governance and performance report · 2016-10-31 · november 2016 our mission: ... 4.4.4 a & e...
TRANSCRIPT
INTEGRATED GOVERNANCE AND
PERFORMANCE REPORT
NHS Lambeth Clinical Commissioning
November 2016
Our Mission: Our Mission is to improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.
Contents 1 INTRODUCTION ................................................................................................ 1
2 EXECUTIVE SUMMARIES ................................................................................ 2
2.1 CCG ASSURANCE – four domains and six clinical priorities ...................... 2
2.1.1 CCG Assurance Framework 2016/17 ......................................................................... 2
2.1.2 Leadership (Domain 4) ............................................................................................... 4
2.1.3 Financial Duties (Domain 3) ........................................................................................ 5
2.1.4 Performance against national constitutional standards 2016/17 .................................. 6
2.2 STRATEGIC AND OPERATIONAL DELIVERY ................................................ 7
2.2.1 Programme Assurance Statements – 2016/17 latest summary position ...................... 7
2.3 QUALITY ASSURANCE ................................................................................... 8
3 CCG ASSURANCE ......................................................................................... 18
3.1 NHS Lambeth CCG Assurance 2016/17 ....................................................... 18
4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK ........................ 19
4.1 Leadership ...................................................................................................... 19
4.1.1 Board Assurance Framework .................................................................................... 19
4.2 Delegated Functions ...................................................................................... 27
4.3 Financial Management ................................................................................... 27
4.3.1 Financial Position ...................................................................................................... 27
4.3.2 QIPP Performance .................................................................................................... 32
4.4 Performance Dashboards ............................................................................. 32
4.4.1 NHS England National Constitution Standards ......................................................... 32
4.4.2 RTT (Referral to Treatment Times for Lambeth Patients) ......................................... 35
4.4.3 Diagnostics (Lambeth Patients) ................................................................................ 36
4.4.4 A & E Waiting Times ................................................................................................. 37
4.4.5 Cancer Waiting Times ............................................................................................... 38
4.4.6 Ambulance Response Times .................................................................................... 40
4.4.7 Improved Access to Psychological Therapies (IAPT) ................................................ 40
4.4.8 New Early Intervention In Psychosis 2 Week Standard ............................................. 40
4.4.9 Dementia Diagnosis Rate ......................................................................................... 41
4.5 Quality Premium 2016/17 ............................................................................... 42
4.6 Quality Alerts .................................................................................................. 44
4.7 Infection Control ............................................................................................ 44
4.8 Mixed Sex Accommodation........................................................................... 44
5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES ...... 45
5.1 Integrated Children and Young People (including Maternity) Programme 45
5.1.1 Programme’s Purpose .............................................................................................. 45
5.1.2 Programme Assurance Statement Quarter 2 2016/17 .............................................. 46
5.1.3 Children and Maternity Programme Board Dashboard .............................................. 49
5.2 Integrated Adults Programme (Elective, Urgent Care, Cancer) ................. 51
5.2.1 Programme Purpose ................................................................................................. 51
5.2.2 Programme Assurance Statement Quarter 2 2016/17 ............................................... 51
5.2.3 Integrated Adults Programme: Older Adults (including Committee in Common and
joint arrangements with Lambeth Council) ............................................................................ 56
5.2.4 Integrated Adults Programme: Long Term Conditions and Medicines Optimisation .. 59
5.2.5 Integrated Adults Programme Dashboard ................................................................. 64
5.3 Better Care Fund (BCF) ................................................................................. 65
5.4 Integrated Mental Health for Adults .............................................................. 66
5.4.1 Programme Assurance Statement as at Quarter 2 .................................................... 66
5.4.2 Mental Health Whole System Dashboard .................................................................. 67
5.5 Learning Disability ......................................................................................... 70
5.6 Staying Healthy (Led by London Borough of Lambeth) ............................. 73
5.6.1 Programme Assurance Statement ............................................................................ 75
5.6.2 Staying Healthy Dashboard ...................................................................................... 76
5.7 Primary Care Development ........................................................................... 84
5.7.1 Programme Assurance Statement ............................................................................ 84
5.7.2 Primary Care Programme Dashboard ....................................................................... 87
5.8 Enabler Programmes ..................................................................................... 90
5.8.1 Governance and Development Risk Register............................................................ 90
5.8.2 Equalities and Engagement ...................................................................................... 93
5.8.3 Organisational Development ..................................................................................... 96
5.8.4 IM&T ......................................................................................................................... 97
5.8.5 Estates.................................................................................................................... 102
5.8.6 Workforce ............................................................................................................... 104
6 QUALITY ASSURANCE ................................................................................ 109
6.1 PALS and Complaints .................................................................................. 109
6.2 Serious Incidents ......................................................................................... 109
6.3 Never Events ................................................................................................ 109
6.4 Freedom of Information (FOI) ...................................................................... 110
Acronyms
AMH Adult Mental Health SLaM South London and Maudsley NHS
Foundation Trust
CCG Clinical Commissioning Group
BCP Business Continuity Plan UCC Urgent Care Centre
CQC Care Quality Commission SMI Serious Mental Illness
CQRG Clinical Quality Review Group LAC Looked After Children
CQUIN Commissioning for Quality and
Innovation Payment
MECS Minor Eye Condition Scheme
CSU Commissioning Support Unit YOS Youth Offending Service
CTR Care and Treatment Review BME Black and Minority Ethnic
EIA Equality Impact Assessments CWD Children with Disabilities
EIP Early Intervention in Psychosis CLAMHS Children Looked After Mental Health Service
EPRR Emergency Preparedness
Resilience and Response
EQA Equality Analysis
FPN Fair Processing Notice H@H Hospital at Home
GSTFT Guy’s and St. Thomas’ NHS
Foundation Trust
PLT Protected Learning Time
IPSA Integrated Personal Support
Alliance
IRT Integrated Respiratory Team
IST Intensive Support Team QIPP Quality Innovation Productivity and
Prevention
IT Information Technology WIC Walk In Centre
KCH Kings College Hospital NHS
Foundation Trust
STP Sustainability and Transformation Plan
LCCG Lambeth Clinical Commissioning
Group
HSCIC Health and Social Care Information Centre
LCSB Local Children’s Safeguarding
Board
NHSI NHS Improvement
LWN Living Well Network DTOC Delayed Transfer of Care
NHSE NHS England NEA Non Elective Admission
PMO Programme Management Office LARC Lambeth Alcohol Recovery Centre
PTL Patient Tracking List STEIS Strategic Executive Information System
PCIF Primary Care Infrastructure Fund IP Inpatient
PRUH Princess Royal University Hospital,
Bromley
SCR Serious Case Review
IMR Infant Mortality Rate
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1 INTRODUCTION
NHS Lambeth Clinical Commissioning Group (CCG) comprises 46 member GP Practices organised
into three localities.
The NHS Lambeth CCG Governing Body is responsible for ensuring that the CCG has appropriate
arrangements in place to exercise its functions effectively, efficiently and economically and in
accordance with the CCG Constitution and our principles of good governance. Membership of the
Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and
nominees from our key Lambeth partners.
The Governing Body is supported by the Lambeth Clinical Network. The purpose of the Clinical
Network is to provide the CCG Board members with sound clinical advice on commissioning care
services, clinical pathways and best practice. The Clinical Network consists of care and clinical
“subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists,
opticians and social care colleagues.
This report sets out how NHS Lambeth CCG is performing against its agreed objectives under the
leadership of the NHS Lambeth Clinical Commissioning Governing Body. It is a tool for providing
assurance to the Governing Body that objectives are being delivered or, where performance is behind
plan, that mitigating actions are in place to address performance improvement.
The 2016/17 Business Plan sets out NHS Lambeth CCG’s corporate objectives. Later is this report,
NHS Lambeth CCG’s Programme Boards and Enabler Work streams report on delivery of their
2016/17 objectives. The Integrated Governance and Performance Report provides a consolidate
picture of delivery of NHS Lambeth CCG’s corporate objectives.
NHS Lambeth CCG Corporate Objectives 2016/17
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2 EXECUTIVE SUMMARIES
2.1 CCG ASSURANCE – four domains and six clinical priorities
2.1.1 CCG Assurance Framework 2016/17
For 2016/17, NHS England introduced a new Improvement and Assessment Framework for CCGs
(CCG IAF). This has replaced the 2015/16 CCG Assurance Framework. In the Government’s
Mandate to NHS England, this new framework takes an enhanced and more central place in the
overall arrangements for public accountability of the NHS.
The Five Year Forward View, NHS Planning Guidance and the Sustainability and Transformation
Plans (STPs) for each area are all driven by the pursuit of the “triple aim”: (i) improving the health and
wellbeing of the whole population; (ii) better quality for all patients, through care redesign; and (ii)
better value for taxpayers in a financially sustainable system. The new framework aligns key
objectives and priorities, including the way NHS England assesses and manages partnership working
with CCGs.
The new 2016/17 Assurance Framework covers health priority indicators located in four domains:
Domain 1: Better Health: this section looks at how the CCG is contributing towards
improving the health and wellbeing of its population;
Domain 2: Better Care: this principally focuses on care redesign, performance of
constitutional standards and outcomes, including priority clinical areas; Maternity, Dementia,
Cancer, Learning Disabilities, Diabetes and Mental Health.
Domain 3: Sustainability: this section looks at how the CCG is remaining in financial
balance, and is securing good value for patients and the public from the money it spends;
Domain 4: Leadership: this domain assesses the quality of the CCG’s leadership, the quality
of care plans, how the CCG works with its partners and the governance arrangements that
the CCG has in place to ensure that it acts with probity, for example in managing conflicts of
interest.
The diagram below summarises the framework:
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The CCG Improvement and Assessment Framework includes a set of 57 indicators across 29 areas.
It is intended that the indicators will be reported quarterly. Not all indicators will be based on data
available each quarter: some indicators will be refreshed quarterly, some will use moving averages to
provide a more up-to-date view and some will only be refreshed annually. Baseline data for each of
the indicators will be available on NHS Lambeth’s website in September.
NHS England has a statutory duty to conduct an annual performance assessment of every CCG.
CCG’s will therefore receive a rating against the four domains, Better Health, Better Care,
Sustainability and Leadership. The rating for this section will be described as follows:
Outstanding
Good
Limited Assurance
Required Improvement
The six clinical priorities will have independent moderation and will be given one of the following ratings:
Top performing
Performing well
Needs improvement
Greatest need for improvement
Ratings will be published on the My NHS website.
https://www.nhs.uk/Service-Search/performance/search
Clinical Priorities 2016/17 baseline assessment
On the 2nd September CCGs received their baseline assessment ratings the 6 clinical priority areas. 4 of these have been now been formally published on the MyNHS website. These are Dementia, Diabetes, Learning Disabilities and Cancer. NHS Lambeth’s ratings are as follows:
Clinical Priority 2016/17 Baseline Assessment
Dementia Top Performing
Diabetes Performing Well
Learning Disabilities Needs Improvement
Cancer Needs Improvement
The CCG will ensure that the performance of these priorities is embedded in its reporting through the relevant Programme Boards, continuing to build on the areas where the CCG is performing well and making progress against plans where further work is required. Further detail on each of these areas can be found within the report.
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2.1.2 Leadership (Domain 4)
The NHS Lambeth CCG Board Assurance Framework (BAF) is included in this report, along with a Heat Map showing the number of risks at each
score for all risks recorded on Lambeth CCG’s Risk Register not just those scoring 12 or above. The BAF and supporting Risk Register are living
documents, updated regularly.
Risk Matrix Impact
Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic 1 4x4=16 2N RTT Performance
5 4x4=16 2C A&E Performance
4x4=16 2M Community Nursing Vacancy Level
4x4=16 4NCBC SEL Strategy - inadequate workforce capacity
4x4=16 4RCBC SEL Strategy - integrated IT systems
4x4=16 7A Financial Planning Risk
1 3x5=15 1A Safeguarding children
10 3x4=12 2A Community Nursing Service Improvement Plan
3x4=12 2B Safeguarding Adults
3x4=12 2K Cancer referral to treatment 62 days
3x4=12 3C Risk to SLaM Contract
3x4=12 3M IPSA Alliance
3x4=12 3N LWN reduction in secondary care demand
3x4=12 5CPCC Walk in Centre Cross Charge risk
3x4=12 6K CSU procurement process risk
3x4=12 6N Change of IT Provider risk
3x4=12 7B QIPP delivery risk
1 4x3=12 5DPCC Minor Ailments Scheme
1x3=3 1x4=4
Risks scoring 12 and above
1x5=5
2x5=10
3 Possible
3x1=3 3x2=6 3x3=9 3x4=12
2 Unlikely
2x1=2 2x2=4 2x3=6 2x4=8
1 Rare
1x1=1 1x2=2
4x5=20
5 Almost Certain
1x5=5 2x5=10 3x5=15 4x5=20 5x5=20
4 Likely
4x1=4 4x2=8 4x3=12 4x4=16
3x5=15
6 6
11061
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2.1.3 Financial Duties (Domain 3)
Financial performance to Month 6 is summarised below.
Performance Area Commentary
Month 6
Position
Revenue Surplus
Lambeth CCG is reporting a surplus of £3.87m for the first half of
the year of 2016/17 and is forecasting a surplus of £7.752m for the
year. This is in line with our target of delivering a 1% surplus
Cash Limit
Cash balances are planned to be maintained at low levels (less
than 1.25% at 30th September 2016). Lambeth CCG's cash
balance at bank at the end of September was £253k. The CCG
expects to meet its cash limit target for the year.
QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target
of £9.151m.
Public Sector
Payment Policy
Public sector payment target is 95% on numbers. The CCG paid
99.47% of NHS invoices based on numbers and 99.72% by value.
Performance for the first six months for Non NHS invoices is
95.75% on numbers and 94.54% by value.
Running CostThe CCG's running cost allowance is £7.6m. The CCG is reporting
a break even position against its running costs budgets.
Key Financial Performance Duties
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2.1.4 Performance against national constitutional standards 2016/17
Our performance against the 2016/17 National Performance Measures is set out below and shows the latest validated position.
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2.2 STRATEGIC AND OPERATIONAL DELIVERY
2.2.1 Programme Assurance Statements – 2016/17 latest summary position
Programme Status/Risks RAG Rating (Red/Amber/Green)
Integrated Children and Young People (Including
Maternity)
Many objectives on track but some risks
identified going forward.
Integrated Adults (Elective, Long Term
Conditions, Older Adults Urgent Care)
Many objectives on track but some risks
identified going forward.
Integrated Mental Health for Adults Some objectives on track but some risks
identified going forward.
Staying Healthy Objectives on track
Primary Care Development Objectives on track
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2.3 QUALITY ASSURANCE
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Guy’s & St Thomas’ Hospital (GSTT) – Month 4 – July 16/17 dashboard data commentary Please note that the majority of M4 data from GSTT has not yet been received due to the internal timelines for the publication of the Trust’s M2 Integrated Quality and Performance Report and therefore there is a reduced commentary.
Friends and Family Test
- The Trust fell short of its internal ‘recommended’ targets for both Inpatient
Friends and Family Test (96% against an internal target of >=97%) and A&E
(84% against an internal target of >=88%). Both scores were lower than the
respective June scores.
- The Trusts Friends and Family IP and A&E response rate continues to be below
internal targets of >=33% and >=18% respectively. A 25.7% IP response rate
was reported in July 2016, the same as June 2016, although there was an
improvement to 17.9% in the A&E response rate.
Maternity
- There has been a significant decrease in the level of caesarean section
rate reported in July 2016 (27.6%) compare to 31.7% in June 2016.
- The number of births per midwife has increased from 28.2 to 28.9 in May.
Safeguarding
The Trust continues to perform well against Children’s Safeguarding
targets in July 2016. Children Level 2 and Level 3 Safeguarding figures
are both above 80%
GSTT (Month 4 – July 2016) CQRG commentary
The information provided in this section is a summary of discussions in the July CQRG
meeting, attended by senior Trust representatives, including the Medical and Nursing
Directors, Clinical Commissioners and Directors of Quality from Lambeth and Southwark
CCGs.
Advance Carenotes IT system - An update was provided by the Chief Nurse regarding
the recent serious incident relating to the poor performance of the Advance Carenotes IT
system. Both internal and external investigations have now concluded, the internal
investigation also had a focus on the Trust procurement process. The draft reports are
now being finalised by should be signed off as final imminently. There will be further
work on improvement plans which should be completed within the next 4-6 weeks. The
identified impact on patients has been minimal; however the increased stress level and
impact on staff that are operating many ‘workarounds’ is an issue which will be
monitored.
Medchart - An update was also provided by the Chief Nurse in regards the serious
incident relating to Medchart following a major IT system failure, which meant it was not
possible to use the Trust’s MedChart (e-prescribing) system over the weekend 25th/
26th of June. This issue was addressed immediately on discovery and the Trust has also
implemented processes to ensure it cannot reoccur, however the medicines
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reconciliation process took several days to complete. Trust actions in response to this
failure were related to improved business continuity planning, such as weekly safety
drills, which will be implemented in order to get staff used to different incidents/
scenarios. A staff engagement exercise was done with c. 2,500 responses received
overall. Responses are currently being analysed and findings will be available soon.
Trust reps confirmed that the Medchart RCA will be completed within 60 days and that
there will be a comprehensive report coming to the Trust Board in September.
Infection Control - The main agenda item was Infection Control. Commissioners noted
the excellent work of the Trust Infection Control team and the Trust’s good performance
across a number of infection control areas. Commissioners did raise a concern about
community staff compliance rates for hand hygiene being relatively low (<80%) and
queried what actions were being taken. Further concerns raised were about Surgical
Site Infections and Clostridium difficile (C-diff) infections and queried the lessons learnt
from the review of the incidents. Trust reps noted that the lessons learnt often were not
transferable across the Trust, rather specific to individual specialties/ incidents. In
regards to the few C-diff lapses of care cases, the lessons learnt have also applied to
specific cohorts of patients. In regard to Antimicrobial Stewardship, IT issues continue to
have an impact. An update on the implementation of the electronic stewardship
surveillance system (“ABx Alert”) was queried. This is still not rolled out but the Trust is
beginning to configure the system.
Other points to note from the CQRG meeting;
A&E demand and GP referrals - An increase was noted in the A&E demand and GP
referrals across Q1, impacting on flow generally within the hospital. Trust reps noted
meetings between Trust reps, CCG/ CSU reps and SLAM, which have been helpful.
Trust analysis shows the volume increase is from all commissioners, including local
CCGs, but also significantly from other areas such as Kent and Essex.
Never Event Action Plan - Trust reps gave a verbal update on progress against Never
Event action plan. Staff involvement in stimulation exercises seems to be a good way for
staff to learn from incidents.
The ‘Going Home’ event, a system wide workshop on discharge, was noted and was
very well attended with plenty of good outputs
52 week waits - There has been an increase in the amount of 52 week breaches related
to the patient choice in particular in diagnostics.
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Quality | King’s (Denmark Hill) Local Dashboard
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Quality | King’s (PRUH) Local Dashboard
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Kings College Hospital (KCH) – Month 4 - July 16/17 data commentary
Falls
- The number of moderate falls reported at Denmark Hill in July was 3. No falls
were reported at the PRUH in July, compared to 1 in June.
- There was only one major fall at the PRUH in July and two at Denmark Hill.
Pressure Ulcers
There was a decrease in the number of all hospital acquired pressure
ulcers in July with a total of 28 (grade 2-4) across both sites compared to
31 in June. There is a noticeable difference in the number of all hospital
acquired pressure ulcers between the two sites, 20 at the DH and 9 at the
PRUH. The majority of pressure ulcers reported at both sites are Grade 2.
No grade 4 ulcers have been reported since the beginning of the year at
either site.
Never Events
There were no never events reported in month 4 at either site.
Healthcare Associated Infections
- A total of 7 C-Difficile cases were reported in July (5 at DH, 2 at PRUH) which is
at total of 21 year to date cases across both sites and under the Trusts trajectory.
