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INTEGRATED GOVERNANCE AND

PERFORMANCE REPORT

NHS Lambeth Clinical Commissioning

July 2017

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 ......................................................................................... 20

3.1 NHS Lambeth CCG Assurance 2016/17 ....................................................... 20

4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK ........................ 21

4.1 Leadership ...................................................................................................... 21

4.1.1 Board Assurance Framework .................................................................................... 21

4.2 Delegated Functions ...................................................................................... 29

4.3 Financial Management ................................................................................... 29

4.3.1 Financial Position ...................................................................................................... 29

4.3.2 QIPP Performance ....................................................... Error! Bookmark not defined.

4.4 Performance Dashboards ............................................................................. 33

4.4.1 NHS England National Constitution Standards ......................................................... 33

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients) ......................................... 35

4.4.3 Diagnostics (Lambeth Patients) ................................................................................ 36

4.4.5 A & E Waiting Times ................................................................................................. 37

4.4.6 Cancer Waiting Times ............................................................................................... 38

4.4.7 Ambulance Response Times .................................................................................... 39

4.4.8 Improved Access to Psychological Therapies (IAPT) ................................................ 39

4.4.9 New Early Intervention In Psychosis 2 Week Standard ............................................. 39

4.4.10 Dementia Diagnosis Rate ......................................................................................... 40

4.5 Quality Premium 2016/17 ............................................................................... 41

4.6 Quality Alerts .................................................................................................. 45

4.7 Infection Control ............................................................................................ 46

4.8 Mixed Sex Accommodation........................................................................... 47

5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES ...... 48

5.1 Integrated Children and Young People (including Maternity) Programme 48

5.1.1 Programme’s Purpose .............................................................................................. 48

5.1.2 Programme Assurance Statement Quarter 3 2016/17 ............................................... 49

5.1.3 Children and Maternity Programme Board Dashboard .............................................. 53

5.2 Integrated Adults Programme (Elective, Urgent Care, Cancer) ................. 55

5.2.1 Programme Purpose ................................................................................................. 55

5.2.2 Programme Assurance Statement Quarter 2 2016/17 ............................................... 56

5.2.3 Integrated Adults Programme: Older Adults (including Committee in Common and

joint arrangements with Lambeth Council) ............................................................................ 62

5.2.4 Better Care Fund (BCF) ............................................................................................ 65

5.2.5 Integrated Adults Programme: Long Term Conditions and Medicines Optimisation .. 67

5.2.6 Integrated Adults Programme Dashboard ................................................................. 74

5.3 Integrated Mental Health for Adults .............................................................. 79

5.3.1 Programme Assurance Statement as at Quarter 2 .................................................... 79

5.3.2 Mental Health Whole System Dashboard .................................................................. 80

5.4 Learning Disability ......................................................................................... 83

5.5 Staying Healthy (Led by London Borough of Lambeth) ............................. 85

5.5.1 Programme Assurance Statement ............................................................................ 87

5.5.2 Staying Healthy Dashboard ...................................................................................... 88

5.6 Primary Care Development ........................................................................... 95

5.6.1 Programme Assurance Statement ............................................................................ 95

5.6.2 Primary Care Programme Dashboard – March 2017 ................................................ 99

5.7 Enabler Programmes ................................................................................... 102

5.7.1 Governance and Development Risk Register.......................................................... 102

5.7.2 Equalities and Engagement .................................................................................... 107

5.7.3 Organisational Development ................................................................................... 113

5.7.4 IM&T ....................................................................................................................... 116

5.7.5 Estates.................................................................................................................... 120

5.7.6 Workforce ............................................................................................................... 123

6 QUALITY ASSURANCE ................................................................................ 125

6.1 PALS and Complaints Quarter report ....................................................... 125

6.2 Serious Incidents ......................................................................................... 128

6.3 Never Events ................................................................................................ 129

6.4 Freedom of Information (FOI) ...................................................................... 130

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 HEE Health Eduction England

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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 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 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

Baseline assessment ratings for 2016/17 have been formally published for all 6 Clinical Priority areas. Detailed information can be found on the My NHS website via the link above. NHS Lambeth CCG is performing well in four out of six of the clinical priorities with overall assessment rating details by Clinical Area below.

Clinical Priority 2016/17 Baseline Assessment

Dementia Top Performing

Diabetes Performing Well

Learning Disabilities Needs Improvement

Cancer Needs Improvement

Mental Health Performing Well

Maternity Performing Well

The CCG continues to ensure that the performance of each 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.

https://www.nhs.uk/Service-Search/performance/search

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2.1.2 Leadership

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 5x4=20 2N RTT Performance

4 4x4=16 2C A&E Performance

4x4=16 2M Community Nursing Vacancy Level

4x4=16 7A Financial Planning Risk

4x4=16 2K Cancer referral to treatment 62 days

1 3x5=15 1A Safeguarding children

10 3x4=12 2A Community Nursing Service Improvement Plan

3x4=12 2B Safeguarding Adults

3x4=12 2Q Electronic Referral System

3x4=12 3C Risk to SLaM Contract

3x4=12 3N LWN reduction in secondary care demand

3x4=12 3O Living Well Network Alliance - Procurement

3x4=12 6K CSU procurement process risk

3x4=12 7B QIPP delivery risk

3x4=12 8B End of Lower Marsh lease

3x4=12 8D Premises needs at Clapham Park

5 4x3=12 5AAPCC Delegated primary care budgets

4x3=12 6S BCP Risk - loss of utilities

4x3=12 6T BCP Risk - internet fraud

4x3=12 6Q BCP Risk - loss of telecoms

4x3=12 6Y Lower Marsh Lifts

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

3 5

110151

4 45

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2.1.3 Financial Duties

Financial performance to Month 2 is summarised below.

Performance Area Commentary

Month 2

Position

Revenue Surplus

Lambeth CCG is reporting an in year surplus of £43k for the first

two months of 2017/18 and is forecasting a surplus of £256k for the

year. The CCG's surplus is in line with our plan of delivering an in

year surplus target of £256k.

Cash Limit

Cash balances are planned to be maintained at low levels (less

than 1.25% at 31 May 2017). Lambeth CCG's cash balance at

bank at the end of May was £472k. 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 £14.163m.

Public Sector

Payment Policy

Public sector payment target is 95% on numbers. The CCG paid

96.12% of NHS invoices based on numbers and 99.63% by value.

Performance for the first two months for Non NHS invoices is

93.66% on numbers and 98.38% by value.

Running Cost

The CCG's running cost allowance is £7.6m. The CCG is reporting

a break even position as at month 2 and will meet its running cost

target for the year.

Key Financial Performance Duties

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2.1.4 Performance against national constitutional standards and other key performance measures 2016/17

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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


Integrated Mental Health for Adults Some objectives on track but some risks


Staying Healthy Objectives on track

Primary Care Development Objectives on track

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2.3 QUALITY ASSURANCE

Quality | Guy’s and St Thomas’ Local Dashboard

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Guy’s & St Thomas’ Hospital (GSTT) – March 2017 CQRG commentary The information provided in this section is a summary of discussions at CQRG meeting in February 2017. This meeting is attended by senior Trust representatives, including the Medical and Nursing Directors, Clinical Commissioners and Directors of Quality from Lambeth and Southwark Clinical Commissioning Groups (CCGs). A progress update was provided in relation to Gastroenterology re-audit results. Trust reps reported on a number of changes made to the pathway including; the appointment of a Virtual Clinic Coordinator, development of a Standard Operating Procedure (SOP), the move from a 2 week to a 1 week turnaround target for outcome letters sent to patients and their GP and the development of a register to monitor delays. The re-audit looked at a sample of 50 virtual clinics (VCs) from Dec 16 – Feb 17 to ensure that the changes had produced significant improvement in the process and that VCs are processed and “outcomed” in a timely manner with letters sent out. The second aim of the audit was to monitor lateness. 3 letters were randomly selected from 50 clinics. 142 patients were sampled and 113 of them had letters. It was agreed that the Trust would look in to the reasons why 20% of letters were missing. 9 letters were not due to be sent and 3 were found to be genuinely missing (as the patient was due to be seen in Outpatient clinic). This is not in line with the SOP and will be clarified with staff. Learning, candour and accountability CQC recommendations - The Trust has completed a gap analysis on death review recommendations. The analysis indicated that only recommendation 7 was applicable; “Provider organisations and commissioners must work together to review and improve their local approach following the death of people receiving care from their services. Provider boards should ensure that national guidance is implemented at a local level, so that deaths are identified, screened and investigated, when appropriate and that learning from deaths is shared and acted on. Emphasis must be given to engaging families and carers”. The Trust looked at evidence of engaging with families during investigation of complaints and SIs and assessed that they are doing well on this. There is also evidence of complaints leading to SIs. However, the Trust has questioned whether it is doing enough to engage families in the development of Terms of Reference and if they are fully reflecting their concerns. The Trust acknowledges that it has more to do to manage evidence more effectively, so that staff can upload evidence - a plan is in place to resolve this. An in depth review across all specialties on death reviews has been completed and the Trust is clear on where they need to be. Each Division has mortality and morbidity arrangements with criteria in place to review death and some work to develop overarching governance. The strength of these arrangements varies across the organisation and GSTT will need to strengthen processes against the structured template and involvement of families/ carers in death reviews. A Trustwide Mortality Review Group will be launched imminently. The group will be clear on expectations for Specialties not using mortality data to triangulate systematic approaches to identify learning. Recognised gaps in data are around identifying deaths occurring outside of the hospital. Terms of Reference are still to be established and the implementation of further guidance from the National Quality Board relating to learning from deaths will take place. Mortality and risk adjusted mortality scores are good, so the Trust is well placed to meet the requirements in the National guidelines.

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Patients ‘lost to follow up’ - Trust reps provided an update on the management of patients ‘lost to follow up’ at Evelina Childrens Hospital. The Trust now has more confidence in how patients are managed. A follow up waiting list has been instituted, with reports on this completed weekly. Regular audits are also being done. An audit has been completed on a further 3000 patients - no harm was identified in any of these patients. The sample now represents 10% of the cohort. The Trust is now planning to look prospectively at reducing the backlog - Commissioners requested a quarterly review of this. Elderly care - key challenges centred around; • ED divert functionality, which was noted to be working better in Lambeth than Southwark • Delayed transfers of care - recognising there are insufficient numbers of placements • Sustainability of workforce (medical and nursing) – creating some vulnerability around the quality of care that can be delivered • Location of the ‘dying patient’ and the need to get more people to their preferred place of death • Sustainability of the National Dementia Strategy • Development of locality older persons services, to deliver care closer home Trust reps reported that older patients are being managed well in ED by ‘age sensitive’ clinical teams. The number of complex patients is higher than it has ever been and the complexity of needs is changing. Patients over 70 years that require a multi-disciplinary assessment, receive an assessment within 24 hours by the Specialist Therapy Assessment Team. There are no known concerns about the management of elderly patients in ED and no SIs related to older people in ED have been reported. The Trust is achieving safe staffing levels on all acute directorate wards including elderly care wards. Trust reps reported that there are robust arrangements in place to ensure that correct levels of staffing and resilience is achieved. End of Life Care - The Trust acknowledged that communication and specifically communication of PEACE (Proactive Elderly Advance Care Planning) documents was a weakness. PEACE documents are not uniformly being transferred out. DNAR forms are also not being consistently transferred and work is needed to improve this. The Trust will develop a QIP to address this. Trust reps reported some difficulties with using Coordinate my Care (CmC) as it is a duplication of recording. Compliance with the National Dementia Strategy – The Trust continues to adhere to the national dementia strategy standards with a named Consultant Trust clinical lead for dementia. All staff receive Level 1 or enhanced Level 2 dementia training Use of anti-psychotic drugs is low, however dementia screening has been a challenge to sustain, as is assessment within 72 hours for emergency admissions - this is due to rapid staff turnover and a lack of visibility about the added value of the assessment by front line staff.

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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) – March 2017 CQRG & data commentary The information provided in this section is a summary of discussions from the March CQRG meeting. This meeting is attended by senior Trust managers, (including the Medical and Nursing Directors), Clinical Commissioners and Directors of Quality from Lambeth, Southwark and Bromley Clinical Commissioning Groups (CCGs). Radiology Trust Action Plan and service modeling The Trust presented CQRG members with a briefing paper on the suspension of the radiology trainee programme. Trust reps reported on the actions undertaken to date and future plans in response to Health Education England (HEE) findings and the subsequent suspension of radiology trainee programme for years 1-3, leading to a loss of 61 trainee sessions. King’s Radiology service had also provided some commentary to HEE in respect of the accuracy of the initial report findings. A final agreed version of the report was published and is in the public domain. The main issues cited by HEE were:

• Patient safety in respect of inpatient and ED reporting and trainee supervision. • Behaviors that undermine professional confidence, performance or self-esteem.

HEE made the following recommendations: • All trainees are supernumerary and need to be overseen by a consultant. • Supervision support needed to be co-located with the trainees

The Trust acknowledged the impact the loss of trainee session would have on how workloads are managed across the department, and believed that the recommended actions were in part due to new clarity in respect of the interpretation of ‘supervision’. As a consequence it is likely that a number of Trusts will need to review the way they are working. The Radiology team are now looking at internal team building and new ways of working to achieve broader work sustainability. They will also look at ways of working with trainees and how training can be delivered better. It was also noted that the location of CT scanners has an impact on workflow and a named Consultant will be physically present in the department to give direct and indirect supervision. The Trust reported that they had undertaken a review of all incidents and were confident that the findings did not substantiate the HEE view that patient safety had been at risk. The Trust was able to evidence that there were 718 adverse incidents (AIs) between 01/01/2016 and 02/03/2017 relating to radiology; of which 5 related to radiological reporting discrepancies where no patient harm resulted. HEE has advised that the Trust will need to ensure the following: - All sessions are to be consultant led and STs will have a named consultant to go to for support. The Trust advised of the following impacts resulting from the suspension:

• Inability to provide the current on call rota tier of trainees overnight • Replacing the 61 sessions – these cannot be readily covered by locums and will have an impact on specialist reporting • There are some potential risks in terms of outsourcing CTs to a third party supplier, but the Trust is working with the supplier to ensure that communication flows and out of hours calls are effectively managed.

A report on Consultant behaviours and culture will be provided by HEE under separate cover. The Trust outlined next steps as follows:

• Go live with Out of Hours service whilst trainees are still in post to test strategies and business continuity over the next 2 weeks • Review of sustainability and the impact on on-call and overall service provision.

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The review will take account of the financial implications resulting from the loss of HEE funding (as this is unlikely to be sustainable in the long term). • Carry out a workforce review.

Patient experience report Q2 and Q3 2016/17 and Staff Survey 2016 results It was acknowledged that the results of the staff survey were significantly poor; however it was also noted to be much more representative this year with an increased response rate. Over 3,000 staff completed the survey compared to 800 in the previous year. Whilst performance was poor the survey results also provided opportunities for improvement. Staff responses were discussed in detail at the Trust Senior Leadership Group. ‘Engagement’ and ‘visibility’ will be a priority, but there was also recognition within the organisation that progress has been made since the time of the survey being undertaken.

