Mission Statement: ‘Making a difference – right care, right place, right time’ St Helens Clinical Commissioning Group Governing Body Meeting Part I (Public) Date: Wednesday, 13 th May 2020 Time: 10.15 am Venue: N/A – via Skype for Business Part 1 of this meeting will be held in public NHS St Helens Clinical Commissioning Group fully support and abide by the pledges set out within the NHS Constitution and we work to ensure we portray the values and behaviours expected of all NHS organisations.
Transcript
Mission Statement:
‘Making a difference – right care, right place, right time’
St Helens Clinical Commissioning Group Governing Body Meeting
Part I (Public)
Date: Wednesday, 13th May 2020 Time: 10.15 am Venue: N/A – via Skype for Business
Part 1 of this meeting will be held in public
NHS St Helens Clinical Commissioning Group fully support and abide by the pledges set out within the NHS Constitution and we work to ensure we portray the values and behaviours expected of all NHS organisations.
Handling Conflicts of Interest during meetings A guide for Chairs and attendees At any meeting where the subject matter leads a participant to believe that there could be a conflict of interest, this interest must be declared at the earliest convenient point in the meeting. This relates to their personal circumstances or anyone that they are aware of at the meeting. 1. Declarations of interests must be clearly identified within the minutes of the
meeting, including any need to withdraw and reasons for not doing so. 2. As a rule, those with pecuniary interests should withdraw from the meeting
and those with non-pecuniary interests could be allowed to stay, depending upon the circumstances. The Chair will determine whether there could be a matter of bias (any unfair regard with favour, or disfavour) in the matter. Members allowed to stay in the meeting may not be allowed to vote on the subject matter.
3. The Chair of the meeting must take a decision as to the need for the
member of the meeting to withdraw or not from the proceedings. Where this may involve the Chair, the Deputy Chair/Vice Chair will take the decision.
4. If the Chair of a meeting is the person to whom the declaration of interests
relates, the chair should vacate the seat and the meeting for that item. If there is no Deputy/Vice Chair present at the meeting, the meeting must first elect a chair from within their number by a show of hands.
5. Members of meetings who are employed by the NHS are subject to the
existing NHS Codes of Conduct.
Meeting of the NHS St Helens Clinical Commissioning Group Governing Body Public Meeting
to be held on Wednesday, 13th May 2020
(VIRTUAL MEETING – via Skype for Business)
AGENDA
Apologies for absence: Declarations of Interest:
Item Time Agenda Item
Purpose Format Presented by
PB20/05/01 10.15 Welcome and Apologies To Note Verbal CCG Chair
PB20/05/02 Declarations of Interest To Note/Action Verbal CCG Chair
PB20/05/03 Page 10.20
Minutes and Actions of the Previous Meeting held on 8th April 2020
For Ratification
Report CCG Chair
PB20/05/04 10.25 Matters Arising For Discussion
Verbal CCG Chair
PB20/05/05 CHAIR AND CLINICAL ACCOUNTABLE OFFICER’S REPORTS 1.
10.35 Chairs Report
For Information Verbal CCG Chair
PB20/05/06 STRATEGY 1. 10.55 CoVid-19
For Information Verbal Chief Nurse
PB20/05/07 KEY ISSUES OF BOARD SUBCOMMITTEES
1.
2. Page
3. Page
4. Page
11.05
(a) Key Issues of the Quality
Committee held on 6th May 2020 to follow
(b) Key Issues of the Finance and Performance Committee held on 29th April 2020 to follow
(c) Key Issues of the Extra
Ordinary Primary Care Commissioning Committee held on 22nd April 2020
(d) Key Issues of the
Executive Leadership Team meetings since the last update
For Information For Information For Information For Information
Report Report Report Report
Chair of Quality Committee Chair of F&P Committee Chair of the Primary Care Commissioning Committee Clinical Accountable Officer
5.
Page
(e) Key Issues of the informal
Audit Committee meeting held on 29th April 2020
For Information
Report
Chair of the Audit Committee
PB20/05/08 GOVERNANCE
1. 11.15
Equality and Inclusion and Covid-19
For Information
Report
Associate Director; Corporate Governance
PB20/05/09 FINANCE 1.
Page
11.20
Financial Covid-19 response and budget for 2020/21
REFLECTION: What difference have we made to local people with the decisions we made in the meeting today? Date and time of next meeting: The next meeting of the NHS St Helens CCG Governing Body will take place on Wednesday, 10th June 2020, Venue and Time to be confirmed.
NOTE: Enclosures are sent to Board Members only – copies will be available from the St Helens CCG website: www.sthelensccg.nhs.uk “The Clinical Commissioning Group hereby resolves that the remainder of the meeting be held in private, because publicity would be prejudicial to the public interest, by reason of the confidential nature of the business to be transacted.” (Section 1 (2) 0f the Public Bodies (Admission to Meetings) Act 1960) If you are unable to attend this meeting, please send your apologies to Cathy Edge [email protected]
The Public Bodies (Admission to meetings Act 1960) permits the CCG to pass a resolution at the meeting to exclude the public and press from part of the meeting by reason of the confidential nature of the business or for other special reasons stated in the resolution. Whenever a resolution to conduct business in private is passed, the resolution itself will be made public.
Meeting held on Wednesday, 8th April 2020 at 10.15 am in Virtual meeting via Skype
Part I (Public Meeting) Minutes
Members Present Initials Role Geoffrey Appleton GA Lay Chair Professor Sarah O’Brien SOB Clinical Accountable Officer Dr Mike Ejuoneatse ME GP Governing Body Member/Deputy Chair (Chair) Tony Foy TF Lay Member - Audit, Governance & Finance Julie Ashurst JA Director of Commissioning, Primary Care and Transformation Dr James Catania JC Secondary Care Consultant Dr Hilary Flett HF GP Governing Body Member Dr Omar Shaikh OS GP Governing Body Member Mark Weights MW Lay Member, Patient and Public Involvement Lisa Ellis LE Chief Nurse Val Davies VD NED, St Helens and Knowsley NHS F Trust Leanne Binns LB Registered Nurse Dr David Reade DR GP Governing Body Member Dr Sue Hyde SH GP Governing Body Member In Attendance Angela Delea AD Associate Director; Corporate Governance Members of the Public 1 Minute-taker Cathy Edge CE PA to the Chair Agenda Item
Action
PB200401 INTRODUCTION & WELCOME
The Chair welcomed the attendees and members of the public to the meeting.
APOLOGIES
Apologies were received from: Iain Stoddart, Chief Finance Officer Sue Forster, Director of Public Health Rachel Cleal, Director of Adult Services The Chair declared the meeting quorate.
PB200402 DECLARATIONS OF INTEREST The Chair reminded the Governing Body members of their obligation to declare any
interest they may have on any issues arising at committee meetings which might conflict with the business of the CCG. All declarations are listed in the CCG’s Register of Interests; which is available on the CCG website at the following link: http://www.sthelensccg.nhs.uk/Library/public_info/St%20Helens%20CCG%20Register%20of%20Declaration%20of%20Interest%2031%2003%2017.pdf
The minutes of the previous meeting held on 11th March 2020 were agreed as a true and accurate record of proceedings. The NHS St Helens CCG Governing Body:
• Ratified the minutes of the previous meeting
PB200404 MATTERS ARISING
Matters arising from the previous meeting held on 11th March 2020 PB190506 Strategy - Annual Report Presentation The Peer Review report on Contact Cares is to be deferred to September 2020. The Clinical Accountable Officer informed the Governing Body that Contact Cares is now co-ordinating discharges from the Trust for Knowlsey and Halton, rather than just St Helens, and making calls to those on the Sheilded list ensuring they have food and support. PB200107 Key Issues of the Integrated Finance and Performance Board - A summary of the integrated performance dashboard will be presented to a future Governing Body meeting post pandemic.
PB200108 Governance - Governing Body Assurance Framework Report on Health Visitor recruitment to be deferred to a future meeting post pandemic.
PB200209 Performance - Performance Update St Helens Cares targets will be included within a future performance report post pandemic. There were no further matters arising.
PB200405 CHAIR AND CLINICAL ACCOUNTABLE OFFICER’S REPORTS
1.
Chair’s Report The Chair reported on the following:-
• The Chair and the Lay Members have a weekly update call scheduled with the Clinical Accountable Officer
• A conference call with the North West CCG Chairs • North West Providers/CCG Chairs conference call planned next week with
the North West Regional Director of NHS England/NHS Improvement • A catch up call with the Leader of the Council with regular catch ups
planned • The Chair wished to pay tribute to all the CCG staff on their outstanding
performance during these difficult times.
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Clinical Accountable Officer’s Report The Clinical Accountable Officer reported on the following:- Major Incident Within 2 weeks of the last Governing Body meeting the whole of the NHS was put on Major Incident alert due to the coronavirus pandemic. The CCG have operationalised its major incident and pandemic policies and all CCG buildings have now closed. NHSE have issued guidance for CCGs & Providers as to what should continue and what business as usual will be stood down during the pandemic response. All CCG nurses have been re-deployed to help in clinical areas except the Chief Nurse, Deputy Chief Nurse and the Clinical Accountable Officer who continue to support the required emergency planning. Other CCG staff are being deployed to help with the community hub work and calls to vulnerable residents and patients. The Clinical Accountable Officer is command centre lead and holding daily pandemic meetings as well as supporting the council with their pandemic response. All ELT leave has been cancelled until end of May and each member of ELT is available 7 days a week. The Primary Care Team is wholly focused on supporting practices, including daily communications to practices. The Clinical Accountable Officer described the volume of information being communicated during the current pandemic and the pressures for the Executive Team in ensuring the appropriate dissemination of information/guidance. She reported that the integrated working in St Helens was a considerable advantage in ensuring appropriate responses to the guidance and that she was also part of the Council’s Strategic Response Team. She reported that the Sheilded list is increasing every day with 14,000 people now listed. She confirmed that the supply of PPE had been a struggle to get out to some practices and community care and that the Trust were a large consumer. She confirmed that she had been informed that there was enough PPE available and that deliveries would continue. The Clinical Accountable Officer reported that Haydock Park Race Course would be opened as a testing centre for NHS staff from Monday, 13th April 2020 and is expected to test between 200-300 front line staff over the next 2 weeks. She also reported that the Manchester Nightingale Hospital will open on 7th April. It was noted that the Manchester Airport testing site had offered 9 testing slots for St Helens GPs on 9th April with names to be submitted by 2 pm. The GP Governing Body Member, HF, queried the plans for testing in the community in order to identify those clear of the virus and the Clinical Accountable Officer confirmed that guidance was still awaited on this issue. Update on Mid Mersey Integrated Working In March 2020, the Governing Body approved plans for the Executive Team to explore potential options for CCG integrated working on a mid Mersey footprint. However, with the absolute focus on supporting the NHS front line to tackle the Covid-19 pandemic NHS England has decided to suspend CCG merger work programmes during Quarter one.