- There have been 2 MRSA cases reported since the beginning of the financial
year. Both at Denmark Hill. No new cases were reported in July.
Staffing
- The Trust is not meeting its internal vacancy rate (<8%) across both sites, with
poorer performance at the PRUH (16.2%) compared to 11.9% at the DH. This is
worse than this time last year when the vacancy rate was 12.3% and 8.5%
respectively.
- There has been a slight improvement in the statutory and mandatory training
rates at DH from 82% in June to 80% in July, although this is still in line with the
Trust’s internal target (>=80%). Unfortunately there was no data submitted for the
PRUH.
Friends and Family Test
- Inpatient. 95% of patients ‘recommended’ DH and PRUH for in-patient (IP) care
in July.
- There has been a slight decrease at the DH in response rate for IP FFT from
15.4% in June to 14.0% in July. The response rate for IP FFT at the PRUH has
decreased from 11.3% in June to 13.3% in July.
- A&E There has been a slight increase in the percentage of patients
recommending A&E across both sites in May. 82% of patients recommended
PRUH for A&E in July compared to 80% June. 75% of patients would
recommend DH for A&E in July compared to 74% in June.
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- The response rate for A&E FFT increase slightly at both sides (DH 3%, PRUH
3.2%) compared to previous month (DH 8.2%, PRUH 13.4%).
Complaints - The number of complaints reported at DH increased in July. At DH there were 85
complaints reported in July compared to 64 in the previous month. The number of complaints reported in July at the PRUH fell from 36 in June to 32 in July.
Safeguarding
- Adult safeguarding training levels remain a challenge at both sites, particularly at
DH falling below the 80% target for Level 2-5. Level 2 Children’s Safeguarding
training targets >=80% were met at DH in July at both sites.
Outliers
- The numbers of outliers have decreased at DH in July.
Deteriorating patients
- The number of deteriorating patient incidents was 2 at DH and 1 at PRUH. This
is no change from the previous month.
Maternity
- Maternity C-section rate continues to be within the target of <27% at the PRUH
(24.6%) and within target of <26% at the DH (25.8%) in July. The numbers of
women booked 12 weeks plus did not meet the target of 90% across either site.
King’s (M4 – July 2016) CQRG commentary
The information provided in this section is a summary of discussions in the May CQRG meeting, attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Lambeth, Southwark and Bromley CCGs.
Emergency Medicine – This was the main agenda item for the July CQRG. There has
been an increase in ED attendances across both sites. There has been an increase in
ED attendances across both sites. It was noted that in addition to a general increase in
demand, patient acuity has also increased with more multi-system pathologies being
seen, along with an increase in frail elderly patients presenting at ED. There are
significant challenges to deliver quality care in a crowded department. Demands on
nursing staff are significant, particularly to support those patients who have a delayed
decision to admit (DTA), which means that the nursing team often does ‘ward rounds’ for
delayed DTA patients, as well as seeing new patients in the department.
The Trust noted that the 4-hour target has led to an expectation from ED attenders that they will be seen relatively quickly and it is being used inappropriately. Currently the Trust is working towards the approach set out by the Royal College for Emergency Medicine (RCEM), for Urgent Care to be provided alongside ED. This is being developed at Denmark Hill and is already the model provided at PRUH. An update was provided in regard to violence and aggression in ED and other areas of the hospital and it was noted that this has increased recently. Also, it was noted that there are increasing numbers of mental health patients requiring a mental bed, attending ED and having to wait a significant amount of time to be placed. These patients often become 12 hour trolley breaches. In 2015/16 there were five 12-hour breaches due to lack of mental health
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beds. From April 16 to July 16, there have already been 11 breaches and the situation is compounded by an increase in mental health referrals. There are a number of initiatives being tested to try and improve the situation, including a ‘Code 10’ Policy which involves a multi-disciplinary team meeting to plan appropriate care for the patient waiting for a mental health bed. The Trust also noted a number of areas of positive achievement and the group reflected that improvements in ED are taking place at the PRUH. Commissioners offered to do as much as possible to support the appropriate discussion and actions with mental health providers on the CAMHS/ MH issue, to help improve the situation for mental health patients and improve bed availability.
Quality Priorities for 2016/17
There are 6 Quality Priorities in this financial year. Quality Priority 1 relates to
Enhanced Recovery After Surgery (ERAS); Quality Priority 2 relates to Emergency
abdominal surgery and aims to improve outcomes following emergency abdominal
surgery by ensuring a well-coordinated, standardised care pathway; Quality Priority 3
relates to Sepsis and aims to improve the implementation of sepsis care bundles, the
prevention of sepsis, as well as the quick recognition of sepsis across both sites; Quality
Priority 4 relates to Surgical Safety and the overarching aim is to improve the quality of
the surgical safety checks by 10%; Quality Priority 5 relates to the Accessible
Information and aims to improve access to information for patients, service users and
parents of patients with disabilities and Quality priority 6 relates to Improving the
Outpatient Experience and also aims to improve communication to patients in clinic
about delays.
Other key points to note from the meeting include;
The Trust presented the results from the 2015 National Cancer Patient Experience Survey. Comparison with previous surveys was difficult because there were a number of significant changes to the 2015 survey, but the Trust had some improved areas and worsened score areas in those questions that remained the same.
An overview of the Trusts’ Quality Strategy for 2016-2020 was provided including its values, priorities and goals. There are 5 medium term quality goals, which need to be achieved over the next 3 years (1. Services amongst the safest 10% in the NHS; 2. Patient satisfaction amongst the best 10% in the NHS; 3. Outcomes as good as the best in the NHS and globally; 4. ‘Outstanding’ CQC rating and 5. Introduction of standardised, evidence-based care pathways to minimise unwarranted variation)
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St Georges CQRG Commentary – July 2016 The information provided in this section is a summary of discussions in the July CQRG meeting. This meeting is attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Wandsworth, Merton, Lambeth and Southwark Clinical Commissioning Groups (CCGs). Stroke Audit The most recent Stroke National Sentinel Audit this gave the trust benchmark position against other London trusts. Improvements have been recognised at the trust following implementation of the recommended staffing levels. The recent data confirms St George’s A grade status for both HASU and SU providing high quality care placing the trust in the top 25% of UK hospitals. Issues: At 60% (although within the London average) the trust is not meeting the London standard that 95% of patients be moved from A&E to HASU within 4 hours; largely due to capacity and repatriation problems. Improvements: Additional consultants has helped patient flow through A&E and seen performance improve to 96.1% in July 2016. The trust is also monitored on the number of minutes of occupational therapy and patient therapy that HASU and SU patients receive – factors for the below average performance are attributed to low staffing/staffing changes and weekend therapy coding issues. Trust’s actions to improve performance targets: (1) investigate reasons for static figures for SALT; (2) increase use of group sessions to deliver therapy more efficiently; (3) liaise with other successful units to obtain lessons learnt so that service improvements can be based on an informed plan. After some discussion regarding failure to reach agreement of the rapid repatriation policy, the group decided to ascertain whether there were sufficient numbers of HASU at St Georges, numbers of HASU beds and stroke beds in SWL, and possibly pursue an evaluation of the stroke pathway through STP. It was agreed repatriation and HASU would be escalated to the Acute Provider Collaborative for a system wide approach to resolving matters. Hospital Mortality
The Hospital Standardised Mortality Ratio (HSMR) and Summary Hospital-level Mortality Indicator (SHMI) were discussed; the audience were asked to note that the values presented are risk-adjusted. Currently the HSMR demonstrates the mortality is ‘better than expected’. The SHMI remains well below 1, and is likely to move to ‘better than expected’ in the next months. The data are retrospective, and the increase in SHMI last year is in part a consequence of higher mortality in the winter of 2014/15. Although SHMI and HSMR values are encouraging, it is important to recognise that the values in London trusts are better than seen nationally, and work trying to link these risk-adjusted values to quality of care, have not demonstrated clear relationships. Therefore these values need to be used with caution. The trust monitors mortality in ‘real time’ and have seen a reduction in raw mortality as expected over the summer. Mortality in the last 3 months is approximately 20% less than the previous 3 months. There is an expectation that all deaths are reviewed at care group level, with a need to strengthen processes of documentation and sharing of information. The outcomes of local reviews need to be collated more systematically. The Trusts mortality monitoring group has a
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wide membership including medical and non-medical members. The public Health representative also sits on CQR membership that is very helpful. The group reviews all deaths following elective admission, and deaths in any mortality signal generated using the Dr Foster platform. There has been work on coding and information that impacts on risk adjusted mortality. St George’s has agreed to be one of approximately 10 trusts nationwide who are engaged in the pilot of a new methodology for case note review. This programme is led from the Royal College of Physicians and St George’s will present at the launch in November 2016. In addition there is considerable interest from the Board, and non-executive director (Sir Norman Williams) who is leading some of the work on ‘avoidable mortality’ nationally. The importance of this work to drive, and feed into learning is considerable. The dissemination of consistent processes, documentation and learning was a key ambition for the Mortality Monitoring Group in the forthcoming years. The agreed time lapse between patient discharge death and coding (2 months) leads to some challenges in national risk-adjustment methodology and benchmarking. It would be ideal to reduce the time to ensure all completed episodes were coded soon after discharge. The trust wants to drive increased consultant involvement in the coding of the patient episodes to ensure accuracy and consistency – this is work in progress. Also information is sent to HSCIC as updates each month, it would be helpful to upload whole ‘year to date ‘data more frequently to ensure any corrections, or uncoded episodes could be corrected in year to ensure risk adjusted data are correct. Safeguarding The trust confirmed that HR is conducting a review of safeguarding training; for assurance purposes the trust advised that training continues as is until the end of the review at which point the numbers of staff trained at level 3 should be known. A verbal update at the October meeting is required from the Trust followed by an action plan for discussion at CQRG on completion of the safeguarding training review. GP Quality Alerts There is an identified major focus on three main themes: outpatients experience, inpatient discharge and diagnostics for discussion and generally where the system is not working for patients.
Duty of Candour The trust is undertaking work to refresh the competencies around duty of candour; weekly scrutiny and exceptions are discussed weekly.
18
3 CCG ASSURANCE
3.1 NHS Lambeth CCG Assurance 2016/17 Following on from the Quarter 1 meeting between NHS Lambeth and NHS England in July, a teleconference took place on 9th September. The meeting predominantly focussed on the draft publication of the 2016/17 baseline assessments of the six clinical priorities (Maternity, Dementia, Cancer, Learning Disabilities, Mental Health and Diabetes) as set out in the Improvement and Assessment Framework. Four of the six priorities (Dementia, Diabetes, Learning Disabilities and Cancer) have been formally published and can be found via the following link: https://www.nhs.uk/service-search/performance/search. High level summaries can be found within this report under the relevant Programme Board sections. The South East London Sustainability and Transformation Plan (STP) was submitted to NHS England by 30 June 2016, in line with the national requirement. Refreshed STPs are to be submitted on 21 October 2016 by each footprint.
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4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK
4.1 Leadership
4.1.1 Board Assurance Framework
The NHS Lambeth CCG Board Assurance Framework (BAF) is included along with a Heat Map showing the number of risks at each score for all risks recorded on Lambeth CCG’s Risk Register not just those scoring 12 or above. The BAF and supporting Risk Register are living documents, updated regularly. The BAF includes the key mitigating actions and tracks progress of risk scores over the previous 12 months.
o Two risks have been re-graded on the Board Assurance Framework:
o 2N ‘Ongoing risk of not achieving the agreed NHS Constitution access performance levels for RTT for incomplete pathways impacting
on the CCG Quality Premium and Assurance Framework’. This risk has been re-graded and scored at 20, as KCH will not meet the
target this year, therefore the likelihood is almost certain. This is consistent with the risk scoring for this risk at Southwark CCG.
o 7A ‘Possible risk that current planning and strategic approach is not sufficiently robust to manage pressures and deliver sustainable
financial position in the context of lower levels of growth in the period to 2020/21’. This has been upgraded due to the risks related to
lower levels of growth over the next 5 years.
o Four risks have been removed from the BAF:
o 5BPCC ‘Risk that the CCG will be unable to secure weekend Walk In Centre service from September 2016 as SELDOC have given
notice to end contract’. The risk score has been reduced to eight as the notice period has been extended until March 2017. This will
continue to be monitored by the Primary Care Commissioning Sub-Committee risk register.
o 5SPCC ‘Likely risk that the review of the PMS contract will result in changes to levels of funding to GP practices impacting on service
delivery and service disruption’ – this has been removed from the BAF and the Primary Care Commissioning Sub-Committee risk
register as the PMS negotiations have stalled for 2016/17. This will be reassessed for 2017/18.
o 5WPCC ‘Risk that the delay in the review of the PMS contract will impact on the CCGs ability to implement commissioning intentions’
has been removed from the BAF and re-scored at six. This is because the GPDF contract has been progressed outside of the PMS
negotiations with providers in order to have 16/17 contracts in place by the end of Q1, enabling the CCG to deliver it’s commissioning
intentions. This will be monitored by the Primary Care Commissioning Sub-Committee risk register.
o PMCF07 ‘Prime Ministers Challenge Fund / Access Hubs - Risk that there will be insufficient resources to continue Access Hubs
beyond March 2016’ – this risk has been removed from the BAF and re-scored at eight as agreement reached with Federations for the
continuation of the Access Hubs. This will be monitored by the Primary Care Commissioning Sub-Committee risk register.
20
Heat Map
There are currently 18 risks rated 12 or above.
Risk Matrix Impact
Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic 1 4x4=16 2N RTT Performance
5 4x4=16 2C A&E Performance
4x4=16 2M Community Nursing Vacancy Level
4x4=16 4NCBC SEL Strategy - inadequate workforce capacity
4x4=16 4RCBC SEL Strategy - integrated IT systems
4x4=16 7A Financial Planning Risk
1 3x5=15 1A Safeguarding children
10 3x4=12 2A Community Nursing Service Improvement Plan
3x4=12 2B Safeguarding Adults
3x4=12 2K Cancer referral to treatment 62 days
3x4=12 3C Risk to SLaM Contract
3x4=12 3M IPSA Alliance
3x4=12 3N LWN reduction in secondary care demand
3x4=12 5CPCC Walk in Centre Cross Charge risk
3x4=12 6K CSU procurement process risk
3x4=12 6N Change of IT Provider risk
3x4=12 7B QIPP delivery risk
1 4x3=12 5DPCC Minor Ailments Scheme
1x3=3 1x4=4
Risks scoring 12 and above
1x5=5
2x5=10
3 Possible
3x1=3 3x2=6 3x3=9 3x4=12
2 Unlikely
2x1=2 2x2=4 2x3=6 2x4=8
1 Rare
1x1=1 1x2=2
4x5=20
5 Almost Certain
1x5=5 2x5=10 3x5=15 4x5=20 5x5=20
4 Likely
4x1=4 4x2=8 4x3=12 4x4=16
3x5=15
6 6
11061
1 51
1
1
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UPDATED Sept 2016
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Key Actions
Denis
O'Rourke3C
Risk to SLaM Contract –
possible risk that the delivery of
AMH redesigns fails to reduce
relapse rates and use of beds
8 12 12 12 12 12 12 12 12 12 12 12 12
Proposition to create an alliance in relation to LWN, voluntary sector, IPSA and SLaM and develop a single
operating framework is out for comments. Positive feedback received. Recommendations being firmed up
for presentation to the Governing Body and LA cabinet.
SLaM looking to see how to reduce length of stay and understand more about those unknown to services -
report expected on bed usage/performance Sept 2016.
SLaM have undertaken a comprehensive review of data quality and accuracy and are feeding this through the
contract negotiation process for 2016/17. Agreed trajectory for 2016/17 but trajectory not currently met (Sept
2016)
Denis
O'Rourke3M
Possible risk that the IPSA
Alliance contract fails to deliver
service and financial outcomes
resulting in poor outcomes for
people and financial challenge 4 12 12 12 12 12 12 12 12 12 12 12 12
1. Supporting alliance in relation to housing supply. Procurement process in place to secure additional
housing provision. Sept 2016 - Two schemes are in progress.
2. IPSA Alliance Leadership Team has signed off an activity plan which will deliver the required service
outcomes. A revised service and financial activity plan will be considered at next IPSA ALT - Oct 2016.
3. Proposition to create an alliance contract in relation to LWN, voluntary sector, IPSA and SLaM and develop
a single operating framework is out for comments. Positive feedback received. Recommendations being
firmed up for presentation to the Governing Body and LA cabinet.
Corporate Objective 1.2:
Quality, Safety &
Effectiveness - To
improve the quality and
safety of local services
Director of
Integrated
Commissioning,
Children
Avis Williams-
McKoy1A
Zero Tolerance Risk - Risk of
failure to safeguard children and
identify and respond
appropriately to abuse
5 15 15 15 15 15 15 15 15 15 15 15 15
Child J review completed and published.
New joint review of SCR in collaboration with Lambeth and Croydon Safeguarding Children's Board and NHS
England, led by Croydon - April 2017.
Implement subsequent SCR commissioning recommendations as required - action plan being updated.
LSCB Executive and Sub working groups now refreshed. Learning and Improvement Sub working group
developing key performance indicators - LSCB dataset KPIs to be reported to the board quarterly.
Paper presented and discussed about safeguarding arrangements with regards to health visiting and school
nurses.
2015 Monthly Progress 2016
ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY
Strategic AimExecutive
Lead
Operational
Lead
Corporate Objective 1.1:
Quality, Safety &
Effectiveness - To
improve health outcomes,
address inequalities and
secure a parity of esteem
Director of
Integrated
Commissioning,
Adults
Risk
Register
Ref
Target
Risk
Score
and
Direction
of Travel
Principal Risk (Obstacle to
achievement of Strategic
Aim)
22
UPDATED Sept 2016
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Key Actions
Liz Clegg 2A
Possible risk to service quality
and safety of community nursing
due to failure to implement the
Service Improvement Plan for
Community Nursing
8 12 12 12 12 12 12 12 12 12 12 12 12
Going forward GSTT plan to:
Introduce mobile technology after the introduction of advanced care notes in September 2015 - The
introduction of new reporting system Care Note has and continues to experience functional problems.
Mitigation plan is set to achieve functioning system by Autumn 2016. Mobile technology on hold until Care
notes upgrade happens in August. Pilot started on 26/09/16 with 20 ipads for District Nurses.
Developing the community matron workforce with the introduction of a deputy matron role to grow staff into the
role as are unable to find staff with the skill set readily available. Completed implementation of the
Transformation plan.
Develop action plans by continuing to measure our services through our patients’ experience - Development
of third party (e.g. Age UK Lambeth, Lambeth Healthwatch) review of patient centred outcomes Q4 15/16 and
Q1 16/17, for roll out Q2 16/17 - DN service has team targets for patient feedback surveys and working this
year towards each team analysing their results monthly and meeting together to decide what they need to
change or do more of as a result. Wound management outcomes and palliative care being developed.
Work better across the local hospitals, community and primary care to support patient pathways ensuring
smooth transfers of care and to develop a transfer of care strategy - Community Matrons working with KCH
and GSTT on in-reach to wards to support discharge of patients identified as frequent users of A&E.
Considering test of similar in-reach for community nursing - some good progress being made with recruiting
to Community Matrons. 29/09/2016 - all but one community matron recruited to (started as deputy to improve
recruitment).
Ensure that clinical strategy is underpinned by working closely with social care and voluntary sector.
New models of care are being tested in pilot form early 2016. Test and learn model of care using Buurtzorg
methodology, to be launched September 2016 - Three nurses have been recruited to for Buurtzorg and will
start in September. Likely to go live in late October 2016 following induction for staff. 29/09/2016 - Buurtzorg
nurses in induction and recruiting more.
Complete audit of response form completed for declined referrals - this is underway in Q2.
Repeat of Age UK survey
CCG: To continue to monitor improvement via CQRG and contract monitoring meetings. Next update Sept
2016.