• In relation to leadership, plans are being taken forward to ensure that Board members take on the responsibility of champion for specific areas identified for improvement.

• It was noted that scores from BME nurses were higher in each of the areas, but there is some indication of discrimination and work related stress. A deep dive has been requested to understand these issues and enable the appropriate remedial actions to be undertaken.

• A new HR post has been agreed, which will have responsibility for inclusivity; the Trust has also sought additional support from NHSi. Plans are underway to re-launch the BME network.

• The relationship with line managers was recognised to be poor and in response the Trust is undertaking work to ensure mechanisms are in place to strengthen relationships between staff and their line managers.

• The first Health and Well-being events have been held at PRUH and DH sites, which received positive feedback from staff.

• Healthcare Assistant and Nurse fora have been established to look at what works well and areas requiring improvement.

• This review is being carried out in a systematic way and will also work with admin and clerical teams.

• It was recognised that staff morale and service user experience are intrinsically linked - as a result the Trust is exploring whether there may be some benefit in aligning work with this staff group and work undertaken to improve outpatient experience.

Complaints The Trust reported 40% compliance on complaints responded to within 25 days. All legacy complaints will be closed by the end of March. Each complaint is being looked at by the department it belongs to. To ensure continued improvement there is now a requirement for every lead and clinical division to respond in a timely way. Cancer The Trust is undertaking a clinical review of 100 day RCAs and has invited the Cancer Alliance to attend. All RCAs of 100 day breaches are being picked up via Cancer Locality Meetings. It was acknowledged that there is a lack of a robust cancer strategy and there is further complexity added through having multiple sites; as a result there is a need to strengthen the process for MDT working across cancer teams. The main themes in delays include; patient choice and delays in diagnostic pathways due to complexity, capacity etc. The Trust has proposed a number of actions in response to the National Cancer Patient Experience Survey results. There has been an establishment of a director led Cancer Delivery

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Group to manage delivery of the patient experience action plan. A Head of Nursing post has been appointed to provide dedicated leadership to Cancer Services. In addition the Trust has successfully appointed to the Cancer Lead Nurse post. In regards to the 2 week access target throughout the first two quarters of 2016/17 performance was good with 94.39% for Q1 and 95.13% for Q2. There has been deterioration in Q3 performance at (89.56%) however this has improved in Q4 (92.5%). Changes in the pathways were the key drivers of poor performance. The Trust has performed relatively well against the 62 day standard and are reviewing plans for ensuring continuous improvement and sustainability. Consideration is being given to putting on additional sessions to address pressures in some clinics such as breast and dermatology. There are some capacity issues within direct access endoscopy and this potentially impacted on overall capacity. There are mechanisms in place for tracking patients along the pathway from day zero. It is intended that the findings will inform the Trust action plan. Work is also being undertaken to drive down waits, with the initial focus being on urology moving to seven days for first appointments. This will positively impact on compliance against the two week wait standard. It is intended that diagnostic capacity will be included in the review process. Month 10 Trust Performance Report Commissioners noted the increase in the number of E-Coli bacteraemia, with 7 new cases reported in January, 6 at the DH and 1 at the PRUH with 115 cases YTD. Trust reps reported that the incidence of E-Coli is above the target threshold of (75 cases) and the final target for 17/19 is not yet confirmed. The Trust will work at a system level to pick up cases pre admission and have already identified some clinical drivers for the increased level of incidence; this included catheter care and the need to ensure that these could be effectively managed by Community Nursing teams and Nursing Homes where required. The Trust had noted that there are a number of admissions occurring out of hours for blocked catheters and that was a need to ensure that there is appropriate provision in place, to ensure there is sufficient capacity and capability in the community to prevent unnecessary unplanned admissions and emergency attendances.

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St Georges CQRG Commentary – March 2017 The information provided in this section is a summary of discussions from the March CQRG meeting. This meeting is attended by senior Trust managers, (including the Medical and Nursing Directors), Clinical Commissioners and Directors of Quality from Wandsworth, Sutton & Merton Clinical Commissioning Groups (CCGs). Duplicate Summaries The Trust noted there has been an ongoing issue with duplicate discharge summaries being sent to GPs. This related to some rules implemented within the IT system 6 years ago whereby discharge summaries were to be sent 4 hours after completion and another rule a year ago whereby the patient had to physically leave the building before the discharge summary was sent. It was believe that these 2 rules were contradicting each other. The 4 hour rule has now been removed so GPs should not be receiving any more duplicates. The process is not the same across all departments and can be sent via 3 different routes; therefore GPs were asked to report back if still experiencing problems. The Trust will from April be compliant with the Royal College headings for discharge summaries. Paediatric Phlebotomy The Trust report showed the service is successful and there has been good improvement with good feedback from GP colleagues. Friends and Family test uptake only has a 10% response rate but the Trust will look at how this can be quickly improved. HEP B heel prick for babies model is being developed by commissioners and Trust and a possible service to be carried out in the near future. Children ‘not bled’ has dropped to 2 a week. CQRG SI Process The process for escalating Make a Difference (MAD) alerts believed to be SI and the general SI process have been agreed. Turnaround times of (10 working days) have been added to the initial processes. SI flow management and escalation to CQRG process was agreed including those identified during the RCA process, also with a 10 day turnaround.

Learning from Deaths

Following on from the CQC’s national review of deaths across NHS Trusts in England, a work programme will be planned internally to look at the systems in place at the Trust to learn from deaths in line with the recommendations.

National Cancer Experience Survey

The Trust presented the results of the June 2015 survey released in 2016. Nationally there were positive findings such as better care and support despite low numbers of CNS’. The Trust also noted improvements in family members’ involvement and care plans.

SGH were ranked 118th out of 140 nationally and came 21st out of 32 in London, the Trust acknowledge that there are no designated cancer wards therefore staff working with patients are not necessarily specifically cancer trained. CNS input and poor access to CNS was considered to be part of the issue. The Trust is working with Macmillan cancer support workers as part of an 18 month pilot using support workers to free up the CNS time allowing CNS more access to patients and as such improvements have been seen in assessments. A 6 month report of the progress of this project will be presented to the Trust board.

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Evaluation of CNS working and patient support is still poor and needs to be revisited, the Trust have no cross cover with only 1 CNS supporting areas with a high numbers of patients.

Funding for 2 CNS posts (Gynaecology and Lung) and some admin support was provided in 2016/17 as part of CQUIN to improve CNS provision. There had been difficulty appointing due to non-recurrent nature of funding. Commissioners were concerned they were not informed of the status of recruitment and remain concerned about the inadequate level of CNS staff within the Trust. The Trust are reviewing the cover of CNS posts.

A recent NHSE assurance meeting highlighted an issue around how staff work together and particularly where patients are being treated in a day case setting whether they were getting the support they required.

Trust Board Quality Report

There is a significant problem with staff turnover, appraisals, retention of staff and morale. A Trust benchmarking committee has found that in all areas except for turnover St George’s was below other Trusts and as such they are targeting areas to improve.

The percentage of staff that would refer a friend or relative dropped to 26% between Q1-2, Trust believe this is due to the CQC rating released during that time. The Trust are undertaking a huge re-engagement piece of work to improve staff morale.

18

SLAM CQRG Commentary – March 2017

The information provided in this section is a summary of discussions from the most recent CQRG meeting in March. This meeting is attended by senior Trust managers, (including the Medical and Nursing Directors), Clinical Commissioners and Directors of Quality from Lewisham, Southwark, Croydon and Lambeth Clinical Commissioning Groups (CCGs). Physical Health The Trust presented a report on a thematic review of physical health. The paper highlighted some challenges; life expectancy is not improving and the mortality gap is worsening. SLaM representation at decision-making level influenced the NHSE national CQUIN scheme for physical health. Each CAG has a physical health lead allowing corporate led work streams to progress. eObs is the Trust’s portable digital platform for documenting patient observations via a handheld tablet device. Physical Health monitoring tools for fluid balance, food intake, blood glucose, weight/BMI/waist circumference, neurological observations are to be tested and launched on eObs at Ladywell in April, and Trust wide later. The speed of system development with eObs had not progressed at the pace first anticipated due to contractual and technical platform development delays in adapting to SLaM protocols. It was noted there has been no reconsideration of the SMI registers for some time and it is a priority to align the Trust’s registers with the GPs registers. Commissioners agreed the need to work on engaging with the 4 boroughs CCG GP mental health leads to commence shared care protocols and clinical information sharing on and develop a work stream. It should be clear who is responsible for a patient’s physical health to ensure consistency. Monitoring pods allow service users to take ownership of a condition. They can measure BMI and blood pressure and can be used whenever they want. The plan is for the measurements to go straight onto EPJS. Previous incidents, including a preventing future death report, related to diabetes and communication back to GPs. The PFD report is to be taken to a future board meeting once the SCR is finalised. CQC Update A summary was provided by the Trust. There was a planned re-inspection of the Acute CAG by the CQC with 1 weeks’ notice. The feedback was positive; however the greatest area of concern is the domain of safety. ePJS had been transformed over time and was in place the week CQC came to inspect, and data is now automatically pulled through. The Trust’s physical care of patients was good with good practice including support for smoking cessation. CQC also approved of the reorganisation of the pathway into a single CAG and the good practice in staffing issues. Significant differences were found for safeguarding. The Lambeth teams demonstrated particularly good safeguarding; however safeguarding referrals at the Bethlem were not always reported and recorded. The Trust is trying to make this more robust. CQC suggested individual safes in patient’s rooms as it is hard to keep possessions safe. The CQC highlighted there was scope to improve communication between wards and community mental health teams. CQC will return in 6 months to inspect the community teams. Quarter 3 Lesson’s Learned Report The Trust presented the Q3 report. Discrepancies in local procedures are identified and the Trust has started to be consistent in embedding them to bring about change. The report is seen by the board and they are able to see if individual actions have been taken, however they have not had a good way historically to see if actions are working.

19

Commissioners requested a deep dive on the SI management process within the Trust in October/November. Commissioners requested more information to understand how minor incidents are addressed and how learning is shared. Quarter 3 Complaints Report The trust presented the Q3 report. The main reason for overdue responses was a lack of timely investigation. The Trust is doing a lot of work on this, including following up overdue responses. Quarter 3 Patient Experience Report The Trust presented the Q3 report. It was highlighted that of those selecting don’t know, neither or a negative response often did this because they disputed their diagnosis. The results for the PEDIC questions show that the % that know how to make a complaint has decreased. Contact to Crisis Line had increased 7.82% from Q2, and the percentage of callers who would recommend it was 94% up 2% from Q2. Care and Treatment, Attitude/Behaviour and Communication were the subjects of most complaints. The team gives the CAGs data as information for them to produce an action plan. In future, CAGs will be asked to demonstrate what they have done about the information. Commissioners asked that the actions in response to the information should go into the deep dives by the service leads. The trust will look into the use social media and will talk to the comms team. Commissioners found the report to be helpful and appreciated the analysis of free text comments and the ‘you said, we did’ section.

20

4 CCG ASSURANCE

4.1 NHS Lambeth CCG Assurance 2016/17 Year-end assessment 2016/17 The final assessment process for 2016/17 concluded at the end of March 2017. The 2016/17 year-

end assessment for CCGs will be available on www.nhs.uk/service-search/Performance/Search from

July 2017. The assessment ratings will be based on an OFSTED style categorisation (Outstanding,

Good, Requires Improvement, and Inadequate). Methodologies that will underpin these assessments

have not yet been finalised and will be shared with CCGs once agreed. Final end of year assessment

results will be reported in July 2017.

The result will be reported to the Integrated Governance Committee in August and the Governing Board in September 2017. NHS Lambeth CCG Assurance 2017/18 NHS Lambeth CCG’s Quarter 1 2017/18 assurance meeting with NHS England took place on 22 June 2017. The meeting reviewed:

- a number of KLOEs (Key Lines of Enquiry) from the Improvement Assessment

Framework 2016/17

- a deep dive into the Maternity Clinical Priority assessment area

- Quality (patient safety and CQRGs).

- Finance – Final accounts 2016/17 performance and 2017/18 latest update

NHS England noted the CCGs comprehensive response to the KLOEs and excellent presentation on

Maternity services. NHS Lambeth CCG was praised for its 2016/17 360 degree survey results,

highlighting that the CCG was one of the few organisations to improve on their results compared to

2015/16.

http://www.nhs.uk/service-search/Performance/Search

21

5 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK

5.1 Leadership

5.1.1 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 Six risks have been added to the BAF:

o 2Q ‘Likely risk that practices do not utilise the e referral service, GSTT and Kings do not provide enough directly bookable appointment

slots and lack of available appointments on the E-Referral system results in utilisation rate of e-referrals not improving and does not

meet 80% ERS target of 80% by October 2017’

o 3O ‘There is a possible risk of challenge to the proposed development of the Living Well Network Alliance through the procurement

process and inability to agree a service and financial package with providers’.

o 5AAPCC ‘Risk that the allocation for NHS Lambeth CCG’s delegated primary care commissioning is not sufficient to meet forecast

2017/18 budgets’.

o 6Q ‘Business Continuity Management Plan Risk - London Health Resilience Partnership Risk Register lists a risk of a significant failure

of the major utility infrastructure as a medium risk. This would mean a widespread loss of the of telecoms network for over a 24 hr

period rendering the site un-usable for the duration of any interruption’.

o 6S ‘Business Continuity Management Plan Risk - London Health Resilience Partnership Risk Register lists a risk of a significant failure

of the major utility infrastructure as a medium risk resulting in a widespread loss of the water, gas, electricity for over a 24 hr period

rendering the site un-usable for the duration of any interruption’.

22

o 6T ‘Business Continuity Management Plan risk - There is a risk that staff may be targeted by internet fraudsters looking to exploit their

personal information to gain access to the secure computer servers. This could lead to a major data breach and a potential loss of

secure patient data’.

o Two risks have been removed from the BAF:

o 5YPCC ‘Risk that the CCG will be unable to conclude PMS discussions within the London timeframe’. This risk title has been revised

to include risks to implementation in October. As negotiations have been completed, the risk has been downgraded and will continue

to be managed at the Primary Care Working Group.

o 5DPCC ‘Financial risk of overspend on Minor Ailments Scheme’ This risk was downgraded as the target risk score was reached and

the list of pharmacies to recommission approved. The risk will continue to be monitored at the Primary Care Working group.

There are currently 21 risks rated 12 or above.

23

UPDATED June 2017

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Key Actions

3C

Risk to SLaM Contract –

possible risk that the

delivery of AMH redesigns

fails to reduce relapse

rates and use of beds8 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. Report to the Governing Body and LA cabinet - Jan 2017. Approval to start procurement process. Prior Information

Notice (expression of interest) has been served and in progress. Report to Governing Body and Cabinet following PIN with outcomes

and recommended next steps - May 2017.

SLaM looking to see how to reduce length of stay and understand more about those unknown to services - revised trajectory agreed

as part of contract negotiations for 2017/18.

SLaM re-organised acute service pathway - being monitored through contract monitoring and Barriers to Discharge.

3O

There is a possible risk of

challenge to the proposed

development of the Living

Well Network Alliance

through the procurement

process and inability to

agree a service and

financial package with

providers.