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The newly appointed Senior Responsible Officer (Paul Sly) has, with the agreement of the two Accountable Officers and NHS England, significantly scaled back the planned work in April, May and June to ensure there is no impact on the Covid-19 response. Background work on developing the High Level Project Plan, Case for Change and the Communication and Engagement Plan will continue, and fortnightly touch points with the Accountable Officers have been scheduled to review progress. 1-2-1 calls with all Governing Body members will be arranged with the SRO in due course to help shape the next phase of integrated working between the three CCGs. The Clinical Accountable Officer confirmed that contingencies were in place should any of the senior team become ill. The NHS St Helens CCG Governing Body:-
• Noted the Chair and the Clinical Accountable Officer’s reports
PB200406 KEY ISSUES OF THE BOARD SUBCOMMITTEES
1.
2.
3.
4.
5.
6.
a. Key Issues of the Quality Committee held on 1st April 2020 – The
Quality Committee scheduled for 1st April 2020 had been cancelled, however, the Committee had virtually approved the Covert Medicines Policy. The Governing Body noted the Key Issue as outlined within the report.
b. Key Issues of the Finance and Performance Committee held on 25th March 2020 – The Chair of the Committee presented the Key Issues from their first Skype for Business meeting. The Governing Body noted the Key Issues as outlined within the report.
c. Key Issues of the Executive Leadership Team Governance Committee held on 12th March 2020. The Clinical Accountable Officer presented the Key Issues. She reported that guidance had been received from NHSE/I on which NHS business needed to continue as usual with the Governing Body meetings being one of those areas. She confirmed that the Executive Leadership Team were meeting every day for any urgent decisions. The Governing Body noted the Key Issues as outlined within the report.
d. Key Issues of the Executive Leadership Team meetings held since the last update – The Clinical Accountable Officer presented the Key Issues from ELT. The Governing Body noted the Key Issues as outlined within the report.
e. Key Issues of the GP Members Council held on 4th March 2020 - The Chair of the GP Members Council presented the Key Issues. The Chair of the GP Members Council reported that GP Members had provided feedback on the Operational Plan 20/21 and received a report on the new out of hours model with reassurance in the way that the service is operating. He proposed that the challenges of the current crisis were an opportunity for the Networks to move forward. He noted that the quoracy of the GP Members Council was in question with a significant number of GPs representing more than one practice and the need for individual practices to ensure their input. The Governing Body noted the Key Issues as outlined within the report.
f. Key Issues and minutes of the Audit Committee held on 18th March 2020 – The Chair of the Audit Committee presented the minutes and Key
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7.
8.
Issues. The Chair of the Audit Committee noted that the timing of the meeting falling at the start of the Covid restrictions meant that External Audit had not been present at the meeting. He reported that the timescales for the Annual Report and Annual Accounts had also been moved to submission on 27th April with the necessary Committee date changes in train. The Governing Body noted the minutes and Key Issues as outlined within the report.
g. Key Issues of the Primary Care Commissioning Committee held on 18th March 2020 – The Chair presented the Key Issues. The Chair confirmed that the Committee was aware that areas of the Primary Care Strategy were subject to change due to the pandemic. The Governing Body noted the Key Issues as outlined within the report.
h. Key Issues of the People’s Board held on 11th March 2020 – The Chair presented the Key Issues. The Chair informed the Governing Body that the People’s Board was also to move to virtual meetings until after the pandemic. The Governing Body noted the Key Issues as outlined within the report.
The NHS St Helens CCG Governing Body:-
• Noted the Key Issues • Noted the minutes of the Audit Committee
PB200308 FINANCIAL PERFORMANCE
1.
Finance Update The Director; Commissioning, Primary Care and Transformation presented the Finance Update. The purpose of the report was to inform the Governing Body of the CCGs financial performance up to month 11 of 2019/20 (February-20) and to provide information on the operational planning and contracting process for 2020/21 which has been suspended due to the NHS response to the COVID-19 virus. 2019/20 Finance Update – Month 11 (February-20) The Director reported that the planned cumulative position at the end of Month 11 is £1,667k deficit (following the receipt of £200k for QTR1 Commissioner Support Fund (CSF)). The actual year to date deficit at month 11 was reported to be £16,535k giving an adverse variance to plan of £14,901k, largely in line with current forecasts and leading to the expected £18m in-year deficit. This forecast had previously been discussed at length with NHS England. She reported a deterioration in Month 11 in the forecast of some key budgets including prescribing, Continuing Healthcare and some acute hospital trusts where settlement arrangements had not been made and payment by results (PbR) remains in force. She noted that despite these additional pressures, the CCG still expects the final out-turn to remain as the forecast out-turn position. 2020/21 Financial Planning The Director informed the Governing Body that the CCG had submitted a draft financial plan on 5th March following release of the operational planning and contracting guidance for 2020/21. The plan that was submitted was for an in-year deficit of £26.5m and was reflective of all the investment requirements specified in the guidance.
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On 17th March 2020, the CCG received a letter from NHS Chief Executive, Simon Stephens, outlining the important and urgent next steps on the NHS response to the COVID-19 virus. The letter stated that the operational planning process for 2020/21 is effectively being suspended. The Director outlined the key issues contained within that letter and how they will impact on the traditional financial planning process. She confirmed that the draft financial plan that was submitted has now been suspended. She reported that COVID-19 response is to be nationally funded with other services to be temporarily stepped down. She confirmed that the development of mental health and IAPT services would continue. The Director reported that the CCG is putting into place these emergency arrangements and that the CCG Finance Team have been focussing on resilience and contingency arrangements should key members of the team become unavailable. She reported that the largest cost to the CCG so far had been mobilising remote working for staff and additional visiting services for primary care. The Secondary Care Consultant queried whether there had been anything formal from NHSE/I regarding historic debt and the Director agreed to keep the Governing Body updated on this should any information become available. The Director reported that GP practices had been sent a template to capture any COVID-19 spending and would invoice the CCG accordingly. She confirmed that these costs would be listed separately within the financial ledger. The NHS St Helens CCG Governing Body:-
• Noted the report
PB200409 PERFORMANCE
The Director; Commissioning, Primary Care and Transformation presented the Performance report. The purpose of the report was to:
• Provide an update on current performance against the NHS Constitutional standards
• Provide an update on current performance against key priority areas including the NHS Oversight Framework
• Provide an update on this month’s Priority Area: The NHS Oversight Framework red RAG measures
She drew the Governing Body’s attention to the attached CCG constitutional performance dashboard consisting of 10 areas. She reported that 8 measures had failed their target within the current reporting period with 4 of those relating to the ambulance service. The remaining 4 were as follows:-
• Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral
• Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E
• Maximum two month (62-day wait from urgent GP referral to first definitive treatment for cancer)
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• STHK ONLY: All patients who have operations cancelled, on or after the day of admission (including the day of surgery, for non-clinical reasons to be offered another binding date within 28 days, or the patient’s treatment to be funded at the time and hospital of the patient’s choice)
She reported that all the current red rated performance measures were listed within Appendix 2, and of these 51 red rated measures, 28 were improving which is 15 more than last month. She reported on the 47 measures within the Repository which are RAG rated as green which is the same as last month with 2 measures RQAG rated amber. She confirmed that following the Operational Performance Reporting and Assurance Group meeting, all action plans have been updated. The Director confirmed that the NHS Oversight Framework was the Priority Area for March 2020 Finance & Performance Committee with the dashboard attached as Appendix 4 of the report which dashboard includes Merseyside benchmarks. The Director confirmed that the Team will be reviewing the targets over the coming months in line with the NHSE/I guidance focussing on those which remain critical. The Governing Body discussed the possibility of raised activity following the pandemic crisis with patients not attending appointments for cancer treatment or presenting with the usual symptoms of concern due to the stay at home message. The Clinical Accountable Officer proposed that the Communications and Engagement Team do some public communications about keeping important health appointments. She also proposed that the Networks may want to consider an exit strategy where they continue with closer working where there are spikes in demand. The Clinical Accountable Officer confirmed that routine bowel screening had been suspended at present. She also confirmed that routine referrals should not be made to the Trust at this time and patients, with capacity, should be asked to represent to their doctor once the Covid restrictions have been lifted. The GP Governing Body Member, HF, reported that consulting advice and guidance had been circulated to practices. The NHS St Helens CCG Governing Body:-
• Noted the report
PB200410 COMMISSIONING
CCG Commissioning Plan The Director; Commissioning, Primary Care and Transformation presented the CCG Commissioning Plan. The purpose of the report was to summarise the Commissioning Plan of the CCG and the St Helens System. The Director outlined the Commissioning Plan for the St Helens system for 20/21. She reported that, in addition to the areas identified, the CCG will work with Cheshire and Mersey Health and Care Partnership as part of any wider projects and will commission on a wider scale at all appropriate opportunities. She informed the Governing Body that the CCG is also working with neighbouring CCGs and St Helens and Knowsley Trust (STHK) to review pathways and commission on a larger footprint, through a Collaborative Commissioning Forum. She reported on St Helens Cares as an established governance and reporting
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system and a lead provider model that is evolving, with the intention of progressing the role of the lead provider further in 20/21. The report was divided into key themes:- Mental Health- Adults Learning Disabilities and Autism – Adults Children, Young People and Maternity Community and Primary Care Elective Care Urgent and Emergency Care Medicines Management The Director; Commissioning, Primary Care and Transformation confirmed that most of the Plan had now been suspended due to the COVID-19 response, with the exception of mental health. She also noted that some of the digital transformation had been progressed in order to support the pandemic response. The GP Governing Body Member, ME, noted that the integrated pathways and end of life care plans would be progressed as part of the pandemic response. The Director confirmed that ELT were accelerating any new areas that required commissioning for COVID-19. The NHS St Helens CCG Governing Body:-
• Noted the report
PB200411 ANY OTHER BUSINESS
There was no other business. The Governing Body reflected that the CCG were responding to the requirement to keep the people of St Helens safe. They noted the response to supporting the front line with a number of staff redeployed to the Trust. The Governing Body wished to pass on the Governments message to Stay at Home, Save Lives. The Chair wished everyone a good Easter break.
