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Meeting of the West Suffolk CCG Governing Body

to be held from 0915–1200 hrs on Wednesday 23 May 2018 in the Edmund Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk, IP33 1LS

AGENDA

The Governing Body will be available to meet with members of the public from

0900 – 0915

GENERAL BUSINESS 1. Apologies for Absence Dr Christopher Browning 2. Declarations of Interest

To declare any interests specific to agenda items Declarations made by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available via contact with the CCG’s Corporate Governance officer or at the CCG website.

All

3. Minutes of the previous West Suffolk CCG Governing Body

meeting. To approve as a correct record Minutes of the West Suffolk CCG Governing Body meeting held on 28 March 2018

Dr Christopher Browning

4. Matters Arising and Action Log Dr Christopher Browning 5. General Update

To receive a verbal report from the Chief Officer Ed Garratt

PATIENT AND PUBLIC ENGAGEMENT 6. Community Engagement Group Minutes

To receive and endorse minutes of the Community Engagement Group meeting held on 26 April 2018

David Taylor Report No:

WSCCG 18-25 STRATEGY AND SERVICE DEVELOPMENT 6. Patient Story 7. West Suffolk Alliance Strategy

To receive and approve a report from the West Alliance Lead Bernadette Lawrence/

Kate Vaughton WSCCG 18-26

8. Children and Young Peoples Services Update – May 2018

To receive and note a report from the Chief Transformation Officer. Richard Watson

Report No: WSCCG 18-27

9. Ambulance Service Review Ed Garratt

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To receive and note a report from the Chief Officer. Report No: WSCCG 18-28

FINANCE, PERFORMANCE AND SCRUTINY 10. Integrated Performance Report - Are the CCGs finances,

performance and quality on track? To receive and note a report from Chief Officers.

Chief Officers Report No:

WSCCG 18-29 11. Governing Body Assurance Framework

To receive and approve a report from the Chief Corporate Services Officer

Geoff Dobson Report No:

WSCCG 18-30 12. Procurement Update

To receive and note a report from the Acting Chief Contracts Officer Jane Webster


GOVERNANCE AND CORPORATE BUSINESS 13. Health, Safety and Risk Committee

To receive and note a report from the Chief Corporate Services Officer Amanda Lyes


14. Managing Conflicts of Interest

a) Declarations of Interest - Six Month Review

To receive and note a report from the Chief Corporate Services Officer

b) Submission of Declarations of Interest by CCG Member

Practices. To receive and approve a report from the Chief Corporate Services Officer.

Amanda Lyes Report No:

WSCCG 18-33a

WSCCG 18-33b

15. Minutes of Meetings:

To receive a report from the Lay Member for Governance seeking the endorsement of minutes and decisions of West Suffolk CCG Sub Committees, those being; a) Audit Committee

The unconfirmed minutes of a meeting held on 3 April 2018.

b) Remuneration and HR Committee The unconfirmed minutes of 10 April 2018

c) Finance and Performance Committee

The confirmed minutes of meetings held on 21 February 2018 and 21 March 2018 and unconfirmed minutes of a meeting held on 18 April 2018

d) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 25 April 2018

a) CCG Joint Collaborative Group The unconfirmed minutes of a meeting held on 19 April 2018

e) West Suffolk CCG Primary Care Commissioning Committee The unconfirmed minutes of a meeting held on 27 March 2018.

Committee Chairs Report No:

WSCCG 18-34

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b) Commissioning Governance Committee

The confirmed minutes of a meeting held on 27 March 2018. 16. Any Other Business 17. Date and Time of future Governing Body meetings

0915 - 1200 Wednesday 25 July 2018, Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

Questions from the public – Maximum 15 minutes

Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.

Exclusion of the Press and Public

The Governing Body is recommended to exclude representatives of the press, and other members of the

public, from the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest; Section 1(2), Public Bodies (Admission to

Meetings) Act 1960.

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Minutes of a meeting of the West Suffolk CCG Governing Body held in public on

Wednesday 28 March 2018 in the The Conference Room, West Suffolk House, Western Way, Bury St. Edmunds, Suffolk

PRESENT: Dr Christopher Browning CCG Chair Dr Zohra Armitage GP Member Dr Simon Arthur GP Member Steve Chicken Lay Member Geoff Dobson Lay Member for Governance Andy Eley Deputy Chief Operating Officer Jo Finn Lay Member for Patient and Public Engagement Ed Garratt Chief Officer Chris Hooper Acting Chief Nursing Officer Jane Payling Chief Finance Officer Jon Reynolds Deputy Chief Contracts Officer Dr Jep Ronoh Consultant in Public Health Richard Watson Chief Transformation Officer Dr Firas Watfeh GP Member David Taylor Chair of Community Engagement Group IN ATTENDANCE: Jo Mael Corporate and Governance Officer 18/023 WELCOME AND APOLOGIES FOR ABSENCE

The CCG Chair welcomed everyone to the meeting and apologies for absence were

noted from: Dr Andrew Hassan GP Member Amanda Lyes Chief Corporate Services Officer Dr Abdul Razaq Director of Public Health Dr Bahram Talebpour GP Member Kate Vaughton Chief Operating Officer Jane Webster Acting Chief Contracts Officer The Chair advised that today was Dr Simon Arthur and Jo Finn ‘s final Governing Body meeting. They were both thanked for their enormous contribution and wished well for the future.

18/024 DECLARATIONS OF INTEREST

On behalf of all Chief Officers present, the Chief Officer declared an interest in

agenda item 7 (Aligning Clinical Commissioning Groups to support development of the Integrated Care System).

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18/025 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 24 January 2018 were approved as a correct record.

18/026 MATTERS ARISING AND ACTION LOG

There were no matters arising and the action log was reviewed and updated.

18/027 GENERAL UPDATE

The Chief Officer reported; • That after two years in post foundations had been laid for increased integrated

care. • The local system was likely to be announced as an Integrated Care System

Wave 2 site in the near future. • Suffolk County Council had recently appointed Nicola Beach as its new Chief

Executive. • Norfolk and Suffolk NHS Foundation Trust had recently appointed Antek Lejk as

its new Chief Executive. • There was to be a coming together of NHS England and NHS Improvement

teams within Midlands and East to reduce duplication • Governing Body Members leaving today were thanked for their contribution and

wished well for the future. The Governing Body noted the Chief Officer’s verbal update.

18/028 MENTAL HEALTH TRANSFORMATION: REFRESH OF THE SUFFOLK

MENTAL HEALTH STRATEGY AND CLINICAL MODEL OF CARE.

The Governing Body was in receipt of a report from the Chief Transformation Officer which advised of the launch of a new programme of work to refresh and redesign the Mental Health model of care. The report set out a proposed way forward for refresh of the Strategy and Clinical Model of Care and included a brief outline of the expected deliverables against the national Mental Health Five Year Forward View. Points highlighted during discussion included; • The CCG was committed to providing ‘parity of esteem’ for mental health

services and there was increased patient focus with exploration of new ways of managing the needs of the local population.

• The Governing Body was informed that service users had been involved at the

start and had helped to determine the approach. Healthwatch had also provided advice.

• The benefit to primary care was questioned and it was explained that there were

good relationships with link workers although there remained some concern at services provided for more complex patients requiring regular interaction.

• There was a desire for the new model of care to enable GPs easy access to

Clinicians.

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The Governing Body approved the launch of the new programme of work to refresh and redesign the Mental Health model of care and welcomed a progress update to a future Governing Body or Executive meeting.

18/029 ALIGNING CLINICAL COMMISSIONING GROUPS TO SUPPORT

DEVELOPMENT OF THE INTEGRATED CARE SYSTEM (ICS)

A report from the Chief Corporate Services Officer sought approval of the actions necessary to achieve further CCG organisational alignment on the journey to establish a strategic commissioning organisation for Suffolk and North East Essex. Health leaders across the Suffolk and North East Essex area had collectively committed to changing the way certain elements of healthcare was provided to the local population in order to deliver the highest quality of care possible within the resources available. In order to facilitate that three separate provider Alliances had been created, West Suffolk, East Suffolk and North East Essex. In order for the emerging Alliances to be able to make the changes necessary and achieve the level of transformation required to deliver improved integrated care for their local population, there would also need to be changes made to the commissioning landscape in which they operated.

Within the context of the Suffolk and North East Essex STP and as part of the development of the wider Integrated Care Systems (ICS) there was now a compelling case for the three CCGs within that footprint to come together on a more formal basis, in order to strengthen commissioning capacity and capability as a single strategic commissioning body. That would also allow existing resources to be delegated to the local provider ‘alliances’ to support the development of integrated services at a locality level within each area. This report went on to outline the steps needed to realise that ambition with proposals for further organisational alignment detailed within Section 4 of the report. Points highlighted during discussion included; • The report had been produced in conjunction with North East Essex and it was

being presented to all three Governing Bodies. • The proposals provided an opportunity to improve outcomes for the local

population via joined up commissioning decisions. • It was felt the proposals should provide good strategic cover to facilitate a strong

delivery structure at a local level. • The CCG would sit on alliance groups and have a role to play at locality level. • Although there was concern as to whether longer contracting periods gave

sufficient flexibility, assurance was provided that appropriate break clauses would be built into such contracts.

• The Governing Body was being asked to approve a direction of travel with more detail coming back to future meetings.

• A Lay Member Forum across all three CCGs had already been established. • The Governing Body was reminded that the CCGs would remain as the statutory

bodies and therefore accountable for the delivery of services. In line with the timeline set out in Section 5 of the report, the Governing Body subsequently;

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1) Agreed to strengthen the governance of local alliance arrangements to allow for delegation of CCG resources where supported and appropriate.

2) Approved appointment of a single Accountable Officer for the Ipswich and

East Suffolk, West Suffolk and North East Essex CCGs with the recruitment and selection process to be agreed with the three CCG chairs.

3) Approved establishment of a Joint Committee between the Ipswich and

East Suffolk, West Suffolk and North East Essex CCGs.

4) Approved further alignment of governance functions across the constituent CCGs, to include the establishment of committees in common.

5) Approved the maximising of opportunities for joint working to include the

sharing of management and staff teams across the constituent CCGs as considered necessary and appropriate.

6) Approved development and initiation of a comprehensive engagement

plan.

7) Approved the initiation of discussions with system partners, to develop the Strategic Commissioner

18/030 BETTER CARE FUND SECTION 75 AGREEMENT

The Governing Body was in receipt of a report which sought approval of the Better

Care Fund section 75 agreement. The Better Care Fund (BCF) was first announced in 2013 with the aim of promoting service integration between the NHS and Local Authorities (LA). The BCF provided a mechanism for joint health and social care planning and commissioning, bringing together ring-fenced budgets from Clinical Commissioning Group (CCG) allocations, the Disabled Facilities Grant (DFG) and funding paid directly to local government for adult social care services - the Improved Better Care Fund (IBCF). Following feedback in the initial years, the requirements of central management and reporting connected with the BCF had been scaled back to some extent with a number of changes being introduced from 2017. Plans and associated section 75 agreements were extended from single year to two years and the national conditions which had to be met to release the funding were reduced from eight to four as detailed in paragraph 2.2. Suffolk County Council, worked in partnership with the three CCGs covering Suffolk to establish the local Better Care Fund Plans. The Suffolk BCF plans had been submitted for sign off by NHS England in September 2017. Following review, the plan was deemed to be approved with conditions, the one outstanding area being to provide further clarification on delivery of the reablement metric. That was provided The formal document which established the Better Care Fund is a section 75 agreement. As the overall BCF operated at County level, arrangements had been made to accommodate the one to many relationship between the council and the CCGs. Separate section 75 agreements had been drawn up for each CCG area to cover the 2017-19 period. A copy of the final agreement for the CCG was attached at Appendix 1 to the report.

The Governing Body approved the Better Care Fund agreement for 2017-19 and proposed monitoring arrangements.

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18/031 2018/19 OPERATIONAL AND FINANCIAL PLANS

The Governing Body was presented with both Financial and Operational Plans for 2018/19 for approval. Financial Plan 2018/19 The framework within which 2018/19 CCG plans were to be developed was set by the ongoing business rules for CCGs and the latest Planning Guidance issued in February 2018. The most relevant elements for the Governing Body to be aware of are set out below: • NHS England had informed the CCG by letter that it would be required to deliver

in year balance in 2018/19. That was in contrast to the two-year plan submitted in 2017 which required the CCG to generate a surplus of £0.3m in 2018/19, and allowed £0.3m of additional expenditure to be made;

• the CCG must plan an uncommitted contingency of at least 0.5% of allocation to mitigate against in year cost pressure;

• the requirement to hold a system reserve which could not be spent by the CCG had now been removed. As that was due to be 0.5% of allocation that change increased flexibility for the CCG;

• the CCG would receive 3.32% growth on its programme allocation and 1.71% uplift on its delegated co-commissioning allocation; and

• the mental health investment standard required CCGs to demonstrate that mental health expenditure would be increased in line with growth in programme allocation.

A high level summary of the allocations due to be received by the CCG in 2018/19 and the proposed deployment of that funding was set out in table 1. Further sections of the paper provided more detail showing how the plan had been built up from the 2017/18 outturn, the investments and cost pressures included, high level savings (QIPP) plan and an analysis of overall financial risk and mitigation. Points highlighted during discussion included; • The financial plan provided a great opportunity for transformation funding

although a key risk going forward was the financial position of main providers. • Having questioned the increase of QIPP associated to continuing healthcare in

light of the need for it not to affect patient care, the Chief Finance Officer explained that there was a need to determine what was deliverable whilst retaining quality. It was important that budgets set were achievable.

The Governing Body:

• Approved the financial plan for 2018/19, subject to any further changes to guidance or allocation.

• Noted the contingencies, investments, risk and mitigations. • Delegated authority to its Financial Performance Committee to approve any

changes required to the final submission and to approve the detailed financial budgets for the CCG.

Operational Plan 2018/19 The activity plan was set out within paragraph 2.2 and followed national guidance and assumptions and was triangulated with local provider activity plans. Points highlighted during discussion included;

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E-referral numbers were questioned and the Chief Finance Officer agreed to investigate and provide more detailed information to the Financial Performance Committee. The Governing Body: • Noted and approved the activity plan and performance trajectories. • Delegated final sign off to the Financial Performance Committee in April 2018.

18/032 PROCUREMENT UPDATE

The Governing Body was in receipt of a report, which detailed procurements

completed since the last update and those currently in progress and planned. Key points highlighted during discussion included; • The integrated urgent care service procurement was ongoing. • A procurement to secure ophthalmology providers for an Ophthalmology Referral

Refinement and Remote Review Platform and a Community Ophthalmology Service had commenced.

• A review of the current Pain Management Service was underway and as part of that review a prior information notice was released to the wider market to allow interested parties to express an interest in the services. As a result, it was likely that a due diligence exercise would be undertaken in respect of pursuing the most capable provider route.

The Governing Body noted the content of the report.

18/033 INTEGRATED PERFORMANCE REPORT

The Governing Body was in receipt of the Integrated Performance Report, which

provided members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial performance and acute activity, together with detailing work being carried out by the transformation, project management office and primary care teams. National reporting measures had been included at the front of the report. Clinical Quality and Patient Safety Key points highlighted included; • Infection control – West Suffolk Hospital was rated ‘red’ although C.difficile had

improved. Data provided by West Suffolk Community Healthcare were currently being reviewed. The CCG was above trajectory year to date with 51 cases against a trajectory of 37.

• Harm free care – there had been a high number of falls in January at West Suffolk Hospital which were being reviewed at the next Quality meeting. An average number of pressure ulcers had been reported although a number were pending assessment.

• Patient satisfaction across providers was average. • Transforming Care was ahead of trajectory. • Cancer performance had improved with there being 10 x 62 day cancer wait

breaches and no reported 104 day cancer wait breaches.

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Having noted West Suffolk Hospital’s performance as reported, its rating by the Care Quality Commission (CQC) as ‘outstanding’ was queried. The Governing Body was advised that the difference in information was due to the CCG and CQC measuring the hospital’s performance across different metrics. Finance • At the end of month 11, the CCG was on track to achieve its year-end control

total of a break-even position. • Key variances were acute services, prescribing and mental health out of area

placements, which were being mitigated by the use of contingency and reserves. • There was currently an underlying surplus of £4m. • QIPP delivery was at 95% of plan. Having questioned the likely financial position if there had been no guaranteed income contract with the acute Trust, the Chief Finance Officer reported that, if working under payment by results, it was likely that meeting financial targets would be more challenging. Transformation Integrated Care – A&E was currently 0.7% above plan with admissions below plan overall. Delayed transfers of care had improved to 3.3% from 2.5%. Resilience work continued with regard to flow through A&E and a solution to improve handover delays was being explored. The winter plan for 2018/19 was currently being developed and due for submission to NHS England in April 2018. Planned Care – elective surgery was 0.6% above plan although there had been no increase to outpatient referrals. Pain Management and Ophthalmology procurements were underway and the 100-day challenge work in relation to three specialties was progressing well with good engagement from Consultants and GPs. Mental Health and Learning Disabilities – the dementia diagnosis rate target continued to be challenging and was currently 62% against a target of 67%. The peri-natal service had been launched. Children and Young People – Special Educational Needs and Disability (SEND) progress had been recognised by the Secretary of State for Education in a recent letter. The emotional well-being hub was due to be launched in April 2018, with speech and language therapy work aimed to address demand and capacity issues due for completion in May 2018. A new Associate Director of Transformation had been appointed jointly with Suffolk County Council to lead a new team dedicated to childrens resource. Having queried whether A&E attendance figures incorporated GP streaming, it was explained that GP streaming was included within the four hour target. Achievement of the dementia diagnosis target was discussed and it was noted that two practices, in particular, had not been able to identify sufficient patients despite support from the CCG and NHS England. Delivery of the target remained a key focus across the CCG. Contractual Performance Key points highlighted included; • West Suffolk NHS Foundation Trust – A&E performance was at 84% and the

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A&E Delivery Board was closely monitoring the situation. Handover delays remained a concern although Delayed Transfers of Care had improved. 18 week referral to treatment time progress had slowed at around 90% and it was thought that the recent bad weather had had an effect. 52 week waits were a key concern although some were due to patient choice.

• Norfolk and Suffolk NHS Foundation Trust – a remedial action plan was in place to improve children and young people’s access to services.

• West Suffolk Community Healthcare – Delayed Transfers of Care were a key focus.

• 111/Out of Hours – there had been high demand during January 2018. • East of England Ambulance Service Trust (EEAST) – December 2017 had

been challenging although there had been some improvement in January 2018. There remained a lot of work to do in order to improve response times.

Project Management Office • The new Head of PMO was keen to develop and enhance the role of PMO within

the CCG. Primary Care • Work was required to improve performance in relation to Annual Health Checks

for people with learning disabilities. That work should include simplification of the SystmOne template.

The Governing Body noted the content of the report

18/034 GOVERNING BODY ASSURANCE FRAMEWORK

The Lay Member for Governance presented the Governing Body Assurance

Framework (GBAF) for January 2018 together with a summary of Chief Officer local risk registers. Amendments and additions to the GBAF were detailed within Section 2 of the report, with key aspects of departmental risk register being listed in Section 3. The Governing Body noted and approved the GBAF as presented.

18/035 MINUTES OF MEETINGS

The Governing Body received the following minutes and decisions from meetings:

a) Audit Committee

The unconfirmed minutes of a meeting held on 6 February 2018.

b) Remuneration and HR Committee The confirmed minutes of 19 September 2017 (previously not presented) and unconfirmed minutes of a meeting held on 13 February 2018

c) Finance and Performance Committee

The confirmed minutes of a meeting held on 20 December 2017 and 17 January 2018.

d) Clinical Scrutiny Committee

The unconfirmed minutes of a meeting held on 28 February 2018

a) CCG Joint Collaborative Group

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The unconfirmed minutes of a meeting held on 1 February 2018

e) West Suffolk CCG Primary Care Commissioning Committee The unconfirmed minutes of a meeting held on 24 January 2018.

f) Commissioning Governance Committee Decision from a virtual meeting held on 22 November 2017 The Governing Body received and endorsed the presented minutes and decisions.

18/036 COMMUNITY ENGAGEMENT GROUP MINUTES

The Chair of the Community Engagement Group (CEG), presented the minutes of

the Group’s last meeting, which had been held on 19 February 2018. Key points highlighted included; • Members of Market Cross, Mildenhall’s Patient Participation Group had attended

the meeting and advised of their joint work with the practice to improve display information. The PPG had also pursued links with local schools and the travelling community and, had assisted the pharmacy with its ‘check your bag’ campaign. A key focus for the PPG going forward was how to involve younger people.

• The Chief Transformation Officer had provided a ‘virtual’ presentation to the group.

• A member of the public had raised concern at the perceived overspend of West Suffolk Hospital and the CEG had felt it would be useful to receive some guidance when dealing with the public to ensure that consistent messages were given.

• Thanks were extended to Jo Finn for all her hard work and the CEG was sorry to see her leave.

The Governing Body noted the update.

18/037 COMMUNITY ENGAGEMENT GROUP TERMS OF REFERENCE

The CCG had recently amended its Constitution to reflect the establishment of

additional committees, update GP practice details, and amend membership of the Governing Body. As part of the approval process, NHS England had requested amendment to Terms of References for some committees to comply with national guidance. The Community Engagement Group was one such committee. The Community Engagement Group’s Terms of Reference had been amended as follows (in accordance with national guidance): • To clarify the agreed delegated powers as set out in Schedule 1; • To clarify that the representatives of HealthWatch and Suffolk Congress were

non-voting attendees, but were considered to hold significant influence. That was to comply with legislation that prevented CCGs from forming joint committees with local authorities, HealthWatch or other organisations;

• To include a section on reviewing the Group’s performance and effectiveness. The revised Terms of Reference had been approved by NHS England as part of its overall approval of the CCG’s revised Constitution, and approved by the Community Engagement Group at its meeting on 19 February 2018 subject to the following:

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• Members had requested clarification re 4 (i) as to why organisations such as

Healthwatch and the Suffolk Congress were referred to as non-voting attendees.

Response: That was in accordance with legislation which prohibited CCGs from forming joint committees with local authorities, HealthWatch or other organisations. Such organisations might attend committee meetings were not eligible to vote.

• Members requested that it was stated in the terms of reference that the Lay Member was also the vice chair

Response: That had been incorporated into the final Terms of Reference.

Having noted the above, the Governing Body ratified the amendments to the Terms of Reference for the Community Engagement Group, as approved by the Group at its meeting on 19 February 2018.

18/038 ENGAGEMENT IN WEST SUFFOLK

The Governing Body was in receipt of a report from the Lay Member for Patient and

Public Engagement which updated on progress with the Engagement agenda in West Suffolk. Patient and Public Engagement had been a key priority for the West Suffolk CCG since its’ inception. It had given voice to residents of West Suffolk and enabled the CCG to better start a new culture in which Patient and Public Engagement was ‘the way we do things’. The West Suffolk CCG was increasingly working with Ipswich & East Suffolk CCG as part of the emerging Sustainability and Transformation Programme. Both CCGs recognised benefits that had been realised because of successful engagement. NHS England wanted to capture measurable outcomes to provide a platform for the introduction of performance managing engagement activity. The two CCGs had developed resources to facilitate further development of the engagement programme across Suffolk. One element would include indicators that added value, there was currently no formal evaluation of engagement activity. The engagement team had produced a report of the progress of engagement activity since 2012 by undertaking an audit during 2017/2018. The current position was detailed within Sections 4 and 5 of the report and a proposed framework and toolkit were appended to the report. Next steps included the development of an action plan for roll out the framework. The Chief Officer suggested that, in future, such a report should seek approval by the Alliance and agreed to present it to a future system executive. The Governing Body supported its Executive in; • Reconfirming the CCG’s Patient and Public Engagement Programme as a key

priority of the CCG. • Approving ‘Working Together: A framework for developing patient, community

and staff partnerships, (2018)’

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_____________________________ _______________________ Chair (Dr Christopher Browning) Date

• Approving ‘Working together: A toolkit for developing patient, community and staff partnerships (2018)’ to ensure there was a robust structure to engagement activity monitoring.

• Supporting the engagement team in development of the next strategy for Communications & Engagement, 2018 – 2021

18/039 ANY OTHER BUSINESS

The Vice Chair and Lay Member for Governance announced that one nomination

had been received in respect of election for the position of CCG Chair and therefore Dr Christopher Browning had been duly elected for a further three year term. Jo Finn, Lay Member for Patient and Public Involvement thanked Ed Garratt, David Taylor, Isabel Cockayne, John Troup and others for all their support and work during her time as a member of the Community Engagement Group and Governing Body.

18/040 DATE AND TIME OF FUTURE GOVERNING BODY MEETINGS

0915 - 1200 Wednesday 23 May 2018, Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

18/041 QUESTIONS FROM MEMBERS OF THE PUBLIC

Cllr Marks from Haverhill raised the following questions;

What steps had the CCG taken to address recruitment and retention issues across the local health system? Could the CCG confirm that a local focus would not be lost from the proposed development of an Integrated Care System? How was the health care summary to develop when out of area hospitals such as Addenbrookes were not willing to share information? In response Governing Body members reported; • Community Education Provider Networks had worked to develop a workforce

plan seeking to address recruitment and retention issues. • A key aim of strategic commissioning going forward was to facilitate a locality

model with providers working as one team within localities. • The Chief Officer agreed to investigate the question with regard to the sharing

of information by Addenbrookes in order that a response might be provided to Cllr Marks outside of the meeting.

WEST SUFFOLK CCG Governing Body

ACTION LOG: 28 March 2018 (updated) MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE Meeting of 29 November 2017 17/113 Discharge to

Optimise and Assess That the Governing Body receive a further update to a future meeting.

Richard Watson

May 2018

Meeting of 24 January 2018 18/010 West Suffolk NHS Trust

Global Digital Exemplar Funding

The Governing Body approved the payment of funding received by the CCG to West Suffolk Hospital NHS Trust in relation to the Global Digital Exemplar funding agreement held between NHS England and the Trust, and requested that it receive an update to a future Executive meeting.

Jane Payling Planned for Executive meeting at end of April 2018

18/017 Freedom of Information

Having questioned whether there might be engagement opportunities within the responses, the Chief Corporate Services Officer agreed to investigate and report back to the Lay Member for Patient and Public Involvement outside of the meeting.

Amanda Lyes Ongoing

Meeting of 28 March 2018 18/028 Mental Health

Transformation The Governing Body approved the launch of the new programme of work to refresh and redesign the Mental Health model of care and welcomed a progress update to a future Governing Body or Executive meeting.

Richard Watson

July 2018

18/031 2018/19 Operational and Financial Plans

E-referral numbers were questioned and the Chief Finance Officer agreed to investigate and provide more detailed information to the Financial Performance Committee.

Jane Payling

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE 18/041 Questions from

Members of the Public

The Chief Officer agreed to investigate the question with regard to the sharing of information by Addenbrookes in order that a response might be provided to Cllr Marks outside of the meeting.

Ed Garratt

GOVERNING BODY Agenda Item No. 06

Reference No. WSCCG 18-25

Date. 23 May 2018 Title

Community Engagement Group

Lead Chief Officer

David Taylor, Chair of Community Engagement Group

Author(s)

John Troup, Acting Head of Communications

Purpose

To present the unconfirmed minutes from the Community Engagement Group meeting held on 26 April 2018.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body:

The Governing Body is asked to consider and note the key items of discussion from the Community Engagement Group.

West Suffolk CCG Community Engagement Group Thursday 26th April 2018

West Suffolk House Bury St Edmunds

PRESENT: David Taylor (Chair) Gill Jones Healthwatch Suffolk Peter Owen Carol Mansell David Dawson Michael Simpkin Margret Marks Graeme Norris IN ATTENDANCE: John Troup – Interim Head of Communications West Suffolk CCG Teresa Farley – Engagement Officer West Suffolk CCG Cllr Terry Clements - Interested party John Ellison– member of the public Kate Vaughton – Chief Operating Officer, WSCCG Jane Payling - Chief Financial Officer Martin Bates – Project Manager WSCCG 100Day challenge Renu Mandal – Transformation Lead - 100 Day challenge Tess Zermanos – Management Team Leadership Programme

Item Action

GENERAL BUSINESS

1. Dave Taylor welcomed everyone. David explained that since the last meeting Jo Finn had decided not to extend her tenure as WSCCG Lay Members for Public and Patient involvement. Resulting in the previous meeting being her last.

2. MINUTES & ACTIONS ARISING Minutes from the 19.02.18 were agreed. Kate Vaughton gave an update on the Alliance work and the work from the ‘building on momentum of connect’ sessions that have taken place in localities to identify needs. Peter Owen provided an update regarding PALS and inter-organisational communication issues. GP Forward View Report – Kate Vaughton will provide an update to the

APOLOGIES: Chrissy Marshall Jane Ballard (CAB) Jon Rapley

CEG. It was suggested that Lois Wreathall or David Brown may be able to come along to a future meeting to update on progress against the five year forward view. Action Log: See action log for current status on all actions.

3. CEG members update

PO report – Report provided along with two documents – Trusted assessments and PowerPoint Sounding Board session. DD – Explained that he is the Director of an Arts and Culture Festival celebrating the life of Pater Hall. The festival aims to improve the health and wellbeing of people in Suffolk. talked about his involvement in the NHS community beds project, which will be brought back to the CEG. ‘Festival of Culture - Celebrating the life of Sir Peter Hall and his birthplace in the Heart of East Anglia, building on his values and legacy, pioneering innovative arts practice and striving for access to high quality culture for all.’ – Information sent out with minutes. GN report GN requested information on the guidelines in place for housing development and GP resources. In addition do GP surgeries have contingency plans in place for proposed development in the future. A discussion was help on volunteering and PPG’s and how volunteers could be recruited. DD advised the Kings Fund paper on volunteering could be useful. MM report MM reported that some pharmacies in Haverhill are not promoting the ‘check your bag’, campaign. Kate Vaughton advised that these pharmacies could be flagged to the Chief Pharmacy Officer. MS report MS informed the members that the Older Person’s Day for Haverhill is planned to take place in Jan/Feb 2019 and will take place at Abbey Croft Leisure once the refurbishment work has been undertaken. MS attended the first meeting of the Haverhill VASP (Voluntary and Statutory Partnership). MS handed out a document to CEG members explaining the vision, aims and objectives of the VASP. A mental Health Awareness week will be taking place between 14th and 20th May. CM explained that the Diocese is currently applying for funding for a project that will look to reduce loneliness and isolation. An update will be provided at the next meeting.

TF,LW TF

4. CHAIR’S REPORT – Dave Taylor Chairman’s Report DT provided an update on Wickhambrook PPG an shared plans for the celebration of the NSH 70th Anniversary.

5. Jane Payling – Chief Finance Officer An update of the end position for the ‘old’ year (April 17- March 18) was provided along with information on the financial plan for the ‘new’ year (April 18 – March 19). A query was raised asking if WSCCG had met its financial targets at a cost to the community, i.e. cancelling operations at West Suffolk Hospital. JP explained that the contract with West Suffolk hospital is a ‘Block’ Contract meaning a set amount of money is provided for the year and not on an operation by operation basis. DD asked if any unit costing had taken place looking at costs of care for individuals and particular services. JP explained that the currently systems in place make this analysis of total costings for individuals tricky, particularly where care is provided by more than one provider. However costing information is available for most aspects of acute care, the committee discussed how patient awareness of costs such as those caused by ‘Did not attends’ can provide a powerful message. PO asked how much has been allocated to the ‘Better care Fund’ (Joint fund with Social Care) in 2018/19 and if this was in addition to the CCG budget. JP agreed to provide further detail on the Better Care Fund and its uses to a future meeting

JP

6.

Martin Bates – 100 Day Challenge WSCCG is working with 3 other CCG’s (Bassenthwaite & Doncaster, Dudley and Somerset) to take part in NSHE 100 Day Challenge. The concept of the 100 day challenge is to make changes quickly to services in identified disciplines. The disciplines identified in West Suffolk are, Ear Nose and Throat, Cardiology and Urology. MB provided an update on the work that is taking place around cardiology and specifically looking at Atrial Fibrillation (AF). MB informed the group about the AliveCor Kardia, a portable device that can detect an irregular beat. This is being taken to events across West Suffolk to help indetify peole who may have AF. The following GP surgeries and Pharmacies are trailing some of the new ways of working : Orchard House and Rookery in Newmarket, Stanton and Wickhambrook and the 4 pharmacies in Newmarket. CEG members asked if they could support with this work. MB to ask for support and volunteers when they are needed. Once the 100 days has finished all CCGs taking part will share their findings and their work. Where successes have been achieved a business case will be put forward to system exec so they changes can continue.

8. AOB

CEG recruitment Recruitment information has been distributed via, the WSCCG website, the health forum, social media, the practice manager newsletter, parish councils and families and communities officers in West Suffolk Councils.

Closing date is 11th May Shortlisting will take place week of the 21st May Interviews will take place week of the 28th May If any CEG members are interested in being part of the interview panel for selection of new members let us know. Planned transformation of Mental Health Services DT has been invited to attend a workshop in June regarding the planned transformation of mental health services in Suffolk. He has asked CEG members for any feedback around mental health that he could feedback at the workshop. Citizens Advice Bureau AGM MS asked if someone from the CCG could attend the CAB AGM on 19th September to talk about the new mental health work.

TP

9. QUESTIONS FROM THE PUBLIC

JE – Commented he has been struck by the commitment of CEG members and the openness of the CCG in providing information. JE asked what is the current situation in primary Care? It was agreed that this could be a future agenda item.

TF, LW

FORWARD PLANNER One life Suffolk presentation – Natasha Rivers – June 2018 Alliance locality update – Kate/ Sandie Robinson/ Dawn Godbold. Children and young people mental health transformation team – update of work Jo John. Planned transformation of mental health services – Eugene. STP update (Accountable care organisations/ Connect are part of STP) CRUK Facilitation Manager – Donna Reeve Care Navigation (SF) Connect update (MB) Primary Care update - Lois

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West Suffolk Alliance Strategy

Lead Chief Officer

Kate Vaughton, Chief Operating Officer Bernadette Lawrence, Area Director, Adult Community Services

Author(s)

Kate Vaughton, Chief Operating Officer

Purpose

To set out for approval, the Alliance Strategy

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: To review and approve the West Suffolk Alliance Strategy. Our approval is sought alongside the approval of each constituent member of the Alliance

1. Purpose 1.1 To set out for review and approval the West Suffolk Alliance Strategy 2. Background 2.1 The attached five- year strategy has been developed by the West Suffolk Alliance of – West

Suffolk Hospital, Suffolk County Council, Norfolk and Suffolk Foundation Trust and Suffolk GP Federation - working with West Suffolk CCG and wider public and voluntary sector partners.

2.2 Our strategy sets out a common purpose and commitments to action. It describes a shared

set of values, which gives us a common focus on people and places.

Our Alliance is one of three within our Strategic Transformation Partnership (STP) area; there are Alliances in Ipswich and East Suffolk and North East Essex too.

3. Current position 3.1 The strategy describes:

• the current and future health and wellbeing profile of our area, alongside our assets and opportunities

• our vision, mission, values and objectives • Four agreed interconnecting ambitions:

o Strengthening the support for people to stay well and manage their wellbeing and health in their communities

o Focusing with individuals on their needs and goals o Changing both the way we work together and how services are configured so that

health and care services are sustainable into the future and work well for people o Making effective use of resources

• our proposed governance • indicative outcomes • our key actions for the next 12 months

4. Patient and Public Involvement 4.1 Our strategy consolidates the development work across the health and care system that

has taken place since the Health and Care Review in 2014. It is based on consultation and engagement sessions where we have spoken to local people about what matters to them and their families. Our commitment to coproduction will mean that as we develop our plans further we will work with people and staff to get their input both on the direction of travel and on specific changes that might be proposed.

5. Recommendation 5.1 The Governing Body is invited to review and approve the Strategy and commit to all

appropriate support in preparing the next stage delivery plans

West Suffolk Alliance Strategy 2018-2023

All about people and places

May 2018 - Edition 1

2. West Suffolk Alliance Strategy 2018-2023 - All about people and places - May 2018 -Edition 1

In September 2016 health and care partners formed the West Suffolk Alliance. We have committed to work together to improve the health and care system in West Suffolk for all people whether they be a child, part of a family or a single adult. Our belief is that by working together in an Alliance we can have an impact on wellbeing, care and physical and mental health outcomes for people.