Liz Clegg 2B
Zero Tolerance Risk - Risk of
failure to safeguard adults and
identify and respond
appropriately to abuse
8 12 12 12 12 12 12 12 12 12 12 12 12
Implement the accountability and assurance framework for safeguarding vulnerable people - Implement
recommendations from NHSE deep dive.
Influence NHSE contracts to include safeguarding training requirements - ongoing.
Complete a GP practice 'stock take' - 31/10/2016
Formulate action plan on basis of stock take - 30/11/2016
Recruit designated doctor for adult safeguarding - 31/12/2016
CCG Safeguarding Adults Policy (non-commissioning), including SG Supervision Policy - 30/11/2016
Ratify CCG Prevent Policy 31/10/2016
Agree dataset with providers that can form basis of all contracted service assurance - 31/10/2016
2015 Monthly Progress 2016
Principal Risk (Obstacle to
achievement of Strategic
Aim)
Target
Risk
Score
and
Direction
of Travel
ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY
Operational
Lead
Risk
Register
Ref
Strategic AimExecutive
Lead
Corporate Objective 1.2:
Quality, Safety &
Effectiveness - To
improve the quality and
safety of local services
Director of
Integrated
Commissioning,
Adults
23
UPDATED Sept 2016
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Key Actions
Corporate Objective 1.2:
Quality, Safety &
Effectiveness - To
improve the quality and
safety of local services
Director of
Integrated
Commissioning,
Adults
Liz Clegg 2M
Likely risk service delivery due
to vacancies in community
nursing resulting in inability to
provide quality safe community
nursing
16 16 16 16 16 16 16 16 16 16 16 16 16
GSTFT forward plan:
Implement actions arising from cultural barometer - Cultural barometer complete. Action around training for
staff and IT
Continue to implement the recruitment strategy - Ongoing and vacancy rate is reducing. 29/09/2016 - current
vacancy in DN service 21%, 17 staff in the pipeline which will bring the vacancy down; some progress has
been made with recruiting senior staff, however, some retirements and staff leaving coming up. Rolling advert
for DN service and inpatient units and applicants for every advert.
New models of care are being tested in pilot form early 2016. Test and learn model of care using Buurtzorg
methodology, to be launched September 2016 - Three nurses have been recruited to for Buurtzorg and will
start in September. Likely to go live in late October 2016 following induction for staff.
CCG: To continue to monitor recruitment levels via CQRG, contract monitoring meetings. Next update Sept
2016.
Bisi Aiyeleso/
Sara White2C
Likely risk of not achieving the
agreed access performance
levels for A&E resulting in
longer waits for patients and
failure of the CCG to meet the
national target
12 16 16 16 16 16 16 16 16 16 16 16 16
A repatriation project has commenced across SE and SW London. has delivered significant improvements;
the numbers of patients awaiting repatriation to local hospitals from Kings, for example, was regularly
reported in excess of 30 and this has now reduced to below 10 on a daily basis. Complete by end of March
2015.
A&E performance remains challenging at both GSTT and Kings. The CCG is now represented at the weekly
performance meeting at GSTT.
Tripartite visit made to GST ED including Lambeth CEO following significant drop in performance.
Acknowledged that performance targets will be challenging during building works/moves and consequential
loss of capacity. ECIP visit scheduled for November to assist with immediate improvements.
Meetings taken place with GST and GP practices on improving processes for the Diversion scheme.
Lambeth and Southwark CCGs ED diversion and Mental Health monthly meeting with acute trusts to identify
schemes that can support the management of activity within the ED and reduction of pressure points e.g.
issues with mental health patient flows.
Provider plans for winter schemes are being agreed through the Lambeth and Southwark A&E Delivery
Board
Harriet
Agyepong2K
Possible risk of not achieving
the access performance levels
for timely access to cancer
treatment (as measured by the
standard for 62 days from GP
referral to treatment) impacting
on the CCG Quality Premium
and Assurance Framework
12 16 16 16 16 16 16 12 12 12 12 12 12
GSTT and KCH have trajectories for achieving the target.
ACN being developed to work across South East London and achievement of performance targets will be
part of their remit.
Consolidated South London plan submitted on 09/09/16 sets out system actions to deliver start year
trajectories - awaiting feedback from NHS England.
Harriet
Agyepong2N
Ongoing risk of not achieving
the agreed NHS Constitution
access performance levels for
RTT for incomplete pathways
impacting on the CCG Quality
Premium and Assurance
Framework
12 16 16 16 16 16 16 16 16 16 16 20 20
KCH and GSTT outsourcing some elective activity to private providers to assist with the reduction of the
backlog - ongoing
A Lambeth and Southwark Planned Care workstream has been established to assist in optimising clinical
pathways and managing referrals.
KCH have a trajectory/plan to reduce long waiters in non-neurosurgery by October, however the plan for
neurosurgery is subject to agreement with specialist commissioning.
2015 Monthly Progress 2016
Strategic Aim
Corporate Objective 2.1:
Sustainable Delivery &
Governance - To secure
delivery of the NHS
constitutional rights and
pledges for all Lambeth
residents
Executive
Lead
Director of
Integrated
Commissioning,
Adults
Risk
Register
Ref
Operational
Lead
Principal Risk (Obstacle to
achievement of Strategic
Aim)
Target
Risk
Score
and
Direction
of Travel
ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY
24
UPDATED Sept 2016
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Key Actions
Christine
Caton7A
Possible risk that current
planning and strategic approach
is not sufficiently robust to
manage pressures and deliver
sustainable financial position in
the context of lower levels of
growth in the period to
2020/21’.
8 12 12 12 12 12 12 12 12 12 12 12 16
SE London CCGs and providers have ownership of STP to deliver transformation across boroughs and
providers.
The Finance and QIPP Working Group and Governing Body have had oversight of the developing 2017/19
Operating Plan.
The CCG delivers transformation through its programmes -ongoing and is working the SELPMO to assess
the impact of the STP plans to support local delivery - ongoing.
The CCG Five Year Strategy and SEL Five Year Sustainability and Transformation Plan (STP) was submitted
in June 2016. CCGs are required to deliver two Operating Plan and contracts by December 2016.
Work is underway to assess activity and finance impact of 201719 commissioning intentions at CCG and
SEL level and these will be built into provider contracts and responsibility for delivery assigned.
CCG is risk assessing QIPP schemes for 2017/19 including phasing and impact and developing further
options for consideration.
CCG is undertaking detailed 2016/17 in-year review of all budgets to seek to recover activity over-
performance, create budget flexibility to manage risk in 2017/18 onwards and identify where costs can be
reduced.
Provider Collaborative Productivity workstream underway to support delivery of efficiency savings across
SEL. Implementation plan is being developed.
Plan has been produced to agree 2017/18 to 2018/19 Commissioning Intentions and deliver accelerated
business planning timetable.
Programme delivery plans are in place to achieve our 2016/17 commissioning intentions and these have
been built into our signed contracts.
Business case development is underway across SE London to implement STP where applicable and
transformation programme is being built into local plans.
The 2016/17 financial framework and start budgets were approved by the GB on 2 March. CCGs required to
hold 1% NR fund to mitigate health strategies.
For SEL STP business cases are being developed as applicable.
Christine
Caton7B
Risk of failure to deliver QIPP
and acute overperformance
leading to CCG risk on financial
sustainability
8 12 12 12 12 12 12 12 12 12 12 12 12
We have developed plans that have impact going into 2016/17 to make sure we are in a position to meet the
financial challenges that lay ahead - March 2016.
The CCG continues to review its performance reporting to improve the way in which we manage delivery
including reflecting the new CCG assurance framework- ongoing
The CCG undertakes in year risk assessments and develops contingency plans to deliver variances from
plan - ongoing.
Commissioning Intentions were reviewed and prioritised by programmes for 2016/17 Operating Plan.
The overall content and financial framework was approved by GB in January 2016 and start budgets on 2
March. Business cases for investment and project plans for programmes including QIPP have been produced
to deliver 2016/17 Operating Plan.
CCG is now working through integrated teams and with the CSU MDT to develop Commissioning Intentions
for 2017/18 and 2018/19 to inform two year Operating Plan and contracts by December 2016 as required by
NHSE/NHSI guidance of 21 July 2016.
CCG is working with providers to agree robust demand management plans to address rising demand and
performance delivery issues as CCG is to be held accountable for these in 2016/17.
2015 Monthly Progress 2016
ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY
Strategic AimExecutive
Lead
Operational
Lead
Risk
Register
Ref
Principal Risk (Obstacle to
achievement of Strategic
Aim)
Target
Risk
Score
and
Direction
of Travel
Corprate Objective 2.2:
Sustainable Delivery &
Governance - To ensure
good governance,
financial stability of the
local health economy,
VfM and the delivery of
statutory responsibilities
Chief Financial
Officer
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Key Actions
Ursula Daee 5CPCC
Financial risk (forecast 262k) as
Lambeth are not able to cross-
charge other CCGs WIC due to
insufficient patient level data on
non-Lambeth patients
4 12 12 12 12
1. Following up receiving patient level data in required format for Monday to Friday attendances
2. Meeting being arranged between CCG (Primary Care and Finance) and CSU to discuss next steps on
invoicing
Ursula Daee 5DPCC
Financial risk of overspend on
Minor Ailments Scheme.
3 12 12 12 12
1. Post payment verification audit to be instigated into the payments made to date - action for Ursula Daee -
commenced
2. Key pharmacies identified. LPC advised that these audits will be undertaken
Corporate Objective 3.1:
System Transformation -
Commission Proactive
care focused on
prevention and early
detection of illness;
Improve outcomes for
Lambeth patients,
achieve better value,
integrated care through
transformation
programmes in
partnership
Director of
Integrated
Commissioning,
Adults
Denis
O'Rourke3N
Possible risk that the LWN does
not reduce demand on
secondary care resulting in the
system becoming unsustainable
and costs in relation to higher
bed usage
8 12 12 12 12 12 12 12 12 12 12 12 12
Negotiating with GP Federation becoming part of the LWN Provider Alliance Group and future alliance
agreement – ongoing. GP+ Scheme will move to GP Federations in October 2016.
Meeting held with voluntary sector providers to signal where heading and how to best organise alliance -
ongoing meetings, further meeting Sept 2016.
Working towards an alliance agreement to support the LWN – April 2016. Workshop in Oct 2015 for whole
market providers to outline plans. Project plan agreed to take this forward. Commissioning intentions for
2016/17 include provision for CCG tapered pick up of LWN posts previously funded by GSTT - ongoing.
LWN - next phase of design work commenced. Identified two key prototypes - testing local area co-ordination
and integration of LWN and CMHT. Scoping out project.
Developing procurement plan for the next phase - draft in testing phase - Oct 2016
Proposition to create an alliance contract in relation to LWN, voluntary sector, IPSA and SLaM and develop a
single operating framework is out for comments. Positive feedback recieved. Recommendations being
firmed up for presentation to the Governing Body and LA cabinet.
2015 Monthly Progress 2016
Executive
Lead
Operational
Lead
Principal Risk (Obstacle to
achievement of Strategic
Aim)
Target
Risk
Score
and
Direction
of Travel
Strategic Aim
Risk
Register
Ref
ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY
Corprate Objective 2.2:
Sustainable Delivery &
Governance - To ensure
good governance,
financial stability of the
local health economy,
VfM and the delivery of
statutory responsibilities
Director of
Primary Care
Development
26
UPDATED Sept 2016
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Key Actions
Una Dalton 4NCBC
SEL Risk for information: Risk
that inadequate workforce
capacity/skills and a lack of
integrated information systems
will affect the delivery of the SEL
Strategy in providing new
models of integrated, high
quality care
4 16 16 16 16 16 16 16 16 16 16 16 16
1. Workforce action plan to be developed from each CRG
2. Borough workforce plan to be reviewed (CEPN plan)
Andrew Parker 4RCBC
SEL risk for information: Risk
that a lack of integrated
information systems will affect
the delivery of the SEL Strategy
in providing new models of
integrated, high quality care
4 16 16 16 16 16 16 16 16 16 16 16 16
Full alignment to CCG Programme Enablers
Andrew Parker 6N
Risk that failure to robustly
identify all existing data
structures in advance of
changes to IT delivery partner
could result in loss of data for
the CCG or loss of service to
GP practices
8 16 16 12 12 12
Completion of discovery phase and identification of transition tasks for the current and new IT provider -
ongoing
Development of data cleansing guidance for CCG
Communications to Practices
HR meetings in place for staff transferring
New timeline to be produced - 31/07/16
Chief Financial
Officer/Director
of Governance
and
Development
Christine
Caton/Una
Dalton
6K
Risk that ineffective
management of commissioning
support service procurement
process may lead to poor
quality service procured.
8 12 12 12 12 12 12 12 12 12
1. Action plan in place for management of procurement process for each service line (GP IT and CCG IT in
progress) - interim arrangements in place with SECSU and transition work with NEL is underway.
2. Begin procurement process for all other services - planned for late 2016
2015 Monthly Progress 2016
Corporate Objective 3.2
System Transformation -
To ensure the CCG’s
commissioning resource
and organisational
capability are effectively
aligned to deliver its
objectives
Director of
Primary Care
Development
Target
Risk
Score
and
Direction
of Travel
Strategic AimExecutive
Lead
Operational
Lead
Risk
Register
Ref
Principal Risk (Obstacle to
achievement of Strategic
Aim)
ASSURANCE FRAMEWORK 2016/17 – PROGRESS SUMMARY
27
4.2 Delegated Functions
NHS Lambeth CCG members have been asked to vote in support of the decision to move
to Level 3 delegation. The deadline is midnight 12th October 2016. The CCGs initial
application is due to NHS England by the 1st of November with the final application to be
submitted by 5th December 2016.
4.3 Financial Management
4.3.1 Financial Position
To deliver financial control totals for resource and cash and support the delivery of
statutory financial duties for 2016/17
The CCG is required by statute to meet certain financial duties to ensure that public funds
are used appropriately. CCGs are required not to exceed the revenue (administration and
programme) and capital resource limits in any one year and to have cash balances of no
greater than 1.25% of the main monthly drawdown for March 2017.
Lambeth CCG’s financial performance as at September is a surplus of £3.876m.
The year end forecast is an underspend of £7.752m which is in line with our planned
target of delivering a minimum 1% surplus.
Running Costs budgets are showing a small underspend of £34k at month 6 and are
within the £22.50 per head Running Cost allowance. We are forecasting an underspend
of £83k for the year.
The CCG has drawn down £205.4m of cash at the end of month 6. The maximum
cash drawdown limit for 2016/17 is £465.8m. The cash balance at the end of September
2016 was £253k.
Revenue Resource Limit
Month 5 -
August
Changes Month 6 -
September
£'000 £'000 £'000
Issued Budgets - Programme 448,210 1,728 449,938
Issued Budgets - Admin (Running Cost) 7,627 0 7,627
Reserves 9,487 (705) 8,782
Planned Surplus 7,752 0 7,752
Total Allocation 473,076 1,023 474,099
Summary of Budgets - September 2016
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Performance Area Commentary
Month 6
Position
Revenue Surplus
Lambeth CCG is reporting a surplus of £3.87m for the first half of
the year of 2016/17 and is forecasting a surplus of £7.752m for the
year. This is in line with our target of delivering a 1% surplus
Cash Limit
Cash balances are planned to be maintained at low levels (less
than 1.25% at 30th September 2016). Lambeth CCG's cash
balance at bank at the end of September was £253k. The CCG
expects to meet its cash limit target for the year.
QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target
of £9.151m.
Public Sector
Payment Policy
Public sector payment target is 95% on numbers. The CCG paid
99.47% of NHS invoices based on numbers and 99.72% by value.
Performance for the first six months for Non NHS invoices is
95.75% on numbers and 94.54% by value.
Running CostThe CCG's running cost allowance is £7.6m. The CCG is reporting
a break even position against its running costs budgets.
Key Financial Performance Duties
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Summary Budgets – Financial Position for September 2016/17
It is essential that the CCG maintains strong internal financial controls to enable it to achieve its
statutory duties, delivers value for money and have a clean bill of audit health.
Actions being taken include:
Delivery of the 2016/17 Internal Audit Plan and making sure that recommendations are
implemented promptly. This is closely monitored by the CCG’s Audit Committee.
Embed understanding across Governing Body Members/Head of Collaborative Forum of
Internal and External Audit including the use of induction for new Governing Body
Members.
Review Standing Orders, Prime Financial Policies and Scheme of Delegation under
review to make sure that they best reflect the needs of CCG and to support accountability
through programme boards.
The CCG is developing and implementing a training programme that along with the
Budgetary Framework supports effective budget management and control.
Plan Actual Plan Actual
£'000 £'000 £'000 % £'000 £'000 £'000 %
Resource Allocation
Programme Resource 231,742 231,742 0 0% 466,472 466,472 0 0% 0 0
Running Cost Resource 3,813 3,813 0 0% 7,627 7,627 0 0% 0 0
Total Resource Allocation 235,555 235,555 0 0% 474,099 474,099 0 0% 0 0
Programme Expenditure
Acute 140,215 139,799 416 0% 280,431 280,908 (478) (0.17%) 1,744 (3,099)
Mental Health 34,962 35,564 (602) (2%) 69,924 71,274 (1,349) (1.93%) (1,160) (1,813)
Community Health 10,090 10,106 (16) (0%) 20,180 20,170 10 0.05% 158 (255)
Continuing Care/Free Nursing
Care 8,203 9,107 (904) (11%) 16,406 18,186 (1,780) (10.85%) (1,356) (2,550)
Primary Care 22,025 22,376 (351) (2%) 44,050 44,526 (477) (1.08%) 8 (936)
Other Programme Costs
including Corporate 7,980 7,698 282 4% 15,960 15,709 250 1.57% 450 (118)
Total Programme Costs 223,475 224,649 (1,175) (1%) 446,950 450,773 (3,823) (0.86%) (154) (8,772)
Running Cost
Pay 1,950 2,159 (210) (11%) 3,899 4,117 (218) (5.59%) (218) (218)
Non Pay 1,864 1,618 246 13% 3,728 3,427 301 8.06% 301 301
Total Running Cost 3,814 3,778 36 1% 7,627 7,544 83 1.08% 83 83
Reserves including
contingency 4,391 3,253 1,139 26% 11,770 8,030 3,740 31.78% 3,740 3,740
Total CCG Expenditure 231,680 231,680 0 0% 466,347 466,347 - 0 (0.00%) 3,669 (4,949)
Surplus 3,876 3,876 0 0% 7,752 7,752 - 0 (0.00%) 11,421 2,803
EXECUTIVE SUMMARY - FOR THE PERIOD - APRIL - SEPTEMBER 2016
Variance ((Adv)/Fav) Variance ((Adv)/Fav)
Year to Date Forecast Outturn
Best Case
Variance
Worst Case
Variance
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Delivery of the action plan from the Financial Control Environment Assessment.
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QIPP Analysis By Delivery Area
2016/17 QIPP Delivery by area is shown in the table below.