DATE OF NEXT MEETING
The next meeting of the Governing Body will be held on Wednesday, 13th May 2020 at 10.30 am via Skype for Business.
Minutes Ratified as Accurate Record Name: Geoffrey Appleton
Signature:
Date:
ACTION POINTS FROM CCG GOVERNING BODY PART I MEETING HELD ON 08.04.20
Action Number
Due From: Action Required: Required by: Completed:
72. Sarah O’Brien/ Sue Forster
PB190111 Performance Research, Innovation and Development Report The Governing Body agreed that the CCG should be more proactive in research, innovation and development and the Clinical Accountable Officer and the Director of Public Health agreed to progress this, in particular with St Helens and Knowsley NHS Trust
17th April 2019 Deferred to Sept 2020
84. Rachel Cleal
PB190506 Strategy - Annual Report Presentation The Chief Nurse to consider contact cares response time and capacity. Update: 10.07.19 - RC reported on a valuation being undertaken of peer review feedback on Contact Cares to be presented to a future meeting.
10th July 2019 - deferred to Sept 2020
98. Iain Stoddart
PB200107 Key Issues of the Integrated Finance and Performance Board A summary of the integrated performance dashboard to be presented to Governing Body in March 2020
11th March 2020 Deferred to Sept 2020
99. Lisa Ellis Sue Forster
PB200108 Governance Governing Body Assurance Framework The Chief Nurse and Director of Public Health to seek information from surrounding CCGs on their experiences of health visitor recruitment and report back.
8th April 2020 Deferred to Sept 2020
101. Cathy Edge
PB200206 Key Issues of the People’s Board held on 22nd January 2020 The Governing Body requested a presentation on the Pause Programme.
8th April 2020/ 13th May 2020 Deferred to Sept 2020
102. Iain Stoddart
PB200207 Strategy Operational Plan The initial submission of the Operational Plan to be presented to the March Governing Body
11th March 2020 Final version to be presented on 8th April 2020
Closed
103. Iain Stoddart
PB200209 Performance Performance Update St Helens Cares targets to be included in the regular performance update.
8th April 2020 Deferred to Sept 2020
104. Lisa Ellis
PB200210 Quality Safeguarding Report The Chair requested the Out of Borough trajectory and how far from home the children were (further away being a greater risk).
13th May 2020
105. Julie Ashurst
PB200307(1) Key issues of the Quality Committee 04.03.20 A further update report on CAMHS was requested for the Part II (private) meeting on 10th June 2020. JA reported that due to Covid 19 all transformations were put on hold nationally to ensure that the NHS could adequately respond to the crisis. However, work has been undertaken in the background to bring a business case together for implementation post crisis which is now ready for ELT approval. This item therefore will be delayed for at least 2 months.
10th June 2020 Deferred to Sept 2020
Extra Ordinary Primary Care Commissioning Committee
PC200405(2) Out of Hours Contract Award It was reported that the mobilisation of the new Out of Hours contract be deferred due to the Covid pandemic.
The Committee noted the decision, made by ELT, to award the contract but delay the mobilisation until April 2021 pending a further review in three months’ time.
PC200406 Primary Care Risk Register The Committee were presented a new risk (PCC122) of the CCG failing to have appropriate planning for primary care to manage the Coronavirus (Covid-19) pandemic.
The Committee noted the report controls and assurance and approved the risk scoring.
Key Issues Report Date
Prepared by: Cathy Edge, PA to the Lay Chair 22.04.20
Verified by: Geoffrey Appleton, Lay Chair, NHS St Helens CCG
NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Governing Body. Formal Minutes, once approved, will be made available to the Governing Body on request. Audit Committee will receive ratified minutes of all committees for information.
06.04.20 Death certification and end of life – need to commission end of life service to link in with community & care homes.
Approved
15.04.20 Due to Covid-19 requested to delay mobilisation of the new OOH Contract to allow more time on the procurement to establish the new service in a stabilised manner.
Approved
30.04.20 Request to continue funding for the Parents in Mind Service to support women experiencing mild to moderate mental health issues in pregnancy and up to two years after giving birth, from 1st Sept 2020 – 31st March 2022. The service would be funded by Perinatal mental health funding.
Approved
04.05.20 ELT200503ii
Request a contract extension up to 30th June 2021 for the Referral Management System providers. This extension will support the improvement of the quality of referrals, effective clinical triage to ensure people are seen in the right place 1st time and support the CCGs challenge to achieve financial efficiencies in 2020/2021.
Approved
04.05.20 ELT200507
Formal request received from NHSE&I asking every CCG to make a formal offer – under the direction of their Local Resilience Forum (LRF),
Agreed
KEY ISSUES REPORT
and in partnership with local authority public health / environmental health teams – to provide a named contact to help ‘train the trainers’ in care homes about PHE’s recommended approach to infection prevention and control.
Key Issues Report Date Prepared by: Michelle Birchall, Exec PA to the Executive Director/Accountable Officer
04.05.20
Verified by: Sarah O’Brien, Accountable Officer
04.05.20
NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.
Audit Committee Business Meeting Notes Meeting Date: 29th April 2020 Agenda Item Ref:
Key Issue Decision/ Action Strategic Objective/ Risk or GBAF Reference
Annual Accounts Draft Presented by the Principal Accountant and CFO.
The committee received the detailed presentation highlighting changes from 2018/9 and Accounting Manual (GAM) amendments. The key points reported were: -The CCG reported a £17.977m deficit position against its 2019/20 in year allocation -This out-turn does not meet the CCG’s control total for 2019/20, but is consistent with the forecast out-turn. -On 17th April 2020 Grant Thornton issued a section 30 report to the Secretary of State to indicate that the CCG will post a deficit -The CCG stayed within its maximum cash drawdown target of £370.3m as set by NHSE -The CCG met its running cost target, posting an underspend of £224k against a £4.4m allocation -The CCG met all of its Better Payment Practice Code targets of paying invoices within 30 days -The CCG has reviewed its going concern and reflected the reasons why the CCG considers itself a Going Concern. The Committee complemented the Principal Accountant, Lisa Roberts, on the continued high standard of the Accounts and clear presentation.
N/A
KEY ISSUES REPORT
Annual Report Draft review and approval -The Committee approved the draft for
submission basing its decision on the principle that it should be fair, balanced and understandable (to the public); the overall absence of jargon was noted. -The Committee considered that the AR was of a good standard generally. Highlighted were the patient stories and integration commentary generally; sections on Cancer (Planned Care), Primary Care, Covid 19, Finance Summary, the Engagement and Governance sections. -Ahead of the comments from NHSE that will need to be considered before final submission in June, the Committee recommended improvements in the Introduction section setting out the challenges and objectives clearly and the Quality section recommending a more strategic content. The ‘Taking Action on Health Inequalities’ section needed more examples of successful actions -The Key Areas section introducing the Performance Overview section is helpful but some of the 9 sub sections are weak e,g, C&M Health and Care Partnership. The Performance Overview section is overly long, guidance recommends 10-15 pages to allow the lay reader to use it to answer all key questions about the CCG’s performance without the need to read the more technical sections. The Committee complimented the Snr Comms Manager, Jeanette Livings and the Governance Manager Hilary Southern for their very skilful efforts.
N/A
Key Issues Report Date Prepared by: Tony Foy 05.05.20 Verified by: NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the relevant Committee Chair. A copy of this Key Issues report will be sent to Governing Body and Audit Committee. Formal Minutes, once approved, will be made available to the Governing Body and Audit Committee on request.
Report to NHS St Helens CCG Governing Body
Date of meeting: 13th May 2020
Governing Body Member Lead: Lay Member: Patient & Public Involvement
Item for: Decision Assurance Information X (Please insert X as appropriate)
Stra
tegi
c
Obj
ectiv
es
This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial stability 2. To integrate health within the place of St Helens through system redesign 3. To deliver improved outcomes for people 4. To be recognised as good system leaders X 5. To support and transform primary care to be a system leader in St Helens Cares
Gov
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and
Ris
k Does this report provide assurance against any of the risks identified in the Assurance Framework? (please specify) 4.7 – Reputational risk to CCG in failing to have appropriate planning and partnership working in place to manage the Coronavirus (Covid-19) pandemic What level of assurance does it provide? Reasonable (List levels i.e. Limited/Reasonable/Significant) Is this report required under NHS guidance or for statutory purpose? (please specify) National Health Service Act 2006 (as amended by the Health and Social Care Act 2012), CCGs have duties to involve the public in commissioning, (section 14Z2)
Purpose of this paper Update Governing Body on a number of issues that need to be considered, from an equality perspective, around their response to the current emergency measures, in addition to the core standards for Emergency Preparedness, Resilience and Response (EPPR). 1. Executive Summary Equality and Inclusion and Covid-19 From an equality perspective there are a number of issues that all NHS organisations will need to consider as part of their response in addition to the core standards for Emergency Preparedness, Resilience and Response (EPPR). The restrictions extended by the emergency coronavirus legislation are designed to protect vulnerable communities, however as they come into effect it is essential to consider carefully the specific impacts they may have on groups who are already disadvantaged in
other ways. Organisations must ensure these groups are not left further behind. The CCG Equality and Inclusion (E&I) Service developed a local Covid-19 Equality Brief (Currently version four Appendix 1) to highlight legal duties to the CCG and its NHS Providers. The brief includes equality considerations for people with protected characteristics and also information sources for Providers and CCGs to access. The CCG E&I Service has kept the equality briefing a live document (via an issues log) to continually update and share across the system and enable the CCG to pay ‘due regard’ to its legal duty during the pandemic and to support recovery. Version 5 will be issued by 8th May 2020. The brief has been distributed to the CCG Covid-19 Pandemic Management team. For Provider colleagues including but not limited to: Executive Team, Incident management teams and Nurse Specialists. Provider workforce including but not limited to human resources (workforce), patient experience, and patient engagement. Key issues to note include: 1. Prompt decision making and ensuring that equality impacts are considered (due regard). CCGs
need to be cognisant of their duties when taking prompt decisions that impact on their population. The E&I service are working closely with the Associate Director Corporate Governance to develop a process to enable the CCG to consider the local impacts and seek assurances from NHS providers. Any gaps and risks with NHS Providers will be escalated to the CCG’s Chief Nurse.
