer to home



0

10

20



FPC & QPSC BR Dr M SmithRisk rating Likelihood Consequence TotalInitial 4 3 12Current 4 3 12Appetite 4 3 12Approach

Rec'd?


8.5. Mental Health & Learning Disabilities

PRINCIPAL THREATS TO DELIVERY

Clinical LeadDate reviewed Oct-17Rationale: Likelihood set as 4 (likely) because delivering the required improvements in mental health outcomes of the local population is dependent upon additional financial resources and a fully trained, accessible workforce. A number of bids to access national funding early (e.g. Integrated IAPT) have been unsuccessful which will delay the ability to increase access to these services, thereby delaying the potential savings associated with the improved outcomes. In order to increase access to Mental Health services, the capacity of the mental health services needs to be increased, primarily by increasing the workforce. There are limited, accredited training courses available locally which limits the abilitry of the service to grow. Consequence set as 3 (moderate) because the mitigated actions outlined will enable mental health services to provide, good quality outcomes and be in a state of readiness to effectively utilise the additional resources as and when they become available. NB Rising clinical need is escalated and responded to.

Tolerate

Service provider developing robust workforce plans in conjunction with Health Education England

Key controls to mitigate threat: Sources of assurance IAPT - Implement NHS England's Demand and Capacity modelling; NHS Englands IAPT Intensive Support Team to undertake a full diagnositc service review

CQC Inspection reports, monitored via Adult Joint Commissioning Group (see note 1)

Quarterly Assurance reports / feedback to NHS England, June Overview & Scrutiny Committee; monitored by C&YPT ECG (see note 2).

Recurrent investment into the continued development of '4:Thought' and performance of CAMHS closely monitored by C&YPT ECG

Commission services collaboratively / hub and spoke model to share resources (incl workforce) - Barnsley leading STP work on adult ASD

Monitored via Adult Joint Commissioning Group (see note 1)Embed social prescribingBarnsley will bid for monies for 24 hour liaison compliance in Wave 2 funding round (during 2018) as advised by NHS England, Crisis Care Concordat Groupkeeps multiagency focus

SYB STP Reporting Framework

SYB STP Reporting Framework

Benchmarking data (Public Health Fingertips), monitored via Adult Joint Commissioning Group (see note 1)

Perinatal Mental Health - Barnsley are part of the successful £2.1m bid of the Specialist Development Fund enabling the Specialist Mental Health Midwife post at BHNFT to be fully funded and the development of a 'hub and spoke' Specialist Perinatal MDT team covering the SWYPFT footprint

MHFYFV Dashboard, monitored via Adult Joint Commissioning Group (see note 1)

Service providers developing in-house training programmes (IAPT)

Actions being taken to address gaps in control / assurance


Monitored via Adult Joint Commissioning Group (see note 1)

Note (1) - Adult Joint Commissioning group minutes go to F&PC for information. It reports into the Health & Wellbeing Board which is attended by the CCG CO and Chair and minutes go to GB. Note (2) - the Childrens & Young People's Trust ECG minutes go to F&PC for information. It reports via TEG to H&WB which is attended by the CCG Chair and CO and minutes go to GB. Specific issues may be raised with GB via quarterly Children's Services updates.

If the CCG and its partners are unable to manage and mitigate the potential barriers to improving mental health services - lack of workforce capacity, limited financial resources, and legacy 'backlogs' - there is a risk that the CCG's ambitions for these services will not be achieved.

Gaps in control

Committee Providing Assurance Executive Lead

PRIORITY AREA 4: MENTAL HEALTH Delivery supports these CCG objectives:



Care closer to home

• Increase the number of children and young people receiveing evidence-based treatment to improve their emotional health and wellbeing • Improve access to psychological therapies (IAPT) from 15% of the local population suffering from depression to 25% by 2020 and improve the IAPT recovery rate to achieve national targets as a minimum; Improve pre and post mental health crisis care support • Crisis care: extend the Liaison Mental Health service in A&E to include children and young people; Implement the Police and Crime Act 2017; Reduce the numbers of suicides in Barnsley to the national average as a minimum • Improve perinatal mental health • Develop robust pathways for adults with ASD / ADHD



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FPC, ACSDB LS NBRisk rating Likelihood Consequence TotalInitial 3 3 9Current 3 3 9Appetite 3 4 12Approach

Rec'd?Apr-17

Jul-17

Aug-17

Aug-17

Dec-17

Sep-17

Apr-18

Mar-18

Gaps in control Actions being taken to address gaps in control / assurance


Alliance contract in place for 2017/18 and 2018/19 for the following integrated service pathways: Neighbourhood nursing, intermediate care, diabetes and respiratory services

Alliance contracts signed off by BHNFT, SWYFT and BHF

As set out in STP MOU legal partnership agreement in place to underpin the Barnsley Accountable Care Partnership arrangements, by April 2018

Legal Partnership Agreement developed and agreed by Governing Body and system partners

Adherence to NHS England's Integrated Support and Assurance Process (ISAP) best practice guidance for the development of accountable care solutions and the associated contractual process, to support the development of accountable care in Barnsley

Progress monitored through Accountable Care Partnership and at Governing Body and through NHSE's CCG Assurance Process

Partner agreement to create an Accountable Care Shadow Delivery Board (ACSDB) in Barnsley to support delivery of accountable care

Agreed at Accountable Care Partnership and subsequently taken to all partnership boards for agreement

Accountable Care Shadow Delivery Board (ACSDB) established October 2017 Agreed at Accountable Care Partnership and subsequently taken to all partnership boards for agreement

Review and revise the terms of reference for accountable care committees & groups in light of establishment of ACSDB

Revised terms of reference agreed at ACSDB and subsequently shared with Governing Body

Key controls to mitigate threat: Sources of assurance Accountable Care Partnership in Barnsley established in early 2016/17. Accountable Care Partnership meeting update shared with Governing Body

STP Memorandum of Understanding signed by all parties in place outlining sign up to direction of travel in system and in place, recognising journey to local accountable care partnerships

STP MOU signed off by Governing Body and all Parties to the STP

Clinical LeadDate reviewed Oct-17Rationale: Likelihood has been scored at 3 (possible) because individual organisation will be required to deliver on their statutory duties and prioritise these over partnership commitments. Consequence has been scored at 3 (moderate) because whilst we would not be able to harness the full benefits of integrated health and care the commissioning and provision of health and care services for Barnsley people would continue.

Tolerate


CCG contributions to system wide working & enabling work streams: Leadership and programme support


8.7 Workforce; 8.8 Digital & IT; 8.9. Development of Accountable Care in Place & System; 8.10. Commissioning reform; 8.11. Sustainable Hospital Services Review

Committee Providing Assurance Executive Lead

PRIORITY AREA 5: STP & ACCOUNTABLE CARE Delivery supports these CCG objectives: PRINCIPAL THREATS TO DELIVERYSystem Level:There is a shared view that in order to transform services to the degree required to achieve excellent and sustainable services in the future, we need a single shared vision and plan in each Place and across South Yorkshire and Bassetlaw. Partners from across health and social care in each Place have come together to develop a single shared vision and plan as part of an Accountable Care System.

Highest quality governance If the CCG and its partners in Barnsley are unable to maintain partner buy-in and agreement; AND / OR if individual organisational barriers and statutory duties prevent partners from remaining focussed on the journey towards accountable care; there is a risk that the ambition for the people of Barnsley to see one NHS and care system and truly integrated services; will not be achieved.


Care closer to home


Place level: development of Accountable Care Partnership which brings Barnsley service providers and commissioners together to plan and deliver care for our population and make best use of the Barnsley £

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A M J J A S O N D J F M0

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A M J J A S O N D J F M0

5

10



FPC RN VariousRisk rating Likelihood Consequence TotalInitial 3 4 12Current 3 4 12Appetite 3 4 12Approach

Rec'd?Mar-17

May-17

Ongoing

Oct-17

Gaps in control Actions being taken to address gaps in control / assuranceRisk Reference 13/31: There is a risk that if the CCG does not develop a clear and robust QIPP programme, then it will not achieve its statutory financial duties

Development of QIPP programmes and savings schemes to be overseen by PMO. Monthly Reports on the CCG’s financial position and forecast outturn to Finance and Performance Committee and Governing Body as part of Integrated Performance Report. Review of budgets undertaken to release to the efficicency programme where committments have not yet been agreed.

Gaps in assurance Positive assurances receivedYear to date as at Month 5 (August 17) has achieved £7m of the £11.5m target, plans now in place to deliver £11.4m of the total target.

Plans now in place to deliver £11.4m of the £11.5m target, with £7m being delivered to Month 5.

Delivery supports these CCG objectives:

Internal Audit (360 Assurance) will follow up recommendations from 2016-17 QIPP reviewMonthly reports to Finance & Performance Committee and Governing BodyFindings will be reported through Audit Committee

8.2. Managing demand and demand management 8.1. Efficiency programmes

Key controls to mitigate threat:

PRIORITY AREA 6: EFFICIENCY PLANS • Free up hospital beds• Best value out of medicines and pharmacy• Reduce avoidable demand• Reduce unwarranted variation in clinical quality and efficiency• Cut the costs of corporate services and administration• Financial accountability and discipline for all trusts and CCGs

PRINCIPAL THREATS TO DELIVERYIf the CCG does not develop a robust QIPP plan supported by effective delivery & monitoring arrangements, there is a risk that the required QIPP savings will not be achieved, resulting in a failure to achieve statutory financial duties and non compliance with NHSE business rules.

Executive Lead Clinical Lead



Care closer to home




QIPP Delivery Group established to maintain oversight of the QIPP programme

Sources of assurance NHSE 'deep dive' on financial plan & PMO delivery arrangements provided independent assuranceF&PC has scrutinised proposed monitoring approach & made recommendations to GB

External support engaged to assist CCG staff in identification of QIPP opportunities, development of QIPP plan, and establishment of arrangements for monitoring & delivery.

Progress reports to QIPP Delivery Group

Committee Providing Assurance

OngoingPMO established to maintain operational oversight of QIPP ProjectsStructured project management arrangements developed to support delivery

Date reviewed Oct-17Rationale: Likelihood currently judged to be 'possible' but will be kept under review. Consequence judged to be 'major' in light of potential impact on statutory duties, performance ratings, and organisational reputation.Tolerate

0

20



FPC JH VariousRisk rating Likelihood Consequence TotalInitial 3 4 12Current 3 4 12Appetite 3 4 12Approach

Rec'd?

PRIORITY AREA 6: EFFICIENCY PLANS Delivery supports these CCG objectives: PRINCIPAL THREATS TO DELIVERY • Free up hospital beds• Best value out of medicines and pharmacy• Reduce avoidable demand• Reduce unwarranted variation in clinical quality and efficiency• Cut the costs of corporate services and administration• Financial accountability and discipline for all trusts and CCGs

Highest quality governance If the CCG does not develop a robust Demand Management and PDA scheme supported by effective delivery & monitoring arrangements, there is a risk that anticipated QIPP savings will not be achieved, and that inequalities in the quality and accessibility to healthcare services across Barnsley will remain. Specific threats include: • Practices may not sign up to the PDA and the Demand Management Scheme or engage with the Map of Medicine tool • Practices may not engage or fully deliver the expected savings. • The initial modelling of the expected reduction in activity may not be correct and will not deliver the expected reduction in activity. • Unknown referral baselines - referrals from some practices may increase.


Care closer to home




8.2. Managing demand and demand management 8.1. Efficiency programmes

Committee Providing Assurance Executive Lead Clinical LeadDate reviewed Oct-17Rationale: Likelihood has been scored at 3 (possible) because this is a multi-faceted programme with a number of projects underneath. Delivery depends on both primary and secondary care compliance and also that the modelling will delivery the expected reductions. Consequence has been scored at 4 (major) because there are significant cost reductions attached to delivering this program which contribute a significant threat to the CCG's QIPP target if they are not met. It will also result in variations in access to care for patients.

Tolerate

Key controls to mitigate threat: Sources of assurance Clinical thresholds (phase 1) and 50+ best practice pathways published on Map of Medicine in place from 1 April and updated on an ongoing basis.

1. Primary Care ReferralsReal time usage information from Map of Medicine; including practice specific information relating to referrals made using the MoM referral forms.

2. Secondary Care ProceduresMonthly retrospective audit of secondary care providers on sample basis to assure compliance.

3. CCG Monitoring InformationFinance and activity information supplied to practices will also to support updates and reporting to QIPP group. This data can be compared with Map of Medicine data to understand compliance, usage and areas to target.

The use of Map of Medicine system as a tool to support adherence to CCG policies under the demand management scheme.

Referral and activity information provided by BI - will be reviewed on a monthly basis by demand management group (project lead and finance) and reported to the QIPP group.

The Demand Management incentive scheme in the PDA to support practice based change:- Regular locality peer review meetings to support referring practitioners to review referral patterns in practice and to identify opportunities where behaviour can be changed.- Practices to have access to their own referral and activity data via an individual practice pack detailing baseline activity and associated finance data updated on a monthly basis.

Via the PDA the CCG has provided continues to provide practices with a suite of support tools (pathways, activity and referral data, peer review and locality meetings, MoM tool) to support success in this area. Furthermore there will be contract monitoring against the PDA requirements including a review of local review meeting attendance register, meetings now scheduled bi-monthly (August 17 to April 18 ) via the BEST process

A standard NHS Contract will be in place Compliance with the contractual requirements in the PDA to be monitored by Primary Care Team and reported via Finance & Performance Committee

Development of Clinical Thresholds (phase 2) as part of a South Yorkshire wide commissioning for value policy.

As part of the South Yorkshire and Bassetlaw Elective and Diagnostic Sustainability and Transformation work stream a working group of South Yorkshire commissioners has been established to review and bring together similar commissioning policies from across the region with the aim of reducing variance between individual CCG policies by producing a standardised ‘commissioning for outcomes’ policy.

In addition to offering more equitable access for patients, this approach will reduce the number of policies providers are required to operate and support consistent implementation.

The CCGs Governing Body approved the principle of working towards a convergent policy at its August Governing Body meeting.

This standardised set of policies and approach will cover the following policies:• Wave 1 Clinical Thresholds (adopted 1 April 2017)• Existing Common Prior Approval Policies (varicose veins, insertion of grommets, and tonsillectomy)• Wave 2 Clinical Thresholds• Existing Plastics and Fertility Policies• Additional Policies Suggested by Doncaster and Bassetlaw CCGs

Gaps in control Actions being taken to address gaps in control / assuranceRisk Reference 13/31: There is a risk that if the CCG does not develop a clear and robust QIPP programme, then it will not achieve its statutory financial duties

Development of QIPP programmes and savings schemes to be overseen by PMO. Monthly Reports on the CCG’s financial position and forecast outturn to Finance and Performance Committee and Governing Body as part of Integrated Performance Report

Gaps in assurance Positive assurances received2/5/17 - At the Practice Managers meeting today practices are still highlighting IT issues with MoM and are concerned how they will achieve the targets set within the PDA.

Support from MoM and CCG staff to ensure issues are resolved. A willingness of most practices to make this work. Practice Managers have asked for a one off meeting to discuss the PDA and in particular the Demand Management Scheme. Representation from the CCG will attend including the lead on MoM to iron out the issues identified. A Q&A and process list will be formulated to support practices in the implementation and ongoing use of MoM.In addition to the Q&A, a series of 'how to' step by step user guides have been circulated to practices to address the common iss es The majorit relate to the integration bet een MoM

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2

A0

1

2

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1

A0

10

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QPSC BR MG / SKRisk rating Likelihood Consequence TotalInitial 3 5 15Current 3 5 15Appetite 3 4 12Approach

Rec'd?

PRIORITY AREA 7: PATIENT SAFETY Delivery supports these CCG objectives: PRINCIPAL THREATS TO DELIVERY • Reduced HCAI in Providers beyond MRSA bacteraemia and C.Difficile• Improved maternity safety by delivery of Better Births within the STP• Ensuring Providers implement Learning from deaths via mandated Death Reviews • Reduced medication errors in Providers

Highest quality governance 1. Maternity reconfiguration is dependent on STP providers cooperating and likely to be strongly contested by the public. 2. Providers have a significant challenge to change culture for Learning from Deaths to be meaningfully adopted


Care closer to home




Committee Providing Assurance Executive Lead Clinical LeadDate reviewed Oct-17Rationale: Whilst all the work has national momentum driving it historically all aspects have proved hard to do therefore we must consider that the risk of not achieving is possible; given the nature of the risks the consequence will always be in the catostrophic category Treat

Key controls to mitigate threat: Sources of assurance Provider reports relating to HCAIs, SIs, medication errors received and reviewed by the CCG Quality & Patient Safety Committee (Q&PSC) oversees QA of provider Sis

CCG on Barnsley Health Protection Board (HPB) which reports to Health & Well Being Board (H&WBB) and minutes seen at Q&PSC

Minutes of all relevant committees seen at Q&PSC

Clinical Quality Board (CQB) for each Provider reports to Q&PSC CQB reports and relevant CQC inspection reports taken to Q&PSCProcess to resolve risk 14/15 with Area Prescribing Committee (APC) which reports to Q&PSC Montitored via Q&PSC

Q&PSC report to the Governing Body Q&PSC Highlights Report and Annual Assurance ReportCCG represented on both Safeguarding Boards which report to the H&WBB Proceedings summarised at Q&PSC via Patient Safety reports, would be escalated to GB by

exception. Minutes of safeguarding boards publicly available via QPSC website.CCG participates in the South Yorkshire & Bassetlaw Quality Surveillance Group (QSG)

Gaps in assurance Positive assurances receivedPrimary Care SEAs are not mandated to come to the CCG and those that do are of variable quality Review of BHNFT position re Better Births in Summer 2016 indicated that all aspects within

BHNFT's gift (i.e. outwith STP decisions) could be positively evidenced and subsequent Dashboard data reflects this being sustained

Gaps in control Actions being taken to address gaps in control / assuranceProvider processes from Learning from Deaths process yet to be confirmed, CCG seeking positive evidence of the support and communicaition of bereaved families and carers

This will be pursued by CQBs

(risk ref 14/15) Potential for harm to patients due to scant or absent information re why medication changes have been made on D1 discharge letters, or resulting from medication reconciliation work not being done robustly.

June 2017 re-audit undertaken in April 2017 will be reported to APC subsequent to the single item Quality Review Meeting held on 18/08/16 with the CCG, NHSE and the Trust.

March 2017 Audit of Quality Monitoring of Primary Care Providers only able to offer limited assurance Action Plan in place to articulate tools utilised and routes of escalation

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2

A0

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Initial Risk Score Residual

Risk Score

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Mitigation/Treatment Lead Owner of the risk

Source of Risk

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CCG 13/3

1,3, 5,6, 8

If the system, via the A&E Delivery Board fails to deliver and sustain improvement in BHNFT’s performance against the target that 95% of A&E patients are treated or discharged within 4 hours there is a risk that the Trust will not meet the level of performance required to achieve its Sustainability and Transformation Funding and also that the CCG will fail to deliver the NHS constitution standard and there will be a

4 5 20 Health Community whole system wide response lead by the CCG Health Community whole system wide response lead by the CCG A&E Delivery Board established A&E Improvement Plan Daily Reporting Winter & Bank Holiday Planning arrangements IHEART Barnsley established and operational offering out of hours GP appointments on evenings and Saturdays

JW

(Finance & Performance Committee)

Risk Assessment

5 4 20 09/17 September 2017 Performance against the 4 hour standard has improved in September. Performance as at 21 September was 95.85% and for Q2 to the same date was 94.41% against an STF target of 94%. August 2017 Performance against the 4 hour standard dipped in August. Performance as

10/17

Domains 1. Adverse publicity/ reputation 2. Business Objectives/ Projects 3. Finance including claims 4. Human Resources/ Organisational Development/ Staffing/

Competence 5. Impact on the safety of patients, staff or public

(phys/psych) 6. Quality/ Complaints/ Audit 7. Service/Business Interruption/ Environmental Impact 8. Statutory Duties/ Inspections

Likelihood Consequence Scoring Description Current Risk No’s

Review

Almost Certain 5 Catastrophic 5 Red Extreme Risk (15-25) 7 Monthly Likely 4 Major 4 Amber High Risk (8- 12) 18 3 mthly Possible 3 Moderate 3 Yellow Moderate Risk (4 -6) 7 6 mthly Unlikely 2 Minor 2 Green Low Risk (1-3) 3 Yearly Rare 1 Negligible 1

Total = Likelihood x Consequence

The initial risk rating is what the risk would score if no mitigation was in place. The residual/current risk score is the likelihood/consequence (impact) of the risk sits when mitigation plans are in place

RISK REGISTER – October 2017

1


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Source of Risk

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reduction in the Quality Premium payable to the CCG.

Implementing plans to establish strengthened GP Streaming in ED in line with national expectations. BHF commenced provision of service in September 2017 in ED but with a GP providing the service December 2017 in new separate primary care area adjacent to ED following building works. IHEART 365 service established, bringing together extended access and OOH GP services.

at 21 August was 91.31% and for Q2 to the same date was 93.69% against an STF target of 94%. July 2017 Performance against the 4 hour standard has improved in July. Performance as at 18 July was 95.31% The STF trajectory for Q2 is 94% Quarter 1 to date is 90.78%.

15/14(b)

4 In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes) there is a risk that there will be a negative impact on primary care workforce and

4 4 16 As for risk 15/14(a) Monitoring at practice level delivery of 0-19 KPIs in relation to practice contracts, utilizing identified escalation routes when core service KPIs are not delivered in real time.

MG

(Primary Care

Commissioning

Committee)

Governing Body

4 4 16 09/17 September 2017 Director of Public Health agreed to share BMBC’s mitigating actions in relation to the 0-19 service with the CCG August 2017 See 15/14(a) and

10/17

2


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

capacity.