8 12 12

Proceed to next phase of procurement process - issue of VEAT - June 2017

Agree negotiation and financial strategy - end June 2017

Discussions with Healthwatch and other stakeholders to ensure they are involved in the process.

Discussions with GSTT Charity regarding funding for pump priming / transitional funding - July 2017

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.

Two SCR's underway jointly with Greenwich (led by Greenwich) and Bromley (led by Lambeth).

Implement subsequent SCR commissioning recommendations as required - action plan updated and being implemented.

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.

Discussed safeguarding arrangements with regards to health visiting and school nurses.

Director of

Primary Care

Development

Christine

Caton/Claire

Hornick

8D

Risk of possible failure to

plan for future premises

needs at Clapham Park

4 12 12 12 12 12 12 12

Work with NHSE to secure capital funds for Phase 1 development, following unsuccessful ETTF bid.Seeking approval for ETTF ‘soft

commitment’ into current pipeline. Awaiting final confirmation of this as well as preferred treatment of grant as tenant’s improvements

and therefore revenue neutral. Awaiting confirmation of this approach from DH/NHSE.

Outline Business Case presented to LCC on 25 May for Phase 1 funding. Awaiting confirmation of outcome.

CCG applying to LBL to secure CIL Funding for Phase 2 development linked to Clapham Park Development. This has been included

on LBL forward plan.

Work with NHSPS to agree lease for June 2017 following landlord extension.

2016 Monthly Progress 2017

ASSURANCE FRAMEWORK 2017/18 – PROGRESS

Strategic AimExecutive

Lead

Operational

Lead

Risk

Register

Ref

Corporate Objective

1.1: Quality, Safety &

Effectiveness - To

improve health

outcomes, address

inequalities and

secure a parity of

esteem

Director of

Integrated

Commissioning

Adults

Denis

O'Rourke

Target

Risk

Score

and

Direction

of Travel

Principal Risk (Obstacle

to achievement of

Strategic Aim)

Corporate Objective


Effectiveness - To

improve the quality

and safety of local

services

24

UPDATED June 2017

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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 - new Care Notes system continues to experience functional problems. Mitigation plan is set to achieve

functioning system by Summer 2017. 320 mobile working devices deployed across adults (district nursing, @home and enhanced

rapid response) and children's services with a further 100 planned for June/July. Work underway to enable access to Carenotes via

ipads.

Review of patient centred outcomes by Age UK completed. Positive outcome overall. Action plan being developed to address gaps

regarding communication when appointments are delayed and communication in the context of delivering bad news.

Wound management outcomes and palliative care being developed \as part of new service KPI's.

Test and learn model of care using Buurtzorg methodology started in November 2016 and continues for one year. More Buurtzorg

nurses are being recruited to expand into Southwark.

CCG: To continue to monitor improvement via CQRG and contract monitoring meetings. Last reviewed again in February 2017.

Additional action plan agreed between CCG and GSTFT regarding communication with General Practice.

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

Recruit designated doctor for adult safeguarding - 30/07/2017

CCG Safeguarding Adults Policy (non-commissioning), including SG Supervision Policy - 31/10/2017

Commissioned services to complete London SAB self-audit tool - ongoing.

Implement the accountability and assurance framework for safeguarding vulnerable people - ongoing.

Implement recommendations from NHSE deep dive - on-going

Influence NHSE contracts to strength safeguarding requirements - ongoing.

Consider implications of Care Plus Partnership review.

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:

Pilot of Ipad use completed with positive outcomes. Staged roll out commenced.

Continue to implement the recruitment strategy - vacancy rate is steady at 22%.

Rolling advert for DN service and inpatient units and applicants for every advert.

Test and learn model of care using Buurtzorg methodology. Went live in Nov 2016 for 1 year. More Buurtzorg nurses being recruited

to expand into Southwark.

CCG: To continue to monitor recruitment levels via CQRG, contract monitoring meetings. Last update Feb 2017.

Additional action plan agreed between CCG and GSTFT regarding communication with General Practice

Sara

White/Kelly

Hudson

2Q

Likely risk that practices

do not utilise the e referral

service, GSTT and Kings

do not provide enough

directly bookable

appointment slots and

lack of available

appointments on the E-

Referral system results in

utilisation rate of e-

referrals not improving

and does not meet 80%

ERS target of 80% by

October 2017

12

IT training plan for GP practices in progress. 3 GP Practices have been visited to offer training and an education session on ERS

processes and to look at best practice. The CCG lead for ERS is working with the CSU IT Facilitator to offer support to GP Practices

on how to resolve issues they are having with the ERS system. Training has been delivered to GP Practices. The IT Facilitator has

provided ERS update sessions. Trusts & CCG doing a stock take of issues.

The working group has established links with the Lambeth and Southwark ICT group and will provide updates to the group and

receive support to resolve issues.

An ERS working group has been established working with the ERS leads from the Trusts GSTT and KCH, the National team and the

CCG. The group will be looking at how to improve performance of ERS utilisation - Stock take being undertaken of the main issues.

Specialty focus agreed with gynae and ophthalmology the first areas of focus with the purpose being to identify common issues that

will impact on other specialties and the bigger issues that need resolving at a higher level. An action plan will be developed and taken

forward by the new ERS Steering Group.

ERS-only plan being developed with GST on a phased basis with some service potentially being booked by ERS only by Q2, to be

discussed at next ERS steering group.

Letter sent to all CEOs re ERS utilisation and ERS paper switch off programme, including that adoption is endorsed by NHSE and

NHSI. National programme launched to oversee paper switch off to be delivered through collaborative approach with NHSE, NHSI

and NHS Digital. CCG needs clear communication with practices to support change. Teleconference with Directors from each of the

5 organisations being set up to discuss system approach.


Operational

Lead

Risk

Register

Ref


Lead

Corporate Objective


Effectiveness - To

improve the quality

and safety of local

services

Director of

Integrated

Commissioning

Adults


to achievement of

Strategic Aim)


Target

Risk

Score

and

Direction

of Travel

25

UPDATED June 2017

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Key Actions

Sara

White/Kelly

Hudson

2C

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&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.

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.

All clinically appropriate patients can now be redirected from GSTT to the Lambeth Hubs, both Lambeth and non-Lambeth residents.

Waterloo Health Centre have allowed patients to be double booked allowing an increase in GP slots. Agreement made for 111 to

book Lambeth patients into the GP Hubs.

Data requirements being reviewed to establish impact of primary care hubs on A&E activity. Impact of primary care hubs on A&E

activity being reviewed. Extension of scheme into 2017/18 being considered.

Evaluation of impact of winter pressure hub extension (to non-Lambeth patients and increased twilight hours capacity) completed and

scheme continued to June 17.

GST local action plans have included increasing consultant presence in ED as well as nursing leadership and posts are currently

being recruited to.

GST re-build plans continue and are scheduled for completion Q1 2017/18. Local action plans are in place to mitigate impact of build

and performance trajectories reflect the challenge in meeting 95% until work is complete.

ECIST visit scheduled for May 2017 to assist with immediate improvements in AAU (following visit last November to ED).

Harriet

Agyepong2K

Possible risk of not

achieving the access


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 12 12 12 12 12 12 16 16 16 16 16 16

KCH has trajectories for achieving the target. GSTT has a trajectory to achieve the target for internal patients by Q2.

ACN works across South East London and achievement of performance targets is part of their remit.

Consolidated South London 62 day plan Improvement and sustainability plan submitted in April 2017 sets out high impact actions to

deliver start year trajectories - awaiting feedback from NHS England.

Harriet

Agyepong2N

Ongoing risk of not

achieving the agreed NHS

Constitution access


RTT for incomplete

pathways impacting on the

CCG Quality Premium

and Assurance

Framework

12 16 16 20 20 20 20 20 20 20 20 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.

A System Oversight Group is in place co chaired by NHSE and NHSI to oversee delivery in a number of areas including RTT.


Executive

Lead


to achievement of

Strategic Aim)

Target

Risk

Score

and

Direction

of Travel

Director of

Integrated

Commissioning

Adults

Corporate Objective

2.1: Sustainable

Delivery &

Governance - To

secure delivery of the

NHS constitutional

rights and pledges

for all Lambeth

residents

Strategic Aim


Risk

Register

Ref

Operational

Lead

26

UPDATED June 2017

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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 16 16 16 16 16 16 16 16 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 published in Oct 2016.

CCGs submitted two year Operating Plan on 27 February 2017 with further submission due on 30 March. Contracts with KCH, GSTT

and SLaM are signed.

The finance and activity impact of 2017-19 commissioning intentions at CCG and SEL level and has been built into provider

contracts.

CCG is risk assessing QIPP schemes for 2017/19 including phasing and impact and developing further options for consideration,

including use of outputs of the RightCare Programme where deliverable.

In recognition of the increased financial risk to the CCG from 2017/18, the CCG is undertaking detailed 2016/17 in-year review of all

budgets to create budget flexibility to manage risk in 2017/18 onwards and identify where costs can be reduced.

CCG is producing a Recovery Plan alongside the 2017-19 Operating Plan to help manage increasing financial risk.

Lambeth and Southwark QIPP working group is meeting to agree acute related implementation plans. Implementation plans are

being finalised.

Provider Collaborative Productivity workstream underway to support delivery of efficiency savings across SEL.

Programme delivery plans are in place to achieve our 2017/18 commissioning intentions and these have been built into our signed

contracts.

The 2017/18 financial framework and start budgets were approved by the GB on 1 March. CCGs required to hold 0.5% NR fund to

mitigate health strategies.

CCGs have been required to deliver SEL wide control total which has been reflected in the 2017-19 Operating Plan submitted on 27

February and then on 30 March. STP wide assurance discussions taking place. SEL CCGs now in Capped Expenditure Process

(CEP). CCGs are reviewing options for extending QIPP e.g. Treatment Access Policy (TAP), Continuing Health Care. NHSE

expectation of significant reduction in gap between commissioning and provider combined control total.

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 2017/18 to make sure we are in a position to meet the financial challenges that

lay ahead

The CCG is reviewing its performance reporting to improve the way in which we manage delivery as we go into 2017/18 including to

reflect the new CCG assurance framework.

The CCG has reviewed the ToR of Finance and Performance Group to operate as the executive arm of the Finance and QIPP

Working Group.

The CCG took the initial 2017-18 risk assessment to the GB in May 2017 and undertakes in year risk assessments and develops

contingency plans to deliver variances from plan - ongoing.

The overall financial framework and start budgets were approved by the GB on 1 March.

CCG is working with providers to agree robust demand management plans to address rising demand and performance delivery

issues. CCG has produced implementation plans for 2017-19 working with providers to agree and assign responsibilities for delivery.

The CCG continues to work with SLAM to understand the drivers of the underlying Mental Health QIPP position and is putting in place

a plan with to mitigate pressures on inpatient bed usage.


Risk

Register

Ref

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


to achievement of

Strategic Aim)

Target

Risk

Score

and

Direction

of Travel

Operational

Lead



Lead

27

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Key Actions

Christine Caton Andrew Parker 5AAPCC

Risk that the allocation for

NHS Lambeth CCG’s

delegated primary care

commissioning is not

sufficient to meet forecast

2017/18 budgets

9 12 12 12

Review of 2016/17 position to better understand flexibilities/pressures

Review detailed 2017/18 budgets with SEL Finance Primary Care Team - June 2017

Use of Primary Care 1% Non Recurrent funding and 0.50% contingency - ongoing

Review of CCG commissioned budgets – other non recurrent and recurrent flexibilities - ongoing

Work with NHSE Primary Care team to identify scope for budget reduction across primary care - ongoing

6Q

Business Continuity

Management Plan Risk -

significant failure of the

major utility infrastructure

as a medium risk which

would mean a widespread

loss of the telecoms

network for over a 24 hr

period.

12 12 12

Review of corporate business continuity arrangements

Review of ICT disaster recovery arrangements

Annual business continuity testing and exercising regime

Continued campaign of staff awareness to business continuity and resilience issues

Commitment to participating in appropriate multi-agency exercising

Commitment to regular review of communications procedures and details

6S

Business Continuity

Management Plan Risk -

risk of a significant failure

of the major utility

infrastructure as a medium

risk resulting in a

widespread loss of the

water, gas, electricity

12 12 12


Review of key Corporate critical supplier business continuity




Commitment to regular review of communications procedures and details

6T

Business Continuity

Management Plan risk -

risk that staff targeted by

internet fraudsters to gain

access to secure servers,

resulting in potential major

data breach/loss of secure

patient data.

9 12 12


Review of internal Information governance best practice and arrangements





Executive

Lead

Director of

Governance

and

Development

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


to achievement of

Strategic Aim)


Operational

Lead

Target

Risk

Score

and

Direction

of Travel

Strategic Aim

Risk

Register

Ref

Anne

Middleton

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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

LWN - next phase of design work commenced. Identified two key prototypes - testing local area co-ordination and integration of LWN

and CMHT. Both projects ongoing.

Review of criteria for accessing the GP Plus service - Sept 2017.

Commencing work of further integration of LWN Hub and assessment and liaison element of the CMHT - Dec 2017.

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 12 12 12

1. Action plan in place for management of procurement process for each service line (GP IT and CCG IT in progress) - transition to

NEL for GP IT/CCG IT is well underway and progressing well. Informal feedback that staff/membership recieving better support since

the transfer. A formal partnership will come into being from 01/04/2017 between SELCSU and NELCSU.

2. Begin procurement process for all other services - the CCG is working with NHS England on a timetable for full procurement. This

is still awaited.

Director of

Governance

and

Development

Una Dalton 6Y

Risk of injury to staff or

failure to comply with the

Disability Discrimination

Act due to ongoing

problems with the lifts at 1

Lower Marsh.

6 12 12 12 12 12 12

NHS Property Services to provide alternative accommodation for staff unable to use Lower Marsh in the interim period.

NHS Property Services to arrange repair of the broken lift by week commencing 23/01/2017 - completed.

Replacement of contacts and completion of tests to identify problems completed. April 2017 - lift one overhaul started with second lift

to follow.

NHS Property Services to complete an incident investigation and share outcome with CCG - update awaited.

Director of

Primary Care

Development

Christine

Caton/Claire

Hornick

8B

Risk of possible failure to

plan for future premises

needs when Lower Marsh

Lease ends 2017

4 12 12 12 12 12 12 12

NHSPS appraisal has been undertaken including a review of current and alternative sites to on appraisal and VFM.

Working closely with CSU to consider further options.

Preferred option was approved by Governing Body in April 2017. Awaiting outcome of NELCSU (majority occupant of Lower Marsh)

business case approval process via NHSE.


Corporate Objective

3.2 System

Transformation - To

ensure the CCG’s

commissioning

resource and

organisational

capability are

effectively aligned to

deliver its objectives

Target

Risk

Score

and

Direction

of Travel


Lead

Operational

Lead

Risk

Register

Ref


to achievement of

Strategic Aim)

29

5.2 Delegated Functions From the 1st of April 2017 NHS Lambeth CCG took on full delegated arrangements for Primary Care Commissioning.