2. Emerging UK and international data suggests that people from Black, Asian and Minority Ethnic (BAME) backgrounds and disabled people are also being disproportionately affected by Covid19 and mitigations around this include:
• Black Asian Minority Ethnic Community Development Service Leads (BAME CDS) (hosted in
SHAP) are sharing support information across BAME networks on a range of issues, such as working with Primary Care leads on the national letters issued to vulnerable people (Initially these letters were not provided in the preferred language to those whose first language is not English).
• Working with Trusts to ensure data required to understand the number of COVID-19 deaths by protected characteristic are recorded and feed into the national work steams (Public Health England)
• Capacity of Translation and Interpretation providers to meet potential demand • Lack of clear and consistent protocols of Translation and Interpretation usage could result in
poor outcomes / discrimination • Accessible Communications to meet information and communication needs for people with a
disability or sensory loss on latest Covid-19 guidance. • Targeted campaigns and information giving; for those at risk (broader than the national highest
risk groups) on key information across protected characteristic and other vulnerable groups.
2. Recommendations Governing Body is asked to note this briefing.
Merseyside CCG Equality and Inclusion Service
COVID-19 Equality Briefing Briefing Date : Monday 30th March 2020 Updated version (4): 20th April 2020
Author of the Paper: Andy Woods Senior Governance Manager Merseyside CCGs Equality and Inclusion Service Email: [email protected] Jo Roberts Merseyside CCGs Equality and Inclusion Service Manager Email: [email protected]
Title: COVID-19 Equality Briefing
Background COVID-19 outbreak means that the NHS is currently operating under
unprecedented emergency measures. From an equality perspective there are a number of issues that all NHS organisations will need to consider as part of their response in addition to the core standards for Emergency Preparedness, Resilience and Response (EPPR). The restrictions extended by the emergency coronavirus legislation are designed to protect those in vulnerable situations and safeguard futures. They have significant implications for all, but as they come into effect it will be important to consider carefully the specific impacts they may have on groups who are already disadvantaged in other ways. Organisations must ensure these groups are not left further behind. https://www.equalityhumanrights.com/en/our-work/news/human-rights-and-equality-considerations-responding-coronavirus-pandemic
Barriers for People with Protected Characteristics and mitigations
The enclosed differential table provides NHS organisations with equality considerations to incorporate in their response to COVID-19 along with some recommended mitigations and information sources.
Key Issues
Prompt decision making without fully considering equality impacts.
Capacity of Translation and Interpretation providers to meet potential
demand.
Lack of clear and consistent protocols of Translation and
Interpretation usage could result in poor outcomes / discrimination
Accessible Communications to meet information and communication
needs for people with a disability or sensory loss on latest Covid-19
guidance
Targeted campaigns and information giving; for those at risk (broader
than the national highest risk groups) on key information across
protected characteristic and other vulnerable groups.
Recommendations
1. Review this Equality specific brief alongside local and national
2. Distribute COVID-19 Equality Brief to all relevant teams across
organisation. For Provider colleagues including but not limited to:
Executive Team, Nurse Specialists’ e.g. learning disability, sickle cell.
All relevant services e.g. ophthalmology, oncology, CAMHS/ IAPT
etc. Provider workforce including but not limited to human resources
(workforce), patient experience, patient engagement etc.
3. Providers to ensure that when they are reviewing services they
develop existing internal documentation to evidence Public Sector
Equality Duty ‘Due Regard’.
4. CCGs and Providers to seek assurance of service provision from
interpreter agencies (language and BSL).
5. Ensure communications are inclusive
6. Develop targeted campaigns to vulnerable people e.g. people with
sickle cell anaemia
7. Providers and CCGs to note that the Equality and Human Rights
Commission has suspended reporting on specific equality duties for
this year. The General Duty is still in force.
Protected Characteristic
Issue Remedy/ Mitigation
Age
Over 65 (and also Disability) Guidelines developed in other countries responding to COVID-19 state that priority should be given to those who have, first, “greater likelihood of survival and, second, who have more potential years of life meaning that pressures on beds and access to respiratory equipment could result in younger, otherwise healthy patients being prioritised treatment over older patients or those with pre-existing conditions.
The challenge for local health commissioners and services if cases continue to rise on current projections is to develop a consistent approach, based on an understanding and communication of risk on a case-by-case basis and to avoid a blunt ageist approach. Refer to Publications approval reference: 001559 Maintaining standards and quality of care in pressurised circumstances https://www.england.nhs.uk/coronavirus/publication/maintaining-standards-pressurised-circumstances/ and BMA ethical issues guidance note: https://www.bma.org.uk/advice-and-support/covid-19/ethics/covid-19-ethical-issues Latest Nice guidelines
Vulnerable People – All Ages Vulnerable people (broader than Government list) being made aware of specific services available to them via targeted campaigns.
Ensure Communications/ Engagement Teams access national and local information sources. https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 https://www.gov.uk/government/publication
People living in Care Homes/ Other Housing COVID-19 poses a higher risk to populations that live in close proximity to each other.
Commissioners to ensure that national and local information is shared with Care Home colleagues.
Disability Sensory; D/deaf people D/deaf, Deaf blind D/deaf people may require additional support to understand national / local guidance on COVID-19 and changes to service.
Ensure there is access to British Sign Language for D/deaf people Commissioners of BSL interpreter services (CCG and Provider organisations) to collate information on interpreter agency provision, capacity and Business Continuity Plans escalating any potential gaps as appropriate through organisation’s internal escalation process. Consider use of Relay UK (previously Next Generation Text) to support communication with patients. https://www.relayuk.bt.com/ Sign Health continues to publish BSL videos on their website to update D/deaf people on the latest COVID-19 guidelines. https://www.signhealth.org.uk/coronavirus/
Sensory; Visual Impairments People with visual impairments may require additional support to understand national / local guidance on COVID-19 and changes to service.
Ensure Communications/ Engagement Teams access national and local information sources: RNIB: https://www.rnib.org.uk/campaigning/priority-campaigns/accessible-health-information/coronavirus-and-accessible-online-information RNIB https://www.rnib.org.uk/news/campaigning/accessible-covid-19-information Public Health England: (Audio, Large Print) https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-/resources Guidance is now available in easy read and in a range of community languages see https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance All NHS organisations to review accessibility tools on websites
Neurodiversity, Learning Disabilities, low levels of
Ensure Communications/ Engagement Teams access national and local
literacy People with neurodiversity or learning disabilities may require additional support to understand national / local guidance on COVID-19 and changes to service.
information sources: https://www.mencap.org.uk/advice-and-support/health/coronavirus-covid-19
Disability: Children
Ensure parents/ carers/ guardians are involved in any changes to care plans.
Cancer People undergoing cancer treatment may need support to understand any changes to treatment plans.
Mental Health: All Redeployment of other care professionals to respond to coronavirus will help save lives. But it also risks leaving already vulnerable older people and those living with mental health conditions exposed.
Organisations to link with Equality Leads for access to local and national support agencies for both staff and patients. https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-covid-19 https://www.mind.org.uk/information-support/coronavirus-and-your-wellbeing/ https://www.mentalhealth.org.uk/coronavirus
Race
People whose first language is not English may need support to understand national/ local guidance and service changes.
Commissioners of language interpreter services (CCG and Provider organisations) to collate information on interpreter agency provision, capacity and Business Continuity Plans escalating any potential gaps as appropriate through organisation’s internal escalation process. Commissioners of language interpreter services (CCG and Provider organisations) to identify if interpreter agencies provider Video provision. Ensure Communications/ Engagement Teams access national and local information sources: https://www.doctorsoftheworld.org.uk/coronavirus-information/#
Guidance is now available in easy read and in a range of community languages see https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance Ensure organisations connect with BME CDW Projects where appropriate to support any targeted communications.
Liverpool: Liverpool Community Development Service (LCDS) http://psspeople.com/whats-happening/news/introducing-liverpool-community-development-services Sefton: Sefton CVS https://seftoncvs.org.uk/projects/bme/ Halton, St Helens and Knowsley: SHAP Ltd http://www.shap.org.uk/housing-support/knowsley/bme-community-development-service/ Ensure organisations can signpost people to Migrant Help. https://www.migranthelpuk.org/contact
Gypsy and Romany Travellers Largely mobile populations and populations with lower literacy are more likely to miss accurate public health messages.
Organisations to ensure communication is effective and clear, through trusted organisations and individuals, in a culturally appropriate and sensitive way. Further support is available through Irish Community Care http://iccm.org.uk/contact/
Sickle Cell Anaemia Not specified as high risk under national guidelines but do a vulnerable group.
UK Thalassemia Society: https://ukts.org/heads-up/coronavirus-information/
Religion and Belief
A person’s religion or belief may impact treatment options
Ensure access to religious and spiritual networks, Provider Lead Chaplain or Spiritual Teams.
A person may have specific religious or spiritual need that they may need you to support them with during the End of Life phase or after death. Current Infection control issues may impact on achieving those needs.