A Governing Body Development Session on 27 April 2017 with service leads agreed to establish a co-production Group with CCG involvement to work on service model The Practice Managers Group are being regularly updated with the 0-19 pathway

(c) below. July 2017 See 15/14(a) below June 2017 Awaiting Update May 2017 A Governing Body Development Session on 27 April 2017 with service leads agreed to establish a co-production Group with CCG involvement to work on service model

15/14(a)

5, 6 In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes)

3 4 12 Membership of Children & Young people’s Trust Oversight through Children & Young People’s Trust ECG Promoting dialogue and

BR

(Quality & Patient Safety

Committee)

Governing Body

4 4 16

09/17 September 2017 (refer also 15/14(c)) EEC reviewed risk 15/14 c and agreed increase the risk score

10/17

3


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

there is a risk that the service quality and safeguarding provided for the 0-19 population will be adversely affected.

shared ownership as commissioners with Public Health The Practice Managers Group are being regularly updated with the 0-19 pathway

from 3x3=9 to 4x4=16. The May Governing Body session did not provide assurance re the co-production model development and we are awaiting confirmation of next steps. There was no evidence of access or outcome reduction via data provided to the Children & Young Peoples Executive Commissioning Group (quarterly). The Practice Manager Governing Body Member and Dr Mark Smith, Governing Body Member were now picking up this work on behalf of the

4


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

CCG. August 2017 See 15/14(c) July 2017 May Governing Body session did not provide assurance re co-production of model development; awaiting confirmation of next steps tbc. No evidence of access or outcome reduction via data provided to ECG (quarterly)

CCG 14/10

2, 5, 6

If the Barnsley area continues to experience a lack of GPs in comparison with the national average, due to GP retirements, inability to recruit etc there is a risk that:

3 3 9 NHS England’s Primary Care Strategy includes a section on workforce planning The CCG’s Primary Care Development Programme has a workforce workstream. Links have been developed

MG

(Primary Care

Commissioning

Committee)

Governing Body

4 4 16 09/17 September 2017 Position remains the same August 2017 Position remains the same July 2017

10/17

5


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

(a) Some practices may not be viable,

(b) Take up of PDA or other initiatives could be inconsistent

(c) The people of Barnsley will receive poorer quality healthcare services

(d) Patients services could be further away from their home.

with the Medical School to enhance attractiveness of Barnsley to students The CCG continues to invest in primary care capacity. The PDA enables practices to invest in the sustainability of their workforce. The innovation Fund saw £0.25m invested in developing new, more efficient and flexible ways of working. The successful PMCF has enabled additional capacity to be made available outside normal hours via the I heart Barnsley Hubs. The CCG is also creating 4 GP fellowships in partnership with SWYPFT. The Workforce Summit Plan. GP Forward View

Position remains the same June 2017 Position remains the same May 2017 Position remains the same March 2017 Position remains as at January 2017 February 2017 Position remains as at January 2017 January 2017 Clinical Pharmacist posts have all been filled.

14/15 1, 5, 6

There are two main risks: 1. Scant or absent information relating to why medication

4 4 16 Ongoing discharge medication risks escalated to BCCG Chief Officer and Chief Executive of BHNFT resulted in 2 quality risk meetings (August and

MG


Committee)

Risk Assessment &

audit of discharge

letters

3 5 15 09/17 September 2017 The audit criteria to be agreed with BHNFT on 13 September 2017 and audit to start

10/17

6


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

changes have been made. Poor communication of medication changes , even if changes are appropriately made for therapeutic/safety reasons, creates a patient safety risk when post discharge medicines reconciliation is being undertaken by the GP practice. The risk being that the GP practice may either accept inappropriate changes when all the patients’ risk factors have not been accounted for by the hospital clinicians or an error has been made or not accept clinically important changes as not confident about the reasons for the change. 2. Clinically significant

November 2016) Area Prescribing Committee (APC) monitor concerns and will report 2017 audit to the Quality & Patient Safety Committee A working Group (with reps from Practice managers Group & BHNFT) looking at D1 Discharge Summary Letters.

immediately. June 2017 Awaiting BHNFT agreement on audit criteria May 2017 Timescales slipped by one month

7


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

safety alerts, such as contraindicated combinations of medication, are being frequently triggered by primary care prescribing systems during post discharge medicines reconciliation when adding medicines to the Patients Primary Care Record. This indicates that either the hospital is not reconciling medicines using the GP Practice Summary Care Record or that the reconciliation is not sufficiently robust.

CCG 15/07

1,5,6

If improvement in Yorkshire Ambulance Service (YAS) performance against the Category A response standard (75% within 8 minutes for Barnsley residents) is not secured and sustained, there is a

4 5 20 July 2016 Regular consideration of YAS incident reporting by QPSC and GB to understand the frequency and severity of incidents associated with ambulance response.

BR


Committee)

Risk Assessment

3 5 15 09/17 September 2017 No additional information to alter the risk July 2017 In two reviewed incidents no evidence of system pressure

10/17

8


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

risk that the quality and safety of care for some patients could be adversely affected.

compromising safety (both attributed to human safety factors) June 2017 No additional information to alter the risk

15/14(c)

1 In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes) there is a risk that the CCG will suffer reputational damage, given the public’s natural assumption that the NHS (CCG) has direct agency over the 0-19 pathway.

3 3 9 Liaise closely with Public Health on a proactive communication strategy Raise through the Patient Council A Governing Body Development Session on 27 April 2017 with service leads agreed to establish a co-production Group with CCG involvement to work on service model

BR

(Equality and Engagement Committee)

Governing Body

4 4 16 09/17 September 2017 On 14 September 2017 the Governing Body agreed to increase the risk score for this risk August 2017 EEC reviewed risk and agreed increase the risk score from 3x3=9 to 4x4=16. The May Governing Body session did not provide assurance re the co-production model development and we are awaiting

10/17

9


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

confirmation of next steps. There was no evidence of access or outcome reduction via data provided to the Children & Young Peoples Executive Commissioning Group (quarterly). The Practice Manager Governing Body Member and Dr Mark Smith, Governing Body Member were now picking up this work on behalf of the CCG. May 2017 A Governing Body Development Session on 27 April 2017 with service leads agreed to establish a co-production Group

10


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

with CCG involvement to work on service model

CCG 13/31

1,2, 3, 8

There is a risk that if the CCG does not develop a robust QIPP plan supported by effective delivery and monitoring arrangements, the CCG will not achieve its statutory financial duties and NHS England business rules.

3 4 12 A Programme Management Office is established with monthly reports on progress against targets through revised organizational governance arrangements : QIPP Delivery Group reporting to Finance and Performance Committee and onward to Governing Body. Monthly Reports on the CCG’s financial position and forecast outturn to Finance and Performance Committee and Governing Body as part of Integrated Performance Report (IPR) Robust financial management is in place for each area of budget withmonthly budget meetings to identify variances from budget and mitigating actions. Development of further QIPP programmes and savings

RN

Governing Body

(Finance &

Performance Committee)

Risk Assessment

3 4 12 09/17 September 2017 Governing Body approved the reduction of the residual score to 12, recognizing the work that had been undertaken and the reduction in the financial gap to 0.1m. August 2017 A Review of budgets has been undertaken with further uncommitted budgets released to the CCG’s QIPP Programme. The Programme Management Office continues to explore all potential areas for QIPP to ensure

12/17

11


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

schemes to be overseen by Programme Management Office. Budget Holders receive training and support from the finance team to allow variations from plan and mitigating actions to be identified on a timely basis. Prime Financial Procedures and Standing Orders are in place

Internal Audit Reports on general financial procedures and Budgetary Control Procedures (including review of shared service functions) Annual Governance Statement Local Counter Fraud Specialist Progress Reports to Audit Committee Annual Report & Accounts subject to statutory external audit by KPMG, reported via Annual Governance (ISA260) Report, and Annual Audit Letter.

full delivery in 2017/18. July 2017 The Programme Management Office has commenced review of ‘Amber’ and ‘Red’ rated schemes to ensure that the financial gap of £0.8m is met. Other schemes in the pipeline are also being explored.

12


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

Monthly monitoring reporting to NHS England Internal Audit (360 Assurance) to follow up recommendation from 2016/17 QIPP review.

CCG 13/10

1,5, 6, 8

If the improvement in the HSMR for BHNFT is not maintained there is a risk of excess deaths occurring.

Clinical Risk

5 5 25 Mortality review meetings in place within the organisation. The CCG Medical Director is a member of the Mortality Steering Group at BHNFT.

Aqua Review completed. Action plan and regular Reports to BHNFT Trust Board.

Action Plan has been shared with the CCG is reviewed by QPSCon a quarterly basis.

MG


Committee)

Risk Assessment

2 4 12 09/17 September 2017 Reviewed by QPSC Sep-17. Agreed to reduce likelihood score from 3 to 2 in light of continued improved, good performance by BHNFT in this area. June 2017 Review scheduled for 3 August 2017 Q&PSC February 2017 No change – Q&PSC to review this risk November 2016- Remains as at

12/17

13


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

August and noted at Nov CQB by BHNFT to relate to sepsis bundle work.

CCG 14/3

2 If the CCG fails to secure Practice Manager engagement there is a risk that the Primary Care development project will fail to deliver transformation. (eg that investments new diagnostic equipment will not deliver the intended benefits).

3 4 12 CCG Involvement with Practice Manager meeting to facilitate engagement and deliver transformation CCG involvement with Practices on Primary Care Development Group

CW

Finance & Performance Committee

Risk Assessment

3 4 12 08/17 August 2017 The CCG continues to have strong engagement from Practice Managers. This month the CCG has commenced roll out of a Practice Manager Development Programme which has been fully booked. The Primary Care Team continues to build and develop good relationships with Practice Managers and the wider practice teams. May 2017 Positive work

11/17

14


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

continues with Practice Managers, and engagement through the Practice Managers Group is strong.

CCG 14/7

1, 5, 6, 8

If the volume of BHNFT activity relating to thrombolysis remains low there is a risk that the Trust cannot sustain the improved performance seen in Q4 of 2014/15 and the viability of the hyper acute service is in question.

5 4 20 July 2016 Performance is monitored through the contract monitoring meetings, with Stroke data provided as soon as is available.

BR


Committee)

BHNFT contract risk

register

3 4 12 07/17 July 2017 Decision requires further modelling - to be made in September 2017 April 2017 Decision by JCCC now deferred until after the General Election in June 2017 February 2017 Public consultation on the proposed option for the future of these services open until February 14th 2017 and a

10/17

15


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

final decision expected to be made by clinical commissioners in April 2017”

14/8 1, 5, 6

If cases of TB occurring in Barnsley are not appropriately reported and escalated, due to a lack of capacity or understanding of procedure within the TB team, there is a risk that the disease could spread within the local population.

4 4 16 A new specification for TB service has been produced. The CCG has met with contracting leads at SWYT and agreed the specification Work is ongoing to review the whole TB pathway. Progress is reported monthly to the QPSC vis the Patient Safety Reports.

BR


Committee)

Risk Assessment

3 4 12 09/17 September 2017 Prioritised for October 2017 June 2017 Non progression of this discussed at June Q&PSC - The Deputy Chief Nurse needed to secure further work for September 2017 subject to securing Public Health England input re TB risk. February 2017 Capacity has affected progress but further work planned

12/17

CCG 15/13

If BHNFT are unable to achieve their control total, as

3 4 12 The CCG’s strategic objectives aim to support a safe and sustainable local

RN

(Finance &

Risk assessment

3 4 12 10/17 October 2017 The Trust

01/18

16


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

agreed with NHS Improvement, there is a risk that the financial sustainability of the Trust may have a detrimental impact on the future of local services for the people of Barnsley.

hospital. In addition to the core contract for 2017/18, the CCG is providing a further £450k non-recurrent funding for 2017/19 to assist the Trust in achievement of its control total. Revised contract governance arrangements (in operation from Oct 2015) will facilitate regular engagement of Board/Governing Body colleagues with an update being provided by the Trust on the financial position The Sustainability meetings held with the Trust have been reestablished to ensure to ensure that sustainable services are delivered for the people of Barnsley.

Performance Committee)

continues to assume delivery of the 2017/18 control total. To date the Trust has achieved all trajectories agreed with NHS Improvement and has received all Sustainable Transformation Funding. The CCG continues to work with the trust to ensure forecast activity assumptions reflect likely demand recognising the continued work of the CCG on Demand Management Initiatives. June 2017 The Trust achieved its control total for 2016/17 and discussions with

17


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

the Trust remain ongoing to explore the financial challenge faced during 2017/19, recognising the work being undertaken by the CCG on Demand Management schemes and the impact this will have on activity. February 2017 No change

CCG 14/12

1, 6, 7

There is a risk that the CCG may not be able to secure a local integrated urgent care network to include GP OOH, extended GP access, NHS 111 and a clinical hub which meets the requirements specified in the Integrated Care Commissioning Standards, by 21 July 2017, when the

3 4 12 Project group in place with significant clinical input, support from procurement expertise and finance. Timeline established. Following NHSE guidance the requirement is now for a local integrated urgent care network to include GP OOH, extended GP access, NHS 111 and a clinical hub which meets the requirements specified in the Integrated Care Commissioning

JW


Risk Assessment

3 4 12 07/17 July 2017 New GP OOH service commenced on 21 July 2017. April 2017 Procurement concluded and decision approved. Mobilisation now ongoing and contract documentation being prepared.

10/17

18


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

current GP OOH contract ends

Standards. March 2017 Evaluation of tender documentation ongoing with a view to identifying a preferred provider during April 2017

15/12 1, 2, 5, 6

If BHNFT does not improve its performance in respect of people waiting longer than 62 days to be treated following an urgent cancer referral, there is a risk to the reputation of the CCG and the quality of care provided to the people of Barnsley in respect of this service.

4 3 12 The CCG and the provider are working as part of a South Yorkshire Cancer Waiting Times Task and Finish Group to develop an action plan to improve cancer performance. BHNFT have undertaken a self-assessment against the 8 key priorities identified by the Cancer Waiting Times Task Force and are implementing improvements to ensure compliance with all of the priorities. Progress is being reviewed by the System Resilience Group.

JW


Risk assessment

3 3 9 08/17 August 2017 All key cancer targets were achieved for Q1. In June the only target not achieved was for 2 week waits (breast symptoms) with performance at 89.6% against a 93% target. This was due to 12 of 115 patients waiting longer than 2 weeks. In all cases this was due to patient choice. May 2017

11/17

19


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

All key cancer targets were achieved for 2016/17.

CCG 14/11 (Inc CCG 14/9 merged Sep-14)

1, 2, 5, 6

If BHNFT does not improve its performance in respect of people waiting > 6 weeks for diagnostic tests (eg due to lack of ultrasound capacity) there is a risk to the reputation of the CCG and the quality of care provided to the people of Barnsley in respect of this service.

4 3 12 The CCG provided additional funding during 2013/14 to support additional clinics and increased capacity to address the issue. Diagnostic performance is monitored as part of contract performance. Contracting team is working with the Trust on options to increase capacity and performance, with a view to bringing a business case to Governing Body later in the year. An action plan is in place at BHNFT to increase capacity to address non - obstetric ultrasound waiting time pressures. Performance to be monitored through quality and performance meetings and contract monitoring.

JW


Risk assessment

3 3 9 08/17 August 2017 Diagnostic waiting times remain low and the standard has been achieved consistently through Q1 2017/18 May 2017 Diagnostic waiting times remain low and the standard was achieved for 2016/17

11/17

20


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

CCG 13/41

1,2, 4,8

Lack of completed Declarations in respect of the Policy on the Managing Conflicts of Interest and the Acceptance of Sponsorship, Gifts and Hospitality

3 3 9 Policy on the Managing Conflicts of Interest and the Acceptance of Sponsorship, Gifts and Hospitality Reminders to Membership Council to submit declarations

RW

(Audit Committee)

Risk Assessment Identified by

Audit Committee 30.05.13

3 3 9 07/17 July 2017 We have updated declarations for all GB members, MC reps and CCG staff and are in the process of updating declarations for relevant practice staff. April 2017 All GB declarations now updated and updates for other groups are progressing well March 2017 As at March 2017 the Register of Interests is up to date A further update is now in progress and all staff, GB Members and Membership Council Representatives

10/17

21


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

have been asked to update their entries and ensure all required fields are complete.

CCG 13/19

1, 5, 8

CCG as Level 2 Responder Barnsley CCG does not meet legislation and standards in relation to protecting Barnsley people from harm related to major incidents and other emergencies.

4 3 12 Contribute to Barnsley Health and Social Care Emergency planning group and work programme, including testing of plans and training Continue to Local Health Resilience Partnership (LHRP) either directly or through Lead CCG rep. Nominated CCG “Accountable Emergency Officer” Ensure contracts with provider organisations contain relevant emergency preparedness and response elements including Business Continuity Emergency Preparedness Memorandum of Understanding with Public Health Public Health (including

JW


Risk Assessment

3 3 9 09/17 September 2017 Self-Assessment undertaken in August against EPRR Core Standards and compliance statement submitted confirming substantial compliance. Only 1 area to be addressed relates to reporting outcome of Self-Assessment and regional assurance in the Annual Report June 2017 All EPRR and Business continuity arrangements are

12/17

22


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

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r re-

asse

ssm

ent

CCG??) Incident Response Plan Reports to Governing Body on emergency resilience issues, including Business Continuity Management NHS England Area Team monitoring report re Emergency Planning Winter Planning Arrangements

in place and in line with NHS E Core Standards – A review against the core standards will be undertaken to inform assurance processes with NHS England prior to October 2017/

CCG 13/13b

1,2 If the CCG fails effectively to engage with patients and the public in the commissioning or co-commissioning of services there is a risk that:

(a) services may not meet the needs and wishes of the people of Barnsley, and

(b) the CCG does not achieve its statutory duty

4 4 16 CCG Engagement and Equality Committee reporting into Governing Body in place Refreshed Patient and Public Engagement Strategy PPE Operational Delivery Group Barnsley Patient Council and OPEN Good relationships with Local Healthwatch Shared membership and knowledge sharing with

JR (KW)

(Governing Body)


Risk Assessment

3 4 12 08/17 August 2017 The volume and complexity of engagement had increased however the internal audit had not yet been received. Once this has been assessed for assurance and by the internal audit process, this would inform any increase/decrease/maintenance in the risk rating.

11/17

23


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

Scor

e

Dat

e R

isk

Ass

esse

d

Prog

ress

/ U

pdat

e

Dat

e fo

r re-

asse

ssm

ent

to involve and consult with patients and the public.

Equality Steering Group The Comms & Engagement team proactively develops and maintains links with partner organisations to facilitate effective engagement in co-commissioning activities both locally and regionally Barnsley Engagement Hub Effective Service Change Guidance and Toolkit / Patient and Public participation in commissioning health and care - Statutory Guidance Organisational member of The Consultation Institute (tCI) CCG links with the Voluntary Sector PRGs are a requirement of the GP core contract / Practice Delivery Agreement Representation on new Primary Care – Operational

May 2017 GB extended development session dedicated to consultation and engagement delivered by tCI in April coincided with launch of new NHSE statutory guidance Some engagement activity delayed due to pre-election period and national guidance received February 2017 E&E Committee agreed to increase the score from 8 to 12 The rationale being to reflect increased public involvement and engagement re STP,

24


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

Like

lihoo

d

Con

sequ

ence

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e

Dat

e R

isk

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ress

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pdat

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asse

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ent

Group from C&E Team

Commissioner’s Working Together etc. November 2016 PPE Activity continues to be delivered to the Workplan.

CCG 15/03

If the CCG does not effectively discharge its delegated responsibility for contract performance management there is a risk that the CCG’s reputation and relationship with its membership could be damaged.

3 4 12 The CCG has access to existing primary care commissioning resource within the Area Team under the RASCI agreement.

The CCG will seek to integrate Area team resources to ensure that the role is carried out consistently with the CCG’s culture & approach.

The CCG is also undertaking a review of management capacity which will incorporate proposed delegated responsibilities. The CCG has an open channel of communication with the Membership Council regarding commissioning and contracting arrangements (eg equalisation).

JH

(Primary Care

Commissioning

Committee)

Risk Assessment

2 4 8 09/17 September 2017 The CCG is currently managing its delegated responsibility for contract performance effectively. This is supported by the CCG’s Primary Care Team and the NHS England Area Team May 2017 The CCG is currently managing its delegated responsibility for contract performance

12/17

25


Risk Score

Ref

Dom

ain

Risk Description

Like

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d

Con

sequ

ence

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Source of Risk

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effectively. This is supported by the CCG’s Primary Care Team and the NHS England Area Team.

CCG 14/16

1, 4, 8

If a culture supportive of equality and diversity is not embedded across the CCG there is a risk that the CCG will fail to discharge its statutory duties as an employer and will not adequately consider issues of equality within the services we commission.

3 4 12 CCG has an Equality Objectives Action Plan, now developed & monitored by Equality Working Group, chaired by Chief Nurse and reporting to the newly constituted Equality & Engagement Committee Expert support & advice from E&D lead and HR Business Partner. Full suite of HR policies in place supported by robust EIA. Robust EIA required to support all policies and proposals – audit has been undertaken and training provided. E&D training is a mandatory requirement for all staff (93%

CM


Risk Assessment

3 4 12 08/17 August 2017 EEC agreed to increase the residual risk score to 3x4=12. Rationale as of 1 July 2017 E&D Lead disestablished via shared arrangement with 2 other CCGs. BCCG progressing access to expert support and advice via ACP and ACS. Risk likelihood revised but all over mitigation functioning as before the review. July 2017

11/17

26


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

e


Source of Risk

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compliant). Values & behaviors included within corporate performance review documentation. Values & behaviours embedded through use of values based recruitment techniques and ‘radiators’ group. Regular staff surveys with resulting action plans.

EEC to review risk 14/16 in August 2017 May 2017 Equality working group to review risk wording and score

CCG 13/15

1,2, 3,6, 8

Failure to receive assurance on performance targets

2 4 8 Monthly integrated performance report.

Performance Report to Finance and Performance Committee and Governing Body Contract Monitoring meetings between commissioner and Providers

Quality & Patient Safety Dashboard to Quality and Patient Safety Group

Clinical quality performance reports

JW


(Governing

Body)

Risk Assessment

2 4 8 09/17 September 2017 No further update – as June June 2017 Performance report updated to include all planning indicators and all CCG IAF indicators. March 2017 Performance Reporting in place to provide assurance.

12/17

27


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

Scor

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Source of Risk

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isk

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ent

Contract Compliance visits Independent Contractors

Internal Audit Report Independent Contractor Quality frameworks (13 June 2012)

Senior Manager sign off process for information issued outside of the organisation

Performance Report to Finance and Performance Committee and Governing Body

Report being revised to reflect targets and plans agreed through the 2017/19 planning round

CCG 13/16

1, 8 Failing to meet the requirements of the regulatory Reform (fire safety) Order to effectively, manage our fire safety arrangements

3 4 12 Fire Brigade inspections (Held by H & S department)

HSE inspections Reviewed Fire and Health and Safety Training within CCG Mandatory training reports

Local shared Fire & H&S service provides oversight health and safety and fire advice through corporate

RW


Risk Assessment

2 4 8 08/17 August 2017 Fire drill at Hillder House (July 2017) went very well – building clear in under 2 minutes. Fire Risk Assessment completed July 2017 – report still awaited but informal feedback suggests no significant risks

11/17

28


Risk Score

Ref

Dom

ain

Risk Description

Like

lihoo

d

Con

sequ

ence

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Source of Risk

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services team Landlord (NHSPS) provides routine maintenance of emergency lights, fire extinguishers etc Annual Organisational Risk Assessments with action plans overseen by H&S Group Oversight of Fire Safety Arrangements by H&S Group reporting to Audit Committee

identified. May 2017 No material change to previously reported position. Fire Risk assessment of new staff room undertaken March 2017 – no significant risks identified. Further Fire training sessions planned May 2017. February 2017 Fire Drill at Hillder House on 30.1.17 – evacuation in just over 2 minutes with no recommendations for improvement.