5.3 Financial Management

5.3.1 Financial Position

To deliver financial control totals for resource and cash and support the delivery of

statutory financial duties for 2017/18

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 monthly drawdown.

At month 2, NHS Lambeth is reporting an in year surplus of £43k. This is in line with out plan of delivering an in year surplus of £256k.

The CCG is reporting a breakeven position for Running Costs as at month 2 and a forcasting a break even forecast outturn, living within the £22.50 per head Running Cost allowance for 2017/18.

Lambeth CCG’s cash balance at bank at the end of May was £472k. This is in line with the national target of keeping the closing cash within 1.25% of cash drawdown.

Revenue Resource Limit

Month 1 - April Changes Month 2 -

May

£'000 £'000 £'000

Issued Budgets - Programme 506,701 138 506,839

Issued Budgets - Admin (Running Cost) 7,656 0 7,656

Reserves 4,971 0 4,971

Historic Surplus - 10,523 10,523

In year Surplus - 256 256

Total Allocation 519,328 10,917 530,245

Summary of Budgets - May 2017

30

Performance Area Commentary

Month 2

Position

Revenue Surplus

Lambeth CCG is reporting an in year surplus of £43k for the first

two months of 2017/18 and is forecasting a surplus of £256k for the

year. The CCG's surplus is in line with our plan of delivering an in

year surplus target of £256k.

Cash Limit

Cash balances are planned to be maintained at low levels (less

than 1.25% at 31 May 2017). Lambeth CCG's cash balance at

bank at the end of May was £472k. 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 £14.163m.

Public Sector

Payment Policy

Public sector payment target is 95% on numbers. The CCG paid

96.12% of NHS invoices based on numbers and 99.63% by value.

Performance for the first two months for Non NHS invoices is

93.66% on numbers and 98.38% by value.

Running Cost

The CCG's running cost allowance is £7.6m. The CCG is reporting

a break even position as at month 2 and will meet its running cost

target for the year.

Key Financial Performance Duties

31

Summary Budgets – Financial Position for May 2017/18

Plan Actual Plan Actual

£'000 £'000 £'000 % £'000 £'000 £'000 % £'000 £'000

Resource Allocation

Programme Resource 85,344 85,344 0 0% 512,066 512,066 0 0% 0 0

Running Cost Resource 1,276 1,276 0 0% 7,656 7,656 0 0% 0 0

Total Resource Allocation 86,620 86,620 0 0% 519,722 519,722 0 0% 0 0

Programme Expenditure

Acute 47,775 47,911 (136) (0%) 286,650 287,466 (816) (0.28%) 950 (6,366)

Mental Health 11,751 11,751 (0) (0%) 70,507 70,507 0 0.00% 97 (350)

Community Health 3,382 3,382 (0) (0%) 20,292 20,292 0 0.00% 213 (240)

Continuing Care/Free Nursing

Care 3,347 3,463 (117) (3%) 20,080 20,780 (701) (3.49%) (51) (1,551)

Primary Care - Delegated

Budgets 9,015 9,014 0 0% 54,087 54,087 0 0.00% - (584)

Primary Care 7,301 7,308 (7) (0%) 43,806 43,842 (36) (0.08%) 490 (566)

Other Programme Costs

including Corporate 1,880 1,730 150 8% 11,280 10,385 895 7.93% 895 817

Total Programme Costs 84,450 84,560 (110) (0%) 506,701 507,359 (658) (0.13%) 2,594 (8,840)

Running Cost

Pay & Non Pay 1,276 1,276 0 0% 7,656 7,656 0 0.00% 0 0

Total Running Cost 1,276 1,276 0 0% 7,656 7,656 0 0.00% 0 0

Reserves including

contingency 894 742 152 17% 5,365 4,451 914 17.04% 914 914

Total CCG Expenditure 86,620 86,577 43 0% 519,722 519,466 256 0.05% 3,508 (7,926)

In Year Surplus - 43 43 - 256 256 3,508 (7,926)

Historic Surplus 1,754 - 1,754 100% 10,523 - 10,523 100.00% 10,523 10,523

Total CCG Expenditure 88,374 86,577 1,797 2% 530,245 519,466 10,779 2.03% 14,031 2,597

NHS LAMBETH CCG

EXECUTIVE SUMMARY - FOR THE PERIOD - APRIL TO MAY 2017

Year to Date Forecast Outturn

Best Case

Variance

Worst Case

Variance Variance ((Adv)/Fav) Variance ((Adv)/Fav)

32

QIPP Analysis By Delivery Area

In 2017/18, QIPP plans total £14,163,. The CCG is current;y fotrecasting to deliver 100% of

QIPP Plans. QIPP delivery by area is shown in the table below.

PROJECT/SCHEME

QIPP

Programme

Planned

QIPP

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

£'000 £'000 £'000 £'000 £'000 £'000

Trust Led Acute 5,075 846 846 0 100% 5,075 0 100.0%

CCG Led Acute 1,945 324 324 0 100% 1,945 0 100.0%

Mental Health 2,349 392 392 0 100% 2,349 0 100.0%

Prescribing 2,015 336 336 0 100% 2,015 0 100.0%

Community Health Contracts 975 163 163 0 100% 975 0 100.0%

Primary Care 270 45 45 0 100% 270 0 100.0%

Continuing Care Services 534 89 89 0 100% 534 0 100.0%

Running Cost Programme 126 21 21 0 100% 126 0 100.0%

Other Programmes 874 146 146 0 100% 874 0 100.0%

Total QIPP Savings 14,163 2,361 2,361 0 100% 14,163 0 100.0%

LAMBETH CCG

QIPP DELIVERY FOR THE YEAR 2017/18

Year to Date - May 2017 Forecast Outturn

33

5.4 Performance Dashboards

5.4.1 NHS England National Constitution Standards

The performance dashboard covers the National Constitution Standards and other key

measures 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 34.

34

NHS Lambeth CCG National Performance Measures for 2016/17 Outturn position

35

5.4.2 RTT (Referral to Treatment Times for Lambeth Patients)

Monthly performance figures 2016/17

Lambeth CCG Performance

Lambeth CCG did not meet the overall incomplete RTT pathway for 2016/17.

RTT performance at GSTT for Lambeth CCG was 90.3%. The main drivers behind GSTT’s RTT performance has been to the increase in referrals, internal issues with capacity, booking practices and waiting list management.

Actions Taken - GSTT

A new RRT performance management framework has been developed and the Trust performance team is currently working with individual services to review their RTT recover action plans and implement the framework.

GSTT are working with local commissioners on demand management for growth in Dermatology, ENT, Neurology, Gynaecology and Ophthalmology.

ENT commenced outsourcing in January 2017 and Orthopaedics are also expected to begin outsourcing at the end of Q1.

Actions Taken - KCH

RTT performance at KCH for Lambeth CCG was 79.4% at the end of March 2017. The main reason for this has been due to the increase in the

volume of patients, alongside the focus on treating the long waiters first.

36

Other drivers include on-going RTT pathway validation, continued focus on supporting the emergency pathway and the delayed opening of extra

beds due to staffing issues.

A revised recovery plan is being developed to address the issues highlighted in the external review undertaken by MBI.

The Integrated Contract Delivery Team are working with KCH and CCGs to assess the costs of insourcing as a means to provide additional capacity

and improve RTT performance.

5.4.3 Diagnostics (Lambeth Patients)

Monthly Performance figures 2016/17

Lambeth CCG Performance

Despite improved performance over the last few months of 2016/17 Lambeth CCG did not meet the 1% diagnostics standard.

Diagnostics performance at GSTT for Lambeth was compliant for the March 2017.

Diagnostic performance at KCH was not met for Lambeth. Underperformance was attributed to CT and MRI services being no-compliant as a result of capacity challenges.

37

Actions Taken

Outsourcing to independent providers by GSTT and KCH are helping to address this underperformance.

KCH are are also securing agency locums and reviewing booking and waiting list processes to ensure that capacity is optimised.

5.4.4 A & E Waiting Times

The national standard states that 95% of patients should be seen within four hours in an A&E department.

Monthly performance figures 2016/17

GSTT Current Performance

GSTT did not meet this target in 2016/17. The performance issues are driven by the Trust’s A&E rebuild along with significant staffing issues towards the end of the financial year. The performance trajectory for 17/18 recognises that the build will not be complete until 2018 and so does not predict meeting 95% performance until March 2018. In the meantime the trust are working with ECIST and have developed comprehensive action plans to incrementally improve performance whilst the rebuild takes place.

King’s Current Performance

KCH did not meet the A&E target in 2016/17. The current improvement is supported by an ED Recovery Plan and Regional Escalation continues into

38

2017/18 and the 2017/18 performance trajectory now predicts that trust will achieve 95% by February 2018. PRUH site is perfoming better than

Denmark Hill site and so the trust predict that Denmark Hill site will meet the target in March 2018.

5.4.5 Cancer Waiting Times

Performance across the majority of cancer waiting times standards fluctuated for most of 2016/17. The most challenging areas have been the achievement of the cancer 2 week wait and the 62 day standard for patients receiving definitive treatment. Patient choice breaches are a significant issue for the 2 week wait standard. Underperformance against the 62 day standard is often attributable to patients whose care is completed at Guy’s and St Thomas’ but who may have started care in a different referring hospital. The SE London Cancer Alliance , together with SE London Cancer Networks are working collaboratively across local clinical and managerial leaders to improve the duty of cancer standards, quality of care and cancer outcomes for the population of south east London. Performance across all of the cancer waiting times standards is expected to return to standard from 2017/18.

39

5.4.6 Ambulance Response Times

London Ambulance Service standards. All 999 calls are prioritised into one of two categories, Category A and Category C. The London Ambulance Service is performance managed against the following three Category A indicators: Category A (Red 1- most serious) calls responded within 8 minutes 75% Category A (Red 2 – serious but less urgent) calls responded within 8 minutes 75% Category A calls responded within 19 minutes 95% The London Ambulance Service has met all three response time standards, despite the challenges that have existed across the system, this is a significant improvement in performance compared to 2015/16.

5.4.7 Improved Access to Psychological Therapies (IAPT)

The standard for people with depression who are referred for and access psychological therapy is 15% for 2016/17. The CCG has performed well in this area, exceeding the target achieving 16.6%. The standard for the proportion of people who subsequently complete therapy and move to recovery is 50% and the CCG achieved 53%.

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 six weeks of referral. The target was exceeded throughout the year achieving 95% 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. Performance throughout 2016/17 has been well above 95% achieving an average of 99.9%.

5.4.8 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;

40

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.

Lambeth initially achieved the target in April (66%) but have missed it in May (33.33%) and June (16.67%). In Q2 they achieved 50%, 62.5%, and 85.7% for July, August and September respectively. For October they achieved 69.23% with this dropping in November to 43%. In December the target has been exceeded – with 75%. In Q4 the target has also been exceeded with January 54%, February 58.33% and March 60% respectively. In April 2017 the performance was 100%.

5.4.9 Dementia Diagnosis Rate

The Health and Social Care Centre (HSCIC) has now published data for Dementia Diagnosis Rate for

the year to March 2017. Lambeth is achieving 89% diagnosis rate against estimated prevalence.

Based on previously reported data NHS Lambeth CCG continues to perform highly in this area.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Early Intervention in psychosis 2 week standard

Actual Performance

Operating Standard

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% o

f E

xp

ecte

d P

rev

ale

nce w

ith

R

eco

rded

Dia

gn

osis

% Recording by GP Practice of Dementia Diagnoses against Expected Prevalence April 2015 - March 2017

41

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.

From April 2017, NHS England has changed the way it calculates the dementia prevalence. It is using

the total number of people registered on a GP Practice list as the baseline for the population of that

borough, rather than using the ONS data as it previously did. As a result of this change, the estimated

prevalence of the number of people with dementia living in Lambeth will increase by 257, from 1,534 in

October 2016 to 1,791 in April 2017. NHS England data from March 2017 shows there are 1,363 people

registered on their GP Dementia Register in Lambeth, this means that the diagnosis rate is 76% rather

than its 89% based on the ONS population data. The national target to achieve is 66.7%.

5.5 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. The Quality Premium 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. Early indications would suggest that the CCG is likely to receive a financial pay award. This would be

calculated on the achievement of both the LAS targets and prescribing targets. Final confirmation and

financial values will not be known until December 2017.

Quality Premium National Measures 2016/17 There are four national measures and in total are worth 70% of the Quality Premium

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. Ongoing education and support following this event from Macmillan GP and nurse. 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;

42

- 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% (against the target of 85%).

Lambeth CCG is currently the highest performing CCG in South East London for this

indicator. It is likely that this target will be met.

43

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)

March 2016 performance = 22%

utilisation

March 2017 requirement to meet

quality premium = 41.6%

March 2016 performance = 22% utilisation

March 2017 requirement to meet quality premium = 41.6%

Year to date position as at March 2017 – 24%

E-referral Steering Group established, reporting into the Planned Care

programme across Lambeth, Southwark and Bromley.

The targets will be more stretching in 2017-19 with the expectation for

CCGs to meet 80% in 2017/18 and 100% by 2018/19.

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. Proposals to focus on the ERS functionality for ERS.

Specialty level work commenced with a view to implementing ERS only as

far as possible for these specialties in Q1 2017/18

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 February 2017 0.759% (achieving the target)

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

44

addition to the reduction required to address increases relating to population

growth.

This figure represents a decrease of 1% of admissions in Quarter 1 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. This will

be reported in July 2017.

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.

The above data shows a decrease in emergency admissions (18.8%) from Quarter

1 to Quarter 4. Based on the data reported we are expecting to achieve this target.

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 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.

45

Latest published data shows that NHS Lambeth is above the England average and in the

lowest performance quartile nationally. However, the data above highlights a decrease in

numbers per 100 000, reporting 2647 and 2619 respectfully. This represents a 1.06%

decrease and currently meets the Quality Premium requirement. This level of performance

will need to be sustained in order to qualify for a Quality Premium award.

5.6 Quality Alerts There were 29 quality alerts reported by Lambeth GP’s and 28 by Southwark GPs in

Quarter 4 regarding Guy’s and St Thomas’ NHS Foundation Trust (GSTFT).

Chart 1 Q4 Quality Alerts regarding GSTFT by Category

Source: QUIC (Lambeth CCG) and Southwark CCG Datix

Additionally, there were 12 Quality Alerts reported by Lambeth GPs relating to KCH, two

for St George’s Hospital, one related to GP practices, one for the Lambeth Collaborative

Hub, one for a local pharmacy, one for St Mary’s Hospital and one for another community

provider. GSTFT made three quality alerts regarding three different general practices in

Lambeth.

The majority of Quality Alerts related to clinical care, communication, referrals and

appointments. Themes included the following:

- Referrals to service missed - Failure to follow up - Discharge letters/ summaries not received - Results not received - Poor communication

The most quality alerts were received in relation to District Nursing, Radiology and general

issues related to the 6 new requirements of the NHS Standards Contract.

46

Quality Alert Actions

Key learning and actions identified by GSTFT and KCH in their Quarter 4 reports in

relation to the themes are summarised below:

GSTFT District Nursing Single Point of Access processes have been reviewed by

an external party and some minor recommendations have been made. The district

nursing team are working continuously with their teams and triage nurses to stress

the need for attention to detail and appropriate action.