Ensure each patient is treated as an individual following local guidance and with support of local infection teams to ensure that where possible religious and spiritual needs are met and undertaken in the safest manner. Guidance relating to issues around death and burial for faith communities https://www.gov.uk/government/publications/covid-19-guidance-for-care-of-the-deceased
Pregnancy and Maternity
Pregnant women are considered in the 'vulnerable' group of people at risk of coronavirus
Ensure pregnant patients are aware of how to access support: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/ Contact ‘Improving me’ to see if specific advice is available
Sex (M/F) During periods of confinement domestic abuse (a crime mostly impacting women and girls) tends to increase, and that the health care that offers a way of identifying this issue will be under unprecedented pressure.
Ensure any communications provide signposting to Voluntary Organisations and referrals to Safeguarding Team or Human Resources Team as appropriate.
Women, including those who are pregnant and on maternity leave, should not be disadvantaged in their careers by following government advice to stay at home.
Ensure group are included in staff communications.
Women are more likely to work in higher risk and low paid key worker roles. https://www.theguardian.com/world/2020/mar/29/low-paid-women-in-uk-at-high-risk-of-coronavirus-exposure
Ensure organisation response considers actions to improve protection and health and well-being of key workers.
Sexual Orientation
Access to key and supportive information Less likely to seek medical attention due to poor experience and discrimination and experience higher levels of health inequality.
Ensure communications from Stonewall are distributed. https://www.stonewall.org.uk/about-us/news/covid-19-%E2%80%93-how-lgbt-inclusive-organisations-can-help Organisations to link with Equality Leads for access to local and national support agencies for both staff and patients.
Gender Reassignment
Access to key and supportive information Less likely to seek medical attention due to poor experience and discrimination.
Ensure communications are from Stonewall are distributed to Provider Trusts, CMCP, Partner organisations including Local Authorities and VCF https://www.stonewall.org.uk/about-us/news/covid-19-%E2%80%93-how-lgbt-inclusive-organisations-can-help Organisations to link with Equality Leads for access to local and national support agencies for both staff and patients.
Marriage and Civil Partnership
Refer to Mental Health -All Ensure communications are inclusive.
Other Health Inequalities and Poverty Migrant workers who are vulnerable and unable to access public funds.
Communications and Engagement Teams to ensure information is accessible to all staff with a view to signposting patients.
From Migrant Help key info re access to funds.docx
People within the criminal justice service and prisons COVID-19 poses a higher risk to populations that live in close proximity to each other.
Ensure organisation response includes information sharing with those delivering services within prisons.
Contact Details of a number of support agencies for people with Protected Characteristics or specific disabilities are available from Provider Equality Leads (via Best Practice Guidance for Reasonable Adjustments). All advice to the public about what to do during the pandemic is issued by Public Health England (PHE) and published at https://www.gov.uk/coronavirus There is also supporting information on https://www.nhs.uk/conditions/coronavirus-covid-19/ This is the only official source of advice. Local, Regional and National information sources is provided as follows:
200409 Accessible
Information about COVID-19.docx
Equalities issues log for COVID-19 Lessons Learnt
Protected Characteristic
Description of Issue
Immediate Action Taken Future proposed Action
All Equalities considerations not published alongside the emergency COVID-19 legislation
CCG Equality and Inclusion Service developed a local briefing to highlight legal duties to Providers and Commissioners. The brief includes equality considerations for people with protected characteristics and also information sources for Providers and CCGs to access.
CCG Equality and Inclusion Service to keep the Equality briefing a live document to continually update and share across the system. Equalities issues log to be maintained for lessons learnt which the Merseyside CCG and Provider Equality Collaborative Group can then incorporate into Equality Objectives and Associated Action Plans.
All Mental Health Services: internal escalation and communication procedures when a staff member may have been in contact with a person with COVID-19
All Equalities and Women’s Committee launch inquiry into the COVID-19 legislation equality considerations
Incorporate recommendations from the inquiry into CCG and Provider Equality Collaborative review.
Race Initial reports into COVID-19 deaths reveal higher numbers of BAME deaths.
BME CDW Project Leads sharing support information across BAME networks.
Data required to understand the number of COVID-19 deaths by protected characteristic. Incorporate recommendations from national review into CCG and Provider Equality Collaborative review.
Race Migrant Workers: employers using COVID-19 as rationale to not pay migrant workers for work undertaken pre COVID-19.
CDW Project Leads supporting individual cases.
Further discussion required with BME CDW Project Workers; LCDS, SHAP and Sefton CVS.
Race National letters issued to vulnerable people were not provided in preferred language to those whose first language is not English.
CCG Equality and Inclusion service emailed CCG Incident Management Response Teams to confirm position/ approach.
To be agreed.
Disability National letters issued to vulnerable people were not provided in preferred format to those with information/ communication needs e.g. large print, easy read.
Refer to above. To be agreed.
Disability National letters issued to 10,924 people who had been treated with radiotherapy for lung cancer but died between 2006 and 2017
National apology issued to families. To be agreed.
Version Change Log
1
2 Additions to barriers matrix
3 *Over 65’s added to Age in relation to bed pressures and access to respiratory equipment. *Recommendations updated to include target audience for brief. *Provider Lead Chaplain or Spiritual Teams added to Religion or Belief. *Safeguarding and Human Resources added to mitigations on Sex (M/F) issue relating to domestic abuse. *End of Life Care needs added to Religion or Belief.
4 *Recommendations updated to include: Providers and CCGs to note that the Equality and Human Rights Commission has suspended reporting on specific equality duties for this year. The General Duty is still in force. *Guidance relating to issues around death and burial for faith communities added to Religion or Belief *easy read and community languages government information source added to Disability and Race *Weblinks added to Age: Vulnerable (All Ages) *Weblinks added to the end of the barriers matrix to include Public Health England official sources of advice *NHS England collated information sources list embedded at the end of the barriers matrix. *Reference to NICE guidance replaced with national guidance on maintaining quality on Age (Over 65 and disability). *BMA ethical guidance added to Age (Over 65 and disability).
Report to NHS St Helens CCG Governing Body
Date of meeting: 13 May 2020
Governing Body Member Lead: Iain Stoddart – Chief Finance Officer
Report Author: Alan Howgate – Deputy Chief Finance Officer
Report title: Financial Covid-19 Response and Budget 2020/21
Item for: Decision Assurance X Information X (Please insert X as appropriate)
Stra
tegi
c
Obj
ectiv
es
This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial stability X 2. To integrate health within the place of St Helens through system redesign 3. To deliver improved outcomes for people 4. To be recognised as good system leaders 5. To support and transform primary care to be a system leader in St Helens Cares
Gov
erna
nce
and
Ris
k
Does this report provide assurance against any of the risks identified in the Assurance Framework? (please specify) Objective 1: To deliver financial sustainability 1.1 Failure to meet statutory financial duties 1.2 Excessive demand not being managed 1.3 Failure to identify and deliver QIPP & Recovery Programme What level of assurance does it provide? (List levels i.e. Limited/Reasonable/Significant) Limited Assurance - In recognition of the financial risk for 2020/21 financial year, and the additional financial risks associated with the Covid-19 response. Is this report required under NHS guidance or for statutory purpose? (please specify) The CCG has a responsibility to adhere to statutory financial duties and in-year financial control total set by NHS England. Both the Finance and Performance Committee and the Governing Body must be clearly sighted on financial issues.
Purpose of this paper In the absence of a finalised 2020/21 operational and financial plan for the CCG, this paper is required to support the CCG Governing Body in its duty to maintain financial probity, stewardship, governance and value for money in relation to the anticipated £364m allocation for 2020/21.
Further explanatory information required: Does this paper link to any of the key themes of the CCG’s Operational Plan & Improvement Plan. If yes, please specify.
Yes – The QIPP agenda incorporates all key themes, but a number of the QIPP schemes have been deferred during the system response to Covid-19
How will this benefit the health and wellbeing of St Helens residents or the Clinical Commissioning Group?
Not directly – this paper reflects the financial implications of the national and local response to Covid-19
Please describe any possible Conflicts of Interest associated with this paper.
None
Please identify any current services or roles that may be affected by issues within this paper.
Current services may be affected by the system response to Covid-19, and this paper reflects the financial implications of that response
What risks may arise as a result of this paper? How can they be mitigated?
The financial risks are described within the paper. Failure to deliver against the CCG statutory financial requirements may lead to regulatory intervention. The deficit position is a system position and not exclusively related to CCG operations. As the system is currently delivering a level of healthcare that is not affordable, future system decisions must be made to bring current provision to financially sustainable levels. This may involve wider engagement and consultation on appropriate response to service changes.
1. Executive Summary As a result of the system response to the Covid-19 pandemic, there have been a number of changes to the financial and contracting arrangements nationally. Contract arrangements have been replaced with mandated block arrangements and arrangements are in place for a system response fund.
The financial implications of the Covid-19 response are detailed in the main report.
2. Recommendations The Governing Body is asked to confirm their understanding of the financial implications and & acceptance:
a) That an expenditure budget will be proposed that is not able, at this stage, to include a system recovery or mitigation plan for the £26.5m deficit and therefore the CCG will operate with a significant deficit whilst the current situation endures
b) That QIPP efficiency measures may pose additional financial risk during the interim period whilst Covd-19 arrangements exist
c) That the approvals process for specific COVID-19 related expenditure is likely to continue to require use of procurement waivers for significant values across partner organisations. These will be reported to the Audit Committee
d) To note the impact on the budgets for the 2020/21 financial year e) The need to review the interim budget by the Governing Body as a minimum at the end of each
quarter.
DOCUMENT DEVELOPMENT
Process Yes No N/A Comments & Date (i.e. presentation, verbal, actual report)
Outcome
Public Engagement (please detail the method i.e. survey, event, consultation)
N/A
Clinical Engagement (please detail the method i.e. survey, event, consultation)
N/A
Has ‘due regard’ been given to Equality Analysis (EA) and any adverse impacts? (Please detail outcomes, including risks and how these will be managed)
N/A
Legal Advice Sought
N/A
Presented to any other groups or committees including Partnership Groups – Internal/External (please specify in comments)
No
Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.
1
NHS St Helens CCG – Financial Covid-19 Response and Budget 2020/21
1. Introduction
1.1 In the absence of a finalised 2020/21 operational and financial plan for the CCG, this paper is required to support the CCG Governing Body in its duty to maintain financial probity, stewardship, governance and value for money in relation to the anticipated £364m allocation for 2020/21.