CCG 13/20

1, 6 Conflicts of interest re commissioning, decommissioning and procurement processes. In anticipation of

3 4 12 CCG has a conflict of interest policy and declarations of interest are included on every agenda. Audit Committee has a

RW


Risk Assessment

2 4 8 08/17 August 2017 Procurement checklists currently being completed for diabetes and

11/17

29


Risk Score

Ref

Dom

ain

Risk Description

Like

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d

Con

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ence

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Source of Risk

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National scrutiny of commissioning decisions made by Clinical Commissioning Group we need to ensure we have: • Robust processes

in place for the review of services which are auditable resulting in the commissioning or decommissioning of services;

• Clear and consistent documentation of declarations of interest

standing item regarding declarations of interest and provides scrutiny of its application. Governing Body development sessions have taken place and conflict of interest is likely to be the subject of future Governing Body development sessions. Register of Procurement Decisions maintained and published on website detailing how any conflicts have been managed Procurement Policy approved Sep 2016 includes detailed section on managing C of I in procurement. Procurement Checklist used for large procurements with potential conflicts.

MSK procurements to ensure any potential conflicts are appropriately managed. May 2017 6 monthly update of Register underway. All GB declarations reviewed and updated. February 2017 Internal Audit review of compliance with Statutory C of I Guidance found the CCG compliant or partially compliant with all aspects of the guidance including being fully compliant in the area of ‘decision making processes and contract

30


Risk Score

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ain

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ent

monitoring

17/02 1 2 3 6 7 8

If the CCG does not put in place appropriate and robust arrangements to mitigate cyber attack there is a risk that the CCGs business systems could be comprised leading to reputation damage business interruption and potential financial loss

3 4 12 eMBED manages and maintains CCG IT systems and servers and ensures appropriate safeguards are in place CCG staff aware of need for vigilance re suspicious emails etc SIRO identified as organizational lead cyber security IT Group to receive routine report on Cyber Security Briefings on cyber security to be provided to Governing Body Training on cyber security to be provided to all staff

RW IT Group QPS Committee

Internal Audit Review

3 3 9 07/17 July 2017 On 13 July 2017 GB approved inclusion of risk 17/02 on the Corporate Risk Register June 1017 QPSC recommended adding risk to the Risk Register and residual risk score to be 3x3=9 May 2017 Internal Audit review of Cyber Security Arrangements provided significant assurance but identified a number of areas where controls could be strengthened. An action plan is in place and will be

10/17

31


Risk Score

Ref

Dom

ain

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d

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sequ

ence

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Source of Risk

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taken forward during 17/18

CCG 15/04

If the CCG is unable to secure sufficient operational & strategic capacity to fulfil the delegated functions this may impact on the ability of the CCG to deliver its existing delegated statutory duties, for instance in relation to quality, financial resources and public participation.

3 5 15 CCG considered its strategic capacity & capability as part of the successful application process. The CCG has access to existing primary care commissioning resource within the Area Team under the RASCI agreement. In addition the CCG is recruiting a Head of Quality for Commissioning Primary Medical Services. The CCG is undertaking a review of management capacity including delegated responsibilities.

JH

(Primary Care

Commissioning

Committee)

Risk Assessment

2 3 6 06/17 June 2017 The CCG has a Primary Care Team to support management of delegated commissioning; this includes individuals with the responsibility for Primary Care Contracting and Quality. May 2017 The CCG has a Primary Care Team to support management of delegated commissioning; this includes individuals with the responsibility for Primary Care Contracting and Quality.

12/17

16/05 Failure to complete reviews of PUPoC

4 3 12

Existing process in place to review outstanding claims as

M Tune

NHSE 2 3 6

09/17 September 2017 QPSC reviewed

09/18

32


Risk Score

Ref

Dom

ain

Risk Description

Like

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Source of Risk

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potentially resulting in imposed fines for maladministration from Ombudsman.

part of South Yorkshire and Bassetlaw collaborative model.

(Quality and Patient Safety

Committee)

risk – noted that the PUPOC risk had not materialised & agreed risk should remain on risk register – to be further reviewed by QPSC Oct 2017 July 2017 QPSC to review in August 2017 February 2017 As of 31/1/17 all cases reviewed Risk to be revisited once appeals period lapsed.

CCG 13/22

2, 6 Variation in performance – capacity within the CCG to support and improve quality in primary care

3 4 12 Performance monitoring FPC Quality Surveillance Group meetings across the system. Primary Care workstream in place.

JH


Identified by Audit

Committee 21/02/13

3 2 6 08/17 August 2017 The CCG is working with its Member Practice to develop a Quality Improvement Tool which will monitor Primary Care Quality on a

02/18

33


Risk Score

Ref

Dom

ain

Risk Description

Like

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d

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Source of Risk

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ent

Quality Monitored via the Quality and Patient Safety Committee. PDA and HITS schemes to stabilize primary care and target health inequalities.

number of indicators. To support Primary Care in Quality Improvement the CCG has developed a Primary Care Quality Improvement Group which will monitor the data captured within the tool, provide support to practices and report and escalate into the Quality and Patient Safety Committee. May 2017 The CCG has a practice delivery agreement with its member practices to address variation in performance. The CCG’s Primary Care Team will provide practices

34


Risk Score

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Dom

ain

Risk Description

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with support and where requested the Primary Care Commissioning and Quality Development Manager will work and support practices if quality issues are identified.

CCG 15/05

1, 3, 8

If the CCG does not comply in a fully transparent way with the statutory Conflicts of Interest guidance issued in June 2016 there is a risk of reputational damage to the CCG and of legal challenge to the procurement decisions taken.

3 3 9 Standards of Business Conduct Policy and procurement Policy updated. Registers of Interests extended to incorporate relevant GP practice staff . Declarations of interest tabled at start of every meeting to enable updating. Minutes clearly record how any declared conflicts have been managed. PCCC has Lay Chair and Lay & Exec majority, and GP members are non voting. Register of Procurement

RW

(Primary Care

Commissioning

Committee)

Risk Assessment

2 3 6 06/17 June 2017 Third lay member now in post and attending meetings of PCCC. March 2017 Third Lay now recruited and will commence on 1.4.17 . Internal Audit has found CCG fully or partially compliant across all areas. January 2017 A third Lay Member is in the process of being

12/17

35


Risk Score

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Dom

ain

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decisions established to record how any conflicts have been managed. Guidance provided to minute takers on recording decisions re managing conflicts of interest.

recruited – once appointed they will join the PCCC as Vice Chair. Internal Audit is currently reviewing the CCG’s degree of compliance with the statutory C of I Guidance.

17/03 1, 3, 5, 6

If the significant changes to the medications prescribed to individuals in accordance with the CCG’s ambitious medicines QIPP programme are not effectively implemented, this could lead to stock shortages, patient confusion, inconvenience, and delays in the receipt of prescribed medication, resulting in a risk to the reputation of the CCG and the quality

3 3 9 About a third of CCG’s undertaking changes using the recommended products which have a high national use. The Area Prescribing Committee (PAC) has endorsed a process by which branded medicines will be considered to be introduced across the local health economy and engaging with all Providers. The CCG is seeking assurances from companies for any medication changes it recommends as part of the process.

MG


Committee)

Area Prescribing Committee

2 3 6 07/17 July 2017 On 13 July 2017 GB approved inclusion of risk 17/03 on the Corporate Risk Register June 1017 QPSC recommended adding risk to the Risk Register. May 2017 The Committee were briefed on issues form the Area Prescribing Committee April 2017 meeting and

01/18

36


Risk Score

Ref

Dom

ain

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of care provided to patients. (Note: financial risks relating to the QIPP programme are covered by risk 13/31 and managed by F&PC).

Advice and support is being provided to Practices. If there was an out of stock situation then the CCG would advise generic scripts are written until supplies come back in. Medicines Management Team is working with community pharmacies to identify and manage any issues. APC receives briefings reports regarding any issues arising. The Quality & Cost Effectiveness Group and the QIPP group are overseeing the implementation of the programme. Proposed changes are in line with accepted good practice and evidence from elsewhere. Implementation of similar changes were introduced in 2016 and the locality has increased experience in safely implementing the

that the APC had introduced a process for any proposed changes. This had been identified in 2016 but had been removed from the Risk Register as QIPP changes were implemented without harm.

37


Risk Score

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ain

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changes which would reduce any potential risk.

CCG 13/30

1, 5, 8

NHS Barnsley does not operate within the legal information processing framework Clinical Risk

1 5 5 Annual information governance toolkit and associate improvement programme

Updated NHS Barnsley IG Framework approved (Nov 2015) Full suite of IG Policies approved, regularly updated, and available to staff via website

Incident reporting process

Internal Audit annual reviews of Information Governance Toolkit evidence

CCG wide training on information governance

SIRO & Caldicott guardian appointed IG expertise commissioned from commissioning support provider (eMBED)

RW

Governing Body

(Quality and

Patient Safety

Committee)

Risk Assessment

1 5 5 09/17 September 2017 The CCG continues to work with eMBED to ensure IG policies & procedures remain compliant with IG Toolkit requirements. Any actions necessary to comply with GDPR & national Data Guardian recommendations will be incorporated in to action plan. March 2017 IG Toolkit review complete – the CCG declared full compliance as in previous years November 2016 IA review of Information Sharing provides

03/18

38


Risk Score

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ain

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significant assurance over the CCG’s arrangements in this area.

CCG 16/02

If GP Practices opt to cease provision under their Primary Medical Services Contract there is a risk that the CCG could not source appropriate provision of services in all localities in Barnsley.

2 4 8 Impact could be mitigated by local provision e.g. BHF APMS Contracts allow increased diversity of provision.

JH

(Primary Care

Commissioning

Committee)

1 4 4 05/17 May 2017 Individual contracts are monitored through the Primary Care Commissioning Committee’s Contractual Issues Report

11/17

CCG 15/06

There is a risk that if the CCG does not effectively engage with the public, member practices and other stakeholders on matters relating to the delegated commissioning of primary care (including redesign of service delivery), the CCG’s reputation with its key stakeholders could therefore be affected.

2 3 6 The CCG has a well-established and effective PPE function, as well as robust governance supporting the function. The existing primary care commissioning resource and expertise within the Area Team can be accessed by the CCG. The CCG considered its strategic capacity & capability as part of the successful application process.

JR

(Primary Care

Commissioning

Committee)

Risk Assessment

1 3 3 10/16 October 2016 – general update to mitigation and treatment August 2016 The CCG continues to hold practice engagement events with practices the last one being at the end of June June 2016 Estates issues

10/17

39


Risk Score

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Dom

ain

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Source of Risk

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The CCG is a member of the Consultation Institute and as such uses learning, best practice and advice service to support any consultation activity.

resolved, the CCG held a practice Engagement event scheduled for 30th June 2016

CCG 13/38

1, 3, 8

If the CCG does not have sufficient processes and controls in place to prevent fraud there is a risk of loss of resources and damage to the CCG’s reputation.

2 3 6 Completion of Self Review Toolkit (SRT) in relation to 2015/16 Commissioner Standards – along with production of an action plan for development/rectification. Annual Budgets and review of these on a periodic basis Budgetary control system Regular Financial Reporting Cashflow Projections Fraud Policy in place Fraud Awareness Fraud locally agreed work plan Prime Financial Procedures, Standing Orders and Scheme of Delegation Audit Reports to Governance

RN

(Audit Committee)

Risk Assessment

1 3 3 04/17 April 2017 SRT submission in March 2017 scored the CCG as ‘green’ overall, an improvement from ‘amber’ overall in 2016.

04/18

40


Risk Score

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ain

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Risk and Audit Group and Audit Committee Local Counter Fraud Specialist Progress Reports to Audit Committee Internal Audit Reports on Treasury Management Financial Controls Counter Fraud Officer in place External Audit Reports Annual Local Counter Fraud Reports

17/04 (added August 2017)

5,6 The CCG is taking forward an ambitious programme over 18 months to improve the quality and cost-effectiveness of primary care prescribing by limiting third- party ordering of repeat prescriptions and improving quality of how medicines are ordered.

2 3 6 Recruited and trained team supporting changes in practices in addition to support from Pharmacy staff working within practices Engagement with all parties through a stakeholder group and communications plan which will identify patients who may require additional support

MG


Committee)

Risk Assessment

1 3 3 09/17 September 2017 On 14 September 2017 the Governing Body approved new risk 17/04 for inclusion on the Risk Register.

09/18

41


Risk Score

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ain

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There is a risk that in this process vulnerable patients may not receive their necessary medicines through changes in their repeat medicine supply system and some patients may not understand changes .

POTENTIAL NEW RISK September 2017


Risk Score

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Risk around the IAPT service from a quality perspective. Requested by QPSC P Otway & Jamie Wike

QPSC

42

GB/Pu/17/10/13


GOVERNING BODY

12 October 2017

COMMISSIONING OF CHILDREN’S HEALTH SERVICES QUARTERLY UPDATE



2. REPORT OF

Name Designation Executive Lead

Brigid Reid Chief Nurse

Author Patrick Otway Head of Commissioning (Mental Health, Children’s and Maternity and Specialised Services)


This report aims to update the Governing Body on the work that has been undertaken since the July 2017 update in relation to the commissioning of Children’s Health Services in Barnsley. Key issues in relation to the commissioning of Children’s Health Services in Barnsley are highlighted and are focused upon the continued implementation of the Future in Mind Barnsley Local Transformation Plan re Emotional Well Being, CAMHS performance and children’s ASD services. Additional information is provided in relation to Child Sexual Exploitation (CSE) and Special Educational Needs and Disability (SEND) work.


• Note the progress made and the risks highlighted.

5. APPENDICES • Appendix 1 : CAMHS Performance Data

Agenda time allocation for report: 10 minutes

1

GB/Pu/17/10/13

SUPPORTING INFORMATION 1. Links to the Governing Body Assurance Framework Risk ref(s) This report provides assurance against the following risks on

the Governing Body Assurance Framework: 1.1, 1.4, 1.5, 4.1, 5.1




Y


Y


Y


Y



N


3.2 Consultation and Engagement Has Comms & Engagement Checklist been completed? N Is actual or proposed engagement activity set out in the report?

NA


NA


NA


NA


NA


NA

2

GB/Pu/17/10/13 1. INTRODUCTION

Subsequent to the arrangements described in previous papers to the

Governing Body the following updates are provided:-

• CAMHS performance • Children’s ASD services • Education, Health & Care Plans (EHCP) • Child Sexual Exploitation (CSE)

2. ISSUES

2.1 2.2

CAMHS Due to the success of the Waiting List Initiatives funded by NHS England (e.g. holding clinical sessions on Saturdays) these initiatives are continuing throughout 2017/18. The positive impact this is having can be seen in the performance data in Appendix 1. SWYPFT have successfully applied for Health Education England (HEE) fully funded posts (3 in total) for parental psychological wellbeing practitioners. One of these posts will be embedded within the Early Years Service offered by the Local Authority, ensuring continued benefits of improved parenting programmes are felt throughout the wider health and social care system. SWYPFT have also submitted a proposal to HEE, with the support of the CCG, for 2 full time Children and Young People IAPT Psychological Wellbeing Practitioners. These posts will strengthen and increase the capacity within the CAMHS service to enable more timely, appropriate assessments and earlier commencement of treatment in the future. Future in Mind Good progress continues to be made within the work-stream priorities funded via Future in Mind. The schools-led emotional health and wellbeing support service currently known as 4:Thought goes from strength to strength and is having measurable, positive outcomes on the lives of the children and young people who access the service. In response to the request by the children and young people of Barnsley the 4:Thought service is being renamed and re-branded and will be re-launched on the 5th October 2017 to become known as MindSpace. A young people friendly website will be launched at the same time. CHILYPEP (Children and Young People’s Empowerment project) continue to facilitate the Barnsley Oasis (Opening up awareness & support and influencing services) Young people’s participation group. These Young Commissioners are already influencing developments in services within Barnsley, having assisted in the re-design of the CAMHS referral process, developed a Youth First Aid Mental Health Kit and they will be attending both the Barnsley Suicide Prevention Strategy Group and the Mental Health Crisis Care Concordat. NHS England require that all Local Transformation Plans are refreshed by 31 October 2017. The refreshed plan will be added to the CCG and BMBC

3

GB/Pu/17/10/13 2.3 2.4 2.5 2.6

websites from 1 November 2017. The fourth Future in Mind Stakeholder event will be held on 18th October 2017, between 4.30pm – 7pm at Barnsley College. Children’s ASD services As reported previously, there are capacity issues within the ASD pathway, particularly the over 5 pathway, resulting in longer waits to assessment and diagnosis than recommended by NICE guidance. As a result of these issues the Community Paediatric Team within BHNFT were asked (by the Local Authority and CCG) to review the pathway. A report following this review has been recently submitted through BHNFT’s own governance arrangements and then shared with partners. Local Authority colleagues (who have a statutory responsibility in relation to ASD services) with support of the CCG, will be re-establishing the multi-disciplinary ASD Steering Group to consider the issues arising from the ASD pathway and any recommendations of the BHNFT review. A more detailed update will be provided in the January 2018 report. Primary Nocturnal Enuresis A managed enuresis alarm service has been procured from De Smit Medical and this pathway is now fully operational Child Sexual Exploitation (CSE) The Barnsley Child Sexual Exploitation Strategy has recently been updated. The strategy recognises that there is frequently a link between CSE concerns and neglect. Consequently, the strategy promotes partnership working between the CSE and the newly established Neglect Sub Group of the Board. The strategy aims to progress a plan based on four main themes: Prepare, Prevent, Protect and Pursue. A deep dive audit is scheduled to take place in early October. The CSE MASH continues to work collectively to share information, assess risk and develop action plans for young people. Partners have been asked to strengthen this process by using the CSE risk assessment tool to support referrals. A formal strategy and action plan is being developed for Operation Make Safe (improving awareness amongst the hospitality industry, late night refreshment venues and taxi drivers). Data for 2016/17 indicates that the majority of Barnsley victims are from a White North European background, with a distinct peak at the age of 14. The same ethnic background also represents the majority of suspects/perpetrators. Barnsley undertakes a high rate of disruption activities, such as serving abduction or harbouring notices, which is seen as good practice along with multiagency working. Care of Children with Complex Health Care Needs In September 2014 the Children and Families Act 2014 came into force. A significant part of this Act was the new Special Educational Needs and Disability (SEND) code of practice which covers children and young people

4

GB/Pu/17/10/13 with SEND from birth to age 25 years. A big challenge for local authorities is to complete transfer reviews of all statements of Special Educational Needs by 31st March 2018 to Education, Health & Care Plans (EHCP). It is important that local authorities meet this deadline and achieve it in a way that ensures good quality assessments are undertaken and high quality plans are implemented. Currently Barnsley local Authority are on track to have all transfer reviews written up by December 2017 and finalised by March 2018. Barnsley Local Authority is currently completing approximately 70% of new referrals for EHCP’s within the statutory timeframe. There continues to be reasonable engagement from health professionals in the provision of clinical information towards the plans but more work is required around the quality of the information provided to allow for realistic measurable health outcomes in EHCP’s. The Designated Clinical Officer (DCO) is meeting with the Local Authority to look at how this can be audited and consequently improved. It is important that EHC assessments are coordinated with other key health assessments for example the Children and Young Peoples Continuing Care (CCC) assessment. An addition to the DCO role is the Lead Nurse for Children’s and Young Peoples Continuing Care. Barnsley now has a full time Continuing Care Nurse assessor in post who works closely with the DCO. The increased capacity is allowing for greater participation and collaboration in the SEND pathway.

3. RISKS TO THE CLINICAL COMMISSIONING GROUP

Risk to realising benefits, or reducing risk, in relation to waiting times to access treatment from CAMHS due to any delay in implementing the priorities within the local transformation plan and local delivery of nationally funded remediation of time to treatment action plan.

5. APPENDICES TO THE REPORT

Appendix 1 : CAMHS Performance Data

6. CONCLUSION

The CCG continues to pursue improved outcomes for vulnerable children and young people and is ensuring that all associated supporting work is progressed to deliver sustainable services to achieve this.

5

CAMHS Key Performance IndicatorsBarnsley

June - 2017

Contents

Indicator PageSupporting Information 3Referrals Received 4Emergency Referrals 6Assessment (Choice) 7Treatment (Partnership) 9Other Information: 11 Discharges Caseload Average Length of Episode Average Contact per Referral Households with Multiple Referrals Out of Area Referrals Received

Produced by Performance & Information Barnsley - CAMHS Key Performance Indicators Page 2 of 13

Supporting Information

For the following KPI topics, activity and performance are reported based on the CCG of the client:

• Referrals

• Contacts

• Waits

• Did not attend (DNA)

• Caseload

• For example - Total referrals received KPI: contains any Barnsley CCG client no matter which SWYPFT CAMHS service they have accessed.

• The CCG of a client is determined by the GP practice the client is registered with.

• Since the upgrade to the RiO clinical system in November 2015, there has been intermittent problems accessing the system that have hamperedreal time data capture and created problems with extracting data for reporting purposes across the organisation, particularly during January. Datafor November 2015 to March 2016 should be used with caution.

• Please note that if a cell is blank there is no activity for that month.


Referrals Received

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 104 116 69 99 102 135 100 125 103 151 114 159 136Other SWYPFT CAMHS 1 1 2 3 2 4 2Total 105 117 69 101 102 138 100 125 105 155 114 159 138

Total Referrals Received

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

GP 47 47 35 43 53 64 43 51 54 66 54 70 36Community based Paediatrics 9 4 5 10 6 15 12 15 5 15 9 13 17Hospital based Paediatrics 5 5 1 9 9 6 1 5 3 14 4 7 17School Nurse 5 12 3 4 4 6 2 3 5 5 3 4Education Service 1 10 8 11 6 12 7 12 8 22 19Social Services 6 2 6 6 1 4 3 5 1 8 2 6 4NHS Hospital Staff - Other 18 10 7 10 11 12 14 16 5 12 8 16 14Other 15 37 11 9 10 20 19 18 25 23 29 22 27Total 105 117 69 101 102 138 100 125 105 155 114 159 138

Referrals Received by Source

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

GP 21 20 13 13 21 32 24 17 18 30 25 17 20Community based Paediatrics 1 2 3 3 1 3 1 2 4 1 5Hospital based Paediatrics 1 1 2 2 2 2 1 5School Nurse 1 5 1 1 1 1 1 1 1Education Service 1 4 7 1 3 2 3 1 4 2 6Social Services 1 1 2 1 2NHS Hospital Staff - Other 1 2 2 1 1Other 1 10 3 3 5 3 8 2 5 9 4 4 4Total 26 39 21 27 36 42 40 26 27 44 37 26 44

Inappropriate Referrals by Source

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 26 39 21 27 36 42 40 26 27 44 37 26 44Total 26 39 21 27 36 42 40 26 27 44 37 26 44

Inappropriate Referrals


Referrals Received Cont.

Signposted Referrals

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

GP 19 17 5 6 11 18 20 13 17 23 19 14 15Community based Paediatrics 2 2 1 1 1 3 3Hospital based Paediatrics 1 1 1 1 4School Nurse 4 1 1 1 1Education Service 3 4 1 2 1 1 1 2 2Social Services 1 1NHS Hospital Staff - Other 1 1 1Other 1 9 2 2 3 3 5 1 2 7 2 2 3Total 22 33 8 15 19 23 29 18 20 32 25 19 27

Signposted Referrals by Source

Description:

Referrals received includes all referral sources, urgencies and inappropriate referrals.Inappropriate referrals includes all referrals marked as "inappropriate","inappropriate advice/liaison given" or "inappropriate (signposted)" upon discharge. This could be done as soon as the referral comes in to the service or may happen after the initial or choice appointment.It does not include any clients where they have been signposted to another organisation/agency after treatment with the service.Signposted referrals are a subset of the total inappropriate referrals.