A patient focussed information leaflet on Fit Notes has been shared by GSTFT with

our GPs via the Connect Newsletter in April 2017. This will be displayed and will

help communicate what patient’s should expect when visiting GSTT. KCH are

working to add the Fit Note to the nursing discharge checklist across all sites as

well as in the pre-op assessment for elective patients.

The GSTFT @Home service has improved the process on the frequency of

repeating blood tests to ensure the latest result prior to discharge are reviewed and

communicated to the patient’s GP, information is communicated in the discharge

summary.

GSTFT General medicine will ensure in future that the anti-coagulation targets and

follow-up arrangements are documented on EDL. This has been discussed with the

Junior Team.

GSTFT MCATS will re-circulate exclusions and inclusion criteria for LIMS service.

The GP practice will ensure correct processes are being followed for checking

rejected referrals.

GSTFT Oncology have now configured the shared 2ww nhs.net inbox to send

automatic replies. The reply confirms that the e-mail has been received and will be

reviewed in 24 hours.

In Q4, KCH experienced issues with overlapping information on discharge

notifications making them illegible – this was a technical issue which was fully

resolved by IT as soon as this was reported and affected EDN’s were resent to

practices.

5.7 Infection Control

C.Difficile – There have been 42 cases of C.Difficile reported to date against a target of 75. The number of cases to NHS Lambeth CCG remains within the target set by NHS England. MRSA - There were 5 cases of MRSA reported in 2016/17 against a target of 0. Post infection reviews are carried out for every case. Consent to access patients notes to carry out the review is usually the cause for the delay in completing reviews within the specified timescales.

47

5.8 Mixed Sex Accommodation There have been five mixed sex accommodation breaches reported during the year so far, against a zero tolerance. All of these cases occurred in the first two quarters of 2016/17 with no further cases reported thereafter.

48

6 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES Further details on all Programme areas can be found on the internet through Programme Governance structures and meetings.

6.1 Integrated Children and Young People (including Maternity) Programme

Responsible Director Amy Buxton-Jennings, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Amy Buxton Jennings, Director, Integrated Commissioning, Children

IAF Indicators 101a, 102a, 124a, 124b, 125a, 125b, 125c

6.1.1 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 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

49

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.

6.1.2 Programme Assurance Statement Quarter 3 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


50

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 4 (January – March ):

Waiting times to EI CAMHS has been improving. The latest report

indicated that the Q3 mean waiting time is 13.55 weeks (down from 15

weeks in Q2). Our aim remains be back on track to achieve target of

11wks by end Q4. The additional funding is recurrent to add capacity to

this team. Additional capacity for NDT team is also being considered as

waiting list is higher than target.

9 providers have been commissioned through the CAMHS Transformation

Funding Programme and contracts are currently being negotiated and

put in place in preparation for the new financial year. CAMHS –

service/team reviews are taking place (5 completed and 2 more booked

in) and a report will be written May/June to inform future commissioning

and look at gaps/concerns. On-going development of tier 2/emotional

wellbeing offer working with VCS and partners.

Perinatal MH engagement work complete for Mild to Moderate levels –

report commissioned. Perinatal Strategy group begun and pathway

development work starting, with the aim to work collaboratively across

SE London.

Asthma pathway development is nearing finalisation. The GP incentive

scheme is being finalised, in conjunction with the primary Care Long

Term Conditions GP Incentive Scheme. This includes developing a

specification for Virtual Clinics. The age range has also broadened to

include 2-18yrs olds

Adolescent health pathway: we are working on developing a more

integrated model for our 5-19 services and those for vulnerable and at

risk children. We are also working on transitions, including work with

CAMHS and Transforming Care agenda (preventing young people going

into in-patient care where possible and supporting them better to come

out and back into the community).

H@H evaluation going well. Work regarding the redesign of the

Community Nursing Service with partners and providers has progressed

well and is drawing to a close, with new CCNT service due to

commence on 1st April.

Children and Young People

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On-going involvement with SEL Maternity Network, 17/18 QS priorities

agreed. GST presented maternity update to CQRG meeting.

Commissioners have set meetings with GSTT to discuss wider

transformation in the pre-birth to 5 years’ arena.

16/17 contract has been completed for Oasis, who has been

commissioned as part of our Youth Violence provision to the value of

£49,146. Multi-agency youth violence task & finish group met once to

decide on priorities. The group will support commissioning intention for

Youth Provision in 17/18. Youth Justice and Health funding received

from NHSE; scoping for liaison and diversion work is ongoing.

New Assistant Director for Children and Maternity has started. C-Section thresholds agreed for 16/17 GST and KCH contracts. Rate of C-

Sections at GSTT remains broadly constant and given the complexity of

the local population GSTT are not reporting to be significant outliers

when compared with statutory neighbours.

We are working on a programme stocktake across the remit of our Children & Maternity Programme Board. Equally we have begun work on our new Children and Young People’s Plan, and are planning to undertake widespread engagement with children, young people and families as well as key stakeholders such as Primary Care, Education, and social care colleagues.

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Key challenges to date: Completed CCG SEND self-assurance. Gaps identified that need

progressing through an action plan. Joint action plan across CCG and Local Authority will be drafted.

While LBL budget cuts continue to impact on the CCG and health of CYP, we are taking an integrated commissioning approach with our transformation planning moving into 2017/18 and beyond.

CAMHS data: while this has begun to improve, it is usually received late due to the time taken to process data for all 7 Boroughs in the SEL area. We are working with the SLAM Performance Team on this.

Transfer from RIO to Care Notes system has caused problems for GST re accuracy of data. Plans are in place around specific areas such as CCNT transfer.

Key risks 2016-17: Shortage of BCG vaccination continues. This is being progressed by

GST but remains an international issue, PHE continue to advise. Primary Care communications are in place through locality meetings.

While there is good progress with waiting times to CAMHS EI service, it remains a risk until we have reached the 10 week target.

We need to embed the Transforming Care Agenda with CAMHS to identify young people with LD at risk of becoming in-patient. There is however some joint work ongoing which is looking at the business case for a joint CAMHs caseworker.

Safeguarding children continues to be an area of risk. Lambeth SCB and partners are currently undertaking several SCRs. The LA CSC remains subject to an Ofsted inadequate judgement.

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). An action plan is being monitored.

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6.1.3 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: 12 rated Green, 12 rated amber, 3 rated red (2 no rating).

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6.2 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 / Kelly Hudson

IAF Indicators (Annex A) 105a, 122a,122b, 122c, 122d, 127c, 127a, 127d, 127c, 127d, 129a

6.2.1 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 looked 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 focused on ensuring that patients are able to access the right care at the right time when medical care is required urgently. This included 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.

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6.2.2 Programme Assurance Statement Quarter 2 2016/17



on target?

Some objectives were achieved.

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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

Key Achievements Quarter 4 (January - March) : Elective

Workstreams established under the Planned Care Board have delivered GP referral audits in order to identify opportunities for managing demand for outpatients services differently. A number of referral guidelines have been developed and are now being signed off across all 5 organisations.

Primary care communications on planned care have been streamlined and in Lambeth include a new planned care section on the GP portal on news and alternative services and a specific section in the GP bulletin for planned care

Peer review service specification as part of GP delivery framework was revised considerably following input from federations and GPs and is now in final draft. Cancer

Bowel cancer – project on increasing uptake of bowel cancer

screening by phoning non-responders now active in 12 practices;

60% of patients contacted have received verbal advice on

completing the test and of these 60% have agreed to have a

further test sent to them for completion

High level review of cancer data for Lambeth practices completed

and practices prioritised for visits by Macmillan and CRUK.

Practice visit (for cancer) framework developed to ensure

consistency of messaging.

Urgent Care

GST continues to divert Lambeth and non-Lambeth patients to the

hubs and additional work with Kings ED has resulted in increased

use of redirection from Denmark Hill.

Gracefield Gardens has closed as a WIC and is now being utilised

Elective, Urgent Care and Cancer

58

consistent communications and signposting of patients. to provide hub capacity.

NHS 111 tender process was stopped due to LAS (sole bidder)

withdrawing from the process. However, LAS confirmed their

intention to continue to work closely with us to provide a seamless

service and their contract has been extended to September 2018

to enable a new tender process to commence. Work is now being

done to engage with interested suppliers to feed into a revised

specification.

Key challenges to date:

No cancer related incentive in the GP Delivery scheme

Pace of delivery expected across planned care programme

Increasing practice use of ERS

Continued increasing activity and acuity within ED departments

Continued difficulties with achievement of RTT targets and increase in demand on outpatient services

Difficulty in reaching high utilisation of hub slots for redirected patients.

Key risks 2016-17 (each risk will continue into 2017/18):

The planned initiatives in the planned care programme may not deliver the expected outcomes for GP outpatient referrals

Limited capacity to deliver work across the project areas

Pace required to affect change in the required timescale

Ambitious targets for ERS nationally

Engagement of whole system to deliver a recovery plan for RTT and A&E performance

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SEL 111 Service update

The purpose of the following information is to provide information on SEL 111 performance for March 2017. 111 KPIs 2016/17 (Unify Sit Rep Data)

Exception Report for March 2017 Key Performance indicators were met except for the following areas:

63.4% of patients were called back within 10 minutes by an NHS 111 nurse advisor (target 100%)

7.4% of calls were asked to attend an A&E department (target of <5%)

Service Update for Impact on Urgent Care System

QR11 Attend Accident & Emergency Department, last 13 months (Data taken from LAS’s weekly UNIFY2 submissions)

There has been a steady decrease of 1.6% in Emergency Treatment Centre (ED and UCC) referrals between October and December 2016, and then a rise in January and March 2017 by 1.9%.

Values Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Offered calls 30094 24952 26825 23718 26637 24171 23589 26840 26425 32779 30715 25879 27401

Answered Calls 29586 24688 26451 23419 25971 23842 23264 26505 26029 32243 30292 25596 27151

% of calls answered within 60 seconds 93.2% 94.9% 93.6% 94.2% 90.7% 95.8% 94.8% 95.0% 93.6% 93.3% 94.5% 96.6% 97.1%

% of Abandoned calls 0.9% 0.6% 0.8% 0.6% 1.6% 0.7% 0.6% 0.4% 0.7% 0.8% 0.6% 0.4% 0.3%

% of Answered calls directed to a 111 clinician 23.3% 23.0% 23.0% 23.3% 21.3% 21.7% 21.5% 22.6% 22.7% 30.2% 31.1% 28.5% 29.4%

% of Callbacks within 10 min 60.6% 64.9% 60.1% 64.8% 56.9% 63.5% 60.9% 59.0% 55.0% 56.0% 55.4% 64.3% 63.4%

% of Answered Calls Dispatched 7.2% 7.3% 8.0% 7.8% 7.2% 8.2% 8.1% 8.1% 8.4% 7.7% 7.8% 7.2% 7.4%

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QR12 Warm Transfers & QR13 Time taken for call back The commissioners have agreed a let for QR12 and QR13, in order to allow LAS to carry out a pilot to prioritise warm transfers and call backs according to clinical need. Impact on Local Urgent and Emergency Care Services Ambulance disposition Data is based on LAS’s daily Adastra call log submissions. Final dispositions are shown as a

percentage of calls logged on Adastra, whereas the UNIFY2 data, in the table above, shows

dispositions as a percentage of all calls answered. Therefore, this data set should not be used for

benchmarking against other providers.

The graph above shows dispatches of red ambulances in March 2017, represented as 3.4%

of the total answered calls, which was slightly less than last month (February 2017). Since

September 2016 the percentage of red ambulances dispatched remained close to 3.8%,

which is also close to the average of the last nine months (3.7%).

In December 2016 the percentage of green ambulances dispatched was lower than red

ambulances; this was the first time in the last fifteen months. However, in March 2017, green

ambulance triage was 4.0%. In November and December 2016 green ambulances were

triaged 4.5% and 3.8% respectively, suggesting a downward trend. Between September and

November 2016 the percentage of green ambulances triaged remained consistently around

4.5%, which was the highest in the last fifteen months.

Overall, in March 2017 the number of total ambulances triaged was 7.6% of the total

answered calls, which is slightly higher than last month. An average the total ambulances

triaged in 2016/17 was 7.9%.

Attend Accident & Emergency Department, last 13 months (Data taken from LAS’s weekly UNIFY2 submissions)

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There has been a steady decrease of 1.6% in Emergency Treatment Centre (ED and UCC) referrals between October and December 2016 and then a rise in January 2017 by 1.02%.

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6.2.3 Integrated Adults Programme: Older Adults (including Committee in Common and joint arrangements with Lambeth Council)


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 (February - March 2017): Better Care Fund (BCF) Quarter 4 - with the exception of Delayed

Transfers of Care (DTOC), Lambeth will achieve and overperform against all other metrics.

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 has been and was ratified at call with NHSE in October. Action now completed

Data from October 2016 shows that 86.6% 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 CCG MHOA commissions have agreed bed numbers and configuration for acute care to separate out organic and functional units. Bed price not yet agreed.

Individual reassessments of day centre users continue. Expected to be completed by February 2017.

Held a very successful older People’s Alliance Contract workshop with over 50 attendees from a wide section of stakeholders.

Nurses recruited to Buurtzorg test and learn site. Due to go live in early 2017

No formal or informal suspensions on any care home for older people in Lambeth.

Older People

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Working across 4 boroughs with regard to the SLaM MHOA specialist care service redesign – each borough has slightly different demands and needs, and commonality and compromise must be agreed

Performance issues with social care providers. One care home closed at the end of August. Formal and informal suspensions all now lifted, however ongoing intensive monitoring required. Three home care agencies are currently high risk. Two are currently suspended. Market factors are having an impact on DTOC (see below)

BCF – Higher levels of DTOC than planned. A number of mitigating

projects in place for 2017/18 DTOC performance e.g. implementation

of Choice Protocol, develop Trusted Assessor role, develop

discharge to assess model for Continuing Healthcare assessments

for Lambeth and Southwark, ongoing quality and safety monitoring of

care homes, introduction of Red Bag scheme for smooth transfer of

care between hospital and care homes.

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 and impact on the rest of the system including increased DTOC

Lack of pace on implementation of new reablement model

Vacancy levels in adult community services and the impact of the

agency cap

Quality of community nursing and interface with primary care

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6.2.4 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. The 2016/17 pooled BCF fund is £23.5million.

Performance against BCF metrics for year end 2016/17 are outlined in the tables below.

1. Non-elective admissions (NEA) - Measured by the rate of non-elective admissions per 100 000 population.

Continued excellent performance against this metric with less than anticipated NEA for 2016/17.

2. Delayed Transfers of Care (DTOC) – Measured by the number of DTOC per 100 000 population for people

aged 18+. More DOTC than planned in Q 1-3, and an improving position for Q4. The overall year end position

is 8% higher than anticipated for 2016/17 and will be a major focus in the BCF Plan 2017/19 currently being

drafted.

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3. 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%. Continued excellent performance against

this metric with a higher percentage of older people still at home 91 days discharge into the reablement service.

4. 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. Continued excellent

performance shows lower than anticipated numbers of people requiring a permanent admission to a care home.