2016/17 QIPP Annual
Plan Plan Actual Variance % Actual Variance % Actual Variance %
Acute
Guys & St Thomas NHSFT
Emergency Admissions 1,316 658 658 0 100% 1,316 0 100% 1,200 (116) 91%
Outpatient redesign and activity reduction 1,570 785 785 0 100% 1,570 0 100% - (1,570) 0%
Prescribing 314 157 157 0 100% 314 0 100% 314 0 100%
GSTT NHSFT - TOTAL QIPP 3,200 1,600 1,600 - 100% 3,200 - 100% 1,514 (1,686) 47%
Kings Healthcare NHSFT
Emergency Admissions 1,237 619 619 0 100% 1,237 0 100% - (1,237) 0%
Outpatient redesign and activity reduction 926 463 463 0 100% 926 0 100% - (926) 0%
Prescribing 38 19 19 0 100% 38 0 100% 38 0 100%
KINGS NHSFT - TOTAL QIPP 2,201 1,101 1,101 - 100% 2,201 - 100% 38 (2,163) 2%
TOTAL ACUTE QIPP 5,401 2,701 2,701 - 100% 5,401 - 100% 1,552 (3,849) 29%
Mental Health
Acute & Early interventions 873 437 437 0 100% 873 0 100% - (873) 0%
Acute Triage 18 9 9 0 100% 18 0 100% - (18) 0%
Mental Health Older Adults 475 238 238 0 100% 475 0 100% 475 (0) 100%
Cascaid Service 56 28 28 0 100% 56 0 100% 56 0 100%
IPSA 508 254 254 0 100% 508 0 100% 508 0 100%
Mental health Other 332 166 166 0 100% 332 0 100% 332 0 100%
Total 2,262 1,131 1,131 0 100% 2,262 - 100% 1,371 (891) 61%
Medicines Management 1,199 600 600 0 100% 1,199 0 100% 1,199 0 100%
Primary Care Savings 212 106 72 (34) 68% 144 (68) 68% 144 (68) 68%
Other Programme Services 607 304 304 0 100% 607 0 100% 607 0 100%
CH - Contracts - Other Providers (non nhs) 220 110 110 0 100% 220 0 100% 220 0 100%
Total 2,238 1,119 1,085 (34) 97% 2,170 (68) 97% 2,170 (68) 97%
Grand Total Gross QIPP 9,901 4,950 4,916 (34) 99% 9,833 (68) 99% 5,093 (4,808) 51%
Investment (750) (375) (341) 34 91% (682) 68 91% (682) 68 91%
Net QIPP 9,151 4,575 4,575 0 100% 9,151 - 100% 4,411 (4,740) 48%
LAMBETH CCG
Year to Date (September) Underlying PositionForecast Outturn
QIPP DELIVERY FOR THE YEAR 2016/17
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4.3.2 QIPP Performance
The table below shows headline RAG-rating each of the NHS Lambeth CCG QIPP schemes for 2016/17.
QIPP Scheme Month 06 2016/17 Update RAG rating
Acute
Continuation of existing schemes from last year and extension of new areas such as outpatient redesign scheduled for later on in 2016/17.
Mental Health On track for reduction in occupied bed days for Lambeth activity at SLAM.
Medicines Management All schemes delivering to plan.
Other Other savings in primary care, other prescribing and community health on track
4.4 Performance Dashboards
4.4.1 NHS England National Constitution Standards
The performance dashboard covers the National Constitution Standards as set out in the
national 2016/17 Assurance Framework. Lambeth CCG’s performance for each of these
measures for the financial year 2016/17 is set out in the table on page 32.
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NHS Lambeth CCG National Performance Measures for 2016/17.
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NHS Lambeth CCG Performance by Provider – Month 4 (July 2016)
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4.4.2 RTT (Referral to Treatment Times for Lambeth Patients)
The CCGs performance in July is primarily driven by the position at KCH and this is expected to be the case for the duration of 2016/17. This is reflected in the CCGs trajectory. KCH returned to reporting its RTT incomplete position in March 2016.
GSTT Current Performance
July is the first month that GSTT has not met the RTT target.
The Trust has highlighted an increase in referrals which will affect its ability to keep track with increased activity and therefore is likely to affect their incomplete performance throughout the rest of the year.
Actions Taken
2016/17 demand and capacity planning to provide assurance that activity plans reflect
backlog clearance trajectory requirements and that capacity is in place to support delivery.
The Trust has flagged this issue with commissioners and NHSI.
The Trust is working to an RTT improvement plan to mitigate performance and working with the CCG on demand management schemes and options.
King’s Current Performance
Not yet meeting the 92% standard, but above planned trajectory so far this year.
Trust wide the reported position in July was 82% in line with the planned recovery
trajectory of 82%. This is a 0.7% increase from June.
Demand management – enhanced focus on demand management in line with national
demand management initiatives.
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Actions Taken
The Trust has submitted an improvement trajectory to get to 88% by March 2017.
An over 18 week backlog reduction trajectory has also been submitted. The trust is currently behind this at 14 909 against a target of 13 841. This highlights that whilst performance is back on track the backlog has not reduced to the level expected. This indicates to the performance improvement being linked to a reduction in the level of activity and or, an increase in new referrals rather than backlog clearance.
KCH continues to work to an agreed RTT action plan to improve performance and reduce backlog over the year.
4.4.3 Diagnostics (Lambeth Patients)
GSTT Current Performance
Currently not meeting the <1% standard as at July 2016.
Performance Trust wide is 1.1%. The Trusts recovery trajectory was to meet the target by July 2016, however, it is likely that the performance will remain static until the end of October 2016.
Actions Taken
The new Cancer Centre at GSST is now open, providing additional MRI capacity.
Process related service improvement work to reduce monthly breaches and timely treatment alongside specific work in urology and cystoscopy.
TSCT phase 2 diagnostic demand and capacity work with a need to link this to a review and assessment of sustainability requirements post recovery.
Outsourcing – further testing of the scope to outsource key diagnostic tests, through the SEL outsourcing initiative to provide further risk mitigation. For some tests where the demand is increasing there is limited alternative provision (GA, Paediatric MRI and paediatric sleep studies)
Wider performance improvement work –diagnostics within the cancer timed pathways
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and elective demand management work. King’s Current Performance
KCH represents the biggest proportion of the underperformance.
Currently not meeting the standard and below trajectory for July by 5.1%
(performance 6.8%).
The two biggest issues are with Ultrasound and Neuro MRI. Utlrasound has
had staffing and capacity issues.
Actions Taken
The Trust has increased the number of sonographers via agency staff to address capacity issues in Ultrasound.
The Trust continues to reduce MRI through agency staff, whilst permanent recruitment is underway.
Weekend GA lists are in place to minimise Neuro MRI backlog.
Cardiac MRI will be outsourced to London Bridge and general MRI to the Alliance.
KCH have a recovery trajectory to get to 1% for August 2016. Weekly reporting shows that this has been missed although the Trust has seen a big improvement to around 2.4% for August (based on provisional data).
4.4.4 A & E Waiting Times
The national standard states that 95% of patients should be seen within four hours in an A&E department.
GSTT Current Performance
Currently not meeting the 95% standard
The Trust has breached the trajectory every month to date.
Draft Performance for August based on weekly figures shows a performance of 89.6% against a planned recovery trajectory of 95.1%.
Performance is driven by higher levels of acuity; the impact of the A&E rebuilding programme; overall capacity constraints.
The Trust has been developing and implementing a comprehensive ED action plan, actions have been split into; Capacity; ED Triage; Escalation;
The Trust recovery plan trajectory for 2016/17 anticipated a return to compliance in
May, however this was missed with planned underperformance from September
across Q3 and Q4 following necessary rebuild configuration and impact at that point
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in the year.
King’s Current Performance
Draft performance figures for August based on weekly figures shows a performance of 87.45% for Denmark Hill and 88.3% trust wide, above the planned recovery trajectory of 87.4%.
KCH STP trajectory for A&E shows under performance Trust wide against the
national performance standard across 2016/17.
KCH has produced an ED recovery plan. This covers: Out of hospital actions
(focussed on admission avoidance; proactive care, access to ambulatory and
rapid access specialist services; early supported discharge and enhanced
community services) In-hospital actions; reviewing and re-designing the
urgent care pathway, non-elective end to end transformation programme and
bed capacity at the PRUH.
4.4.5 Cancer Waiting Times
Lambeth missed 5 of 9 cancer targets in July. 62 day performance improvement is linked to reducing late referrals to GSTT. A system wide recovery trajectory has been agreed. The actions will support improvement across SEL but are considered high risk.
Cancer 2 week wait.
July’s underperformance relates to 89 breaches. 73 at GSTT, 13 at KCH and 3 at St Georges. 74 were categorised as patient choice.
There is a particular issue at GSTT for patients referred for lower GI cancers. A telephone triage clinic has been set up which allows patients to book directly into Endoscopy diagnostics. Whilst this change in the pathway speeds up the process of attending the diagnostic appointment it means the previous outpatient appointment does not occur to stop the 2 week wait clock resulting in breaches. The clock now stops when the diagnostic takes place. On occasion this is after 2 weeks.
The Trust is working to improve its booking processes direct from the telephone triage to ensure the endoscopy can happen sooner. Performance is expected to improve over the coming months.
KCH has seen an increase of 25% in referrals for 2 week referrals. This is an over performance of 7%. A review is underway to identify where the additional referrals are
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coming from. An action plan will be developed to address the findings and will be taken through the Cancer Locality Group.
Cancer 2 weeks breast symptoms - July’s under performance relates to 13 breaches. 8 were unavoidable and 5 avoidable.
Cancer 31 day subsequent treatment – drugs July’s underperformance relates to 1 breach at GSTT due to a patient not being well enough for treatment.
62 day standard Current Performance
Actions Taken
Actions taken
Current performance against the 85% standard is not being met
There has been a slight improvement in performance over the last two months,
however, performance is still below planned recovery trajectories.
July’s performance 77.3% related to 10 breaches. (8 at GSTT, 2 at KCH)
GSTT’s performance against this target remains challenging. Overall trust-wide
performance improvement is linked to reducing later referrals into the trust from
other providers, as well as maintaining internal performance of 85%.
A system wide recovery trajectory has been agreed at tripartite level, separate
trajectories from both GSTT and KCH outlining improvement in the amount of
patients referred to GSTT within 38 days have been produced. However with this
information GSTT is predicted to not meet the 85% target trust wide across
16/17 due to the impact of referrals from outside of SE London.
GSTT has committed to meet the target for internal patients for all months, but
has been below this target, the Trust now predict to meet internal performance in
Q4 . Actions to reduce late referrals from other providers will support a Trust
wide improvement for GSTT but are considered high risk.
SPG Cancer Improvement Plan has been developed through the 62 day cancer
waits group. This pulls together an agreed set of actions from all Trusts.
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4.4.6 Ambulance Response Times
LAS Current Performance
The performance standard for Cat A (Red 1) has been met every month since
April 2016. This is a notable improvement compared to performance during
2015/16.
The Performance standard for Cat A (Red 2) and Cat A 19 was narrowly
missed for July 2016, but had been achieved for every month prior to this.
4.4.7 Improved Access to Psychological Therapies (IAPT)
The standard for people with depression referred for and accessing psychological therapy is 15% for 2016/17. The CCG continues to perform well in this area, exceeding the target in Q2 for 2016/17. The actual target number per quarter is 1656 (3.75%) with this being exceeded in Q2 with 1,843 (4.17%) accessing treatment. The standard for the proportion of people who complete therapy and move to recovery is 50%. Performance in this area for Q2 has been 50%. NHS Lambeth CCG has performed consistently well against the target for the proportion of Lambeth patients finishing a course of treatment receiving their first appointment within 6 weeks of referral. The target for Q2 in 2016/17 was exceeded with 95.26% achievement against the 75% target. Strong performance is also being maintained against the 95% target for the proportion of patients finishing a course of treatment receiving their first appointment within 18 weeks of referral. In Q2 for 2016/17 the service achieved 100%.
4.4.8 New Early Intervention In Psychosis 2 Week Standard
The NHS Guidance for the Implementation of the EIP Access and Waiting Time Standards defines clock stop as when:
An individual is accepted onto the caseload of an EIP service capable of providing a full package
of NICE concordant care, and;
Allocated to and engaged with an EIP care co-ordinator.
The SLaM EIP pathway interpreted the guidance to mean that individuals require a face to face assessment for suitability for EIP services, as well as a face to face contact with a care co-ordinator to evidence the beginning of engagement, within 14 days. However, it has become apparent that the requirement to have both a face to face assessment and a further follow up face to face appointment with an EI care coordinator to stop the clock is a higher bar than that set by the standard, as agreed by the London EIP Clinical Reference Group. This has impacted on the achievement of the EIP target.
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Lambeth initially achieved the target in April (66%) but have missed it in May (33.33%) and June (16.67%). They have achieved the target in July (50%) and July (62.5%).
4.4.9 Dementia Diagnosis Rate
The Health and Social Care Centre (HSCIC) has now published data for Dementia Diagnosis Rate for
the year to August 2016.
Based on previously reported data NHS Lambeth CCG continues to perform highly in this area.
The graph shows published data for NHS Lambeth CCG’s GP practices, for the percentage of patients
for the CCG with a dementia diagnosis recorded against estimated prevalence. The rate would be
expected to fluctuate slightly month on month as patients join and leave GP practices.
On the 2nd of September NHS England published four of the six clinical priorities as set out in the
2016/17 Improvement and Assessment Framework. Dementia was one of them. NHS Lambeth CCG
was awarded a rating of ‘Top Performing’. A high level summary is detailed as follows:
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4.5 Quality Premium 2016/17
The Quality Premium (QP) scheme rewards CCGs for improvements in the quality of the services they commission. The scheme also incentivises CCGs to improve patient health outcomes and reduce inequalities in health outcomes and improve access to services.
Quality Premium 2016/17
The QP will be paid to CCGs in 2017/18 to reflect the quality of the health services commissioned by them in 2016/17. It will be based on measures that cover a combination of national and local priorities, alongside the requirement to fulfil the expectations of the Quality, Financial and NHS Constitutional Gateways.
National Measures There are four national measures and in total are worth 70% of the QP
Cancer diagnosed at an early stage (20% of quality premium) - To earn this portion of the
quality premium, the CCG will need to either:
- Demonstrate a 4 percentage point improvement in the proportion of cancers (specific
cancer sites, morphologies and behaviour) diagnosed at stages 1 and 2 in the 2016
calendar year compared to the 2015 calendar year or;
- Achieve greater than 60% of all cancers (specific cancer sites, morphologies and
behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year.
Cancer diagnosed at an early stage
Current Performance (IAF 122a)
54.9% (2014)
Ongoing work to support earlier diagnosis has included:
The implementation of the NICE 2WW referral forms
A cancer PLT focused on approaches to support early diagnosis and increasing patient understanding of an urgent referral for suspected cancer
The dissemination to GP practices of tools to support patient conversations regarding an urgent appointment for suspected cancer
GP Patient Survey overall experience of making a GP appointment (20% of quality premium) - To earn this portion of the QP, the CCG will need to demonstrate in the July 2017 publication, either:
- Achieve a level of 85% of respondents who said they had a good experience of making an
appointment, or;
- A 3 percentage point increase from July 2016 publication on the percentage of
respondents who said they had a good experience of making an appointment.
Latest published data in July 2016 shows performance at 84.7%.
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E-Referrals increase in the proportion of GP referrals made by e-referral
(20% of quality premium) – To earn this portion of the QP, the CCG will need to,
either:
- Meet a level of 80% by March 2017 (March 2017 performance only) and
demonstrate a year on year increase in the percentage of referrals made
by e-referrals (or achieve 100% e-referrals), or;
- March 2017 performance to exceed March 2016 performance by 20
percentage points.
E-referrals
Current Performance (IAF 128b)
20% (July 2016)
March 2016 performance = 22% utilisation
March 2017 requirement to meet quality premium = 41.6%
July 2016 performance – 20%
E-referral group to be enhanced with accountability into the Planned Care
Programme Board.
Revised planning required to develop plans to deliver planning guidance
targets for the next 2 years
Proposal to develop advice & guidance function taken to Digital Technology
group
Improved antibiotic prescribing in primary care (10% of quality premium)
Antibiotic prescribing
Current Performance (IAF 107a)
Target Value by the end of 2016/17
to be equal or less than 1.161
Latest data July 0.77%
Quality Premium - Local Measures For 2016/17, the local element of the QP focuses on the Right Care programme and is worth 30% of the overall QP. NHS Lambeth CCG has selected the following three local measures for 2016/17 each worth 10%:
Mental health admissions to hospital: Rate per 100,000 population aged 18+
Based on a steady increasing trajectory from our baseline position we are targeting
a reduction of 5 emergency mental health admissions for 2016-17. This is in
additional to the reduction required to address increases relating to population
growth.
This figure represents a decrease of 1% of admissions in Quarter 1 of 2016-17,
followed by a reduction of 1.5%, 2% and 2.5% in subsequent months as the
benefits of our mental health programme are realised over the course of the year.
We are proposing an end of year only figure to allow for in year variations.
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Respiratory: Emergency admission rate for children with asthma per 100,000
population aged 0–18 years
NHS Lambeth CCG is targeting a decrease of 5% of emergency admissions for
children with asthma which translates into a reduction of 11 children's admissions
during 2016-17. We are basing this target on the business case for our new
asthma service elements of which are already in place, others of which will come
on-line throughout the financial year.
Trauma and injury: Injuries due to falls per 100,000 population ages 65+
NHS Lambeth has a large scale programme of work in progress in relation to falls
prevention underway in Lambeth. Based on expected trajectories towards this
target, we are targeting a reduction of 1% of injuries across 2016/17.
Our targets recognise that performance will accelerate over time as increasing
numbers of patients access the service and continue to benefit from it year on year.
Data will be reported in November 2016.
4.6 Quality Alerts Quarter 2 report will be available in November 2016.
4.7 Infection Control
MRSA - There have been 2 cases of MRSA reported during May and June against a target of 0. C.Difficile – There have been 15 cases of C.Difficile reported to date. This is within the target threshold of no more than 25 during the year.
4.8 Mixed Sex Accommodation There have been 3 mixed sex accommodation breaches reported during June and July 2016 against a target of 0.
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5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES Further details on all Programme areas can be found on the internet through Programme Governance structures and meetings.
5.1 Integrated Children and Young People (including Maternity) Programme
Responsible Director TBC, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)
Clinical Lead Dr Nandini Mukhopadhyay
Programme Lead Sharafat Ali, interim Assistant Director Children & Maternity
IAF Indicators 101a, 102a, 124a, 124b, 125a, 125b, 125c
5.1.1 Programme’s Purpose
The Integrated Children and Young People and Maternity (CYPM) Programme is responsible for making and implementing decisions in relation to commissioned services for children, young people and maternity across the Borough of Lambeth. The remit of the programme extends across both physical and mental health. As an integrated programme, the aim is to ensure that children and young people’s physical, psychological and social needs are addressed in a comprehensive, cohesive manner. Our children and families services are provided from pregnancy to 18 years old (up to 25 for young people with a disability). They cover a range of services provided both in hospital and in the community. Services are planned and bought through an integrated health and social care team, with the aim of ensuring:
Children have the best start in life
Children and young people are strong and have positive lifestyles and behaviours
Children and young people achieve their ambitions and do well at school Early intervention in children’s health and wellbeing is vital to help reduce the number of years of life lost by the people of Lambeth from treatable conditions. It also helps to improve the quality of life of people with one or more long-term conditions. The CYPM programme is made up of three overarching areas of work:
Children and adolescents mental health services (CAMHS)
Child health and early intervention services
Maternity Services
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The programme Board maintains a strategic overview of the quality of services being delivered to children, young people and pregnant women in the Borough, holding providers to account where appropriate. Working in partnership with the Primary Care Development Board the CYPM Programme maximises the care of children and young people in primary care. Working in partnership with the Primary Care Development Board, Lambeth Early Action Partnership (LEAP) and the Children and Young People Health Programme, the CYPM Programme maximises the care of children and young people in primary care and the development of evidence based early intervention services that improve health and wellbeing outcomes.
5.1.2 Programme Assurance Statement Quarter 2 2016/17
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned – is it
on target?
Some objectives on track but some risks
identified going forward.
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Key aims for 2016-17:
Develop and implement CAMHS Strategy and Transformation Plan, including reduced waiting times and reduction in Tier 4 activity
Develop comprehensive perinatal mental health pathway
Develop comprehensive paediatric asthma pathway
Reduce paediatric admissions through re-commissioning of comprehensive community children’s nursing service
Develop Integrated Early Years Pathway (as part of Healthy Child Programme)
Implement and deliver LEAP Programme
Improve child health pathways through CYPHP
Implement Maternity Transformation Programme and community midwifery models
Deliver borough wide Youth Violence programme
Develop integrated adolescent pathway (as part of HCP)
Key Achievements Quarter 2:
Waiting times to EI CAMHS has reduced to 11wks (on track to
achieve target of 10wks by Q4)
CAMHS Transformation Plan on track. First Co-production Group
took place informing JCG. Plans for 16/17 underspend agreed.