Comments:Signposted/Inappropriate referrals include referrals from previous months dependent upon time seen i.e. rejected from Choice/Initial Assessment, etc

Also Inappropriate total included those signposted.


Emergency Referrals

Emergency Referrals Received

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Description:

Emergency Referrals Received counts any referral with an urgency of "Emergency".Response within 4 hours is a direct (face to face) or indirect contact following receipt of the referral.

Comments:

Other SWYPFT CAMHS data relates to clients previously with an address, and/or GP, from other SWYPFT CAMHS area’s.

The service has introduced a new team based process which enables clinicians to record emergency assessments.


Assessment (Choice)

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Total Choice Contacts

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 14 15 7 8 15 27 22 31 22 26 30 11 15Overall Average (Days) 14 15 7 8 15 27 22 31 22 26 30 11 15

Average Wait to Choice Contacts (days)

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Total Referrals Waiting for Choice Contacts


Assessment (Choice) Cont.

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Choice DNA

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 10% 25% 7% 15% 7% 7% 19% 10% 13% 8% 9% 11% 5%

Overall Percentage 10% 25% 7% 15% 7% 7% 19% 10% 13% 8% 9% 11% 5%

Choice DNA Rate

Description:

The total number of assessment (Choice) contacts reflects all choice contacts where the client attended that have an outcome attached to them.The average wait is given in days. Please note that whilst appointments may be available, clients may choose an appointment that suits them better outside of 4 weeks.The total referrals waiting for assessment (Choice) is a snapshot at month end; these clients could have a Choice appointment booked but not yet attended.

Comments:

Next Available appointment as at 12-7-17:1. New St – 28-7-172. Grimethorpe – 1-8-173. Hoyland – 19-7-17Total clients waiting for choice as at 12-7-17:57 (42 booked and 15 waiting for opt-in contact)


Treatment (Partnership) Contacts

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Total Partnership Contacts

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Total Waiting for Treatment

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

0 - 3 Months 84 68 65 70 64 74 59 63 67 91 84 92 933 - 6 Months 118 109 93 79 84 72 77 78 83 78 87 90 1116 - 9 Months 104 122 118 111 89 80 74 72 60 65 60 67 639 - 12 Months 61 58 74 86 111 100 102 71 59 51 50 41 55> 12 Months 124 123 117 116 125 136 138 130 124 131 85 91 90Total 491 480 467 462 473 462 450 414 393 416 366 381 412

Barnsley CAMHS: Partnership Current Waits

Apr16 - Jun16

Apr16 - Jul16

Apr16 - Aug16

Apr16 - Sep16

Apr16 - Oct16

Apr16 - Nov16

Apr16 - Dec16

Apr16 - Jan17

Apr16 - Feb17

Apr16 - Mar17

Apr17 - Apr17

Apr17 - May17

Apr17 - Jun17

Barnsley CAMHS 284 294 303 304 300 296 297 324 327 316 396 308 246Other SWYPFT CAMHS 119 119 119 107 107 107 107 107 107 55Overall Avg Days 279 291 301 301 297 293 295 322 325 312 396 308 246

Average Length of Wait to Partnership


Treatment (Partnership) Contacts Cont.

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17


Partnership DNA

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 14% 19% 18% 14% 16% 15% 13% 15% 17% 14% 18% 13% 14%

Overall Percentage 14% 19% 18% 14% 16% 15% 13% 15% 17% 14% 18% 13% 14%

Partnership DNA Rate

Description:

The total treatment (Partnership) contacts includes all outcomed treatment contacts.The total waiting for treatment (Partnership) and current waits by time band are a snapshot at month end.The average length of wait to treatment (Partnership) is a year to date position in days based on clients who have had their first treatment contact (referral receipt date to dateof 1st treatment contact).CAMHS wait for Partnership by number of months waiting includes only East and West CAMHS (excludes other teams such as LAC).DNA = Client did not attend.

Comments:The pathway and MDT process are now implemented across the service and the MDT are allocating from the waiting lists.

The Service now has an automated report for un-outcomed appointments not recorded in the system and the data manager continues to issue this to staff on a monthly basis to sustain timely recording of contact data

The service has submitted information to the CCG and NHS England relating to the waiting list initiative.


Other Information

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 149 141 121 156 130 140 96 172 124 124 142 119 160Other SWYPFT CAMHS 1 1 3 3 2 5 1 1Total 150 142 121 159 130 143 98 172 124 129 143 119 161

Total Discharges

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 1382 1347 1349 1313 1309 1301 1307 1280 1265 1288 1287 1330 1326Other SWYPFT CAMHS 6 5 5 5 5 5 3 3 3 4 3 3 4Total 1388 1352 1354 1318 1314 1306 1310 1283 1268 1292 1290 1333 1330

Caseload

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 285 362 495 511 412 405 468 537 545 431 438 468 421Other SWYPFT CAMHS 9 129 385 5 845 11 25Overall Average (Days) 282 359 495 510 412 395 482 537 545 407 433 468 421

Average Length of Episode (days)

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Barnsley CAMHS 6 10 6 11 9 8 10 9 9 7 9 8 10Other SWYPFT CAMHS 11 7 32 3Overall Avg Contact 6 10 6 11 9 8 11 9 9 7 9 8 10

Average Contact per Referral


Other Information Cont.

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Failed to attend (repeated DNA, Cancel/CNA) 12 14 32 17 12 12 7 18 22 11 8 15 10Failed To Attend At All 6 5 8 5 7 2 3 7 6 7 3 7Inappropriate Referral 2 1 2 8 11 3 1 3 6 1 8Inappropriate Referral (Advice/Liaison Given) 2 5 11 12 9 8 8 8 6 9 6 6 9Inappropriate Referral (Signposted) 22 33 8 15 19 23 29 18 20 32 25 19 27Moved Out Of Area 13 3 3 3 4 1 2 6 2 1 4 5Other 32 26 14 30 22 31 21 30 24 18 46 28 38Patient Death 1Patient Discharged Him/Herself Or Was Discharged By A Relative Or Advocate 6 7 11 7 4 3 1 10 9 5 6 6Patient Discharged On Clinical Advice Or With Clinical Consent 44 41 30 65 40 45 22 72 30 37 34 33 47Signposted to a Locala service 1Signposted to External Organisation/Agency 5 3 1 4 3 2 1 3 4 3 5 6Transferred to adult mental health service 5 3 1 5 2 2 1 2 1 6 3Transferred to other health care provider - high secure unit 2Transferred to other health care provider - not medium/high secure unit 1 1 1Total 150 142 121 159 130 143 98 172 124 129 143 119 161

Discharge Reasons


Description:

Average length of episode is from initial contact to discharge based on discharges in the month.Average number of contacts per referral is from referral to discharge and excludes inappropriate referrals., emergency referrals and those with zero or one contact.

Comments:Other SWYPFT CAMHS data relates to clients previously with an address, and/or GP, from other SWYPFT CAMHS area’sThe total caseload includes those children waiting for an ASD assessment who were accepted when the pathway was hosted by Barnsley CAMHS.


GB/Pu/17/10/14


Governing Body

12 October 2017

Integrated Performance Report


Decision Approval Assurance Information

2. REPORT OF

Name Designation Executive Lead Roxanna Naylor / Jamie

Wike Acting Chief Finance Officer / Head of Planning, Delivery and Performance

Author Roxanna Naylor/ Jamie Wike

Acting Chief Finance Officer/ Head of Planning, Delivery and Performance


3.1 The Finance and Performance reports aim to provide an overview of the performance of NHS Barnsley Clinical Commissioning Group (BCCG) up to the end of August 2017.

3.2 The reports provide details of the latest performance against key performance indicators and an overview of the financial performance of the CCG up to 31 August 2017, together with forecasts for the year end.

3.3 The Finance and Performance Committee have received a more detailed report containing all indicators monitored by the CCG and detailed financial analysis to enable them to maintain oversight of performance and finance and provide assurance to Governing Body.

3.3 The performance report attached at Appendix 1 provides a high level dashboard and an exception report which covers the NHS Constitution standards, quality indicators, key performance indicators linked to local priorities and financial performance.

3.4 Key performance indicators issues which are highlighted within the exception report are:

• The 4 hour standard for patients waiting in A&E (Commissioner) • The proportion of people waiting 6 weeks or less from referral to first IAPT

treatment appointment. Following previous discussions at Governing

1

GB/Pu/17/10/14 Body regarding IAPT performance, a draft action plan has been produced by the service and is attached at Appendix 2

• Cancer patients referred with breast symptoms seen within 2 weeks • Cancer patients seen within 31 days for subsequent treatment

(Radiotherapy)

3.4 For information, also attached to this report at Appendix 3 is a copy of a letter received from NHS England regarding changes to the ambulance national standards and reporting arrangements. The letter includes details of the changes to ambulance response standards, performance expectations, implications for contracts and application of sanctions.

3.5 The finance report attached at Appendix 4 provides an assessment of the current financial performance of the CCG up to 31 August, together with head line messages and forecasts for the year end.

3.7 The CCG continues to forecast to achieve all financial duties and planning guidance requirements, with an in-year balanced budget position. However, the forecast position, after risk assessment, has deteriorated and any further risk/contract overtrading will require additional efficiencies to be generated in order to achieve financial duties. Further information on the CCG’s financial performance targets is set out in section 2 of Appendix 4. The Finance and Performance Committee noted that as at 31 August the CCGs efficiency programme was expected to deliver £11.4m, leaving a shortfall of £0.1m against the £11.5m target. The CCG may be required to take immediate action to deliver further efficiencies should the forecast position continue to deteriorate from Month 6.


Note the contents of the report including:

• 2017/18 performance to date, the IAPT action plan and the NHS England Letter on changes to the ambulance national standards and reporting arrangements

• projected delivery of all financial duties, predicated on the assumptions outlined in this paper

• the current forecast £0.1m shortfall on the CCG’s efficiency programme and the development of schemes being undertaken to ensure delivery of the £11.5m target.

• the immediate action required should the forecast position deteriorate further.

2

GB/Pu/17/10/14 5. APPENDICES

Performance Section

• Appendix 1 – Barnsley CCG Monthly Performance Report to Aug 2017 • Appendix 2 - Draft IAPT Improvement Plan • Appendix 3 - NHS England Letter - changes to the ambulance national

standards and reporting arrangements Finance Section

• Appendix 4 – Finance Report 2017/18 – Month 5


15 minutes.

3



the Governing Body Assurance Framework: 1.1, 1.3, 1.4, 3.1 and 4.1


support its business







NA

Are any financial implications detailed in the report? Section 3


NA


NA


NA


NA


NA


NA

4

NHS Barnsley Clinical Commissioning Group Performance Report for Governing Body

CCGs are accountable to their local populations and to NHS England for planning and delivering comprehensive and high quality care that meets the needs of their local community. We have created the tools that you need to ensure that your activities and operations are compliant with the targets set within the CCG Assurance Framework.

Indicator Target Period Performance

% 4 hour A&E waiting times - seen within 4 hours - CCG (Monthly) 95.00% 92.26% 91.74%

In August, 92.26% (CCG) and 92.53% (BHNFT) of patients were seen and treated within 4 hours.Whilst this shows a dip in performance from the July position, local data shows that BHNFT performance has improved in September with performance as at 26 September at 94.68% for the month. Quarter 2 performance to date is 94.14% and is therefore above the agreed STF trajectory of 94%The A&E delivery Board is continuing to oversee the implemention of the A&E improvement plan. This is currently being reviewed to ensure learning from 2016/17 along with key activitys to deliver the national urgent care delivery plan priorities are reflected in the plan. Preparations for Winter are also underway with detailed plans for winter in place.

Proportion of people waiting 6 weeks or less from referral to first IAPT treatment appointment

75.00% 68.21% # -

Barnsley CCG performance for August 2017 was 68.21%, missing target by 6.79%. Whilst the national standard was achieved in the 2nd half of 2016/17, this has not been sustained into 2017/18.This measure relates to those patients completing treatment in the month so does not show current waiting times.The NHS England Intensive Support Team (IST)undertook a review of the IAPT commissioning and delivery arrangements in July 2017. This will result in a detailed action plan to deliver sustained improvement in performance against all standards.Waiting times for Patients entering treatment in June were much reduced with 92% waiting less than 6 weeks and therfore the focus of the action plan will be to sustain this position.A Contract Performance Notice has been issued to the provider requiring the development of a detailed action plan on receipt of the IST report and this will be monitored through contract monitoring arrangements.

Cancer - % Patients referred with breast symptoms seen within 2 wks of referral

93.00% 89.42% 93.22%

Barnsley CCG performance for July 2017 was 89.42%, missing target by 3.58%.Year to date performance for Barnsley CCG for 2017/18 is 93.22%, surpassing target by 0.22%.In July, 11 out of 104 patients referred with breast symptoms waited over 2 weeks following urgent referral.In 10 of the 11 cases the breach reason was due to the patient changing their appointment date with the other case being due to the patient being ill.As the target has not been achieved for 2 subsequent months a Contract Performance Notice was issued to BHNFT.

Cancer - % Patients seen within 31 days for subsequent treatment (Radiotherapy)

94.00% 83.33% 93.23%

Barnsley CCG performance for July 2017 was 83.33%, missing target by 10.67%.Year to date performance for Barnsley CCG for 2017/18 is 93.23%, missing target by 0.77%.In July, 6 of 36 patients waited over 31 days for subsequent radiotherapy treatment. All breaches occurred at Sheffield Teaching Hospitals and were due to outpatient capacity.As the breaches occurred at STH, the issue has been raised with Sheffield CCG as the lead commissioner who are working with the trust to improve pathways and ensure adequate capacity is in place.

Exception Report 2017/18Key Performance Indicators by Exception

Actual Period Actual YTD

Governing Body Dashboard

Exception Report

Outcomes Target Actual Period Actual YTD Period TrendImproved Access to Psychological Services-IAPT: People entering treatment against level of need 1.25% 1.27% 1.26% Aug-17Improved Access to Psychological Services-IAPT: People who complete treatment, moving to recovery 50.00% 52.17% - Aug-17Estimated diagnosis rate for people with dementia 66.70% 82.67% 73.68% Aug-17Unplanned hospitalisation for chronic ambulatory care sensitive conditions - Yearly 1236 1281 - YTD 2015/16Unplanned hospitalisation for chronic ambulatory care sensitive conditions - Current Provisional 1236 1264 January 2016 to December 2016 (Provisional)Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s - Yearly 344 327 - YTD 2015/16Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s - Current Provisional 344 287 January 2016 to December 2016 (Provisional)Emergency admissions for acute conditions that should not usually require hospital admission - Yearly 1675 1871 - YTD 2015/16Emergency admissions for acute conditions that should not usually require hospital admission - Current Provisional 1675 1846 January 2016 to December 2016 (Provisional)Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) - Yearly 607 649 - YTD 2015/16Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) - Current Provisional 607 549 January 2016 to December 2016 (Provisional)% Patient experience of primary care - GP Services 84.93% 83.47% - Jul-17% Patient experience of primary care - GP Out of Hours services 66.96% 67.00% - Jul-17% 4 hour A&E waiting times - seen within 4 hours - CCG (Monthly) 95.00% 92.26% 91.74% Aug-17% Patients on incomplete non-emergency pathways waiting no more than 18 weeks (Commissioner) 92.00% 92.39% 91.89% Jul-17Number of 52 week Referral to Treatment Pathways Incomplete (Commissioner) 0 0 6 Jul-17% Patients waiting for diagnostic test waiting > than 6 wks from referral (Commissioner) 1.00% 0.63% 0.63% Jul-17Cancer - % Patients seen within 2wks referred urgently by a GP 93.00% 96.30% 95.27% Jul-17Cancer - % Patients referred with breast symptoms seen within 2 wks of referral 93.00% 89.42% 93.22% Jul-17Cancer - % Patients seen within 31 days from referral to treatment 96.00% 98.18% 98.18% Jul-17Cancer - % Patients seen within 31 days for subsequent treatment (Surgery) 94.00% 100.00% 98.82% Jul-17Cancer - % Patients seen within 31 days for subsequent treatment (Drugs) 98.00% 100.00% 100.00% Jul-17Cancer - % Patients seen within 31 days for subsequent treatment (Radiotherapy) 94.00% 83.33% 93.23% Jul-17Cancer - % Patients seen within 62 days of referral from GP 85.00% 91.30% 87.20% Jul-17Cancer - % Patients seen from referral within 62 days (Screening Service: Breast, Bowel & Cervical) 90.00% 100.00% 94.59% Jul-17Cancer - % Patients being seen within 62 days (ref. Consultant) 85.00% 75.00% 77.42% Jul-17Category 1 YAS - 8 Minute Response Time 75.00% 65.79% 70.41% Aug-17Category 2R YAS - 19 Minute Response Time 95.00% 77.68% 80.59% Aug-17Category 2T YAS - 19 Minute Response Time 95.00% 68.49% 73.13% Aug-17

Performance

Governing Body Report 2017/18

Governing Body Dashboard

Exception Report

Proportion of people on Care Programme Approach (CPA) who were followed upwithin 7 days of discharge 100.00% 94.00% 94.00% Q1 17/18Urgent operations cancelled for a second time 0 0 0 Jun-17Ambulance handover delays of over 30 mins 0 75 1512 Aug-17Ambulance handover delays of over 1 hour 0 1 179 Aug-17Use of broad spectrum antibiotics 10 6.5 - Mar-17Satisfaction with accessing primary care 85.00% 67.96% - Jul-17% Patient experience of primary care - GP Services 84.93% 83.47% - Jul-17Trolley waits in A&E -zero waits from decision to admit to admissions over 12 hours - BHNFT (Month) 0 0 0 Aug-17Improvement in health related quality of life for people with a long term mental health condition 0.53 0.40 - YTD 2015/16Proportion of people waiting 18 weeks or less from referral to first IAPT treatment appointment 95.00% 99.54% - Aug-17Proportion of people waiting 6 weeks or less from referral to first IAPT treatment appointment 75.00% 68.21% - Aug-17Cancelled operations rebooked within 28 days 0 0 0 Jun-17

Outcomes Target Actual Period Actual YTD Period TrendIncidence of healthcare associated infection (HCAI) - MRSA (Commissioner) 0 0 2 Aug-17Incidence of healthcare associated infection (HCAI) - MRSA (Provider) - BHFT 0 0 0 Aug-17Incidence of healthcare associated infection (HCAI) - C.Diff (Commissioner) 3 2 19 Aug-17Incidence of healthcare associated infection (HCAI) - C.Diff (Provider) - BHFT 1 1 3 Aug-17Number of mixed sex accomodation breaches (Commissioner) 0 0 0 Aug-17

Quality

GB/Pu/17/10/14.2

IAPT IST REPORT ACTION PLAN

The action plan below has been devised following initial feedback from the IST from their visit to the Barnsley IAPT service on 11th July 2017. Although it is acknowledged that further information, meetings and validation of data is required before the final report is produced, the BDU wishes to act quickly in areas where actions can be taken to make immediate improvements to the service. The Plan below therefore represents ‘quick wins’ and areas that can be addressed ahead of receipt of the final report and is based on verbal feedback received from the IST on 12th July 2017 and an email summary received subsequently from the Support Team. This plan will be updated and revised as further information is received from the IST, and again on receipt of the Final report. The Service also attended the CCG Governing Body on the 27th July and it was agreed that actions from this meeting would be added to this action plan.

No.

Issue

Action

Lead

Timescale

1 IST received feedback from Service Users that the wording of our initial letter was unwelcoming

Service users to review standard correspondence letters and advise on content and tone

Linda Pickersgill to take to Recovery form Reading group to discuss letter with clients

September 2017 Agreed to split into two letters one for treatment and one for assessment. Assessment letter reviewed with service users and signed off, now being used in practice Treatment letter rewritten by staff to go to service users for

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

feedback.

2 IST identified data quality issues in relation to recording of ethnicity, religion and presenting problem and disorder specific measures

Develop new referral form to capture info straightaway Admin to check data is inputted where available Clinicians to input as appropriate

Liz/Tom/Victoria IAPT Action plan meeting to address this issue (28th September 2017) Development has started on new referral form to improve collection of demographics. The contract performance notice has been shared with staff. Key data requirements have been reviewed again in the team meeting. Maintained additional admin support from non-recurrent money and data quality work is ongoing. Recording of presenting problem has increased from 58% in January 17 to 84% in August.

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

3 IST noted that some service users had received unusually high numbers of sessions of therapy

Review of cases apparently in receipt of high numbers of sessions, lessons to be learned from this and processes revised. Picked up in management Supervision and to take to IAPT Action plan meeting - to look at the individual caseloads to monitor numbers of sessions offered.

Tom/Liz/Victoria IAPT action plan meeting to discuss and identify a team approach to best ways of getting regular monitoring (IAPT action plan meeting is 2 weekly)

4 IST found the clinical pathway and administrative processes confusing and complicated

• Clinical pathway to be mapped out and reviewed

• Administrative pathway to be mapped out and reviewed

Tom, Liz and Victoria

To discuss with team further in IAPT action plan meeting (2 weekly meetings – next one 16th August 2017) Mapping completed and sent to IST Admin treatment hub reorganised in order to reduce wasted sessions for treatment.

5 IST raised concerns about paper and electronic systems holding different information

Solution to be sought to scanning of paper documents into the electronic system (as per Paper light guidance)

Andrea Wilson Paul Foster

Andrea Wilson has taken this issue to the Operational managers meeting.

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

6 IST raised concerns about use of and administration around paper notes

Service to identify where/why paper notes are used within the system (may link to actions 4 and 5 above) Paper notes are used to review a client’s history which is essential. Currently the trust hasn’t got paper light accreditation so paper notes are required to store paper that cannot be scanned and uploaded to RIO e.g. GP paper referral. All letters generated by the service are saved and uploaded.

Trust wide paper light lead. Linked to number 5 Andrea Wilson and Paul Foster

Andrea Wilson has taken this issue to the Operational managers meeting.

7 IST noted that significant time and effort was spent on managing interfaces with other teams and services

Points of interface to be identified and actions agreed to ensure smooth transition of service users up and down the clinical system

Liz/Tom/CoreTeam/SPA team/IHBTT

Meeting held 13th September improved pathway agreed with SPA and Core, further meeting required to agree changes with Core Psychology before changes can be implemented.

8 IST supported the appointment of a Clinical Lead for the service

Clinical Lead role/JD to be reviewed and revised following 2 failed recruitment initiatives to maximise chances of a successful appointment

Liz/Tom Clinical Lead job description agreed. This post has been advertised once but unable to shortlist anyone. Post has now gone back out to advert.