87%

88%

89%

90%

91%

92%

93%

94%

95%

96%

97%

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17

Actual

Plan

0

20

40

60

80

100

120

140

160

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17

Actual

Plan

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6.2.5 Integrated Adults Programme: Long Term Conditions and Medicines Optimisation


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 (Jan - March):

Defined Care Co-ordination Cohort recommendations collaboratively with Local Care Networks and supported the development of the care planning element

Contributed to the Medicines Optimisation theme within the Our Healthier South East London Sustainability and Transformation Plan.

Started Mental Health Virtual Clinics for cohorts of complex patients on the SMI register

Launched NHS England National Diabetes Prevention Programme (Healthier You).

100% of practices submitted National Diabetes Audit 2015-16 data by deadline

Implemented Phase 1 and 2 of the National Diabetes Prevention Programme (NDPP) where practices are referring into the programme after an NHS Health Check or opportunistically.

Successfully won NHSE National Diabetes Treatment and Care Programme bids: a) to improve uptake and provision of structured education and b) to improve achievement of the NICE treatment targets (HbA1C, BP and total cholesterol)

Agreed Community heart failure team key performance indicators and service specification

Supported the implementation of the Dawn AC Anticoagulation software yellow slip system for anticoagulation results (replacing yellow books) at GSTT

Published 2015-16 CCG Hypertension outcomes from GP Delivery Framework initiative as an example of good practice on the NICE Local Practice Collection website

Successfully won BHF Blood Pressure Award Programme bid for funding to support community approaches to the testing and detection of high blood pressure in the UK

Won the Service Redesign category in this year's PrescQIPP

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.

Innovation Awards for Lambeth CCG’s Optimising medicines for COPD and asthma – an integrated approach project

Reached agreement with KCH for extension of the IRT role to include Oxygen, Spirometry, Single Point of Referral re-designs and pathways as of 1.4.17.

Successfully held learning events on Diabetes and Respiratory

South East London Area Prescribing Committee updated guidance relating to: stroke prevention in Atrial Fibrillation; Anticoagulants in Venous Thromboembolism; Blood Glucose Control pathway; Seronegative Spondyloarthropathy pathway; shared care guidelines for use of cinacalcet; shared care guidelines for use of azathioprine and mercaptopurine for the treatment of Inflammatory Bowel Disease in adults; management of Cow's Milk Protein Allergy guidelines; heart failure management guidelines and South London Policy for Patients Self-testing International Normalised Ration (INR); adult focal epilepsy treatment pathway; share care prescribing guidelines for somatropin (growth hormone) in paediatrics; shared care prescribing guideline for attention deficit hyperactivity disorder in children, adolescents and adults; oral anticoagulant alert card (information for healthcare professionals); Guidance for the Management of Hypertriglyceridaemia; Guidance on Prescribing Statins and Lipid Management for the Primary and Secondary Prevention of Cardiovascular Disease (CVD) in Adults and developed new guidance on: sacubitral valsartan for chronic heart failure; botulinum toxin; dulaglutide and guanfacine. shared care guideline for Apomorphine for the treatment of Parkinson’s in Adults; recommendation on use of Calcipotriol/betamethasone cutaneous foam spray (Enstilar®) for the treatment of psoriasis vulgaris in adult patients; revision of recommendation on Dapagliflozin for type 2 diabetes; IBD Pathway Monitoring Framework; RA Pathway Monitoring Framework; Botulinum toxin type A injection for the treatment of refractory diabetic gastroparesis in adults; Insulin glargine 300units (Toujeo) for Type

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2 Diabetes Mellitus; Emollient Guide for adults and children including patient information leaflet and template letters; ‘ RED, AMBER, GREY list with background paper; Prescribing Query Proforma; Calculating creatinine clearance for DOACs; PCSK9 Inhibitors in hypercholesterolaemia; Management of Cows' Milk Allergy ; Alzheimer's Integrated Medication Guideline.

Saved an estimated £51,093 in Quarter 3 2016-17 from Prescribing Support Dietician implementation (cumulatively (Q1-Q3) saved £162,013.91)

Launched 2016/17 Waste Campaign

Evaluated Minor Ailments Scheme

Completed 2016/17 individual practice visits

Disseminated Quarter 1 & 2 & 3 2016-17 Medicines Optimisation Prescribing Dashboard

Completed practice achievements and payments for the medicines optimisation and Long Term Conditions Schemes 2015/16.

Publicised the European Antibiotic Awareness Campaign Met the requirements of the NHS England Quality Premium

Antimicrobial resistance (AMR) Improving antibiotic prescribing in primary care

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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 –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 12) Overall the prescribing budget was underspent at Month 12 by £1,028,591 (3.%, see finance report). The North Locality is underspent by 3.1%, the South East by 3.7% and the South West by 2.4% B. Spend per ASTRO-PU (data available quarterly)

2016/17 Spend per APU Achievement

Threshold CCG

average

No of practices achieving

threshold (out of 46)

Q1 2016/17 <£8.30 £8.03 31

Q2 2016/17 <£8.30 £7.90 34

Q3 2016/17 <£8.30 £8.03 31

Q4 2016/17 <£8.30 £7.67 33 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 0.774 0.774 0.769

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

0.768 0.769 0.764 0.767 0.759 Data not available

Co-amoxiclav, Cephalosporins & Quinolones

Target Value by end of 2016/17 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% 9.0% 8.9%

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

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8.8% 8.6% 8.4% 8.4% 8.4% Data not available

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 £47,515 £42,989 £63,890 £45,323 £63,803

£76,474 £99,714 £40,534

Actual savings OptimiseRx/Waste & deprescribing

£49,734 £46,809 £49,399 £51,703 £79,175 £80,706 £77,860 £66,435 £68,931 £69,645 £69,631 £74,070

*Total actual savings (cumulative)

£72,350 £164,778 £262,782 £360,416 £487,107 £610,802 £752,552 £864,310 £933,241 £1,143,163 £1,312,508 £1,427,912

**From November 2016, OptimiseRx reporting changed to reflect actual savings by month rather than projected

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6.2.6 Integrated Adults Programme Dashboard

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6.3 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.

6.3.1 Programme Assurance Statement as at Quarter 3



on target?

Some objectives on track, but some risks

identified.

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6.3.2 Mental Health Whole System Dashboard

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1. OBDs - These beds include Acute, Triage and PICU. 4. EIP - During March 10 people experiencing their first episode of psychosis waited for treatment with people 6 seen within 2 weeks, giving a total of 60%. Of the 4 not seen 2 people accepted and waiting F2F and 2 delayed referral from SLaM team. 6. AMHPs - In March there were a total of 107 referrals with a total of 79 assessments Of the 79 assessments 58 leading to detention, 0 leading to informal admission, 11 not leading to admission, 10 S135 warrants obtained, 2 S135 warrants executed, 9 S136 used, 3 not assessed or no bed. There were an additional 48 EDT referrals made. 8. DTOC - The DTOC figure has increased from previous months, however it is still under 7.5%. The number of lost OBDs is not currently available. 9. LWN - There were a total of 604 introductions to the hub in February with 482 closures. 10. GP+ - There are currently 145 people on the GP+ scheme, with a total of 184 people who have been on the scheme since the beginning. 11/12. Talking Therapies - SLaM is above target for numbers entering treatment, and is above the 50% recovery rate this month. 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. There is a low number of legacy moved in January due to a delay in Supported Housing Schemes becoming available. 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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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 4 (Jan - March):

“Black Thrive” is in the process of recruiting a chief officer to lead the partnership. The CCG is actively supporting BT by promoting and encouraging commissioner and provider representation on the three core working groups – prevention, access and experience.

>450 introductions per month to LWN being sustained.

IPSA activity and financial plan on target, 20% saving secured at M!2;

Formal procurement phase for Living Well Network Alliance through issuing of PIN expression of interest 8 March 2017 (closed 6 April). Following evaluation and reports to board intention is to proceed to next stage – VEAT notice.

Positive meeting with NHSE on 26 May to discuss next stage of LWNA proposals and intention to proceed to VEAT following PIN stage.

Acute pathway – barriers to discharge working group meeting fortnightly. Position for M12 and M1 17/18 has deteriorated, scrutiny taking place of slam recovery plans.


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.

OBD trajectory.

SLaM contract 17/19 negotiation.

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 – planned OBD reduction is not delivered. .

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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6.4 Learning Disability

Responsible Director To be confirmed

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Laval Lebon

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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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

Positive Behaviour Support Service – determine best funding option and agree implementation plan

Primary Care

Key achievements Quarter 4

NHS England assured the SELTCP programme. Our TCP set up, governance and plan have received positive feedback.

SELTCP appointed a voluntary sector organisation to set up and run a ‘South East London TCP Forum’ for people with lived experience, and to undertake other engagement work

The SEL TCP secured an additional £320k transformation funding bid from the NHS England investment committee. Proportion of people with a learning disability on the GP register receiving an annual health check was 71% at end of March


Our inpatient numbers are higher than they should be at this point in the three-year trajectory

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

There is uncertainty around Specialised Commissioning and we need greater understanding of the plans for Specialised Commissioning and to be more involved in shaping their development.

CTRs within 10 days of admission to an ATU, as diagnosis of LD or Autism not formerly diagnosed

Positive Behaviour Support Service - Whilst our London TCP Board recognises this as something we need across south east London, it was not possible to set this up within the first year. The differing existing provision within boroughs means that putting in place a consistent service across all of south east London is a significant change. At the moment, we don’t have the commitment or the funding to make this happen.

A consistent pathway across south east London

Key risks 2017-18:

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

Financial pressure on CCGs and local authorities – a key objective of the programme is to reduce the number of individuals in mental health hospitals and specialist learning disability/ autism assessment and treatment units. Discharging these individuals, with very complex care needs into CCG-commissioned inpatient beds (from those commissioned by NHS England) or into the community will lead to financial pressures on CCGs and councils.

The South East London TCP not meeting its inpatient trajectory for year 1 or year 3

Financial, reputational and community safety risk of moving forensic patients from out of area inpatients units to south London, as part of specialised commissioning’s New Care Models Programme.

Learning Disability

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6.5 Staying Healthy (Led by London Borough of Lambeth)

Responsible Director Ruth Hutt, 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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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 4

Balanced budget set and savings proposals determined with consultation process commenced

Public health specialist team now embedded in Lambeth local authority

New DPH in post

Links made between Health and Wellbeing Strategy and Community Plan, particularly around tackling health inequalities

Commissioning intentions communicated to key partners

Implemented agreed changes to HIV Care and Support pathways and transitional group working well

Negotiating new GUM/RSH contracts with acute providers and working with London on ensuring implementation of Integrated Sexual Health Tariff London-wide

Excellent progress with regard to recommissioning and remodelling of adolescent sexual health/substance misuse services and Staying Healthy services

New process of invoice validation agreed with primary care providers

Completed first stage of savings consultation – moving to service level consultations now


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 and challenges with ISHT implementation

Rising levels of STIs

Staffing – loss of key staff at critical times

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 clinics at the expense of those that have been redesigned locally

Staffing – loss of key staff at critical times

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 – 30% cut in funding now confirmed

Loss of specialist Public Health capacity to work effectively across the local health economy

Staying Healthy

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6.5.1 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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6.5.2 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 Frequency >>> Most Recent Data >>> Trend RAG (PHOF)

Comment

PHOF 2.04 Under 18 Conceptions

Annual 24.7 33.8 28.7 Improving Red

Latest data 2015. Continuing downward trend in u18 conceptions, despite slight increase in 2014.

PHOF 3.02 Chlamydia Diagnoses for 15 to 24

Annual 4,463 4,364 4,045 Worsening Green

Latest data 2015, no performance update since last IGC. Lambeth continues to have good chlamydia screening coverage and rate of diagnoses.

PHOF 3.04 HIV Presentations at Late Stage

Annual 35.2 30.0 23.7 Improving Green

Latest data 2013-15, no performance update since last IGC. Previously Amber, now Green. Lambeth's HIV late diagnosis rate is lower than London, England and comparable boroughs. It is also showing improving trend.

PHE % Repeat Terminations for under-25s

Annual 31.9 30.7 29.8 Improving Amber

Latest data 2015, no performance update since last IGC. Performance Red to Amber, continuing improving trend compared to national. U18 conception rates in Lambeth started to come down from 2004, which will continue to impact on repeat abortions to u25s.

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Sexual Health Frequency >>> Most Recent Data >>> Trend RAG (PHOF)

Comment

Local % Post-abortion LARC Uptake

Quarterly 31 29 29.6 N/A N/A Recommmend this indicator removed from IGC, due to changing nature of priorities and LARC delivery sites.

Substance Misuse Frequency >>> Most Recent Data >>> Trend RAG (PHOF)

Comment

PHOF 2.15i Successful Completions from Treatment (Opiates)

Quarterly 5.5 6.6 6.8 Improving Amber

Latest data Q4 2016/17. Above national average and 1 percentage point below top quartile for local comparator areas. This metric now attached to financial envelope of contract for focus on sustained improvement. Provider (Integrated Treatment Consortium) improvements through weekly team leader meetings to ensure client transfers are actioned and recorded correctly.

PHOF 2.15ii Successful Completions from Treatment (Non-opiates)

Quarterly 42 43 42 Improving Green

Latest data Q4 2016/17. 5 percentage points above national average and 3pp below top quartile for local comparator areas. Provider (ITC) have specialist leads for cannabis and crack, and protocols for non-opiate pathways (e.g. detox protocols for users of novel psychoactive substances).

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Substance Misuse Frequency >>> Most Recent Data >>> Trend RAG (PHOF)

Comment

PHOF 2.15iii Successful Completions from Treatment (Alcohol)

Quarterly 48.0 46.6 49.0 Improving Green

Latest data Q4 2016/17. 9 percentage points above national average; an area of strength for Lambeth. Provider (ITC) have care pathways for those reducing alcohol intake (psychosocial) and those seeking abstinence (detox). For abstinence, ITC have reduced waiting times for doctor appointments for quick access to detox, and encourage uptake of recovery programme earlier in treatment.

PHOF 2.16 Prison Transfers to Community Treatment

Annual N/A N/A 16.9 N/A Red Recommend this indicator removed from IGC, due to lack of confidence in new national data collation methods.

PHOF 2.18 Alcohol-related Hospital Admissions

Annual 626.0 646.0 603.0 Improving Green Latest data 2015/16

DOMES % Hepatitis B Vaccine Completions

Quarterly Recommend this indicator removed from IGC, due to no longer being a key indicator in commissioned activity.

Health Improvement Frequency >>> Most Recent Data >>> Trend RAG (PHOF)

Comment

PHOF 2.17 Recorded Diabetes

Annual 4.7 5.0 5.2 Increasing N/A

Latest data 2014/15 Indicator to be assessed as part of Public Health refresh of corporate performance reporting.

PHOF 4.04ii Mortality from Preventable CVD

Annual 50 52 55 Improving Amber

Latest data 2013-15 Indicator to be assessed as part of Public Health refresh of corporate performance reporting.