Our focus within the Alliance is on people and places.

The strategy for our Alliance is to move from working as individual organisations towards being a fully integrated single system, with a shared vision, clear local priorities, able to both provide an improved service for people in West Suffolk and also to tackle the sustainability issues faced by the system together.

Delivery of our strategy is a critical element of the wider Suffolk and North East Essex Sustainability and Transformation Partnership Plan.

We have developed four interrelated ambitions. These demonstrate how as Alliance partners we will make progress together. They do not displace our own organisational priorities, but rather show the added value from Alliance working. This strategy is backed up with a Five Year Delivery Plan.

This strategy consolidates the development work across the health and care system that has taken place since the Health and Care Review in 2014. It is based on consultation and engagement sessions where we have spoken to local people about what matters to them and their families. Our commitment to coproduction will mean that as we develop our plans further we will work with people and staff to get their input both on the direction of travel and on specific changes that might be proposed.

Introduction

Suffolk County Council (in particular Adult and Community Services, and Health, Wellbeing and Children and Young People Services)

West Suffolk Foundation Trust (hospital and community health provision)

The Suffolk GP Federation Norfolk and Suffolk Foundation Trust (mental health services)

Working closely with the West Suffolk Clinical Commissioning Group

The Alliance sees the partnership with the Ipswich and East Alliance, and with wider stakeholders as crucial, including District and Boroughs, the Ambulance Service, independent care providers and the voluntary and community sector, employers, education providers and business.

West Suffolk Alliance members


West Suffolk in numbers

Brandon

Mildenhall

Stanton

Bury St Edmunds

Newmarket

Haverhill

Sudbury

Forest Heath

St Edmundsbury

Babergh

1 hospital -

West Suffolk Hospital

24 GP surgeries

6 Integrated

Neighbourhood Teams /Connect

sites

West Suffolk

population is

227,8002016 ONSestimate

1hospice

30 health beds

in community

4 health centres

49 care homes

3District

and Borough Councils

29 Home care providers

registered in west Suffolk

89schools

1inpatient

mental healthunit

Over

2,000voluntary and

communitygroups


It is imperative that the Alliance works collaboratively to develop new models of health and care. Current arrangements will not address the rising needs for services, and the associated costs of these. Nor will they deal with the anticipated reduction in the ratio of working to non-working people and the impact on both our workforce and the numbers of people that will require health and care provision.

Overall the population of West Suffolk is generally healthy with high life expectancy.1 However, it is estimated that 1 in 6 adults smoke,2 6.7% of people have diabetes, nearly 10% of adults have a Body Mass Index of 30 or over, and there is much higher incidence of osteoporosis than in England as a whole.3 These factors have a significant impact on wellbeing and health, incidence of disease and healthy life expectancy.

What are the big challenges for people in West Suffolk?

The health and wellbeing gap

1 http://webarchive.nationalarchives.gov.uk/20160109203331/http:/www.ons.gov.uk/ons/ dcp171776_356961.pdf2 https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/ smoking-and-tobacco-applying-all-our-health3 https://fingertips.phe.org.uk/profile/prevalence/data#page/1/gid/1938132820/pat/46/par/ E39000031/ati/152/are/E38000204/iid/90443/age/239/sex/44 https://www.healthysuffolk.org.uk/uploads/Population_Projections_FINAL.pdf

The care and quality gap

The challenge in West Suffolk is from a combination of the forecast rise in population (11.6% between 2017 and 2037) 4 and the anticipated larger proportion of residents who have multiple long term conditions including dementia. For example the number of people living with dementia is likely to almost double in the next 20 years and most of these new cases will be in people aged over 85. The system will need to be responsive to the changing demographics of West Suffolk over the next 20 years.

The funding and efficiency gap

Our staff are critical for getting moving - they care about services for people in West Suffolk, and they know what needs to be fixed. We must harness that knowledge and passion.

Dr Stephen DunnChief Executive, West Suffolk Foundation Trust

http://webarchive.nationalarchives.gov.uk/20160109203331/http:/www.ons.gov.uk/ons/dcp171776_356961.pdf

http://webarchive.nationalarchives.gov.uk/20160109203331/http:/www.ons.gov.uk/ons/dcp171776_356961.pdf

https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health

https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health

https://fingertips.phe.org.uk/profile/prevalence/data#page/1/gid/1938132820/pat/46/par/ E39000031/a

https://fingertips.phe.org.uk/profile/prevalence/data#page/1/gid/1938132820/pat/46/par/ E39000031/a

https://www.healthysuffolk.org.uk/uploads/Population_Projections_FINAL.pdf


West Suffolk has many assets and opportunities to help overcome these challenges and enable delivery of our vision:

• Our towns and villages have many vibrant community and voluntary sector organisations who provide invaluable activities and services and work actively with us and our local authority partners.

• We have excellent clinical and professional leaders and staff in all of our organisations who are increasingly working together.

• We have a strong track record in working in partnership - across organisations and most importantly with patients to make services better whilst managing costs and cutting waste.

• Communities and politicians are in support of retaining and building services locally.

CQC rate the quality of our health and care services as good, in many areas outstanding, and there is a clear plan for services which need improvement.

• West Suffolk Hospital is rated as ‘outstanding.’ • 22 GP practices are rated ‘good’ and the other 2 are rated ‘outstanding.’ • SCC Children’s Services are rated good in all aspects. • Over 80% of our care homes and home care services are rated ‘good’ or ‘outstanding.’• Mental health services require improvement and are working with partners

to deliver agreed improvements and explore future service models. • Special Education Needs and Disability services for children and young people were rated as ‘inadequate’ but are now recognised by the Department for Education and Ofsted as making good progress.• 87% of schools in Suffolk are judged ‘good’ or ‘outstanding’ by Ofsted.

“Mrs Proctor was full of praise for the carers she had when she came out of hospital. She said they went over and above to support her recovery. One of them came to her in the snow at 10.00pm at night. She felt she could not fault the care they gave.”

“Walter wrote to thank the Brandon Community Healthcare Team for all the care and attention they had given him. It had been difficult at times, but the family has come through and the team are brilliant.”

What are the assets and opportunities for West Suffolk?

A key relationship for us is with the Sustainability and Transformation Partnership, as we are delivering large elements of their programme.

Pete DevlinOperations Director, Suffolk, Norfolk and Suffolk Foundation Trust


Our vision

Voluntary Sector GPs

Community Health

MentalHealth

Acute and

Specialist

SocialCare

Self

Care and Voluntary Sector

Acute and Specialist Services

Com

mun

ity Prim

ary and Social Care Services

Co-ordinating services around the individual - so that if feels like one service

‘I have to tell my story multiple times to different people.’

‘I’m left waiting for services whilst they argue over who pays.’

‘I don’t get a say in my treatment.’

‘When I’m discharged from a service, I’m not sure where to go next.’

From this

‘I completed an integrated care plan, setting out who will provide care and support to me and when.’

‘I receive more care in or near to my home, and haven’t been to hospital for ages.’

‘I feel fully supported to manage my own conditions and live independently.’

To this


Joining up services around the needs of people

The Alliance has committed to joining up services around the needs of people. This case example shows how we need to work better with partner agencies to support people to stay well and living in their own communities. The case study highlights that individuals with complex needs require coordinated input and support from system partners. At times this can be difficult to achieve, particularly when people do not want to engage with services. However, it is important that we commit to this coordinated approach as fragmented care impacts individual quality of life and makes additional demand on the services offered by system partners. Mark is in his early twenties and has a diagnosed mild learning disability. He was admitted to a specialist hospital placement after concerns about his challenging behaviour and contact with the criminal justice system.

His stay in hospital was for over a year and whilst in hospital there were problems with aggression towards staff and damage to property. During the admission Mark was also diagnosed with a personality disorder.Mark was assessed as having capacity to consent to his care and support plan. As risk and challenge increased, the level and intensity of support was increased.Eventually Mark was in receipt of 24 hour 2 to 1 support.

Case Study: Why taking a co-ordinated approach is important

Despite having this intensive support there were multiple serious incidents of self harm, aggression to staff and involvement with criminal justice and multiple safeguarding referrals. After an assault on a staff member, that led to Mark’s arrest, the support provider withdrew their support due to the level of risk he posed to staff members. Mark has continually refused support from Mental Health Services, and does not engage with any support or treatment offered. Attempts to refer Mark to specialist residential placements have been unsuccessful either because providers are worried about risk or because he refuses to engage. As a result of the assault and the offending committed whilst in receipt of 2 to 1 support Mark received a custodial sentence and is now in prison. ACS staff are working with colleagues across NSFT, probation and the CCG to consider next steps and plan for prison discharge. There is also a need to look at the skills and capacity of our provider sector require to support people with behaviour that challenges services and who pose a risk to themselves and others.


Connect

The Connect programme is central to the delivery of our strategy - All about people and places.People’s health and wellbeing are influenced by a large number of factors. The Connect programme aims to harness the statutory, voluntary and community sectors to work together to develop a co-ordinated approach in our localities, to improve the health and wellbeing of individuals and communities. We already have many examples of joint working, for example with the District and Borough Councils, with the police force and with local community organisations but we plan to focus on this much more during the following year. Integrated Neighbourhood Teams are a core element within each Connect area and work across a defined group of GP practices. They are made up of health and care staff, and will provide co-ordinated joined up care for people and proactive support for those most at risk of deteriorating health. INTs have been established in Haverhill, Bury Town, Bury Rural, Sudbury and Mildenhall, with a team in Newmarket to be developed. There are of course strong links to specialist provision, and to the local and regional hospital network, but the aim is to pull in more and more specialist support through the INT so that people can be supported to manage their health and care needs in their own homes, in their local community.

Mildenhall

Newmarket

Haverhill

Sudbury

Bury Town

Bury Rural


“It’s brilliant sitting next to community health Occupational Therapists. I can pop over and talk to them instead of making referrals. The person we are working with gets a much better service.“

Suffolk County Council Home First OT

The development of the Integrated Neighbourhood Teams (INT) is a key feature of model in West Suffolk. In Mildenhall the health and social care team are now co-located and have been working closely together over the past six months to develop a shared approach to their caseload through implementing trusted assessment and care coordination.

The health and social care therapists, nurses and Home First teams now work more closely holding weekly Multi-Disciplinary Team reviews of their caseloads ensuring the care to the individual is coordinated and without duplication. The INT work in Mildenhall will now move on to focus on bringing shared access to the two main IT systems and how equipment budgets can be aligned.

Staff have embraced the ideas of Freedom to Act and Freedom to Speak Up and we have added Freedom to Integrate in order to support our teams to work more collaboratively.

Case study - Mildenhall Integrated Neighbourhood Team

Collaborating and working in an Alliance way


We will:

• Focus on people and places in West Suffolk integrating services around people’s homes, neighbourhoods and communities. We will give priority to what works for families, individuals and communities and will be bold and ambitious about what can be achieved.

• Create a financially sustainable system through managing demand differently and through committing to using the West Suffolk pound in the best way locally, reducing duplication and waste.

• Address health inequalities across West Suffolk focusing on prevention, accessibility, integration, effectiveness and sustainability of services to ensure that existing health inequalities in West Suffolk are reduced.

• Strive for the best quality services based on the outcomes we have agreed, within the resources available.

• Design things together and collaborate working with people, communities and partner organisations in West Suffolk. We will agree collectively how we do things so that we only do them once and support each other through change as our organisations adapt, building trust and having frank and honest discussions when needed.

• Be innovative redesigning our services using the experience of people and front line staff, and looking at national and international evidence. We will coproduce our changes designing effective and integrated services which meet people’s needs.

As Alliance partners we have agreed the following values:

This is about evolution, not revolution - learning what we can do together, and making sure the budgets we each hold support doing the right thing clinically and professionally.

Dr Nick JenkinsMedical Director, West Suffolk Foundation Trust


Our commitment is to deliver the following four interconnecting ambitions. Action on these ambitions is taking us from where we are now to where we want to be in 2023.

We strongly believe that working as an Alliance will lead to better services for people in West Suffolk.

Allan CadzowDirector for Children and Young People, Suffolk County Council

1. Strengthening the support for people to stay well and manage their wellbeing and health in their communities

Building local integrated working, across all ages and across both physical and mental health.

2. Focusing with individuals on their needs and goals

Looking at how we co-ordinate services to help people of all ages keep well, get well and stay well.

3. Changing both the way we work together and how services are configured …

… so that health and care services are sustainable into the future and work well for people.

4. Making effective use of resources

We will use the West Suffolk pound in the best way locally, reducing duplication and waste. All our organisations face challenging finances and if we work together we can use our resources better.


Ambition 1 - Strengthening the support for people to stay well and manage their wellbeing and health in their communities

We want to reduce health inequalities and keep people healthy at home by treating them earlier. We want to stop people from becoming unwell by giving them the right support close to home, with hospitals only needed for specialist care. Our communities should be safe and healthy and should support wellbeing and prevent ill health, alongside a health and care system that is organised with an increased focus on prevention.

We want to provide more integrated services, driving efficiency and high quality care. This requires local leadership and a willingness to work across all aspects of our systems to do what is right for people of all ages and with both physical and mental health.

Our partners are keen to play a full part in the delivery of this Strategy and we recognise the critical importance and range of the opportunities they bring.

Our future vision

1. We are introducing different ways of working that help people to manage health and care problems earlier. For example, through proactive risk stratification and follow through, good information and advice and care co-ordination. We also want expertise, experience and efficiencies to be shared widely so that everyone in West Suffolk can benefit equally from the same high standards of specialist care.

2. We are developing local integrated teams so that people’s whole needs are looked after rather than each element in isolation. We want GPs, social work staff, nurses and other health professionals, the voluntary sector and others to work together to co-ordinate and deliver care locally.

3. We are exploring how we can jointly deliver short term care to people in a crisis that gives them the help they need to stay out of hospital and long term care.

4. Our teams will be given opportunity to innovate and set priorities for change, with local leadership to bring together all elements of our system to work together, and transform services so that they meet local need. We see the engagement of GPs as critical in making this a success.

5. We recognise the wider influences on wellbeing and health - environment, infrastructure, housing, education and employment.

The Alliance will work with the private, voluntary and wider public sector to ensure that our communities can thrive.

Action we are taking to achieve this


Ambition 1 - Strengthening the support for people to stay well and manage their wellbeing and health in their communities

• We will build our Connect programme across all six localities, setting up locality delivery groups, embedding the locality lead role, with shared decision making, plan with local priorities and common data set.

• Develop new volunteer roles in the community through the Helpforce programme

• Continue to roll out the Making Every Contact Count programme

• Understand who is most at risk from poor health and health crisis and target support to keep them well.

• Develop the SEND local offer so that young people have access to up to date local information to support them to live good lives.

People will start to notice that they can access both health and care together through any of our Alliance organisations.

The first twelve months

The LifeLink project in Haverhill addresses social needs by equipping individuals and families with the tools they need to become more resilient and address their current issues. In addition it provides a space for people to build new relationships and support networks through connecting people - linking lives together. To date the LifeLink Coordinators have worked with 95 individuals/families helping and providing them with a space to talk through their current situation, needs, interests and aspirations. Both coordinators are trained in coaching techniques, allowing the participant to lead the conversation and realise their own solutions. The LifeLink Coordinators simply listen, ask the right questions and then support them in accessing certain groups, support services and provision. We have seen very quickly the positive impact this is having on the lives of participants and their loved ones, with a clear uplift in emotional wellbeing and connectivity within the town. We have invested in a wider evaluation with a focus on a reduction on reliance on GP services and prescription drugs, this data will take longer to collate, however some participants have indicated that they no longer feel the need to see their GP or take antidepressants. It became very clear that social prescribing can support an individual’s journey back into employment or volunteering. We therefore teamed up with Department of Work and Pensions and Suffolk County Council Skills Department and rolled out Moving Towards Work with the understanding that this would sit alongside LifeLink to support those furthest from the labour market. A lot of learning has come from this collaboration which will be applied to future endeavours. Partnership working has been key to the success of this project to date and will continue to be at the centre of how we continue to develop this project within Haverhill.

Case Study: Partnership working in Haverhill


Ambition 2 - Focusing with individuals on their needs and goals

We believe that if our services can be focused on an individuals needs and goals that this will both work better for people in West Suffolk, and be a more efficient use of resources. This means changing the way we work, giving people more information and choice, and being more flexible in our responses. It means working closely across our professions, including with non health and care organisations, and with families and family carers so that people get co-ordinated, integrated care.

Our future vision

1. We want to test out new ways of delivering health and care services that break down traditional organisational boundaries. The Buurtzorg Test and Learn site in Barrow is exploring how district nurses can support people through providing more holistic care, and encouraging independence. If the test is successful we would roll out this model across other areas of West Suffolk.

2. We are exploring ways to create person centred plans with people, so that they have one outcome focused plan that explains how services and other supports will help them to meet their wellbeing and health needs, whether they have a physical or mental health problem, whatever their age, or if they are a carer for someone. Wherever possible we will support these plans with a personal budget.

3. When people get help it will be co-ordinated. We will check with people if we can share records across relevant professionals, backed up by trusted assessment, so that they do not have to keep repeating their story.

4. We aim to support self care and self management, handing control back by using health coaching, assistive technology, digital offers as default and through making better use of community pharmacies and social prescribing.

5. Feedback from people who use our services will be used to inform our redesign options, and how we spend our West Suffolk pound.



Ambition 2 - Focusing with individuals on their needs and goals

• Develop integrated pathways between acute and primary care.

• Take the lessons from the Buurtzorg Test and Learn to develop a model that works for people in West Suffolk.

• Develop the use of technology and exploit our digital expertise.

• Introduce care-coordination, trusted assessment and start to develop a shared single customer plan.

• We will streamline and co-ordinate services for children and young people with ADHD, autism and behavioural issues so that they don’t have to go through different pathways to receive services.

People will have conversations with health and care staff that are much more holistic and which address people’s own priorities.

The first twelve months

Buurtzorg is a Dutch model of care that has been successful in supporting people who have nursing and personal care needs and who are living in their own homes. In West Suffolk, the Neighbourhood Nursing and Care Team are testing a model inspired by Buurtzorg to see how it can work alongside our Integrated Neighbourhood Teams and wider health and care system. Buurtzorg is very different from our current model of care, as individual nurses do both nursing and personal care tasks. They also work with family, friends and local community groups, alongside other formal professionals, to put in a wide range of supports and options for people so that they can become more independent and live a good life. The evidence is that this approach leads to a reduction in care needed over time and to fewer hospital stays. It is very early days with the “Test and Learn” and there are challenges trialling a radically different model of care within our existing system. However, the team have already identified benefits to working in this way, for example:

• Helping families to identify where additional benefits such as Attendance Allowance are due.

• Providing personal care as well as nursing and health care.• Monitoring blood sugars and supporting better self care.• Developing “What if” plans so that everyone knows what will happen in a crisis with the person with the health problems or with their family carer.• Linking people in with local community groups and activities.

Case Study: Buurtzorg Test and Learn


Ambition 3 - We will change both the way we work together and how services are configured

We want people in West Suffolk to start well, live well, age well and die well - and this means prioritising the prevention of ill health, whether physical or mental, as well as recognising the multiple factors that lead to ill health and deterioration of health.

We believe that working as Alliance partners we have the flexibility and freedoms to use our collective resources to make this happen. Our workforce are key to success and will be at the forefront of this work.

Our priorities for change will be driven by local need so that time and energy goes into sorting out the things that matter most to people in their area and which will make the biggest difference to health inequalities.

Our future vision

1. We are developing a Five Year Delivery Plan which shows how we will deliver the outcomes we have agreed as a system. We have agreed to move away from a focus on our own organisations to delivering what works best for people in West Suffolk.

2. Health and care system leaders are meeting together regularly with other partners, such as district and borough councils and the police, to plan how we deliver our vision for people in West Suffolk and to track action against our delivery plan.

3. We will share this draft strategy more widely with people in West Suffolk, with our staff and with partner organisations so that we can listen to what people think about our plans and use these to improve and strengthen our delivery going forward.

4. Our intention is to move towards an Integrated Care System, where we can truly use our resource flexibly to meet local need, acknowledging that this will take time to develop. Steps on the way will include moving contracts held by Alliance partners under the control of the Alliance and ensuring we have fully engaged GPs in West Suffolk.

5. We are expanding our collaboration with partner organisations such as the voluntary and community sector and the district and borough councils so that we can work together, bringing housing, environment, volunteering and other important factors into the mix, recognising their impact on wellbeing and health.



Ambition 3 - We will change both the way we work together and how services are configured

We made the decision to begin our service transformation by developing the new Suffolk SEND Strategy for 2017-2020. This work was led by Suffolk Parent Carer Network and involved partners from health, care and education. Together we developed a shared vision, aims and priorities forming the basis of the strategy. These encompassed our inspection findings, but also took account of the wider evidence base we had from SPCN, our staff and local stakeholders. Once the priorities were agreed we jointly developed the objectives that set out the scope of the work. Each priority has co-accountable leads from health, education and social care supported by a critical friend from SPCN. These teams developed the action plans that sit beneath each objective and provide the detailed programme of work that will enable us to deliver the strategy. In parallel we consulted on the strategy, including the objectives, and have incorporated the feedback from the respondents into our final version of both strategy and action plans. There was strong support for the new strategy, with over 80% of the 109 respondents agreeing with the vision, aims and objectives, and 88% agreeing that the priorities identified were the right ones.

We have cross referenced the Ofsted/CQC findings from the inspection against the strategy objectives and action plans to ensure that all the matters raised by inspectors have been addressed within the action plans we have developed. Through this approach we have swiftly been able to develop a new SEND Strategy for Suffolk, while at the same time responding to the inspection findings. We have one integral plan of action to deliver the change we need and are now ready to begin our long term programme.

• We will develop a Five Year Delivery Plan that shows our priorities and specific actions over the next twelve months. There will be a senior lead for each area of

our plan.

• We will set up and deliver an engagement plan to share the draft strategy and the delivery plan.

• We will finalise the outcomes framework and measures and will start to monitor our system together, taking action where we are not making sufficient positive progress.

• People who work in our system will no longer experience organisational barriers to change.

Organisational barriers will no longer prevent us from achieving our system aims.

The first twelve monthsCase Study: Special Education Needs and Disabilities - working together for improvement


Ambition 4 - We make effective use of resources

Between Alliance partners we spend more than £340 million on health and adult social care services in West Suffolk. This does not include the cost to the wider economy of poor health and wellbeing. We believe that we can use our resources even more effectively if we work together, including eventually being able to shift resources between organisations.

This will help us to maintain services whilst demand on our system is growing, whether this be for GPs, social care, mental health services or acute and community health services.

Alongside this we see a greater role for people and our communities, taking charge of - and responsibility for - managing their own health and wellbeing, whether they are well or ill. We will invest more in preventing ill health and aim to replace high cost interventions with lower cost case management.

Our future vision

1. Our Delivery Plan will reverse the current trend that is leading to higher hospital spend by increasing the proportion of our health and care budgets that is spent in the community, and this, alongside a local approach to commissioning in West Suffolk, will help us to achieve value for money.

2. We will work to get a whole system understanding of health and care resources in West Suffolk and how we use them as a key step towards becoming an Integrated Care System.

3. We will work together to address the financial pressures within each of our Alliance organisations.

4. We will develop and implement plans for: • Information Technology and Digital Solutions • Estates • Comms and engagement • Workforce • Organisational development • Communications

5. We will to take every opportunity to use our assets together to reduce duplication and drive out inefficiency. For instance, we plan to share public sector buildings aiming for community hubs in each of our localities, as part of a wider strategy to consolidate corporate functions, and we are looking at how we can share data and create single patient records. We are reviewing pathways to reduce the waste caused by hand offs and reassessment.



Ambition 4 - We make effective use of resources

IT and digitalWe will develop the use of technology and exploit our digital expertise. We have a head start in West Suffolk as we are running one of the sixteen Acute Global Digital Exemplar programmes in England. We would like to use technology to deliver benefits to people (for example access to records, self help information, digital monitoring and new innovations such as robotics) and to our organisations (for example shared care records, and a single data reporting view). We are piloting GovRoam in Newmarket Hospital early Summer 2018.

EstatesMaking shared use of our public sector estates will help us to achieve a number of our ambitions. Our staff tell us that it will help them to develop Integrated Neighbourhood Teams, plus it will be more efficient use of resources.

WorkforceOur workforce is our most important asset and we want them to feel a strong ownership of the West Suffolk Alliance Strategy and plan. Our delivery plan will be driven by them along with people who use our services and their carers, which will ensure that our organisational cultures develop in response to system and pathway changes.

Organisational DevelopmentWe will recognise talent across our organisations and ensure that career pathways are flexible, including with independent care providers. We have obtained external funding to help us with this work, which is being carried out throughout Suffolk. We want to explore joining up our workforce where this makes sense, across clinical and non-clinical teams. We are putting in place initiatives that will ensure that West Suffolk is an attractive place to work.

CommunicationPeople in west Suffolk expect us to work across barriers and boundaries, and we will need to use their experience and stories to develop our plans and to show where this have changed for the better. Our communications strategy will also be key to creating an Alliance culture, where staff feel part of an integrated system and a priority is ensuring the messages and priorities for the Alliance are cascaded throughout our organisations and with partners.

We will have plans for the following areas that support delivery of effective services on the ground.

Our organisations retain their own decision making and accountability, but we put our Alliance principles into action and make sure that decisions are taken with these in mind.

Mike HennesseyDirector of Adults and Community Services, Suffolk County Council


Joining up services around the needs of people

Case Study: Sharing information to make a real difference

On the evening of Sunday 1st April, which was a bank holiday weekend, an acutely unwell lady was brought to West Suffolk Hospital Accident and Emergency Department. She had a stage 4 ovarian cancer, and was very vague about her history and not able to give information about her condition or treatment. We were able to determine that she was under the care of a consultant at Addenbrooks Hospital, but as it was Sunday evening of course there was no one around involved in her care to speak to.

However a recent innovation at West Suffolk Hospital is that we are able to access Addenbrooks Hospital care records. Because of this we were able to see an up to date treatment plan and the results of her most recent scan.Access to this information meant that we were able to expedite her treatment with the right medication and care plan without the need for another CT scan or any other diagnostic tests in order to work out what do next. This meant her stay in hospital was only short and we were able to stabilise her condition, relieve her pain, and discharge her the next day. Importantly we were able to update her patient notes so that her own GP and her own consultant were made aware of what had happened and had live information on her condition and the treatment we had provided.

We want to change our health and care system so that it works for people - their lives and ambitions. This is the starting point for the changes we want to make.

Kate VaughtonChief Operating Officer, West Suffolk Clinical Commissioning Group


Working with:

Ipswich and East Suffolk Alliance

Childrens Alliance

Mentally Healthy Communities Board

Suffolk Commissioners Group

Suffolk Health and Wellbeing Board

Suffolk and North East Essex Transformation Partnership

West Suffolk Alliance forums for discussions and decision

Our Alliance is driven by a System Executive Group comprising director and clinical lead representatives from West Suffolk Hospital, Suffolk County Council - Adult and Children’s Services, Norfolk and Suffolk Foundation Trust, Suffolk GP Federation, West Suffolk Clinical Commissioning Group, our district and borough, voluntary sector and patient representative groups. Our nominated lead represents our Alliance at STP level.

Wider system governance

West Suffolk System Executive Group

A&EDelivery

Board Alliance Steering Group

Transformation Delivery Group

Locality Groups


West Suffolk Alliance Strategy - in context

The West Suffolk Alliance Strategy is part of a wider network of plans and strategies and builds on these to show how we will add value through Alliance working. The Strategy is intended to show how we will deliver key aspects of the Suffolk and North East Essex Sustainability and Transformation Partnership Plan.

It also recognises that to improve the wellbeing, health and independence of people in West Suffolk a wide number of partners must be involved.

The Strategy should be read alongside our Five Year Delivery Plan. This shows the programmes and projects that we are collaborating on together to turn our vision into reality.

Some programmes are led across both Alliance areas on behalf of both East and West Alliance and there are interconnected programmes with North East Essex Alliance partners.

West Suffolk Alliance Strategy

District and Borough Council

Priorities

Mental Health

Strategy for Suffolk

Five Year Forward

View

GP Five Year Forward

View

Suffolk County Council Priorities

and Transformation Programmes

SNEE Sustainability

and Transformation

Plan

Community Resilience Strategy

West Suffolk CCG

Transformation Plan

West Suffolk Foundation

Trust Strategy

Health and Wellbeing

Board Strategy

Joint Learning Disability Strategy


West Suffolk System outcomes

Together we have developed a set of system outcomes around eight domains:

Progress against these outcomes will show how we are moving forward as a system, and will help us to work together as Alliance partners, not just as individual organisations.

The has more information about our outcomes, and how we intend to measure progress against them.

This work is still under development - so the radar chart shown below is an illustrative example of how we would plot our progress. We aim to have outcomes developed at Alliance level as well as at a locality level.

Draft chart - figures are not correct

1. Local people have an excellent experience of care and support

2. Health and Care inequalities will be reduced

3. Reduction in the incidents of avoidable harm

4. Money is used for best effect across the health and care system

5. Local people are supported to stay well

6. Local people with health and care needs are supported to avoid deteriorating health and managing crisis

7. Local people’s health and wellbeing is optimised after a period ill health or injury

8. Local people are supported to have a good death


System outcomes - OPERa framework

• Health and care inequalities will be reduced• Alliance activity focuses on effective prevention• Local people are supported to stay well• Local people with health and care needs, including

those with chaotic lifestyles, are supported to avoid deteriorating health and managing crisis

• Local people’s health and wellbeing is optimised after a period of ill health or injury

• There is a reduction in incidents of avoidable harm

• The Slope Index of Inequalities narrows• The length of healthy life expectancy, and the

proportion of healthy life expectancy within total life expectancy, increases

• Self care, PAM, A&E attendances, 111, Early help metrics (SC)

• Unplanned age standardised acute admission rates reduce; chaotic lifestyle metric from RE

• The proportion of eligible people entering reablement and rehabilitation services increases; effective whole system reablement % increases

• Serious incidents/case reviews within health and care reduce

OUTCOMES - Health and care outcomes for our population

• Alliance working leads to a culture change of acting in the interests of the system, not those of constituent organisations

• Health and care teams and pathways are effectively integrated, increasing efficiency and reducing duplication

• The Alliance develops a shared vision and values which actively guide decision making

• There is shared control and rapid decision making in all parts of the Alliance system

• The Alliance benefits from shared back office functions through making savings from reduced duplication of functions

• The Alliance develops population-level business intelligence across line of business systems to guide targeted, risk-based, interventions

• The incidence of markers of poor use of Alliance resources reduces (e.g. elective cancellations, readmissions, etc.)

• All Alliance partners can demonstrate effective culture change through business cases, prioritisation decisions and case studies

• Key Alliance care pathways demonstrate increased efficiency by improving outcomes, reducing cost, increasing throughput etc..

• All Alliance partners can demonstrate use of Alliance vision and values in decision making and case studies

• All Alliance partners agree that governance arrangements are timely and effective

• Savings from combined back office Alliance functions are achieved

• Effective targeted interventions are introduced based on population insight from combined clinical systems

• System DTOCs reduce

PROCESSES - We maximise the opportunities available to us through Alliance working to improve health and care processes


System outcomes - OPERa framework

• Local people give positive and consistent feedback about their personal experience of care and support, and their experience of care and support for their loved one

• Local people are supported to have a good death

• The proportion of of local respondants who agree with the Alliance’s measured ‘I statements*’ in relation to their own/their loved ones care and support is high, and increases over time; CQC findings; safeguarding volumes

• Performance against defined key measures in this area (Family and carer feedback; % dying in preferred place of death including home; use of advance care planning) is high and improves over time

EXPERIENCE - Local people have an excellent experience of care and support

• Services are delivered within the combined Alliance financial envelope

• Financial flows work to incentivise services which intervene early to improve outcomes and manage need and demand

• The Alliance workforce are motivated, skilled and enabled to work flexibly including within integrated teams

• The Alliance workforce is sustainable with a larger pool of trained people available to cover hard to fill vacancies and ‘strength in depth’ making it easier to recruit and manage demands of flexible workforce (particularly GPs)

• System achieves annual budgets/ agreed control totals as per the STP, including efficiency requirements

• PMPM (Per member, per month) spend on unplanned acute care decreases as a proportion of total spend

• Staff survey, roster coverage levels, % of workforce with multiple skills, ‘trusted assessor’ working, caseloads

• The Alliance develops as sustainable workforce and sickness and vacancy rates in key risk staff groups are low and decrease over time

RESOURCES - Resources are used for best effect across the Alliance


For more information

To find out more or to get in touch with us please contact:

We have not created new organisations through alliance working. Rather we are developing ways to allow existing organisations to come together to work far more closely and effectively than ever before.

Dr Paul DriscollChair, Suffolk GP Federation

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Children and Young People’s Update - May 2018

Lead Chief Officer

Richard Watson, Chief Transformation Officer

Author(s)

Eugene Staunton, Associate Director for Transformation Jo John, Transformation Lead for Child and Adolescent Mental Health Services

Purpose

Provide a progress update on the Children and Young People’s priorities including progress on the Children’s Emotional Health and Wellbeing Plan

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement x 3. Improve the health & care of older people 4. Improve access to mental health services x 5. Improve health & wellbeing through partnership working x 6. Deliver financial sustainability through quality improvement Action required by Governing Body: The Governing Body is requested to note for information:

• The Suffolk Children’s Alliance is responsible for taking forward our Children and Young People’s programme of work focussing on the six collective priorities.

• The progress made in the Suffolk Children’s Emotional Health and Wellbeing Plan

1. Background 1.1 In recognising that children’s services draw on a complex support system across health,

social care, community and education, and the more recent requirements of the SEND Action Plan, the Suffolk Children’s Alliance (includes representation from Ipswich & East Suffolk and West Suffolk CCGs, Ipswich Hospital NHS Foundation Trust, West Suffolk Foundation Trust, Norfolk & Suffolk NHS Foundation Trust and Suffolk County Council: Children and Young People CYP Services) has six collective priorities:

• Children’s Emotional Health and Wellbeing Plan. Delivery of the multi-agency plan and

all projects contained therein. • Special Educational Needs and Disability (SEND). Delivery of multi-agency plan and

system response to findings of Department for Education (DfE) and NHSE Inspection. • Speech and Language Therapy and Communication. Review of current service

provision and agreement of new Suffolk model/joint commissioning arrangements • Neurodevelopmental and Behaviour Pathway. Agreement of a system wide pathway

supporting Autism (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder and Behaviour.

• Children and Young Peoples Community Health Services. Delivery and implementation of service specification for Integrated Community Paediatric Services.

• Agreement of Acute/Emergency Paediatric Pathway. Clarity on urgent care pathways in, out and via Ipswich Hospital and West Suffolk Hospital.

1.2 To lead the delivery of these priorities and recognising the growing complexity and breadth of

both the CYP and Mental Health/Learning Disability Programmes, Sara Blake has been appointed to a new role of Associate Director of Transformation, Children and Young People working across and jointly accountable to both the CCGs and Suffolk County Council.

2. Update 2.1 Children’s Emotional Health and Wellbeing Plan

It has been a period of national and local focus for the commissioning and provision of services for Children’s emotional health and wellbeing over the past 3 years. Since the first Suffolk Children’s Emotional Health and Wellbeing Plan was signed off by NHS England in October 2015, the plan is refreshed annually at the end of October in line with the NHS England Assurance process and is located at http://www.healthysuffolk.org.uk/healthy-children/EWB2020

2.2 Emotional Wellbeing Hub (Single Point of Contact) For many years, services which support children’s emotional health and wellbeing have been provided by a range of providers across health and care. Children, young people and their families have often experienced a fragmented service offering little or no information and professionals (i.e GPs and teachers), have referred to a number of destinations in the hope that someone will respond. We identified that the creation of a single point of contact (Emotional Wellbeing Hub) was a vital priority across agencies. In particular close working was required between Norfolk and Suffolk Foundation Trust (NSFT) as our local NHS provider of mental health services and Suffolk County Council’s (SCC) Children and Young Peoples Directorate and Ipswich and East and West Suffolk CCG’s. It was also imperative that the co-production of this work was genuine and that young people and families would be involved throughout the development and implementation of this project. All partners have therefore worked collaboratively to ensure that co-production

http://www.healthysuffolk.org.uk/healthy-children/EWB2020

http://www.healthysuffolk.org.uk/healthy-children/EWB2020

is fully embodied in the new service, in the culture of the multi-agency team and that therefore the experience for young people, families and professionals is a positive one. The vision for the multi-agency Emotional Wellbeing Hub is that no child, young person (0-25) or their family will be turned away without being offered the appropriate help, information or advice they need. The Emotional Wellbeing Hub went live on Monday 16 April 2018 and replaced the previous NSFT Access and Assessment Services for 0-25 years. The Hub is a new multiagency team offering a central point of contact and information for people who are concerned about the mental health or emotional wellbeing of a child or young person in East or West Suffolk. The Hub will be different in the following ways;

• A single phone number for children, young people, parents, carers and professionals to get help and advice on Emotional Health and Wellbeing

• Open for self-referral and parent/carer referral • Direct access to a new multidisciplinary team of highly skilled, sensitive and

empathic Emotional Wellbeing Practitioners who will provide therapeutic support, guidance and triage in relation to concerns about a young person’s wellbeing and mental health.