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

9 IST noted that clinical staff appeared to be spending less face to face time with service users than would be expected in an IAPT service of this type

Clinical facing time data to be understood on an individual practitioner basis to better understand the capacity available to the team Submit correct staff absence data to IST to check against current data

Liz/Tom/Victoria Cathryn

To resubmit data -August 2017. Data re submitted. From here action plan monitoring and increase contacts if necessary via IST feedback and IAPT action plan meeting Piloting staff emailing case managers a weekly summary of face to face offered appointments, DNAs and cancellations and reasons why if target not achieved. Week commencing 11.9.17

10 IST noted that IAPT staff were expected to input into 2 clinical systems and that this was highly inefficient and detracted from the delivery of therapy sessions

The service to maximise utility of PCMIS and withdraw from recording data on RIO with the following safeguards: • Internal and external activity reporting

requirements were met • Access to client data on PCMIS was made

Andrea Wilson/Sean Rayner Liz Holdsworth/P&I Liz Holdsworth/Jill

Andrea Wilson took this issue to the extended management team meeting. Confirmation received from Andrea

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

available to MH teams in the wider system to reduce clinical risk

Jinks Wilson on the 25.8.17 that the service could stop double inputting measures on RIO and move towards just using PCMIS to its full capability. Staff informed no need to double input measures on RIO 30.8.17 Meeting arranged with Trust IT and PCMIS September / October in order to plan a safe transition.

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

CCG Governing Body Action Plan a Improving communication with GPs • Attending Practice Meetings

• Review written communication with the LMC

• Devise a where to refer chart for SWYPFT mental health services

• Attend Practice managers meeting • Utilise Link Role better to improve

communication

Management Secretary to arrange for management team to visit GP practice meetings Management to attend LMC meeting, we have asked to be informed what meeting we can attend

Ongoing over next few months – dependent on GP practice availability (first meeting arranged for 4th October 2017) Manager of SPA /EIT and IHBBT contacted to request appropriate wording for flow chart. Lynda Pickersgill is in the process of pulling a list of third party and Voluntary organisations together. Flow chart has now been developed this is being shared with some GP practices and will then be revised before being circulated across the CCG

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

b Further Data required • DNA’s by GP Practice for CCG and as requested by individual practices

• DNA comparison by group and face to face

• DNA comparison by referral routes

Cathryn Milthorpe End of August 2017 Completed and sent to Brigid Reid and Patrick Otway 25.9.17

c Increasing attendance at group work • Suggested development of a group of expert patients who would be willing to be contacted by clients before they attend groups to share experience

• Direct people more to the YouTube video on the website re patient experience

• Improve data quality around recording of group work

•

IAPT Action Plan meeting to discuss and generate plans to sell the groups more effectively Current group leaders to discuss with group clients re becoming an expert patient in this area.

December 2017

d Improve the offer of digital therapy • Express interest in Digital IAPT • Buy licences for Silvercloud if not

accepted for Digital IAPT • Explore Sound Doctor as a

signposting option

Liz/Tom/Victoria Expression of Interest re Digital IAPT expressed, waiting to hear back re bid. Tom Has reviewed Sound Doctor (internet based self-help. This is very much focussed on Long Term Conditions, but not

GB/Pu/17/10/14.2

No.

Issue

Action

Lead

Timescale

directly for mild to moderate anxiety or depression. This may be useful for integrated IAPT but of no use for Core IAPT. Follow up email to Sarah Boul NHS England who says that services should hear beginning of October if successful.

e Improve Access in GP practices • Meet with Dr Guntamukkala • Meet with Dr Krishnaswamy • Meet with Dr Holloway (Garland

House) • Meet with Dr Kakoty

As per “a” Dates booked As of 25.9.17 two out of the 4 practices had been visited.

f Improving the quality of referrals • Linked with 1 around visiting practices and feeding back DNA rates

• Development and roll out of IAPT prescription pad

• Encourage Self-referral

As per “a” Internet self-referral now available Prescription pads re IAPT to be ratified and rolled out

October 2017 Leaflets promoting self-referral have now arrived and been distributed by Kirsty Waknell. Prescription pad sent for design.

Re: Contract Variation Letter

Dear CCG Officer, Changes to the ambulance national standards and reporting arrangements

On 13 July 2017 Jeremy Hunt accepted Sir Bruce Keogh’s recommendations on improvements to the ambulance services in England and associated national

standards and reporting arrangements. This letter sets out the arrangements required to enact these changes. Ambulance Response Standards

The current Red 1 and Red 2 national standards are being replaced by a new call prioritisation system which sets standards for all 999 calls to ambulance services, including those requiring an ambulance intervention passed to ambulance services

via 111. These two sets of standards are not comparable, and this will be clearly stated in national publications at https://www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/# from August 2017.

The new Ambulance Quality Indicator (AQI) standards will be phased in as each ambulance service adopts the new system, on a trajectory agreed with the NHS England Ambulance Response Programme (ARP) team and in discussion with local

commissioners, with the intention that all services are reporting to the new standards by the end of November 2017. The first monthly publication to include this new reporting will be August 2017 data, released in October 2017 for some implementer sites. The Statistical Note published on 10 August contains a description of changes

to statistical reporting as a result of the new standards.

NHS England Medical Directorate

5th Floor (5W52) Quarry House

Quarry Hill Leeds LS2 7UE

Gateway number - 07178 CCG Officers

Cc: Ambulance Trusts CEO, Lead Ambulance Commissioners and Regional Leads

7th September 2017

https://www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/

https://www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/

In addition, the revised Clinical Quality Indicators (CQI) will include reporting of data across the patient pathway as ambulance trusts begin to utilise national outcome databases. Reporting of CQIs will move to a quarterly schedule to better monitor

trends, and will be ready for full publication in April 2018 due to the preparatory work required for the new stroke indicator. The STEMI and cardiac arrest outcome data, which are unchanged, will be available ahead of this.

For the first three months following the introduction of the revised AQIs, Trusts will continue to submit and NHS England will continue to collect a small number of the previous measures for statistical monitoring purposes. This will help to monitor the impact of slight definitional changes in the new specification, so that NHS England

and others can answer questions along the lines of “Did ambulance services answer more calls in 2018 than in 2013?” Previous items to be collected during this period are:

• Calls presented to switchboard • Calls that received a face-to-face response • Incidents not transported to a Type 1 or Type 2 A&E

The new AQIs include revised and standardised definitions for “Hear and Treat” and “See and Treat” which will impact on reporting of these two interventions. All providers will likely see a step change in their rates, either positive or negative,

during the initial period, depending upon current reporting practice. Performance expectations

From the date of this letter (7 September 2017), the sanctions set out in the NHS Standard Contract which relate to the old Ambulance standards will not apply. Updated sanctions, reflecting the new standards currently being introduced, will be considered from 1 April 2018. NHS Improvement will similarly not investigate or

intervene in ambulance trusts on the basis of performance standards whilst the old set are being phased out and the new set phased in. It is recognised that ambulance trusts will need the remainder of the financial year to

enable the revised standards to bed in, and to allow time for the required system changes to be made. Necessary changes to workforce and fleet are still progressing in provider services that have already adopted the new code set, giving an indication of the operational impact of the new system. New standards may not be consistently

achieved until new ways of working are in place. Thus commissioners would be expected to work with their providers to monitor performance against the new standards and to discuss progress, but with an understanding that progress will not be able to be formally judged until 1 April 2018. We would expect there to be a

particular focus on Category 1 and key clinical quality indicators in these discussions, in order to ensure that the sickest patients continue to receive the fastest possible response. We would also expect there to be regional oversight of these arrangements, in line with winter planning and assurance processes.

These changes will not be effective in isolation and are reliant on commissioners ensuring that a system wide approach to urgent care transformation is enacted.

Ambulance services could be supported by the commissioning of alternative referral pathways, the elimination of hospital handover delays, and other initiatives to increase their ability to effectively discharge patients at scene, or on the phone.

An NHS England internal ‘check and confirm’ of the revised AQIs will be undertaken in early spring 2018 to ensure that we are measuring and reporting the items that best reflect those aspects of clinical care that truly benefit patients. This will be

completed before 1 April 2018. NHS England and NHS Improvement will discuss the inclusion of the new standards in the Single Oversight Framework (SOF), and NHS Improvement will monitor the

progress of implementation as part of routine processes prior to formal inclusion. Contracts and Sanctions

Commissioners should therefore not levy any financial sanctions associated with the current national ambulance response standards for the financial year of 2017/18. Where sanctions have already been applied in respect of the standards in the 2017/18 financial year, commissioners should make arrangements to repay the

funding withheld to the relevant providers. NHS England will shortly consult on a National Variation to make in-year changes to the 2017/19 NHS Standard Contract. Amongst other changes, this National Variation

will replace the existing ambulance response standards with the new ones. We intend that the National Variation will be implemented in local contracts by 1 January 2018, but with compliance with the new standards becoming a contractual requirement only from 1 April 2018, as described above.

NHS England will also consider whether further changes need to be made to the CCG Quality Premium scheme as a consequence of these changes. Local Incentive Schemes

We are aware that a number of local contractual incentive schemes may exist, which rely on data collected by the current AQIs. Issues are likely to arise where these

schemes relate to required improvements in “See and Treat” and “Hear and Treat” rates, given the definitional changes described in this letter. We advise that local discussions should take place between commissioners and providers as to the impact these changes may have. However, careful consideration should be given

before sanctions or incentives are applied, particularly where there have been significant changes to the rates from the agreed baseline position. If further advice on this point is required, commissioners can contact the NHS England ARP team. Regulation

NHS Improvement will be reflecting these changes in their approach to the regulation and oversight of provider organisations, and will set out details of the changes

required to the Single Oversight Framework.

Data Reporting and Publication

Until notified, commissioners and providers should continue to submit all existing

monthly data collections. Summary

It is our intention that the revised national ambulance standards and reporting requirements will support a focus on clinical care and patient outcomes and experience. This presents a unique opportunity for commissioners and providers to work together in partnership to ensure the successful implementation of these

changes, thereby building a firm foundation for future service developments that will deliver the vision set out in the Urgent and Emergency Care review. Yours sincerely,

Professor Jonathan Benger, MD FRCS DA DCH DipIMC FCEM. National Clinical Director for Urgent Care, NHS England.

GB/Pu/17/10/14 Appendix 4

NHS Barnsley Clinical Commissioning Group

Finance Report 2017/18

Month 5


1 Headline Messages and contents

Headline Messages

• The CCG continues to forecast achievement of financial duties and planning guidance requirements, with an in-year balanced budget

position. As previously reported this position is predicated on the delivery on the CCG’s £11.5m efficiency programme and in year forecast position. Further information on the CCG’s financial performance targets is provided in section 2.

• The CCG’s Efficiency Programme Management Office (PMO) monitor and review delivery of the CCG’s £11.5m efficiency programme.

In the year-to-date (YTD), the CCG is reporting achievement of £7m against its plan, however, it is important to note that NHS BSA Prescribing data in only available to Month 3 and therefore the £3.4m YTD position reported by the Head of Medicines Optimisation has not yet been confirmed through actual prescribing data. Internal validation is however undertaken by the Head of Medicines Optimisation to validate the reported position. The forecast position on schemes, as reported by project managers, shows a £0.1m shortfall against the £11.5m target.

• Barnsley Hospital NHS Foundation Trust (BHNFT) contract activity data has been received for Month 5 (flex), and based on the Trust

forecast position is showing an overspend position of £6.4m against plan. A robust forecast position is not yet developed, due to ongoing analysis being undertaken. A meeting is due to take place with the Trust to set out the principles of the forecast moving forward. This will include a full review of referrals, waiting times for treatment and coding issues. The outcome of this meeting and revised position will be reported to the Finance and Performance Committee in November.

• Other Acute contract activity to Month 4 (flex) is showing an underspend position across all providers of £843k. Variances are across

a variety of delivery points and specialities. All contracts will continue to be monitored to ensure further potential risks are reported. • Month 3 data has now been received for Primary Care prescribing budgets from NHS BSA and is showing a forecast underspend

position of £849k against budget. This is in the main due to reductions in central drug costs. The Prescribing budget has been reduced to reflect the £4.7m efficiency forecast and the Head of Medicines Optimisation has confirmed the current forecast position is accurate based on information received to date. This will be closely monitored as further data is received and validated.

• Continuing Healthcare budgets are forecasting significant pressures with a forecast overspend of £418k against budget. The

pressures are in the main due to changes to the section 117 criteria and changes in the cost of care packages. A full review is currently being undertaken and the forecast will be updated to reflect the findings of this review. This remains a volatile budget area and will continue to be monitored.

• Further risks and mitigations were considered by the Finance and Performance Committee. The current projections in the ‘Most

Likely’ scenario indicate a potential net mitigation of £2.2m. This will offset the current forecast overspend of £2.1m in section 3. Any further contract overtrading/budget risks will require immediate action to ensure that the CCG delivers its financial duties/targets and business rules. Risks will be escalated to the CCG’s Efficiency PMO immediately to allow mitigating actions to be developed and delivered.

Contents

Headline Messages and Content Financial Performance Targets Monthly Finance Monitoring Statement – Executive Summary

1 2 3

2 Financial Performance Targets

1) Financial Duties

NHS Act Section

Duty2017/18

Target £'000

2017/18 Forecast

Performance £'000

2017/18 Forecast

Achievement

223H (1) Expenditure not to exceed income 411,855 411,855 YES223I (2) Capital resource use does not exceed the amount specified in Directions 0 0 YES

223I (3) Revenue resource use does not exceed the amount specified in Directions 411,221 411,221 YES

223J(1) Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 YES

223J(2) Revenue resource use on specified matter(s) does not exceed the amount specified in Directions (Note 1) 405,584 406,054 YES

223J(3) Revenue administration resource use does not exceed the amount specified in Directions 5,637 5,167 YES

2) Financial targets/NHS England Business Rules requirements

Target/Business Rule Requirement2017/18

Target

2017/18 Forecast

Performance £'000

2017/18 Forecast

Achievement

Delivery of in year balanced position 0 0 YES0.5% Contingency to manage in-year pressures (Note 2) 2,052,000 2,052,000 YES1% non-recurrent reserve - 50% to remain uncommitted, to act as an NHS system risk reserve. (Note 2) 1,868,005 1,868,005 YES

Note 1 : This figure represents the revenue resource allocated for programme expenditure. It can be exceeded to the extent that it can be compensated for by underspends against the administration resource allocation. The CCG plans to utilise £367k of administration resource to cover additional spending on commissioned services for the population of Barnsley.

Note 2 : These figures, both representing 0.5% of CCG resource allocation, however the 1% non recurrent reserve does not include Primary Care Co-Commissioning budgets in the calculation.

Comments The CCG continues to forecast to achieve all financial duties/targets and NHS England (NHSE) Business Rules, this is however predicated on the delivery of the CCG’s efficiency programme and in year forecast position.

3 Monthly Finance Monitoring Statement – Executive Summary

PROGRAMME AND RUNNING COST AREAS

ANNUAL BUDGET

RECURRENT £000

ANNUAL BUDGET

NON RECURRENT

£000

TOTAL ANNUAL BUDGET

£000

YTD BUDGET

£'000

YTD ACTUAL

£'000

YTD VARIANCE

OVER / (UNDER)

£

FORECAST OUTTURN

£000

FORECAST VARIANCE

OVER / (UNDER)

£000PROGRAMME EXPENDITUREAcute 199,933 571 200,504 83,563 82,750 (813) 203,401 2,896Mental Health 33,310 187 33,497 13,957 13,889 (68) 33,432 (66)Community Health 36,361 154 36,515 15,258 15,264 6 36,521 5Primary Medical Services (Co-Commissioning) 34,708 0 34,708 14,388 14,407 19 34,912 204Primary Care Other 57,232 218 57,450 23,968 23,095 (874) 56,300 (1,151)Continuing Health Care 16,224 184 16,408 6,819 7,211 392 16,826 418Other Programme Costs 18,872 (316) 18,557 7,554 7,546 (8) 18,560 3TOTAL COMMISSIONING SERVICES (INCLUDING PRIMARY CARE RESERVES) 396,642 999 397,640 165,507 164,161 (1,345) 399,951 2,311Corporate Costs 2,330 24 2,354 981 790 (191) 2,246 (108)Depreciation / Property Charges 941 0 941 392 387 (5) 936 (5)TOTAL CORPORATE COSTS 3,271 24 3,295 1,373 1,177 (196) 3,182 (113)TOTAL PROGRAMME COSTS (INCLUDING PRIMARY CARE RESERVES) 399,913 1,023 400,935 166,879 165,338 (1,541) 403,133 2,197RUNNING COSTSPay 3,502 (94) 3,408 1,290 1,191 (99) 3,266 (142)Non Pay 1,916 144 2,060 858 740 (117) 2,140 80Income (181) 0 (181) (76) (77) (2) (239) (58)TOTAL RUNNING COSTS 5,237 50 5,287 2,072 1,854 (217) 5,167 (120)Other Plans required to deliver Target Efficiency Programme (81) 0 (81) 87 0 (87) (81) 0CCG Reserves 7 2,771 2,778 (569) 0 569 2,778 0NHS England Planning Guidance Reserves 434 1,868 2,302 0 0 0 2,302 0In Year (Over)/underspend 0 0 0 (1,277) 0 1,277 (2,078) (2,078)TOTAL RESERVES/CONTINGENCY (EXCL. PRIMARY CARE RESERVES) 360 4,639 4,999 (1,759) 0 1,759 2,921 (2,078)TOTAL EXPENDITURE 405,510 5,712 411,221 167,193 167,192 0 411,221 (0)Programme 410,130 (4,546) 405,584 165,120 165,120 0 405,584 0Running Costs 5,487 150 5,637 2,072 2,072 0 5,637 0RESOURCE ALLOCATIONS 415,617 (4,396) 411,221 167,192 167,192 0 411,221 0

SURPLUS/(DEFICIT) 10,108 (10,108) (0) (0) 0 (0) (0) 0

Comments • Acute expenditure and forecasts reflect Month 4 data for most providers. Barnsley Hospital NHS Foundation Trust data for Month 5 flex has been received and is reflected

in the forecast position, further analysis is being undertaken to ensure the forecast includes the impact of demand management initiatives. • Prescribing forecasts are projecting a forecast underspend of £849k due to reductions in central drug costs. GP prescribing remains broadly in line with budget. • Continuing Care forecasts are projecting an overspend of £418k, this is mainly attributable to the application of a new S117 matrix and some changes in the CHC process.

This is currently being reviewed by the Chief Nurse and Deputy Chief Nurse to mitigate any further emerging risks. • Other variances from budget are in the main across staffing related budgets.

GB/Pu/17/10/15


GOVERNING BODY

12 October 2017

Quality, Innovation, Productivity and Prevention (QIPP) Programme Reporting


Decision Approval Assurance X Information X

2. REPORT OF

Name Designation Executive Lead Jamie Wike Head of Planning, Delivery and

Performance Author Jamie Wike Head of Planning, Delivery and

Performance


3.1 The QIPP programme reporting dashboard aims to provide the Governing Body with an overview of progress and performance against the schemes within the CCG QIPP/Efficiency Programme. The progress of each scheme has been reviewed by the QIPP Delivery Group and the dashboard has been reviewed by the Finance and Performance Committee.

3.2 The dashboard attached at Appendix 1 is intended to provide the Governing Body with a high level overview of current delivery of the QIPP programme with this covering report providing details of any areas highlighted by the Finance and Performance Committee for the attention of the Governing Body. The schemes and projects included within the dashboard include those which are being delivered in 2017/18 but with savings expected in 2018/19

3.6 On reviewing the dashboard and discussing progress against CCG QIPP/Efficiency Programme, the Finance and Performance Committee highlighted the following areas for the attention of the Governing Body in order to provide assurance that appropriate action is being taken to mitigate any risks to delivery of the programme:

• The need to firm up and agree expected impacts (financial and activity) for those schemes where this has not been finalised.

• The PMO were requested to follow up on schemes not on track and ensure support is provided to bring projects in line with project plans/timescales.

• The requirement to bring forward opportunities or identify new opportunities for efficiency savings during 2017/18 to deliver the £11.5m

1

GB/Pu/17/10/15 efficiency target, noting the current gap of £0.1m.

• To identify further opportunities to mitigate against contract overtrading that may be experienced above the 0.5% contingency.


• Note the contents of this report and the dashboard attached at Appendix 1.

5. APPENDICES • Appendix A – QIPP Reporting and Escalation Dashboard


10 mins

2



the Governing Body Assurance Framework: 6




Y



Y


Y



NA

Are any financial implications detailed in the report? NA Whilst no financial evaluation form has been completed and there are no direct financial implication relating to this report, the report and attached dashboard do provide an overview of financial performance against the CCG efficiency plans. The Integrated Performance Report provides further details relating to current reported financial performance against the CCG Efficiency Plan.


NA


NA


NA


NA


NA


NA

3

FPC/17/10

Page 1

QIPP Shemes and ProjectsScheme Status (RAG)Project Finance Activity

*

*

N/A

N/A

N/A

*

N/A

*

Clinical Thresholds Wave 1

Lower back acupuncture has been decommissioned

Project is on track in line with revised milestones

Cohort 1 - Core Service is in place and a high level of referrals being received.Cohort 2 - Some progress is being made in commencing work with HIU however delays in identifying appropriate cohort have impacted on project timescales and may reduce potential for savings.

This monthly QIPP programme dashboard is intended to be used to provide an overview of current delivery of the QIPP programme. The dashboard is set out in 2 distinct sections, one to provide assurance on the delivery of QIPP schemes/projects, the second to set out any risks or issues identified by the QIPP delivery Group. The Integrated Performance Report provides a further source of assurance in relation to delivery of the specific areas of the QIPP programme which contribute to the CCG efficiency programme.

Quality Innovation Productivity and Prevention (QIPP)Programme Reporting and Escalation Dashboard

Lower Back Acupuncture

CommentaryThe status for delivery of financial savings is currently red to reflect the impact of remodelling work. The project status is amber due to ongoing challenges agreeing audit processes with the acute trust.

MOM Implemented in all practices and activity levels being monitored and reviewed

Practices are completing work earlier than planned allowing for earlier reporting of end of year position ahead of phasing targets. Monitoring is taking place of other potential growth pressures in prescribing to identify any risks to the financial savings.

Plan on track

Procurement concluded and revised contract value agreed.

Care Navigation

Social Prescribing

Map of Medicine

Prescribing - Medicines Optimisation

Intermediate Care

GP Out of Hours

FPC/17/10

Page 2

Project Finance Activity

*

*

*

*

*

*

N/A

RAG - Red = Off track, significant resk to delivery - Amber = Off track but plans to recover - Green = On track

Issues and Risks for Escalation

DiabetesThis project is being delivered in 2017/18 however there are no efficiencies identified within the 2017/18 QIPP Plan

Respiratory

Clinical Thresholds Wave 2

Care Homes

Prescribing - Medicines Ordering, Safety and Waste Currently on track

Project being delivered in line with plans however further work is required to assess the anticipated level of savings to be achieved in 2017/18

No anticipated savings in 2017/18. A phased approach will be taken to ensure full engagement with primary care to maximise take up. This could result in reduced financial benefit as the original assessment was based upon 100% take up in 2018/19

* At this point it has not been possible to validate acute contract and other activity data to assess the delivery of the anticipated activity reduction.

Clinical Thresholds - Compliance with existing policies

Policies in place and monitoring arrangements in place however further work is ongoing to agree expected saving in line with modelling work relating to wave 1.