Refresh of CAMHS TP underway.
Perinatal MH engagement work complete, including with GP’s &
women
GP delivery scheme up and running. Plans in place for a childhood
asthma workshop to align all the work across Lambeth and
Southwark
H@H evaluation going well, report due in Sept. Notice has been
given to Lewisham for current CCNT. Transfer arrangements
currently being agreed.
EY HCP working group in place, developing pathway and key
milestones. Initial stakeholder workshop and governance
arrangements in place.
On-going involvement with SEL Maternity Network, 17/18 QS
priorities agreed. GST presented community midwifery model to
CMB, attending All Practice locality meetings
16/17 budget for youth violence to fund A&E programmes. Multi-
agency youth violence task & finish group being set up as part of
SLP
Work has started to scope integrated adolescent health pathway with PH
Children and Young People
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Key challenges to date:
Completed CCG SEND self-assurance. Gaps identified that need progressing through an action plan
LBL budget cuts continue to impact on the CCG and health of CYP. Integrated commissioning approach essential to ensure good outcomes are achieved
CAMHS Review delayed until Sept ‘16– still missing some data etc from SLAM. This is being managed via the contract, but remains a concern
C-Section thresholds agreed for 16/17 GST and KCH contracts, however there is on-going issue of how to improve rate of natural births. This is being worked up through the joint L&S Maternity group and the CMB coms strategy
Transfer from RIO to Care Notes system has caused problems for GST re accuracy of data. This is being monitored but has impacted on accuracy of EYMDS reporting
Key risks 2016-17:
Shortage of BCG vaccination continues, only high risk babies to be vaccinated. This is being progressed by GST but remains an international issue, PHE continue to advise
Although there is good progress with waiting times to CAMHS EI service, it remains a risk until we have reached the 10wks target
Safeguarding continues to be a risk with increased numbers of SCR and low level IMR’s
Health Visiting review 1&2 continue to be low and are at risk in light of cuts to PH Grant. An improvement plan is in place with GST (reporting issues and accuracy of data due to Care Notes also having an impact)
Loss of organisational memory with two senior posts leaving. This is being addressed through recruitment and we have interim AD replacement already started to ensure continuity & effective handover
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5.1.3 Children and Maternity Programme Board Dashboard
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The current RAG rating of the 29 indicators based on latest published data on the dashboard is as follows: 11 rated Green, 11 rated amber, 6 rated red (1 no rating).
RAG Indicator description Notes
EHC3 Percentage breastfeeding 6-8 weeks after birth Although this indicator has been red RAG rated, The problems experienced by GSTT in the transition of the old data system to the new Care Notes System (as reported in 2015-16) persist. The reported achievement of 43.6% for this indicator may be unduly low.
EHC7 Percentage immunisations at 5 years Commentary will be presented at the next Programme Board meeting
EHC8 Percentage of health review 1 completed in line with target
Due to data migration issues there is a question over the accuracy of the quarter three and four figures. GSTT have advised ‘We would expect these to be higher. A review of data
sources and recording will be undertaken’.
EHC9 Percentage of health review 2 completed in line with target
SAF 1
Admission of full-term babies to neonatal care unit (without congenital abnormalities) (GSTT)
Data subject to revision in reporting by GSTT during the year.
SAF 2
Number of paediatric re-admissions Commentary will be presented at the next Programme Board meeting
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5.2 Integrated Adults Programme (Elective, Urgent Care, Cancer)
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)
Clinical Lead Drs. Di Aitken, John Balazs, Martin Godfrey & Paul Heenan
Programme Lead Sara White / Bisi Aiyeleso
IAF Indicators (Annex A) 105a, 122a,122b, 122c, 122d, 127c, 127a, 127d, 127c, 127d, 129a
5.2.1 Programme Purpose Work within Elective Care is aimed at collectively bringing together acute care clinicians to work closely with primary care to ensure seamless referral for testing, diagnosis and onward referral to appropriate specialist services. This will support the provision of equality across the borough for services regardless of geographical location or provider providing care. This work also supports the achievement of national targets (such as referral to treatment and cancer targets) as well as areas that are nationally mandated (such as the delivery of the e-referral service). We are supporting an increase in appropriate referrals into secondary care through the provision of tools, training and other forms of support to ensure that referrals, diagnostics and community based care is consistent across our whole geography. We are striving to ensure standardisation and reflection of best practice. Cancer work within 2016/17 will look at approaches to support the uptake of guidelines promoting the early diagnosis and treatment of cancer, the implementation of new pathways for rapid diagnosis for people with “vague symptoms” that may result from cancer or other serious illness and improved levels of screening e.g. bowel screening. Work within the Urgent Care work stream is focused on ensuring that patients are able to access the right care at the right time when medical care is required urgently. This includes commissioning services that provide an alternative to A&E such as the Integrated Urgent Care service (previously known as 111) and GP access hubs. Work also includes providing sufficient pressure surge management support to the urgent care system, particularly in winter but also and other times of pressure such as heatwaves or infection outbreaks, bank holidays and during industrial action.
5.2.2 Programme Assurance Statement Quarter 2 2016/17
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned – is it
on target?
Some objectives on track but some risks
identified going forward.
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Key aims for 2016-17: Elective
Maximising the quality and appropriateness of outpatient referral through use of the electronic tools available, reducing unwarranted variation between clinicians and practices
Ensuring that patients are treated along the most appropriate care pathway throughout their healthcare interventions
Securing the delivery of 18-week referral to treatment targets
Ensure that there is effective use of diagnostics across the primary and secondary care systems. Cancer
Improve cancer screening rates, identifying cancer earlier, instigating the early treatment of patients with cancer through improvement in the 62-day wait cancer performance in order to deliver improved outcomes for patients Urgent Care
Supporting the commissioning of services within the urgent care system including the integrated urgent care service
Commissioning to ensure that Urgent Care is better configured to deliver for example a front ended co-located Urgent Care Centre within ED on the St Thomas’ site, supported by consistent communications and signposting of patients.
Key Achievements Quarter 2 : Elective
Agreement at Eye Group to not progress community OHT monitoring in the community and to focus efforts on implementing triage of ophthalmology referrals via MECS where appropriate
Cancer
Bowel cancer work plan produced with delivery of initiatives in this financial year.
Revised approach to practice visits on Cancer awareness agreed by working group and delivery to start in November.
MDC pilot successfully recruited to consultant post and mobilisation now commencing. Urgent Care
‘Out of Hospital Care Initiatives for 2016/17’ – plan produced to support ED recovery at both sites
New A&E delivery Board established, and first meeting taken place, replacing the Lambeth and Southwark Urgent Care Working Group and Systems Resilience Group, attended at executive level by member organisations, to deliver the improvements that can lead to a recovery of A&E performance
Elective, Urgent Care and Cancer
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On the 2nd of September NHS England published four of the six clinical priorities as set out in the 2016/17 Improvement and Assessment
Framework. Cancer was one of them. NHS Lambeth CCG was awarded a rating of ‘Needs Improvement’. A high level summary is detailed as
follows:
Clinical Priority Area Overall Rating Action Plans/Commentary
54.9% 81.6% 70.3% 84.3%
New of cases of cancer
diagnosed at stage 1 and
2 as a proportion of all
new cases of cancer
diagnosed
Of people with an urgent
GP referral having first
definitive treatment for
cancer within 62 days of
referral
of adults diagnosed with any
type of cancer in a year who
are still alive one year after
diagnosis.
of responses ,which were
positive to the question
"Overall, how would you rate
your care?"
Indicator Rating
Needs Improvement Cancer (Sara White / Bisi Aiyeleso)
Early detection work: implementation of NICE guidance on suspected cancer
referrals in primary care. Supported by education resources locally.
Invested in 2 year pilot for new pathway for cancer vague symptoms .
Latest data for Cancer 62 day is 77.2% (June 16) under-performance against the
recovery trajectory of 85.4% but an increase on performance in May (70%).
Completed analysis on bowel cancer screening uptake across Lambeth.
Identifying patient cohorts to focus targetted interventions. Action plan
drafted for this year.
CCG will be submitting the SEL Cancer Improvement Plan in line with the
timescale on 9 September 2016.Recent PLT implementing the 2ww NICE
guidance.
Lambeth CCG has been recognised as being one of the most improved CCGs as
measured by annual one-year cancer survival rates. The CCG was presented
with the award at the All-Party Parliamentary Group on Cancer's Summer
Reception.
Key challenges to date:
Increasing practice use of ERS – area of focus currently is the use of ERS for referrals into the LIMS service
Time required to manage the providers of the MECS schemes (A business case has been taken to the Integrated Adults board with an approach to help address this challenge)
Continued increasing activity within ED departments
Continued difficulties with achievement of RTT targets
Key risks 2016-17:
Limited capacity to deliver work across the project areas
Engagement of whole system to deliver a recovery plan for RTT and A&E performance
The Delivery Framework may not deliver the expected outcomes for GP outpatient referrals
Difficulty with recruitment to consultant post within Multidisciplinary Diagnostic Centre could lead to delay in implementation of the model
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SEL 111 Service update
The purpose of the following information is to provide information on SEL 111 performance
for October 2016.
111 KPIs 2016 (Unify Sit Rep Data)
Exception Report for October 2016
Key Performance indicators were met except for the following areas:
All Key Performance Indicators (KPIs) have been met, with the following exceptions:
51.5% of calls were warm transferred to an NHS 111 nurse advisor within 30 seconds where required (target 98%)
63.5% of patients were called back within 10 minutes by an NHS 111 nurse advisor (target 100%)
9.1% of calls were asked to attend an A&E department (target of <5%)
QR6 Life threatening referrals LAS are completing an audit to understand where the three minute target is exceeded; what the reasons are; and therefore inform what actions (if any) are required. Warm Transfers & Time taken for call back The commissioners have agreed a let for the targets covering warm transfers and time taken for call back, in order to allow LAS to carry out a pilot to prioritise warm transfers and call backs according to clinical need.
Attend Accident & Emergency Department, last 13 months (Data taken from LAS’s weekly UNIFY2 submissions)
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There has been a slight drop in Emergency Treatment Centre (ED and UCC) referrals during August
2016. Performance was at its worst in August 2015 when over 10% of patients were advised to attend
A&E (against a target of 5%), performance was then improving in subsequent months to around 9%
(with a blip in January 2016 when this rose to 9.7%. There was then another rise in June 2016 where
again approx. 10% of calls were advised to attend A&E. Since then the trend has been for
performance to improve for this target. (9.3% in July and 9.1% in August). This target is a nationally
defined target with the national performance average currently being around 7%. LAS is completing
work to try and improve their position to the national average. This includes auditing call handlers
whose levels of referrals to A&E are higher than the call handler average as well as providing training
to cover this aspect for all call handlers.
Service Update for Impact on Urgent Care System
QR11 Attend Accident & Emergency Department, last 13 months
Ambulance dispositions have continued to decrease in August 2016. LAS still have the lowest percentage of ambulance dispositions, when compared to the other London 111 providers.
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5.2.3 Integrated Adults Programme: Older Adults (including Committee in Common and joint arrangements with Lambeth Council)
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)
Clinical Lead Di Aitken
Programme Leads Liz Clegg (AD, Older People), Cllr Jackie Meldrum
IAF Indicators (Annex A) 104a, 105b, 105c, 106a, 106b, 127b
Programme Purpose The specific outcomes for this project are:
To support older people to remain independent and able to manage their health well with the right level of timely support and advice when they need it to remain at home
That fewer older people will be admitted to hospital or residential care reducing the number of beds required and shifting resources to community based care
To provide good quality care and achieve cost efficiencies by providing more integrated health and social care.
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Key aims for 2016-17: BCF deliverables including reducing the number of delayed transfer
of care, reduction in number of people going into residential care, reduction in the number of emergency admissions and percentage of people remaining at home 90 days post reablement/rehabilitation
To ensure that all Previously Un-assessed Periods of Care (PUPOC) Continuing Healthcare claims are managed and resolved in line with the national deadline
Increase the pace of implementation of the new format of the new version of the Coordinate My Care (CMC) register
To maintain and increase the diagnosis of dementia against the estimated prevalence
To work together with Southwark, Lewisham and Croydon to agree a service redesign (proposed by SLaM) for the delivery of inpatient and specialist mental health services for older people.
To commission post diagnostic support for people with dementia
To support LBL with the engagement of alternative day opportunity offers for older people
Key Achievements Quarter 2 (July – August): BCF Management and Narrative Plan 2016/17 agreed via national
moderation as low risk.
BCF Q1 report 161/7 report submitted reporting achievement against metrics where data available – refer challenges section below.
Project Smith – small grants scheme ‘live’ for Vassall, Coldharbour, Stockwell, Larkhall and Ferndale. Includes developing communities in Extra Care facilities and has also attracted funding from Housing Association in North LCN.
All of the Previously Un-assessed Periods of Care (PUPOC) Continuing Healthcare claims have been investigated locally with outcomes notified to claimants. NHS England informed that deadline met and will be ratified at call with NHSE on 12.10.16
Data from August 2016 shows that 86.3% of the estimated prevalence of those with dementia in Lambeth have a diagnosis recorded on their GP’s Dementia QoF Register, this has increased slightly from the previous month. GP referral rates continue to be steady to the memory service.
The 4 boroughs are continuing to meet to agree the model required. The data collection period has finished and is being used to populate the care pathway in order to understand the demand and capacity required.
Key stakeholders have submitted their proposals regarding models of post diagnostic support they wish to offer and this will be taken to the Committee in Common in due course for
Older People
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Key challenges to date:
Working across 4 boroughs with regard to the SLaM MHOA inpatient and specialist care service redesign – each borough has slightly different demands and needs, and commonality and compromise must be agreed
Successful closure of Dulwich Care Centre at 31 August 2016, within challenging timeframe of four weeks.
Performance issues with social care providers. 22% (2/9) of care homes for older adults currently suspended due to quality issues, requiring intensive quality monitoring with another care home identified as high risk with possibility of suspension. Three home care agencies are currently high risk. Two are currently suspended – awaiting news of any CQC enforcement action
BCF – unable to report reablement metric in Q1 as GSTT
Key risks 2016-17:
A risk of delay with the SLaM service redesign if the model is not agreed – this would have a financial impact on each CCG
Social care provider issues – maintaining quality
Lack of pace on implementation of new reablement model
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5.2.4 Integrated Adults Programme: Long Term Conditions and Medicines Optimisation
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)
Clinical Lead Dr John Balazs
Programme Leads Vanessa Burgess Assistant Director and Chief Pharmacist
IAF Indicators 103a, 103b, 105d, 107a, 107b, 128a
Programme Purpose The 15 million people in England with long term conditions have the greatest healthcare needs of the population (50% of all GP appointments and 70% of all bed days) and their treatment and care absorbs 70% of acute and primary care budgets in England. The impact of multi-morbidity is profound. People with several long-term conditions have markedly poorer quality of life, poorer clinical outcomes and longer hospital stays, and are the costliest group of patients that the NHS has to look after. The purpose of this work stream is to improve the quality and length of life of people, people with three or more long term conditions, and to promote the clinical and population behaviours which allow the right care to be delivered in the right setting. To ensure meaningful access to effective services, and to maximise the efficiency of those services, a well-coordinated and collaborative patient journey between physical, psychological and mental health components of pathways is required, as well as cross-cutting pathways where common co-morbidities exist and the interdependency of mental and long term physical health conditions is recognised. Medicines are a highly valued and effective intervention but medicines are not always taken as intended (30% to 50% of medicines) and medicines side effects are known to cause 5-8% of hospital admissions. Therefore, a key theme is to support patients in understanding and taking their medicines better. Primary care prescribing expenditure is growing nationally by 3% and hospital medicines expenditure on medicines by 15%, some of which are medicines commissioned by CCGs. A strong theme of the work is to deliver cost effective, value based prescribing, and support the CSU in managing CCG commissioned high cost drugs spend. Management of antimicrobial resistance is also a key theme with targeted use of appropriate antibiotics only when necessary being a key deliverable.
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Key aims for 2016-17:
Design and implement an integrated and personalised approach to managing the physical and mental health of people with one or more long term condition underpinned including increasing use of Care and Support Plans. Integrate approaches from the NHS England best practice programmes (Right Care, Long Term Conditions).
Maximise the potential of community and primary care to support individuals with diabetes through development of our Integrated Model for Diabetes including review and commissioning of a sustainable intermediate care service.
Focus on prevention of diabetes through joint working with Lambeth Council and South London partners to implement the National Diabetes Prevention Programme in Lambeth.
Develop community services for people with Cardiovascular disease that successfully maintain individuals within outside of acute care including commissioning heart failure virtual clinics, reviews and optimisation for people with hypertension and re-commissioning of the Ambulatory Blood Pressure Monitoring Service.
Continue our work to prevent stroke in people with Atrial Fibrillation in line with the London Stroke Prevention in Atrial Fibrillation group and London Stroke Strategic Clinical Network.
Further develop systems and ways of working in the integrated respiratory service to ensure a comprehensive service that directs referrals effectively and provides easy access to the most appropriate care. Improve diagnosis and management of individuals with respiratory symptoms through improved access to and quality of spirometry.
Support improvements medicines review and adherence to enable self-care and the best health gain from medicines.
Ensure best value and patient outcomes from the primary care
Key Achievements Q2 (July – August only):
South East London Area Prescribing Committee updated guidance relating to stroke prevention in Atrial Fibrillation and anticoagulants in Venous Thromboembolism and developed new guidance on sacubitral valsartan for chronic heart failure
Care Home Pharmacists project is on track to deliver the anticipated savings with 3/10 completed care home reviews delivering a total of £20,843 in savings.
Continued work with Local Care Networks to produce Care Co-ordination Cohort recommendations
NHS England National Diabetes Prevention Programme (Healthier You) launched.
Individual practice visits completed
Quarter 1 2016-17 Prescribing support dietician report completed (estimated savings £53,804)
100% of practices submitted National Diabetes Audit 2015-16 data by deadline
Ongoing discussions with KCH to agree implementation of Oxygen, Spirometry, Single Point of Referral re-designs and pathways.
Contribution to the Medicines Optimisation theme within the Our Healthier South East London Sustainability and Transformation Plan.
Practice achievements and payments for the medicines optimisation scheme 15/16 completed.
Community heart failure team key performance indicators and service specification agreed
Supporting the implementation of the Dawn AC Anticoagulation software yellow slip system for anticoagulation results (replacing yellow books) at GSTT.
Long Term Conditions – Medicines Management
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prescribing budget and CCG commissioned “high cost” medicines by working in partnership with clinicians and people across the health economy
Support achievement of the NHS England quality premium related to antimicrobial prescribing.
Key challenges to date:
Commissioning of a Spirometry service for Lambeth CCG patients
Implementing key findings of the review of ambulatory blood pressure monitoring
Key risks 2016-17:
Potential for lack of engagement by General Practice in Medicines Optimisation and Long Term Condition Virtual clinics Schemes via GP Delivery Framework
The primary care prescribing budget may not remain within budget for 16/17 due to the introduction of new drugs on the market, e.g. New Oral Anticoagulant medicines, NICE approved drugs, newer diabetes drugs and the impact of NICE Guideline 28 (NG 28).
There are significant and large potential projects requiring project and procurement resource – spirometry, Ambulatory Blood pressure monitoring and the Community diabetes service. Resource and time constraints may lead to non-delivery of these projects.