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Health Improvement Frequency >>> Most Recent Data >>> Trend RAG (PHOF)

Comment

% NHS Health Checks offered which were taken up in the quarter

Quarterly 23.1 22.6 19.6 N/A N/A Latest data Q3 2016/17 Ongoing respecification to target and motivate uptake for populations at risk

% Successful Four-Week Quitters who set a Quit Date

Quarterly 35.7 31.0 33.2 Similar N/A

Latest data Q3 2016/17 Performance continues to remain broadly similar to previous reporting periods, and LB Lambeth now embarked on re-commissioning smoking services based on agreed framework of key priority populations.

Number of Smokers Setting a Quit Date

Quarterly 762 717 725.0 Similar N/A Latest data Q3 2016/17 As above

Risk Title Risk / Opportunity Cause Effect Current Risk Score

Risk Owner

Risk Review

Public Health Budget Reductions

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

High Ruth Hutt 1/4/17: Still a significant risk.

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Risk Owner

Risk Review

Public Health Embedding Prevention

Signficant 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

Medium Michelle Binfield

1/4/17: Progress has been made but savings in specialist team will impact achievement of outcomes.

Sexual Health GUM Testing Activity Costs

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


1/4/17: Risk has been downgraded from High to Medium, due to improved prices and marginal rates through negotiation, and activity not continuing to increase.

Primary Care Activity Costs

Costs across Primary Care services are discovered to be above that forecasted and therefore outside of the financial envelope available.

Increase in and loss of control over the costs from Health Improvement activity across Primary Care.

Activity costs rise above level affordable within the Health Improvement contract

Medium David Orekoya

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Risk Owner

Risk Review

Staying Healthy Resdesign

The staying healthy re-commissioning process fails to produce the desired outcomes - namely of realising the savings by 1st April 2018 and delivering a high quality and value for money service offer for the local population.

There is the risk that re-commissioning through market testing does not prove successful in identifying appropriate providers.

Savings are not realised by April 2018. Re-commissioning does not produce the outcome of having a high quality and value for money service in place.

Medium David Orekoya

Public Health Staffing

The number of staff in Public Health teams will be reduced as staff leave and are not replaced and savings are taken

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

Medium Ruth Hutt 1/4/17: Loss of Lead Commissioner (resigned) and freezing of vacancy is creating pressure – interim solutions being sought. Senior Commissioning Officer also leaving his post at end April.

Public Health Activity Contracts

Increased activity in mandatory services results in cost pressures to be met in Public Health Grant budget

Public Health services are often statutory / mandatory, open access / demand-led, and contracted on activity.

Demand and activity rises above level affordable within limits of PH Grant, particularly after organisational savings


1/4/17: Risk is maintained but some mitigation linked to issuing of capped contract to GP Federations which minimises risk re: GPs. Activity picture for 16/17 is not yet known and delay presents risks.

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Risk Owner

Risk Review

Public Health Commissioning Consultations

Consultation on public health savings met with legal challenge

PHC Contracts subject to negotiated changes to meet organisational savings targets

Budget savings not met due to legal challenge

Low Michelle Binfield

1/4/17: Consultations being managed well. No challenge with previous round of savings. Recent consultation on 17-20 budget cuts was not challenged.

Primary Care Invoicing

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

Low David Orekoya

1/4/17: Much improved picture and steps have been taken to reduce risks

LHPP Withdrawal

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

Low Paul Steinberg

1/4/17: Two smaller boroughs pulled out but service continuing for two more years.

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6.6 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.

6.6.1 Programme Assurance Statement


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 4 (January – March):

Local Care Network (LCN) development - Agreement has been reached in principle around the cohort searches for people with 3 or more long term conditions. Outcomes have been agreed for the care coordination work. A series of workshops were held to look at the navigator/connector roles across health and care and voluntary services. There was a decision making event held on 1 March 2017 for LCN Board members around the care coordination pathway. There was a visit to Nottingham CCG to learn from their Vanguard work around integrated care for people with long term conditions. LCN Chairs were appointed for both the South West and South East and there are interim co-chairs in the North subject to further recruitment. Ethnographic engagement training and field work was completed which has generated patient stories.

A Lambeth Integrated System statement developed and agreed at the Governing Body on 18 January 2017. Next steps in development, to include invitation to partners to join an alliance leadership team.

Contracts for the Access Hubs and GP Federation Delivery Framework (to support general practice to work at scale) are being finalised for 2017/18. We held a successful joint launch of the GP Delivery Framework with the GP Federation on 18 May 2017.

Funding confirmed for 2017/18 to underpin the key areas of the GP Forward View Principles. The implementation of the resilience aspects is being driven through via Lambeth’s GP Federations and an MOU has been put in place to specify the support that will be provided to practices, utilisation of funding and reporting requirements. Assurance reporting to NHSE is on-going.

We continue to work with the GP Federations to improve the utilisation of the access hubs, which are not yet at full capacity.

Primary Care Development

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Following the decision by the GB to close the Walk-in Centre, this was officially closed on 31 March 2017. Work was undertaken with the GP Federations to agree a transition plan that placed additional and re-profiled appointments in the Gracefield Gardens Access Hub. The closure was also supported by a communications plan to raise awareness of the change and to signpost patients to alternative services.

PMS negotiations with the LMC, with GP Federations attending in an advisory capacity, commenced in December 2016 and are expected to conclude by early June 2017 with the new PMS contract to come into force on 1 October 2017. A joint LMC/CCG engagement event with Practices is scheduled for 21 June.

The GP Federations Development Framework for 2017/18 is currently being finalised.

Lambeth CCG has now moved to being fully delegated with the first meeting in public of the Primary Care Commissioning Committee Meeting held on 3 May.

Following the agreement for changes to the Minor Ailment Scheme, all pharmacies have now been advised of the PCCC decision to target the scheme to only the most deprived areas of the borough. Contracts to pharmacies who will continue provision, will initially run until 31 August 2017. The continuation of the scheme past this date is dependent on the Governing Body’s decision in July 2017 regarding the NHS Prescriptions public consultation which ends 23 June 2017.

GP IT refresh of out of warranty equipment took place during Q4. This included PCs, printers, scanners, servers and switches. The process went smoothly and all practices now have equipment that is in warranty. The future roll-outs will take place on a 5-year rolling schedule.

Clinical leadership for mental health continues to develop and supports practices. In quarter 4, the mental health clinical

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leads have been facilitating the reconciliation of the practice based SMI registers with SLaM records. Clinical information exchange of this type and scale has not been previously successful and the leads have been instrumental in ensuring practices receive, understand, process and return and submit the data and information. Annual appraisals will be conducted to review achievement and areas for development and to produce a work plan for 2017/18.

Lambeth Community Education Provider Network (CEPN) has enabled training and education for the practice nurse workforce throughout the year. Through the recruitment of a lead practice manager, the CEPN facilitated the funding of a programme of training courses for administrative staff and practice managers.

CEPN is also leading on the development of the pharmacists in general practice network.

Key challenges to date: Negotiations with the LMC regarding the PMS Premium – pause

prevented progress. Discussions now proceeding

Negotiations with the Federations over Access Hub Model. Procurement issue now overcome as no challenge to VEAT notice

SELDOC WIC contract – agreement reached with SELDOC for the continuation of the service until 31

st March 2017, which aligns with

implementation of WIC review recommendations

Fully robust budgetary/ contractual control

Key risks 2016-17: Continued poor uptake of extended access hub capacity, especially

on Sundays.

Smooth decommissioning of the Walk in Centre, with patients understanding the changes, how to access hub, to not adversely impact on their care or on A&E attendance.

Federation model doesn’t deliver the changes in primary care models. This is being mitigated through Board to Board discussions and contract meetings.

The re-structure of the Primary Care team still outstanding, leaving key posts vacant.

LCN care coordination milestones have been incorporated into the GP Delivery Framework 2017/19. Discussions on how to utilise both the GP Delivery Framework and PMS premium funding to support transformational change have started. Risks around data sharing and IT platforms to support integrated care planning.

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6.6.2 Primary Care Programme Dashboard – March 2017

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6.7 Enabler Programmes

6.7.1 Governance and Development Risk Register

For risks 6K, 6Y, 6Q, 6S & 6T 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. Undertake a Lower Marsh Communications exercise to be arranged for June 2017.

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;

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


Current Risk


noncompliance could result in the CCG in an employment tribunal or county court.

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 - amended Records Management Policy approved by IGC with clarification of EIA. Follow up with GP Practices completion of FPN actions - spot check audit of all practice websites checked. A number of practices have not put the FPN in place. IG team to write practices regarding this. Revised PIA for discussion at IGSG May 2017. Review of PIA in light of GDPR.

Risk that failure to manage and apply information security standards leading to the hacking of public internet pages and 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 - Support from new provider to be agreed as regards providing policies for adoption by the CCG. Provided by IT for IG Toolkit - to be adopted for use in the CCG. 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 discussed at Jan 2017 IGSG - Provided by IT for IG Toolkit - to be adopted for use in the CCG. More detailed report to IGSG required to include number of attempted attacks per month, how many were

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Risk Title

Risk Register


Current Risk


successful and mitigating actions taken as a result.

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

Business Continuity Management Plan Risk - Influenza type Pandemic Flu risk identified from London Health Resilience Partnership Risk Register - any widespread outbreak would result in a major loss of staff and may impact on some recovery actions.

Programme Board /

Directorate Risk

Register

9 Mitigate Review of corporate business continuity arrangements Annual business continuity testing and exercising regime Continued campaign of staff awareness to business continuity and resilience issues Commitment to participating in appropriate multi-agency exercising Commitment to regular review of communications procedures and details

Business Continuity Management Plan Risk - London Health Resilience Partnership Risk Register lists a local accident and/or terrorist incident on the local railway and/or transport network as a high risk. This could greatly impact on Lambeth CCG staffs’ ability to reach the site.

Programme Board /

Directorate Risk

Register

8 Mitigate Review of corporate business continuity arrangements Annual business continuity testing and exercising regime Continued campaign of staff awareness to business continuity and resilience issues Commitment to participating in appropriate multi-agency exercising Commitment to regular review of communications procedures and details

Business Continuity Management Plan Programme 8 Mitigate Review of corporate business continuity arrangements

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Risk Title

Risk Register


Current Risk


Risk - London Health Resilience Partnership Risk Register lists severe weather as a high risk impacting on staffing levels and could cause disruption to the transport network.

Board / Directorate

Risk Register

Annual business continuity testing and exercising regime Continued campaign of staff awareness to business continuity and resilience issues Commitment to participating in appropriate multi-agency exercising Commitment to regular review of communications procedures and details

Business Continuity Management Plan Risk - There is a risk that hackers may gain access to the CCG public internet pages and make unauthorised changes to the content. This could lead to a major data security breach and the potential for a large amount of reputational damage.

Programme Board /

Directorate Risk

Register

9 Mitigate Review of corporate business continuity arrangements Review of internal Information governance best practice and arrangement Annual business continuity testing and exercising regime Continued campaign of staff awareness to business continuity and resilience issues Commitment to participating in appropriate multi-agency exercising

Business Continuity Management Plan Risk - The CCG work and operate out of a NHS Property Services leased building. This presents a risk to the organisation if this building becomes unavailable and is not communicated to the CCG in an effective and timely manner. This could lead to greatly reduced response and recovery time frames.

Programme Board /

Directorate Risk

Register

9 Mitigate Review of corporate business continuity arrangements Review of key Corporate critical supplier business continuity and ICT disaster recovery arrangements Annual business continuity testing and exercising regime Continued campaign of staff awareness to business continuity and resilience issues Commitment to participating in appropriate multi-agency exercising Commitment to regular review of communications procedures and details

106

Risk Title

Risk Register


Current Risk


Business Continuity Management Plan Risk - Lambeth CCG procures a large amount of services from single suppliers. This poses a significant risk to operations and services if the provision of these services are affected.

Programme Board /

Directorate Risk

Register

6 Mitigate Review of corporate business continuity arrangements Review of key Corporate critical supplier business continuity and ICT disaster recovery arrangements Annual business continuity testing and exercising regime Continued campaign of staff awareness to business continuity and resilience issues Commitment to participating in appropriate multi-agency exercising Commitment to regular review of communications procedures and details

Risk of confidential information being compromised due to confidential waste bins unlocked/over filled, resulting in potential breach of Data Protection Act and financial penalties from the ICO

Programme Board /

Directorate Risk

Register

9 Mitigate Regular monitoring Ensure confidential waste issues addressed as part of negotiations should new lease be agreed Educate staff to ensure bins are only used for confidential waste

107

6.7.2 Equalities and Engagement

Responsible Director Una Dalton, Director Governance and Development

Clinical Lead Dr. Raj Mitra

Programme Lead Catherine Flynn, Engagement Manager

Purpose: To enact the Public Sector Equality Duty

108

Key aims for 2016-17: Data use

Review data requirements for 2016/17 target setting and action plans against equalities objectives

Bring equalities data focus to CQRG specs

Review opportunities with GSTT for focus in specific area – e.g. learning disabilities

Engaging diverse voices

Ensure that engagement activity is appropriately targeted at programme and corporate level

Use agreed templates for planning involvement activity to highlight equalities focus

Record equality data concerning participants in engagement activity – standard forms

Health inequalities

Ensure CCG programmes have clear and measurable equalities objectives and targets and workplans in place

Workforce

Implement WRES; equality analysis of HR policies Leadership

Ensure inclusive recruitment procedures and processes

Collect equality data on applications and appointments to governing body and senior management

Produce annual statutory compliance report(s) as required

Key Achievements to Q4 (March 2017): Equalities objectives and progress reviewed at Engagement, Equalities and

Communications Committee (Apr, Jun, Sept, Nov 2016 and Mar 2017) – detailed reports from primary care, adults programme and cyp programme boards

Clear and measurable targets set, with data sources identified for reporting; programme boards scheduling discussions and reports against their equalities objectives – gaps remain in cyp data

Data anomalies reviewed re: primary care programme’s objective on learning disability health checks – data coding issues identified and resolved – resulting in a new baseline for progress against this objective, and significant progress (from 16% baseline to 71% year-end coverage of health checks)

Equalities annual reports from GSTT, KCH and SLaM part of CQRG agendas; broader discussions with providers about bringing equalities dimension into presentations and reports on clinical agenda items more routinely

Further discussion initiated with GSTT equalities lead re: equality data in reports to CQRG and on complaints, incidents etc. (to be continued)

Learning disabilities ‘task force’ gained grip and momentum, with clinical leadership and now federation involvement; EMIS template to support management trialled and made available to all practices, revisions now in place against new codes; campaign continues with GP bulletin articles, media releases and toolkit to support practices available on GP portal

Templates in use for planning inclusive engagement at CCG level

Stage 1 equality analysis of OHSEL elective orthopaedic proposals undertaken (SEL-wide)

Pre-consultation engagement undertaken with key groups identified by equality analysis as likely to be affected by OHSEL elective orthopaedic proposals

Ongoing engagement through LCN and commisisoners with Portuguese speakers in North Lambeth - workshop with members of Portuguese-Speakers’ Community Centre on NHS 111 and procurement of integrated urgent care service – Sept 16)

Equality analysis of WIC review fed into implementation plan

Equality analyses of 3 proposals for NHS prescriptions in development at year-end to inform GB decision July 2017