CVD - Atrial Fibrillation

PID currently in development and therefore unable to fully assess progress however activity is continuing including engagement and preparation for the procurement process.

Service mobilisation underway. Service to commence October. The anticipated investment was revised upwards to reflect the earlier than anticipated recruitment to posts in 2017/18.

Plans are in place to deliver wave 2 however the level of savings originally anticipated in 2017/18 will not be delivered due to the commencement date being pushed back to late in the year in line with other SY&B CCG's.

Commentary

Overall the key projects are being delivered in line with plan however in some areas the level of savings included in the origibnal plan may not be achieved.The IPR provides financial details of the YTD position being reported at month 5.The key risk to delivery of the required efficiency savings as part of the QIPP plan is that delivery of all the projects which are currently identified to achieve savings in 2017/18 will not achieve the required level of savings.Taking account of all currently agreed schemes which are rated as green, there remains a shortfall of approximately £100k. The Programme Management Office (PMO) contine to explore 'Amber', 'Red' rated schemes and schemes in the pipeline to ensure delivery of the £11.5m target. The PMO also acknowledges that schemes above this need to explored to mitigate any contract overtrading above the 0.5% contingency.

GB/Pu/17/10/16


GOVERNING BODY

12 OCTOBER 2017

QUALITY HIGHLIGHTS REPORT PART 1A – SUMMARY REPORT 1. THIS PAPER IS FOR

Decision Approval Assurance X Information

2. REPORT OF

Name Designation Executive Lead B Reid Chief Nurse Author P Dawson

S MacGillivray

Quality Administrator Designated Nurse Safeguarding Adults & Patient Experience


Provide the October Governing Body with the agreed highlights of the September 2017 Quality & Patient Safety Committee. The information provided is in addition to the monthly performance report and ongoing risk management via the Assurance Framework and Risk Register. Four quality issues are highlighted and rated: • Reduction in HSMR – green • Primary Care Quality Dashboard – amber • CQC inspections – amber • Risk Assessment – IAPT performance - amber


• Note the Quality Highlights identified

5. APPENDICES • Appendix A – Quality Highlight Report


10 minutes

Green = positive assurance Amber = concern being monitored, for information Red = articulated risk or escalation



the Governing Body Assurance Framework: 4, 7




Y




Y



NA



NA


NA


NA


NA


NA


NA


GB/Pu/17/10/16 Appendix A – September 2017 QPSC Quality Highlight Report Issue Consideration

Action

Reduction in HSMR It was noted that the HSMR for BHNFT has fallen to 94. This means that it has been below 100 for the past year. Our risk (13/10) was therefore reviewed by the committee.

It was agreed that the likelihood should be amended to the score of 2 meaning that the new score is 12 but that it would remain on the risk register to ensure continued monitoring.

CQC inspections Following contact with one GP practice regarding an imminent inspection under the new CQC regime the committee discussed the need for the CCG to share relevant intelligence with the CQC on a proactive basis. It was also noted that the CQC will conduct their ‘well led’ inspection of BHNFT in mid-November which means that an unannounced inspection of some services there will occur within the next few weeks.

It was agreed that the Senior Primary Care Commissioning Manager will liaise with the local CQC manager to obtain an idea of timescale and update Committee members, Practice Managers and BCCG Chairman and Chief Officer accordingly.

Primary Care Quality Dashboard

The draft Primary Care Quality Dashboard was presented to the Committee. It was commended for the progress made with some further amendments required.

The Senior Primary Care Commissioning Manager will make the amendments, to go to Primary Care Commissioning Committee for information on 28/09/17 and for final sign off at the public Governing Body meeting on 12/10/17.

Risk Assessment – IAPT performance

The Head of Governance & Assurance shared the request from the Finance & Performance Committee that Quality & Patient Safety Committee formally risk assess the impact on quality that persistent poor performance by the IAPT services is having.

The Head of Governance and Assurance will work with Head of Commissioning, BCCG and Head of Planning, Delivery and Performance, BCCG to develop a draft quality IAPT risk for the next Q&PSC to consider. It was agreed that the Finance and Performance Committee would need to do the same with regard to the performance element.


GB/Pu/17/10/17


Minutes of the meeting of the Barnsley Clinical Commissioning Group AUDIT COMMITTEE held on Thursday 21 September 2017 at 3.00 pm in the Boardroom, Hillder House, 49/51 Gawber Road, Barnsley S75 2PY PRESENT: Nigel Bell Audit Committee Chair – Lay Member for Governance Marie Hoyle Practice Manager Member Chris Millington Lay Member for Patient and Public Engagement and Primary

Care Commissioning IN ATTENDANCE: Leanne Hawkes Deputy Director, 360 Assurance Kay Meats Client Manager, 360 Assurance Kay Morgan Governance and Assurance Manager Roxanna Naylor Acting Chief Finance Officer Richard Walker Head of Governance & Assurance Amy Warner KPMG Audit Manager APOLOGIES Claire Croft Counter Fraud Specialist Dr Madhavi Guntamukkala Governing Body Member

Agenda Item

Note

Action

Deadline

AC 17/09/01

QUORACY

The meeting was declared quorate.

AC 17/09/02

DECLARATIONS OF INTEREST, SPONSORSHIP, GIFTS AND HOSPITALITY

The Committee noted the Declaration of Interests Report. No new declarations of interest were received.

AC 17/09/03

MINUTES OF THE PREVIOUS MEETING HELD ON 27 JULY 2017

The minutes of the meeting held on 27 July 2017 were verified as a correct record of the proceedings.

AC 17/09/04


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Agenda Item

Note

Action

Deadline

• Minute reference AC 17/07/09 - Annual Audit Letter and potential fee variation for additional work in relation to the service auditor report for Capita in respect of payments to GPs. The KPMG Audit Manager reported that a slight increase in fee for additional work in respect of CAPITA was anticipated for 2017/18, the exact amount was not known at this time. The Committee noted that Primary Care Support Services provided by CAPITA would be further considered under agenda item 18, a letter from NHSE relating to the service Auditor Report in respect of Primary Care Support England (PCSE) Services and the position going forward.

The Committee noted the Matters Arising Report.

AC 17/09/05

ASSURANCE ON COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES

The Head of Governance and Assurance introduced his report which provided the Audit Committee with assurance in respect of compliance with the CCG’s Standing Orders and Prime Financial Policies. It was noted that agenda item 9 ‘Losses and Special Payments – Redrose Care Ltd irrecoverable debt’ would request the Committee to approve the write off of an irrecoverable debt.

The Committee discussed the single tender waiver relating to SWYPFT’s provision of a transportation service of mail, sterile equipment and other stores. The Head of Assurance clarified that: • The actual end date for the current contract was 31

March 2018 and the proposed extension was to 31 March 2019.

• The transport elements to all other service provided by SWYPFT were being identified with a view to informing the CCG’s future course of action in relation to transport services.

The Practice Manager Member commented the transportation service was valued by Practices.

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Agenda Item

Note

Action

Deadline

The Audit Committee noted the report and the two single tender waivers appended to the report.

AC 17/09/06

INTERNAL AUDIT PROGRESS REPORT

The Client Manager, 360 Assurance presented the Internal Audit Progress Report to the Committee. The Committee noted that: • Planning was in progress for quarter 3 work and this

would be presented to the Audit Committee in January 2018 with quarter 4 work to the March meeting of the Committee.

• The planned STP/ACS Joint Review would now not take place, freeing up a potential 5 days of audit capacity.

• In response to a question raised relating to the Review of Committee Governance and recommendation about Committee Terms of Reference the Head of Governance and Assurance advised that the CCG did not normally include the specifics about cancelling a meeting in a Committee Terms of Reference however for one particular Committee meetings had been cancelled on a number of occasions.

The Deputy Director, 360 Assurance drew member’s attention to the Head of Internal Audit (HOIA) Work Programme: Stage 1, advising the Committee that an initial assessment of the GBAF had been undertaken with no concerns identified. A survey about the GBAF would be circulated to Governing Body members. The scheduled Risk Management Review would also inform the HOIA work.

The Committee discussed the 360 Assurance Briefing Paper ‘Your Data: Better Security, Better Choice, Better Care and the following main points were noted: • The CCG’s Senior Information Risk Owner SIRO was

the Head of Governance and Assurance • CCG IT services were provided by eMBED. • The CCG did not have any unsupported systems,

assurance of this had been requested from eMBED. This assurance would also support the CCGs Information Governance Toolkit assessment.

• The new IG training was available to Practices

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Agenda Item

Note

Action

Deadline

The committee noted: • Progress against the Audit Plan • Key messages from the internal Report Review of

Committee Governance • The information and guidance papers produced by

360 Assurance. Agreed Actions: • The Client Manager and Acting Chief Finance

Officer to agree reallocation of available 5 days within the Audit Plan.

• To arrange a meeting with Audit Committee members and the Client Manager around the process of ‘follow up’ work from internal audit reviews.

• To arrange for the Information Governance Manager eMBED to attend a Practice Managers Group.

• To ascertain if Andy Mellor, Assistant Director 360 Assurance can attend a Practice Managers Group to present on Cyber Security

• To request assurance from eMBED about 3rd party involvement in CCG systems such as websites.

RN/KM

KM

RW

KM

RW

30.11.17

19.10.17

30.11.17

30.11.17

30.11.17

AC 17/09/07

UPDATE FROM EXTERNAL AUDITORS KPMG

The KPMG Audit Manager presented the Technical Update to the Committee. It was noted that items included in the Technical Update were extracted from national documents, a true context could therefore be lacking in the Update. .

Members attention was drawn to the item relating to the NHSE’s investment to support people with a learning disability. The Committee were informed that the CCG’s Head of Commissioning, Patrick Otway was working with the North Kirklees, Greater Huddersfield and Wakefield Transforming Care Partnership to determine how best to deploy this money.

The Committee noted the report. Agreed Actions: • To convey the Audit Committee’s comments about

AW

30.11.17

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Agenda Item

Note

Action

Deadline

context within the Technical Update to KPMG

AC 17/09/08

LOSSES AND SPECIAL PAYMENTS – Redrose Care Ltd Irrecoverable Debt

The Acting Chief Finance Officer informed the Audit Committee that an outstanding debt with Redrose Care Ltd was irrecoverable despite the CCGs efforts to recover the debt. The Committee Chairman suggested advising the Local Counter Fraud Specialist of the debt. This would not change the legal status of the debt and Counter Fraud could still investigate.

The Committee noted the contents of the report and approved the write off of the irrecoverable debt for £19,412.50 against provision created in 2015/16.

Agreed Action:

To inform the Local Counter Fraud specialist of the Redrose debt.

RN

30.11.17

AC 17/09/09

POLICY ON POLICIES

The Head of Governance and Assurance introduced the Policy on Policies to the Committee. The Committee Chair queried a requirement to have a signed copy of an approved policy and a library of hard copy policies for business continuity purposes. It was clarified that a master copy of each policy was retained centrally and electronically in the CCG Policy folder, additionally all policies were shared within the CCG and included on the staff intranet and website. On this basis it was agreed that the reference to maintaining a set of hard copies could be removed from the Policy.

The Committee approved the proposed changes to the Policy on Polices – the Development and Management of Procedural Documents.

AC 17/09/10

FRAUD BRIBERY & CORRUPTION POLICY

The Committee considered and approved the proposed changes to the Fraud, Bribery and Corruption Policy.

AC 17/09/11

AUDIT COMMITTEE MEETING DATES 2018

The Committee approved the meeting dates for 2017-18. Members were informed that due to financial year end

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Agenda Item

Note

Action

Deadline

timescales the papers for the April 2018 meeting may be distributed the day before the meeting or tabled at the meeting.

AC 17/09/12

TERMS OF REFERENCE HEALTH AND SAFETY GROUP

The Committee approved the Terms of Reference for the Health and Safety & Business Continuity Group. Agreed Action: To provide the Audit Committee with a concise Health, Safety, Fire and Business Continuity Assurance Report on a quarterly basis.

RW

30.11.17

AC 17/09/13

FULL REVIEW ASSURANCE FRAMEWORK RISK REGISTER

The Head of Governance and Assurance introduced his report. In line with reporting timescales the Audit Committee were provided with the full Assurance Framework, full Corporate Risk Register and Procurement Register.

It was noted that the Committee received the full Assurance Framework and Risk Register twice a year with exception reports submitted to other intervening meetings. The Audit Committee had responsibility to ensure that the Assurance Framework and Risk Register were regularly reviewed and updated by risk owners, the Governing Body and its Committees. It was noted that 360 Assurance were undertaking a review of ‘risk’ which would hopefully provide assurance that the Assurance Framework and Risk Register were being maintained.

In response to a question raised the Head of Governance and Assurance provided an explanation in relation to risk reference 17/04 around primary care prescribing. The residual score for the risk was low however, the Quality and Patient Safety Committee had noted the potential for the risk and requested that the risk remain on the register until mitigation actions proved successful in controlling the risk.

The Committee • Reviewed the Full Assurance Framework and Risk

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Agenda Item

Note

Action

Deadline

Register • Determined that all risks are being appropriately

Managed • Noted the increased residual score to ‘red’ extreme

for risk reference 15/14(c) • Noted the risks added and removed from the Risk

Register • Did not Identify any potential new risks or risks for

removal • Noted the report.

AC 17/09/14

REGISTERS OF INTERESTS, GIFTS HOSPITALITY & SPONSORSHIP AND PROCUREMENT DECISIONS

The Head of Governance and Assurance presented the Registers of Interests, Gifts Hospitality & Sponsorship and Procurement Decisions Report to the Committee. Register of Interests & Register of Gifts, Hospitality and Sponsorship The Committee were assured that the Corporate Affairs Team were continuing to ensure CCG staff made appropriate declarations via regular reminders and Committee meetings. The Team were also following up declarations from Practices. New guidance stated that as a minimum the CCG should publish the interests of ‘decision making’ staff. However in the spirit of openness and transparency the CCG continued to publish the interests of all staff on the CCG website. Register of Procurement Decisions The Committee noted the decision making arrangements and management of conflicts of interests recorded on the Register of procurement Decisions.

The Committee noted the report and the assurance that the report provided in respect of Registers of Interests, Gifts Hospitality & Sponsorship and Procurement Decisions.

AC 17/09/15

HEALTH AND SAFETY & FIRE UPDATE

The Head of Governance & Assurance advised that as

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Agenda Item

Note

Action

Deadline

discussed under minute reference AC 17/09/12 a written Health Safety Fire and Business Continuity Report would be provided to future meetings of the Audit Committee.

Health and Safety & Fire The Head of Governance & Assurance reported that a Health and Safety & Fire inspection including the asbestos register had determined some very low risk recommendations. The recommendations were being taken forward by the Health & Safety, Fire and Business Continuity Group. The CCG was essentially a low risk organisation in terms of Health and Safety & Fire.

Business Continuity The Head of Governance & Assurance informed the Committee that the CCG’s Business Continuity arrangements had been reviewed and refreshed. With the Business Continuity Plan and staff emergency contact details being updated. To provide assurance, the CCGs Business Continuity arrangements were to be tested including a communication test message to all staff and a table top ‘Business Continuity’ exercise.

The Committee noted the Health & Safety fire and Business Continuity Update.

AC 17/09/16

ESCALATION OF ITEMS TO GOVERNING BODY

The following key issues for the Audit Committee meeting were highlighted to raise at the October 2017 Governing Body Meeting:

• Policy on Polices • Terms of Reference Health Safety Fire and Business

continuity • Fraud Bribery and Corruption Policy • 360 Assurance GBAF Survey to all Governing Body

Members.

AC 17/09/17

PCSE AND SERVICE AUDIT REPORT POSTION GOING FORWARD

The Committee considered the letter from NHSE relating to PCSE and the service audit report position going forward and in terms of audit work for KPMG. The Committee were informed that the Practice Managers

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Agenda Item

Note

Action

Deadline

Group had identified a number of issues affecting Practices from the Primary Care Support Service provided by CAPITA. A Practice Manager was writing to NHSE, collectively on behalf of all Practice Managers to express the difficulties encountered by Practices. The Primary Care Commissioning Committee had also been picked up these issues with an ambition to get the primary Care Support Service working better.

The Acting Chief Finance Officer advised that a number of additional internal controls had been put in place around payments made to Practices due to incorrect information from PCSE.

NHSE should be held to account for the poor Primary Care Support services provided by CAPITA.

The Committee noted the Letter from NHSE regarding ISAE3402 Service Auditor Report in Respect of Primary Care Support England (PCSE) Services.

AC 17/09/18

REFLECTION ON HOW WELL THE MEETING’S BUSINESS HAS BEEN CONDUCTED

Members reviewed the effectiveness of the committee; it was noted that written Health Safety Fire and Business Continuity assurance reports rather than verbal would be submitted to Audit Committee meetings. • The Agenda papers were appropriate and informative • No training needs were identified.

AC 17/07/19

DATE AND TIME OF NEXT MEETING

The next meeting of the Audit Committee will be held on Thursday 30 November 2017 at 1.00 pm in Meeting Room 1, Hillder House, 49/51 Gawber Road, Barnsley, S75 2PY.

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Putting Barnsley People First Minutes of the Meeting of the NHS Barnsley Clinical Commissioning Group FINANCE & PERFORMANCE COMMITTEE held on Thursday 7 September 2017 at 10.30am in the Boardroom, Hillder House, 49 – 51 Gawber Road, Barnsley S75 2PY. PRESENT: Dr Nick Balac - Chair Dr John Harban - Elected Member Governing Body Dr Andrew Mills - Membership Council Member Lesley Smith - Chief Officer Roxanna Naylor - Acting Chief Finance Officer Dr James Holloway - Elected Member Governing Body Jamie Wike - Head of Planning, Delivery & Performance Dr Madhavi Guntamukkala - Elected Member Governing Body Nigel Bell - Lay Member Governance IN ATTENDANCE: Leanne Whitehead - Executive Personal Assistant APOLOGIES: Patrick Otway - Head of Commissioning (MH, Children, Specialised) Agenda

Item Note Action &

Deadline FPC17/136 QUORACY

The meeting was declared quorate.

FPC17/137 DECLARATIONS OF INTEREST, SPONSORSHIP, HOSPITALITY AND GIFTS RELEVENT TO THE AGENDA

The Committee noted the declarations of interest report. There were no declarations of interest raised relevant to the agenda.

FPC17/138 MINUTES OF THE PREVIOUS MEETING HELD ON 3 AUGUST

2017 – Approved.

FPC17/139 MATTERS ARISING REPORT

The Committee received the matters arising report and the following updates were given: FPC17/126 QIPP Reporting The month 4 PDA data will be shared with members as soon as

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available.

FPC17/140 UPDATE ON RECENT PUBLISHED AND EXPECTED GUIDANCE – No update to report.

FPC17/141 UPDATE ON CONTRACTING CYCLE

The Acting Chief Finance Officer presented an update to the Committee on the Contracting Cycle. It was reported that the alliance contract for Intermediate Care was still to be signed by SWYPFT which was causing a hold up as a new contract could not be issued in relation to Respiratory services until signatures were complete. It was noted that this would be followed up as soon as possible. It was noted that all patients had now moved out of Mount Vernon Hospital. It was reported that work was ongoing around the overtrade position at BHNFT and currently the assessment of risk around that position was around a £5.5m overtrade position. This position assumed that activity would continue at the increased levels experienced at the start of the year to month 4. It was noted that the Acting Chief Finance Officer had requested a referral data set for the last 3 years to understand the position on current referrals and the impact of the demand management scheme. It was reported that a request was sent to the lead commissioner for Spa Medica (Wakefield CCG) to ask if Barnsley could become an associate in the contract due to increasing activity for cataract surgery with that provider and the CCG not having any power to enforce the clinical thresholds policies given the increasing volume of activity. This request had been rejected due to ongoing issues with the provider but once these issues were resolved the lead commissioner would review this again. An update was provided on respiratory services. It was expected to have full staffing levels by December as there was a slippage of 0.9fte since the last update. Dr J Harban reported he had been in discussions and there could be some potential problems around IT and equipment in the community. Actions Agreed:

• Dr J Harban gather the facts around these potential issues and write a letter to the providers setting what is to be expected and requesting a hit list of frequent attenders so these users can be targeted by the respiratory nurses.

• Review Specification with Commissioning and Transformation Manager and to check IT funds costings to see if any in the spec.

JH

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The Committee noted the report and its contents including:

• the update on the 2017-19 Alliance contract • the update on 2017/18 contract monitoring • the non-contracted activity with Spa Medica and the

work to be undertaken.

FPC17/142 APPROVAL AND OR UPDATE ON PROCUREMENTS

The Chief Officer provided a verbal update to members on the Approval and or Update on Procurements. It was reported that the diabetes notice to terminate letters had been issued. Agreed Actions:

• Acting Chief Finance Officer to pick up with CAT Team re tariff/block based in the model.

It was reported that the procurement checklist to MSK had been completed and the conflict of interest issues had been mitigated. It was noted that a single tender waiver had been actioned for the current mail and specimen delivery service provided by SWYPFT due to the contract being extended. A singe tender waiver has also been actioned in relation to the project support for Get Fit First in Barnsley. Agreed Actions:

• Acting Chief Finance Officer to check with Head of Assurance if there is any duplication around the delivery service.

The Committee received and noted the update.

RN

RN

FPC17/143 REVIEW OF COMMITTEE WORKPLAN/AGENDA TIMETABLE

The Head of Planning, Delivery and Performance presented the committee workplan/agenda timetable to the committee for approval. Agreed Actions:

• It was agreed to add the Better Care Fund Plan to the October agenda and reword the Commissioning Intentions to 2018/19.

• It was agreed that the Commissioning Intentions should be an update of the previous ones and SYB ones and do an addendum/update on those to the October Meeting.

LW

JW

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The Committee received and noted the workplan.

FPC17/144 INTEGRATED PERFORMANCE REPORT

Performance The Head of Planning, Delivery and Performance updated members on the performance section of the report with the following areas highlighted with exception:

• The 4 hour standard for patients waiting in A&E (Commissioner)

• The number of people who complete IAPT treatment, moving to recovery

• The proportion of people waiting 6 weeks or less from referral to first IAPT treatment appointment

• Cancer patients referred with breast symptoms seen within 2 weeks

It was reported that the hospital were currently on track to deliver the quarter 2 A&E 4 hour wait target of 94% with performance to date at94.17%. It was reported that IAPT was still an issue and that the Head of Commissioning was chasing the final feedback from the Intensive Support Team and the improvement plan so this could be reviewed. An in-depth discussion took place with the following actions agreed. Agreed Actions:

• Head of Commissioning to draft a letter to SWYPFT in relation to the IAPT service outlining the ongoing concerns, and to ask for a plan that set out when targets would be delivered in order to provide the CCG with assurance that action is being taken and can be monitored.

• Action plan to be shared with Governing Body in October.

Finance The Acting Chief Finance Officer presented the finance section of the report to Committee highlighting that the QIPP shortfall position as reported in the report of £0.9m has now reduced to a shortfall position of £0.1m as at Month 5. It was noted that prescribing was currently underspent and that it appeared from the position that the QIPP schemes were been highly effective. It was noted that the risks to the CCG included the ongoing pressure on Acute contracts and the impact of national price reductions (Cat M) being held by NHS England.