• Every referral receives a response – no wrong door! • Hand-holding to get to the right service • Peer support • Fewer children, young people and families will fall through the gaps between

services or ‘ping pong’ around the system 2.3 Individuals and professionals can contact the service as follows:

Telephone: 0345 600 2090

Monday to Friday 8am – 7.30pm for consultation or advice prior to referral Email: [email protected]

Visit: Emotional Wellbeing Gateway 2.4 Useful Information/Sign posting

• The new online Emotional Wellbeing Gateway can assist parents, carers, and professionals who are worried about a child or young person’s emotional wellbeing. The website includes

o Information about emotional wellbeing support. o Practical advice for parents and carers concerned about their child’s mental

health. o A directory of local services to support children, young people, and families.

• The Source is a website for young people to access information, advice and guidance on issues they may face in their everyday lives.

mailto:[email protected]

http://www.emotionalwellbeinggateway.org.uk/

http://infolink.suffolk.gov.uk/emotionalwellbeinggateway

http://www.thesource.me.uk/

• Ask the Expert (provided by Suffolk Young People's Health Project - 4YP) provides on line 1:1 support for young people (age 12-25), Monday to Wednesday, 5 - 7pm

• Chat Health is a confidential text service for young people and families provided by the school nursing team Monday to Friday 9am – 4.30pm for help about a range of issues. Text a school nurse on 07507 333356.

2.5 Perinatal Mental Health

In February 2018 we launched an enhanced community offer to provide additional capacity at both Ipswich Hospital and West Suffolk Hospital for screening and identifying perinatal women in Suffolk with severe mental health needs. The service, provided by NSFT, delivers direct assessment and interventions for women presenting with severe perinatal mental ill health, preconception counselling for women with known severe mental health problems and consultation for primary, secondary and universal health services. It consists of a team of four whole time equivalents - two specialist peri-natal mental health nurses (in post since August 2017), a Consultant (in post February 2018) and admin support. In addition we have just been successful in a bid for £366,000 from NHS England Community Services Development Fund to provide an expansion of this service to support women with moderate to severe mental ill health. The enhanced service will extend the team capacity from the current four whole time equivalents to 11.5 whole time equivalents and will provide access to specialist mental health interventions for women with, or at risk of, moderate as well as severe mental health issues through robust pathways of step up/step down between mother and baby units and crisis and specialist community mental health services.

2.6 Crisis Care

Partnership working with Ipswich Hospital, West Suffolk Hospital, NSFT, SCC, families and young people has led to the development of a model for a new crisis service for young people (0-18) in Suffolk to include the following core elements:

• The new service will work closely with the Emotional Wellbeing Hub

• The service will work across Suffolk

• The core function of the team will be to support young people and families at a time of crisis and offer a brief intervention where required i.e. home visits, follow up contacts

• Crisis line – feedback from young people and families has led NSFT to review the existing service to ensure we can deliver a more responsive out of hours crisis line for people of all ages

• Focus on early intervention to prevent crisis

• Joint health and care working The service will operate in two shift patterns - 7 days a week 08:00 – 16:00 and 15:00 – 23:00. Following recruitment, this service is due to go live Summer 2018 and will be evaluated and reviewed as part of the wider all age crisis work.

2.7 Healthwatch – My Health, Our Future

Healthwatch Suffolk was commissioned through a £20,000 investment from the Transformation Plan to undertake a research project called “My Health, Our Future” with an initial eight schools across East and West Suffolk.

http://www.healthwatchsuffolk.co.uk/news/my-health-our-future-a-new-project-as-part-of-the-children-and-young-peoples-emotional-wellbeing-plan/

The project is designed to help each school to identify the emotional wellbeing needs of pupils to inform steps that can be taken to increase support and promote healthy psychological development. The findings have been summarised and benchmarked with other national data in order to provide a State of Suffolk report, released November 2017 the report has received significant positive local media coverage. The recommendations from the report are:

1. The Emotional Wellbeing 2020’s Workforce Development programme should proactively offer all secondary schools training and development.

2. Stakeholders should work collaboratively to provide a systematic approach to upskilling children and young people on issues regarding mental health and wellbeing across secondary schools in Suffolk.

3. Personal, Social, Health and Economic Education (PSHE) and Relationship and Sex Education (RSE) should include digital literacy and online safety.

4. Emotional Well-being 2020 stakeholders should work collectively to promote children and young people’s voices throughout health and education systems, such as the Health and Wellbeing Board.

5. The Emotional Well-being 2020 should increase funding for early support 6. Schools should be engaged on the forthcoming Emotional Wellbeing Hub and,

where possible, should receive increased signposting material. 7. Healthwatch Suffolk will help My Health, Our Future schools to implement a Mental

Health and Wellbeing Roadmap.

Healthwatch Suffolk has been commissioned again through the work with Suffolk Community Foundation to continue the work with the initial schools and to extend the project to a further 8 high schools. Nationally, in recognising the important roles of schools in supporting the emotional wellbeing of children and young people and the challenges around capacity and funding, in December the Government published a Green Paper Transforming Children and Young People’s Mental Health Provision setting out their plans for children and young people’s mental health services. The proposals include introducing mental health support teams (linked to groups of schools and colleges), designated leads for mental health in all schools, new guidance for schools that will address the effect of trauma and a four-week waiting time target across Children and Adolescents Mental Health Services (CAMHS). We provided both a local and regional response to the Consultation and await the outcome of this.

2.8 Neurodevelopmental and Behaviour (including ADHD, Autism and Conduct Disorder)

Commitment from the Children’s Alliance that aligns the key priorities set out in both the Suffolk Children’s Emotional Wellbeing Transformation Plan and the SEND Action Plan around the need for a clear and consistent pathway for families and young people with behaviour and conduct disorder issues including ADHD and Autism. Specifically, this will support the delivery of the outcomes set out in Priority 3 of the SEND Action Plan.

So why a Neurodevelopmental and behaviour pathway?

• Local recruitment challenges faced by multiple organisations in recruiting suitably qualified professionals

• Some children and young people with Autistic Spectrum Disorder (ASD) may have concurrent diagnoses and/or comorbidities so may require support from multiple

pathways, with multiple professionals, multiple care/support plans and inconsistent communication.

• Some children and young people with emotional and wellbeing issues will not be diagnosed with ASD, Attention Deficit Hyperactivity Disorder (ADHD) but require similar help and support from pathways within education, health and social care (or all) in order for them to lead a full and active life.

• Multiple requirements of the Special Educational Needs and Disability (SEND) Statement of Action and the Suffolk Children & Young People’s Emotional Wellbeing Transformation Plan to address ADHD, ASD and Conduct & Behaviour Disorder pathways.

• Meeting the need for effective transition arrangements between children and adult services that combine medical, psychological and wider social care support.

• NHS East of England looking at how Systems can consider a more holistic way of managing neurodevelopmental disorders

• Norfolk reviewing its neurodevelopmental pathway – supporting a consistency of approach across the full Suffolk footprint

A proposal and recommendation will be developed for the SEND Board meeting in September 2018. This system wide approach, focussed on responding to the presenting need will enable improved outcomes for young people and families in Suffolk.

2.9 Speech and Language Therapy and Communication (SaLT)

Also identified as an area for focus in Priority 3 of the SEND Action Plan is the provision of speech and language therapy. The SaLT ‘As Is’ model and supporting narrative which includes full and explicit details on commissioner, costs, resource alignment, pathways, transition points, issues, gaps and areas that work well has been co-produced and fully signed off by the SaLT Working Group. This now provides a solid foundation to build the new service model. The SaLT ‘To Be’ map has commenced and is being co-produced to develop the desired service model. A number of options are being pulled together to form an inclusive Options Appraisal which will go the Group late May 2018.

3. Patient and Public Engagement 3.1 Underpinning the delivery of all of the children and young people’s work is the co-production

with our partners, which includes representation from across our Alliance (Ipswich & East Suffolk and West Suffolk CCGs, Ipswich Hospital NHS Foundation Trust, West Suffolk Foundation Trust, Norfolk & Suffolk NHS Foundation Trust and Suffolk County Council: Children and Young People CYP Services), young people, Suffolk Parent Carer Network (SPCN), Schools, Voluntary sector organisations and Healthwatch Suffolk.

4. Recommendation 4.1 The Governing Body is requested to note for information:

• The Suffolk Children’s Alliance is responsible for taking forward our Children and Young People’s programme of work focussing on the six collective priorities.

• The progress made in the Suffolk Children’s Emotional Health and Wellbeing Plan

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Ambulance Service Review

Lead Chief Officer

Dr Ed Garratt, Chief Officer

Author(s)

John Harris, Head of Ambulance Commissioning

Purpose

For CCG governing bodies’ information only, sharing the main outcomes of the review, including the agreed split of contract shares between Consortium CCGs.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement Yes 3. Improve the health & care of older people Yes 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: For Noting

1. Background 1.1 NHS England (NHSE) and NHS Improvement (NHSI) jointly commissioned an independent

service review as part of the 2017/18 mediation settlement for the EEAST 999 service Contract.

1.2 Undertaken by Deloitte LLP and ORH Limited with input and final sign off from a Project

Steering Group comprising representatives from NHSE, NHSI, EEAST and Commissioners, the aim of the review was to understand the operational and financial change required to meet national performance standards and to develop a contracting framework to sustainably fund the services. The review is intended to assist the local health economy in delivering an improved service for patients in the East of England.

1.3 The review followed the introduction of the National Ambulance Response Programme

(ARP), which set out new constitutional performance standards for ambulance providers. At EEAST, the two-year transition to this model began in October 2017. The ARP aims for the most appropriate resource to be sent to patients the first time, by allowing call handlers additional time to identify a patient’s needs.

1.4 The current Consortium arrangements for the EEAST 999 service contract involve 19 CCGs

jointly commissioning the service with Suffolk CCGs as the lead commissioner. To ensure local needs are reviewed and services are adapted for patients in each area, there are four localities. These localities (Essex; Bedfordshire & Hertfordshire; Norfolk & Waveney; and Suffolk & Cambs) will align to the new system-wide Sustainability and Transformation Partnership footprints – of which there are six – to ensure the Contract remains flexible to local patient needs and care pathway planning. The full report can be found here: http://www.eastamb.nhs.uk/EEAST-ISR-Report-March-2018.pdf

2. Key Issues 2.1 The review found that EEAST requires more investment in the core service to increase its

staffing and capacity to improve the service and meet the requirements of ARP. 2.2 The estimated core service cost requirements are c£225m for 2018/19 and dependent on

activity projections, up to c£240m for 2019/20 respectively. This is anticipated to cover the full year costs of additional staffing but excludes paramedic re-banding costs which were out of scope of the review. Increased capacity estimates are for circa 330 new WTEs in post and an extra 160 Double Staffed Ambulances (DSAs) on the road. The modelling in the report shows that the ambulance service is predicted to see improved response time performance for the sickest patients, particularly in the least densely populated areas of east of England such as Norfolk and Suffolk (see page 75 and 76 of the report).

2.3 The review provides for a 3 year workforce plan which is expected to deliver an additional

330 FTE, in addition to normal workforce planning requirements. While Ambulance Trusts are expected to transition to a BSc Programme (4 year), Health Education England have agreed to support a continuation of the EEAST 3 Year Student Paramedic Programme.. Hence, Student Paramedics recruited in Year 1 would be expected to qualify at the end of Year 3 while those recruited in Year 3 are expected to qualify in Year 5.

2.4 The frontloading of the workforce plan in Year 1, together with the continuation of PAS and

overtime capacity to cover educational abstraction, is expected to enable EEAST to deliver ARP standards in aggregate across the consortium from Q1 2019/20. These estimates were based on a detailed set of assumptions that were agreed by the Project Steering Group as part of the review. These assumptions are set out in the report, and changes to these assumptions would affect the overall estimates.

http://www.eastamb.nhs.uk/EEAST-ISR-Report-March-2018.pdf

2.5 The review reflects discussions in the Project Steering Group, which resulted in their recommendation that a six-year service contract be agreed from 2018/19 to provide stability and certainty to EEAST, with two year intervals to review key aspects of the contract around quality and performance. To allow key risks to be managed by both parties, the review sets out contract levers around activity, performance, and accounting for handover delays at hospitals. These levers were developed collaboratively and agreed with the Project Steering Group and will be applied from 2019/20 to allow for a transition year whilst EEAST build up their capacity.

2.6 The review was used as the basis of discussions on contract funding between EEAST and

Commissioners for the 999 contract. Based on these discussions, the contract funding for 2017/18, 2018/19 and 2019/20 is estimated by EEAST and Commissioners as follows:

2017/18 to 2018/19

2018/19 to 2019/20

Financial Summary £m £m

Core Services 213.5 225.0

Paramedic Rebanding (CCG Allocation 17/18 to 18/19) 2.6 1.6

Non-Core Services 8.9 8.9

CQUIN 4.9 5.4

Total 229.8 240.8 2.7 The contract funding splits for the above, and estimated contract values for 2018/19

onwards, were agreed based on a vote by Consortium Accountable Officers on behalf of their CCGs. It was carried by a 73% majority. It means contract allocations are based on individual CCG estimated activity levels, at standard HRG costs and adjusted by the (average) length of job cycle times for responses. Contract shares will be reviewed again at the proposed two-year contract interval points.

Sustainability and Transformation Partnership Level Contract Shares under the agreed option are as follows:

Core Contract Shares 2017/18 2018/19

STP Contract Shares %

Core Contract Value £m

Contract Shares %

Core Contract Value £m

Cambs & Peterborough 14.3% 30.5 14.6% 32.8 Herts & West Essex 20.8% 44.4 21.3% 47.9 Mid & South East Essex 19.1% 40.8 19.1% 43.0 Beds & Luton 9.5% 20.3 9.1% 20.5 Norfolk & Waveney 20.4% 43.6 19.8% 44.4 Suffolk & North Essex 15.9% 33.9 16.1% 36.3 Total 100% 213.5 100% 225

Performance

The regional aggregate improvement in Category 1 Mean time of Response is forecast as follows: Quarter 17/18 Q1

18/19 Q2 18/19

Q3 18/19

Q4 18/19

Q1 19/20

Q2 19/20

Q3 19/20

Q4 19/20

FTES in Post 2,785 2,930 2,973 3,060 3,033 3,066 3,146 3,166 3,118

Category 1 Mean Time (7 min target)

08:25 08:11 08:05 08:06 07:37 06:58 06:58 06:57 07:00

The review sets out three core levers, which will be adopted in the contract:

• Activity – marginal rate adjustments at 80% of HRG cost for activity variations above or below plan;

• Handover delays – lost hours not exceeding forecast assumptions; • Performance – Quarterly Cat 1 mean forecast times to be met.

Handover delays and performance trajectories not being on forecast in any given year will result in a change to the following year’s contract value, based on a sliding scale. These levers operate at a trust-wide level in line with the review recommendations. Activity variations are to be settled on an agreed Indicative Activity Plan that is based on demand estimates provided by commissioners during the review workshops. There are principally three HRG currencies: for Calls, Hear & Treat and ‘See’ response volumes. This lever will be applied at a CCG level from 2019/20 onwards. Key opportunities

• Regional aggregate response times are estimated to improve from the outset as ARP continues to become normal practice.

• The framework is designed for there to be benefits for frontline staff, and thus support workforce retention. For example, a greater proportion of frontline staff taking their meal break and finishing on time.

• The framework is designed for EEAST to become operationally and financially sustainable, whilst meeting national performance standards and supporting the wider system.

• The framework is designed for Commissioners to have greater certainty around their expenditure and service performance.

Key risks • Workforce recruitment and retention and key rostering changes are key performance

drivers – these dependencies were recognized by the Project Steering Group as the highest risk elements if not implemented as forecast;

• Rising handover delays will denude Dual Staffed Ambulance capacity on the road and this has high impact on high acuity response times;

• Rising demand above forecasted levels of activity could impact on performance, especially where higher acuity demand continues to rise.

• Reductions in activity will reduce EEAST expected income in 2019/2020, requiring a reduction in the workforce plan to remain within the available cost envelope.

Actions and next steps • EEAST and lead commissioner to organise quarterly briefing for east of England MPs on

progress with the implementation of the associated EEAST Transformation Programme.

• EEAST to produce monthly progress update report for CCGs. • Commissioners to join the EEAST Transformation Programme Board to ensure

transparency of progress, risks and opportunities. CCG Funding 2018/19

3. Recommendation 3.1 The Governing Body is asked to note the report.

1




Integrated Performance Report

Lead Chief Officer

Chief Officer Team

Author(s)

Alex Briggs, Head of Corporate Intelligence

Purpose

To provide members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial position and transformation activity.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: To note the position regarding financial and service performance; review actions being taken with regard to patient safety and clinical quality issues; and any actions to mitigate risks or poor performance.

Integrated Performance Report

Roll Forward Month May 2018

1

Part 1 – National Reporting Measures ……………………………………………………….

Part 2 - Clinical Quality & Patient Safety ……………………………………………………

Part 3 - Finance and Information………………………………………………………………

Part 4 - Transformation…………………………………………………………………………

Part 5 – Contractual Performance by Provider…………………………………………….

Part 6 – PMO ……………………………………………………………………………………..

Part 7 – Chief Operating Officer………………………………………………………………

3-5

6-9

10-11

12-15

16-17

18-19

20-25

2

National Reporting Measures

May 2018

3


Month Ending 31st March 2018

Indicator Ref Description Framework

Reporting Frequency

Current Period

Current Period Target

Current Period Actual

Rolling 6 Months

Latest Applicable

TargetYTD Actual Comments

NHS 2.3.i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (WC1.1.1) NHS Outcomes Monthly Feb-18 154 153 1658 1,501WSFT (indication of performance on Annual

measure E.A.4)

NHS 2.3.ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (WC1.1.2) NHS Outcomes Monthly Feb-18 28 16 226 198WSFT (indication of performance on Annual

measure E.A.4)

E.A.S.1 Estimated diagnosis rate for people with dementia NHS EC Annex A Support Measure

Monthly Feb-18 67% 62.0% 67% 62.0% WSCCG

NHS 3a Emergency admissions for acute conditions that should not usually require hospital admission (WC1.1.3) NHS Outcomes Monthly Feb-18 320 277 2866 2,405WSFT (indication of performance on Annual

measure E.A.4)

NHS 3.2 Emergency admissions for children with Lower Respiratory Tract Infections (WC1.1.4) NHS Outcomes Monthly Feb-18 20 17 224 195WSFT (indication of performance on Annual

measure E.A.4)

E.A.S.4 Healthcare acquired infection (HCAI) measure (MRSA) NHS EC Annex A Support Measure

Monthly Feb-18 0 0 0 0 WSCCG

E.A.S.5 Healthcare acquired infection (HCAI) measure (clostridium difficile infections) NHS EC Annex A Support Measure


E.B.1The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted pathways

NHS EC Annex B Measure


E.B.2The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted pathways



E.B.3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways NHS EC Annex B Measure


E.B.S.4 Number of 52 week Referral to Treatment Pathways NHS EC Annex B Support Measure


E.B.4 Diagnostic test waiting times NHS EC Annex B Measure


E.B.5 A&E waiting time - total time in the A&E department NHS EC Annex B Measure

Monthly Feb-18 95% 85.2% 95% 89.7% WSFT

E.B.S.5 Trolley waits in A&E NHS EC Annex B Support Measure

Monthly Feb-18 0 0 0 0 WSFT

NATIONAL PERFORMANCE MEASURES - 2017/18 - WEST SUFFOLK CCG (1/2)

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Treating and caring for people in a safe environment and protecting them from avoidable harm

Referral To Treatment Pathways

Diagnostic test waiting times

A&E waits



Indicator Ref Description Framework

Reporting Frequency

Current Period

Current Period Target

Current Period Actual

Rolling 6 Months

Latest Applicable

TargetYTD Actual Comments

E.B.6 All Cancer 2 week waits NHS EC Annex B Measure


E.B.7 Two week wait for breast symptoms (where cancer was not initially suspected) NHS EC Annex B Measure


E.B.8Cancer day 31 waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis



E.B.9 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-surgery NHS EC Annex B Measure


E.B.10 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-anti cancer drug regimens NHS EC Annex B Measure


E.B.11 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-radiotherapy NHS EC Annex B Measure


E.B.12Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer



E.B.13Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service



E.B.14Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status


Monthly Feb-18 86% 100.0% 87% 77.8% WSCCG - Target is Monthly National Average

E.B.15.i Ambulance clinical quality – Category A (Red 1) 8 minute response timeNHS EC Annex B

MeasureMonthly Oct-17 75% 52.7% 75% 60.9% WSCCG

E.B.15.ii Ambulance clinical quality – Category A (Red 2) 8 minute response timeNHS EC Annex B

MeasureMonthly Oct-17 75% 45.9% 75% 53.0% WSCCG

E.B.16 Ambulance clinical quality - Category A 19 minute transportation time NHS EC Annex B Measure

Monthly Oct-17 95% 80.4% 95% 81.5% WSCCG

EBS7a Ambulance handover time - 1) Handover delays over 30 minutes NHS EC Annex B Support Measure


EBS7b Ambulance handover time - 2) Handover delays over 1 hour NHS EC Annex B Support Measure


E.B.S.1 Mixed Sex Accommodation (MSA) Breaches NHS EC Annex B Support Measure


E.B.S.2 Cancelled Operations NHS EC Annex B Support Measure


E.B.S.6 Urgent Operations cancelled for a second time NHS EC Annex B Support Measure


E.A.3 IAPT Roll Out NHS EC Annex A Measure

Monthly Feb-18 1.25% 1.6% 13.75% 17.5%

E.A.S.2 IAPT Recovery Rate NHS EC Annex A Support Measure

Monthly Feb-18 50% 50.6% 50% 50.4%

E.B.S.3 Mental Health Measure – Care Programme Approach (CPA)NHS EC Annex B Support Measure


Cancer waits - 2 week wait

Cancer waits - 31 days

NATIONAL PERFORMANCE MEASURES - 2017/18 - WEST SUFFOLK CCG (2/2)

Cancer waits - 62 days

Ambulance Measures

Mixed Sex Accommodation

Cancelled Operations

Mental Health

WSCCG position. Performance is from local NSFT data w hich historically differs to NHSE reported by 4-5% better. June NHSE data is

now w ithin 1%

Clinical Quality

May 2018

6

↓

Mar Apr May June July Aug Sep Oct Nov Dec Jan FebArea Ref Provider Headlines

Infection

Prevention and

Control (1)

3-9

West Suffolk Hospital NHS

Foundation TrustA RG G G G

0 case of CDI reported against a trajectory of 2, YTD 16 cases reported against a trajectory of 16.

No cases of MRSA BSI reported YTD.

West Suffolk Community

Services^ ^^

R AR R G

G GNo cases of CDI or MRSA BSI reported

^ data was reported with West Suffolk Hospital NHS Foundation Trust.

West Suffolk CCG R RR RR

GA G G G G

3 cases of CDI reported against a monthly trajectory of 4. YTD cases are 54 against trajectory of 41

and an end of year trajectory of 45. 1 cases of MRSA BSI reported and awaiting third party

assignment.

R G A A A

R

^

G

R R R G Falls per 1,000 bed days decreased to 7.49 with a total of 9 falls reported.


Foundation Trust (2)G R

G

Falls 8 & 11

R RR


Services3* 1*5*

1 2*4


Services (3)G RR GR A R

G G G A

0*6

Pressure Ulcers

(4)

9, 12

& 13


Foundation Trust5 2*4 3 5

2 Unexpected / potentially avoidable death

1 Infection prevention and control incident

1 Unexpected/potentially avoidable injury causing serious harm


Foundation Trust4 34

0 0 0 0

Norfolk and Suffolk NHS

Foundation Trust1 11 01

2

0

1 1


Services0 01

2

Serious Incidents

and Never Events

(5)

12-14

10

00

410 4 4 1

East of England Ambulance

Service NHS Trust1 200 10 0 0 0

5

4

0

4

No serious incidents reported.

12 grade two pressure ulcers reported in total

4 grade three pressure ulcers reported in total

* 21 pressure ulcers pending avoidable status determination from December 2017.

18 grade two pressure ulcers reported in total

3 grade three pressure ulcers reported in total

* 49 pressure ulcers pending avoidable status determination from October 2017.

No serious incidents reported.

6

7*

4*

5

1

1 Confidential Information Leak

R

R

0

7

2 3 1

4 3

113 9 4 8

R

78 falls reported.

Error in recording noted from October - January 2018 data will be updated next month.A

↓

Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb

G

A

Headlines

AA A A A

Area Ref Provider


Foundation TrustA

G

A A A


servicesG GG GG A A G

Norfolk and Suffolk NHS

Foundation TrustA AA AA

1 complaint received - OOH's service.A A A R GG

East of England Ambulance

Service NHS TrustG 3 complaints received. The reasons for these complaints were; delay transport / driving and attitude.A A A A A AA GA A G

G

GG G

Care UK G GAA G

G G G G GTransforming

Care (7)15 West Suffolk CCG G

Patient

Experience (6)20-43

A AOutstanding; 12, Good; 79,

Requires Improvement; 26, Inadequate; 1AA A A A A

Ahead of trajectory (5) with 3 patients in care.

Care Homes (8) 44-45 Suffolk A AA

GG

A

G

A

4 complaints received. Common reasons for these complaints were; all aspects of clinical treatment

and attitude.

A

A

A GA

G

A A

19 complaints received. Reasons for complaints have not been reported.

FFT results positive towards the organisation.

1 complaint received.

FFT results positive towards the organisation

G

G

(1) Infection Prevention and Control - The RAG rating is subjective based on an expert review of the individual organisations overall infection prevention and control performance with particular consideration being given to performance in relation to MRSA and C Diff infection rates.(2) Falls - WSFT falls per 1,000 occupied bed days Green ≤6.63; Amber 6.64 - 7.00; Red ≥7.01(3) Falls - Community falls per 1,000 0ccupied bed days Green ≤8.60; Amber 8.61 - 9.50; Red ≥9.51(4) Pressure Ulcers - Total number of avoidable pressure ulcers reported.(5) Serious Incidents - The number of actual serious incidents raised by the individual organisations; excluding pressure ulcers.(6) Patient Experience - The RAG rating is subjective based on an expert review of the individual organisations overall patient experience performance with particular consideration being given to performance in relation to the Friends and Family Test and time frames to respond to complaints.(7) Transforming Care - The RAG rating is subjective based on an expert review of the organisation overall performance.(8) Care Homes - The RAG rating is subjective based on an expert review of performance within the care home sector.

WSFT Cancer BreachesNHS Improvement and NHS England are working together to deliver a regional cancer recovery plan. We are required to;

Routinely report numbers of over 62 day breaches and outcomes/learning themes to Public Board/Governing Body meetings.

Routinely report numbers of over 104 day breaches and outcomes/learning from RCAs and harm reviews to Public Board/Governing Body meetings.

The CCG are not aware of any patient harms caused as a result of WSFT breaching the cancer standards.

Each case that breaches 104 days is reviewed by a clinician at WSFT and an assessment of harm is made. No patient harms recorded for the breaches reported

Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

6 10 7.5 12.5 10 7 4 9 8.5 9 11

0 0 0.5 0 0 1 0 1.5 0 0.5 0

1 0 0 1 1 0 0 1.5 0 0 0

7 10 8 13.5 10.5 8 4 12 8.5 9.5 11

0 2 3 2 3 2.5 1.5 1 3.5 0 2

0 0 0 0 0 0.5 0 1 0 0 0

1 0 0 0 0 0 0 0.5 0 0 0

1 2 3 2 3 3 1.5 2.5 3.5 0 2

62 Day wait following urgent

GP Referral (EB12)62 Day wait following NHS

Cancer Screening (EB13)62 Day wait following

Consultant Upgrade (EB14)

Total 62 Day Breaches

104 Day wait following urgent

GP Referral (EB12)

104 Day wait following NHS

Cancer Screening (EB13)

104 Day wait following

Consultant Upgrade (EB14)

Total 104 Day Breaches

Chief Finance Officer


10

Finance – HeadlinesMonth Ending 31st March 2018

Rating Key Movement Key

l On or better than target h Improvement

l Below target 1 No Change

i Deterioration

Variance from Plan £1.8ml h 1 1

At Month 12, the CCG acheived an in year surplus of £1.8m. The variance of £1.8m is mainly due

to the release of 0.5% System Risk Reserve and refund of category M rebate.

Principle overspends include Acute Services (£3.3m), Mental Health Services (£0.3), Prescribing

(£0.2m), Other Primary Care (£0.2m) and Running Costs (£0.1m). These are mitigated by the

release of Contingency (£1.5m) and underspends in Other Programme Services (£1.3m),

Continuing Care (£1.2m), Property Recharges (£0.3m) and Community (£0.2m).

Underlying Surplus / (Deficit) £4.6ml h h h

This indicator adjusts the forecast surplus by removing the impact of non-recurrent costs and

allocations and the full year effect of in year adjustments in order to show the recurrent

position. Key adjustments include adjusting for the mandatory 0.5% system reserve, 0.5% non-

recurrent reserve and other non recurrent/ full year adjustments.

QIPP Delivery 102%l h i i

At month 12, the CCG has delivered £10.5m of QIPP against a target of £10.4m (102% delivery).

This is mainly delivered through QIPP from WSFT GIC, Prescribing QIPP and CHC QIPP. M11

delivery was 95%, the increase is mainly due to an improvement in the CHC and Prescribing

positions.

Key Metric ValueLast 3 Months

MovementRating Headlines

Transformation

May 2018

12

Transformation Overarching HeadlinesProgramme Key Indicators

April 2018Key Highlights April 2018

Key Actions May 2018

Integrated Care

A&E 0.7% above planEmergency Admissions 1.7% below plan(Based on NHSE activity YTD at M11)

WSFT Acute DTOC 3.5% (week commencing 30/3/18)

• Falls Early Intervention Vehicle business case jointly drafted with EEAST and EIT

• Suffolk Falls Strategy drafted and comments received from Steering Group. Second draft produced and discussed with operational groups and frailty lead

• Trusted Assessment policy and Privacy Impact Assessment sent to LMC for comment/information

• Trusted Assessor framework drafted to support roll out of role to all west Suffolk care homes

• DTOC improvement plan continues to be implemented across all hospital sites. Focus on improving validation and escalation processes

• Priorities for Locality work agreed by organisational leads at to inform strategy

• System winter review and draft Surge plan completed• Support to Go Home evaluation completed and paper

presented Alliance Steering Group • Care Home demand management action plan approved• Admission conversion review completed• D2OA pathway 1 project coordinator post commenced

• Joint review of GP streaming app (WSFT/IHT/Suffolk GP Fed) to make this less risk adverse and therefore increase service appointment utilisation

• Recruitment to Integrated Care coordinators commenced

• D2OA pathway 2 paper approved by Alliance Steering Group

• West Suffolk Integrated Therapies implementation plan developed

• 100 day challenge focus on 30% discharges before noon metric to commence

• Virtual Ward assessment for Discharge to Optimise and Assess completed and presented to the Transformation Delivery Group (TDG)

• Falls car business case to be submitted to TDG• Suffolk falls strategy to be discussed at TDG• Delirium pathway scoping completed• Integrated Respiratory Pathway scoping

completed• Integrated EOL strategy drafted and presented to

Alliance Steering Group• “Personalise My Zimmer” in west Suffolk launched

at Care Homes Forum• Trusted Assessor framework to be approved by

Trusted Assessment Steering Group and TDG• Community Matrons case for change submitted

Transformation Overarching Headlines

Programme Key Indicators April 2018

Key Highlights April 2018


Planned Care

Elective activity is 2.3% above plan. Total Outpatients are 4.5% below plan (OP 1st

=4.4% below and OP FUP =4.6% below.)(Based on NHSE activity at M11)

• Elective Care Collaboration remains on track as we head towards the 75 day marker

• Planning is taking place for a 100 day sustainability event• Final QIPP plans have been submitted to NHSE• WSFT has suggested that they will reach aggregate

compliance with the RTT standard by October 2018• Working with Trust to identify the quantum of activity

which can be removed through demand management to support the RTT achievement

• Ophthalmology tender has taken place and is now at standstill for 10 days before successful bidders are appointed

• Pain shadow board meetings continue to take place monthly to develop a revised model of care and proposed to operate an Most Capable Provider process

• Revised opportunity data for Rightcare has been received. Discussions taking place to identify the appropriate projects to progress

• eRS paper switch off took place on 3 April 2018. Currently delivery of electronic referrals is at 92.8%

• Integrated physiotherapy strategy is in draft and is for submission to the Joint System Group and Clinical Executive

• Annual planner for planned care transformation and Contract SDIP have been agreed internally and shared with WSFT. They are for formal sign off at Planned Care Board on 25 April 2018

• Trust Access Policy to be ratified by the Clinical Executive when we are in receipt of SOP for the discharge of patients back to GP

• Final preparation for the 100 day close and sustainability event with inclusion of STP colleagues

• Work is progressing to align the CCG QIPP with the RTT and CIPs at WSFT

• ‘Pathway for Pathways’ is being refined for introduction to clinicians in June

• As first specialty for demand management progression, dermatology system meeting will progress on 3 May 2018 with multidisciplinary attendance

• RAP for RTT has been requested from WSFT and will be completed jointly with the CCG team

• On-going meetings for STP specialty teams to ensure sharing of information and practice

• Review of the process for gatekeeping of LPP policies for WSFT will complete in May as part of the demand management Workstream

Transformation Overarching HeadlinesProgramme

Key Indicators April 2018

Key Highlights April 2018


Mental Health and LD

Dementia Diagnosis Target Rate of 67%.Actual at Feb 18:West: 62%I&E: 67%

• New Mental Health programme of work set out at MHCB on 13 April 2018. Co-production approach/engagement plan in development. Programmes of events drafted (now-Sept 18).

• IAPT- ‘Living Life to the Full’ pilot moving into implementation phase with 13 East GP Practices. Will provide self care materials to support patients and GPs in primary care. Likely start date July 2018

• Perinatal Bid (Phase Two) submitted to NHSE. Response due by the end of the April 2018.

• NHSE agreed our action plan for dementia diagnosis target on 21 March 2018. West behind target but on trajectory

• Annual health check in primary care for patients with Serious Mental Illness (SMI). Target 30% in 17/18 and 60% in 18/19 Options in development including an enhanced service payment

• Psychiatric Liaison Enhanced Service at IHT commences end of April 2018. WSFT service still recruiting

• IAPT: Suffolk Wellbeing. Draft web pages for increased Suffolk focus website in development. NHSE IAPT tel call on Long Terms Conditions (LTC) approach on 17 April 2018

• SMI health assessment approach to be agreed in primary care

• First system wide Crisis task and finish group meeting

• Early Intervention in Psychosis (EIP). Discussion with NSFT to finalise a case for developing a dedicated service

• Police Led High Intensity Networks for High Users of Services- proposal being developed

Children, YoungPeople and Maternity

• Emotional Wellbeing Hub (0-25 years). Hub will be fully operational with a phased implementation beginning from 16 April 2018. Public launch during mental health awareness week 14-20 May 2018

• Neurodevelopmental and Behaviour Pathway (including ADHD, Autism and Conduct Disorder). 4x meeting completed. Clinical conversation now underway to set the agenda for the next meeting

• CAMHS Crisis pilot service for <18 years, subject to successful recruitment aiming to be operational from June 2018

• Speech and Language Therapy and Communication. Fourth meeting of SALT group met on 14 March 2018. The ‘As Is’ map is now almost complete. Next meeting (20.04) will focus on future model

• SEND Inspectors revisit on 17 April 2018

• Continued implementation of crisis CAMHS service

• CYP AD joint (CCG/SCC) post successfully appointed to start on 16 May 2018

Contracts

May 2018

16

Contracts headlinesContract Current

MonthPrevious 6 months (most recent on left)

Headlines

The Ipswich Hospital Trust February

• A&E performance remains below the 95% requirement (89.3% Feb from 90.2% in Jan). A system wide recovery plan is in place that will be managed through the A&E Delivery Board.