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Medicines Optimisation & Long Term Conditions – data element A. Overall Performance 2016/17 (Month 4) Overall the prescribing budget was underspent at Month 4 by £254,374 (2.2%, see finance report). The North Locality is underspent by 3.5%. The South East and South West Locality are overspent by 2.2 % and 1.5% respectively. B. Spend per ASTRO-PU (data available quarterly)
2016/17 Spend per APU Achievement
Threshold CCG
average
No of practices achieving threshold (out of 47)
Q1 2016/17 <£8.30 £8.03 31
Q2 2016/17 (full quarter data unavailable at time of report) <£8.30
Q3 2016/17 <£8.30
Q4 2016/17 <£8.30 C. NHS England Antibiotic Quality Premium Monitoring Dashboard (12 month rolling data)
NHS England Antibiotic Quality Premium monitoring dashboard (12 months rolling data) Green = target met
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
Antibacterial items/STAR PU13
Target Value by end of 2016/17 to be equal to or less than 1.161:
0.774 0.775 0.772 0.770 Data not available
Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17
Co-amoxiclav, Cephalosporins & Quinolones
Target Value by end of 20116/17 to be equal to or less than 10%
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
9.5% 9.4% 9.2% 9.0% Data not available
Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17
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D. QIPP Savings (Prescribing data)
2016/17 Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar
Projected savings
£66,611 £66,611 £66,611 £66,611 £66,611 £66,611 £133,222
£133,222
£133,222
£133,222
£133,222 £133,222
Cumulative £66,611 £133,222 £199,833 £266,444 £333,056 £399,667
£532,889
£666,111
£799,333
£932,556
£1,065,778
£1,199,000
Actual savings ePACT prescribing data
£22,616
£45,619 £48,604 £45,931 Data not available
Actual savings OptimiseRx/Waste & deprescribing
£49,734
£46,809 £49,399 £51,703 £79,175
*Total actual savings (cumulative)
£72,350
£164,778
£262,781
£360,416
£439,591
Diabetes 2016/17 Improvement and Assessment Framework Baseline assessment
Diabetes was one of the six clinical priority areas published on the 2nd September. A highlevel summary is details as follows:
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5.2.5 Integrated Adults Programme Dashboard
Work is in progress to refresh the 2016/17 dashboard, however there is extensive monitoring of Improvement Assessment indicators through contract monitoring meetings and joint working. A finalised dashboard will be available in Quarter 3. Total Integrated Contract – by POD (SLAM Month 4)
Lambeth GP Referrals
Total Integrated Contracts - By POD (SLAM Month 4) SLAM Month 4
FINANCE ACTIVITY
£'000s
YTD Plan YTD ActualYTD Variance
(Over)/Under
YTD Variance
(Over)/UnderYTD Plan YTD Actual
YTD Variance
(Over)/Under
YTD Variance
(Over)/Under
Elective £13,852 £12,479 £1,373 9.9% Elective 10,790 9,981 809 7.5%
Emergency £16,895 £17,986 -£1,091 -6.5% Emergency 8,127 8,509 -382 -4.7%
Non-Elective £759 £979 -£220 -29.0% Non-Elective 1,131 1,089 42 3.7%
Maternity Pathway £8,441 £8,404 £37 0.4% Maternity Pathway 7,542 7,535 7 0.1%
A&E £5,782 £6,038 -£256 -4.4% A&E 43,340 45,023 -1,683 -3.9%
Out Patient 1st £5,150 £5,212 -£62 -1.2% Out Patient 1st 32,305 33,341 -1,036 -3.2%
Out Patient Follow Up £6,136 £6,889 -£752 -12.3% Out Patient Follow Up 78,392 81,287 -2,895 -3.7%
Out Patient Procedure £3,245 £3,185 £59 1.8% Out Patient Procedure 15,927 15,316 611 3.8%
Unbundled Diagnostics £1,337 £1,441 -£104 -7.8% Unbundled Diagnostics 11,228 14,128 -2,901 -
Critical Care £3,287 £3,204 £84 2.5% Critical Care 2,694 2,443 252 9.3%
Direct Access £3,192 £3,181 £11 0.3%
Drugs & Devices £2,663 £3,152 -£489 -18.4%
GUM £0 £0 £0 0.0%
Community £12,419 £12,243 £176 1.4%
Other £6,915 £7,382 -£467 -6.7%
Total YTD Performance - Underlying £90,073 £91,774 -£1,701 -1.9% Check: £0 £0
Contractual Adjustment £0 -£1,350 £1,350 0.0%
Total YTD Performance - Cost & Volume £90,073 £90,424 -£351 -0.4%
Block Contract Adjustment £0 -£128 £128 0.0%
Total YTD Performance - Contractual £90,073 £90,296 -£223 -0.2%
Note: This shows the POD breakdown for all acute contracts and GSTT community
-35.0%
-30.0%
-25.0%
-20.0%
-15.0%
-10.0%
-5.0%
0.0%
5.0%
10.0%
15.0%
YTD Variance (Over)/Under
-6.0%
-4.0%
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
YTD Variance (Over)/Under
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5.3 Better Care Fund (BCF)
The Better Care Fund (BCF) was announced by the Government in the June 2013 spending round, to
ensure a transformation in integrated health and social care. The Better Care Fund (BCF) creates a
local single pooled budget to incentivise CCGs and local authorities to work more closely together
around people, placing their well-being as the focus of health and care services.
NHS Lambeth CCG and London Borough of Lambeth continue their commitment to develop integrated
care and broadening the scope of integrated commissioning.
In the 2015/16 BCF plan, Lambeth council and CCG collectively pooled £23.4million under a section 75
arrangement. The 2016/17 pooled BCF fund is £23.5million.
Performance against BCF metrics for 2016/17 are outlined in the table below and latest performance
where available. Quarter 2 will be available in November 2016.
Non-elective admissions (NEA) - Measured by the rate of non-elective admissions per 100 000
population.
Delayed Transfers of Care (DTOC) – Measured by the number of DTOC per 100 000 population for
people aged 18+
Reablement – Measured by the proportion of older people 65+ who are still at home 91 days after
discharge from hospital into reablement/rehabilitation services. Target 90.1%
Permanent admissions to residential care - Measured by long term support needs of older people
aged 65+ met by permanent admission to residential or nursing care per 100,000 population.
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5.4 Integrated Mental Health for Adults
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older People)
Clinical Lead Dr Paul Heenan
Programme Lead Denis O’Rourke, Assistant Director
IAF Indicators (Annex A) 107a, 123a, 123b, 123d, 123e
Programme Purpose The mental health programme covers adults of working age in Lambeth. It is supported by the Lambeth Living Well Collaborative (LLWC), which is the partnership platform aiming to apply co production practice to the commissioning and delivery of mental health care and support in the borough. The overall aim of the programme is to ensure that people with mental health problems obtain access to support as early (and so avoid crisis) and as close to home as possible. We are aiming to re model our high cost low volume investment pattern to one which supports a larger number of people at lower cost through the provision of holistic support delivered by an alliance of providers working together to deliver the programmes (and collaborative's) big 3 outcomes.
5.4.1 Programme Assurance Statement as at Quarter 2
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned – is it
on target?
Some objectives on track, but some risks
identified.
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5.4.2 Mental Health Whole System Dashboard
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1. OBDs - These beds include Acute, Triage and PICU. The profile that SLaM report on each month is different, even though the end number is correct. The CCG is querying this with SLaM. 4. EIP - During July 10 people experiencing their first episode of psychosis waited for treatment with 5 people seen within 2 weeks, giving a total of 50%.. 6. AMHPs - There were a total of 86 assessments for June. Of the 86 assessments 57 assessments lead to detention, 2 leading to informal admission, 16 not leading to admission, 10 S135 warrants obtained, 2 S135 warrants executed, 10 assessments following S136 admission, 13 not assessed and 4 assessed yet no bed available. 8. DTOC - During July DToC is 2.6%. Due to SLaM not providing all monitoring data, the number of OBDs lost as a result has not been reported. 9. LWN - There were a total of 449 introductions to the hub in June with 337 closures. 10. GP+ - There are currently 130 people on the GP+ scheme, with a total of 145 people who have used the service since the beginning. In June there were 117 people on the scheme with 13 new people in July. 11/12. Talking Therapies - Talking Therapies - SLaM are meeting the target on both number of people entering treatment and the recovery rate. 13. IPSA - This is the number of people who have been in either residential care or rehabilitation beds where the IPSA team have worked with them to move into the new service offer. 14. IPSA - The target is the estimated number of new people who would have entered the previous system (rehab or residential care), the actual shows how the new service has been effective at diverting 'new people' away from bed based provision.
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Key aims for 2016-17:
Developing the Living Well Network to provide integrated multiagency support to individuals with mental health problems
Redesigning the services we commission from our local mental health provider (SLaM)
Implementing the Integrated Personal Support Alliance to deliver recovery focused personal care and support for people with complex needs
Key Achievements Quarter 2:
Black Well Being partnership – secured £100k grant toward development costs and bid submitted to GSTcharity for additional development funding.
>400 introductions per month to LWN being sustained.
GP Plus scheme now supporting >130 people.
Draft proposition for next phase of LWN out for comment with partners.
NHS Lambeth CCG invited to join the new IAPT employment adviser programme.
Pilot agreed between SLaM and LWN to support Early Intervention in Psychosis support.
IPSA Procurement process commenced in relation to two new supported living schemes >20 units
Talking Therapy targets met
Delayed Transfers of care are well within target
Key challenges to date:
Delivery of EIP target remains challenging across all four SLaM boroughs. Part of the issue is the definition of first contact/assessment. This being worked on between the Trust and four CCGs.
Key risks 2016-17:
Procurement of next phase of LWN fails to attract a response from providers capable of delivering the system wide outcomes and savings we are seeking
SLaM Contract – delivery of AMH redesigns fails to deliver the planned reduction in relapse rates and use of beds
IPSA Alliance fails to deliver transformation and savings as planned
Workforce culture change is slow to adapt to the need for co-productive/personalised approach
System interface – perverse incentives, behaviours not addressed by new rules
LA funding reductions impacts on delivery of social care and support outcomes.
Changes to housing benefit rules constrain development of supported living schemes.
Mental Health
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5.5 Learning Disability
Responsible Director To be confirmed
Clinical Lead Dr Nandini Mukhopadhyay
Programme Lead Sharafat Ali
IAF Indicators 124a, 124b
Programme’s purpose The CYPM programme is also responsible for the strategic commissioning of Adult learning disability and physical disability services and is the governance mechanism by which Lambeth manages its commitment under the South East London Transferring Care Programme.
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Key aims for 2016-17: SEL Transforming Care Programme (SRO is Greenwich)
Coordinate all local Transforming Care related monitoring and activity
Embed Care Treatment Review (CTR) process across Adult and Children’s
Develop Enablement Centre in Lambeth
Positive Behaviour Support Service – determine best funding option and agree implementation plan
Personalisation agenda
Primary Care
Key achievements Quarter 2
The Transforming Care Caseworker has chaired 4 Community CTRs which have prevented hospital admissions
The work with 2 providers to develop operating model for the enablement centre, has been completed
Task force set up to increase uptake of the learning disabilities health check
Key challenges to date:
The CCG has not developed its plans to expand personal health budgets, so that that people with learning disabilities outside of CHC criteria are included
NHSE Specialised Commissioning data poor quality
At Risk of Admission Register
CTRs within 10 days of admission to an ATU, as diagnosis of LD or Autism not formerly diagnosed
Key risks 2016-17:
SEL TCP requirement is to discharge people into the
community but the inpatient population is remaining fairly static as we haven’t yet implemented alternative services to prevent people with LD/ASC being admitted – this continues to be a risk going forward
CCG Dowries – Lambeth CCG has to provide dowries for people in CCG commissioned places, who have been there for five years or more from 1 April ‘16
Unquantified risks resulting from patients transferring from Low/Medium beds (funded by NHSE) to locked rehab beds (funded by the CCG)
Risk of collating timely and accurate data to develop and maintain the At Risk of Admission Register across Children and Adults
Development of enablement centre is dependent on securing capital investment from Lambeth Council
Learning Disability
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2016/17 Improvement and Assessment Framework Clinical Priority Area baseline assessment – Learning Disabilities
On the 2nd of September NHS England published four of the six clinical priorities as set out in the 2016/17 Improvement and Assessment Framework.
Learning Disabilities was one of them. NHS Lambeth CCG was awarded a rating of ‘Needs Improvement’. A high level summary is detailed as
follows:
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5.6 Staying Healthy (Led by London Borough of Lambeth)
Responsible Director Dr Sarah Corlett, Interim Director of Public Health, Lambeth
TBC, Director of Integrated Commissioning (Public Health, Children & Young People, Adult Disabilities)
Clinical Lead Dr. Raj Mitra
Programme Lead London Borough Lambeth
Programme’s Purpose The Lambeth Staying Healthy Partnership Board (SHPB) is the lead partnership body reporting directly to the Health & Wellbeing Board on strategy, action, investment and progress to prevent ill health, promote health and wellbeing and reduce health inequalities of the Lambeth population. The Board is led jointly by Lambeth Council and Lambeth CCG with the Director of Public Health and a Staying Healthy Clinical lead acting as co-chairs. It has oversight of local delivery against the Public Health Outcomes Framework and the commissioning of health services where responsibility has transferred to local government. In addition, the SHPB has responsibilities, as delegated by the Health and Wellbeing Board, to advise and steer the JSNA process and assure JSNA products such as specific needs assessments and factsheets. The Board also has oversight for the development and approval of Patient Group Directions (PGDs) by having an agreed policy and process for PGD development and approval. The SHPB formally reports to the Lambeth Health and Wellbeing Board, and to the Lambeth Clinical Commissioning Group through the Integrated Governance Committee.
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Key aims for 2016-17: Redesign/recommissioning of health improvement
services (ie: smoking cessation, weight management, exercise referral, health checks)
Transformation of sexual health service offer in line with goals set out by London Sexual Health Transformation Project (ie: channel shift online and clinic rationalisation) and introduction of new Integrated Sexual Health Tariff
Redesign/recommissioning of substance misuse and homeless health services
Integrating specialist/commissioning teams
Redesign of HIV care and support pathways
Work with GP Federations to lead population health contracts
Refresh of the Health and Wellbeing Strategy
Contribute a health and wellbeing perspective in the development of the Lambeth Community Plan
Oversight to the JSNA process and sign off of relevant products
Key Achievements Quarter 2:
Worked with GSTT and Healthwatch to complete consultation on channel shift and changes to sexual health clinics
Public health specialist team now embedded in Lambeth local authority
Work with GP Federations on new model/oversight of primary care services across substance misuse and health improvement
Links made between Health and Wellbeing Strategy and Community Plan, particularly around tackling health inequalities
GLA agreed Food Flagship Programme objectives achieved
Completed partnership review of Staying Healthy Board and agreed new programme objectives and terms of reference
Commissioning intentions communicated to key partners
Commissioning blueprint and associated toolkit for homeless health agreed through the London Homeless Health Programme
Implemented agreed changes to HIV Care and Support pathways and transitional group established
Three-year contract extension agreed with SLAM in respect of the Integrated Treatment Consortium
Key challenges to date:
Financial position – impact of Government cuts and council need for savings to help balance budget, will affect outcomes detrimentally given scale of cuts
Establishing the specialist PH team within the council and filling vacancies that have been carried prior to and during the restructure with Southwark
Increasing levels of need and increasing population levels
London wide GUM negotiations and open access issues
Key risks 2016-17: Resource/time available to undertake the redesign and consultation work needed
to achieve a balanced budget in 17/18 and beyond
London not moving towards transformation at the same pace and ambition as Lambeth, leaving the potential for growth in use of out of borough clinics at the expense of those that have been redesigned locally
Austerity – cuts to advice services, cuts to social care, welfare benefit changes, increased homelessness, etc
Loss of Mayoral funding for offender/substance misuse services which Public Health joint funds
Loss of specialist Public Health capacity to work effectively across the local health economy
Staying Healthy
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5.6.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating
(Red/Amber/Green)
Is your programme delivering
as planned – is it on target?
Yes
What are the risks you have
identified to date and how are
you mitigating against these?
Risks have been identified and are being mitigated or managed as far as possible. The
risks include:
1. Financial – we have experienced a 10% cut to PH Grant during the period 2016/17 to
2019/20 and a programme of work is underway to determine how to deliver the reduction in
spend. The cut represents a loss of gross of over £5m. There is likely to be further pressure
on the PH budget linked to the need for council-wide savings to meet a £50m budgetary
shortfall. The loss of grant is likely to mean services are reduced and outcomes are
detrimentally affected. We are mitigating this by working strategically to remodel and
recommission key services and with a close eye on health inequalities.
2. Structural – the PH specialist team is returning to Lambeth as a stand-alone team but with
some funding reductions that mean staff posts will not be able to be filled and a restructure
is needed. The setting up of new systems and IT and the move back to Lambeth presents
some short term risks to service continuity as arrangements bed in.
3. External – continued/extended programme of welfare cuts likely to negatively impact on
housing, youth homelessness, income/poverty, mental well-being, etc. The impact of these
wider determinants of public health creates a risk to the success of the programme in
meeting intended outcomes.
4. Sexual health – continuing growth in need/demand for services, efforts to manage
costs/demand proving problematic (complicated by open access issues, market
development issues and differences in London-wide approach to issue).
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5.6.2 Staying Healthy Dashboard
The Public Health Outcomes Framework (PHOF) was used to identify the national indicators relevant to each of the three main commissioning areas
(sexual health, substance misuse, health and wellbeing). Commissioners were also consulted to identify the local priorities. Where KPIs are annual,
local data will be used where possible and appropriate to provide quarterly updates. The Staying Healthy Board is to agree which other indicators
could help to demonstrate progress against the wider determinants of health that are specifically within the Board’s remit.
Sexual Health Source Frequency Reporting RAG Comment
PHOF 2.4 Under 18 conceptions
PHOF Annual
Date 2011 2012 2013 2014
Red
No performance data update since last IGC report. Recent increase is not statistically significant compared to change from 1998. Lambeth's change from 1998 baseline is 60%, compared to 51% nationally.
per 1,000 pop 34.8 33.2 24.7 33.8
London 28.7 25.9 21.8 21.5
PHOF 3.2 Chlamydia diagnoses for 15-24
PHOF Annual
Date 2012 2013 2014 2015
Green Lambeth continues to have good chlamydia screening coverage and rate of diagnoses.
per 100,000 pop
4585 4463 4364 4045
London 2263 2328 2313 2200
PHOF 3.4 HIV presentations at late stage
PHOF Annual
Date 2009-11 2010-12 2011-13 2012-14
Amber No performance data update since last IGC report.
per 100,000 pop
39.7 39.3 34.7 29.9
London 46.7 44.6 40.5
% Repeat terminations for under 25s
PHE Annual
Date 2012 2013 2014 2015
Amber
Performance changed from Red to Amber, continuing improving trend compared to national average. U18 conception rates in Lambeth started to come down from 2004, which will continue to impact on repeat abortions to under 25s.
% 32.9 31.9 30.7 29.8
London 33.0 32.6 32.3 31.0
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Sexual Health Source Frequency Reporting RAG Comment
% Post-abortion LARC uptake
Local Provider
Date 2015/16 Q1
2015/16 Q2
2015/16 Q3
2015/16 Q4
N/A LARC uptake has improved due to a staff training programme on contraceptive counselling. % 34 30 35 33
Substance Misuse Source Frequency Reporting RAG Comment
PHOF 2.15i Successful completions from treatment (Opiates)
NDTMS Monthly Date Mar-16 Apr-16 May-16 Jun-16 Red Provider has now established project working group to address slippage in performance by implementing robust data assurance process. To be monitored closely through monthly business meeting with service leads and quarterly contract monitoring. In addition, this will be a core metric for Integrated Treatment Consortium contract extension.
% 6.4 5.7 5.6 5.1
PHOF 2.15ii Successful completions from treatment (Non-opiates)
NDTMS Monthly Date Mar-16 Apr-16 May-16 Jun-16 Green Continued to improve in this key metric, now GREEN. Performance will continue to be monitored through provider forum and individual contract monitoring to ensure positive direction of travel is maintained.
% 41.4 42.6 42.4 43.6
PHOF 2.15iii Successful completions from treatment (Alcohol)
NDTMS Quarterly Date 2015/16 Q4
2016/17 Q1
Green New indicator. Initial performance GREEN, will continue to monitor through provider forum and individual contract monitoring to ensure good performance is maintained.