1.2 The local and national health and care responses to the COVID-19 pandemic
follow the £12 billion package of measures, announced in the March budget to support public services, individuals and businesses through the economic disruption caused by COVID-19.
1.3 Within the budget measures is a COVID-19 response fund, initially set at
£5 billion that has been created for: • The NHS to treat Coronavirus patients, including maintaining staffing levels • Local Authority actions to support social care services and vulnerable people • Ensuring funding is available so other public services are prepared and
protected
1.4 Subsequent to announcing the response fund, on 17th March 2020 NHSE/I confirmed the suspension of contract negotiation and operational planning processes, to enable Health and Care systems to respond to the COVID-19 Pandemic.
1.5 An extraordinary and interim budget will need to be proposed that reflects the CCG
Governing Body responsibilities for:-
• Maintaining access to prioritised services. • Providing extra resources needed by the NHS and associated public services
to tackle the virus. • Ensuring that financial probity, governance and value for money in delivering
the above are maintained.
2. Business Continuity Plans (BCP)
2.1 Since confirmation that the NHS is operating at Major Incident Level 4, the Finance Team have reviewed and activated the finance element of the CCGs BCP with priority functions confirmed as:-
• Financial advice and support to development of the St Helens COVID-19 system
response. • Following the national process to enable cash payments to Providers from 1st
April 2020 and supplementing this process where required. • Maintaining a register of all COVID-19 investments and following the process for
recovery of this expenditure. • Completion of the Annual Accounts and Annual Report.
2
• Maintaining financial high levels of financial probity across all areas of expenditure including our anti-fraud policies and procedures.
2.2 All contract negotiations with Providers have been paused and we have started to
make payments to our providers on the basis set out in Appendix 1. This is to ensure that providers of care have the cash balances to rapidly redeploy and mobilise services as part of the COVID-19 plans. Arrangements for payment of main NHS providers for the first 4 months of 20/21 are on a block basis, based on M9 (2019/20) expenditure plus an inflationary uplift.
2.3 Given the fast-tracking of some assurance processes for new services that would normally be covered through procurement, a condition of such payments are that Providers agree to operate on an open book basis and provide other assurances on expenditure and income to ensure no duplicate payments eg receipt of block income plus Furloughed receipts from HM Treasury.
2.4 When we reach the pandemic recovery period, it is anticipated that further guidance will be issued as to any necessary payment reconciliation processes and any changes to the financial regime.
3. Interim Budget
3.1 On 5th March 2020 the CCG submitted its draft 2020/21 plans at £26.5m deficit
compared to a Control Total of £360k. At this stage this included a £5.3m QIPP target. These were the values in discussion with the regulator at that time, but have not been formally accepted as the Operational Planning process for 20/21 has not been concluded.
3.2 It is unclear on what basis the CCG prepare its interim 20/21 budget but the following elements require consideration:
• The core “Business as Usual” (BAU) allocation which, within standard
business rules, the CCG is required to operate and plan within. (its core programme, Primary Medical Care and Running Cost allocations – total £364m)
• An additional element of financial risks, in excess of confirmed allocations, that the standard CCG operational plan would have planned to address through a combination of planning, negotiation, efficiency (QIPP) processes and serious consideration over the CCG operating with a deficit and the need for an associated system recovery plan
• Recognition that measures taken to deliver the 19/20 control total may result
in additional non-recurrent expenditure in 2020/21
• An additional element of extraordinary and exceptional savings due to the interim payment of block contracts and secured Independent Sector capacity nationally
• An additional element of extraordinary and exceptional costs which are
anticipated to be recovered through funding from the national COVID-19 response plan.
3
3.3 National Covid-19 planning for Phase 1 assumes a 12-16 week period of operating
in an interim financial regime. During this time interim funding and exceptional measures will be in place. However, there is no certainty to either this or the period of time post-pandemic, during which processes and funding return to BAU. For this reason, the expenditure budget will include a full year of financial risk, as at this stage the CCG cannot realistically plan to implement the full QIPP measures (£5.3m) and other mitigating actions. It is hoped that a full year of operating within the extraordinary budget will not be necessary and its continuation should be reviewed at least quarterly.
3.4 The value included for the COVID-19 response plan is an initial assessment which
will need to be constantly reviewed and updated. Guidance confirms that all NHS organisations will be able to recover appropriate costs through a nationally determined monthly process. At this stage an estimate of £4.2m has been assumed for Health and Care costs transacted through NHS St Helens CCG; the whole system costs will be greater than this as St Helens & Knowsley Hospitals Trust, North West Boroughs and St Helens Council will seek separate reimbursement. The most significant element of CCG recoverable expenditure is likely to relate to the costs of care for people discharged from hospital under new nationally implemented processes for which it is nationally estimated that the CCG require c£770k per month.
3.5 A summary of the overall budget compared to notified allocations is set out at below,
taking account of the elements in section 3.2 and in dialogue with regulators. It is anticipated that this plan will still carry a significant risk of deficit for the financial year.
4. COVID-19 Recoverable Expenditure
4.1 The CCG is able to recover though a monthly process additional expenditure
incurred in responding to COVID-19. The initial estimate is that nationally CCGs will spend an additional £1.3bn, from this an estimate of £4.2m for St Helens CCG has been calculated. Indicative allocated sums from NHSE/I are at £770k per month subject to expenditure cost reclaim. This will be continually reviewed and updated.
4.2 Of a national allocation to Local Authorities of £1.6bn, St Helens Council has
received £6.4m for council response to Covid-19. Subsequently a further £1.6bn nationally has been made available to Councils, but it is uncertain of the value
£ millionNet deficit on original plans 26.5Plus QIPP delivery risk 5.3Original financial risk 5 March 2020 31.8
Changes due to Covid-19 actions from April to end July 2020Benefit of block contract arrangements / Independent Sector arrangements -6.9 Covid-19 additional expenditure 4.2Less national Covid-19 reimbursement -4.2
Likely outturn on current basis 24.9
4
receivable by St Helens.
4.3 In accordance with guidance the CCG has already moved rapidly to mobilise services and increase capacity in conjunction with partners. This has meant accelerating approval processes for some services and, in accordance with procurement law following a waiver process to secure capacity and services. It has been agreed that the CCG CFO, through the Finance Team, be responsible for maintaining a register of all COVID-19 related CCG expenditure and ensuring liaison with Local Authority partners. All CCG expenditure will be reported to the Governing Body having first been endorsed by the CCG Executive Leadership Team and further scrutinised by the Finance & Performance Committee.
4.4 Due to discharge guidance emphasising Local Authority lead on discharge
procurement, current commitments for April are being developed. During March there was very little cost incurred to be recharged. Procurement commitments for discharge will be recharged to the CCG from the Local Authority plus other CCG identified costs. It is recognised that entering into some contracts will be exceptional transactions driven by the national discharge guidance and is supported by all system partners. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880288/COVID-19_hospital_discharge_service_requirements.pdf
5. Market Management - Provider Support and Stabilisation
5.1 The Government has set out a role for CCGs to support providers of health and care who will face significant challenges throughout this period and thereafter. Part of this will be through the cash based approach to contracting described in paragraph 2.2. Another will be our approach to procurement and extension of existing contracts. We are currently reviewing those contracts that are due to expire in the next 12 months and will set out a recommendation and process for each contract.
6. Governing Body Decisions The Governing Body is asked to confirm their understanding & acceptance:-
a) That an expenditure budget will be proposed that is not able, at this stage, to
include a system recovery or mitigation plan for the £26.5m deficit and therefore the CCG will operate with a significant deficit whilst the current situation endures.
b) That QIPP efficiency measures may pose additional financial risk during the interim period whilst Covd-19 arrangements exist.
c) That the approvals process for specific COVID-19 related expenditure is likely to continue to require use of procurement waivers for significant values across partner organisations. These will be reported to the Audit Committee
d) To note the impact on the budgets for the 2020/21 financial year e) The need to review the interim budget by the Governing Body as a minimum at
Proposed Provider Cash Payment Plan during Covid-19 Response
Organisation Basis Description NHS Trusts Nationally set
payment NHSE/I will issue to each CCG a mandated schedule of the Trusts to pay and a stated monthly value.
General Practices Locally set The CCG will calculate a payment for each practice based on 19/20 contract and payments plus inflationary uplifts.
GP Federations / PCNs
Locally set The CCG will calculate a payment based on 19/20 contract value plus inflationary uplifts
Care Homes Contract / Invoice
Care Homes will continue to invoice on a patient level basis. Should any care home be unable to invoice then the CCG will arrange emergency payment.
Hospices Contract / Invoice
The CCG will calculate a payment based on 19/20 contract value plus inflationary uplifts. The issue of the impact of reduced voluntary donations will continue to be reviewed based on national guidance. The CCG will consider requests for re-profiling of the annual contract payments.
Independent Sector Acute Providers
CCG Commissioning suspended
Activity for acute IS providers will be commissioned and paid for nationally
Voluntary Sector Contract / Invoice
Where services are continuing to be delivered the CCG will calculate a payment based on 19/20 contract value plus inflationary uplifts and consider re-profiling of payments.
Other Providers Contract / Invoice
The CCG will risk assess each providers ability to invoice and will determine an appropriate payment.
Note: In addition the Cabinet Office have issued a procurement policy note relating to contracts ended due to Covid-19 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/874178/PPN_02_20_Supplier_Relief_due_to_Covid19.pdf
Report to NHS St Helens CCG Governing Body Committee
Date of meeting: 13.5.20
Governing Body Member Lead: Lisa Ellis
Author: Helen Newton, Andrea Derbyshire, Sharon Kelly
Report title: Safeguarding Children and Adults Update (Part 1 of the meeting)
Item for: Decision Assurance Information x (Please insert X as appropriate)
Item for: Decision Assurance Information X (Please
insert X as appropriate)
Strategic Objectives
This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial stability 2. To integrate health within the place of St Helens through system redesign 3. To deliver improved outcomes for people x 4. To be recognised as good system leaders 5. To support and transform primary care to be a system leader in St Helens Cares
Governance and Risk
Does this report provide assurance against any of the risks identified in the Assurance Framework? (please specify) What level of assurance does it provide? (List levels i.e. Limited/Reasonable/Significant) Is this report required under NHS guidance or for statutory purpose? (please specify) No
Purpose of this paper To provide an update to the Governing Body Members in relation to Safeguarding Children, Adults and Looked After Children
Further explanatory information required: Does this paper link to any of the key themes of the CCG’s Operational Plan & Improvement Plan. If yes, please specify.