• Overall 18 week standards were missed (90.0% against 92% standard). Urology, T&O, General Surgery, Neurology, Ophthalmology and Rheumatology breached in February. Recovery plans in place.

• Delayed Transfers of Care were 3.9% in February 2018 (target 3.5%).• 62 day cancer performance (unvalidated) rose to 81% from 74% (85% target)• Diagnostic Tests within 6 weeks was 99.7% (was 98.8%) against 99% target

West Suffolk Hospital NHS Foundation Trust February

• A&E performance rose to 85% in February from 84% in January, all actions to improve this performance are managed through the A&E delivery board.

• 18 weeks: Performance was stable at 90% in February against 92% target. The action plan is discussed at a 2 weekly steering group.

• 13 patients breached 52 weeks.• 62 day cancer target was not achieved at 79% (was 86%).

Norfolk and Suffolk NHS Foundation Trust February

• CQC rated NSFT Inadequate• Early Intervention in Psychosis performance did meet standard (0% - 1 patient) in 14 days

(target 50%).• AAT routine referral to assessment within 28 days performance fell to 42% from 67% for

children and from 82% to 76% for adults. Staff capacity is the primary cause, recruitment should stabilise or improve performance.

• NSFT remain on track for Improving Access to Psychological Therapies access at over 16% seen against standard of 14%. 50% recovery rates have been achieved for the last 5 months in IES but fell to 49.8% for WSCCG.

Suffolk Community Healthcare February

• The local teams met response times for referrals , 4hrs, 72hrs and 18 weeks,• DTOCs remain above plan in the community provisions and actions are being monitored

through the delivery boards

Care UK: GP Out Of Hours February

• February demand was very high and out of hours did not meet response standards• The procurement for both OOH and 111 is in progress

Care UK: 111 February• The 111 service did not meet the 60 second response standard 95% requirement, only

achieving 70.1% due to high demand • 36% of green ambulance calls were diverted to a more appropriate service after clinical

validation against the trajectory of 34%.

East of England Ambulance Service NHS Trust

February• Cat 1 category response worsened to 10:18 mins in February for IES (was 09:33) and to 10:20

from 10:14 for WS. A recovery plan is agreed between EEAST and CCG consortium. • New ARP standards introduced from October 2017

Key

Improvements and/or continued good performance – no major concerns/risks noted

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

PMO

May 2018

18

West Suffolk CCG PMO Monthly Reporting April 2018

Savings Summary • Over 100% of QIPP delivered• CHC overachieved significantly• MH OOA is not going to achieve target QIPP• Pain and Integrated Care are unlikely to meet

their QIPP target but are included within the WSFT GIC

Original

Full Year

Revised

Full YearPlan Plan Plan Actual

JT WSFT GIC Contracts 3,116,447£ 3,116,447£ 3,116,447£ 12 3,116,447£ 3,116,447£ -£ 0% G G G

KV Prescribing Prescribing 2,068,116£ 2,068,117£ 2,273,896£ 12 2,068,116£ 2,273,899£ 205,783£ 10% G G G

JT CHC CHC 1,660,137£ 1,660,137£ 4,089,234£ 12 1,660,140£ 4,089,236£ 2,429,096£ 146% G G G

CH MH OOA Placements CYP/MH/LD 557,064£ 557,063£ 293,088£ 12 557,064£ 293,088£ 263,976-£ -47% G R R

AL Corporate Pay Costs Corporate 147,830£ 147,830£ 147,830£ 12 147,830£ 289,469£ 141,639£ 96% G G G

AL Corporate Non-pay Cost Corporate 55,713£ 55,713£ 55,713£ 12 55,713£ 54,964£ 749-£ -1% G A A

JT Non Acute Contracts Contracts 215,470£ -£ -£ 12 215,470£ -£ 215,470-£ -100% R R

JT Community Contracts Contracts 678,919£ 443,000£ 311,862£ 12 678,919£ 311,862£ 367,057-£ -54% R R

CA Corporate budget hoovering Corporate 193,765£ 193,765£ 12,890-£ 12 193,765£ 153,780-£ 347,545-£ -179% R R

JT Other Acutes Contracts 2,083,947£ -£ 276,482£ 12 2,083,947£ 276,482£ 1,807,465-£ -87% R R

JT Ambulance Contracts 527,898£ -£ -£ 12 527,898£ -£ 527,898-£ -100% R R

JT Investment Contracts 923,000-£ -£ -£ 12 923,000-£ -£ 923,000£ -100% G G

RW Integrated Care Programme WS ICN -£ -£ -£ 11 497,443£ 462,887£ 34,556-£ -7% G R R

RW CYP and Maternity CYP/MH/LD 201,565£ -£ -£ 11 166,606£ 245,738£ 79,132£ 47% G G G

RW Pain Planned Care 115,500£ -£ -£ 11 105,500£ 64,580£ 40,920-£ -39% A R R

RW MSK Planned Care 306,600£ -£ -£ 11 289,460£ 1,107,214£ 817,754£ 283% G G G

JT CHC FYE 16/17 NA 600,000£ -£

KV GP Access slippage NA 400,000£ -£

AL Additional Corporate NA -£ -£

10,382,306£ 9,242,072£ 10,551,663£ 10,382,309£ 10,551,668£ 169,359£ 2%

10,382,306£ 10,382,306£ 102%

1,140,234-£ 169,357£

89.02% 101.63%

Reported

NHSE

Forecast

No

n

PM

O

Target Savings Requirement

Variance to plan

Ca

sh

QIP

P

Exec

ownerProgramme/Projects Workstream

No

n

PM

O

Totals

In G

IC

MntYTD PMO

Confidence

Scheme

finance

On

Budget?Var

QIPP Coverage Variance

Benefit will be released in corresponding QIPP line above

Chief Operating Office

May 2018

20

Regulator Inspections: CQC

Practices visited: 24Visits pending: 0• Outstanding 2• Good 22• Requires Improvement 0• Special Measures -

Primary CareList closures:One practice in west Suffolk has informally (temporarily) closed its list due to capacity issues. The CCG is actively supporting remedial action.

Experience of making an appointment (Quality Premium):

Target: Achieve a level of 85% (or 3% increase on July 17

baseline) of respondents who said they had a ‘good’

experience of making a GP appointment

Current position (July 17 i.e. baseline):

• CCG overall: 77.7% (national avge. 72.7%)• 10/24 practices achieved >85%• 11/24 practices achieved >73% and <85% • 3/24 practices below national avge.Note: Results not statistically significant at practice level due to small

sample size.

Learning Disabilities – Annual Health Checks:

Target: 75% of adults and young people (over 14) with learning disabilities to have an Annual Health Check.

Current position (Qtr 3 2017/18):

• CCG overall: 36% (431 checks in Q1,Q2 & 3 1,201 on registers)• Estimated number of checks required – 901 p.a.• 3/24 practices on target to achieve target at year end

Dementia Diagnosis:Target: Achieve a diagnosis rate of 67%.Current position (February 18):

• CCG overall: 62% • 8/24 practices achieved >67%• 10/24 practices achieved >50% and <67% • 6/24 practices <50%

QOF Dementia Register - 2,176 patients.

21

Programme Summary

QIPP

CCGPM

Exec Owner

Workstream

G G A

QIPP target YTD (Month 9)

Actual QIPP Schemes YTD (Month 9)

Milestone

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 1,895,773 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ £ 172,343 £ 172,343 £ 172,343 £ 172,343 £ 172,343 £ 172,343

Actual £ 1,444,741 406,233£ 115,589£ 28,463-£ 246,634£ 67,747-£ 80,100£ £ 234,134 £ 82,241 £ 350,387 -£ 15,156 £ 40,789

Variance -£ 451,032 £ 233,890 -£ 56,754 -£ 200,806 £ 74,291 -£ 240,090 -£ 92,243 £ 61,791 -£ 90,102 £ 178,044 -£ 187,499 -£ 131,554

Risks/Issues

No milestones due in January. All milestones are on track.

Key Issue

QIPP schemes have delivered planned savings, however the effect of NCSO drug cost pressure has had a significant effect on the prescribing budget. The finance RAG reflects the overall

budget position and not the performance of the prescribing schemes. The unforseen cost of NCSO drugs was £1.03m to WSCCG.

Summary

Objectives

A range of prescribing projects to realise £2.068m QIPP.

Overall Confidence Project delivery RAG Finance RAG

Total QIPP target for 2017/18 2,068,116£

1,940,645£

1,551,088£

Note: January and February figures are projected estimates.

Milestones Status Comment

Prescribing

• Prescribing visits have been fine-tuned further with a particular and sustained focus

on supporting 9 practices that are still in an overspend position, according to Dec 2017

data

As last month, Wale and I will update our Workbooks, showing significant points in

green for you to extract for the IPR as needed.

• Prescribing policies and supporting documents have been updated for gluten free

food and specialist infant formula, enabling on-going progress to be made in containing

prescribing costs in these areas.

• Significant progress is now being made on prescribing of continence and stoma items,

with dedicated support from our primary care stoma nurse and appliance nurse.

Prescribing - QIPP Scheme Top Achievements

West Suffolk

Linda Lord

Kate Vaughton

22

Prescribing QIPP SchemesProject (Planned Savings)

Project Plan Status

£YTD Actual

(Planned)

Key points/highlights

P01 – Analgesics (£300k)£768.9k(£225k)

* Work is underway, in collaboration with the West Sufolk Pain Services, to develop a range of supporting documents for GPs to aid reduction in inappropriate prescribing of analgesics.

* Medicines Management technicians and practice staff continue to actively switch Lyrica and Alzain to generic pregabalinfor all indications. This is a significant cost saving initiative.

* Prescribing Reports discussed at prescribing visits and they are also posted on the WSCCG website. The reports include a detailed analysis of analgesics prescribed and show where practices are outliers regarding cost per 1000 patients and items per 1000 patients. They also show the top 20 analgesics prescribed.

P02 – Continence(£50k)

£25.8k(£37.5)

* Qufora leg and night bags switch matrix updated

* Switch to Qufora leg and night bags ongoing

* Appliance nurse now actively supporting practices with cost-effective prescribing of continence products

P03 – Diabetes and Endocrine(£70k)

£325.8k(£52.5k)

• All milestones for this project now complete.

• Some practices now reporting switch from liothyronine to levothyroxine.

• Further implementation of WSCCG Policies on cost effective prescribing of BGTS, lancets and needles; follow up at Q4 practice meetings.

P04 – Enabler Workbook(£778k) (£583.6k)

* RAP scheme continues to be promoted at practice meetings as a tool to encourage implementation of prescribing savings

* Revised antibiotic formulary strongly promoted to all practices across West and East Suffolk, with supporting data, including national KPIs.

* Technicians and clinical pharmacists actively engaged in cost effective prescribing initiatives

* Cost effective and appropriate dietetic prescribing continues to be implemented.

* GF and IF policies updated.

* Further initiative launched to ensure no prescribing of ONS or enteral feeds without advice from a dietitian.

P05 – Mental Health(£70k)

£84.7k(£52.5k)

* Letter written to practices where trimipramine is prescribed. Practices advised to carry our reviews under the terms of the polypharmacy LES with a view to stopping the medication or switching to a modern antidepressant if on-going treatment still indicated

* WSCCG Prescribing Lead GPs' education event held on 17 January to discuss and explain key issues regarding cost-effective prescribing of two mental health drugs - quetiapine and trimipramine. An expert speaker from NSFT was in attendance with excellent GP attendance and engagement

23

Prescribing QIPP Schemes

Project (Planned Savings)

Project Plan Status

£ YTD Actual (Planned)

Key points/highlights

P06 – Polypharmacy(£200k)

£167k(£150k)


• Potential extension of the LES to 2018-19 not yet agreed. Discussions continue.

P07 - Rebates(£120k)

£69.7k(£90k)


• Rebate schemes accepted continue to be reviewed .

• Rebate schemes accepted by the WSCCG posted on WSCCG website.

P08 – Respiratory(£200k)

£311.5k(£150k)


• Additional COPD kits made up and distributed to practices to further support adherence to the COPD formular.

• Prescribing reports actively promoted to demonstrate to each practice where savings can be made regarding prescribing of formulary inhalers for COPD.

• Continued promotion of the updated COPD guidelines , promoting cost effective treatments aligned to each patient’s GOLD grade

P09 - Wound Care(£70k)

12.8k(£52.5)

* Prescribing reports actively promoted to WSCCG practices. The reports demonstrate to each practice where further savings can be made on woundcare items and other therapeutic areas

* Adherence to the Suffolk Woundcare formulary continue to be promoted

* Appliance nurse now actively supporting WSCCG practices with cost-effective prescribing of wound care and continence products

P10 – ScriptSwich(£100k)

£136.7K(£75k)

* ScriptSwitch profile updated with safety/cost-effective messages relating to dietetic products, beta-blocker containing eye drops for glaucoma, prednisolone soluble tablets, etc.

* Monthly report sent to all practices

P11 - Self Care (£60k)

£36.6K(£45k)


• Prescribing of self care medicines continue to be discussed at Q4 practice prescribing meetings. GPs strongly encourage not to prescribe OTC medicines for minor conditions.

P12 – Stoma(£50k)

£1.2k(£37.5k)


• Hollister sub-contract with WSFT in place .

• Hollister nurse now carrying out stoma reviews across practices.

24

West Suffolk CCG PMO Monthly Reporting April 2018

Programme Summary

QIPP

CCG

PM

Exec Owner

Workstream

Summary

Objectives

G G G

QIPP target YTD (Month 10)

Actual QIPP Schemes YTD (Month 10)

Milestone

Financial Results

Results YTD Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan £ 2,068,116 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ 172,343£ £ 172,343 £ 172,343 £172,343 £ 172,343 £ 172,343 £ 172,343

Actual £ 2,273,899 406,233£ 115,589£ 28,463-£ 246,634£ 67,747-£ 80,100£ £ 234,134 £ 82,241 £350,387 -£ 15,156 £ 40,789 £ 829,158

Variance £ 205,783 £ 233,890 -£ 56,754 -£200,806 £ 74,291 -£ 240,090 -£ 92,243 £ 61,791 -£ 90,102 £178,044 -£ 187,499 -£131,554 £ 656,815

Prescribing - QIPP Scheme Top Achievements

West Suffolk

Linda Lord

Kate VaughtonPrescribing

• Closure/summary reports being worked on

• 17/18 workbooks completed.

No milestones due.

A range of prescribing projects to realise £2.068m QIPP.

Overall Confidence Project delivery RAG Finance RAG

Total QIPP target for 2017/18 2,068,116£

2,388,383£

1,895,774£

Note: February and March figures are projected estimates.

Milestones Status Comment

of 3

GOVERNING BODY

Agenda Item No. 11


Date. 23 May 2018

Title Governing Body Assurance Framework and Chief Officers Risk Registers

Lead Chief Officer Amanda Lyes, Chief Corporate Services Officer

Author(s) Tony Buckle, Risk Manager

Purpose To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for May 2018.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by the Governing Body:

The Governing Body is requested to review and approve the updated West Suffolk CCG GBAF for May 2018.

1. Background 1.1 Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body, Clinical Scrutiny and Audit Committees at each of their meetings. 2. GBAF - Key Issues 2.1 Actions highlighted with a grey background are complete and will be removed from the next

version. 2.2 The following amendments have been agreed by COT at their regular review meeting: Risk No and

Owner Risk description and actions update

2

Jane Payling

Failure to achieve financial balance in 2018-19, secure financial sustainability and deliver optimum service from the financial resources available. This update reflects the new financial year. There are revisions to the Granular Operational Risks, Key Controls Established and Assurance of Controls descriptions. The initial RAG rating is 15 with the revised RAG rating after controls being 10. The rating of gaps in controls is classified as ‘manageable’. Action 2 complete - GBAF finance risk to be updated to 2018/19 Action 1 new action – budgets uploaded and financial reporting in place for 2018/2019; target date June 2018

27a

Lisa Nobes

Potential impact of service quality delivered by NSFT. Action 1; Regular monitoring of Patient Safety & Quality:- Monthly meetings with Provider reviewing comprehensive range of reporting. Undertaking quality visits to services – update; Monthly CQRM continues with key areas for discussion each month Action 2; Attendance a challenge at monthly Overview and Assurance Group – update; DDON attends meetings Action 3; Monthly programme of announced/unannounced QIVs – update; QIVs undertaken as identified (not monthly) and reports shared with NSFT Action 4; Initiate joint CQRMS quarterly (with Norfolk) – update; first meeting planned for June/July 2018 Action 7; Ensure on-going communications with the public – update; as messages needed working in partnership with NSFT Action 8; Outstanding requests / concerns to be escalated formally – update; all quality and patient safety concerns are escalated to the SLA meeting following each CQRM.

27b

Jane Webster

Poor performance of mental health services. Additional key control established revised,

- Recruitment plan in progress Action 5 complete - CCG Executive to determine with Trust Executive when Lark Ward can safely open; target date May 2018, complete April 2018 Action 6 new action - Children’s routine assessment waits to recover to 28 days; target date July 2018 Action 7 new action – Lark Ward reopening; target date unknown

33

Jane Webster

WSFT is failing in their 18 week RTT performance on both an aggregate level and individual specialty level Action 5 new action - Achievement of 92% RTT target; target date October 2018

34

Lisa Nobes

Significant issues identified with the blood transfusion service at West Suffolk Hospital. Action 3i new action - Re-inspection due October 2018 – outcomes to be fed back; target date October 2018

35

Lisa Nobes

Failure to comply with SEND Reforms. Additional assurance of controls; Monitoring visit 17 April, positive outcome and feedback from DoE. Self-assessment August 2018

36

Lisa Nobes

CCG will not be able to meet its statutory duties to safeguard children and adults in Suffolk. Key controls established, 2 have been revised; Recruitment plan developed. CCG looking at interim recruitment of medical support - recruitment via BMJ has commenced coupled with letter to Chief Executives and Medical Directors to all acute Trusts. Continue to advertise Designate Doctors post but more focussed work required – designated nurses hours have been increased to support Designated Doctor vacancy and workload

40

Lisa Nobes

Currently East of England Ambulance are unable to meet the demand for its services, which may impact on the safety of patients. Action 3 complete - Establish a regular forum to review and share learning from the SIs reported by EEAST; target date May 2018 Action 4 new action - Risk summit 10 May 2018, awaiting outcome to determine next steps; target date TDB

3. Chief Officers Risk Registers

3.1 As previously agreed, a brief highlight report on current risks which may cause concern to

the CCGs from local Risk Registers is included in a summary table document with this report. These are reviewed on a regular basis by COT and also reviewed by the Risk Forum.

3.2 The Risk Forum reviews all the departmental risk registers each month and they are all up to

date. The Risk Forum met on 19 April 2018 and the risk register summary table has been updated as a result of the meeting.

Governing Body Assurance Framework and

Action Plan

2018 - 2019

Version Control:

MONTH

VERSION No

REVIEWED BY

SUMMARY OF CHANGES

April 2018

61

COT 16 April 2018 Clinical Scrutiny 25 April 2018

Approved

May 2018

62

Clinical Scrutiny 16 May 2018 Governing Body 23 May 2018 Audit Committee 5 June 2018

June 2018

63

July 2018

64

August 2018

65

September 2018

66

October 2018

67

November 2018

68

December 2018

69

January 2019

70

February 2019

71

March 2019

72

Governing Body Assurance Framework

Overview

The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement. The GBAF should be seen as a working document and will be updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body at each of its meetings. The GBAF is linked to the CCG Risk Register, the content of which is also provided for review by the Chief Officers Team. A flow chart setting out how risks are identified and managed is set out overleaf. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above and are of strategic concern migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern. The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.

RISKS IDENTIFIED THROUGH:

External Assessment & Audit + Guidance & Alerts

Serious Incidents, Complaints, Public Health &

Quality Issues

Public & Stakeholder Engagement

Business & Service Delivery Plans

CCG Governing

Body Own & Manage Risks & the Chief

Officers Team Reviews the

Directorate Risk Registers and the

GBAF

Governing Body Assurance Framework

Overview & Scrutiny by the Audit Committee

Assurance to the Governing Body

Individual Risks Jointly Managed by Designated Chief

Officers & Clinical Leads

Work Stream Risk Assessments

Review by Clinical Scrutiny Committee

Review by Local Risk Forum

RAG Score Framework

Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain

Consequence score ↓

5: Catastrophic 5 10 15 20 25

4: Major 4 8 12 16 20

3: Moderate 3 6 9 12 15

2: Minor 2 4 6 8 10

1: Negligible 1 2 3 4 5

The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:

In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:

Define the risk explicitly in terms of the adverse consequence or consequences that might arise

Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified

RAG Score

Progress

Risk Assessment

Revising Risk Ratings

CRITICAL (15-25)

There may be significant gaps in controls to ensure effective management.

Controls are in place but insufficient resources

Controls are in place but external forces may be preventing progress.

There are insufficient controls in place to address the cause or source of the risk

Controls are considered insubstantial or ineffective Controls are being implemented but are not yet in place If this risk were to materialise, the situation could be

irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.

If controls are inadequate then the revised risk rating increases

If controls are uncertain, the revised risk rating stays the same as the original risk rating

If they are perceived as adequate, then the revised risk rating decreases

CHALLENGING (8-12)

Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.

There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.

MANAGEABLE (1-6)

Progress is being made in accordance with plans. There are no significant concerns.

The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.

Consequence score (severity levels) and example of descriptions

1 2 3 4 5

Risk Domains Negligible Minor Moderate Major Catastrophic 1. Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment. No time off work

Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects

Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients

2. Quality / complaints / audit

Peripheral element of treatment or service suboptimal Informal complaint/inquiry

Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report

Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards

3. Human resources / organisational development/staffing / competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis

4. Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation Reduced performance rating if unresolved

Single breech in statutory duty Challenging external recommendations/ improvement notice

Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report

Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report

5. Adverse publicity / reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence

6. Business objectives / projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget Schedule slippage

5–10 per cent over project budget Schedule slippage

Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met

Incident leading >25 per cent over project budget Schedule slippage Key objectives not met

7. Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget Claim less than £10,000

Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million

8. Service/business interruption

Loss/interruption of >1 hour

Loss/interruption of >8 hours

Loss/interruption of >1 day

Loss/interruption of >1 week

Permanent loss of service or facility

9. Environmental impact

Minimal or no impact on the environment

Minor impact on environment

Moderate impact on environment

Major impact on environment

Catastrophic impact on environment

RISK NUMBER: 02 DATE RISK ADDED:

AC

CO

UN

TAB

LE O

FFIC

ER

& G

P O

WN

ER

DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

IN

ITIA

L R

AG

RA

TIN

G

(LIK

ELIH

OO

D x

CO

NSE

QU

ENC

E)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

ATIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

JP +

CB

Failure to achieve financial balance in 2018/19, secure financial sustainability and deliver optimum service levels from the financial resources available.

In 2018/19 the CCG

QIPP target is £10.54m, which if not fully identified and delivered puts achievement of financial balance at risk

Increasing levels of demand and unachievable savings targets in acute Trusts activity. Providers require extra financial support to maintain or meet clinical quality, contractual standards or financial control totals.

Variability in prescribing levels and higher prices driven by market conditions (e.g. No Cheaper Stock Obtainable)

Pressures due to nationally negotiated pay awards not being fully funded in the health system.

3 x 5

15

Guaranteed Income

Contract (GIC) values agreed with main acute providers for 18/19.

Active scrutiny and challenge for all variable activity contracts.

Clinical Executive and Governing Body review expenditure and significant investments

Project management approach to delivery of the QIPP through the PMO.

Continued push for further QIPP opportunities through benchmarking including the Right Care initiative and NHSE MOO.

Continued focus on strong budget management

Focus on reducing activity levels through joint transformation team with WSH.

Inclusion in the budget of 1% contingency

Monthly Financial

Performance Committee considering finance and PMO reports

COT including business review process

GP engagement Governing Body NHS England

performance reviews Internal & External

Audit Monthly SLA

provider meetings STP DOFs group

providing system-wide financial overview

CCG PRIORITY: Deliver financial sustainability Integrated performance report area. Finance and Performance

█ CHALLENGING

2 x 5

10

2 x 5

10

2. GBAF finance risk to be updated to 2018/19 Target: May 2018 Completed: Complete 1. Budgets uploaded and

financial reporting in place for 2018/19.

Target: June 2018 Completed:

See following sheet for next risk

RISK NUMBER: 20 DATE RISK ADDED: MAY 2014

AC

CO

UN

TAB

LE O

FFIC

ER

& G

P O

WN

ER



INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)



RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

MO

NTH

RE

VISE

D RA

G R

ATIN

G


COMPLETION

RW

+ S

A

Failure to redesign and commission services covered by the Urgent Care and Health and Independence reviews within required timescales

Potential for services

to fall out of contract including with the pause NHS England have put onto the Integrated Urgent Care procurement

Risk that the full potential benefits of a transformational redesign are not met leading to patient care being adversely affected and inefficiencies in the system

Reputational damage

to commissioners

4 x 4

16

Contracts in place

with the Consortium (West Suffolk Hospital, Ipswich Hospital and Norfolk Community Services) for adult and children’s community services plus extension of contract to 111 and Out of Hours with Care UK all running to Oct 2017.

Redesign of core components of the Urgent Care and Health and Independence Review underway since mid-2015 such as development of Connect East Ipswich, creation go Crisis Action Team and Frailty Assessment Base at Ipswich Hospital.

Clinical Executive considered and agreed approach to wider redesign of services for

COT review Executive Group

review Health &

Wellbeing Board review

Governing Body Review

Area Team Strategic Plan Review

CCG PRIORITY: Demonstrate

excellence in patient experience and patient engagement

Improve the health and care of older people

Improve access to mental health services

Improve health and wellbeing through partnership working

Deliver financial sustainability through quality improvement

█ CHALLENGING

3 x 4

12

3 x 4

12

1. Integrated Urgent Care Service commences

Target: October 2018 Completed:

T

commissioning by Oct 2017 in Nov 2015.

Programme staff recruited to and project plan in development.

Associate Director Redesign leads agreed for each component part of the work programme and a fortnightly delivery group meeting involving all parts of the two CCGs in place.

Task and finish groups set up with wider system partners for each of the component parts of the programme to develop the clinical models and specifications.

Procurement resulted in a tie between providers. An additional 6 months likely be negotiated with Care UK while procurement is re-run.

Governing Bodies agreed in Jan 2018 to launch a new procurement for the service with an expected go live date of Oct 2018.

Project group in place to oversee the procurement

Integrated performance report area. Clinical Workstream

RISK NUMBER: 27a DATE RISK ADDED: July 2015 (Renumbered January 2016)

ACCO

UNTA

BLE

OFF

ICER

&

GP

OW

NER



INIT

IAL

RA

G R

ATI

NG

(L

IKEL

IHO

OD

x C

ON

SEQ

UEN

CE)



RAG RATING OF

GAPS IN CONTROLS

RA

G R

ATIN

G L

AST

M

ON

TH

RE

VISE

D RA

G R

ATIN

G


COMPLETION

LN +

RT

Potential impact of service quality delivered by NSFT CQC re-inspection report dated October 2017 gave the Trust an overall rating of “Inadequate” placing the Trust into Special Measures for the second time

Reduction in quality of

service and inability to meet performance and clinical quality targets

Maintaining safer staffing levels in accordance with NICE & NQB guidance

Adverse financial position may impact adversely on the quality of care delivered

Potential increase in contract issue log referrals

Ligatures posing rises to patient safety

Seclusion facilities not fit for purpose.

Lack of confidence in performance data.

Failure of Board to demonstrate leadership in patient safety.

4 x 4

16

Monthly meetings to

review / challenge quality performance

Quality dashboard Attendance at

monthly stakeholder assurance meetings led by NHS Improvement / CQC

Oversight of quality improvement plans (trust / local) and monthly monitoring of progress by quality team and workstream

Support for NSFT mock CQC inspections and feedback

Announced and Unannounced quality improvement visits

Sign off provider CIPs and associated QIAs

Monitor primary care contract issues and Trust response

Appointment of Improvement Director by NHSI

Buddy Trusts identified for the

Demonstrated

improvement against identified contractual key performance indicators evidenced through quality dashboard escalation of issues via SLA meetings

Confidence that NSFT have structures in place to deliver the required quality improvements

Assurance that actions detailed in the quality improvement plan have been implemented

Test that actions detailed in the quality improvement plan have resulted in changes at an operational level

To ensure that CIP schemes do not

█ CHALLENGING

4 x 4

16

4 x 4

16

1. Regular monitoring of Patient Safety & Quality:- Monthly meetings with Provider reviewing comprehensive range of reporting. Undertaking quality visits to services

Target: June 2018 Completed: Ongoing - Monthly CQRM continues with key areas for discussion each month. 2. Attendance a challenge at monthly Overview and Assurance Group Target: June 2018 Completed: Update - DDON attends meetings. 3. Monthly programme of announced/unannounced QIVs

Target: June 2018 Completed: Update - QIVs undertaken as identified (not monthly) and reports shared with NSFT. 4. Initiate joint CQRMS quarterly (with Norfolk)

Target: June 2018 Completed: Ongoing – first meeting planned for June/July 2018

T

Trust to work with/learn from

Interviews held for new Chief Executive

Deep dive report presented to Clinical Scrutiny

have an adverse impact on quality

Timely response to contract issues with effective learning reducing numbers

Joint review of plans to act on the areas of concern identified in the Trust mock CQC inspection report.

CCG PRIORITY: Improve access to

mental health services

5. Continue partnerships with patients & their carers to understand issues, ideas & progress Target: June 2018 Completed:

6. Enhance clinical relationships between CCG, practices & NSFT Clinicians Target: June 2018 Completed: 7. Ensure on-going communications with the public

Target: June 2018 Completed: Ongoing - as messages needed working in partnership with NSFT 8. Outstanding requests / concerns to be escalated formally. Target: June 2018 Completed: Update - all quality and patient safety concerns are escalated to the SLA meeting following each CQRM.


RISK NUMBER: 27b DATE RISK ADDED: January 2016

ACCO

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(L

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RAG RATING OF

GAPS IN CONTROLS

R

AG

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LA

ST

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NTH

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COMPLETION

JW /

RT

Poor performance of mental health services

Poor performance

against a number of performance indicators, most notably Access and Assessment Team (AAT): Routine Assessment of children (<18s) within 28 days

NSFT rated inadequate following CQC inspection in October 2017

Closure of Lark Ward (Woodlands Unit) in Ipswich in April 2018 due to ongoing safety concerns/ staff vacancies, leaving no PICU within Suffolk. This has resulted in some patients being dispersed out of county. Date for reopening the ward not yet established

4 x 4

16

Remedial Action

Plan agreed for Children’s’ Routine Assessment performance indicator

CNO regularly reviewing progress with CQC action plan via Clinical Quality meetings

Recent Lark ward closure subject to Director discussion

Recruitment plan in progress

Reported to the

workstreams, Clinical Executive and Governing Body as appropriate

Progress routinely monitored at monthly SLA meetings / clinical quality review meetings

CCG PRIORITY: Improve access to

mental health services

█

CHALLENGING

4 x 4

16

4 x 4

16

4. CQC: to ensure all action points within the CQC report are addressed

Target date: June 2018 Completed:

5. Lark Ward closure; CCG Executive to determine with Trust Executive when Lark Ward can safely open

Target date: May 2018 Completed: April 2018 6. Children’s routine

assessment waits to recover to 28 days

Target: July 2018 Completed: 7. Lark ward reopening Target: TBC Completed:

T

RISK NUMBER 33 DATE ADDED February 2017

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(L

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RA

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RA

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COMPLETION

JW

WSFT is failing in their 18 week RTT performance on both an aggregate level and individual specialty level

Due to the implementation of e-care, WSFT were estimating the RTT performance. Now the PTL has been validated, the Trust is failing the 18 week RTT performance but data quality issues persist Deep dive into specialty level demand has shown a risk of long waiting times for ENT and Dermatology These specialties are recovering and recent modelling indicates longest waits in T&O, Urology, Gynaecology Reported high numbers of 52wk breaches continue but reducing in numbers

4 x 4

16

Steering group meets at least monthly Contractual performance review at each contract meeting 2 weekly RTT review

meeting RTT reduction model

developed and tracked

100 day improvement

programme launched in ENT, Cardiology and Urology.

Monthly review of waiting times going forward when e-Care allows. CCG Priority: To ensure high quality local services

█

CHALLENGING

4 x 4

16

4 x 4

16

1. Action plan received from Trust. Plan shared with NHSE and NHSI. Plan to be reviewed at 2 weekly steering group.

Target: Ongoing Completed: 2. Progress against action

plan to be monitored and scrutinized at monthly contracting meetings

Target : Ongoing Completed: 4. Agreement of formal

recovery trajectory at aggregate and specialty level

Target date: May 2018 Completed: 5. Achievement of 92% RTT

target Target: October 2018 Complete

a

RISK NUMBER 34 DATE ADDED March 2017

AC

COUN

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INIT

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(L

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RA

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ISED

RA

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COMPLETION

LN

Inspection by MHRA in January 2018 identified a number of failures to comply with the guide to Good Manufacturing Practices for blood transfusion. This is the second inspection that identified areas for improvement Significant issues identified with the blood transfusion service at West Suffolk Hospital (WSH) run by NEESPS during an inspection by the MHRA – January 2017

No critical failures identified, two major failures identified (previous inspection identified critical and major failures). Quality governance processes and staffing – adequate numbers, suitably qualified, up to date job descriptions. There is a risk that the

service may be suspended which would mean that an alternative service provider would have to be found for WSFT to provide: Emergency Department, Maternity, Major Surgery and Intensive

4 x 5

20

Action plan to MHRA

who are reviewing

Full inspection in six months

Trust / TPP

improvement plan

Monthly Trust / TPP updates on progress against plan to MHRA / NHSI

Serious Incident Reporting

MHRA / NHSI review and sign off of proposed actions Target dates for improvements to made by are met leading to regulatory compliance Review of Serious Incidents to assess if harm has resulted Inspection findings support the assurance provided in the weekly updates of the improvements being made within the service. These have

█

CHALLENGING

3 x 5

15

3 x 5

15

1. Monitoring of SI reports

Target: May 2018 Completed: 2. Effective communication

on developments to stakeholders E.G. Primary Care

Target: May 2018 Completed:

3. CCG to monitor the implementation of the provider agreed actions (below): e. Recruitment plan to be

developed and implemented Target: May 2018 Completed:

a


Care Services amongst others

now changed to monthly updates. CCG Priority: To ensure high quality local services

f. MHRA to be provided with details of the WPE LIMs validation process Target: June 2018 Completed: g. Draft workforce plan has

been agreed with turnaround director, awaiting formal sign off from partner board

Target date: June 2018 Completed: h. Competency sign off for

laboratory staff - Two staff members have completed their competency assessment and one other is approaching completion

Target date: June 2018 Completed: i. Re-inspection due

October 2018 – outcomes to be fed back

Target: October 2018 Completed:

RISK NUMBER 35 DATE ADDED March 2017

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RA

G R

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G L

AST

M

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ACTION POINTS & TARGET DATES FOR COMPLETION

LN

Failure to comply with SEND Reforms

The failure to

implement the requirements of the SEND reforms has resulted in the cohort of children receiving a sub-optimal service which could potentially significantly restrict their development / potential and has led to regulatory noncompliance and resultant adverse publicity

5 x 4

20

Written statement of

implementation actions to achieve compliance dated May 2017. Further year of ongoing work to fully implement reforms

SEND Programme Board (& associated sub-groups) in place to provide strategic leadership and governance overseeing implementation of improvement actions

Appointment of SEND programme manager / leads across each organisation to deliver implementation of improvements

Appointment of band 7 SEND support worker to operationally deliver SEND reforms

Increased time for DCO

Written statement signed off by Regulators Ongoing inspection reviews demonstrating improvements Milestones to achieve implementation are monitored and rated green Health milestones are on target to achieve by 2019/2020 Key individuals in each organisation leading pathway changes and reforms Monitoring visit 17 April, positive outcome and feedback from DoE. Self-assessment August 2018

█

CHALLENGING

5 x 3

15

5 x 3

15

1. Scoping of SEND need identified through accurate data collation and analysis from all stakeholder

Target: Oct 2018 Completed:

2. Support and monitor progress of the implementation of the strategy

Target: Oct 2018 Completed: 3. Develop action plans to support

development of new pathways Target: Oct 2018 Complete: 4. Ensure robust leadership and

governance for SEND in CCG Target: Oct 2018 Completed:

RISK NUMBER 36 DATE RISK ADDED: September 2017

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(L

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RA

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COMPLETION

LN

CCG will not be able to meet its statutory duties to safeguard children and adults in Suffolk.