% 44.3 47.6
PHOF 2.18 Alcohol-related hospital
PHOF Annual Date 2011/12 2012/13 2013/14 2014/15 Amber Continued monitoring of local initiatives, incl. alcohol care teams in per 100,000 pop 658 642 626 646
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Substance Misuse Source Frequency Reporting RAG Comment
admissions London 572 554 541 526 hospital settings and work with GP Federations to improve early detection and delivery of alcohol brief interventions.
PHOF 2.16 Prison transfers to community treatment
PHOF Quarterly Date 2016/17 Q1
N/A New performance indicator, to be assessed and understood as part of recommissioning of Integrated Offender Management.
% 16.9
National 30.3
% Hepatitis B vaccine completions
NDTMS Quarterly Date 2015/16 Q2
2015/16 Q3
2015/16 Q4
2016/17 Q1
Red This will be a core metric to be included in revised SLA for Integrated Treatment Consortium contract extension. Performance to be tied to CQUIN payment.
% 20.2 18.9 19.5 18.8
London 27 27 28 28
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Health Improvement Source Frequency Reporting RAG Comment
PHOF 2.14 Smoking Prevalence
PHOF Annual Date 2012 2013 2014 2015 Red Working with Public Health Specialist team to refresh local tobacco control strategy, to take into account changing population demographics in the borough, which includes evidence of entrenched smoking behaviours within key at-risk populations.
% 22.0 19.9 19.0 21.2
London 18.2 17.1 17.2 16.3
Take up of NHS Health Checks
Local Quarterly Date 2015-16 Q2
2015-16 Q3
2015-16 Q4
2016-17 Q1
Amber Evidence of slight improvement. Ongoing re-specification of Health Checks will examine best approach to target and motivate those at the most vascular risk, to improve uptake amongst these populations.
% 17.6 22.4 19.1 23.1
England 48.6
PHOF 2.17 Recorded Diabetes
PHOF Annual Date 2011/12 2012/13 2013/14 2014/15 N/A No performance data update since last IGC report. % 4.4 4.7 5.0 5.2
London 5.6 5.8 6.0 6.1
PHOF 4.04ii Mortality from preventable CVD
PHOF Annual Date 2009-11 2010-12 2011-13 2012-14 Amber No performance data update since last IGC report. per 100,000
pop 61 54 50.3 51.9
London 55.1 52 50.2 49.2
% successful four-week quitters who set a quit date
Local Quarterly Date 2015-16 Q2
2015-16 Q3
2015-16 Q4
2016-17 Q1
Amber Performance remains variable. Work currently onging in partnership with CCG to recommission smoking and related lifestyle behaviour changing services.
% (n) 40% 37% 38% 35.7%
(324 of 817)
(269 of 732)
(332 of 872)
(272 of 762)
Number of smokers setting a quit date
Local Quarterly Date 2015-16 Q2
2015-16 Q3
2015-16 Q4
2016-17 Q1
Amber As above.
n 817 732 872 762
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Risk Register
It was agreed at the Staying Healthy Programme Board meeting on the 12th of August that the Staying Healthy Risk Register would be not be reported in the Integrated Governance and Performance Report, as the risks relate to Public Health. NHS Lambeth CCG will continue to review and monitor these risks through the Programme Board meetings.
Risk Title Category Type Nature Risk / Opportunity Cause Effect Current Likelihood
Current Impact
Current Risk Score
Risk Owner
SH GUM Costs Increase [CCMM0005]
Operational Threat Financial
The cost of GUM services may exceed expected amount
LSHTP does not deliver in line with local transformation, and GUM activity and costs increase past baselines
Wider public health budget will be impacted
Likely (3) Major (8) High Andrew Billington
PHC Budget Reductions [CCMM0014]
Strategic Threat Customer/Citizens
Public Health services may experience increased demand (e.g. worsening wider determinants of health) and restricted supply (e.g. decommissioning services)
Budget reductions across the public sector, incl. Public Health Commissioning, other Lambeth departments, and the NHS
Increased pressure on existing services and commissioning budgets and worsened health for local population
Very Likely (4)
Serious (4) High Michelle Binfield
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Risk Title Category Type Nature Risk / Opportunity Cause Effect Current Likelihood
Current Impact
Current Risk Score
Risk Owner
PH Embedding Prevention
Strategic Threat Management
Significant short-term savings may not allow for long-term investment in prevention
Although importance of prevention is acknowledged, treatment and care services experiencing high demand
Lack of systematic approach to prevention leading to increased demand for local health and social care services
Likely (3) Serious (4) Medium DPH
PHC Staffing Operational Threat Management
The number of staff in Public Health Commissioning team could be reduced as staff leave and are not replaced
Lambeth has changed staffing practices in light of financial pressures (e.g. enhanced redundancy, recruitment freeze)
Remaining team will need to deliver on all responsibilities with reduced number of staff
Likely (3) Significant (2)
Medium Michelle Binfield
PHC Commissioning Partnerships
Operational Threat Management
Financial and operational risks and pressures faced by other boroughs could impact on Lambeth's commissioning strategy
Lambeth commissions services in partnership with other boroughs
Services commissioned by Lambeth in partnership with other boroughs will be negatively affected
Likely (3) Significant (2)
Medium Michelle Binfield
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Risk Title Category Type Nature Risk / Opportunity Cause Effect Current Likelihood
Current Impact
Current Risk Score
Risk Owner
PHC Wider Determinants
Strategic Threat Customer/Citizens
The wider determinants of health could be affected by changes across other council departments through reduced budgets
Lambeth Council experiencing severe financial and budgetary difficulties
The long-term health of the population will be compromised.
Likely (3) Significant (2)
Medium Maria Millwood
PHC Primary Care Invoicing
Operational Threat Reputational
Primary Care providers may experience significant delays in payment
Deficiencies in internal business processes hinder activity validation and financial administration
Primary Care providers may disengage from service provision, with impact on demand management and financial forecasting
Likely (3) Significant (2)
Medium David Orekoya
PH Joint Strategic Needs Assessment
Operational Threat Management
Insufficient capacity provided across the council and CCG to support the work of the JSNA
PH Specialist Team lead on JSNA, require partnership working with council and CCG contacts who are not yet identified
Delay in refresh of JSNA
Likely (3) Significant (2)
Medium DPH
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Risk Title Category Type Nature Risk / Opportunity Cause Effect Current Likelihood
Current Impact
Current Risk Score
Risk Owner
PHC Decommissioning
Operational Threat Customer/Citizens
Commissioned public health services may not be able to meet the needs of the local population
Public Health Commissioning decommission existing services or recommission to focus on prevention
The long-term health of the population will be compromised.
Unlikely (2) Significant (2)
Low Michelle Binfield
HIVPP Withdrawal Operational Threat Management
London boroughs may choose to reduce or stop their annual contributions to the London HIV Prevention Programme
All London boroughs are subject to considerable financial pressures and budget reductions
London HIVPP will be forced to limit interventions and commissioned activity
Unlikely (2) Significant (2)
Low Paul Steinberg
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5.7 Primary Care Development
Responsible Director Andrew Parker, Director Primary Care Development
Clinical Lead Dr. Martin Godfrey
Programme Lead Ursula Daee, Assistant Director Primary Care
IAF Indicators 128b, 128c,128d
Programme’s Purpose This programme seeks to enable a transformation of Community based /out of hospital care where high quality, locally responsive and sustainable primary care is the building block for the future health and care system. Through this, Lambeth citizens can expect a primary care system that is proactive in its approach, accessible and responsive to local needs and coordinated around the individual. The programme aims to enable a general practice system that can collaborate successfully across the borough, with patients and citizens, and be a valued, well developed and attractive place to work. The programme will coordinate the key system enablers of Estates, workforce and digital technologies to facilitate this transformation.
5.7.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned
– is it on target?
Objectives on track
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Key aims for 2016-17: GP Patient Survey – overall experience of making a GP appointment
– a) Achieve a level of 85% of respondents who said they had a good experience of making an appointment; or b). A 3 percentage point increase from July 2016 publication on the percentage of respondents who said they had a good experience of making an appointment
Developing local Clinical Leadership and new ways of working across Healthcare system
Develop General Practice to work at scale
Make Primary Care a more attractive place to work
Primary Care Commissioning
Develop new ways of working to reduce variation in Primary Care
Give people in Lambeth the opportunity for their voice to be heard
Primary Care is better configured to deliver an increased range of services to patients
Unscheduled care
Develop enhanced Primary Care Access in Lambeth
Utilise the community pharmacy network & other community services to improve outcomes for patients through integrated care and by improving safety, access and focussing on prevention
Reduce variation in equality for local populations
Key Achievements Quarter 2:
Appointed interim AD to support LCNs in their development to move forward with key objectives in a timely manner.
Delay in issuing of contracts to GP Federation for Access Hubs due to procurement issues to be resolved with NHSE.
National funding for Extended Access expected in coming weeks.
Locality Managers undertaking practice visits to support delivery of the GP Delivery Framework.
Specification for HoNAs issued in September to Federations. GP+ specification to be issued to practices in October as now commissioning this service directly from practices
Proposal submitted for GP Forward View OD funding.
Review of WIC, A&E redirection service and Gracefield Gardens access hub commenced.
PMS contract negotiations still not progressed at London level.
Discussions taking place with membership to move to fully delegated commissioning.
Minor Ailment Scheme review commenced.
Contract with PPG agreed and signed.
Primary Care Performance Dashboard revised (included equality objectives).
Primary Care Development
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Key challenges to date: On-going pause in negotiations with the LMC regarding the PMS
Premium
Negotiations with the Federations over Access Hub Model going forward and sustainability of Federations as organisations took considerably longer than expected. Successful conclusion is dependant on agreement by CCG and NHSE that contract can be issued for 3 years.
SELDOC WIC contract – agreement and implementation of next steps since receipt of termination notice received
Fully robust budgetary/ contractual control
Key risks 2016-17: GP Federation contract – decision to support contract length for
access to run for 3 years.
WIC costs – recovery of income for non-Lambeth patients. Also, cost
of Lambeth patient attending non-Lambeth WIC may exceed income
Minor ailments – review of future requirement
Federation model doesn’t deliver the changes in primary care models
Preparedness for Level 3 – fully delegated commissioning
LCN development not at speed required to deliver the changes needed in Lambeth.
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5.7.2 Primary Care Programme Dashboard
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5.8 Enabler Programmes
5.8.1 Governance and Development Risk Register
For risks 6K and risk 6N, scored 12, please see the Board Assurance Framework.
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Possible failure of the CCG to have robust business continuity plans to ensure ongoing service delivery resulting in delay in delivery of CCG outputs, potential non-compliance with NHSE Assurance Framework and impact on relationships/loss of confidence with providers, members and NHSE.
Programme Board /
Directorate Risk
Register
6 Mitigate NHS Property BCPs to be obtained and reviewed – to await revision post environmental risk assessment June 2016. Undertake a Lower Marsh EPRR exercise and LCCG Communications exercise – to be discussed at November Health and Safety Working Group November 2016.
Equality Act Risk - Likely risk that the CCG does not currently collect information that provides assurance that they are meeting public sector equalities duties; public engagement work doesn’t systematically target groups of protected characteristic and therefore CCG cannot demonstrate how it fosters good relations. This could result in a breach of the law and loss of reputation; non compliance could result in the CCG in an employment tribunal or county court.
Programme Board /
Directorate Risk
Register
8 Mitigate EIA's to be carried out as a key feature of commissioning intentions process Programmes and enablers to continually collect EDS evidence Targeting of groups for specific engagement, e.g. GP interpreting, IUC procurement, OHSEL EOC proposals
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Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Possible risk of non-compliance with information governance requirements relating to processing of personal confidential data on QUIC system, resulting in a breach of personal confidential information
Programme Board /
Directorate Risk
Register
6 Mitigate To review the retention and destruction schedule to include retention of quality alert data - to add to the Records Management Policy July 2016 Follow up with GP Practices completion of FPN actions - to discuss at IGSG
Ongoing unlikely risk of staff shortage and recruitment and retention problems causing disruption to critical services/essential business functions
Programme Board /
Directorate Risk
Register
6 Mitigate Ensure all plans are ratified and implemented Ensure that, so far as is reasonably practicable, staffing levels and skill mix in critical services are protected from financial pressures.
Ongoing unlikely risk to premises resulting in denial of access/loss of use of premises causing disruption to critical services/essential business functions.
Programme Board /
Directorate Risk
Register
8 Mitigate Ensure all parts of the organisation have integrated arrangements for response to a major incident. Ensure all critical services and essential business functions have business continuity plans in place which are aligned with ISO 22301. Maintain current Southwark Access list and physically test ability of a selection of staff to log in at Tooley Street
Ongoing unlikely risk to technology resulting in disruption to critical services and essential business functions.
Programme Board /
Directorate Risk
Register
8 Mitigate Assess situation against information governance toolkit Ensure plans keep pace with the introduction of new technology and the increasing dependency on technology Ensure that, so far as is reasonably practicable, that arrangements are in place with suppliers of critical systems to ensure swift replacement and commissioning into service Review CSU Disaster Recovery Plan against CCG Business Continuity recovery assumptions
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Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Risk that failure to manage and apply information security standards leads to the introduction of viruses and software to electronic devices and IT networks, resulting in a loss or breach of CCG data
Programme Board /
Directorate Risk
Register
9 Mitigate CCG Internet Acceptable Use Protocol - Sept 2016 ICT progressing with providing policies for adoption by the CCG. Support from new provider to be agreed. Staff training and awareness - discussed at Sept 2016 IGSG. Staff will need to sign up to CSU policies once adopted and for this to be included in induction. Support from new provider to be agreed. Agree format of reporting attempted cyber attacks to IGSG - CCG contacts given access to SUSI to view relevant reports, however these reports not yet available. Upgrade CCG systems from Internet Explorer version 11 - some issues with Windows updates not having been completed, so roll out delayed.
There is a risk CCG data held on the incident management system is not securely protected due to gaps in the contract held with software provider, resulting in a potential breach of data and loss of public confidence in the CCG
Programme Board /
Directorate Risk
Register
8 Accept Regular review at IGSG New account manager to discuss concerns further within the organisation
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5.8.2 Equalities and Engagement
Responsible Director Una Dalton, Director Governance and Development
Clinical Lead Dr. Paul Heenan
Programme Lead Catherine Flynn, Engagement Manager
Purpose: To enact the Public Sector Equality Duty
Equalities
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Key aims for 2016-17:
Build skills and knowledge of staff and Governing Body: induction on legal duties, promote, provide or commission training and development in areas of engagement; coaching, modelling, mentoring
Manage relationships with key stakeholders: Scrutiny, Health and Wellbeing Board, Healthwatch; coordinate briefings, inductions, ensure reports are provided and responded to
Use CCG and partner websites and e communications to promote involvement opportunities
Support public participation in work of Governing Body: promote public forum, support development of patient stories for papers
Develop and support patient and public involvement in CCG programme areas: provide policy and legal guidance and practical support as required
Ensure statutory reporting completed
Key Achievements Q2:
Engagement objectives and progress reviewed at Engagement, Equalities and Communications Committee (Apr, Jun, Sept)
Up-to-date induction materials in place for all staff and GB members re: legal and policy frameworks and CCG approaches; induction meeting with new GB lay member for patient and public involvement
Briefings for Scrutiny as required re: OHSEL programme; input into SE London JHOSC in particular re development of proposals for elective orthopaedic care; members of South-east London Stakeholder Reference Group (including OSC members) provided assurance on thorough and responsive engagement to date in OHSEL, particularly on elective orthopaedic plans across SEL
Chairs meetings continue, shaping agendas for HWB; pre-meet in July (open forum for public) involved workshop discussion on the refresh of Lambeth’s Health and Wellbeing strategy and links with Lambeth’s Community Plan. It included a discussion on the four Health and Wellbeing key themes of: early action and prevention, integration, health and wellbeing in all policies and housing, along with discussion on related aspects of the Community Plan on narrowing the gap and focus on inequalities
CCG website used to promote Governing Body and public forum, open meetings of Lambeth Health and Wellbeing Board and the South-East London Primary Care Joint Committee; also promoted Healthwatch meetings eg on Black Wellbeing, and Council consultation on public health services
CCG public forum well-attended with broad range of questions addressed
Development/delivery of engagement plans for ultrasound, GP interpreting, NHS 111, elective orthopaedic care (OHSEL), children and young people’s emotional wellbeing capacity-building, and primary care co-commissioning; advice and guidance as required in other areas
Funding of PPG Network to support development of patient voice into quality of primary care and CCG commissioning; production of film to support development of PPGs and launch at Patient Participation Awareness Week event; engagement with people with learning disabilities to inform campaign materials
Work across SEL to engage in OHSEL and STP; targeted engagement in line with equality analysis on EOC proposal development; series of workshops with Healthwatch to engage them directly and to inform and support HW work planning for 2016-17; clinical commissioner engagement through CCG localities (EOC)
Engagement
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Key challenges to date:
Volume and pace of work taking place at supra-Lambeth level (eg OHSEL, STP, PCJC, Strategic Partnership)
Key risks 2016-17:
Legal duty to involve
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5.8.3 Organisational Development
Responsible Director Una Dalton, Director Governance and Development
Programme Lead Lucy Day / Janie Conlin, Assistant Director Organisational Development
Purpose:
Develop CCG to best support delivery of the organization’s priorities
Ensure the CCG supports staff and provides resources to enable them to carry out their work
Assess development needs of Governing Body to enable it to function most effectively
Key aims for 2016-17:
Develop CCG to best support delivery of the organisation’s priorities
Ensure the CCG supports staff and provides resources to enable them to carry out their work
Assess development needs of Governing Body to enable it to function most effectively
Key Achievements Q2:
Learning from participation in national staff survey distilled and priority actions being taken forward with staff. CCG has signed up to 2016/17 national survey (voluntary for CCGs)
Induction for new SE Locality Governing body member.
OD expertise and facilitation provided to primary care team to enable improved understanding of individual preferences and team dynamics using various OD tools and techniques including Myers Briggs
Multidisciplinary virtual training (webinar) procured and delivered for Clinical Network on De-mystifying Commissioning
Member practice event designed and delivered regarding developing general practice, constitutional changes and listening to our membership
Key challenges to date:
Prioritising development time and activity over immediate deliverables
Long term sickness within team
Key risks 2016-17:
Ensuring the organisation prioritises some development time and activity over immediate deliverables
Effective engagement of our membership
Succession planning clinical leadership
Establishing new ways of working with revised skill mix in OD team
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5.8.4 IM&T
Responsible Director Christine Caton, Chief Financial Officer, Andrew Parker, Director of Primary Care Development
Clinical Lead Dr Adrian McLachlan
Programme Lead Jeremy Burden and Graham Crawford Business Intelligence & ICT (CSU) Jo Steranka, Digital and Business
Intelligence Development Manager
IAF Indicators (Annex A) 144a, 144b
Scope of business area This business area covers both business information support and information systems. This business is provided to
Lambeth CCG by South East CSU.
Objectives of business area
The overall aim of the IM&T enabler work stream is to ensure that good quality clinical information is accessible in an
integrated shared clinical record and to ensure that information systems are available to support the clinical business
needs of NHS Lambeth Clinical Commissioning Group. A robust IT infrastructure needs to be in place to enable this to
happen.
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Key aims for 2016 – 17:
GP Information Management & Technology
Ensure smooth transition to new GP IM&T Delivery Partner (NE London
CSU).
Ensure alignment of GP IM&T service delivered by the IM&T Delivery
Partner (NE London CSU) with the NHS England GP IT Operating
Framework, the CCG Practice Agreement and the GP Forward View.
Deploy available capital resources to support GP IT in a timely manner.
Review General Practice technology requirements, develop bids and
deploy resources to support innovation in Primary Care.
Develop existing digital resources (including clinical content
management system, SMS texting, arrival and calling-in boards and
national systems such as Electronic Prescription Service and NHS e-
Referrals) to work towards Paperless at the Point of Care in Lambeth by
2020.