N/A
How will this benefit the health and wellbeing of St Helens residents or the Clinical Commissioning Group?
Provides assurance that Looked after Children, Safeguarding Children and Adult arrangements and processes are robustly monitored within commissioned healthcare providers to ensure the safety and wellbeing of all residents of St Helens
Please describe any possible Conflicts of Interest associated with this paper.
N/A
Please identify any current services or roles that may be affected by issues within this paper.
N/A
What risks may arise as a result of this paper? How can they be mitigated?
N/A
1. Executive Summary Safeguarding Children and Adults Commissioned Health Services Performance for Q4, 2019/20 In accordance with NHSE/I guidance, formal Safeguarding KPI reporting is stepped down at Q4 in favour of position statements and reporting by exception. St. Helen’s and Knowsley Teaching Hospitals NHS Trust – All safeguarding training is on hold during the Covid-19 crisis, with the exception of induction training for new staff, which although reduced in content; continues to incorporate safeguarding information and team contact details. General footfall into the hospital and the Urgent Treatment Centre has reduced and a significant reduction in Emergency Department attendances and admissions for both adults and children has been noted since implementation of the lock down. Despite this, the Trust report that the Safeguarding Team continue to receive requests for support and advice and there has been a specific increase in requests for advice in relation to supporting patients with a learning disability at this time. Increased scrutiny of Emergency Department and Paediatric Liaison records, is taking place to provide additional assurance that referrals are not being missed. Following the transition of the UTC from Bridgewater to StHK on 1.12.19; work is required to address the gaps in safeguarding practice identified through a series of audits carried out by the Bridgewater Safeguarding Team and shared with StHK. Work to progress the action plans required will be resumed by StHK, with a particular focus on supervision arrangements, as the Covid -19 crisis allows. Risk due to this period of instability is reflected in the CCG Risk Register. In the meantime, StHK report active engagement by the Trust Safeguarding Team with staff employed under the Community Services
Contract and reasonable assurance is provided via activity data in relation to requests for internal safeguarding support, referrals to both Adults and Children’s Social Care and risk assessment/referrals in relation to domestic abuse concerns. Further work is being undertaken regarding working arrangements within the Children’s Community Paediatrics Contract to align this service with Trust safeguarding arrangements. Assurances have been gained from StHK in respect of vulnerable children and the offer during the Covid situation. Attendance at safeguarding meetings continues virtually. The CCG Designated Nurses are in regular contact with the Assistant Director and Named Nurses/midwife for Safeguarding. No areas of significant risk are currently identified. CCG links to Midwifery continue with updates due to the vulnerable nature of new births and amendments to the face to face contact schedule. Planning in relation to recovery work post Covid-19 will commence as soon as reasonably practicable. Bridgewater Community NHS Trust (St Helens): Bridgewater opted to submit a formal Safeguarding KPI return at Q4. Due to the transition of services from Bridgewater to StHK; KPI data reportable to St Helens relates to a significantly reduced cohort of staff (from 154 at Q2 to 30 at Q4). Training compliance data collection continues to present a challenge due to longstanding ESR issues. This is acknowledged by the Trust however work to reconcile the data is on hold amid the Covid-19 crisis. Narrative provided alongside the formal data submission indicates satisfactory training compliance alongside low levels of safeguarding activity; not unexpected in view of the services retained by this provider. North West Boroughs Healthcare NHS Foundation Trust: In relation to Looked After Children compliance with health assessments for Q4 remains similar to Q3 (68-74%). During the COVID-19 crisis health assessments are being undertaken virtually in line with Public Health Guidance and there is an expectation that meetings are attended virtually as required. An implementation plan has been introduced to ensure that the team progresses to full service development during the COVID-19 recovery period. Self-assessment forms for adult health clearances have been provided by CoramBaaf to be used if Gp’s are unable to comply with requests due to increased pressures associated with the crisis. In relation to safeguarding children the Trust have provided performance data as per the usual reporting tool with the exception of some areas given the Covid situation. This was in agreement with the Trust. Weekly virtual meetings have taken place with 0-19 PH commissioners, Designated Nurses, NWBH 0-19, Camhs service manager and NWBH safeguarding leads as a means of working together to identify vulnerabilities, risks and mitigations and provision of Designated Nurse support to identify the cohort of children that present as most vulnerable using NWBH risk matrix. Furthermore the meetings have requested a response from NWBH as to service provision for identified vulnerable children within the current situation and how that feeds into a partnership approach. 0-19 attendance at safeguarding children meetings continues virtually. Q4 submission to the CCG reflects some of the issues regarding safeguarding activity that were raised at CCG Quality Committee during Q3. This will remain on the agenda at future business and contract meetings. Early information from NWBH MASH Nurse reports that the start of Covid in March saw a visible drop in the number of referrals and requests for health information. Although not yet back to pre Covid levels there is a week on week increase in such. The themes and trends for requests for health information during April have tended to be related to domestic abuse and its links with emotional harm followed by referrals for parental lack of supervision. Further themes, data and trends around referrals are being collated.
Safeguarding Adults Updates Learning Disabilities Mortality Review (LeDeR) The NHS St Helens CCG Annual LeDeR Report 2019-20 has been submitted to the CCG Quality Committee for approval and is included (below) to apprise the Governing Body of progress made in the last year along with plans for continued improvement going forwards. During the Covid-19 crisis; the LeDeR Steering Group continues to hold virtual meetings with Key partners, to ensure that opportunities to share good practice and to identify areas of risk continue at this time.
LeDeR - St Helens CCG Annual Report 19 Liberty Protection Safeguards (update) Implementation of the Liberty Protection Safeguards is on hold due to the Covid-19 crisis. The Governing Body will be updated when information regarding future plans is released. Domestic Homicide Review (DHR) One DHR is complete and a second is nearing conclusion. Formal recommendations and learning will be shared when the final report is released. Prevent The St Helens Channel Panel continues to hold virtual meetings attended by key partners. Requests for information in relation to Prevent concerns are currently being made for urgent/high risk cases only. Routine update requests are on hold at this time. Support for GPs The Designated Nurses continue to offer support to Primary Care amid the Covid-19 crisis. The Designated Nurse Safeguarding Adults has been working alongside Primary Care to provide support in relation to Mental Capacity Act, Advance Care Plans and DNACPR decisions as well as ad hoc, case specific advice and support. Recommendations For the Governing Body Members to note
Process Yes No N/A Comments & Date (i.e. presentation, verbal, actual report)
Outcome
Public Engagement (please detail the method i.e. survey, event, consultation)
x
Clinical Engagement (please detail the method i.e. survey, event, consultation)
x
Has ‘due regard’ been given to Equality Analysis (EA) and any adverse impacts? (Please detail outcomes, including risks and how these will be managed)
x
Legal Advice Sought
x
Presented to any other groups or committees including Partnership Groups – Internal/External (please specify in comments)
x
Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.
LeDeR – Annual Report MH/HN/V1-April 20
LeDeR Annual Report 2019-2020 Introduction
This is the first annual report presented by NHS St Helens Clinical Commissioning Group as required by the ‘The NHS Long Term Plan January 2019’.
The persistence of health inequalities between different population groups has been well documented, including the inequalities faced by people with learning disabilities. Today, people with learning disabilities die, on average, 15-20 years sooner than people in the general population, with some of those deaths identified as being potentially amenable to good quality healthcare.
The Learning Disabilities Mortality Review (LeDeR) Programme was established to support local areas to review the deaths of people with learning disabilities, identify learning from those deaths, and take forward the learning into service improvement initiatives. It was implemented at the time of considerable spotlight on the deaths of patients in the NHS, and the introduction of the National Learning from Deaths Framework in England in 2017.
The programme has developed a review process for the deaths of people with learning disabilities aged 4 and upwards. All deaths receive an initial review by a reviewer.
The most significant challenge to the delivery of the programme nationally has been the timeliness with which mortality reviews have been completed, largely driven by four key factors:
a) Large numbers of deaths being notified before capacity was in place locally to review them.
b) The limited resources available to undertake reviews and the low proportion of people trained in LeDeR methodology who have gone on to complete a mortality review.
c) Trained reviewers having sufficient time away from their other duties to be able to complete a mortality review.
d) The process not being formally mandated.
Deaths notified in St Helens to the LeDeR Programme
Table 1 (below) details deaths reported (by year) in St Helens.
Note: 4 reviews were returned to the National LeDeR Team due to being duplicate referrals or due to no evidence that the patient concerned had a learning disability.
LeDeR – Annual Report MH/HN/V1-April 20
Table 1
As of January 2019 the CCG had a backlog of 17 reviews outstanding. An options appraisal was carried out by the Designated Safeguarding Adult Nurse (Local Area Contact (LAC)) and the CCG agreed to invest to recruit an internal reviewer/Project Lead on a temporary contract. In April 2019, the Project Lead was appointed to undertake the backlog of reviews and to establish Business as Usual processes going forward. This role would also support the LAC with identification of themes, dissemination of learning, and the participation and co-ordination of local steering groups. The role was in place until 31/03/2020.
St Helens LeDeR Activity/ Achievements in 2019-2020 St Helens has taken a system leadership role and established and embedded its own local steering/implementation group supported by Cheshire and Mersey Regional Network group to oversee the LeDeR programme of work and in particular, action on local improvements based on the evolving National and Local picture. This is chaired by the Designated Safeguarding Adult Nurse/ Local Area Contact within St Helens CCG and supported by Project Lead employed by the CCG. The Local Steering Group is well represented by Health, Social Care, Experts by Experience and the 3rd Sector agencies.