Capacity Designate Doctors post vacant Designate Nurse for looked after children also leading on SEND project Governance Leadership for Designated Nurses needs strengthening to ensure direct access to CNO Team Relationships Relationship difficulties within the team are distracting from the safeguarding portfolio of work

4 x 4

16

Recruitment plan developed. CCG looking at interim recruitment of medical support - recruitment via BMJ has commenced coupled with letter to Chief Executives and Medical Directors to all acute Trusts Continue to advertise Designate Doctors post but more focussed work required – designated nurses hours have been increased to support Designated Doctor vacancy and workload Increase hours for LAC Designated Nurse. Line Management of MASH to change. Gap Analysis undertaken. Clear line management infrastructure for Designated Nurses. Bi-monthly reporting to Clinical Executive

Post advertised and successfully recruited to. Cover arrangements agreed until such time as a permanent appointment is made Changes to line management affected – designate nurses reporting to the Chief Nursing Officer Team relationship are improved greater focus on core work

█ CHALLENGING

4 x 4

16

4 x 4

16

1. Continue to advertise Designated Doctor vacancy Target: July 2018 Completed: 2. Review of resources to

support the safeguarding agenda

Target: July 2018 Completed: 3. Action plan to be developed to support the implementation of the recommendations of the safeguarding review Target: July 2018 Completed: 4. Enact recruitment plan Target: May 2018 Completed:

RISK NUMBER 37 DATE ADDED: December 2017

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RA

G R

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COMPLETION

JW/S

A

A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience.

• Clinical risk of patients not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments. • Risk of patient experience deterioration due to long waits. • Risk of breaching

constitutional obligations.

4 x 4

16

Daily reporting of

performance. Escalation of Health

Dtoc daily for CCG and system support

OOH cover and 111 support continually reviewed to ensure rotas are in place to manage surges

Admission avoidance schemes fully operational and a rolling reminder in place to primary care and OOH

GP streaming in place

111 targets to reduce inappropriate referrals to A+E

A&E Board in place Assess and address

staff shortages in medical and nursing rotas 10 days in advance

Daily performance information supplied and monitored, regular discussions and monthly formal contract meetings. Formal contract notification to WSFT for joint working and review of performance in A+E requirement. Remedial Action Plan established by A+E delivery board.

CCG PRIORITY: Improve health

and wellbeing through partnership working

Integrated performance report area. Contractual Performance

█ CHALLENGING

4 x 4

16

4 x 4

16

1. Complete actions from A&E Delivery Board Action Plans: j. Improve streaming

options in A&E k. Improve NHS111 call

triage and streaming to clinicians

l. Improve ambulance triage and streaming to alternative responses

m. Improved patient flow within the hospital

n. Improved discharge from hospital

Actions are monitored monthly by the A&EDB o. Revised remedial

action plan agreed with WSFT

Target: September 2018 Completed:

RISK NUMBER 38 DATE ADDED JANUARY 2018

AC

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COMPLETION

MB

W/C

B

Significant reduction in the capacity of GP services in Haverhill affecting access times for patients, demand for other services and retention of clinical staff

Clinical risk of patients not being seen in appropriate timescales Risk of patient experience deterioration due to increased waits Risk of Haverhill practices not being able to function List closures Increased prescribing costs Increased use of A&E and secondary care services, especially in CUHFT

4 x 4

16

CCG Primary care strategy and support team in regular contact with practices LMC/CCG/Fed meetings Weekly Clinical Executive meetings Bi-monthly Governing Body meetings Utilisation of Vulnerable Practices Fund, resilience funding and £3 per head Transformation Fund Resilience funding available CCG funded telephony system for C&CM

Currently: Primary care co-commissioning strategy CCG Priority To ensure high quality local services

Integrated performance report area. Clinical Quality and Patient Safety

█ CHALLENGING

4 x 4

16

4 x 4

16

1. Ongoing support into Haverhill continues

Target: March 2018 Completed: 2. Solution to estate issues

being investigated Target: March 2018 Completed:

3. Key stakeholders are briefed, including neighbour practices

Target: March 2018 Completed: 4. Targeted extended access

(funding as a cost pressure) to Haverhill to assist with demand.

Target: March 2018 Completed: 5. Additional capacity into

extended hours initiative in Haverhill using winter monies

Target: March 2018 Completed:

a

RISK 39 DATE ADDED February 2018 – risk is owned by Ipswich and East Suffolk CCG. For note on West Suffolk CCG GBAF

ACCO

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RA

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RA

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COMPLETION

JW/S

A

EEAST is failing performance targets against ambulance response categories, particular concern are delays in the higher acuity Category 1 and 2 calls.

Capacity EEAST under achieving on required number of productive paramedic hours that EEAST can deliver ‘on the road’. Demand Increase in acuity and volume of calls. Both direct to 999 and through 111 services. This includes rising care home 999 activity. Operational Procedures Reduction in productive paramedic hours due to delays in hospital arrival to handover and handover to clear.

5 x 4

20

Weekly performance reviews and forecasting update with Commissioners and Provider. EEAST risk summit convened in Feb 18 and will continue to review progress of performance. Monthly Contract Review focuses on local performance attainment and issues. Adoption of 30 minute maximum handover time. 111 enhanced clinical triage for calls triggering an ambulance in place 90% of all C3/C4 calls being clinically validated.

Minutes and actions circulated to attendees of weekly performance review meeting. EEAST risk summit actions regularly updated with diarised meetings internally and externally to NHSE/NHSI. Monthly review of waiting times going forward when e-Care allows. CCG Priority: To ensure high quality local services.

█

CHALLENGING

5 x 4

20

5 x 4

20

1. Action - EEAST risk summit action plans for individual areas all due to be completed by 15th February.

Adoption of 30 minute maximum handover time.

Introduction of GP Heralded scheme for booking transport to hospital.

111 enhanced clinical triage for calls triggering an ambulance.

Work with care homes to reduce reliance on 999.

Target: Continuing work, although further actions will fall out from this. Completed

a

RISK 40 DATE ADDED FEBRUARY 2018

AC

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IN

ITIA

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AG

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(LIK

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RAG RATING OF

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R

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ED R

AG

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COMPLETION

LN

Currently East of England Ambulance are unable to meet the demand for its services, which may impact on the safety of patients

High levels of incidents / serious incidents reported end December 2017 through to February 2018. Early analysis, subject to further investigation suggests that high levels of reporting are due to system pressures and resultant delays attending.

5 x 4

20

Contract in place with

KPI’s Monthly Joint CCG

Contract Quality Review meetings

Monthly contract & performance meetings

Risk Summit Process System wide actions to

reduce demand and handover delays – including Care Homes specific

Robust investigation, then review of serious incident investigation reports through enhanced joint localities SI review Panel

External oversight of EEAST internal SI processes

EEAST weekly reporting of numbers of incidents considered SIs declared

Quality reports

received monthly

Appropriate challenge to reported quality metrics, agreeing actions where improvements required

Performance metrics

demonstrate that both demand and handover delays are reducing

Assurance that

incidents have been robustly investigated and that learning shared across system to mitigate against reoccurrence.

Assurance that robust

effective processes exist

Clear Communication of the numbers of SIs being declared

█

CHALLENGING

5 x 4

20

5 x 4

20

1. Monthly Joint CCG Contract Quality Review Meetings

Target: July 2018 Completed: 2. Produce report of trends

and themes from the Sis referenced at the risk summit

Target date: May 2018 Completed: 3. Establish a regular forum to

review and share learning from the SIs reported by EEAST

Target date: May 2018 Completed: May 2018 4. Risk summit 10 May 2018,

awaiting outcome to determine next steps

Target: TBD Completed:

Departmental Risk Register summary of top risks

Date: May 2018

For: COT and requested committees

Department Risk Description / consequences

Current controls / assurance

RAG Actions with status Completion date

Responsible person

1. Corporate Services

Failure to recruitment and retain GPs locally.

Work with Suffolk GP Fed on the development of schemes to attract / retain GPs. International recruitment bid successful and Project Team appointed. Successful bid for CCT Fellowship programme to recruit GP Trainees. Suffolk Locum Services established to support current locum GP’s and recruit new GP’s. GP5YFV workforce plan to oversee the whole project. PMO structure to monitor progress. STP project group to monitor progress on all work streams.

9

Bid in progress to establish a coordinated GP Retention scheme to include national initiatives and local schemes have been identified following three local workshops. Develop new clinical models that allow the substitution of GP capacity by other clinical professionals.

31 March 2020

Amanda Lyes

2. Corporate Services

Understanding of GDPR and implementation for Primary Care contractors

CCGs to recruit an IG lead for Primary Care. GPs have IG / GDPR via GP Fed and Suffolk Primary Care.

10

CCGs told they are responsible for providing GP IG support. CCG awaiting minimal level of service spec from NHSE. CCGs then to produce service spec for GP GDPR and IG support. This will be supported by a CCG IG lead for Primary Care, role to be advertised May 2018.

July 2018 Amanda Lyes / Paul Cook (IG)

Risk Description / consequences


Actions with status Completion date

Responsible person

1. COO Ips & East and West

Sustainability of robust primary care, individual practices that are at risk of service failure

Continue to work with Ipswich Primary Care, utilising the funds from the Vulnerable Practices Fund Continue to work with Haverhill practices and GP Federation to ensure sustainable primary care in the town

16

IESCCG: Heat map developed and updated monthly. Practices identified for support. First Practice Resilience Fund decision Feb 2017, two practices in Ipswich had successful bids WSCCG: Haverhill continues to have capacity issues; reduction in GP Partners, and both practices in the area now reliant upon locum cover. Haverhill Family Practice had to close its list in December, services now reduced. CCG supporting Lakenheath with capacity issues and Long Melford with GP recruitment issues

31 March 2018

David Brown / Lois Wreathall

2. COO Ips & East

CCG is entering into an agreement with IBC for abortive costs with a range from £0 to £380k

Regular meetings with the 3 practices to identify and respond to issues that may cause the project to stall

16

Outline agreement drafted. Approach agreed by PCCC 27.9.17. Some practices expressing concern re negative equity Being followed up.

31 March 2018

David Brown

3. COO Ips & East and West

Potential for harm and service disruption if patient risks are not adequately managed by the SAS service

Existing controls eg police attendance may be revised and supplemented in light of outcome of review

16

New GP identified. Incident review pending Alternative premises options being assessed Participation in area wide procurement

March 2018 - delayed

David Brown




Responsible person

1. Contracts Lack of visibility on 18 week RTT at WSFT. Patients not seen in timely manner

On GBAF 16

Reviewed on GBAF May - Oct 2018

Jane Webster

2. Contracts IHT failing to meet A&E 4 hour standard presenting a potential risk to patient safety and experience

On GBAF 16

Reviewed on GBAF Sept 2018 Jon Reynolds

3. Contracts WSFT failing to meet A&E 4 hour standard presenting a potential risk to patient safety and experience

On GBAF 16

Reviewed on GBAF Sept 2018 Jane Webster

4. Contracts EEAST is failing performance targets against ambulance response categories, particular concern are delays in higher acuity Category 1 and 2 calls.

On GBAF 20 Reviewed on GBAF Continuing Jane Webster




Responsible person

1. Finance Controlled Environment for Finance (CEfF). Breach in respect of patient identifiable data.

Mandatory training for all staff. CEfF established and procedures in place.

12

Working with IG Consultant to ensure risk minimised. Additional concerns re access to footplate at EH via the fire doors. Privacy screens now ordered.

31 May 2018 Mark Game

2. Finance Financial data and systems unavailable due to loss of access to systems or IT failure (cyber-attack)

IT disaster recovery plans in place and tested. All staff issued with new laptops, etc.

12

EH HQ has led to some network issues / instability. More remote / home working has resulted in some connectivity issues / increased downtime. Delay in roll out of jabber starting to become an issue, however being trialled by the Corporate Intelligence team during April/May

June 2018 Mark Game (in conjunction with Head of

IT)




Responsible person

1. Nursing Paediatric speech and language service delivered by SCH has a back log

The CCG has allocated additional funding to the service and is working with SCC on a new working model

12

March18. Mapping of current services to be finalised at end of March with future service requirements developed thereafter

Oct 2018 Chris Hooper

2. Nursing CHC appeals. CHC team unable to release staff to support review panels resulting in unquantified financial risk as cases are unable to be processed and reviewed.

Redesigned appeals process in place

12

Appeals to transfer to Landmark House to make it easier to access notes. CHC Nurse allocated to Appeals.

June 2018 Chris Hooper / Michael Wigg




Responsible person

1. Risk of Disconnect between STP and BAU agendas

Moving towards STP working, there is a potential for duplication or gaps around local CCG level working

Communications within the team and across the STP. Regular meetings with STP partners

9 Discussion of different agendas at SMT and STP specialty meetings. Conversation with NHSE

December 2018

Chief Transformation

Officer

2. Transformation 100 day challenge programme-lack of Trust engagement—potential reputational risk

Overview from Transformation teams and planning of future meetings. NHSE overview and support

12 Escalated in Trust (9/01/18) April 2018 Chief Transformation

Officer

of 3

GOVERNING BODY

Agenda Item No. 12


Date. 23 May 2018

Title Procurement Update: Summary of Activity 2018/19

Lead Chief Officer Jane Webster, Acting Chief Contracts Officer

Author(s) Jane Garnett, Procurement Lead

Purpose To update the Governing Body on the procurements completed since the last procurement update and those currently in progress and planned for 2018/19.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

It is recommended that the Governing Body note the work undertaken and the evolving procurement work programme for 2018/19.

1. Update 1.1 The table below summarises the current health service procurement activity.

Procurement Name PQQ Bidders

ITT Bidders

Awarded to Contract Start

Integrated Urgent Care (OOH / 111) 2 TBC 01/11/2018

Ophthalmology Referral Refinement and Remote Review Platform (Lot 1)

1 1 01/09/2018

Integrated Pain Management Services

TBC TBC TBC

Current Procurements 1.2 Integrated Urgent Care (OOH / 111)

The procurement for this service re-started in January 2018 and is running jointly with Ipswich and East Suffolk CCG and North East Essex CCG as part of the Sustainability and Transformation Plan (STP). The revised procurement is being led by North East Essex Clinical Commissioning Group and is currently proceeding through the award governance process within the three CCGs. The award for this procurement is subject of a report within the May 2018 Governing Body.

1.3 Ophthalmology Referral Refinement and Remote Review Platform

A procurement to secure ophthalmology providers for an Ophthalmology Referral Refinement and Remote Review Platform and a Community Ophthalmology Service (IESCCG only) started in January 2018. This is a joint procurement with West Suffolk NHS Foundation Trust, Ipswich and East Suffolk CCG and Ipswich Hospital NHS Trust. The procurement for two services is being undertaken as a single process with two distinct lots to allow a reduction in duplication where possible and to allow the option of joint submissions across the lots. Ipswich and East Suffolk CCG and Ipswich Hospital NHS Trust will be procuring the Community Ophthalmology Service under Lot 2 as this will be restricted to the Ipswich and East Suffolk locality, whereas the Ophthalmology Referral Refinement and Remote Review Platform will extend across both CCGs. This procurement is currently in the standstill period; the outcome of the standstill period is not yet known and the award details have not been released publically at the time of writing this report.

Future Procurements 1.4 Integrated Pain Management Services

A review of the current Pain Management Service is underway and as part of this review a prior information notice was released to the wider market to allow interested parties to express an interest in the services. This is an informal market engagement process to understand the potential for a successful competitive tender process versus looking to carry

out a ‘most capable provider’ process with the incumbent providers who form part of the West Alliance. One organisation responded to the prior information notice and met with representatives from West Suffolk Clinical Commissioning Group; however, it was apparent from the meeting that they would not want to provide the community aspects of the service specification. With this in mind the CCG are looking to start a ‘Most Capable Provider’ process which will look to establish whether West Suffolk NHS Foundation Trust and Suffolk GP Federation are uniquely placed to deliver integrated services moving forward in a manner which would not be able to be reproduced by a partnership of other providers. This process will entail evaluating evidence to understand the offer from the organisations to ensure that the capacity and capability are secure and that the service offer provides advantages which would not be matched by a partnership of other providers.

2. Key Points 2.1 The following list of services are likely to be in the procurement portfolio over the coming

year; the shaded areas denote when it is anticipated that these will be actively procured and mobilised.

Please note this list does not include any Ipswich & East Suffolk CCG only procurements

3. Patient and Public Involvement 3.1 Members of the Community Engagement Group were involved in the evaluation of the

Integrated Urgent Care Service tender. 3.2 The procurement team have secured patient representation for the Ophthalmology Services

tender, and will look to seek involvement in the Integrated Pain Management procurement process.

4. Recommendation 4.1 It is recommended that the Governing Body note the work undertaken and the evolving

procurement work programme for and 2018/19.

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GOVERNING BODY

Agenda Item No. 13


Date. 23 May 2018

Title Health, Safety and Risk Committee


Author(s) Tony Buckle, Risk Manager

Purpose To update the Governing Body on current health and safety issues

Applicable CCG Clinical Priorities: 1. Develop clinical leadership2. Demonstrate excellence in patient experience & patient engagement3. Improve the health & care of older people4. Improve access to mental health services5. Improve health & wellbeing through partnership working6. Deliver financial sustainability through quality improvement


To note the report.

1. Purpose 1.1 To advise the Governing Body of work currently being undertaken in relation to Health &

Safety.

2. Background 2.1 The Health, Safety and Risk Committee, chaired by the Chief Corporate Services Officer,

continues to meet on a quarterly basis.

2.2 The committee review the H&S annual plan at these meetings to ensure that the CCGs remain compliant with current H&S legislation.

3. Key Points

3.1 The last meeting of the committee was on 8 May 2018.

Issues reviewed included the following items • Health & Safety training continues on-line, staff have been provided with information

about how to access the training (via The Buzz). The current compliance with the training is 100%.

• There was one health and safety related incident reported since the last meeting. A

brief description of the incident was given. No further action was necessary. • Details were given of the latest sickness absence statistics. More detailed information

is now available. The tables presented highlighted monthly percentage sickness rates against the target rate. Also, data can be broken down into specific absence reasons, age group, directorate percentages and numbers. Current sickness rate is 2.72% against a target of 2%.

• The CCGs attend the Endeavour House, West Suffolk House and Landmark House

‘Business User Group (BUG)’ meetings. Any health and safety concerns from the Health, Safety and Risk Committee will be relayed to the ‘BUG’ meetings.

• The Safetyboss update (the CCGs H&S Advisers) stated that there were no major

changes to health and safety legislation. The latest version of the newsletter they produce twice per year was given to the attendees; this is displayed on noticeboards.

• The CCGs have registered to take part in the Vitality Health / Financial Times ‘Britain’s

Healthiest Workplace’ initiative. This is an assessment of an organisations well-being including mental health. The results are available later in the year.

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Reference No. WSCCG 18-33a


Declaration of Interests – Six Month Review

Lead Chief Officer

Amanda Lyes, Chief Corporate Services Officer

Author(s)

Colin Boakes, Governance Advisor

Purpose

The report provides a public record of relevant and material interests declared by members of the West Suffolk CCG Governing Body, its sub-committees, staff and member practices.

Applicable CCG Clinical Priorities: 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: The Governing Body is asked to review the current register, and consider whether any action in relation to non-responders might be required.

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1. Background

1.1 Clinical commissioning groups (CCGs) manage conflicts of interest as part of their

day-to-day activities. Effective handling of conflicts of interest is crucial to give confidence to patients, tax payers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. It is essential in order to protect healthcare professionals and maintain public trust in the NHS. Failure to manage conflicts of interest could lead to legal challenge and even criminal action in the event of fraud, bribery and corruption.

1.2 Conflicts of interest are inevitable in commissioning. It is how we manage them that

matters. Section 14O of the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) (“the Act”) sets out the minimum requirements of what both NHS England and CCGs must do in terms of managing conflicts of interest.

1.3 As a minimum, CCGs must have robust systems in place to identify and manage

conflicts of interest. This should involve creating an environment in which CCG staff, Governing Body and sub-committee members, and member practices feel able, encouraged and obliged to be open, honest and upfront about actual or potential conflicts. Transparency in this regard is expected to lead to effective identification and management of conflicts. The effect should be to make everyone aware of what to do if they suspect a conflict and ensure decision-making is efficient, transparent and fair. To this end, CCGs are now required to implement this statutory guidance in a manner that is clear and robust, but not overly prescriptive or complex

1.4 To further support CCGs in managing the risks of conflicts of interest, NHS England

has issued revised statutory guidance that supersedes Managing Conflicts of Interest Statutory Guidance, which was published in December 2014. The guidance has been further strengthened in light of findings of NHS England’s 2015/16 co-commissioning conflicts of interest audit, the National Audit Office’s (NAO’s) report on conflicts of interest management in CCGs and feedback received from a range of stakeholders and partners, including the BMA, RCGP, GMC, NHS Clinical Commissioners, CCGs, Healthwatch England, NHS Improvement, NHS Protect, and other organisations, as part of a public consultation exercise.

2. Key Points 2.1 As a result of the revised guidance CCG Officers, Governing Body members, GPs,

all staff, including students, agency and seconded staff, together with practice staff with involvement in CCG business are now required to complete declarations.

2.2 Declarations are sought on an annual basis in October with an update by exception in April of each year and the register published on the CCG’s website.

2.3 The updated register following the recent six-month review is attached to the report

at Appendix 1. Correspondence issued in an attempt to acquire declarations is as follows:

• CCG Governing Body and Sub-Committee Members – original request sent

on 2 April 2018 with reminders on 24 April 2018 and 30 April 2018. Register now complete.

• CCG Member Practices – original request to the Chief Operating Team (COO

team responsible for chasing practices) on 29 March 2018 with reminder on 24 April 2018.

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• Staff – original request on 4 April 2018 with reminder on 24 April 2018

Those individuals and practices that have not yet responded to the April review are indicated by red dates in the ‘date of receipt’ column.

3. Recommendation 3.1 The Governing Body is asked to review the current register and also to consider it

alongside the recommendations set out in the accompanying paper IESCCG 18-34b ‘Managing Conflicts of Interest: Submission of Declarations of Interest by CCG Member Practices.

Interests of:

Governing Body and Sub-Committee MembersAll CCG Staff

Member Practices

Register of Interests

April 2018

West Suffolk CCG

Financial Interests

Non Financial Professional

Interests

Non Financial Personal Interests

From To

Governing Body GP Member Zohra Armitage Session GP fo Suffolk GP Federation Direct 2015 Ongoing 20/04/2018 No further action required YesHusband is a consultant urologist at Addenbrookes Hospital Indirect 01/01/2014 Ongoing 20/04/2018 No further action required Yes

Lay Member for Governance and Vice Chair CCG Geoff Dobson Nil 03/04/2018 YesCCG Chair Christopher Browning PMS Provider, Practice Partner Long Melford Direct 2000 Ongoing 30/04/2018 To be declared at relevant meetings Yes

Chair, Hartest Parish Council Direct 2012 Ongoing 30/04/2018 To be declared at relevant meetings YesOut of Hours doctor for Care Uk Direct 2000 Ongoing 30/04/2018 To be declared at relevant meetings YesGP+ doctor for Suffolk GP Federation Direct 2000 Ongoing 30/04/2018 To be declared at relevant meetings Yes

Lay Member Steve Chicken Owner and MD of Galliform Ltd, consultancy and training company. No NHS activity Indirect 2009 Ongoing 06/04/2018 No further action required YesChief Officer Ed Garratt Chief Officer for Ipswich and East Suffolk CCG Direct Mar-16 Ongoing 03/04/2018 To be declared at all relevant meetings and events YesGoverning Body GP Member Andrew Hassan Nil 24/04/2018 YesChief Corporate Services Officer Amanda Lyes Chief Corporate Services Officer for Ipswich and East Suffolk CCG Direct Ongoing 24/04/2018 None YesChief Nursing Officer Lisa Nobes Chief Nursing Officer for Ipswich and East Suffolk CCG Direct Ongoing 03/04/2018 None YesChief Finance Officer Jane Payling Audit Committee Chair for Tower Hamlets GP Care Group Direct Ongoing 03/04/2018 To declare when appropriate Yes

Chief Finance Officer for Ipswich and East Suffolk CCG Direct 25/09/2017 Ongoing 03/04/2018 None YesConsultant in Public Health Medicine Jep Ronoh Husband is a salaried GP at Hardwicke House Surgery and does locum work for Care UK, Out of hours provider Direct Ongoing 24/04/2018 YesGoverning Body GP Member Bahram Talebpour Partner in a GP Practice holding a contract with Hazell Court Direct Ongoing 18/04/2018 To declare when appropriate YesChair of Community Engagement Partnership David Taylor Chairman of Hargrave Parish Council Direct Apr-17 Ongoing 04/04/2018 No further action required YesChief Operating Officer Kate Vaughton Nil 10/04/2018 YesGoverning Body GP Member Firas Watfeh Local Medical Committee member Direct 01/08/2015 Ongoing 18/04/2018 To be declared at relevant meetings Yes

Works for Care UK and GP+ Direct 01/04/2013 Ongoing 18/04/2018 To be declared at relevant meetings YesGP Partner at Haverhill Family Practice Direct 04/07/1905 Ongoing 18/04/2018 To be declared at relevant meetings Yes

Chief Transformation Officer Richard Watson Chief Transformation Officer for Ipswich and East Suffolk CCG Direct Jun-16 Ongoing 03/04/2018 None YesActing Chief Contracts Officer Jane Webster Acting Chief Contracts Officer for Ipswich and East Suffolk CCG Direct Nov-17 May-18 03/04/2018 To be declared as necessary YesGoverning Body GP Member Vacant GP PostGoverning Body GP Member Vacant GP PostGoverning Body GP Member Vacant GP PostGoverning Body PM Member Vacant PostGoverning Body PM Member Vacant PostLay Member for Patient and Public Involvement Vacant PostSecondary Care Doctor Vacant Post

West Suffolk CCG Governing Body and Sub Committee Members

Title First Name Last Name Direct or Indirect

Date of Interest Date of Receipt

Action Taken to Mitigate Consent to Publish

Type of InterestDeclared Interest

Declared Interest

Financial Interests

Non Financial

Professional Interests


From To

yes Mrs Helen Abel Lead Contract Manager - Acute Nil 04/04/2018 Yes

Mr. Adewale Abimbola Senior Pharmacist Nil 19/04/2018 Yes

Mrs. Joanne Agnew Nurse Coordinator Nil 05/04/2018 Yes

Mrs Caryn Akers Referral Facilitator Nephew is a radiographer at Addenbrookes Indirect 30/10/2017 Ongoing 04/04/2018 No further action necessary Yes

Mr. Angus Alamein Press Officer Nil 04/04/2018 Yes

Mrs. Frances Aldridge Clinical Systems Support Analyst Nil Direct Mar-16 Ongoing 04/04/2018 Yes

Mr Simon Aldridge Head of PMO Nil 05/04/2018 Yes

Mrs Claire Allen Medicines Management Technician Nil 24/04/2018 Yes

Miss Katie Allison Advanced Practice Support Pharmacist Nil 29/09/2017 Yes

Mrs Rebecca Ambrose Nurse Coordinator Nil 20/10/2017 Yes

Mrs Phyllis Anderson Human Resources Manager Nil 04/04/2018 Yes

Dr Caroline Angus STP Prevention Programme Manager No form received as yet

yes Mrs. Julie Atkins Contracts Manager Requested declaration not be published Indirect Ongoing 02/04/2018 To declare when appropriate No

yes Indirect Ongoing 02/04/2018 To declare when appropriate No

yes Miss Carrie Bacchus Contract Manager Leave - April 2018

Dr Padmanabhan Badrinath Consultant in Public Health - IFR Panel Employee of Suffolk County Council Direct 2013 Ongoing 03/04/2018 To be declared when necessary YesSeconded one session a week to Cambridge University to carry out student teaching and evaluation

Direct 2013 Ongoing 03/04/2018 To be declared when necessary Yes

Member of the BMA Direct 2013 Ongoing 03/04/2018 To be declared when necessary Yesyes Mrs Clare Banyard Asso Director of Transformation Leave - April 2018

Miss Julie Baran Digital Programme Manager Sole director of J Baran Consultancy Ltd previous supplier of services/consultants to the NHS

Direct Feb-13 Ongoing 04/04/2018 None Yes

Mrs. Leanne Bartholomew Senior Medicines Management Technician Band 6 RBH Employed on casual basis by GP Practice Direct 2013 Ongoing 04/04/2018 To be declared as necessary Yes

Mr. Martin Bate Redesign Project Manager Treasurer for St Edmundsbury Local Diabetes UK Group Direct 2016 Ongoing 04/04/2018 No further action necessary Yes

Wife is Nursing Asst in Fracture Clinic, West Suffolk Hospital Indirect 2014 Ongoing 04/04/2018 No further action necessary Yes

Mr. Paul Belton Data Architect Wife works as pharmacist at West Suffolk Hospital Indirect 20/08/2005 Ongoing 09/04/2018 To declare when appropriate Yes

yes Mrs. Ameeta Bhagwat Finance Manager Nil 04/04/2018 Yes

Mrs Michelle Black CHC Nurse Assessor Bank staff member for Suffolk Community Healthcare Direct Jan-17 Ongoing 28/09/2017 None due to end Yes

Miss Lisa Bond IT Training Coordinator Nil 06/04/2018 Yes

Mrs Rachel Bottomley Senior Transformation Lead Nil 04/04/2018 Yes

Mrs. Sally Bovey IT Training Coordinator Nil 04/04/2018 Yes

Mrs. Helen Bowles Transformation Lead Nil 05/04/2018 Yes

Mrs. Hannah Boyce Contract Manager Partners mother is employed as colorectal nurse at Colchester Hospital Indirect Ongoing 10/04/2018 No further action required Yes

Mr. Alexander Briggs Head of Corporate Intelligence Nil 10/04/2018 Yes

Miss Louise Brookes Project Manager Nil 18/04/2018 Yes

yes Mr. David Brown Deputy Chief Operating Officer Wife is partner in Horkstow GP solutions (dormant) Indirect N/A 04/04/2018 None Yes

Mr Gregory Brown Contracts Manager Nil 04/04/2018 Yes

yes Mrs. Nicola Brunning Lead Contracts Manager - Community Sister is a paediatric nurse at Ipswich Hospital Indirect - Ongoing 09/04/2018 None Yes

Mr Anthony Buckle Risk Manager Wife works at Two Rivers Medical Practice Indirect 06/11/2017 Ongoing 04/04/2018 None Yes

Mrs. Lois Rebecca Bull System Flow Manager Member of HCPC Reg Physio work at Ipswich Hospital NHS Trust Direct Oct-15 Ongoing 04/04/2018 None Yes

Mrs. Jill Burgess Reporting Analyst Nil 05/04/2018 Yes

Mrs. Jennifer Burman Implementation Administrator Nil 04/04/2018 Yes

yes Mrs. Valerie Butcher Acute Commissioning Finance Specialist Nil 04/04/2018 Yes

yes Miss Catherine Butler Head of GP Prescribing Partner works as a CQC registration inspector in Midlands and East Region Indirect Oct-15 Ongoing 04/04/2018 None Yes

Mrs. Joanne Bye Senior Medicines Management Technician Band 6 RBH Requested declaration not be published Direct Sep-06 Ongoing 02/04/2018 To declare when appropriate No Direct Mar-09 Ongoing 02/04/2018 To declare when appropriate No

Ms. Jennifer Cahill Project Officer Nil 26/04/2018 Yes

Mrs. Eve Calderbank Finance Manager Nil 04/04/2018 Yes

Mr Luke Cannon SQL Developer Nil 25/09/2017 Yes

Miss Gail Cardy Project Support Officer Member of Bury St Edmunds DAA Direct 2017 Ongoing 28/09/2017 To declare when appropriate Yes

Advocate of Dementia Together Direct 2017 Ongoing 28/09/2017 To declare when appropriate

yes Mr. Martin Casbolt ITSM Programme Manager Nil 04/04/2018 Yes

yes Mrs. Sandra Chambers Business Support Manager Nil 24/04/2018 Yes

Mrs. Hayley Charman Communication & Engagement Officer Leave - April 2018

Mrs. Beaulah Chizimba Designated Nurse Safeguarding Children Director of a company which is not trading and is filed as a dormant company at company house

Direct Ongoing 04/04/2018 No further action required Yes

Sister is the Director of (PHOEBE) a voluntary organisation which works to promote health, opportunity, equality, benevolence and empowerment for black and ethnic minority women and children in Suffolk

Indirect 2017 Ongoing 04/04/2018 No further action required Yes

Mr Rifat Choudhury Advanced Practice Support Pharmacist Bank Pharmacist at Ipswich Hospital Direct Oct-17 Ongoing 04/04/2018 No further action required Yes

Wife works at EPUT as a mental health pharmacist Indirect 2018 Ongoing 04/04/2018 No further action required Yes

Direct or Indirect

Staff ListBudget

Signatory £5k+

Consent to PublishDate of Receipt Action Taken to MitigateTitle First Name Last Name Type of Interest Date of InterestPosition Title

Miss Lauren Clarke CHC Administrator Nil 09/04/2018 Yes

Mrs. Susan Clarke Dietetic Advisor Nil 04/04/2018 Yes

yes Mr Mark Clinton Snr Mangement Accountant Wife works for Stroke Early Supported Discharge Team provided by Norfolk Communty Health and Care

Indirect Ongoing 26/04/2018 Yes

yes Ms. Anna Cochrane Head of ICT & Informatics Husband is Senior Manager of Pure Resourcing recruitment consultancy Indirect Ongoing 04/04/2018 None Yes

yes Ms. Isabel Cockayne Head of Communications & External Relations On Secondment to EEAST April 2018

Mrs. Hayley Collins Patient Experience Officer Nil 16/04/2018 Yes

Mr. Paul Cook IM&T Project Manager Nil 04/04/2018 Yes

Mr. Daniel Cox Clinical Systems Support Manager Nil 04/04/2018 Yes

yes Mr. Richard Cracknell Head of Operations Wife and sister employed by Ipswich Hospital NHS Trust Indirect Ongoing 11/04/2018 No further action required Yes

yes Trustee of charity funding care in Romania Direct Ongoing 11/04/2018 No further action required Yes

yes Aunt and Uncle and Cousin work for Care UK Indirect Ongoing 11/04/2018 No further action required Yes

yes Member of Drive Team at Castle Hill Primary School Direct Ongoing 11/04/2018 No further action required Yes

Mrs. Merele Cruz Placement Support Officer Nil 04/04/2018 Yes

Mrs. Chloe Cummings Business Support Officer Nil 04/04/2018 Yes

Mrs Valerie Dadge Finance Assistant Nil 24/04/2018 Yes

Miss Elizabeth Davey Business Support Officer Leave - April 2018

yes Mr Perry Jaime Djahit Contracts Manager Partner is a midwife at Ipswich Hospital Indirect 15/01/2018 Ongoing 24/04/2018 Yes

Miss Bethany Dowling Business Support Officer Nil 04/04/2018 Yes

Mrs. Karen-Lynne Dowsing Transformation Lead Nil 24/04/2018 Yes

Mrs. Leonie Dozzell MASH:Business Support Officer Nil 25/04/2018 Yes

yes Mrs. Cindie Dunkling Designated Nurse Safeguarding Children Nil 31/10/2017 Yes

Ms. Michelle Eaton Care Homes Manager Nil 04/04/2018 Yes

yes Mr. Andrew Eley Deputy Chief Operating Officer Nil 04/04/2018 Yes

Ms. Rebecca Ellwood Placement Support Officer Leave - April 2018

Ms. Lisa Elmy CHC Nurse Assessor Husband is a Senior Matron at West Suffolk Hospital Indirect 23/01/2018 Ongoing 06/04/2018 Yes

yes Ms. Amanda Estall Redesign Project Manager Daughter is an Emergency Nurse Practitioner at Addenbrookes A&E Indirect 31/10/2016 Ongoing 26/04/2018 None Yes