PO

PO

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It was also reported that a coding issue had been found within the acute contracts in relation to sepsis, NHS England guidance suggests that this should be cost neutral, however cost pressures are currently being experienced in the activity data provided by trusts. It has been agreed that a SY&B response to Trusts will be drafted that can be shared with Trusts locally. Agreed Actions:

• Confirm the SY&B position in relation to sepsis and respond to our local providers.

• Acting Chief Finance Officer to chase joint response

letter in relation to Cat M drugs. It was reported that the CCG were on track to deliver all financial duties. Month 4 PDA data would be available to the following week and this would then be shared with members. Agreed Actions:

• The Chair agreed to pick up targeted support to practices with the Head of Delivery.

The Committee noted the report and its contents including:

• 2017/18 performance to date • continued projected delivery of all financial duties,

predicated on the assumptions outlined in this paper • the forecast £0.9m shortfall on the CCG’s efficiency

programme noting this position was now £0.1m. Identify further schemes to ensure delivery of the £11.5m target and also cover any contract risk which may arise beyond the 0.5% contingency currently held in reserve to manage in-year pressures.

RN

RN

NB

FPC17/145 QIPP PROGRAMME REPORTING

The Head of Planning, Delivery and Performance presented an update on the QIPP programme. It was noted that most plans were on track and delivering as expected. The Committee noted the report and its contents and were asked to:

• Note the content of the dashboard and identify any specific actions that the committee agree in relation to the QIPP/Efficiency Programme.

• Note the shortfall of £900k against the £11.5m target, with the revised position now at £0.1m as described

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in the discussion on the Integrated Performance Report.

• Note the requirement for further efficiency to be delivered should contract overtrading be experienced above the 0.5% contingency.

• Agree the content of the dashboard and any risks for escalation for presentation to Governing Body.

FPC17/146 ASSURANCE FRAMEWORK

The Head of Planning, Delivery and Performance presented the Assurance Framework to the Committee. It was noted that there were no new risks since the last meeting, the assurance framework currently has 1 red risk 1.1 urgent and emergency care and 2 amber risks. Agreed Actions:

• Agreed to re score risk 1.1 from a 15 to a 12 making this now an amber risk

• Agreed for QPSC to review amber risk 4.1 and the scoring of this and also as part of the Risk Register for the Quality and Patient Safety and to consider whether a risk in relation to IAPT and the impact of long waits on patient safety should be included.

The Committee were asked to:

• Review the risks on the Assurance Framework for which the Finance and Performance Committee is responsible

• Note and approve the risks assigned to the Committee • Review and update where appropriate the risk

assessment scores for all Finance and Performance Risks

• Identify any new risks that present a gap in control or assurance for inclusion on the Assurance Framework

• Agree actions to reduce impact of extreme and high risks

• Identify any sources of positive assurance to be recorded on the Assurance Framework to reassure the Governing Body that the risk is being appropriately managed.

JW

JW

FPC17/147 RISK REGISTER

The Head of Planning, Delivery and Performance presented the Risk Register to the Committee. It was noted that there were no new risks, the risk register currently has 2 red risks; 13/3 A&E performance of 95% for 4 hours and 13/31 QIPP programme.

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Agreed Actions:

• Await September A&E figures and then relook at the score for 13/3 before recommendation to the Governing Body.

• Agreed to change likelihood score of 13/31 from a 4 to 3 The Committee were asked to:

• Review the Finance and Performance Committee Risk Register for completeness and accuracy

• Note and approve the risks assigned to the Committee • Review the risk assessment scores for all Finance and

Performance risks • Identify any other new risks for inclusion on the Risk

Register • Agree actions to reduce impact of extreme and high

risks • Identify any positive assurances relevant to these risks

for inclusion on the Assurance Framework. • Make recommendation to the Governing relating to the

residual score for risk 13/3.

ALL

JW

FPC17/148 MINUTES OF THE BHNFT CONTRACT EXECUTIVE BOARD – No minutes available

FPC17/149 MINUTES OF THE SWYPFT CONTRACT EXECUTIVE BOARD – No minutes available meeting on 27 July 2017 cancelled

FPC17/150 MINUTES OF THE CHILDRENS EXECUTIVE COMMISSIONING GROUP HELD ON THE 19 JUNE 2017

FPC17/151 MINUTES OF THE ADULTS JOINT COMMISSIONING GROUP – No minutes available.

FPC17/152 MANAGEMENT TEAM DECISIONS WITH FINANCIAL IMPLICATIONS

The Head of Planning, Delivery and Performance presented the report the Committee. It was reported that the following expenditure had been committed via Management Team during August:

• Agreed to pay £32,595+VAT to Attain to support the ‘Get Fit First in Barnsley’ project.

• Agreed to pay £2,180 2017/18 annual fee to the Yorkshire & Humber Public Services Network, comprising £1,680 contribution to the cost of the Transition Resources Team (TRT) overseeing the procurement of a replacement of the N3 network, and £500 towards the GovRoam wireless solution

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• Primary Nocturnal Enuresis - approved payment of £3,850 to enable Enuresis alarms to be provided under a ‘managed’ scheme.

The Committee noted and received the report.

FPC17/153 ANY OTHER BUSINESS

17/153.1 Referral Data The Acting Chief Finance Officer shared a handout showing the referral data from BHNFT for a 12 months period for information, further information has been for the last 3 years to allow an assessment to be undertaken of the impact of Demand Management initiatives.

FPC17/154 DATE AND TIME OF NEXT MEETING

Thursday 5 October 2017 at 10.30 am in the Boardroom at Hillder House, 49 – 51 Gawber Road, Barnsley, S75 2PY.

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Minutes of the meeting of the Membership Council held on Tuesday 26 September 2017 at 7.00 pm at Hillder House, 49/51, Gawber Road, Barnsley, S75 2PY PRESENT: Dr M Ghani (Chair) Elected Member (The White Rose Medical Practice) Dr A Adekunle Elected Member (Chapelfield Medical Centre) (part) Dr A Ali Elected Member (Woodland Drive MC) Dr E Czepulkowski Elected Member (Royston High Street Practice) Dr Z Ibrahimi Elected Member (Hoyland First PMS Practice) Dr M H Kadarsha Elected Member (Hollygreen Practice & Apollo Court MC) Dr S Krishnasamy Elected Member (Royston Group Surgery) Dr G Kay Elected Member (Huddersfield Road Partnership) Dr I Saxena Elected Member (Caxton House Surgery) Dr S Sepehri Elected Member (Hill Brow Surgery PMS Practice) Dr M Smith Elected Member (Victoria Medical Centre) IN ATTENDANCE: M Austin Primary Care Team J Frampton Project Lead M Hoyle Governing Body Practice Manager Member C Millington Lay Member M Simms Secondary Care Clinician L Smith Chief Officer R Walker Head of Governance and Assurance F Wickham Governance, Assurance & Engagement Facilitator APOLOGIES: Dr N Balac Chairman Elected Member (St Georges Medical Practice) Dr J Harban Elected Member (Lundwood Medical Centre) J Holdich Head of Delivery (Integrated Primary and Out of Hospital

Care) Dr J Holloway Elected Member (Dr Mellor and Partners) Dr P Kakoty Elected Member (The Kakoty Practice) J Logan BHF Brierley Medical Centre & BHF Highgate Surgery,

Goldthorpe MC – Chief Executive, Barnsley Healthcare Federation

Dr J MacInnes Elected Member (The Dove Valley Practice) Dr A Mills Elected Member (Ashville Medical Centre) B Reid Chief Nurse The Chair welcomed members to the September Membership Council meeting.

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Agenda Item Note Action Deadline

MC 17/09/01

QUORACY

The meeting was not quorate. It was noted therefore that any items requiring decision would not be able to be approved at this meeting and other measures would be required for the decision to be made by Members.

MC 17/09/02

DECLARATION OF INTERESTS INCLUDING SPONSORSHIP & HOSPITALITY

The Membership Council noted the Declarations of Interests Report. No further updates were received.

MC 17/09/03

MINUTES OF THE MEETING HELD ON 25 JULY 2017

Dr Czepulkowski queried minute reference MC 17/07/03 in relation to Map of Medicine. He noted that his comments, that he was dissatisfied with the MoM tool and that he had asked for the CCG to look at it again, were missing and it was important that they be recorded due to the strength of feeling. It was agreed that the minutes would be amended and brought back to the meeting in November 2017 for ratification.

FW

MC 17/09/04

MATTERS ARISING

The Membership Council agreed to remove the items marked as complete from the Matters Arising Report. MC 17/07/07 FLU VACCINATION REPORT 2016/17 – the Governance, Assurance and Engagement Facilitator advised that the proportion of pharmacies against GP numbers detailed had been requested. It was asked if this could be completed for the next meeting. MC 17/03/02 DECLARATION OF INTERESTS – whilst declarations for Members and their relevant staff are held by the CCG, further detail is required for a handful of practices. The Governance, Assurance and Engagement Facilitator will chase information and inform the Practice Manager Member of those outstanding so that she can raise this item at the next Practice Manager Group meeting. MC 17/03/06 PDA AND HITS CLINICAL THRESHOLDS – it was advised that this had been requested to be included on the agenda for the CCG Chair’s next meeting with MPs.

FW

FW

Page 2 of 6

GB/Pu/17/10/19


MC 17/05/05 MEMBERSHIP COUNCIL REPRESENTATION ON CCG COMMITTEES - it was noted that there were still outstanding vacancies on the Audit and Quality & Patient Safety Committees. Expressions of interest should be made to the Head of Governance and Assurance.

MC 17/09/05

PROPOSED CHANGES TO CONSTITUTION – STANDARDS OF BUSINESS CONDUCT & MANAGING CONFLICTS OF INTEREST

The Head of Governance and Assurance advised Members that in June 2017 NHS England published revised guidance on managing conflicts of interest for CCGs. In light of this Governing Body agreed amendments to the CCG’s Policy which centred on minor changes to the thresholds for declarations of gifts and hospitality. As the Policy forms part of the CCG’s Constitution any amendments come to Membership Council for ratification. Members were asked their views on removing the Policy from the Constitution in order to facilitate an easier process in the future. Members present felt that this was a pragmatic approach and were supportive of the proposal. As the meeting was not quorate it was agreed that the Head of Governance and Assurance would contact other Members to gain their views. It was noted that the Governing Body GP Members had approved the proposal and therefore these names could be added to those supporting the change.

RW

Membership Council were supportive of the proposal however as the meeting was not quorate virtual approval from Members not present would be sought.

MC 17/09/06

CARE HOMES

The Chair advised that this item had been removed from the agenda as the work was not complete. It will be brought to the meeting in November.

Membership Council noted the update.

MC 17/09/08

MEDICAL INTEROPERABILITY GATEWAY (MIG)

The Head of Governance and Assurance presented the paper on the MIG. It was noted that it is now 2 years since the Membership Council gave their approval to support the MIG. Members

Page 3 of 6

GB/Pu/17/10/19


were reminded that the MIG is a portal for healthcare staff in user organisations to see part of a patient’s record. Feedback suggests that it is a useful tool and has a positive impact. All GPs are now signed up, together with the Barnsley Healthcare Federation, BHNFT, SWYPFT, YAS and the Barnsley Hospice. Each month sees an increase in use. Currently the Barnsley Metropolitan Council (BMBC) are not signed up to the system, however a number of their teams have expressed a wish to do so. The Head of Governance and Assurance has requested BMBC to provide further detail to clarify what benefits they would derive from having access to the MIG. It was asked if Members supported the proposed roll out of the MIG to BMBC. The Chief Officer noted that it was beneficial for the CCG if all partners use the system. Further discussion centred on YAS and 111 usage. Members asked the Head of Governance if it was possible to get a breakdown of the figures for BHNFT, i.e. links to emergency care or pharmacists etc. Members noted the information governance requirements and data sharing agreements. A clear plan of what will be shared with BMBC needs to be developed. It was agreed that the Head of Governance and Assurance, Primary Care Team representative and Information Governance Lead would lead on this. The Chair asked that this be brought through the Quality & Patient Safety Committee as there are clinicians and the Caldicott Guardian on the Committee. The Practice Manager Member was very pleased to report that Barnsley CCG and Barnsley Healthcare Federation had won the ‘Management and Culture Project of the Year’ category of the Public Sector Paperless Awards for the implementation of the MIG. The Public Sector Paperless Awards recognise the progress in digital transformation in the Public Sector and it was fantastic that Barnsley colleagues were able to accept this award and promote Barnsley healthcare as an innovative system. The Practice Manager Member will bring the Award to future Governing Body and Membership Council meetings.

RW

RW

MH

Page 4 of 6

GB/Pu/17/10/19


Membership Council noted the report.

MC 17/09/09

LOCAL MATERNITY SYSTEM REPRESENTATION

A South Yorkshire and Bassetlaw (SYB) Local Maternity System (LMS) Board has been developed to lead the work of the SYB LMS. The Board meets monthly and the membership is made up of representatives from Trusts and CCGs within SYB, as well as other stakeholders that have a link into maternity services. The Board is seeking a GP Local Maternity System representative. Expressions of interest should be forwarded to the CCG’s Medical Director.

ALL

Members noted that the SYB LMS Board is seeking GP representation.

MC 17/09/10

NHSE DIABETES PREVENTION PROGRAMME (NDPP)

Members were updated on the delivery of the NDPP project, both across South Yorkshire & Bassetlaw and locally across Barnsley. The service mobilisation and performance profile were noted. It was advised that there are no caps on referrals as long as the patients meet the criteria. It was recognised that much of this work is through Practice Managers.

Members noted the update.

MC 17/09/11

MEMBERSHIP COUNCIL BRIEFING

The following items were agreed for the CCG Member Practice Briefing:

• Award for MIG • Declarations of Interest • Local Maternity Board Representative • Membership Council Representatives Vacancies on

Committees

MC 17/09/12

ANY OTHER BUSINESS

Map of Medicine (MoM) Members further discussed the MoM tool and whether it was here to stay. It was noted that the CCG is working to address the issues and software ‘patches’ should resolve

Page 5 of 6

GB/Pu/17/10/19


the technical issues. Dr Czepulkowski advised that his practice was not happy with the MoM. As the MoM leads were not present the concerns raised will be taken back to them and an update brought to the meeting in November. Practice Manager Concerns Dr Czepulkowski asked Members how the interests raised by Practice Managers are best represented in the CCG; i.e. for technical IT support, PCSE, Smartcards and Pensions. It was advised that the Practice Managers Group, chaired by the Governing Body Practice Manager Member, was the appropriate forum to raise these issues. Minutes from the Practice Managers Group meeting go to the Primary Care Development Group which escalates items within the CCG if necessary. It was noted also that Practice Managers are encouraged to attend the Locality meetings which are a good forum for sharing and resolving concerns. The Chief Officer asked if Members felt that the Practice Managers Group minutes should come to Membership Council. Following discussion the Chair summed up that as there is a feedback mechanism already in place this should be used. However, the Practice Manager Member agreed to speak to the CCG Chairman to clarify the position. Practice payments A member noted an issue with payments to their practice and the support available. The Chair recognised the issue, which was not of the CCG’s making, and asked that this be dealt with outside this meeting.

MGu

MH

MA

MC 17/09/13


The next meeting of the Membership Council will be held on Tuesday 28 November 2017 at 7.00 pm in the Boardroom Hillder House, 49/51 Gawber Road, Barnsley S75 2PY.

Page 6 of 6

GB/Pu/17/10/20


Minutes of the NHS Barnsley Clinical Commissioning Group

QUALITY & PATIENT SAFETY COMMITTEE Thursday 03 August 2017, 15:00pm-17:00pm

Meeting Room 1, Hillder House PRESENT:

Brigid Reid (Chair) Dr Sudhagar Krishnasamy Chris Lawson Chris Millington Mike Simms Martine Tune

- - -- - -

Chief Nurse & Caldicott Guardian Associate Medical Director Head of Medicines Optimisation Lay Governing Body Member for Public and Patient Engagement Governing Body Secondary Care Doctor Deputy Chief Nurse/Head of Patient Safety

IN ATTENDANCE:

Richard Walker Paige Dawson Lynne Richards

- - -

Head of Governance and Assurance Quality Administrator Primary Care Commissioning and Quality Development Manager

APOLOGIES: Catherine Wormstone Dr Mark Smith Dr Mehrban Ghani

- - -

Senior Primary Care Commissioning Manager SWYPFT Contracting Lead from the Governing Body Medical Director

Agenda Item

Note

Action

Deadline

QPSC 03/08/01

APOLOGIES & QUORACY

Apologies were noted as above. The meeting was declared quorate on arrival of the Associate Medical Director.

QPSC 03/08/02

DECLARATIONS OF INTEREST RELEVANT TO THE AGENDA

The declaration of interest paper was considered. It was agreed two changes needed to be made; ‘White Rose Medical Practice’ to be amended to ‘Rose Tree Practice’ and Dr Kadarsha to be removed

Adopted QPSC Minutes 2017.08.03 Page 1 of 8

GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

from the register since he has not attended a meeting since July 2016 and is no longer part of the committee membership.

Actions: • ‘White Rose Medical Practice’ to be amended

to ‘Rose Tree Practice’ and Dr Kadarsha to be removed from the register.

RW

07/09/17

QPSC 03/08/03

PATIENT STORY

The Head of Medicines Optimisation shared a patient story which related to Oxycodone prescribing. A patient had been prescribed a similar drug to which she was used to taking regularly and had unfortunately presumed that she would take the medication the same amount of times (twice a day) as her previous medication. It was highlighted that more time should be invested in preparing patients to take medication as prescribed and the important role of Medicines Management in early detection of complications/issues/risks.

QPSC 03/08/04

MINUTES OF THE PREVIOUS MEETING 22/06/17

The minutes from 22 June 2017 were approved as an accurate record.

The Associate Medical Director arrived to the meeting at 15:20pm.

QPSC 03/08/05


22/06/01 – Apologies & Quoracy The Head and Governance and Assurance confirmed this had been chased up, without success. It was agreed that the Associate Medical Director will follow this up. 22/06/03 – Patient Story The Primary Care Commissioning and Quality Development Manager updated the Committee and confirmed that local data in relation to DNA’s was not routinely collected. 18/05/12 - Individual Funding Request 22/06/17 - The Deputy Chief Nurse confirmed that she had emailed Alison Ball for an Annual Report and will circulate to the Committee once she has received this.

SK

13/09/17


GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

03/08/17 – The Deputy Chief Nurse will circulate the report once she has received this. 22/06/07 – Monthly Quality Metrics Report The Deputy Chief Nurse confirmed that adding Primary Care complaints into the report will remain a challenge since NHS England receive and manage complaints relating to Primary Care and BCCG does not receive feedback from NHSE despite many requests. This is known by NHSE Director of Nursing, Carole Lavelle but no solution is currently available. It was also confirmed that the Deputy Chief Nurse had asked the Infection Prevention Control team to provide a briefing paper in relation to the scabies incident for the Primary Care Commissioning Committee to have sight of. 22/06/08 – Risk Register and Assurance Framework It was confirmed work in relation to the TB risk (14/8) is in progress with the Deputy Chief Nurse.

MT

MT

13/09/17

13/09/17

QUALITY AND GOVERNANCE QPSC 03/08/06

PREVENTION OF FUTURE DEATHS

It was agreed that this agenda item will be deferred to the September 2017 Q&PSC meeting as the Medical Director will be present. The Deputy Chief Nurse confirmed that she has a meeting on the 16 August 2017 with the Medical Director regarding this agenda item.

Actions: • The Quality Administrator will add this agenda

item to the September 2017 Q&PSC agenda

PD

13/09/17

QPSC 03/08/07

PARLIAMENTARY AND HEALTH SERVICE OMBUDSMAN RESPONSE TO BHNFT COMPLAINT AND BHNFT LETTER TO COMPLAINANT

The Chief Nurse shared this was a complaint about an incident in 2014 raised initially with BHNFT and subsequently escalated to Parliamentary And Health Service Ombudsman (PHSO). The Chief Nurse highlighted that there were two underlying issues; concerns regarding process regarding complaints and incident investigation and


GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

clinical aspects. BHNFT have produced an action plan in relation to the PHSO recommendations. BHNFT have assured BCCG that actions have been taken since this case and processes have improved. We noted the profile regarding reduction of harm from falls and our continued monitoring regarding complaints and serious incidents.

QPSC 03/08/08

BOWEL AND CERVICAL SCREENING OF PEOPLE WITH A LEARNING DISABILITY

It was agreed that the Quality Administrator will circulate the data summary sheet in relation to Bowel And Cervical Screening Of People With A Learning Disability for information. The Deputy Chief Nurse will consider how to present this data at the next Health Protection Board meeting on the 23 August 2017 and will consider how the data will be shared to Membership Council and Practice Managers Group. It was also highlighted that once the data is shared that it may be a good idea to include the data as an indicator in the Quality Dashboard dependant on thoughts from Membership Council.

Actions: • The Quality Administrator will circulate the

summary data document to Committee members

• The Deputy Chief Nurse will consider how to present this at the next Health Protection Board meeting on the 23 August 2017

• The Deputy Chief Nurse will consider how the data will be shared to Membership Council and Practice Managers Group

PD

MT

MT

13/09/17

23/08/17

13/09/17

QPSC 03/08/09

GRAM-NEGATIVE BLOOD STREAM INFECTIONS - LETTER TO SYSTEM

It was highlighted that the aim is to reduce healthcare associated Gram-negative blood stream infections by 50% by March 2021 and 10% by the end of 2017/18. It was agreed the focus will be on UTI’s (urinary tract infections) - how they are spotted, treated and managed. Three meetings have been set up to create the improvement plan that will be submitted to


GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

NHS Improvement by September 2017. The Medical Director is the Executive Lead and it was agreed that Q&PSC Committee members will seek every opportunity to champion this piece of work. A collaborative approach is needed to secure the required improvements.

QPSC 03/08/10

CAMHS REPORT

The report included current performance of CAMHS by sharing the presentation to the CAMHS Overview & Scrutiny Committee held on 21 June 2017. It was highlighted more Shared Care Prescribing work re complex case capacity could be included in the Service if GP’s could have greater confidence in responsiveness of the psychiatrists should they have a query, it was agreed the next step is to set up a task and finish group to work on this. The Chief Nurse will set up an initial meeting between herself, the Medical Director, the Head of Medicines Management. Discussions took place regarding Autism. It was agreed that the Chief Nurse will raise this in the Children and Young Peoples Trust in relation to what can be done as a borough to make it Autism friendly.