Digital Roadmap
Work with the 5 other CCGs in the South East London (SEL) Digital
Footprint (Bexley, Bromley, Greenwich, Lewisham and Southwark) to
develop the SEL Digital Roadmap for submission alongside the SEL
Sustainability and Transformation Plan.
Work with relevant Lambeth Programmes and leads to deliver the SEL
Digital Roadmap Universal Capabilities:
- Professionals across care settings can access GP-held
information on GP-prescribed medications, patient allergies and
adverse reactions
- Clinicians in urgent and emergency care settings can access key
GP-held information for those patients previously identified by
GPs as most likely to present (in U&EC)
- Patients can access their GP record
- GPs can refer electronically to secondary care
Key achievements Quarter 2:
GP Information Management & Technology
Mobilisation of the new contract continues. Significant challenges have
been encountered which have resulted in arrangements being made to
transfer the SE CSU IM&T department as a whole to NE London CSU
from November 2016.
Quality of GP IM&T is judged against the NHS England GP IT Operating
Framework and associated documents and measured using the GP IT
Digital Maturity Assessment. Following publication of the 2016 data, an
Action Plan has been prepared to monitor improvements to the service.
The deployment of hardware purchased by the 2015/16 NHS England
Capital Allocation was completed in August. 2016/17 funding has been
confirmed by NHS England. Planning in underway for deployment of
hardware to practices.
The Estates and Technology Transformation Fund has been
significantly oversubscribed. NHS England has put in place a process
to prioritise bids and moderate the prioritisation. We are awaiting the
outcome of the bidding round.
Digital Roadmap
NHS Lambeth CCG continues to work closely with colleagues in the
other 5 CCGs in the South East London Local Digital Footprint to deliver
the draft Local Digital Roadmap for submission at the end of October.
Work on the final texts of the narrative document and appendices is
ongoing.
The SEL Local Digital Roadmap has been co-ordinated by the Our
Healthier South East London Programme Management Office (PMO).
The PMO is co-ordinating work to improve secondary care digital
maturity.
Lambeth DataNet
The Lambeth DataNet Steering Group, with representation from the 3
stakeholder organisations – NHS Lambeth CCG, London Borough of
IM&T
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- GPs receive timely electronic discharge summaries from
secondary care
- Social care receive timely electronic Assessment, Discharge and
Withdrawal Notices from acute care
- Clinicians in unscheduled care settings can access child
protection information with social care professionals notified
accordingly
- Professionals across care settings made aware of end-of-life
preference information
- GPs and community pharmacists can utilise electronic
prescriptions
- Patients can book appointments and order repeat prescriptions
from their GP practice
Work through Our Healthier South East London processes to improve
secondary care digital maturity.
Revise the draft Lambeth CCG IM&T Strategy to incorporate the
aspirations of the Digital Roadmap
Lambeth DataNet
Ensure successful data warehouse development.
Work with partners and stakeholders to develop business intelligence
resources to support innovation in Primary Care.
Corporate Information Management & Technology
Ensure smooth transition to new GP IM&T Delivery Partner (NEL CSU)
IM&T Support to Programmes
Support Programmes to use IM&T to innovate and achieve change
Lambeth Public Health Department and Kings College London
continues to oversee development of Lambeth DataNet.
Following some delay in data extraction by the IM&T department at
Guy’s & St. Thomas’s NHS Foundation Trust due to misunderstandings
about the structure of the data extract provided by EMIS, data has now
been loaded to the data warehouse. User Acceptance Testing is now
under way.
Corporate Information Management & Technology
* Transfer of corporate IM&T to the new Delivery Partner is happening in
parallel to that for GP IT. Work is beginning on documenting data files
on the existing servers prior to moving them onto the new servers of the
CCG’s new Delivery Partner.
IM&T Support to Programmes
* The Digital Technology Group has met twice now. The Group is
accountable to the Community Based Care Programme Board.
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Key outstanding issues:
GP Information Management & Technology
* New GP IT service: Mobilisation of newly procured GP IT service
began in May 2016. Insufficient information was available to the new
supplier to complete mobilisation within the expected period, with go-live
on 01/08/2016. Planning for transfer to the new supplier continues.
* The Primary Care Digital Maturity Assessment (DMA) has highlighted a
significant number of areas where improvement is needed to deliver the
GP IT service specified by NHS England. Development of an action
plan to take this forward is required.
2015/16 GP IT Refresh: At the end of the quarter, network switch
deployment was delayed for reasons outside the control of the GP IT
Delivery Partner.
* Funding bids for 2016/17 GP IT hardware refresh remain to be finalised
with NHS England. The outcome of bids to the Estates and Technology
Transformation Fund (ETTF) will not be known until November 2016.
* Introduction of new technologies: Plans for the introduction of new
technologies has been dependent on allocation of funding by NHS
England. Final funding levels have yet to be confirmed.
Digital Roadmap
* Finalisation of the texts of the narrative and appendices will continue
during autumn 2016. Preliminary feedback has been received from
NHS England London and work is under way to respond to that
feedback.
* Work with Programmes on delivery of the Universal Capabilities will
begin once the Roadmap has been approved.
* Revision of NHS Lambeth CCG’s IM&T Strategy could not begin until
the Primary Care Digital Maturity Assessment and Local Digital
Roadmap were available.
Lambeth DataNet
* Once the data warehouse has been built, it will be tested by analysts
Key risks going into 2016-17:
GP Information Management & Technology
* New GP IT service: Significant challenges posed lack of internal
systems within the outgoing GP IT Delivery Partner forces transfer to
the new supplier over a protracted period. This could impact on service
to General Practice and reputational damage to NHS Lambeth CCG.
* Primary Care DMA: Failure to deliver to Primary Care the GP IT service
specified in the GP IT Operating Model 2016/18 could undermine
transformation in delivery of Primary Care services.
* Funding Bids: Underfunding of the introduction of technology such as
e-consultation and mobile working undermines the ability of Primary
Care to deliver transformation in patient care.
* Introduction of new technologies: late approval of funding bids risks
there being insufficient time to implement schemes before the end of the
financial year and loss of funding therefore.
Digital Roadmap
* Risks associated with the Local Digital Roadmap are around delivery of
the Universal Capabilities, which involve transformation for primary,
secondary and social care. At this stage these risks await
quantification.
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from Lambeth Public Health, Kings College and NHS Lambeth CCG.
Once it has been signed off, a piece of technical work will be needed to
enable use of the data in the data warehouse. It is anticipated that this
will be complete before Christmas 2016.
* Whilst some high-level work has been carried out to identify how
Lambeth DataNet can support innovation in Primary Care, further work
is needed to identify opportunities for high quality business intelligence.
IM&T Support to Programmes
* The Digital Technology Group will have its first meeting at the end of
August 2016. Preparation for this is under way.
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5.8.5 Estates
Responsible Director Christine Caton, Chief Financial Officer
Clinical Lead Dr. Adrian McLachlan
Programme Lead Claire Hornick
IAF Indicators (Annex A) 145a
Scope of business area This business area is responsible for ensuring maximum use of the CCG commissioned estate across Lambeth.
Objectives of business area
The purpose of the Estates enabling work stream is to make sure that we are getting value for money from the estate
we commission and that this estate supports the delivery of effective and high quality new models of healthcare
provision.
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Key aims for 2016-17: To Review the potential use of Section 106 Funds already received
and create a plan for allocation
Completion of a Norwood review
Completion of a North Lambeth Feasibility Review
Feasibility on the Akerman Health Centre
Secure funding for additional capacity for the Nine Elms Vauxhall Programme
Strategic review on the utilisation of accommodation in each locality
Actively participate in the SEL Estates Enabler Workstream of the Sustainability and Transformation Plan (STP) and ensure that outputs of productivity workstream from pan SEL providers (SLAM, GSTT, KCH) are built into Lambeth Local Estates Planning
Secure Section 106/CIL Funding for the development of Estate within Lambeth
Communicate the Improvement Grant process to all practices
Key Achievements Quarter 2: Streatham Review Workshop
Submission of the re-prioritised EETF submissions
Submission of the expression of interest for One Public Estate
Submission of improvement grants
Key challenges to date: ETTF applications submitted but the outcome has been delayed until
October 2016
Nine Elms residents arrive in advance of accommodation being funded and ready for occupation in Wandsworth will impact in Lambeth
Ensuring all practices are aware of Improvement Grant opportunities for 17/18
Requirement to re-prioritise ETTF submissions across South East
London
Creating a plan B for projects submitted to ETTF
Encouraging practices to apply for Improvement Grant funding
should ETTF application be unsuccessful
Engagement with other providers to develop co-location plans
Key risks 2016-17: North Lambeth Feasibility is required before the outcome of the ETTF
process is known
Nine Elms residents arrive in advance of accommodation being funded and ready for occupation in Wandsworth will impact in Lambeth
Secure Section 106/CIL Funding for the development of Estate within Lambeth
Estates
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5.8.6 Workforce
Responsible Director Una Dalton, Director Governance and Development
Clinical Lead Dr. Adrian McLachlan
Programme Lead Fiona Stirling , HR Business Partner, South London CSU
IAF Indicators 128d, 163a, 163b, 164a
Scope of business area To purpose of this business area is to ensure the provision of an effective
Human Resource service to staff and managers across the organisation.
Objectives of business
area
The objectives of this business area are to ensure that managers and staff
across the CCG have access to up to date advice and support on all
matters relating to the recruitment, management and development of staff
within the CCG.
Lambeth Community Education Provider Network (CEPN) Lambeth Community Education Provider Network continues to meet regularly. We are in the process of reviewing our membership and we were delighted to welcome Catherine Pearson from Healthwatch Lambeth and Nicola Kingston to join the network recently. The network continues to progress a number of priorities:
Nursing Leadership Roundtable Discussion
Over 20 nurse leaders in Lambeth met on Tuesday 11th October at the Health Foundry to discuss how we can work together across the Borough to recruit and retain nursing staff. Colleagues from Trusts, Primary Care, Health Education England, Lambeth GPs, Southbank University and NHS England came together to discuss this important issue.
The event was chaired by David Monk, Facilitator and led by Dr Martin Block, Chair of Lambeth
CEPN. The discussion focused on some of the big challenges facing each part of the system on nurse recruitment and retention and where we might be able to work together to move this agenda forward. There was unanimous support from nurse leaders that the conversation was helpful and we agreed to meet again. A second event is planned for January 2017. In the meanwhile we will write up our discussion and this will be circulated to all GB shortly.
The development of practice nurses
Our four Lead practice nurses, as part of the Lambeth Clinical Network, continue to work to develop and support approximately 100 practice nurses across primary care in Lambeth. The focus of the team is on development, support and supervision of local nurses. Recent successes have included:
- the standardisation of training for health care assistants (HCAs) - an increase in the number of practices taking nurse placements - an increase in the number of practice nurses and HCAs taking part in clinical
supervision - an increase in the number of trained nurse mentors - an increase in the number and range of training courses available locally.
The development of practice managers
We are currently advertising a new role on the Clinical Network as Lambeth Practice Manager lead role. The purpose of this role is to have dedicated time for a Practice Manager to work with their peers, with the CCG and with Federations to develop a vision for practice management in Lambeth.
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They will be a voice for practice managers locally with the capacity and ability to influence. The advertisement will close in late October and we hope to appoint by early November.
Community pharmacy
The CEPN, at its meeting in September agreed to fund a Community Pharmacy lead role as part of the Clinical Network. Similar to the role of our nurse leads, the pharmacy role will work with primary care colleagues to maximise the benefits of engaging pharmacists in Primary Care. To date seven Lambeth GP practices have recruited Community Pharmacists and the lead role will support them as a network.
Development of non-clinical staff in primary care
As part of the Five Year Forward View for Primary Care some resources have been identified to support the development of non-clinical staff in primary care. The CEPN has been working with Southbank to identify relevant training and development and will work with Lambeth practice managers to maximise this resource. A further update on this work will be presented to the November meeting of the CEPN.
GP recruitment and retention – round table discussion planned for early 2017
Following the success earlier this week of the CEPN roundtable discussion on the recruitment and retention of nurses, the CEPN plans to host a similar discussion on the recruitment of GPs in the Borough. We will work with Federation colleagues and Health Education England to plan the event – due to take place in February 2017.
CCG Membership Based on feedback from practice visits a review of our current Protected Learning time arrangements is underway. As you know we currently hold six PLTs each year, five based on the work of our programmes and one practice based event. Feedback on the PLTs during 2016 has been mixed. Working with Raj Mitra, GP lead for Education and Martin Godfrey, Clinical Network lead, we will present proposals on the development of PLTs in early November.
Population health fellows Governing Body members agreed to fund a second and final year of the current Population Health Fellows scheme. As GB will be aware, fellows spend their time between a GP practice, Commissioning Projects and completing a masters. We invited all practices to express an interest in hosting a fellow for this second year and we have received 20 formal responses. A meeting will be held on Friday 14th October with the fellows, Federation and the CCG to agree next steps.
South East London Workforce Priorities The South East London workforce group continues to meet – the two key workforce priorities for local Trusts is the delivery of £30m in savings on bank and agency staff over the next three years and the review of all back office functions to achieve savings targets. Lambeth CEPN is working with all South East London CEPN to agree what work can be done locally to support delivery of STP workforce priorities.
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NHS Lambeth CCG’s Human Resources services are provided by South Commissioning Support Unit
and the organisation’s named Business Partner is Fiona Stirling, providing support to managers and staff
within the CCG. Since March 2015 payroll and pensions services is been provided by SECSU in-house
team.
Our workforce profile as at August 2016 is as follows:
As at 31st August 2016 the CCG has a headcount of 70 and a FTE of 64.04. Over the past 12 months there has been a general increase in staffing numbers, with an increased headcount of 7 from 1st September 2015 to 31st August 2016.
Staff turnover
The overview of the last 12 months is inconsistent and increases and decreases each month with a peak in September 2015 and August 2016. Generally speaking the CCG has a higher turnover rate than the
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national average (which may be attributable to the London factor) although the position improved from April to June 2016 where the CCG has a lower rate than the national CCG average rate (the national CCG average turnover rate for June 2016 was 1.29%, this is the latest data that can be retrieved from Iview).
Starters - Rolling 12 Months (Headcount & FTE) There has been zero starters in August 2016, and 23 starters in total through-out the preceding 12 months.
There has been 4 starters in June 2016, and 25 starters in total through-out the preceding 12 months. Leavers - Rolling 12 Months (Headcount & FTE)
There has been 12 leavers in total over the preceding 12 months. Each month has been fairly consistent with either none or 1 or 2 employee's leaving each month with a peak in August 2016.
Sickness Absence
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Sickness absence figures are currently available as at 31st July 2016. The sickness absence percentage rate for Lambeth CCG at 31st July was 2.07% which shows an improvement from June 2016 which had an absence rate of 4.46%. The target is 2.50%. The national CCG average for May 2016 was 2.57%, which is the latest data that can be retrieved from Iview. Cases are being managed in accordance with the Lambeth CCG Promoting Attendance at Work Policy with appropriate support through HR and Occupational Health.
Employee Relations cases
There are no employee relations cases progressing to a formal hearing stage.
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6 QUALITY ASSURANCE
6.1 PALS and Complaints PALs and Complaints data for Q2 2016/17 will be published in the December report.
6.2 Serious Incidents
Serious Incident data for Q2 2016/17 will be published in the December report.
NHS England published a revised Serious Incident (SI) Framework in March 2015.
Serious Incidents are defined as:
Acts and/or omissions resulting in unexpected or avoidable death of one or more people;
includes suicide/self-inflicted death and homicide by a person in receipt of mental health
care within the recent past;
Unexpected or avoidable injury to one or more people that has resulted in serious harm;
Unexpected or avoidable injury to one or more people that requires further treatment by a
healthcare professional in order to prevent the death of the service user or serious harm;
Actual or alleged abuse where healthcare did not take appropriate action/intervention to
safeguard against such abuse occurring or where abuse occurred during the provision of
NHS-funded care.
A Never Event
An incident (or series of incidents) that prevents, or threatens to prevent, an
organisation’s ability to continue to deliver an acceptable quality of healthcare services,
including (but not limited to) failures in the security, integrity, accuracy or availability of
information; Property damage; Security breach/concern; Incidents in population-wide
healthcare activities like screening and immunisation programmes; Inappropriate
enforcement/care under the Mental Health Act (1983) and the Mental Capacity Act (2005)
including Deprivation of Liberty Safeguards (MCA DOLS); Systematic failure to provide an
acceptable standard of safe care or Activation of Major Incident Plan
Major loss of confidence in the service, including prolonged adverse media coverage or
public concern about the quality of healthcare or an organisation.
6.3 Never Events
NHS England published a revised Never Events Policy and Framework along with the revised Serious
Incident Framework in March 2015.
The definition of a Never Event has also revised:
They are wholly preventable, where guidance or safety recommendations that provide strong
systemic protective barriers are available at a national level, and should have been implemented
by all healthcare providers
Each type has potential to cause serious patient harm or death (but may not).
Evidence that never event type has occurred in the past and risk of recurrence remains.
Occurrence of the Never Event is easily recognised and clearly defined.
Never events data for Q2 2016/17 will be published in the December report.
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All serious incident issues are followed up at on-going provider Serious Incident Monitoring meetings for each provider, this includes reviewing the progress of overdue investigation reports. These meetings are chaired by the CCG Clinical Quality Lead. Serious incidents are closed by the CCG through the Serious Incident Review Group, which is a sub-committee of the Integrated Governance Committee.
6.4 Freedom of Information (FOI) The number of requests received by the CCG is similar to the number of requests received by other CCGs South East CSU provide a Freedom of Information (FOI) service to. The table below shows the number of requests received by month and by quarter for the financial year 2016/17. It also shows the number of requests received in 2015/16 for comparison. There has been a 16% reduction in the total number of requests received for the year to date (YTD) when compared to the same point in 2015/16. However the number of complex requests has
Performance Indicators Targets which are given within the Freedom of Information Act: The FOIA states that applicants should be given a response within 20 working days. Good practice guidance suggests that at least an 85% response rate should be achieved. The table below shows the CCG’s performance for this quarter. Figures for 2015/16 have been provided for comparison.
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The CCG achieved a 96% response rate for the quarter. This is a good achievement and exceeds the current good practice guidance suggested by the ICO. South East CSU’s FOI Team continues to work hard with CCGs staff to ensure the number of occasions which the CCG are unable to respond within the 20 workings days is kept to a minimum.
Year
Ap
ril
Ma
y
Ju
ne
Ju
ly
Au
gu
st
Sep
tem
be
r
Octo
be
r
No
vem
be
r
Decem
be
r
Jan
ua
ry
Fe
bru
ary
Ma
rch
To
tal Y
TD
Target
2015/16
28 20 29 42 27 23 29 21 15 23 23 18 298
Compliant 28 20 29 42 27 23 28 19 15 23 21 18 293
Breached 0 0 0 0 0 0 1 2 0 0 2 0 5
% 100% 100% 100% 100% 100% 100% 97% 90% 100% 100% 91% 100% 98%
Target
Quarter 1
77
Quarter 2
92
Quarter 3
65
Quarter 4
64 298
Compliant 77 92 62 62 293
Breached 0 0 3 2 5
% 100% 100% 95% 97% 98%
Target
2016/17
37 27 19 15 26 18 0 0 0 0 0 0 142
Compliant 37 25 18 15 24 18 0 0 0 0 0 0 137
Breached 0 2 1 0 2 0 0 0 0 0 0 0 5
% 100% 93% 95% 100% 92% 100% - - - - - - 96%
Target
Quarter 1
83
Quarter 2
59
Quarter 3
0
Quarter 4
0 142
Compliant 80 57 0 0 137
Breached 3 2 0 0 5
% 96% 97% - - 96%
Target – The total number of requests received.
Compliant – The total number of requests responded to within the statutory 20 working days.
Breached – The total number of requests not responded to within the statutory 20 working days.
% - The percentage of the total number of request received which were responded to within the statutory 20 working days.