Father is a user of the diabetes and respiratory services Indirect Ongoing 26/04/2018 Yes

yes Ms. Nerinda Evans Associate Director of Redesign Nil 24/04/2018 Yes

Miss Christine Eyers Clinical Review Nurse Paramedic Bank contract with East of England Ambulance Service Direct Ongoing 04/05/2018 None Yes

Mrs. Beverley Farnish Nurse Coordinator Advisor for the Care Quality Commission - Mental Health Direct Ongoing 05/04/2018 None Yes

Mrs. Helen Farrow Senior Executive Assistant Nil 04/04/2018 Yes

Miss Victoria Fennell PMO Manager Nil 06/04/2018 Yes

Dr Jonathan Ferdinand GP Associate Spouse is an Obs and Gynae Consultant at West Suffolk Hospital Indirect Mar-17 Ongoing 30/10/2017 None Yes

Ms. Emma Finbow Finance Officer Nil 04/04/2018 Yes

Mrs Cherry Finch IFR Lead Officer Nil 09/04/2018 Yes

Mrs. Marie Forster Continuing Healthcare Senior Business Administator Nil 10/04/2018 Yes

Mrs. Beata Francis Business Support Officer Nil 09/04/2018 Yes

Mrs. Tracey Frost Senior Medicines Management Technician Nil 04/04/2018 Yes

Mr. Christopher Fryer Placement Support Officer Nil 02/11/2017 Yes

yes Mrs. Lucy Game Operational Manager, NHS Continuing Healthcare Husband is Head of Accounting and Control for Ipswich and East and West Suffolk CCGs

Indirect Ongoing 04/04/2018 No further action required Yes

yes Mr. Mark Game Head of Accounting and Control Wife holds a senior position with CCGs managing Continuing Healthcare team

Indirect Ongoing 04/04/2018 To be declared when appropriate Yes

Miss Jane Garnett Lead for Procurement Nil 04/04/2018 Yes

Mrs Deborah Gibbs Senior Co-ordinator Continuing Healthcare Nil 31/10/2017 Yes

yes Ms. Gabrielle Gilhooly PALS Manager Nil 05/04/2018 Yes

Ms. Marielena Giner Patient and Public Engagement Officer Nil 13/10/2017 Yes

Mr. Michael Gooch Emergency Planning & Resilience Officer Nil 04/04/2018 Yes

Mr Stuart Graham Website Development Officer Nil 05/04/2018 Yes

Miss Tracey Green MASH:Business Support Officer Felixstowe Town Councillor Direct 2015 Ongoing 26/04/2018 No further action required Yes

Suffolk Coastal District Councillor Direct 2015 Ongoing 26/04/2018 No further action required Yes

Ms. Tabitha Griffin Named Nurse Safeguarding in Primary Care Nil 31/10/2017 Yes

Ms. Anita Hall CHC Administrator Nil 24/04/2018 Yes

Ms. Isobel Hall Placement Support Officer No form received as yet

yes Mrs. Elizabeth Hallworth Clinical Executive & Chief Operating Office Operation Mana Father and brother owners of Optometric Practices in Suffolk Indirect Nov-13 Ongoing 04/04/2018 None Yes

Ms. Holly Hammond Business Support Apprentice Nil 30/04/2018 Yes

yes Mrs. Louise Hardwick Head of Operations Nil 09/04/2018 Yes

Mr. John Harris Head of Ambulance Commissioning Consortium Nil 12/04/2018 Yes

Mrs. Janet Harrison Individual Funding Request Officer Nil 02/10/2017 Yes

Mr. Benjamin Harvey Infection Control Lead Nurse Nil 05/04/2018 Yes

Ms. Julia Hather Lead Nurse Nil 04/04/2018 Yes

Miss Julie Hattrell Children's Contract Manager Brother is a commissioner with Suffolk Public Health Indirect Ongoing 04/04/2018 None Yes

Mrs Donna Hawes Medicines Management Technician No form received as yet

Mrs. Doreen Hayden Clinical Coordinator Nil 24/04/2017 Yes

Miss Julia Hiley Estates Project Manager Employed by West Suffolk CCG 1.5 days and North Essex CCG 2.5 days per week

Direct Ongoing 13/05/2018 None Yes

Miss Molly Hill Finance Officer Nil 24/04/2018 Yes

Mr Graham Hillson Strategic Project Officer Nil 04/04/2018 Yes

Mrs. Sarah Hobbs Nurse Coordinator Nil 18/04/2018 Yes

Mrs. Christine Hodby Adult Safeguarding Lead, Lead for MCA/DOLS, Lead for Prev Nil 05/04/2018 Yes

Mrs. Elizabeth Hogg Nurse Coordinator Nil 04/04/2018 Yes

Mrs. Hazel Hole Independent Lay Member Nil 04/04/2018 Yes

Mrs. Ruth Holmes Finance Assistant Nil 04/04/2018 Yes

Mrs. Caroline Holt MASH:Specialist Nurse Nil 04/04/2018 Yes

yes Mr. Roger Holt Financial Accounts Manager Nil 04/04/2018 Yes

yes Mr Chris Hooper Deputy Chief Nursing Officer Wife works for Community Services Provider in senior role Indirect 2013 Ongoing 03/04/2018 None Yes

yes Ms. Suzanne Hoy Contract Manager Nil 17/04/2018 Yes

Mr Robert Hudson Interim Deputy Chief Finance Officer Director of Abby Consulting Ltd Direct Ongoing 24/04/2018 Yes

yes Mrs. Belinda Hume Head of Commissioning & Finance Husband is Dep Chief Operatingn Officer of Norfolk and Waveney NHS Arden and Greater Midlands CSU

Indirect - Ongoing 24/04/2018 Yes

yes Mr. Matthew Hunt IM&T Coordination Manager Nil 18/04/2018 No

Mrs. Lisa Hutchinson Medicines Management Technician Leave - April 2018

yes Mrs. Julie Irving Information Sharing Programme Manager Nil 17/04/2018 Yes

Mrs Fiona Jackson Human Resources Officer Nil 04/04/2018 Yes

Mrs. Melanie Jacobs Payments Officer Nil 04/04/2018 Yes

Mrs. Jennifer Jarratt Systems Administrator Nil 05/04/2018 Yes

Mr. Martin Jarrett Redesign Project Support Manager Nil 24/04/2018 Yes

Mrs. Claire Jay Transformation Lead Family in need of secondary and community care Indirect 01/01/2016 Ongoing 10/04/2018 None Yes

yes Mrs. Jo John Transformation Lead Nil 09/04/2018 Yes

Mrs. Karen Johnson Senior Information Analyst Nil 04/04/2018 Yes

Miss Jessica Jones Continuing Healthcare Nurse Assessor Leave - April 2018

Miss Eleanor Joyce Business Support Apprentice Nil 26/04/2018 Yes

Mrs Sharon Keeble Patient Safety and Clinical Effect Adminstrator Nil 05/04/2018 Yes

yes Mrs. Julie Kerridge Senior Management Accountant Nil 04/04/2018 Yes

Mrs Carol King Business Support Officer Nil 09/04/2018 Yes

Mrs Fiona Kreamer Finance Assistant Nil 04/04/2018 Yes

Mrs. Laura Krolik Commissioning Implementation Manager Govenor of primary school Direct May-18 Ongoing 26/04/2018 Yes

Miss Tina Larter Business Support Officer Sister is a trainee nurse with UCS at Ipswich Hospital Indirect 2017 Ongoing 26/04/2018 No further action required Yes

Mother is an employee of Leading Lives Indirect Ongoing 26/04/2018 No further action required Yes

Father is an employee of 'What's Up' Social Enterprise Indirect 2016 Ongoing 26/04/2018 No further action required Yes

Ms. Tralee Lashley Appliances Nurse Nil 01/05/2018 Yes

Mrs. Lucy Lillistone Patient Experience Officer Nil 05/04/2018 Yes

Mrs. Linda Lord Chief Pharmacist Nil 04/04/2018 Yes

Mrs. Joanne Mael Corporate Governance Officer Nil 04/04/2018 Yes

Mr Darren Maguire Escalation Coordinator Nil 17/04/2018 Yes

Mrs Elizabeth Mapplebeck Corporate Portfolio Programme Manager Nil 04/04/2018 Yes

Mr Roderick Marau Transformation Lead No form received as yet

Mrs Rachel Marchment Finance Manager Nil 24/04/2018 Yes

Mrs. Lorna Marriott Project Manager - Contracts Nil 04/04/2018 Yes

Mrs. Samantha Ann Melero Clinical Review Nurse CT Superintendent Radiographer at West Suffolk Hospital Direct Jul-00 Ongoing 06/04/2018 None Yes

Miss Caitlin Miller Apprentice Nil 05/04/2018 Yes

Mr Atif Ali Mirza Finance Assistant Nil 25/10/2017 Yes

Mr Derek Mitchell Estates Project Manager Nil 09/04/2018 Yes

Ms. Shelley Mitchell Business Development Officer Nil 04/04/2018 Yes

Mrs. Crystal Moles Clinical Review Nurse Nil 24/04/2018 Yes

Ms. Helen Moore Nurse Coordinator Nil 26/04/2018 Yes

Mrs. Wendy Moore Clinical Threshold Team Nil 04/04/2018 Yes

yes Mrs. Hannah Morgan Assistant Management Accountant Leave - April 2018

Ms. Jacqueline Morris Business Support Officer Nil 04/04/2018 Yes

yes Mrs. Gillian Mountague Redesign Project Manager Nil 04/04/2018 Yes

Mrs Julie Munroe Nurse Coordinator No form received as yet

yes Miss Sheila Murnion Head of High Cost Drugs Management Nil 24/04/2018 Yes

Mrs. Hannah Neumann-May Senior Transformation Lead - Mental Health Nil 04/04/2018 Yes

Miss Victoria Newbery Clinical Assurance & Professional Lead Nil 04/04/2018 Yes

Mrs Louisa O'Brien Continuing Healthcare Nurse Assessor Nil 29/09/2017 Yes

yes Mr. Dean Onno Transformation Lead Nil 04/04/2018 Yes

yes Mrs Amy Osborne Contracts Manager Nil 13/04/2018 Yes

yes Mrs. Lorraine Parr Transformation Lead Husband works for Priory Group Indirect Ongoing 04/04/2018 None Yes

yes Volunteer for Samaritans Direct Ongoing 04/04/2018 None Yes

Mrs. Lisa Parrish Transformation Lead Ym RUFC Safeguarding Officer Direct Sep-14 Ongoing 09/04/2018 None Yes

yes Miss Claire Pemberton Commissisoning Implementation Manager Nil 05/04/2018 Yes

Mrs. Elizabeth Mary Peters Nurse Coordinator Nil 16/10/2017 Yes

Mrs Sharon Phillips MASH Specialist Nurse Nil 29/09/2017 Yes

Mrs Margaret Phillips SEND CIC Co-ordinator Nil 31/10/2017 Yes

Ms. Janice Pickett Placement Support Officer Nil 04/04/2018 Yes

Mr Scott Pomroy Commissioning Support Officer Nil 06/04/2018 Yes

Mrs Hannah Pont Transformation Lead Nil 04/04/2018 Yes

Mrs. Joanne Laura Porter Information Analyst Nil 31/10/2017 Yes

yes Mrs. Caroline Procter Co-Commissioning Manager Nil 04/04/2018 Yes

Miss Julie Purnell MASH Senior Health Research Officer Nil 12/10/2017 Yes

Mrs. Linda Jane Putland Nurse Coordinator Bank Nursing Contract with Sanctuary Supported Living Direct Jul-16 Jan-18 26/04/2018 None Yes

Miss Caroline Pyrozuk Safeguarding Administrator No form received as yet

Mr. Stuart Quinton Primary Care Contracts Manager Nil 04/04/2018 Yes

Mrs. Michaela Rainbird Transforming Care Administrator Nil 04/04/2018 Yes

Mrs. Caroline Ratcliff Redesign Project Manager Nil 09/04/2018 Yes

Mr. Alexander Ratcliffe Clinical Systems Support Analyst Self employed (Clinical System Solutions) providing advice to healthcare providers in the area

Direct Ongoing 04/04/2018 Should not be involved in contract negotiations nor provide consultancy services that would conflict with CCG business

Yes

Miss Emma Ratcliffe Medicines Management Technician Nil 04/04/2018 Yes

Mrs. Emily Rawlinson Commissioning Implementation Manager Leave - April 2018

yes Mrs. Jemma Redfern Senior Co-ordinator Continuing Healthcare Nil 26/04/2018 Yes

yes Mr. Jonathan Reynolds Deputy Chief Contracts Officer Nil 28/09/2017 Yes

Mrs Dawn Richardson STP Support Officer Nil 04/04/2018 Yes

Mrs. Catherine Ritson Nurse Coordinator Nil 02/11/2017 Yes

Dr Victoria Roberts GP Associate No form received as yet

Mr. Andrew Robertson End of Life Administrator Nil 05/04/2018 Yes

yes Mrs. Sandie Robinson Head of Planning and Delivery Nil 04/04/2018 Yes

Mrs Jane Rooney Head of Planned Care Transformation Nil 06/04/2018 Yes

Mrs. Emma Rougier-Pirie MASH:Specialist Nurse Nil 04/04/2018 Yes

Mr. Christopher Rouse Nurse Coordinator Nil 16/10/2017 Yes

Mrs. Alison Sadler Redesign Project Manager Nil 04/04/2018 Yes

Mr Russell Sawar Finance Officer Nil 26/04/2018 Yes

yes Mrs. Wendy Scott Children's Paediatric Continuing/Shared Care Reviewer Nil 16/04/2018 Yes

Mrs. Gemma Scruby Medicines Management Technician Nil 23/10/2017 Yes

Mrs. Rachel Seago Practice Support Manager Husband is creative consultant for Fellowship Productions (the company that produced the West Suffolk CCG website)

Direct Ongoing 04/05/2018 Yes

Mrs Penny Short Executive Assistant Nil 04/04/2018 Yes

Mr. Amerjit Singh Information Analyst Nil 31/10/2017 Yes

Mrs Stephanie Smyth Nursing Coordinator No form received as yet

Miss Gemma Spall Clinical Coordinator Nil 24/04/2018 Yes

Mrs Sarah Spink Senior Pharmacist Nil 04/04/2018 Yes

Mrs Karen Squirrell Nurse Coordinator Nil 04/04/2018 Yes

yes Mr. Eugene Staunton Head of Planning and Delivery Wife works for Macmillan Direct Ongoing 16/10/2017 No further action required Yes

Mrs. Victoria Stearn Clinical Review Nurse Nil 04/04/2018 Yes

Miss Patricia Stevens Redesign Project Manager Nil 04/04/2018 Yes

Mrs Rhian Summer-Hill Nurse Coordinator Nil 26/04/2018 Yes

Mr Dominic Surman-Wells MASH Specialist Nurse Nil 12/10/2017 Yes

Mrs. Emma Taggart Nurse Coordinator Nil 04/04/2018 Yes

Dr Rosalind Tandy GP Associate Employed by Suffolk Community Healthcare as GP providing medical assessment for children in care.

Direct Sep-16 Ongoing 16/04/2018 Yes

Salaried GP at Swan Surgery Direct Jun-13 Ongoing 16/04/2018 Yes

Husband is Consultant Psychiatrist and Clinical Director of UCP Cambridge Indirect May-15 Ongoing 16/04/2018 Yes

Miss Kelly Tatum Business Support Officer Nil 28/09/2017 Yes

yes Mrs. Anita Taylor Contract Manager Nil 16/04/2018 Yes

Mr. Lee Taylor Transformation Lead Aspect Living Foundation Charity - Trustee - Meals on Wheels Direct Feb-18 Ongoing 04/04/2018 No further action required Yes

yes Mrs. Jessica Taylor-Allum Information Analyst Brother is employed in FAB Unit at Ipswich Hospital NHS Trust Indirect Ongoing 04/04/2018 No further action required Yes

Mrs. Emma Thackwray Senior Data Analyst Nil 05/04/2018 Yes

Mrs. Claire Tilbrook Medicines Management Technician No form received as yet

Mrs. Rachael Trinder Finance Assistant Nil 04/04/2018 Yes

yes Mr John Troup Communications Manager Nil 04/04/2018 Yes

Mr Paul Tubby MASH Specialist Nurse No form received as yet

yes Mr. Giles Turner HR Business Partner Nil 24/04/2018 Yes

Ms. Megan Turner Finance Assistant Nil 26/04/2018 Yes

Mrs. Rebecca Turner Transformation Project Officer Nil 04/04/2018 Yes

Mrs Natalie Unwin Project Manager Nil 09/04/2018 Yes

Mrs. Lisa Wadey Finance Assistant Leave until June 2018

Mr. James Waites Account Manager (contracts) Nil 04/04/2018 Yes

Mrs. Sandra Walker Nurse Coordinator Nil 28/09/2017 Yes

yes Ms. Kate Walker Head of Digital Strategy & Transformation, Nil 04/04/2018 Yes

Mrs. Katy Walton Complaints Manager Nil 04/04/2018 Yes

Miss Eleanor Ward Business Support Officer Father is Leader of Babergh District Council Indirect Ongoing 04/04/2018 No further action required Yes

Mr. Colin Webb Information Contracts Manager Nil 04/04/2018 Yes

Miss Rebecca Webber Administrator Nil 04/04/2018 Yes

yes Mrs. Melanie Webster Senior Co-ordinator Continuing Healthcare Nil 04/04/2018 Yes

Mrs Tracey Welham MASH Specialist Lead No form received as yet

Mrs Julie White HR Business Manager Nil 04/04/2018 Yes

yes Mr. Michael Wigg Clinical Quality Contracts Manager Nil 26/04/2018 Yes

Mrs Samantha Wilson Practice Support Manager Brother Radiotherapist at Ipswich Hospital Indirect 2012 Ongoing 06/04/2018 No further action Yes

Sister in law senior nurse at West Suffolk Hospital and Bank staff at Ipswich Hospital

Indirect 2012 Ongoing 06/04/2018 No further action Yes

Mrs Ceinwen Wilson Patient Safety and Clinical Effect Adminstrator Nil 04/04/2018

Ms. June Wingfield Nurse Coordinator Nil 06/04/2018 Yes

Mrs. Jacquelyn Wood MASH:Specialist Nurse Nil 16/04/2018 Yes

Mrs. Rebecca Woods Nurse Coordinator Nil 04/04/2018 Yes

Mr. Stephen Woods Patient Safety Manager Nil 04/04/2018 Yes

Mrs. Amy Woodward Care Homes Administrator Nil 05/04/2018 Yes

Mrs. Trudy Woor Redesign Project Manager Nil 10/04/2018 Yes

Mrs Kelly Worger Individual Funding Request Officer Nil 04/04/2018 Yes

Mrs. Lois Wreathall Head of Practice Support Trustee of Abbeycroft Direct Mar-16 Ongoing 04/04/2018 None Yes

Mrs Jo Wyatt STP Secondment to STP - April 2018

Financial Interests

Non Financial

Professional Interests


From To

Angel Hill GP Sara Garrod Nil 04/04/2018 YesGP Paul Harrison Nil 06/04/2018 YesGP Laura Leach Nil 12/04/2018 YesGP Elizabeth Polli Nil 24/04/2018 YesGP Helen Spring Nil 01/04/2018 YesGP Sujata Surti Nil 06/04/2018 YesGP William Tasker Nil 03/04/2018 YesGP Susanna Unsworth Nil 24/04/2018 Yes

Botesdale Health Centre GP Lauren Bate Nil 03/04/2018 YesCompany Secretary and shareholder in Botesdale Rural Services Ltd trad Direct 2008 Ongoing 03/04/2018 To declare when appropriate YesDirector/Owner Mooncoast Ltd Direct Ongoing 03/04/2018 To declare when appropriate

GP Tim Cooke Owns a 33% third share of Health Centre Direct Ongoing 25/04/2018 No further action required YesGP Lisa FennelowGP Donald MacEachern

Brandon Medical Practice GP Emmanuel Obiabo Nil 06/04/2018 YesGP Jacquelyn Rae

Clements Christmas Maltings GP Fiona Andrews Husband works for East Anglian Air Ambulance Indirect Sep-15 Ongoing 25/04/2018 None YesGlemsford Surgery GP Mary Giblin Owners of Pharmacy Direct Oct-15 Ongoing 03/04/2018 To be declared when appropriate Yes

GP Matthew Piccaver Owners of Pharmacy Direct Oct-15 Ongoing 03/04/2018 To be declared when appropriate YesGuildhall Surgery GP Simon Whitehead Nil 31/10/2017 Yes

GP Jane O'Donnell Nil 31/10/2017 YesGP Jonathan Huck Nil 31/10/2017 Yes

Guildhall and Barrow Surgery GP Heather Griffin Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 30/10/2017 To declare at all relevant committees when in attendance YesGP Lucy Hickson Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 06/04/2018 To declare at all relevant committees when in attendance YesGP Mark Hunter Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 05/04/2018 To declare at all relevant committees when in attendance YesGP Michael Jones Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 30/10/2017 To declare at all relevant committees when in attendance YesGP Peter Smye Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 30/10/2017 To declare at all relevant committees when in attendance YesGP Kate Wallace Director/Shareholder in company providing pharmacy services Direct 2013 Ongoing 26/04/2018 To declare at all relevant committees when in attendance Yes

Hardwicke House Surgery GP Alison CookeGP Jamie GilmourGP Bassam MorganGP Susmitha PavulviGP Rakesh Raja GP Partner in PMS Practice Direct Ongoing 06/11/2017 To declare at all relevant committees when in attendance Yes

Provides cover for rehab beds at Hazell Court Direct Ongoing 06/11/2017 To declare at all relevant committees when in attendance YesTrustee Brightstars Children's Charity Direct Ongoing 06/11/2017 To declare at all relevant committees when in attendance Yes

GP Bahram Talebpour Partner in a GP Practice holding a contract with Hazell Court Direct Ongoing 18/04/2018 To declare when appropriate YesGP Amanda Woods

Haverhill Family Practice GP Firas Watfeh Member of West Suffolk CCG Governing Body Direct 01/04/2016 Ongoing 18/04/2018 To be declared at relevant meetings YesLocal Medical Committee member Direct 01/08/2015 Ongoing 18/04/2018 To be declared at relevant meetings YesWorks for Care UK and GP+ Direct 01/04/2013 Ongoing 18/04/2018 To be declared at relevant meetings Yes

Lakenheath GP Judith Roberts Nil 26/04/2018 YesLong Melford Practice GP Christopher Browning PMS Provider, Practice Partner Long Melford Direct Ongoing 30/04/2018 To be declared at relevant meetings Yes

Chair, Hartest Parish Council Direct Ongoing 30/04/2018 To be declared at relevant meetings YesOut of Hours doctor for Care Uk Direct Ongoing 30/04/2018 To be declared at relevant meetings YesGP+ doctor for Suffolk GP Federation Direct Ongoing 30/04/2018 To be declared at relevant meetings Yes

GP Elizabeth Hornung GP Partner of Dr Browning WSCCG Chair Indirect Ongoing 07/11/2017 None YesMarket Cross Surgery GP A Mabourukoje

GP Godfrey Reynolds Chairman of Mildenhall Sick and Poor Fund Direct 1990 Ongoing 26/04/2018 To be declared when appropriate YesGP J Satish

Mount Farm Surgery GP Senior Partner Claire Giles Training Programme Director GP Training emplyed by HEEofE Direct Ongoing 17/10/2017 None YesExaminer for RCGP - occasional sessions Direct Ongoing 17/10/2017 None YesGP appraiser Direct Ongoing 17/10/2017 None Yes

GP Brian Ainsworth Nil 01/05/2018 YesGP Bethan Hughes Nil 16/04/2018 YesGP Martin Polli Wife is a partner at Angel Hill Surgery Indirect Ongoing 17/10/2017 No further action required Yes

Orchard House Surgery GP Sarah Ladner Nil 01/11/2017 YesGP Judith Lomas Member of Orchard House Health Ltd Direct Ongoing 04/04/2018 To be declared at relevant meetings Yes

Partner in Suffolk Primary Care Direct Ongoing 04/04/2018 To be declared at relevant meetings YesGP Tom McGonigle Requested not for publication Direct 01/02/2017 Ongoing 24/11/2017 To be declared at relevant meetings No

Requested not for publication Direct 01/04/2017 Ongoing 24/11/2017 To be declared at relevant meetings NoGP Helen Pullan Member of Orchard House Health Ltd Direct Ongoing 16/04/2018 To be declared when appropriate Yes

Partner in Suffolk Primary Care Direct 01/04/2017 Ongoing 17/11/2017 To be declared when appropriate YesGP Rupert Wace Member of Orchard House Health Ltd Direct 01/11/2016 Ongoing 04/04/2018 To be declared when appropriate Yes

Spouse is a partner at Rookery Medical Centre Indirect 21/06/1905 Ongoing 04/04/2018 To be declared when appropriate YesPartner in Suffolk Primary Care Direct 01/04/2016 Ongoing 04/04/2018 To be declared when appropriate Yes

Oakfield Surgery, Newmarket GP Andrea BarclayGP Deepa GuptaGP Nicholas Rayner

Rookery Medical Centre GP Partner Melanie Jackson Director/Shareholder in company providing pharmacy services 2017 Ongoing 12/10/2017 To declare at relevant committees when in attendance YesGP Partner Daniel Knowles Director/Shareholder in company providing pharmacy services Dec-16 Ongoing 11/04/2018 To declare at relevant committees when in attendance YesGP Partner Emma Ramsey Director/Shareholder in company providing pharmacy services 2017 Ongoing 12/10/2017 To declare when appropriate Yes

Husband works for Anglia Community Eye Services Ongoing 12/10/2017 To declare at relevant committees when in attendance YesGP Partner Malini Wace Director/Shareholder in company providing pharmacy services Direct 2017 Ongoing 12/10/2017 To declare when appropriate Yes

Siam Surgery GP Naseer Ahmed Nil 26/04/2018 YesGP Piotr Bulacz Nil 26/04/2018 YesGP Shalini Cross Nil 26/04/2018 Yes

West Suffolk Member PracticesPractice First Name Last Name Declared Interest Type of Interest Direct or

IndirectDate of Interest Date of

ReceiptAction Taken to Mitigate Consent

to PublishTitle

GP Malina Giusca Nil 26/04/2018 YesStanton Surgery GP Lucy Ross Nil 26/04/2018 Yes

GP Sara Raton-Lunn Nil 26/04/2018 YesGP Nicholas Redfern Nil 26/04/2018 Yes

Swan and Forest Surgeries GP Emma Derbyshire Non Executive Director of Swan Pharmacy Direct Ongoing 01/11/2017 To declare at all relevant committees when in attendance YesGP Crispin Dunne Non Executive Director of Suffolk GP Federation and shareholder in phar Direct 2014 Ongoing 16/04/2018 To declare when appropriate Yes

Member of LMC, GP Appraiser Direct 2005 Ongoing 02/11/2017 To declare when appropriate YesGP John Gove Requested not for publication Direct Ongoing 06/11/2017 To declare at all relevant committees when in attendance NoGP Matthew Mailey Requested not for publication Direct Ongoing 03/11/2017 To declare at all relevant committees when in attendance NoGP Peter Neale Requested not for publication Direct Ongoing 06/11/2017 To declare at all relevant committees when in attendance NoGP Kirsty Reid Requested not for publication Direct Ongoing 06/11/2017 To declare at all relevant committees when in attendance NoGP Rosalind Tandy Employed as an associate by West Suffolk CCG Direct 2012 Ongoing 16/04/2018 None Yes

Employed as medical assessor for children in care Direct 2016 Ongoing 16/04/2018 None YesHusband is Consultant Psychiatrist and Cliincal Director at UCP Cambridge

Indirect May-15 Ongoing 16/04/2018 To declare when appropriate Yes

Victoria Surgery GP Ian ChapmanGP Nick HarpurGP Victoria Hunter Shareholder in G&B Medical Services Ltd Direct 23/05/2016 Ongoing 04/04/2018 To be declared at relevant meetings Yes

Husband is also a director of G&B Medical Services Ltd Indirect Ongoing 04/04/2018 To be declared at relevant meetings YesGP Simon LovegroveGP Jane Pallister

Wickhambrook Surgery GP Paul Cooper Nil 01/11/2017 YesGP Angela Clifton Brown Nil 06/11/2017 Yes

Woolpit Health Centre GP Clare Davies Director/Shareholder in company providing pharmacy services Direct 2010 Ongoing 03/04/2018 To be declared as necessary YesHusband is Consultant Paediatrician at West Suffolk Hospital Indirect 2002 Ongoing 03/04/2018 No further action required Yes

GP B McCannGP A McCollGP William Ridsdill-SmithGP B SpriggsGP R West

Meeting Date Committee/Body Individual Declaration Made Attendance Capacity27/04/2016 Joint Commissioning Committee Dr Christopher Browning As a GP within the West Suffolk area Remained in meeting

21-Feb-17 Remuneration and HR Committee Colin Boakes Item 8 (IR35 - New HMRC Off Payroll Rules) Colin Boakes declared interest as he was affected Remained in meeting - no decision taken

18/04/2017 Remuneration and HR Committee Amanda Lyes Amanda Lyes declared an interest in agenda item 09 (Remuneration of GP Governing Body Members and Chief Officers) and left the room when that item was discussed.

Left the room when item discussed

13-Jun-17 Audit Committee Kevin Bernard Item 13 - Waivers - as the practice manager for Botesdale Health Centre provider of ultrasound services

Remained in meeting as no decision required

25-Oct-17 Governing Body 'Private' Dr Christopher Browning As an employee of the out of hours service Remained in the meeting29/11/2017 Primary Care Commissioning Committee Dr Christopher Browning As a GP within the West Suffolk area Remained in meeting29/11/2017 Governing Body Dr Christopher Browning and Dr

Firas WatfehDr Christopher Browning and Dr Firas Watfeh declared an interest in agenda item 13 (Emergency Department Streaming Update) as they were both employed to carry out sessions as part of the streaming service. They both remained in the meeting whilst the item, which was for note, was discussed.

Remained in meeting

24/01/2018 Primary Care Commissioning Committee Dr Christopher Browning Dr Christopher Browning declared an interest as a GP within the CCG area. Remained in meeting28/02/2018 Primary Care Commissioning Committee Dr Christopher Browning Dr Christopher Browning declared an interest as a GP within the CCG area Remained in meeting28/02/2018 Commissioning Governance Committee Dr Christopher Browning No declarations of interests, other than those already published, were received. (Dr Christopher

Browning had previously declared as a GP contract holder at Long Melford and PMS contract holder)

Remained in meeting

27/03/2018 Primary Care Commissioning Committee Dr Christopher Browning Dr Christopher Browning declared an interest as a Personal Medical Services (PMS) provider. Remained in meeting

28/03/2018 WSCCG Governing Body Ed GarrattJane PaylingRichard WatsonChris Hooper

On behalf of all Chief Officers present, the Chief Officer declared an interest in agenda item 11 (Aligning Clinical Commissioning Groups to support development of the Integrated Care System).

Remained in meeting

25/04/2018 WSCCG Executive Dr Zohra ArmitageDr Christopher BrowningDr Andrew HassanDr Bahram TalebpourDr Firas Watfeh

Drs Armitage, Browning, Hassan, Talebpour and Watfeh all declared an interest in agenda item 4 (Subcutaneous Methotrexate Injection Options Paper) insofar as it might relate to primary care, they remained in the meeting.

Remained in meeting

25/04/2018 WSCCG Clinical Scrutiny Committee Dr Firast Watfeh As a GP in Haverhill, Dr Firas Watfeh declared an interest in item 6 (Governing Body Assurance Framework) insofar as it related to Haverhill Practices.

Remained in meeting

WEST SUFFOLK CCG - LOG OF DECLARATIONS

of 3

GOVERNING BODY

Agenda Item No. 14

Reference No. WSCCG 18-33b

Date. 23 May 2018

Title Managing Conflicts of Interest: Submission of Declarations of Interest by CCG Member Practices

Lead Chief Officer Amanda Lyes – Chief Corporate Services Officer

Author(s) Colin Boakes – Independent Governance Advisor

Purpose To inform the Governing Body about the ongoing difficulties in achieving a 100% compliance in the submission of declarations of interest from some GP practices together with recommendations for improvement

Applicable CCG Priorities: N/A 1. Develop clinical leadership2. Demonstrate excellence in patient experience & patient engagement3. Improve the health & care of older people4. Improve access to mental health services5. Improve health & wellbeing through partnership working6. Deliver financial sustainability through quality improvement


To note and approve

1. Background 1.1 NHS England published revised statutory guidance for CCGs on managing conflicts of

interest on 17 June 2017. This replaced the 2016 version of the guidance. 1.2 The guidance has been updated to ensure it is fully aligned with the recently published cross

system conflicts of interest guidance – Managing Conflicts of Interest in the NHS: Guidance for Staff an Organisations.

1.3 A key and on-going element of the guidance is a requirement for all relevant individuals to

submit a declaration of interests and this includes GP Partners and/or Directors of each CCG member practice.

1.4 All CCGs are required to undertake an audit of conflicts of interest management as part of

their internal audit on an annual basis and this includes compliance in the submission of declarations of interest.

2. Key Issues

2.1 In line with the statutory guidance, the West Suffolk CCG requires relevant individuals to submit an annual declaration of interest using the approved form, normally in October of each year. This is updated by exception each year, normally in April. There is also an obligation upon all relevant individuals to declare any new conflicts of interest immediately they become known and in any event within 28 days.

2.2 The declarations of interest form is simple and straightforward to complete and is provided with appropriate guidance on the various types of interest. It therefore takes only minutes to complete and is a task that is only required once each year unless there are changes.

2.3 The last internal audit of conflicts of interest management was undertaken in February 2018. Whilst this provided an overall substantial level of assurance, there was only partial compliance in respect of processes for declaring interests and this related almost entirely to submissions from GP practices.

2.4 Review by internal audit of the CCG conflict of interest master log highlighted that no response had been received from a number of member practices following the October 2017 annual declarations exercise.

2.5 The Corporate Services Office provided a number of reminders but regretfully some practices and/or GP partners still failed to respond.

2.6 At the Governing Body meeting on 29 November 2017, the Chief Corporate Services Officer provided a public record of relevant and material interests declared by members of the West Suffolk CCG Governing Body, its sub-committees, staff and member practices in October 2017 and escalated the issue regarding GP practice non-responders, requesting that its members and the Chief Operating Officer assist in order to achieve a 100% compliance.

2.7 Each GP practice in England is required by law to be a member of a CCG. The BMA guidance for GP’s on ensuring transparency and probity states that as a member of the CCG, practices are expected to act in the spirit of the CCGs Constitution which may also contain specific obligations (i.e. where something must be done) and which a requirement to submit an annual declaration of interest is one such obligation.

2.8 In addition, the Royal College of General Practitioners and NHS Confederation briefing on the issue stated that ‘if conflicts of interest are not managed effectively by CCGs, confidence in the probity of commissioning decisions and the integrity of clinicians involved could be seriously undermined’

2.9 A recommendation arising from the 2018 internal audit was that a further report be presented to the Governing Body regarding non-compliance by some GP Practices, clarifying the level of risk this presents to the reputation of the CCG in terms of managing conflicts of interest, together with recommendations for achieving 100% compliance.

3. Recommendations 3.1 It is clear that simply sending the declaration of interest forms to relevant individuals does not

necessarily result in a universal response, particularly from some GP practices. 3.2 It is therefore recommended that for GP practices an alternative process be employed,

namely that declarations of interest be a standing agenda item for the practice engagement visits at the appropriate time each year.