Actions: • The Chief Nurse will set up an initial meeting

between herself, the Medical Director, the Head of Medicines Management

• It was agreed that the Chief Nurse will raise with the Children and Young Peoples Trust in relation to what we can do as a borough to make it Autism friendly

BR

BR

13/09/17

13/09/17

QPSC 03/08/11

MONTHLY QUALITY METRICS REPORT

The Deputy Chief Nurse presented the Quality Metrics report. It was highlighted that more work to develop our approach to managing Serious Incidents will be carried out on arrival of Hilary Fitzgerald (Quality Facilitator, BCCG) in September 2017. The draft Terms of Reference (TOR) for the Primary


GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

Care Quality Review Group were considered. It was agreed to change the group name to ‘Primary Care Quality Improvement Group’. It was agreed that the Primary Care Quality Improvement Group will report information into the Q&PSC and Q&PSC will share intelligence to the Primary Care Commissioning Committee (PCCC) via the routine quality update where quality issues may have an impact on Primary Care contracting. It was also agreed to invite the Engagement Manager BCCG (Emma Bradshaw) to the Primary Care Quality Improvement Group. The notes of the Quality Review meeting held on 03 August 2017 to go to the PCCC and to the September 2017 Q&PSC meeting. Committee members to consider the ‘GP Patient Survey’ for the September 2017 Q&PSC meeting, the Senior Primary Care Commissioning Manager will also go through key points at the meeting.

Actions: • The Deputy Chief Nurse to change the Primary

Care group name on the TOR to ‘Primary Care Quality Improvement Group’

• The Deputy Chief Nurse to invite the Engagement Manager BCCG (Emma Bradshaw) to Primary Care Quality Improvement Group

• The notes of the Quality Review meeting held on 03 August 2017 to go to the PCCC and to the September 2017 Q&PSC meeting

• Committee members to consider the ‘GP Patient Survey’ for the September 2017 Q&PSC meeting

MT

MT

LR

ALL

13/09/17

13/09/17

08/08/17

21/09/17

QPSC 03/08/12

RISK REGISTER & ASSURANCE FRAMEWORK

The Deputy Chief Nurse confirmed that risk 16/05 in relation to PuPOC had not materialised, therefore, it was agreed the risk should remain on the risk register and be reviewed in September 2017. It was agreed that the Quality Administrator will circulate a new risk drafted to be added to the risk register in relation to Medicines Waste.


GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

It was confirmed that Committee members will share their views on the proposed risk with the Head of Governance and Assurance by 18 August 2017. The Head of Governance and Assurance then proposed to take the risk to Governing Body in September 2017 for approval.

Actions: • The Quality Administrator will circulate the

new proposed risk to Committee members • Committee members will share their views on

the new proposed risk with the Head of Governance and Assurance by 18 August 2017

PD

ALL

04/08/17

18/08/17

COMMITTEE REPORTS AND MINUTES GENERAL QPSC 03/08/13

MINUTES OF THE 7 JUNE 2017 AREA PRESCRIBING COMMITTEE

There were no items raised.

QPSC 03/08/14

MINUTES OF THE 1 JUNE AND 5 JULY 2017 PRIMARY CARE QUALITY & COST EFFECTIVE PRESCRIBING GROUP MEETING

For information.

QPSC 03/08/15

CLINICAL QUALITY BOARDS: • SWYPFT – 21 June meeting cancelled by

SWYPFT – next meet 30 August 2017 • BHNFT – 20 July meeting cancelled by

BHNFT– next meet 21 September 2017

For information.

QPSC 03/08/16

MINUTES OF THE 25 JULY 2017 HEALTH PROTECTION BOARD

For information

QPSC 03/08/17

MINUTES OF THE 20 JUNE 2017 HEALTH OF CHILDREN IN CARE & CARE LEAVERS STEERING GROUP

For information.

QPSC 03/08/18

ANY OTHER BUSINESS

There was no other business to raise.


GB/Pu/17/10/20

Agenda Item

Note

Action

Deadline

QPSC 03/08/19

AREAS FOR ESCALATION TO THE GOVERNING BODY AND ITEMS TO BE COVERED IN HIGHLIGHT REPORT

There were no items to escalate to the Governing Body. It was agreed the highlight report to Governing Body should include: • Cervical Screening for Learning Disabilities – red • Gram-Negative Blood Stream Infections – green • Shared Care – amber • Improving Quality in Primary Care – green • PHSO complaint – amber

PD 17/08/17

QPSC 03/08/20


The date and time of the next meeting to be held on Thursday 21 September 2017, 12.30pm - 14.30pm, Hillder House, Boardroom


GB/Pu/17/10/21


GOVERNING BODY

12 October 2017

Primary Care Commissioning Committee Assurance Report


Decision Approval Assurance x Information

2. REPORT OF

Name Designation Executive Lead Chris Millington Lay Member Author Fran Wickham Governance, Assurance and

Engagement Facilitator


This report is to provide the Governing Body with highlights from the 28 September 2017 Primary Care Commissioning Committee meeting. GP Five Year Forward View The Committee received an update on the key issues and headlines relating to Primary Care and implementation of the GP Forward View. The Committee agreed that a stand-alone report would be brought to the Governing Body in October 2017. The report is detailed at item 10 on the agenda. Understanding Mitigations to Assess the 0-19 Service Risk Score The Primary Care Commissioning Committee considered information from the Director of Public Health that the 0-19 Service risk no longer features on the Barnsley Council’s Risk Register and is to provide further details to the CCG as to the mitigating actions.


Note the contents of this report.

Agenda time allocation for report: 5 minutes.

1




2.1 and 5.2.


support its business


Y




Y



NA



NA


NA


NA


NA


NA

2

1

South Yorkshire and Bassetlaw Sustainability and Transformation Partnership

Collaborative Partnership Board

Minutes of the meeting of

14 July 2017

The Boardroom, 722 Prince of Wales Road

Decision Summary

Minute reference

Item Action

73/17 Matters arising 65/17 Sharon Kemp informed members that a meeting will take place in August for Local Authorities and CCG Chairs to discuss the work each organisation is progressing in their respective areas. Sharon Kemp added that proposals emerging from the meeting will be useful to feed into the Collaborative Partnership Board (CPB) and a paper will be brought for members consideration at the meeting in September 2017.

SK

74/17 National Update Kevan Taylor suggested that it would be useful to know the impact on workforce shifts and an agreement that there should be a no banding approach. Kevan Taylor should approach Ben Chico for information relating to this matter. Will Cleary Gray added that the planned engagement meetings will be part of the wider communications strategy that will be coming to the Oversight and Assurance Group meeting and the Collaborative Partnership Board for discussion. The Chair added that there will also be a report brought to the Collaborative Partnership Board regarding the rebranding for the ACS in September.

KT HS HS

75/17 ACS Memorandum of Understanding Sharon Kemp informed members that Local Authorities are meeting together mid-August 2017 and will therefore provide feedback on the MOU by mid-September 2017. The Chair added:

The MOU was not a legal document, it is a high level

Local Authority CEO’s

2

framework allowing us to negotiate with the Centre.

The MOU will have gone through most governing bodies for support by the end of July 2017.

Local authorities will liaise with Will Cleary-Gray outside this meeting regarding their timeline and a form of words to support the MOU.

Will Cleary-Gray should draw up a shortened version of this MOU that could be used by Local Authorities for their meeting during August.

Will Cleary-Gray will bring any issues back to the next Board meeting.

ALL LA CEO’s WCG

WCG

76/17 Acute Hospital Services Review Professor Welsh presented to the Collaborative Partnership Board (slides will be circulated after this meeting). The Chair informed members that:

Will Cleary-Gray will liaise with Alexandra Norrish to ensure Chief Executives are contacted regarding discussions that she needs to progress.

Will Cleary-Gray and Jackie Pederson will review the process regarding Overview and Scrutiny – testing out that in each place all organisations are included.

Ensure timescales to approach Healthwatch are brought forward.

The Acute Hospital Services Review should be an agenda item on the providers meeting on 31st July 2017.

AO’s and CCG’s to consider if they require a similar meeting to the providers meeting that is happening on 31st July 2017.

JA WCG WCG/JP

HS WCG CCG AO’s

78/17 Connection and Workforce Framework Peter Hall added the draft report is out for review and comments and contributions are welcomed. A report will be brought to Collaborative Partnership Board members regarding strategic proposals.

PH, TG, BC

80/17 Commissioning Reform and Development of Accountable Care Partnerships Idris Griffiths was invited to present the paper on this subject (the presentation will be circulated to members).

JA

3

South Yorkshire and Bassetlaw Sustainability and Transformation Partnership

Collaborative Partnership Board

Minutes of the meeting of

14 July 2017

The Boardroom, 722 Prince of Wales Road

Name Organisation Designation Present Apologies Deputy for

Sir Andrew Cash CHAIR

South Yorkshire and Bassetlaw ACS

ACS Lead/Chair and CEO, Sheffield Teaching Hospitals NHS FT

Adrian Berry South West Yorkshire Partnership NHS FT

Deputy Chief Executive Rob Webster CEO

Adrian England Healthwatch Barnsley Chair

Ainsley Macdonnell

Nottinghamshire County Council

Service Director

Anthony May CEO

Alison Knowles Locality Director North of England,

NHS England

Amy Fell Yorkshire Ambulance Service NHS Trust

Planning and Development Trainee Manager

Accompanied Matthew Sandford

Anthony May Nottinghamshire County Council

Chief Executive

Ben Chico Working Together Partnership Vanguard

Project Manager

Ben Jackson Academic Unit of Primary Medical Care, Sheffield University

Senior Clinical Teacher

Brian Hughes NHS Sheffield Clinical Commissioning Group

Director of Commissioning

Maddy Ruff

Catherine Burn Voluntary Action Representative

Director

Chris Edwards NHS Rotherham Clinical Commissioning Group

Accountable Officer

Chris Welsh South Yorkshire and Bassetlaw ACS

Independent Chair of the Acute Hospital Services Review

Debbie Hilditch Healthwatch Doncaster Representative

Des Breen Working Together Partnership Vanguard

Medical Director

Diana Terris Barnsley Metropolitan Borough Council

Chief Executive

Greg Fell Sheffield City Council Director of Public Health

John Mothersole CEO

Frances Cunning Yorkshire & the Humber PHE Centre

Deputy Director – Health & Wellbeing

4

Helen Stevens South Yorkshire and Bassetlaw ACS

Assc. Director of Comms & Engagement

Ian Atkinson NHS Rotherham Clinical Commissioning Group

Deputy Chief Officer

Chris Edwards

Idris Griffiths NHS Bassetlaw Clinical Commissioning Group

Accountable Officer

Jackie Holdich NHS Barnsley Clinical Commissioning Group

Head of Delivery (Integrated Primary/Out of Hospital Care

Jackie Pederson NHS Doncaster Clinical Commissioning Group

Accountable Officer

Jane Anthony South Yorkshire and Bassetlaw ACS

Corp Admin, Exec PA, Business Manager

Janette Watkins Working Together Partnership Vanguard

Director

Jeremy Cook South Yorkshire and Bassetlaw ACS

Interim Director of Finance

John Mothersole

Sheffield City Council

Chief Executive

John Somers Sheffield Children’s Hospital NHS Foundation Trust

Chief Executive

Julia Burrows Barnsley Council Director of Public Health

Kathryn Singh Rotherham, Doncaster and South Humber NHS FT

Chief Executive

Kevan Taylor Sheffield Health and Social Care NHS FT

Chief Executive

Lesley Smith NHS Barnsley Clinical Commissioning Group

SYB ACS System Reform Lead, Chief Officer, NHS Barnsley CCG

Louise Barnett The Rotherham NHS Foundation Trust

Chief Executive

Louise Nunn SYB ACS Assistant Head of Finance

Maddy Ruff NHS Sheffield Clinical Commissioning Group

Accountable Officer

Matthew Groom NHS England Specialised Commissioning

Assistant Director

Matthew Sandford Yorkshire Ambulance Service NHS Trust

Associate Director of Planning & Dev

Rod Barnes

Mike Curtis Health Education England

Local Director

Neil Taylor Bassetlaw District Council

Chief Executive

Paul Moffat Doncaster Children’s Services Trust

Director of Performance, Quality and Innovation

Paul Smeeton Nottinghamshire Healthcare NHS Foundation Trust

Chief Operating Executive

Peter Hall Peter Hall HR HR Consultant

Richard Henderson

East Midlands Ambulance Service

Chief Executive

Richard Jenkins Barnsley Hospital NHS Foundation Trust

Chief Executive

5

Richard Parker Doncaster and Bassetlaw Teaching Hospitals NHS F T

Chief Executive

Richard Stubbs

The Yorkshire and Humber Academic Health Science Network

Acting Chief Executive

Rob Webster South West Yorkshire Partnership NHS FT

Chief Executive

Roger Watson East Midlands Ambulance Service

Consultant Paramedic Operations

Richard Henderson

Rupert Suckling Doncaster Metropolitan Borough Council

Director of Public Health

Sharon Kemp Rotherham Metropolitan Borough Council

Chief Executive

Simon Morritt Chesterfield Royal Hospital

Chief Executive

Steve Shore Healthwatch Doncaster Chair

Tim Gilpin TG HR Ltd HR Consultant

Will Cleary-Gray South Yorkshire and Bassetlaw ACS

Sustainability & Transformation Director

Minute reference

Item Action

70/17 Welcome and introductions The Chair welcomed members to the meeting.

71/17 Apologies for absence The Chair noted apologies for absence.

72/17 Minutes of the previous meeting held 9th June 2017 The minutes of the previous meeting were agreed as a true record.

73/17 Matters arising 67/16 SCR/STP Health Led IPS Employment Service. The Chair informed members this was a huge £8m project coming into our Accountable Care System (ACS). Kevan Taylor informed members this would be a 3 year funded project which would help people with mental health and learning disabilities to secure and retain work. Procurement for the project will be starting soon and will be using the Sheffield CCG and combined authorities. Health representation concerning the governance of this project will be via Kevan Taylor and Jackie Pederson. 65/17 Sharon Kemp informed members that a meeting will take place in August for Local Authorities and CCG Chairs to discuss the work each organisation is progressing in their respective areas. Sharon Kemp added that proposals emerging from the meeting will be useful to feed into the Collaborative Partnership Board (CPB) and a paper will be brought for members consideration at the meeting in September 2017.

SK

6

All other matters arising would be picked up as part of the agenda.

74/17

National Update The Chair gave members the following update on national issues concerning the ACS: There will be an all day meeting with the Secretary of State on 19th July 2017 that he will be attending with Will Cleary-Gray. The meeting will cover discussions on:

Metrics for measuring the 44 STP’s (national scorecards).

A capital announcement.

Development of ACS and National support. The Chair and Will Cleary-Gray attended a meeting on 13th July 2017 with NHS England and NHS Improvement and had discussions on the context of the programme with regards to:

The post-election legal framework.

Workforce and industrial relations.

Financial discussions. The Chair added that at the NHS England and NHS Improvement meeting he conveyed that he envisages this ACS will:

Have a development phase (1st October 17 to 31st March 17), a shadow phase (1st April 18 to 31st March 18) and an operational phase (1st April 2019).

Focus on the 3 major projects at place level: the Acute Hospital Services Review, the Commissioning Review and pushing back office functions all supported by transformation programme in each place/ACP and across the ACS.

Progress when it is ready, and therefore, there is the facility in the MOU to extend the phases if required. It is important that we are a cohesive organisation.

NHS England and NHS Improvement have agreed the national scorecards and we want to determine the elements of our local scorecards e.g. educational attainment, career ladders within our organisations, addressing health inequality issues. Kevan Taylor suggested that it would be useful to know the impact on workforce shifts and an agreement that there should be a no banding approach. Kevan Taylor should approach Ben Chico for information relating to this matter. The Oversight and Assurance Group met on 12th July 2017 and decided to progress arranging the following meetings in the coming months:

Audit Committee Chairs to discuss governance

Bringing Non Executive and lay members of boards and governing bodies together to discuss the common agenda of working together.

Governors of Foundation Trusts.

Councillors in local authorities.

Arranging a conference for 200-300 people (something with a similar membership of the old Guiding Coalition group) to

KT

7

ensure membership is up to date on matters.

Suzy Brain England and Helen Stevens will be leading on the last four meetings identified above. Will Cleary Gray added that the planned engagement meetings will be part of the wider communications strategy that will be coming to the Oversight and Assurance Group meeting and the Collaborative Partnership Board for discussion. The Chair added that there will also be a report brought to the Collaborative Partnership Board regarding the rebranding for the ACS in September.

HS HS

75/17 ACS Memorandum of Understanding Will Cleary-Gray updated members on the progress of the Memorandum of Understanding (MOU). The MOU has been developed in conjunction with Collaborative Partnership Board members from March 2017 to June 2017. Feedback has been incorporated into the MOU and a final document has been circulated to Collaborative Partnership Board members to obtain support from their governing bodies and this process should be complete by the end of July 2017. The MOU formed part of the assessment of South Yorkshire and Bassetlaw STP and it was required in order to become an Accountable Care System. Sharon Kemp informed members that Local Authorities are meeting together mid-August 2017 and will therefore provide feedback on the MOU by mid-September 2017. The Chair added:

The MOU was not a legal document, it is a high level framework allowing us to negotiate with the Centre.

The MOU will have gone through most governing bodies for support by the end of July 2017.

Local authorities will liaise with Will Cleary-Gray outside this meeting regarding their timeline and a form of words to support the MOU.

Will Cleary-Gray should draw up a shortened version of this MOU that could be used by Local Authorities for their meeting during August.

Will Cleary-Gray will bring any issues back to the next Board meeting.

Local Authority CEO’s ALL LA CEO’s WCG

WCG

76/17 Acute Hospital Services Review The Chair welcomed Professor Chris Welsh who is the South Yorkshire & Bassetlaw Accountable Care System Independent Director of the Acute Hospital Services Review to the meeting. Professor Welsh presented to the Collaborative Partnership Board (slides will be circulated after this meeting). The presentation provided members with an update of the Review’s design principles, objectives, working definition of sustainability, approach and high level programme plan, communications and engagement strategy, methodology for initial short-listing of services. Professor Welsh added the following comments:

JA

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The final report is due with the Oversight and Assurance Group on 28th April 2018 and there is zero time contingency in the plan to accommodate any delay.

Drafts will be brought to Collaborative Partnership Board in due course.

The number of people involved in this review is significant and due to time constraints involved conversations may not be in person therefore technology will be used to assist in the process.

The recommendations for one service could be applicable to others in the region.

Work will carry on after the review and it could take 5-10 years to create a cultural change.

The majority of people requiring hospital care will still receive their care locally.

Members commented:

Peter Taylor from the workforce steering group should be approached for information regarding workforce issues e.g. reporting on services now and forward look on issues.

There is a meeting on 31st July at Don Valley House for Medical Director, Directors and CEO’s and a viewpoint from the providers at this meeting could be obtained.

It is important that Healthwatch is included in the approach to ensure the community is engaged in the process.

The Chair informed members that:

Will Cleary-Gray will liaise with Alexandra Norrish to ensure Chief Executives are contacted regarding discussions that she needs to progress.

Will Cleary-Gray and Jackie Pederson will review the process regarding Overview and Scrutiny – testing out that in each place all organisations are included.

Ensure timescales to approach Healthwatch are brought forward.

The Acute Hospital Services Review should be an agenda item on the providers meeting on 31st July 2017.

AO’s and CCG’s to consider if they require a similar meeting to the providers meeting that is happening on 31st July 2017.

The Chair thanked professor Chris Welsh for his presentation and his attendance at this meeting.

WCG WCG/JP HS

WCG CCG AO’s

77/17 Finance Update Louise Nunn presented the Finance Update paper for July 2017 on behalf of Jeremy Cook. Louise asked Collaborative Partnership Board members to note the following key issues:

The ACS financial refresh work is ongoing. The new financial modeling tool was reconciled to the Price Waterhouse Coopers (PWC) Model and identified understated savings by £6.5m.

The actions agreed to take forward work on the Hyper Acute Stroke business case i.e. the project will be managed through the 3 groups – the finance group, commissioning/contracting group and the operational group.

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The ACS has been selected as one of six nationally to participate in the strategic estates planning and implementation project set up to assist ACS’s develop and implement their estates strategy. The key actions agreed were to undertake a prioritisation process, improve utilisation of estate, review options for the provision of CAMHS tier 4, consider estates implications for housing developments and surplus estates and rebuild options across South Yorkshire and Bassetlaw.

Will Cleary-Gray informed members that Yorkshire Ambulance Service (YAS) had made assumptions regarding flow in the Hyper Acute Stroke business case. ACS is working through the assumptions with YAS and these are being flagged to Collaborative Partnership Board members today as they could have implications on the business case. The Collaborative Partnership Board noted the contents of the finance paper presented and thanked Louise Nunn for presenting the finance report.

78/17 Connection and Workforce Framework The Chair welcomed Tim Gilpin, Peter Hall and Ben Chico to the meeting and invited them to give their presentation. Peter Hall presented the information to the meeting. Members were very supportive of this work area and noted:

The impact on primary, community and social care that needs to be quantified and aligned within the strategy.

The importance of changing behaviours.

The voluntary sector and unpaid sector and how the people involved could be engaged. There are 47,000 volunteers in our area.

Prevention is also key.

The horizontal integration with back office functions must be considered.

Peter Hall added the draft report is out for review and comments and contributions are welcomed. A report will be brought to Collaborative Partnership Board members regarding strategic proposals. The Chair thanked Tim Gilpin, Peter Hall and Ben Chico for their presentation and attendance at this meeting.

PH, TG, BC

79/17 Development of a Single Accountability Framework The Chair welcomed Mark Janvier to the meeting and invited him to present this report on behalf of Alison Knowles. Mark Janvier identified:

The developments made on external oversight where SYB ACS is represented on the national working group to design the new arrangements.

The internal assurance arrangements which consisted of two elements: our operating model and the structure of the assurance framework.

That SYB ACS needs to design the operating model and governance, to support assurance within the system.

The tiered structure of the assurance framework.

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Collaborative Partnership Board members were agreed that it is essential to get the outcome metrics right. The Collaborative Partnership Board received the Update on Single Accountability Framework and noted this is work in progress.

80/17 Commissioning Reform and Development of Accountable Care Partnerships Idris Griffiths was invited to present the paper on this subject (the presentation will be circulated to members). The Collaborative Partnership Board noted the progress presented on the emerging model for accountable care in South Yorkshire and Bassetlaw based on:

Collaboration rather than competition.

Integration of commissioning and provision, both at ACS and in local place.

An integrated ACS at STP level, underpinned with Accountable Care Partnerships (ACPs) in place, each with a single management structure across primary, community, mental health and acute care and (and possible social care and public health) ready to take a capitated budget for their population.

Members added:

That good progress has been made across ‘place’ and it is good for communities to see a simpler mechanism.

The voluntary sector/Healthwatch should be included as they have a wealth of experience that can be utilised.

There is something for everyone to get everyone around the table which we can then test, this is a learning environment and if something is not right we can resolve it.

The Chair thanked Idris Griffiths for presenting this paper that was also accredited to Chris Edwards, Jackie Pederson, Maddy Ruff and Lesley Smith. Collaborative Partnership Board members noted the plans for commissioning reform and the progress on ACP development in each of the five places.

JA

81/17 Summary Update to the Collaborative Partnership Board The SYB ACS Collaborative Partnership Board received and considered the summary update for the ACS workstreams and will use this information to inform local discussion.

82/17 Any Other Business There was no other business brought before the meeting.

83/17 Date and Time of Next Meeting Members were informed there will be no Collaborative Partnership Board meeting in August 2017.

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The next meeting will take place on 8th September 2017 at 9.30am to 11.30am in the Boardroom at 722 Prince of Wales Road, Sheffield.

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