St Helens CCG consistently receives notifications of deaths of those with a Learning Disability from the national system and co-ordinates all the LeDeR Reviews across the Borough. The Project Lead was assigned to undertake all reviews received for St Helens patients.
Robust quality assurance, governance and reporting structures have been established. A database has been created for monitoring purposes and to capture recommendations, themes and lessons learned. Standard Operating Procedures have been implemented and approved at Quality Committee.
The CCG has strong links with the Child Death Overview Panel and this is aligned with the LeDeR Methodology so that learning is shared across the county in relation to Children’s services, Generic Health services and Specialist Learning Disability Services.
To ensure robust oversight of quality and governance processes; all completed LeDeR reviews are scrutinised by the CCG/LA Quality Assurance Group. In addition the Local Steering Group also receives thematic information that arises from the programme.
By December 2019 the backlog of cases had been successfully completed, quality assured and archived by Bristol University and business as usual was on track within timescales.
Table 2 below shows progress during the last 12 months 2019-2020.
Year Death Reported Number of Deaths Reported Reviews Completed in Year
2017-2018 5 0
2018-2019 16 1
2019-2020 13 26
LeDeR – Annual Report MH/HN/V1-April 20
April 2019 Recruited internal Project Lead
LeDeR Training completed
Established processes:- QA, Governance &
Reporting
Created database for monitoring
purposes
Established key relationships
4 x Reviews Completed
May 2019 2 x Reviews completed
June 2019 1 x Review completed
Standard Operating Procedure
Approved at QC
July 2019Opt Out
Application Submitted
2 x Reviews completed
August 2019
Performance Bid Submitted
1 x Review Completed
September 2019
Successful Opt Out application
approved
5 x Reviews Completed
1st Local LeDeRSteering Group
took place
October 2019
Notified of successful
performance bid
5 x Reviews Completed
November 2019
Provided progress update to NHSE
Local LeDeRSteering Group
Engagement & Comms T & F
Group
2 x Review Completed
December 2019
Learning into Action Bid Submitted
3 x Reviews Completed
January 2020
Engagement & Comms T & F
Group
Recruited Quality Support Officer
Recruited Lead Nurse
Timeline of Progress 2019-2020
Table 2
Funding Bids 2019-2020
Opt Out Application
NHS England (NHSE) commissioned the North East Commissioning Support Unit (NECS) to undertake completion of reviews identified as backlog. CCG’s could opt out, if they could meet a clear criteria set out by NHSE as below:
• Member of a Local Steering Group
• Reviews to be completed within 6 months of allocation , with backlog to be cleared by March 2020
• Themes and recommendations addressed from completed reviews
• Annual report written and shared with stakeholders
• CCG Investment in the local delivery of the LeDeR Programme
• Decreasing backlog over a 6 month period
• Proportion of reviews to be allocated to reviewer within 3 months of notification
• Quality Assurance process in place to provide scrutiny, to include agencies external to CCG
St Helens CCG successfully opted out and funding was awarded to support completion of the backlog project based on the robust processes in place and the number of backlog reviews which had been completed.
Performance Bid
A bid to support performance was submitted by the CCG to NHSE to deliver the LeDeR requirements as set out in the NHS Operational Planning and Contracting Guidance for 2019-2020 as follows:
• CCGs should be members of a LeDeR Steering Group and have a named senior person with lead responsibility.
• LeDeR reviews should be completed within 6 months of notification of the death.
• CCGs must address the themes and recommendations from completed reviews.
• An annual report must be written by the CCG that shows the actions taken from LeDeR reviews and shared with stakeholders
• MOU in place to ensure achieve requirements
Funding was required to build additional capacity, develop quality assurance processes, support administrative or project support in delivering on the above requirements. The CCG were successful and have been awarded funding for performance.
Learning Into Action Bid
A bid was submitted in November 2019 to secure Learning into Action Funding which would support developing initiatives/ projects to reduce health inequalities, increase access and reduce early deaths, improve service delivery across hospital and community services and improve health outcomes for people with a learning disability.
The bid submitted by St Helens CCG was successful and this will support plans to provide a nurse to lead on learning disabilities within a Primary Care setting, in order to:
• Work to increase awareness for People with learning disability and their carers/ family by supporting education around key conditions such as diabetes, respiratory disease, sepsis, cancer screening, constipation
• Coordinate services for people with Learning Disabilities who also have dementia and or Mental Health problems
• Work collaboratively with all agencies including Medicines Management • Work to increase general awareness in relation to the needs of people with learning disabilities • Increasing understanding and use of reasonable adjustments • Increase awareness and improving management of health conditions • Identifying early deteriorating of health and escalation • Management, escalation and effective treatment of constipation • Improve the quality of our Learning Disability Register within our commissioned services and Primary
Care • Aim to improve both the uptake and quality of annual health checks
St Helens Borough; context versus National Findings
National Findings Local Findings
The median age of death for people with learning disabilities
Average is: - 58 years Men it is 59 years Women it is 56 years
Average is:- 56 years Men it is 67 years Women it is 53 years
Setting of Death Hospital - 64% Home - 30% Hospice- 2%
Hospital – 56% Home – 38% Other - 6%
Causes of Death 1) Respiratory 31% 2) Circulatory 16% 3) Sepsis 11% 4) Cancer 10%
1) Respiratory 34% 2) Cancer 13% 3) Heart Attack 6%
Good Practice Examples from Completed Reviews
• GPs regularly reviewed medication and had undertaken health checks
• Acute staff coordinated best interest meetings around treatment options and plans and encouraged collaboration with multi-agency partners
• Support offered and availability of the Community Learning Disability Team was evident in the records
reviewed
• Holistic Learning Disability assessments were undertaken and shared appropriately with health professionals
• Visual boards were provided to aid communication and ease anxiety
• IT system alerts for Learning Disability patients in relation to being included in hospital avoidance
programmes and care plans formulated to support this
• End of life pathways comprehensively followed
Themes and Recommendations
The following themes have been identified from the reviews undertaken in St Helens:
• Learning Disability Classification - classification of learning disability or attempt to clarify baseline level of functioning has been inconsistent
• A lack of formal assessments e.g. Mental Capacity Assessments, Best Interest decision making and Multi Agency decision making.
• Documentation incomplete / minimal reference to health passport
• DNACPR documentation lacks detail of discussions regarding treatment, other options available and who was involved in the DNACPR decision
• Cause of death - includes Learning Disability as a contributory factor (2 cases)
• Age/ gender appropriate health screening attendance unclear in health records
• Annual health checks – variation in quality of checks and associated health action plan
• Professional awareness – inconsistent general understanding and application of Metal Capacity Act (2005) to practice.
• A lack of clear communication and care planning between multi agencies
• Easy read materials and signposting not easily accessible
Feedback from Stakeholders
“The St Helens LeDeR process has been supportive of the Trust by reducing the amount of clinical support required in accessing information to undertake a review. The steering group has wide engagement which is improving communication links across the area. The learning from the reviews is being shared at the steering group; sub group’s actions are demonstrating improvements and sharing the ongoing actions to improve the coordination of care and information sharing across St Helens for those with a Learning Disability”. (St Helens and Knowsley Teaching Hospitals NHS Trust, Assistant Director of Safeguarding)
“It is really positive to see the efforts that are going on in St Helens for some of the most vulnerable people in our community. The variety of stakeholders that attend this group shows that there is a real commitment to making this steering group work as does the sub group that looks at the written communications for people with learning disabilities and making sure they have access to accessible and good quality information”. (Manager, Healthwatch, St Helens)
“In the autumn (2019) I was invited to the inaugural meeting of the St Helens Local LeDeR Steering Group where I learned that St Helens were tackling the local backlog in LeDeR mortality reviews. This backlog is by no means a local issue… however St Helens were prepared to take the Bull by the horns and address the local problem themselves. Having been told that the backlog had been successfully dealt with and they were now addressing the ‘current’ list… I confess I was both surprised and delighted”. (St Helens LeDeR Steering Group member and Expert by Experience)
In February 2020, NHS St Helens CCG received formal thanks and congratulations from the NHSE National Learning Disability Team for our hard work in successfully implementing the LeDeR programme in St Helens.
Actions and Next Steps
The CCG is taking the following action in response to the themes identified:
• Learning disability registers in Primary Care are being restructured in collaboration with community health and social care agencies to provide accurate data around patient LD classifications and baseline levels of functioning. This will improve the offer of reasonable adjustments and may better inform decision making and signposting to other support services.
• A CCG nurse will now work closely with the Community and Acute Trust to improve service delivery to triangulate the patient journey and work collaboratively with all other agencies including Medicines Management, to work to increase general awareness in relation to the needs of people with learning disabilities. They will promote the use of reasonable adjustments and aim to improve the uptake and quality of annual health checks.
• Completed annual health checks and health action plans will be reviewed by the CCG to increase the quality and ensure consistency across the Borough. Themes identified will direct further initiatives as we aim to reduce health inequalities for people with learning disabilities.
• A Communications and Engagement Group has been established to develop a resource library to provide easily accessible easy read documentation to patients, families and carers. This will include self-care in relation to management of health conditions, identifying health concerns and management/effective treatments.
• We will be working closely with Learning Disabilities Teams in health and social care to increase understanding and application of the principles of the Mental Capacity Act to ensure that professionals feel
confident, knowledgeable and supported around this.
• Initiatives will be developed based on themes identified, the first being around the appropriate use of the hospital passport.
• Provider Quality Visits will incorporate Learning Disability accessibility.
• The CCG will support the planned communication campaigns being offered in the Borough
Conclusion
The past year has been both challenging and rewarding. St Helens CCG has worked hard to successfully achieve the completion of back log reviews, progress our business as usual caseload and implement a system wide approach to improving the health and social care experience of patients with learning disabilities. At 31.3.20, we have no backlog and have 4 ‘business as usual’ cases in progress. We have utilised the St Helens Cares Model to bring agencies together and to work collaboratively on initiatives such as increasing the uptake and quality of annual health assessments and the implementation of our resource library. St Helens CCG is committed to delivering the LeDeR Programme and will continue to seek to improve the health outcomes/ health and wellbeing for people with a learning disability.