3.3 It is further recommended that the Practice Manager be given responsibility for ensuring

forms are completed and returned. 4. Approval 4.1 In order to demonstrate a full 100% compliance at the 2019 internal audit, the Governing

Body is requested to approve the foregoing recommendations.

of 38

GOVERNING BODY

Agenda Item No. 15


Date. 23 May 2018

Title Minutes of Meetings


Author(s) Jo Mael, Corporate Governance Officer

Purpose The report incorporates for endorsement, minutes and decisions from the following meetings;

a) Audit CommitteeThe unconfirmed minutes of a meeting held on 5 April 2018.

b) Remuneration and HR CommitteeThe unconfirmed minutes of 10 April 2018

c) Finance and Performance CommitteeThe confirmed minutes of meetings held on 21 February 2018 and 21March 2018 and unconfirmed minutes of a meeting held on 18 April2018

d) Clinical Scrutiny CommitteeThe unconfirmed minutes of a meeting held on 25 April 2018

e) CCG Joint Collaborative GroupThe unconfirmed minutes of a meeting held on 19 April 2018

f) West Suffolk CCG Primary Care Commissioning CommitteeThe unconfirmed minutes of a meeting held on 27 March 2018.

g) Commissioning Governance CommitteeThe confirmed minutes of a meeting held on 27 March 2018.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: To endorse the minutes as attached to the report whilst noting that ‘unconfirmed’ minutes remain subject to change by the relevant Committee/Group.

Unconfirmed Minutes of a meeting of the West Suffolk Clinical Commissioning Group Audit Committee held on Tuesday 3 April 2018

(Inquorate Meeting)

PRESENT Geoff Dobson - Lay Member for Governance (Chair) IN ATTENDANCE Neil Abbott - Head of Internal Audit Colin Boakes - Governance Advisor, CCG Vicky Chong - Ernst & Young Mark Game - Head of Accounting and Control Lisa George - Local Counter Fraud Specialist, TIAA Kevin Limn - TIAA Jane Payling - Chief Finance Officer Jerry Wedge - Audit Chair, North East Essex CCG 18/019 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted from; Steve Chicken – Lay Member Mark Hodgson - Ernst and Young: External Audit Amanda Lyes - Chief Corporate Services Officer Alison Riglar – Ernst and Young: External Audit


No declarations of interest, additional to those already published, were received.

18/021 MINUTES OF THE PREVIOUS MEETING

As the meeting was inquorate approval of the minutes of the West Suffolk CCG Audit Committee held on 6 February 2018 would be deferred until the next meeting.

18/022 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising and the action log was reviewed and updated with comment as follows: 18/005 – General Data Protection Regulation (GDPR) – the Committee noted the update and requested that it receive a further update in June 2018.

18/023 ANNUAL REVIEW OF TERMS OF REFERENCE

Although in receipt of the Committee’s current terms of reference for annual

review, approval would be deferred until the next meeting as the meeting was inquorate.

18/024 AUDIT CHAIRS LETTER FEBRUARY 2018

Those present were in receipt of a letter sent from NHS England to Audit Chairs,

dated 27 February 2018 in relation to Plans for Strengthening Assurance for Delegated Commissioning. It was highlighted that the CCGs had already carried out an internal audit of delegated primary care commissioning. Those present noted the content of the letter.

18/025 EXTERNAL AUDIT BRIEFING

Those present were in receipt of the most recent external auditor’s Audit

Committee briefing and the Committee’s attention was brought to the following sections; • How Brexit might relate to the NHS • The effect of the collapse of Carillion • Quality accounts requirements for 2017/18 • IFRS 15 – revenue from contracts with customers • Working together to reduce duplication within General Practice • EU General Data Protection Regulations • Key questions for the Audit Committee to consider were set out at the end of

the briefing. In relation to IFRS 15, it was questioned how NHS England might determine if CCGs had fulfilled their obligations. It was suggested that the June 2018 update to the Committee in respect of the General Data Protection Regulation (GDPR), include a response to the question, as outlined in the briefing, as to whether the CCG had a data protection programme and if it was able to provide evidence of how it complied with the requirements of the GDPR. In response to questioning, it was explained that working together to reduce duplication within general practice was in respect of the facilitation of increased knowledge sharing and communication. The Chief Finance Officer agreed to circulate a framework published by The Care Quality Commission and NHS England aimed at making the organisations work more effectively together and reducing duplication in the regulation and commissioning of general practice. Those present noted the external audit briefing.

18/026 INTERIM HEAD OF INTERNAL AUDIT OPINION REPORT

The Head of Internal Audit presented the draft internal audit annual report and

advised that although some audits required completion, an overall ‘reasonable’ assurance level had been achieved. Those present noted the content of the report which it felt appropriately reflected the year’s work.

18/027 INTERNAL AUDIT PROGRESS REPORT INC RECOMMENDATION TRACKER

The Head of Internal Audit presented the internal audit progress report with

highlighted points being; The following two audits were awaiting finalisation:

• Continuing Healthcare – the final management response was awaited • Better Care Fund – it was anticipated that the audit would be complete by

the end of the week.

Recommendation Tracker There were currently six recommendations that had exceeded their original completion dates. Two were associated with the completion of Ipswich and East Suffolk CCG’s constitution and were being progressed. Although some target dates had been revised, comments and updates were now being received in respect of all outstanding recommendations. Those present noted the content of the report.

18/028 INTERNAL AUDIT REPORTS

The following internal audit reports were received:

a) Assurance Review of IT Contracts

The assurance assessment for review of IT Contracts had resulted in an overall ‘substantial’ assurance level being achieved.

b) Assurance Review of Managing Conflicts of Interest

The assurance assessment for review of Managing Conflicts of Interest had resulted in an overall ‘substantial’ assurance level being achieved.

c) Information Governance Toolkit V14.1

The assurance assessment for review of the Information Governance Toolkit V14.1 had resulted in an overall ‘reasonable’ assurance level being achieved.

Those present noted the reports.

18/029 LOCAL COUNTER FRAUD ANNUAL REPORT

Those present received the Counter Fraud Annual Report for 2017/18 which

summarised work carried out by the Local Counter Fraud Specialist during the year under the terms of the service level agreement. It was explained that the annual report now contained the draft self-review tool and that there was an error in the presented report as the ‘hold to account’ standard should be ‘neutral’. The results from the self-review tool would be submitted to the Counter Fraud Authority (CFA) via an on-line submission process. After review of the submission the CFA was able to undertake an assessment should it be felt necessary. Those present noted the Counter Fraud Annual Report.

18/030 DRAFT COUNTER FRAUD RISK ASSESSMENT AND STRATEGIC WORK

PLAN

The Committee was in receipt of the draft Counter Fraud Risk Assessment and Strategic Work Plan. The work plan had been discussed with the CCG’s Chief Finance Officer and work had been based on areas previously been identified. Points highlighted included; • It was noted that the CCG had already commenced work in relation to the

delegated commissioning of primary care. • There was a need for the CCG to continue work with its providers to ensure

they had relevant policies in place and a review of some providers was likely in order to obtain evidence.

As the meeting was inquorate approval of the Counter Fraud Risk Assessment and Strategic Work Plan would need to be deferred until the next meeting.

18/031 YEAR END UPDATE

Those present were in receipt of an early draft of the accounting policies and

annual report for review and comment. Whilst there remained a lot to do to ensure the documents were ready in time to meet the challenging timetable, the process for collation of annual report information had been much improved. Comments included; • Accounting changes included some new elements such as a section in respect

of assets. • The Annual Report was subject to proof reading by the Communications

Team. • The need to ensure that information in respect of the inspections of Mental

Health services and Special Education Needs and Disability remained consistent and up to date was recognised.

• Steve Chicken should be identified as a Lay Member and not as the Lay Member for Conflicts of Interest as written.

• On Page 11 there was a paragraph that started with ‘This’ and did not finish. • There was no member profile for Geoff Dobson or Bill Banks with the

corporate governance information or West Suffolk CCG, and Geoff Dobson had not been noted as attending Clinical Scrutiny Committee meetings.

Those present noted the draft reports and looked forward to seeing revised documents at future meetings.

18/032 INDIVIDUAL FUNDING REQUEST UPDATE

Those present received a report from the Acting Chief Nursing Officer which, as

requested at a previous meeting, provided an update on progress against the Individual Funding Request management action plan. Those present noted the report and that actions from the internal audit had been addressed and there was nothing outstanding.

18/033 DRAFT ANNUAL AUDIT REPORT

Those present were in receipt of the current draft of the Annual Audit Committee

Report for comment. The Committee recognised that further information was to be added to the report when available and that the final report was due for presentation to the Governing Body in July 2018. Those present were satisfied with the report subject to final approval by the Audit Committee Chair prior to its presentation to the Governing Body in July 2018.

18/034 GOVERNING BODY ASSURANCE FRAMEWORK AND RISK REGISTERS

Those present received the latest Governing Body Assurance Framework (GBAF)

and risk registers. It was noted that the responsibility of each Committee in respect of presentation of the GBAF had been included within the action log. The Audit Committee’s role was to satisfy itself that an appropriate process was in place and it was noted that the content of the GBAF was regularly reviewed by the Chief Officer Team and Clinical Scrutiny Committees, with approval by the Governing Body. Those present noted the GBAF as presented.

18/035 HOSPITALITY AND GIFTS REGISTER

Those present received the CCG Hospitality and Gifts Register for 2017/18, which

detailed gifts and hospitality reported to have been received by CCG employees. Those present noted the content of the report.

18/036 WAIVERS OF COMPETITIVE TENDERING

No waivers of competitive tendering were received. 18/037 ANNUAL PLAN OF WORK

The annual plan of work was reviewed and noted. 18/038 ANY OTHER BUSINESS AND REFLECTION

No items of other business were received and it was felt that the meeting had

been managed well, with all members being offered the opportunity to contribute. 18/040 DATE OF NEXT MEETING

An informal meeting in relation to the Annual Accounts and Annual Report was planned for Monday, 23 April 2018 at 2.00pm in the Minsmere room at Endeavour House. An Extraordinary meeting in respect of the Annual Accounts and Annual Report had been scheduled to take place on Monday, 21 May at 2.00pm in the Abbey room at Endeavour House. The next full meeting of the Committee is to be held on 6 June 2018 at 2.00pm in the Dorothy Room at Endeavour House, 8 Russell Road, Ipswich, Suffolk, IP1 2BX.

_____________________________ ______________________ Chairman (Geoff Dobson) Date

Unconfirmed Minutes of a meeting of the West Suffolk Clinical Commissioning Group Remuneration and Human Resources Committee Meeting held on

Tuesday, 10 April 2018

(Inquorate Meeting)

PRESENT: Geoff Dobson Lay Member for Governance (Chair) IN ATTENDANCE: Amanda Lyes Chief Corporate Services Officer Jo Mael Corporate and Governance Officer 18/016 WELCOME AND APOLOGIES FOR ABSENCE

The Chair advised that as the post of Lay Member for Patient and Public

Involvement was currently vacant, the meeting was inquorate. Any decision would be deferred until the next meeting.


No declarations of interest were received. 18/018 MINUTES OF THE PREVIOUS MEETING

As the meeting was inquorate, approval of the minutes of the West Suffolk

CCG Remuneration and Human Resources Committee meeting held on 13 February 2018, was postponed until June 2018.

18/019 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising and the action log was reviewed and updated

with comment as follows; 18/007 – GP Election Process – with regard to Lay Member recruitment, the Chief Corporate Services Officer reported that Ipswich and East Suffolk CCG had offered the position of Lay Member of Patient and Public Involvement and were awaiting acceptance. West Suffolk CCG recruitment to the same role was ongoing. 18/008 – Workforce Report Quarter 3 – having noted that management costs had not been included within today’s report, the Chief Corporate Services Officer agreed to circulate the information outside of the meeting and ensure it was included within future reports. Updates in relation to the apprentice levy and Community Education Provider Network (CEPN) would be provided to the June 2018 meeting.

Part One

18/020 WORKFORCE REPORT QUARTER 4

Those present were in receipt of a report from the Chief Corporate Services Officer, which provided information on a wide range of key HR performance indicators and sought to benchmark where possible against national and local performance data. Points highlighted during discussion included; • Data Awareness Training completion was now at 80% compliance, with

plans to achieve 100% by the end of April 2018. • Having queried how staff turnover was calculated the Chief Corporate

Services Officer agreed to clarify and report back. • Sickness/absence had reduced by 0.36% overall, with the outcome of a

recent health survey indicating reduced levels of sickness since the office moves.

• Andrea O’Connell, Nurse Improvement Consultant would be leaving the CCG now that Lisa Nobes had commenced in the role of Chief Nursing Officer.

• Secondment of the CCG’s Head of Communications to the East of England Ambulance Service NHS Trust was to be extended for a further three months. Likewise, John Troup had been extended in his role as Interim Head of Communications.

• The Chief Corporate Services Officer confirmed that the Interim Deputy Chief Finance Officer was on a fixed term contract until June 2018.

• Having queried over recruitment within West Suffolk CCG’s Chief Operating Office, it was explained that the over recruitment had been agreed with the Chief Officer due to a lack of administrative support.

• As the Corporate QIPP target for 2018/19 was to be similar to that of 2017/18, it was likely to be challenging to achieve.

Those present noted the content of the report.

18/021 ACCOUNTABLE CARE SYSTEM UPDATE

The Chief Corporate Services Officer reported;

• That an announcement in relation to the achievement of Integrated Care

Service Wave 2 status, was expected in the near future, and it was hoped that additional funding might follow.

• Both Suffolk CCG Governing Body’s had supported the direction of travel in relation to the Integrated Care Service at meetings held in March 2018. As North East Essex CCG was not due to present a strategic commissioning report to its Board until May 2018, the timetable had been affected.

• A strategic commissioning workshop was planned on 1 May 2018, and would be attended by members of the Integrated Care Service Project Board which included representatives from NHS England, Commissioners, Providers, County, District and Borough Councils. The aim of the workshop was to explore strategic commissioning going forward.

• Next steps included the exploration of increased alignment of teams and ‘drop in sessions’ for staff had commenced.

Those present noted the update.

18/022 ENDEAVOUR AND LANDMARK HOUSE MOVES

The Chief Corporate Services Officer presented a report that provided an

update on work completed to support staff and the CCG aims and objectives in the move to Endeavour House and Landmark House. The moves to Endeavour House/Landmark House had gone well with the first move out date achieved successfully on the 20 October 2017 and the final move completed on the 13 November 2017. Rushbrook House was

subsequently closed from mid-November 2017 that enabled the clearance work to be completed prior to handback to the Landlord on the 31 December 2017.

The change of base had provided staff with increased flexibility on how their journey to work was made as staff were not automatically guaranteed parking at a base. Costs incurred over and above the daily parking rate of £3 at Endeavour House and £1.50 at Landmark House were being reclaimed by staff through the monthly expenses claims process.

The agreed one-year retention and recruitment premium of £345 payable in monthly instalments was being paid to staff up to pay point 26 (£31,696) as were the additional travel costs for those staff affected by the change of base.

The CCG had joined the County Council’s current Green Travel Plan and staff were actively accessing the discounts offered with ongoing discounts available on various bus and train travel. The Park and Ride facility was now free for staff until the end of December 2018 when a review of continuation of the discount was due to be undertaken by Suffolk County Council.

Staff at West Suffolk House were expected to follow the same “hot desk” policy as was in place at Landmark and Endeavour Houses. Costs associated to the moves were detailed within Section 4 of the report. Points highlighted during discussion included; • Desk space remained a key issue and, in particular, the finance directorate

was seeking additional space. • There had been no major concerns raised with regard to car parking as

staff were utilising the County Council’s green travel plan with discounts to park and ride and train travel. Others were taking the opportunity to walk or cycle to work. The main concern with parking was for those people coming back to the office throughout the day.

• Savings achieved from the office moves would continue to be a QIPP saving into 2018/19.

Those present noted the content of the report

18/023 NURSING DIRECTORATE

As requested at the previous meeting those present were in receipt of a report

which provided an update on nursing directorate posts, and incorporated progress against the action plan. Documents presented for review included; a) Chief Nursing Directorate Organisational Chart b) Chief Nursing Directorate Action Plan c) Chief Nursing Directorate information for Development Day d) Chief Nursing Directorate Risk Register The Chief Corporate Services Officer reported that Lisa Nobes had commenced in the role of Chief Nursing Officer last week and was currently exploring options for recruitment of a second Deputy Chief Nursing Officer. As a result of Lisa’s recruitment, responsibility for the Continuing Healthcare Team would now transfer back to the Chief Nursing Officer. Having noted that the presented organisational chart might be subject to change once Lisa was established in post, it was agreed that the Committee receive an update from the Chief Nursing Officer to a future meeting. The need for a more integrated and coordinated approach across nursing

areas such as primary care, community and acute, was highlighted. Those present noted the content of the report

18/024 PDP PROCESS 2018/19

Those present were in receipt of new PDR guidance and subsequent new

PDR paperwork for 2018/2019, which incorporated talent management and nurse revalidation. The Chief Corporate Services Officer advised that the new documentation had been presented to the Chief Officer Team, who had felt that it provided the opportunity for more beneficial conversations between employers and employees. The new documentation was currently being tested with the Corporate Services team. It was explained that the Pay Progression Policy had not been presented to today’s meeting for approval as it required further revision in light of the announcement of the recent NHS pay award which would introduce fewer incremental steps in forthcoming years. Those present noted the content of the report and requested an update in October 2018, which should include identification as to how the new process had affected talent management, together with identifying how it had assisted with the management of staff.

18/025 GENDER PAY GAP

Those present were in receipt of a report that contained Gender Pay Gap

information in relation to the CCG. The Equality Act 2010 (Specific Duties and Public Authorities) Regulations 2017 require all organisations employing 250 or more people to report annually on their gender pay gap. The regulations underpinned the Public Sector Equality Duty, and required bodies like the CCG to publish gender pay gap data by 30 March 2018, and thereafter annually.

The report went on to detail gender pay gap information in relation to the CCG. Due to Government mandated rules and calculations, which meant the CCG had to include GP Governing Body members in its pay calculations, the figures might appear skewed. However, because the GP members of the Governing Body played an important part in the CCG’s strategic planning process which affected the local health economy, that highlighted a need to look at how the CCG might attract more female GPs to become Governing Body members.

It should be noted that the lower tier of pay contained a disproportionate number of women (88.5%) and that the percentage of males in the higher pay bands increased substantially. Even though six of the CCG’s eight chief officers were female, at deputy level and below in the higher tier of pay the gender difference fell in favour of males. Those present noted the content of the report.

18/026 POLICIES FOR APPROVAL

No policies were received for approval. 18/027 ANNUAL PLAN OF WORK

Those present noted the current annual plan of work and that it would be

further revised in line with actions agreed at today’s meeting. 18/028 ANY OTHER BUSINESS

http://www.legislation.gov.uk/uksi/2017/353/contents/made

http://www.legislation.gov.uk/uksi/2017/353/contents/made

https://www.gov.uk/government/publications/public-sector-equality-duty

https://www.gov.uk/government/publications/public-sector-equality-duty

_____________________________ ______________________ Chairman (Geoff Dobson) Date

No items of other business were received. 18/029

DATE AND TIME OF NEXT MEETING

The next meeting was scheduled to take place on 12 June 2018 at 10.30am in the Minsmere Room at Endeavour House.

Minutes of WS CCG Financial Performance Committee Meeting held on Wednesday 21 February 2018

PRESENT: APOLOGIES: Dr Zohra Armitage, GP Governing Body Member (ZA) Dr Simon Arthur, GP Governing Body Member (SA) Dr Christopher Browning GP Governing Body Member (CB) Steve Chicken, Lay Member and Chair (SC) Geoff Dobson, Lay Member – Governance (GD) Jo Finn, Lay Member – Patient & Public Involvement (JF) Ed Garratt, Chief Officer (EG) Dr Andrew Hassan, GP Governing Body Member (AH) Robert Hudson, Deputy Chief Finance Officer (RH) Martin Jarrett, Project Support Manager (MJ) Amanda Lyes, Chief Corporate Services Officer (AL) Jane Payling, Chief Finance Officer (JP) Dr Bahram Talebpour, GP Governing Body Member (BT) Kate Vaughton, Chief Operating Officer (KV) Dr Firas Watfeh, GP Governing Body Member (FW) Richard Watson, Chief Transformation Officer (RW) Jane Webster, Deputy Chief Contracts Officer (JW) MINUTES: Laura Elliott – Business Support Officer for Primary Care and Executive Assistant to COO Office (Governance), WSCCG

Isabelle Cockayne, Head of Communications (IC) Andrew Eley, Deputy Chief Operating Officer (AE) Chris Hooper, Acting Chief Nursing Officer (CH)

Item Action

1. WELCOME AND APOLOGIES FOR ABSENCE The Chair welcomed all to the meeting and apologies for absence were noted.

2. DECLARATIONS OF INTEREST There were no declarations of interest expressed.

3. MINUTES OF EXECUTIVE MEETING 17 JANUARY 2018

The minutes of the Financial Performance Committee meeting held on 17 January 2017, were reviewed and agreed as a true record.

4. MATTERS ARISING

There were no matters arising.

5. ACTION AND DECISION LOG 17 JANUARY 2018

Action 32 – Property Services Update: JP disclosed that she had received confirmation that the organisation would not be charged and a credit note would be awarded shortly. The action was therefore closed. Action 63 – JP updated that she was scheduled to attend a meeting on 12/03/2018, and would thereafter update. The action was therefore closed. Action 64 – JP updated that this action was completed at the Clinical Executive Meeting. Action 65 – RW updated that a recent telephone discussion had been cancelled. The action is therefore ongoing.

6. FINANCIAL POSITION MONTH 10

RH reported that the CCG is on target at month 10 and predicted that the financial year would end in financial balance. Acute Services were showing an overspend of £1 million which is mainly due to underachievement of other acute QIPP. Prescribing has a deficit of £600k once the impact of No Cheaper Stock Obtainable drugs (NCSO) and Cat M clawback has been taken into account. Mental Health was also experiencing a deficit of £400k, largely due to out of area placements. JP updated that it is possible that the Cat M clawback will be released back to the CCG by NHSE, however these monies will not be available to be spent, their being allocated likely by month 12. AH highlighted how prescribing had achieved a 5% reduction in spending in comparison to last year; EG queried if this was due to lessons learned. AH indicated that this was a result of lessons learned over previous years, in which reductions in opiate prescribing had witnessed the largest saving. FW added that prescribing visits had also been very productive, and KV stressed that there had started to be a culture change.

7. PMO SUMMARY REPORT AND APPENDIX

MJ introduced discussions indicating that there had been no significant change since last month; year to date 97% of planned QIPP savings has been achieved, 97% of the total required QIPP has been identified and 81% of the total planned QIPP has been achieved, year to date. Those schemes (CHC and Corporate) which have been dramatically over-performing are showing reduced year to date variance this month, suggesting savings are becoming more difficult to deliver. Prescribing appeared not to be meeting QIPP targets though as earlier discussed, this is in the wake of the impact of NCSO drugs, when the impact of these is removed the prescribing QIPP programmes are achieving target. Mental Health out of area placements are not expected fully to achieve the target level of savings by the end of the year. MJ reported that overall, projects are on par for completion and next year’s plans are largely in place. KV queried the size of the QIPP still be identified for next year, and JP reported that this was approximately £2.5 million. GD highlighted that budget holders had worked hard to achieve the QIPP savings and keep the CCG on its financial target; SC added that budget holders are also making good progress for next year. AH informed that lessons had been learned in regards to MSK, which shows the benefits of joint working. RW highlighted that the upcoming 100 Day Challenge will spotlight these elements.

8. NHSE 2018/2019 PLANNING GUIDANCE

JP introduced the guidance, reporting that the presentation incorporated slides from a regional discussion. An additional £2 billion had been allocated for NHS funding, of which £600 million is included in CCG allocations. RW discussed National Activity Pressures, which identified the following:

• Non Elective growth +2.3% - to be split between 1+ length of stay (+1% growth) and zero length of stay (+7.3% growth).

• A&E growth 1.1%. • Total Outpatient attendance growth +4.9% (4.0% per working day). • Elective growth +3.6% (2.7% per working day). • GP Referrals growth +0.8% (no change per working day). • The guidance includes a section on STPs, which must ensure the alignment of

Commissioner and Provider assumptions. This is now more critical than ever as the activity and finance plans are aligned between Commissioners and Providers.

BT indicated that the GP referral growth was unrealistic; RW highlighted that this was based on national assumptions. SA added that the pressures for patient demand and referral was challenging but there was room for reduction; BT re-emphasised however that this was not realistic, bearing in mind the Outpatient Attendance growth. RW indicated that this may reflect other referrals, for example those to Allied Health Professionals. There have also been coding issues previously, which have now been rectified.

9. DRAFT 2018/19 FINANCIAL PLAN

JP introduced the discussion, indicating that key assumptions which had been included to

generate a budget which delivers the required break even control total for the new financial year. Additional flexibility is available due to the relaxation of the 0.5% system reserve requirement. EG stressed the need to maintain a good financial position, and the discussion concluded that whilst NCSO pressures were not fully resolved and funding for pay awards above 1% are still possible, the 1% contingency should be maintained. A discussion took place regarding the Mental Health Investment Standard (MHIS), and the assumption that the NSFT contract would be inflated in line with the programme uplift to demonstrate parity. RW added that the uplift would be tied to 5 Year Plan deliverables. AH indicated the need for investment so that Mental Health teams could contribute to lessen the prescribing of drugs and offer more alternatives. BT queried the proposed WSH contract uplift of £2.4 million, stressing the need to keep those monies within primary care. JP explained that the proposed budget followed the GIC III principles of sharing the CCG’s resources with its main providers, including secondary care. She went on to explain that the trust was on track to achieve its control total and hence the Sustainability and Transformation Funding (STF) in 2017/18, but that the financial outlook for 2018/19 is challenging, with savings of over 8% being required to achieve the control total, a figure which KPMG has assessed as being unachievable. CB highlighted that not all activity was undertaken within the acute trust, however JP stressed that if the trust did not achieve control totals the enhanced STF (which becomes the Provider Sustainability Fund in 2018/19) would not be achieved. EG indicated that the trust had previously invested in community beds at Glastonbury Court; AH pointed out that this would generate space and capacity. The CCG would like to explore how this investment in the community might be used to support the hospital position overall. SA proposed creating a Transformation Fund for the Systems Executive Group to oversee which could enable the hospital to become more effective; the hospital can then spend those monies in the community. RW emphasised the need to agree a reasonable position for the trust in terms of ongoing recurrent funding, in addition to having access to bid from Transformation funds. BT proposed that Frailty, Community Beds and Nursing Homes could be an appropriate investment. After further discussion, JP agreed to review the draft budget in the light of this meeting, and re-present an updated proposal at the Clinical Executive meeting on 28/02/2018. Final budgets would be taken to the March Governing Body for approval.

11. INTEGRATED CARE SYSTEMS UPDATE/SYSTEM FINANCE UPDATE

Discussion deferred until next meeting.

12. ANY OTHER BUSINESS

No other business was identified.

Meeting closed at 12.05. Date of next meeting: Wednesday 21 March 2018, Room GFR 14, West Suffolk House.

Minutes of WS CCG Financial Performance Committee Meeting held on Wednesday 21 March 2018, 10.45-12.30

Room 14, West Suffolk House PRESENT: APOLOGIES: Dr Zohra Armitage, GP Governing Body Member (ZA) Dr Simon Arthur, GP Governing Body Member (SA) Dr Christopher Browning GP Governing Body Member (CB) Steve Chicken, Lay Member and Chair (SC) Geoff Dobson, Lay Member – Governance (GD) Jo Finn, Lay Member – Patient & Public Involvement (JF) Ed Garratt, Chief Officer (EG) Dr Andrew Hassan, GP Governing Body Member (AH) Robert Hudson, Deputy Chief Finance Officer (RH) Amanda Lyes, Chief Corporate Services Officer (AL) Jane Payling, Chief Finance Officer (JP) Dr Bahram Talebpour, GP Governing Body Member (BT) Kate Vaughton, Chief Operating Officer (KV) Dr Firas Watfeh, GP Governing Body Member (FW) Richard Watson, Chief Transformation Officer (RW) Jane Webster, Deputy Chief Contracts Officer (JW) MINUTES: Laura Elliott – Business Support Officer for Primary Care and Executive Assistant to COO Office (Governance), (LE) Emma Gaskell, Primary Care Manager, (EGa) Tess Zermanos, Assurance Manager - Suffolk & North East Essex STP, (TZ)

Simon Aldridge, Head of Programme Management, (SAld) Isabelle Cockayne, Head of Communications (IC) Andrew Eley, Deputy Chief Operating Officer (AE) Chris Hooper, Acting Chief Nursing Officer (CH)

Item Action 1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed all to the meeting and apologies for absence were noted.

2. DECLARATIONS OF INTEREST

There were no declarations of interest expressed.

3. MINUTES OF EXECUTIVE MEETING 21 FEBRUARY 2018

The minutes of the Financial Performance Committee meeting held on 21 February 2018, were reviewed and agreed as a true record.

4. MATTERS ARISING


5. ACTION AND DECISION LOG 21 FEBRUARY 2018

Action 65 - PMO Summary Report and Appendix

RW reported that there has not been an NHSE meeting yet, though they have been kept updated. Action was therefore closed. Action 66 – Draft 2018/19 Financial Plan For discussion on today’s agenda. Action therefore closed.


JP introduced discussions, reporting that at the end of month 11, the CCG was on target to hit in year break even. Principle overspends year to date include Acute Services (£2.0m), Prescribing (£0.6m) and Mental Health Services (£0.5). These are mitigated by the release of Contingency (£1.4m) and underspends in Continuing Care (£0.8m), Other Programme Services (£0.6m), Running Costs (£0.2m) and Property Recharges (£0.1m). An underlying surplus of £4.3 million is reported - this indicator adjusts the forecast surplus by removing the impact of non-recurrent costs and allocations and the full year effect of in year adjustments in order to show the recurrent position. Key adjustments include adjusting for the mandatory 0.5% system reserve, 0.5% non-recurrent reserve and other non-recurrent/ full year adjustments. GD queried the variances discussed in the document, indicating that the reserve figures appeared to move around between month 11 and the full year. JP clarified matters, explaining that there had been a consolidation of the reserve in the full year position. GD and JP agreed to discuss this further outside of the meeting. EG pointed out that going back in time the underlying surplus had been previously measured at around £200k and this had now increased to £4million. He asked how had this been achieved. JP disclosed that a large amount of work had been done to achieve these savings, and the overall position had been recently reviewed as part of the 2018/19 planning preparation. This was cautious good news. AH highlighted, that given the CCG is still under target funding levels, it had done very well in terms of finance. The discussion moved to the Top 10 Variances as discussed on page 5 of the document. The reason for the large underspend on Addenbrooke’s was questioned. JW reported that this was due to a combination of factors, including the tendency for this provider to send through annual plans which tend to overstate the actual activity levels. She went on to explain that the contract and activity levels are monitored very closely by Suffolk CCGs with a high level of challenges being made by proactive individuals the Finance and Contracts team, resulting in significant reductions in the overall payments due. FW pointed out that 60% of Haverhill patients choose to attend Addenbrooke’s rather than West Suffolk, often due to transport links. JP therefore offered to investigate and assess the history of activity between Addenbrookes and WSFT, the results of which would be discussed at a future meeting. EG briefly queried West Suffolk Hospital GIC performance. JP informed that had current activity levels been paid for under payment by results, the unchallenged financial value would exceed the GIC value. A thorough review would be undertaken at the end of the year.

JP

7. YEAR END POSITION – (PROPOSED SUPPORT FOR WSFT)

JP discussed the year end position, explaining that CCG finances in 2017/2018 had experienced a number of ups and downs. Following financial cut backs in previous years, the overall finances appeared positive with the anticipated receipt of GP Access monies during the year. When this anticipated £1.4m was found not to be forthcoming, the CCG Executive looked at a number of ways to cover the costs of the planned GP Access rollout, which included use of non-recurrent monies and a slow-down of the service roll out. As the year has progressed a number of matters have come together, leading to an improved financial position. The Finance Department is now predicting that the CCG will achieve its break even control total and, when this is put alongside the un-

spendable 0.5% system reserve and likely return of category M clawback, the final reportable position will be a significant surplus. Furthermore, there are additional sums which can be deployed non-recurrently during 2017/18 of £1.1m which if not deployed will further increase the surplus. The paper put forward a proposal to use £727k of non-recurrent funding to support costs experienced at WSH relating to the dissolution of the TPP pathology services, and to undertake the KPMG efficiency review. GD queried the relationship between the WSH figures included in the finance report (£300k overspend) and the £700k figure being requested as non-recurrent support. EG responded explaining that the £300k related to a previous year agreement reached with the Trust. EG added that if the CCG were to assist WSFT, the trust anticipates achievement of its control total which will give access to approximately £3 million of Sustainability and Transformation Funding (STF), permitting access to better services. JP also reported that WSFT was in negotiation with NHSE in regards to next year’s control total, and is therefore unlikely to be in a position to return any funding to the CCG in 2018/19. GD queried the remainder of the 2017/2018 surplus. After further discussion in relation to possible options, it was concluded that JP would consider a specific proposal around removing the cap on the Prescribing incentive scheme, investigate the trust’s ability to access bonus STF funding and any other remaining commitments which would then be recommended to the Governing Body the following week.

JP

8. PMO SUMMARY REPORT AND APPENDIX

JP discussed PMO in SAld’s absence, reporting that year to date, 95% of planned QIPP savings had been achieved, 97% of the total required QIPP had been identified, Mental Health Out of Area was not going to achieve target QIPP, and Continuing Healthcare continues to over perform GD asked if there were any penalties from NHSE in regards to the 97% achievement of QIPP. JP reported there was not, as performance is judged on achievement of the overall control total. SC queried plans for next year’s QIPP, to which JP replied, 3% overall QIPP, for which SAld is working with the finance team to finalise.

9. DRAFT 2018/19 FINANCIAL PLAN

JP discussed the 2018/19 Draft Financial Plan, which was due to be presented at next week’s Governing Body. The Financial Performance Committee was asked:

• To note the process followed to date for developing the draft financial plan • To review the plan which is being submitted for approval by the Governing

Body. • To request delegated authority from the Governing Body for finalising the plan

prior to submission to NHSE in April. Fundamentally, the CCG is required to prepare annual financial plans which are constructed with due regard to the national business rules of financial planning, setting out rules which determine the level of surplus to be generated, contingencies to be held, and a requirement to commit a proportion of expenditure on a non-recurrent basis. A draft financial plan, approved by the Executive Committee following discussion at the Financial Performance Committee, was submitted to NHSE on 8 March; the plan set out reflects those discussions. As the plan sets out the financial strategy for the coming year, the Governing Body is the committee which approves the plan for the financial year. The final plan submission will be made at the end of April taking account of any further changes in contract values and other refinements. The Governing Body will be asked to delegate approval of any further amendments. GD pointed out the 3% QIPP and queried if Acute Services were covered under a GIC, which JP confirmed. GD went on to probe the implications of current performance for West Suffolk. JP responded that the GIC agreement gives actual

values of what the trusts will be paid. An offer has been given to WSFT, which leaves them uplifted in line with resources, however there remains an affordability gap within the hospital’s financial plan. WSFT is currently negotiating a change to its control total with its regulator NHS Improvement; otherwise, they may not sign up to the control total which would mean no access to Provider Sustainability Fund (the new term for STF) and could put them in the special measures category. RW highlighted that in order to achieve savings, the trust was at liberty to work with others. JP indicated that further work was to be done as a wider system. RH pointed out WSFT’s low reference costs, concluding that WSFT is relatively efficient. JF highlighted the development of the wider integrated care system with other partners, requesting suggestions of improvement, to which AL responded, an emerging organisational development plan would shortly address.

10. SYSTEM FINANCE UPDATE

*11.52 RW and JW left the meeting. RH discussed the Month 10 STP Finance Dashboard (note this is a month behind CCG reporting). As discussed previously, the dashboard is work in progress, with some areas being more advanced than others. NHS organisations are forecasting achievement of the combined STP control total (max. £46.42m deficit). To achieve this, overall savings of over £100m are forecast to be delivered. Year to date performance is lower than plan particularly at the Ipswich Hospital Trust and to a lesser extent WSFT, offset by overachievement in Colchester Hospital University Foundation Trust. JP added discussion in regards to reference costs and how the model hospital has now been constructed as a benchmarking tool. GD asked how relative efficiency was taken into account in the construction of provider control totals, particularly that concerning WSFT; JP replied that currently relative efficiency was not a feature of control total calculations.

11. INTEGRATED CARE SYSTEMS UPDATE

RH discussed the final agenda item, disclosing that a planned Finance Away Day scheduled for 13/04/2018 would be an opportunity to update on STP planning, benchmarking and expectations for 2019/20 and 2020/21. This was a system wide event for Finance Departments. Keith Wood from NHS England had attended the Ipswich and East Suffolk CCG FPC the previous day and updated on a call with regulators regarding the development of system control totals. The potential inclusion of providers in multiple system control totals (e.g. for NSFT) is now seen as possible, as is adoption of a system control total for part of the year.


SC queried if the cumulative surplus of the CCG could be drawn down for future use; JP said she would approach NHSE in regards to this matter to feed into the construction of a long term financial plan.

JP

Meeting closed at 12.09. Date of next meeting: Wednesday 18 April 2018, Room GFR 14, West Suffolk House.

Unconfirmed Minutes of WS CCG Financial Performance Committee Meeting held on Wednesday 18 April 2018, 10.45-12.30

Room 14, West Suffolk House PRESENT: APOLOGIES: Simon Aldridge, Head of Programme Management, (SA) Dr Zohra Armitage, GP Governing Body Member (ZA) Dr Christopher Browning GP Governing Body Member (CB) Steve Chicken, Lay Member and Chair (SC) Geoff Dobson, Lay Member – Governance (GD) Andrew Eley, Deputy Chief Operating Officer (AE) Ed Garratt, Chief Officer (EG) Dr Andrew Hassan, GP Governing Body Member (AH) Amanda Lyes, Chief Corporate Services Officer (AL) Lisa Nobes, Chief Nursing Officer (LN) Jane Payling, Chief Finance Officer (JP) Dr Bahram Talebpour, GP Governing Body Member (BT) Kate Vaughton, Chief Operating Officer (KV) Dr Firas Watfeh, GP Governing Body Member (FW) Richard Watson, Chief Transformation Officer (RW) Jane Webster, Deputy Chief Contracts Officer (JW) MINUTES: Laura Elliott – Business Support Officer for Primary Care and Executive Assistant to COO Office (Governance), (LE)

Robert Hudson, Deputy Chief Finance Officer, (RH)

Item Action

1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed all to the meeting and apologies for absence were noted.

2. DECLARATIONS OF INTEREST

There were no declarations of interest expressed.

3. MINUTES OF EXECUTIVE MEETING 21 MARCH 2018

The minutes of the Financial Performance Committee meeting held on 21 March 2018, were reviewed and agreed as a true record.

4. MATTERS ARISING


5. ACTION AND DECISION LOG 21 MARCH 2018

Action 68 – has now been completed. Action 67 – for update at the next Financial Performance Committee Meeting, on 16 May 2018. Action 69 – for update at the next Financial Performance Committee Meeting, on 16 May 2018.


JP introduced discussions, and gave apologies for any delays in receipt of papers. This has been due to year end commitments. JP disclosed that WSCCG had achieved its target and that the in-year break-even control

total had been accomplished. At Month 12, the CCG achieved an in-year surplus of £1.8m. The variance of £1.8m was mainly due to the release of 0.5% System Risk Reserve and the refund of Category M rebate, in line with NHS England’s expectations. As reported throughout the year, a range of financial variances occurred across budget areas. Principle overspends include Acute Services (£3.3m), Mental Health Services (£0.3m), Prescribing (£0.2m), Other Primary Care (£0.2m) and Running Costs (£0.1m). These are mitigated by the release of Contingency (£1.5m) and underspends in Other Programme Services (£1.3m), Continuing Care (£1.2m), Property Recharges (£0.3m) and Community (£0.2m). The group congratulated the CCG team on the favourable outturn. FW queried what the prospects may be for next year. JP indicated that it was anticipated that the CCG would again break even. BT queried what would happen to the 2017/18 surplus, to which JP reported that this would form part of the cumulative surplus and could be released through specific application. JP agreed to investigate the process to draw down prior year surpluses and report back the group.

JP

7. 2018/19 FINANCIAL PLAN UPDATE AND QIPP PLAN

*10.50 – LN left meeting *11.09 – SA joined meeting Finance and Activity Plans for 2018/19 had been presented at the March Governing Body. Final submissions are due to NHS England by 30/04/2018. The Governing Body had delegated the final changes to the Financial Performance Committee, for approval. The proposed amendments to the financial plan included the following:

• Additional costs for GP indemnity- £0.2m • Additional cost pressure of £0.05m on the Primary Care Delegated budget as a result

of GMS & PMS contract negotiations. This will need to be funded from the CCG programme allocations

• Correction in presentation of the GP transformation funding which was showing the CCG as an outlier

• Realignment of QIPP based on the latest contract values and budgets • Identification of additional QIPP to reduce the unidentified gap

In addition, it was noted that the GP access allocation will be received after the 30/4 submission so the plan will be adjusted in year. Whereas the costs for GP access have been included in the plan, the allocation (funding) is currently not included. This additional allocation will help support the additional primary care costs set out above relating to indemnity and delegated budget inflation. It is anticipated that the remainder of the funding will be used to support the GP access costs already included within the budget and enable primary care to make a small contribution to QIPP. RW introduced Section 3 of the paper, which set out a small number of activity changes which are proposed for the final plan submission, highlighting how the GIC had helped in terms of risk taking and there was confidence in the delivery of all of the individual PODs. AE outlined RTT data and waiting times for eating disorders, and JW disclosed that more formal details on RTT data breakdown had been requested and was due by the end of the week. After further discussion, the group agreed to approve the proposed amendments to the finance and activity elements of the plan. JP briefly outlined the high level QIPP plan, contained in the paper. Whilst a high proportion of the QIPP was either “banked” or identified to individual schemes or areas, £750k remained to be fully tied down. JP explained the process in place between the Contracting, Transformation and Finance teams which would endeavour to return with a plan to identify the £750k from actions against out-of-county contracts. In the meantime, it was proposed this element would be allocated against acute with an element of the reserve transferred to offset. BT queried the plan to roll out GP Access to other areas. KV informed that DB would discuss this further, the revised calculation for this now being £3.34/head. BT also queried the outlier issue within the GP Transformation Plan. JP reported that this was an administrative issue which had subsequently been resolved. EG pointed out that having 2/3 of the required QIPP “banked” was a great thing however stressed the importance of being aware of future risks and the need for regular reviews.

SC also queried the CCGs approach to End of Life Care, which JP informed was shown in the QIPP plan as savings on the hospice contract which had previously been agreed. JW added that the hospice felt it was able to continue and monitor itself, which has been written into a two year negotiation. A Transformation Meeting has been scheduled for next week to discuss End of Life developments. GD queried if a £3.4 million contingency was in place and whether there were any consequences surrounding pay awards. JP reported that the CCG budget contained at 1% contingency and that 2% pay award had currently been budgeted. The discussion was closed with an action for JP to investigate both the national position regarding funding for the pay award and WSHs progress on agreement of control total.

JP

8. QUALITY PREMIUM

JP introduced the Quality Premium (QP), which is intended to reward clinical commissioning groups for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. QP is a national scheme, overseen by NHS England. The current scheme is in place for 2017/18 and 2018/19, although there has recently been a number of changes introduced for 2018/19. Nationally, £278m is available for QP, equivalent to £5 per head of population. West Suffolk CCGs had the ability to earn up to £1.25m in 2017/18. Historical performance, both nationally and locally had been very poor. Low performance levels can be attributed in part to the design of the scheme which involves achieving a wide range of QP targets, funding for which can only be accessed after passing through a number of financial, quality and NHS constitution target gateways. SA informed that reporting was currently undertaken by the Information Team, in future this could be added to the PMO portfolio potentially adding more value. After further discussion, it was agreed that the return on investment was worthwhile for the updated 2018/19 version of the Quality Premium. CB queried if success would generate non-recurrent funds in 2019/10 which JP confirmed.

9. INTEGRATED CARE SYSTEM UPDATE

JP led the integrated care system update, reporting on presentations from a recent Finance Away Day. Workstreams were outlined as follows:

• Financial Governance (lead Kirsty Denwood, NEECCG) • Financial Planning (lead Jane Payling, Suffolk CCGs) • Financial Reporting (lead Mark Madden, EPUT) • Predictive Planning & modelling (lead Dawn Scrafield, CHUFT) • Investment Process & Programme Management (lead Craig Black, WSH)

System Control Totals were also briefly discussed. CB asked if WSFT had negotiated a new control total with its regulator, would this be reflected in the STP wide control total, which JP confirmed. Content concerning debt, spend per weighted population and distance from target, were all included in the given pack. SC queried how JP planned to report on the DOFs group in the future. JP responded that she would use the action log from STP DOFs and incorporate into the Integrated Care System item.

10. PMO REPORTS

*11.28 – AE left meeting. SA discussed the PMO reports, pointing out that owing to the timing of the financial ledger close, further information had since been received and SA will endeavour to circulate this accordingly. SA reported that the PMO was reviewing ambers and reds for overview next month.

SA

RW added that in regards to Pain, high expectations had previously been sent, and it was anticipated that these would be more realistic next time. In regards to QIPP Acute, RW indicated that activity deliverable was awaited from WSFT for future planning. SC queried how acute improvement would be reported. RW responded that it would be monitored via the appropriate boards and forwarded to the Financial Performance Committee, via the PMO. BT informed that patients had reported dissatisfaction with the Community Pain Management service; RW recommended forwarding this finding to the GP Federation. FW highlighted that this dissatisfaction was an ongoing issue and RW reported that he would be arranging a meeting with the GP Federation and WSFT, to conclude this issue. RW to report outcome of this meeting at the next FPC.

RW


No other business was raised.

12. REFLECTION

SC closed the meeting emphasising the success of the financial year, though also advised caution against complacency and future system risks.

Meeting closed at 12.09. Date of next meeting: Wednesday 18 April 2018, Room GFR 14, West Suffolk House.

Unconfirmed Minutes of WSCCG Clinical Scrutiny Committee held on Wednesday 25 April 2018 from 1030–1200hrs

Green Duck. Technology House, Western Way, Bury St Edmunds, Suffolk

PRESENT: Dr Christopher Browning GP Governing Body Member and CCG Chair (Chair) Dr Zohra Armitage GP Governing Body Member Steve Chicken Lay Member Geoff Dobson Lay Member for Governance Andy Eley Deputy Chief Operating Officer Ed Garratt Chief Officer Dr Andrew Hassan GP Governing Body Member Amanda Lyes Chief Corporate Services Officer Lisa Nobes Chief Nursing Officer Jane Payling Chief Finance Officer Dr Bahram Talebpour GP Governing Body Member Dr Firas Watfeh GP Governing Body Member Jane Webster Acting Chief Contracts Officer IN ATTENDANCE: Jo Mael Corporate Governance Officer Sheila Murnion Lead Contracts Manager, High Cost Drugs (Item 18/016 only) Lois Wreathall Head of Primary Care (Item 18/018 only) 18/012 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted

from; Dr Jep Ronoh Consultant in Public Health Medicine Kate Vaughton Chief Operating Officer Richard Watson Chief Transformation Officer


As a GP in Haverhill, Dr Firas Watfeh declared an interest in item 6 (Governing Body

Assurance Framework) insofar as it related to Haverhill Practices.

18/014 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 28 February 2018 were reviewed and approved as a correct record.

18/015 MATTERS ARISING & REVIEW OF ACTION LOG


(The Chair advised that Agenda item 08 relating to BMI would be taken first)

18/016 BMI ST EDMUNDS HOSPITAL CARE QUALITY COMMISSION REPORT –

UPDATE

The Committee was presented with a further update on BMI’s progress against the action plan submitted to the Care Quality Commission (CQC) to address the requirement notices in the CQC report published on 26 September 2017 following its inspections on 16 and 20 of March 2017. The detailed action update was set out within Section 4 of the report. The Committee was advised that initially BMI had had to be reminded of its obligation under the contract to provide monthly updates on progress, and subsequent meetings had been held with BMI’s Executive Director to discuss the action plan progress. The Committee was reassured that BMI had been offered support by the CCG but that the offer had not been taken up, the new CQC inspector was due to visit BMI on 25 April 2018. The Committee was disappointed with BMI’s progress to date and the Chief Nursing Officer offered to attend on a future visit. The Committee noted the report and requested a further update in July 2018.

18/017 INTEGRATED PERFORMANCE REPORT

The Committee was in receipt of the Integrated Performance Report, with key points highlighted during discussion being; Clinical Quality and Patient Safety • Infection Control – E.Coli bacterium was high in west Suffolk and would be an

area of focus for the CCG’s new infection control lead who was soon to start in post.

• West Suffolk Hospital infection control progress was good although falls were increasing. The hospital was still unable to provide falls data per 1000 bed days. A harm free forum had been established. The Committee was disappointed that falls data per 1000 bed days remained unavailable and the Chief Nursing Officer agreed to investigate.

• Transforming Care – performing well against trajectory with 3 patients in care. Finance • The CCG had achieved its financial targets at year-end and the draft accounts

had been submitted. Transformation • The Committee noted the report. Contracts • West Suffolk Hospital’s A&E performance remained below the 95% target (85%).

18 week referral to treatment performance was at 90% and there was an aim to achieve the target in October 2018. Cancer performance had improved in March 2018.

• Norfolk and Suffolk NHS Foundation Trust was being monitored closely with regard to referral to assessment times.

• The 111 service was finding it challenging to meet targets and an action plan was in existence.

Primary Care • Month 11 prescribing figures had identified that the CCG was £1.1m underspent.

18/018 GOVERNING BODY ASSURANCE FRAMEWORK

The Committee was in receipt of the current version of the CCG Governing Body

Assurance Framework (GBAF) reviewed by the Chief Officer Team every month and by the Governing Body and Audit Committee at each of their meetings.

Amendments/additions were detailed within paragraph 2.2 of the report. Local risks included implementation of the General Data Protection Regulation. NHS England had recently advised CCGs that from 1 April 2018 they would need to fund additional information governance support to primary care – discussions would be required internally as to the form of that support. West Suffolk CCG GPs had already met to determine what might be required in respect of current data held. The Chief Corporate Services Officer and Head of Primary Care agreed to discuss the issue outside of the meeting. The Committee reviewed the clinical risks as presented. ‘Deep Dive’ - Haverhill The Committee was in receipt of a presentation which set the context and gave an overview of the pressures and reduced GP capacity within Haverhill. Points highlighted included; • There was increased demand within Haverhill with individuals visiting their GPs

on a higher than national average number of times per year. • Haverhill Family Practice had informally closed its list. • Having previously increased its boundary size Wickhambrook was seeing an

influx of patients from Haverhill • Clements and Christmas Maltings surgery had embraced the GP Five Year

Forward View objectives and facilitated appropriate appointments with allied health professionals.

• Issues identified by the Suffolk GP Federation included; GPs were not happy to take on the role of a Duty Doctor; there was a need to employ an Operations Manager which would require additional funding.

• A resilience bid had been submitted in order to acquire additional locum staff. • Dr Andrews had recently resigned and had been completing eight sessions per

week. How to reduce demand was a key issue and other options, such as the increased use of District and School nurses might require exploration, together with the facilitation of remote telephone or administrative working by other GPs within the CCG area. It was questioned whether it might be feasible to employ a salaried GP to carry out care home work or seek support from the Alliance. Although 25 international recruits were due to be available later in the year, there would need to undergo a conversion course before they were able to work unsupervised in the UK. Following discussion the Committee requested that the Head of Primary Care seek to produce an options paper for consideration at the next meeting.

18/019 NORFOLK AND SUFFOLK NHS FOUNDATION TRUST DEEP DIVE

The Committee was in a receipt of a report which provided a a comprehensive

overview of the CCG’s scrutiny of Norfolk and Suffolk Foundation Trust’s (NSFT) performance over the past year in light of the recent Care Quality Commission (CQC) report. Due to time constraints it was agreed that the paper be deferred until the May 2018 meeting. The Chief Nursing Officer agreed to update the paper prior to its presentation. The Committee noted the report.

18/020 PROPOSED MODEL FOR INTEGRATED CARE IN SUFFOLK AND NORTH EAST

ESSEX

The Committee was in receipt of a paper which outlined the proposed model for

integrated care in Suffolk and North East Essex. The Committee noted the model as presented.

18/021 POLICIES FOR APPROVAL

No policies were received for approval.

18/022 DATE OF NEXT MEETING

Wednesday 16 May 2018, 1030-1200 hrs, Room 14, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

Ipswich & East Suffolk Clinical Commissioning Group

West Suffolk Clinical Commissioning Group

Unconfirmed Minutes of the CCG Collaborative Group meeting held on Thursday, 19 April 2018, 10.30am in the Kersey Room, Endeavour House

PRESENT Martin Smith (MS) CCG Collaborative Group Chair Dr Christopher Browning (CB) Chair, West Suffolk CCG Governing Body Geoff Dobson (GD) Lay Member (Governance) West Suffolk CCG Graham Leaf (GL) Lay Member (Governance) Ipswich & East Suffolk CCG Dr Mark Shenton (MS) Chair, Ipswich and East Suffolk CCG Governing Body Ed Garratt (EG) Chief Officer, Ipswich & East Suffolk and West Suffolk CCGs IN ATTENDANCE Jo Mael (JM) Corporate Governance Officer Minute

Action

18/013 Welcome and apologies The Chairman welcomed all to the group and no apologies for absence were received.

18/014 Declarations of Interest

No declarations of interest were received.

18/015 Minutes of meeting held on 1 February 2018

The minutes of a meeting held on the 1 February 2018 were agreed as a correct record.

18/016 Matters arising and review of action log


18/017 Chief Officer Update

The Collaborative Group was in receipt of a paper from the Chief Officer, which outlined the key achievements and instances when both CCGs had provided leadership in 2017/18. The Chief Officer reported that assurance meetings had been held with NHS England since distribution of the agenda. Both CCG’s meeting had gone well with NHS England being pleased with progress. Clarification of the ratings was awaited. The Collaborative Group was pleased to note the content of the report.

18/018 Corporate Key Performance Indicators

Points highlighted included; • The Chief Officer reported that the Department of Education had been

pleased with the CCGs progress following its recent visit with regard to Special Educational Needs and Disability (SEND).

• Safeguarding work was progressing well and moving forward. • Lisa Nobes had commenced in the role of Chief Nursing Officer and was

making good progress. • Jan Thomas, Chief Contracts Officer was extending her period of

secondment to Cambridge and Peterborough CCG by a further six months.

• Isabel Cockayne, Head of Communications was extending her period of secondment to the East of England Ambulance Service NHS Trust.

The Collaborative Group noted the corporate key performance indicators as presented.

18/019 Integrated Care System

The Group was in receipt of a report which had been presented to the CCGs Governing Bodies at the end of March 2018. The Chief Officer advised that although both Ipswich and East Suffolk and West Suffolk CCGs had approved the report, it had been deferred by North East Essex CCG. The Collaborative Group noted the update.

18/020 Commissioning of Mental Health Services

The Group was in receipt of a report which had been presented to the CCGs Governing Bodies at the end of March 2018. The Chief Officer reported that since concern raised at the previous Collaborative Group meeting in respect of mental health service provision, partners in Suffolk had come together to develop a programme of work going forward and to build a model for change. That model had subsequently been approved by the Governing Bodies in March 2018. A recent meeting had been held with representatives from both CCGs, NHS England, acute Trusts, Suffolk County Council and Norfolk colleagues to explore actions and options going forward, and at the point of a clear strategy being developed it was envisaged that a consultation exercise would take place. The Group was advised that, at present, 60% of referrals into the mental health service were not assessed and that access continued to be a key concern. The need to closely monitor the newly established childrens emotional and well-being hub, was emphasized. The Collaborative Group noted the report and that mental health services was to be standing agenda item going forward.

18/021 Provision of Finance Services to North East Essex CCG

The Group was in receipt of a report, from the Chief Finance Officer which included a proposal and business case for the provision of financial services to North East Essex CCG. The proposal to provide the financial services function to NEECCG included the following changes to staffing levels: • TUPE employment of the existing band 7 staff member (from the CSU)

• Employment of two additional members of staff: 1 x band 5 and 1 x band

8a to support the existing Suffolk team.

• Overview and management of the increased service to be provided by the Head of Financial Accounting and Control and his financial services team.

NEECCG would pay Suffolk CCGs £148,000 per annum for provision of the service, the majority of which would be spent on the staff costs outlined above. The overall service would be more cost effective for the CCGs than the current arrangement and mark the first step in bringing together the finance teams across the STP. Having carefully considered the paper, the following concerns were raised; • That there might be a need to review the cost to North East Essex CCG

in respect of the resource being provided. • That a three month review should be built into the service provision. • There was a need to consider whether trade union consultation was

required either by North East Essex or Ipswich and East and West Suffolk CCGs.

• Approval of the staffing aspect should be via the CCGs Remuneration and HR Committee.

The Collaborative Group therefore approved, in principle, the changes in staffing required to provide the service from 1 July 2018, subject to; 1) The Chief Finance Officer being asked to review the paper in respect of

the costs association to provision of the service and in order to build in a three month review.

2) The Chief Corporate Services Officer being asked to consider whether any trade union consultation was appropriate.

3) Approval of the staffing aspect by the CCGs Remuneration and HR Committee.

EG

18/022 Any Other Business

1) Inquorate Statutory Committees

Concern was raised that recent meetings of Audit Committee and Remuneration and HR Committee had been inquorate due to vacancies in West Suffolk CCG not having been filled. The Chair of West Suffolk CCG asked that the current membership be forwarded to him outside of the meeting for review.

2) Collaborative Group Chair

Martin Smith, Collaborative Group Chair, advised other members of his intention to step down from the position and that today would be his final meeting. Martin was thanked for this contribution both for the PCT and the CCG and wished a happy retirement.

JM

18/023 Date of Next Meeting

The next meeting of the CCG Collaborative Group was scheduled to take place on 7 June 2018 at 11.00am in the Kersey Room (Ed Garratt’s Office) at Endeavour House, 8 Russell Road, Ipswich, Suffolk, IP1 2BX

Unconfirmed Minutes of a meeting of the West Suffolk CCG Primary Care Commissioning Committee held in public on Wednesday, 27 March 2018 at

Hadleigh Town Hall, Market Place, Hadleigh, Suffolk

(This meeting was held with the Primary Care Commissioning Committee of Ipswich and East Suffolk CCG in line with ‘in common’ meeting arrangements)

PRESENT: Jo Finn Lay Member for Patient and Public Involvement, WSCCG (Chair) Steve Chicken Lay Member, WSCCG Geoff Dobson Lay Member: Governance and CCG Vice Chair, WSCCG Ed Garratt Chief Officer, WSCCG /IESCCG Jane Payling Chief Finance Officer, WSCCG/IESCCG Kate Vaughton Chief Operating Officer, WSCCG Dr Christopher Browning West Suffolk CCG Chair (Part) Lucy James NHS England Stuart Quinton Suffolk Primary Care Contracts Manager, NHS England Andy Yacoub Healthwatch IN ATTENDANCE: Maddie Baker-Woods Chief Operating Officer, IESCCG David Brown Deputy Chief Operating Officer, IESCCG Jo Mael Corporate Governance Officer, IESCCG/WSCCG Claire Pemberton Head of Primary Care, IESCCG Caroline Procter Co-Commissioning Manager, IESCCG Dr Mark Shenton Ipswich and East Suffolk CCG, Chair Lois Wreathall Head of Primary Care, WSCCG Julie White Primary Care Development Manager, IESCCG/WSCCG

18/16 APOLOGIES FOR ABSENCE

Wendy Cooper NHS England Cllr Tony Goldson Health and Wellbeing Board Simon Jones Local Medical Committee Jane Webster Acting Chief Contracts Officer, IESCCG/WSCCG


Dr Christopher Browning declared an interest as a Personal Medical Services (PMS)

provider.


The minutes of a West Suffolk CCG Primary Care Commissioning Committee meeting held on 24 January 2018 were approved as a correct record.

18/19 MATTERS ARISING AND REVIEW OF OUTSTANDING ACTIONS

There were no matters arising and the action log was reviewed and updated with comment as follows; 18/07 – Care Quality Commission – the Head of Primary Care questioned the value of comparative data as the requirements were subject to change. Ipswich and East Suffolk CCG had developed a database of learning from CQC inspections and there was intention to use that information as the basis for a training and development event.

18/20 GENERAL UPDATE

As today was the first ‘in common’ meeting with the Primary Care Commissioning

Committee of Ipswich and East Suffolk CCG, Ipswich and East Suffolk CCG’s Chief Operating Officer reported that both Committees had much in common such as; • There was a single Suffolk Personal Medical Services (PMS) contract across both

CCGs and a briefing paper was being developed in respect of the update of the General Medical Services (GMS) contract.

• Both CCGs worked closely with the Suffolk GP Federation and Suffolk Primary Care. • Both CCGs had good quality primary care across their areas with two practices

within each CCG having been identified as ‘outstanding’ by the Care Quality Commission.

• There was good prescribing performance by practices. • Training and development events were held for practices by both CCGs. • Workforce was a common challenge going forward. The Committee noted the update.

18/21 PRIMARY CARE CONTRACTS AND PERFORMANCE MONITORING

The Committee was in receipt of a report that provided an update on contractual and

performance related matters in respect of GP Practices. Key points highlighted included; • The Haverhill Family Practice had informally closed its list on 22 December

2017, due to the pressure of patients wanting to register with them, whilst they had been unable to recruit additional GP partners or salaried staff.

• West Suffolk CCG had been allocated funds for 2018/19 of £826,473 to

provide extended access in West Suffolk. Currently the Bury St Edmunds hub based at West Suffolk Hospital was open Monday to Friday from 6.30 – 9 pm and Saturdays 9-5. The opening times would be extended to meet the national criteria during 2018/19.

• The Haverhill hub had opened early October 2017at the Clements site in

Haverhill. The hub provided a Saturday service 9-5 with four clinicians and a mix of other clinical staff providing care.

The Committee was informed that Ipswich and East Suffolk CCG had a history of producing and publishing detailed practice information and, although similar information existed and was managed within West Suffolk CCG via discussion at practice visits, it had not previously been reported to the Primary Care Commissioning Committee in detail. The Committee noted that the CCG’s Commissioning Governance Committee had approved an uplift to Local Enhanced Services at an earlier meeting. It was questioned whether introduction of the GP+ service had helped to stabilise GP practices within Ipswich. Whilst it was hard to measure any specific instances, patients were being encourages to utilise weekend slots and there had been no dramatic change to A&E attendance levels. Concern was raised that many patients might not be aware of GP+ and it was

suggested that thought be given to developing additional communications, particularly as the service was now seeking to extend the type of practitioners available with the inclusion of nurses and physiotherapists. Care Navigators were to be introduced in West Suffolk late Spring 2018. Healthwatch was receiving increased positive comment with regard to optional services being provided by practices. It was noted that evaluation of the GP+ service provided in Ipswich and East Suffolk would help to inform establishment of the service in West Suffolk. It was agreed that patient feedback information and the number of GP+ appointments utilised by individual practices be reported to a future meeting.

The Committee noted the update.

18/22 PRIMARY CARE DELEGATED COMMISSIONING – FINANCE REPORT

The Committee was provided with an overview of the Primary Care Delegated

Commissioning Budget at month 11. • At the end of month 11, the GP Delegated Budget spend was £3k below plan. • The Local Enhanced Service (LES) budget was on plan. • The GP Forward View funding received year to date was fully committed. As agreed

by the CCG’s Executive the savings on that budget would be used to partially fund the GP+ service which was not funded through any additional funding in 2017/18.

• Key risks at month 11 were overachievement of 2017-18 Quality Outcome Framework (QOF), Care Quality Commission costs, additional primary care postal/transport costs and property costs which had not been budgeted for. Those risks were being mitigated by the use of contingency and reserves. The Chief Finance Officer reported that postal/transport costs were to be incorporated within the general CCG budget going forward.

The Committee noted the financial performance at month 11.

(Dr Christopher Browning entered the meeting)

18/23 WORKFORCE

Julie White, Primary Care Development Manager was welcomed to the meeting to give a short presentation on workforce developments. The Committee was informed that Community Education Provider Networks (CEPNs) in Ipswich and East and West Suffolk had been established 18 months ago with key focus being training and education. There had since been a move by NHS England to bring the CEPNs together across the Sustainability and Transformation Plan (STP) footprint which had resulted in the development of three CEPN Steering Boards and the establishment of a CEPN Operations Group. The CEPN had worked to develop a GP Forward View workforce plan to transform the primary care workforce. Further recent changes had seen Health Education England seek to develop training hubs in order to provide support to practices. Development of the training hubs was likely to result in opportunity to access additional funding streams to assist the upskilling and recruitment of staff. New roles to be pursued as a result of additional funding included the recruitment of a Health Ambassador Coordinator and a Lead Education Nurse. Funding would also be used to pursue the recruitment of GPs, facilitation of Fellowships and development of Practice Managers. The need to continue to engage existing staff and the health and social care workforce across the STP was recognised. The Committee welcomed the update and it was felt that the creation of connections between the CEPN and the training hubs would be key going forward. It was highlighted that Suffolk County Council might be able to assist with reaching out to Secondary Schools with regard to career advice.

The Committee noted the update and welcomed presentation on progress to a future meeting.

18/24 ANY OTHER BUSINESS

No items of others business were received.


The next meeting of West Suffolk CCG’s Primary Care Commissioning Committee was scheduled to take place at 2.00pm on Wednesday, 23 May 2018 in the Conference Room at West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

18/26 QUESTIONS FROM THE PUBLIC

No questions were received.

Unconfirmed Minutes of a meeting of the West Suffolk CCG Commissioning Governance Committee held on 27 March 2018

COMMITTEE: Geoff Dobson Lay Member: Governance (Chair) Steve Chicken Lay Member Jo Finn Lay Member for Patient and Public Involvement Ed Garratt Chief Officer Jane Payling Chief Finance Officer PRESENT: Maddie Baker Woods Chief Operating Officer, Ipswich and East Suffolk CCG Jo Mael Corporate Governance Officer Kate Vaughton Chief Operating Officer, West Suffolk CCG

18/016 APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were received from: Jane Webster Acting Chief Contracts Officer


No declarations of interests, other than those already published, were received.


The minutes of the meeting held on 28 February 2018 were approved as a correct record.

18/019 MATTERS ARISING AND ACTION LOG

There were no matters arising from the previous meeting and the action log was reviewed and updated.

18/020 ANNUAL REVIEW OF TERMS OF REFERENCE

The Committee was in receipt of its terms of reference for annual review.

Although it was felt that the terms of reference might require future review in light of the changing landscape and potential increased role of the Committee it was felt that, at present, the terms of reference remained fit for purpose and therefore; The Committee approved its terms of reference as presented.

18/021 PRESCRIBING BUDGET 2018/19 AND

REWARDING APPROPRIATE PRESCRIBING (RAP) SCHEME 2016/17 AND 2018/19

The Commissioning Governance Committee was in receipt of a report which sought: • Approval of additional funding of up £208,000 to enable RAP Scheme payments for

2017-18 Q3 and Q4 to be made. • Approval of a prescribing budget of £37,732,883 • Approval of a RAP Scheme for 2018-19, with a cap of £600k for the WSCCG.

A RAP Scheme was currently in place for 2017-18 and all practices (GMS, PMS and APMS) were encouraged to participate. It rewarded practices financially for making savings from their prescribing budgets; a percentage of the savings achieved (20-35%) was paid back to practices for reinvestment in patient care whilst the remaining percentage was retained by the CCG, also for reinvestment. The RAP Scheme was one enabler for containing prescribing costs, facilitating a win-win scenario for both practices and the CCG as a whole.

The prescribing spend for 2017/18 was forecast to be £37,737,095. If ‘abnormal’ No Cheaper Stock Obtainable (NCSO) were removed, that would be 3% under budget.

Practice payments are awarded every quarter and to date payments of £223,004 had been made for Q1 and Q2. A payment cap of £350k had been agreed at the start of the financial year 2017-18. Prescribing data was now available for Q3 and it was evident that the cap had been exceeded, meaning that full payments could not be awarded to practices for Q3 and there were no funds remaining for Q4 payments. The RAP Scheme had been a successful driver for delivering implementation of cost effective prescribing changes in 2017-18, and so it would be helpful for full payments to be made available for Q3 and Q4 to maintain on-going practice engagement. Similarly, it would be helpful to secure a higher cap for the RAP Scheme for 2018-19 to facilitate on–going engagement next year. A RAP Scheme was under development for 2018-19 and it was recognised that a higher cap was required than 2017/18. A cap of £600K was being proposed on the basis of: performance in 2017/18; experience of the Ipswich and East scheme in year two, which showed a similar level of reinvestment was required each year; and affordability. Proposals under discussion for the revised scheme included: • Payments that are capped either per practice or per quarter • Payments that are linked to delivery of KPIs or defined ‘effort’. Having queried whether identified QIPP schemes were achievable, it was noted that many of them were a continuation of current work and therefore there was confidence in delivery of the schemes. It was noted that savings required at a national level in respect of Category M drugs were to be returned to CCGs with the intention that they contribute to the CCG surplus. The role of Patient Participation Groups (PPGs) in the reduction of waste and quality improvement was questioned, together with how PPGs might be informed as to how savings were reinvested into primary care. The Committee was advised that PPGs had been involved in the campaign in respect of over the counter medications and there should be opportunity to embed more engagement in other elements of the QIPP programme going forward. The need for a clear audit trail in relation to patient benefit was highlighted. The Committee was advised that its Governing Body was due to consider the use of the current underspend at its meeting scheduled to take place on 28 March 2018. The Commissioning Governance Committee subsequently approved:

• Additional funding of £207,540 for the RAP Scheme 2017-18 • A prescribing budget of £37,732,883 for 2018/19 • Funding of £600k for a similar RAP Scheme for 2018-19.

18/022 ENHANCED SERVICES - UPLIFT

The CCG commissioned a range of services from local practices, which were reviewed by

the Commissioning Governance Committee on an annual basis. The Committee was being asked to consider a proposal to increase those payments by 3.32%.

Due to budgetary constraints, there had been no uplift for 2017/18 and the proposed increase was to reflect an increase in staffing and consumable costs. The percentage was based on the proposed uplift that had been applied to other provider contracts. By way of comparison, the overall primary care contract uplift for 2018/19 was 3.34%.

The budgetary implications had been largely reflected within the budget that was to be presented to the Governing body for approval. The Committee approved the increase of 3.32% to enhanced services.

18/023 POLYPHARMACY ENHANCED SERVICE (LES)

The Commissioning Governance Committee was being asked to approve the

Polypharmacy ES to be offered to all WSCCG practices (GMS, PMS and APMS) in 2018/19. The Polypharmacy ES was currently agreed until 31 March 2018 and it was being proposed that it run for a further year (with a slight modification), to 31 March 2019. The Medicines Management Team monitored the ES and practices were required to submit a polypharmacy report each month indicating how many polypharmacy medication reviews had been carried out. The reports also detailed drugs that had been stopped/dose reduced because they had been identified as being no longer required which enabled the savings (regarding the drug costs only) to be calculated. Patients and the public had consistently advocated the eradication of waste and focus on quality and the ES delivered those objectives. The updated Polypharmacy ES for 2018-19 was appended to the report. Changes are linked to improved patient safety as they promoted the reduction of inappropriate prescribing of high dose opioids and gabapentinoids. Over-prescribing of those drugs had been flagged as a significant national and local priority, e.g. by the NHS England Accountable Officer for Controlled Drugs. Appendix 2 outlined a summary of savings achieved from the Polypharmacy ES to date. The budget required for the Polypharmacy ES for 2018/19 was £179,008 which was based on: • A payment of £45 per polypharmacy medication review • Practices performing one polypharmacy medication review per 1,000 ASTROPUs per

quarter.

The terms of the ES stated that the number of polypharmacy reviews could be exceeded by a particular practice provided it had received confirmation from the Medicines Management Team that they are achieving an acceptable average 12-month saving per polypharmacy medication review. That meant that the allocated budget of £179,008 might be exceeded provided that the savings achieved outweighed the payments awarded. The need to keep the ES under review going forward was emphasized, together with developing a rigorous process to identify achievements. It was felt that improved understanding of the reporting mechanism might be beneficial. The Committee was advised that whilst GPs were usually the initiators of reviews, patients should be able to request a review if desired.

Having queried why such work was subject to an enhanced service rather than considered as business as usual, it was explained that the enhanced service was due to the level of review required for some patients. The number of incidences whereby patients were re-initiated onto medications was queried and it was suggested that an audit to investigate might be of benefit. After careful consideration, the Commissioning Governance Committee subsequently approved the Polypharmacy ES for 2018-19, subject to the undertaking of a six-month review, which should include an outcomes audit.


Meetings of the Commissioning Governance Committee are arranged as and when

required.