Equality analysis of 2 corporate policies undertaken

Equalities

109

Workforce equalities data provided by CSU


Finalising equalities targets and workplan for children’s programme objectives

Mainstreaming approaches to equality objective-setting and reporting across all CCG programmes

Key risks 2016-17:

Compliance with Equality Act

Current incomplete reporting on programme equalities objectives (cyp)

Achievement of SMI and smoking equalities objective

110


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 Q4 (to March 2017):

Engagement objectives and progress reviewed at Engagement, Equalities and Communications Committee (Apr, Jun, Sept, Nov, March)

up-to-date induction materials continue to be in place for all staff and GB members re: legal and policy frameworks and CCG approaches; new GB lay member and new staff have had induction materials and/or meetings. Coaching support to management trainee in children’s programme on engagement in CYP Plan

input into development of national policy - work with NHS England re refreshed statutory guidance on participation and proposed participation indicator for CCG Assurance and Assessment Framework

development of participation skills for patients - involvement in NHS England PPV training

programme (x2 sessions in Lambeth) and promotion with patient groups

Briefings and face-to-face informal meetings provided for Scrutiny as required – have covered OHSEL programme, Walk in Centre, integration, STP, NHS prescription proposals and joint work with SLaM older adults, and mental health developments (SLaM); 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

Ad-hoc informal briefings with lobbying group Keep Our NHS Public (Feb 2017)

Monthly chairs meetings continue, shaping agendas for HWB; July pre-meet (open forum for public) involved workshop discussion on 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; the CCG submitted papers for the October health and Wellbeing Board on primary care co-commissioning, elective orthopaedic centre proposals and the South-east London Sustainability and Transformation Plan; the pre-meeting had a focus on children’s services in Lambeth; Feb 2017’s pre-meet focuses on alliancing. Agreement on joint plan for health and wellbeing trail at the Lambeth Country Show and extensive input from chairs into Lambeth STP ‘civic engagement’ event (planned for May/June 2017)

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; we invited people via our website (among other channels) to our event about

Engagement

111

improving GP services and co-commissioning in October; we promoted opportunities for people to get involved with Healthwatch activity, advertising trustee vacancies, promoting meetings on Black Wellbeing, and encouraging people to take Healthwatch’s survey on mental health support from GPs; we posted our film on community-based care and also advertised Lambeth Council’s consultation on public health services; we provided information and consulted on proposals for the NHS walk in centre in Streatham and for NHS prescriptions using our website and an online survey, among other routes including face to face meetings with patients and their representatives

CCG public forum well-attended with broad range of questions addressed (Jul, Sept, Nov, Jan, March 2017)

Development/delivery of engagement plans for ultrasound, GP interpreting, NHS 111,

elective orthopaedic care (OHSEL), children and young people’s emotional wellbeing

capacity-building, development of CYP Plan for Lambeth (vision and ambition) and primary

care co-commissioning; advice and guidance to consult on review of NHS walk-in centre,

NHS prescriptions and as required in other areas; discussion with long term conditions and

local care network leads on models for engagement in LCNs and care co-ordination work

Continuing funding of PPG Network to support development of patient voice into quality of

primary care and CCG commissioning and development of specification and contract for

PPG Network for 2017-18; dissemination of film to support development of PPGs

(launched at Patient Participation Awareness Week event); engagement with people with

learning disabilities to inform campaign materials to increase uptake of health checks

Our Healthier South-East London and Sustainability and Transformation Plan (STP) work across SEL; targeted engagement in line with equality analysis on elective orthopaedic care proposal development; series of workshops (x4) with Healthwatch to engage directly and inform and support HW work planning for 2016-17 and 2017-18; clinical commissioner engagement through CCG localities (elective orthopaedic care, NHS prescriptions);

Cross-programme/corporate: work with LBL colleagues on development of health trail for Lambeth Country Show, and CCG corporate and programme participation

Annual report on participation submitted to NHS England by deadline 31 October 2016 and to Governing Body 2 Nov 2016

112


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

113

6.7.3 Organisational Development


Programme Lead Lucy Day / Janie Conlin, Assistant Director Organisational Development

Governing Body Lead Adrian McLachlan

Purpose:

1. Develop CCG to best support delivery of the organisation’s priorities 2. Ensure the CCG supports staff and provides resources to enable them to carry out their work 3. Assess development needs of Governing Body to enable it to function most effectively

The below sets out the year-end achievement against the three identified priorities detailed above. Delivery is attributable to the efforts of many, not just the OD team. Further context is set out in the OD plan and 2017/18 business plan.

114

2016/17 year-end achievement

1. Develop CCG to best support delivery of the organisation’s priorities

CCG rated as good in the NHS England annual assurance process

Numerous awards and recognition for our innovative work

Programme health check process designed and conducted in Quarter 4 and informed 2017/18 business plan

De-mystifying commissioning designed and delivered to support clinical network members adopt a commissioning

perspective and to harness member engagement. 92% of participants scored course 7/10 or above and there was excellent

qualitative feedback

Approach to member practice events consciously adapted to promote mature dialogue and ownership of membership

OD plan refreshed in October 2016 informed by performance reviews, events and engagement

2. Ensure the CCG supports staff and provides resources to enable them to carry out their work

Positive staff survey results 69% of workforce recommending Lambeth as a place to work, 76% are involved in deciding

changes that affect work (average 60%) 92% confirm training helps them to stay up-to-date (average 80%) 71% have

adequate materials, supplies and equipment to do their work (71% average)

93% study leave applications for CCG staff approved in 2016/17

Range of postgraduate qualifications achieved by members of CCG staff

Outstanding energy and commitment in our all staff events – including personal pledges to address priorities emerging from

the national staff survey, for example health and well-being; which subsequently became our most significant area of

improvement in our national staff survey results on last year

Achievement of Mayor’s London Healthy Workplace Charter

Continued development of our commissioning support arrangements, including the establishment of a new ICDT team and

cross programme commissioning intentions process introduced in 2016/17

OD interventions provided to individual teams to improve effectiveness and contributing to higher levels of engagement

115

where there has been intervention (reference staff survey engagement reports)

3. Assess development needs of Governing Body to enable it to function most effectively

Individual and collective development needs sought through appraisal processes and regular dialogue, as well as review

processes e.g. programme health checks.

GB seminars, individual courses and away times have been informed by those development identified needs. This has

included a review of clinical lead responsibilities (particularly associated with programmes) and GB roles refined for 2017/18

360 stakeholder feedback indicates very positive results with 83% response rate and results are more positive on every

question compared to our own position last year

Key challenges to date Prioritising time and activity for high impact interventions over immediate deliverables Embedding new ways of working

Key risks for 2017-18 Ensuring the organisation continues to prioritise some development time and activity over immediate deliverables

Unknown impact of SEL Review

Succession planning clinical leadership

116

6.7.4 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

NHS 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.

117

Key aims for 2016 – 17:

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 4 (January – March):

Transition to the new GP IM&T Delivery Partner is now complete.

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. Digital Maturity assessments have been

completed for primary care, secondary care and mental health organisations

Progress continues towards provision of the standard of service specified in

the GP IT Operating Framework.

Orders were placed for hardware for deployment before the end of March

2017. The CCG has been awarded GPIT funding for 2017/18.

Digital Roadmap

The SEL Digital Roadmap is published on the OHSEL website at

http://www.ourhealthiersel.nhs.uk/Downloads/Strategy%20documents/20161

130-_SEL%20LDR.pdf

The Sustainability and Transformation Plan Digital Work Stream is now in

delivery mode focussing on the digital themes:

o Citizens Own Their Health And Care Records

o Digital Access to Care

o Electronic Transfer of Requests and Information

o Sharing Patient Records With Other Care Settings

o Health Records Management

o Underlying Infrastructure

Future governance for the SEL STP Digital Workstream is to be updated,

and will include information governance copnsiderations throughout.

NHS England are prioritising delivery of e-Referrals and Patient Online.

IM&T

http://www.ourhealthiersel.nhs.uk/Downloads/Strategy%20documents/20161130-_SEL%20LDR.pdf

http://www.ourhealthiersel.nhs.uk/Downloads/Strategy%20documents/20161130-_SEL%20LDR.pdf

118

- 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 NHS 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 DataNet

The Lambeth DataNet Steering Group, with representation from the 3

stakeholder organisations – NHS Lambeth CCG, London Borough of

Lambeth Public Health Department and Kings College London continues to

oversee development of Lambeth DataNet.

Lambeth DataNet has won a prestigious HSJ Value Award on 24 May for

Improving the value of Primary Care Services.

The Lambeth Datanet Access Policy has been drafted and reviewed.

Datanet User Acceptance Testing has been concluded.

The data quality testing exercise, undertaken by the Datanet Analyst Group

has also been concluded, which provides assurance that the data stored in

the datanet warehouse is accurate and robust.

Corporate Information Management & Technology

Transfer of corporate IM&T to the new Delivery Partner has happened in

parallel to that for GP IT. Work continued 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 continues to meet, with a comprehensive

agenda and good representation, including guest presenters.

119

Key outstanding issues:

GP Information Management & Technology

New GP IT service: General Practice aspirations for their IM&T

need to be defined and incorporated into a plan and programme

of work to deliver effective and efficient technology.

Primary Care Digital Maturity: Improvement in Primary Care digital

maturity will be a long-term project. Development of consistent

use of systems such as e-Referral and GP2GP across all

Practices will take effort over a number of years.

Funding: Estates and Technology Transformation Fund bids were

not successful. This has a significant impact on transformation of

Primary Care through use of technology. Alternative funding

sources are being sought.

Digital Roadmap

Once the SEL Digital Roadmap has been submitted, work will

need to begin to set up the structures and implement the

aspirations the Roadmap contains.

Work by Lambeth Programmes on delivery of the Universal

Capabilities is under way. The Universal Capabilities are based

around NHS technologies which have proved difficult to

implement. This means that long-term delivery plans are

required to ensure milestones are met and the technologies are

fully utilised.

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

Whilst some high-level work has been carried out to identify how

Lambeth DataNet can support innovation in Primary Care,

further work is required.

Key risks going into 2016-17:

GP Information Management & Technology

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.

Fundings: 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.

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.

120

6.7.5 Estates

Responsible Director Christine Caton, Chief Financial Officer

Clinical Lead Dr. Adrian McLachlan

Programme Lead (TBC) Christine Caton Chief Financial Officer

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.

121

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 review for the Akerman Health Centre to address underutilisation

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 4 (January – March):

Gracefield Gardens Estates and Technology Transformation Fund (ETTF) outline business case, which sets out the way in which Gracefield Gardens can accommodate primary care need and maximised service delivery is being completed

The Lambeth One Public Estate (OPE) submission received £275k for projects that include KCH, Ward in the community, Station Road and the Brixton Hub. The bid for the North Lambeth GP Practice relocation was considered business as usual and not funded. A revised bid for this scheme will be submitted when future OPE rounds are confirmed.

Nine Elms Vauxhall practice infrastructure funding was approved in principal by LB Lambeth from Section 106/Community Interest Levy Funding. This bid, alongside the LB Wandsworth funding proposal, was ratified at the NEV Strategy Board on 16 December. Implementation plans are being developed.

The Clapham Park Practice development outline business case was taken to the London Capital Committee (LCC) for approval on 25 May 2017. ‘Soft commitment’ funding for phase 1 has been recommended for inclusion as a Phase 1 ETTF bid. The practice lease expiry date has been extended to 29 June 2017.

The CCG has obtained a letter of support from Metropolitan Housing, providing in principle support for a payment in lieu of providing a GP Practice as part of the Clapham Park Estate development. The CCG is bidding for this as Community Interest Levy (CIL) funding through LB Lambeth Council.

Stockwell Section 106 funding request was submitted to the council for their consideration in the early part of April 2017

Three CCG practices received improvement Grants in the 2016/7 programme, Binfield Surgery, Hurley Clinic and Herne Hill Road Group practice, the total value of these bids amount to £182,710

The CCG Governing Body recommended approval of the

Estates

122

extension of the Lower Marsh lease for CCQ headquarters.

Key challenges to date: Section 106 funds are utilised to most effectively deliver estates

improvement

NEV Business case successfully awarding Lambeth with funds to

develop the affected practices

Engagement with other providers to develop co-location plans

Unsuccessful ETTF Application, plans for alternative funding

Securing a value for money rent at Lower Marsh or alternative

location

Key risks 2016-17:

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 estates within Lambeth within competing resources

Clapham Park Practice lease expiry

Lower Marsh Lease expiry

Lack of estates capacity at CCG level to support deliver of estates strategy. The CCG is currently discussing collaborative arrangements with Bromley and Greenwich CCGs.

Estates

123

6.7.6 Workforce


Clinical Lead Dr. Adrian McLachlan

Programme Lead Charles Beardsley, 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.

NHS Lambeth CCG’s Human Resources services are provided by the South East Commissioning

Support Unit and the organisation’s named Business Partner is Charles Beardsley, 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 31st March 2017 is as follows:

Staff in Post As at 31st March 2017 the CCG has a headcount of 81 and a FTE of 73.04. Over the past 12 months, there has been a general increase in staffing numbers, with an increased headcount of 8 from April 2016 to 31st March 2017.

73 74 77 73 70 73

77 76 77 78 82 81

0

10

20

30

40

50

60

70

80

90

Substantive Staff in Post (Excludes Bank, Honorary) Fte & Headcount

Headcount

Fte

124

Staff turnover

The turnover rate for March 2017 is 0%. The overview of the last 12 months is inconsistent with increases and decreases each month peaking in August 2016. Generally speaking the CCG has a higher turnover rate than the national average (which may be attributable to the London factor) although the position has improved since November 2016 with the CCG registering a zero percentage rate for the months of December 2016 to March 2017. The national CCG average rate for January 2017 was 1.73%, this is the latest data that can be retrieved from Iview.

Starters - Rolling 12 Months (Headcount & FTE)

There has been 1 starter in March 2017 and over the year, starters have been inconsistant month on month, with a peak in June 2016.

Leavers - Rolling 12 Months (Headcount & Fte)

There have been 11 leavers over the rolling year and 1 in March 2017. Each month has been quite consistant with 1 or 2 employees leaving, apart from August which saw the amount of leavers rise to 3.

Employee Relations cases

Lambeth CCG has been called to attend an employment tribunal in early May 2017 as part of a challenge associated with the recruitment and selection to a role within the CCG. Una Dalton, Director of Governance and Development can provide further information as required. There are no other cases progressing through the formal stages of a HR policy although a number of cases are being managed in line with the informal stage of a HR policy.

1 1

4

0 0

3 3 2

1 1 2

1

012345

Starters - Rolling 12 Months (Headcount and FTE)

Headcount

FTE

125

7 QUALITY ASSURANCE

7.1 PALS and Complaints Quarter 4 report

New Complaints

There were seven new complaints in this quarter. This is 40% more than the new complaints received in the same quarter of 2015-2016. In this financial year there has been a 20% increase overall in the number of complaints compared to 2015/2016. Of the new complaints received four were for the CCG to respond to, two were for other providers to respond and one was an MP enquiry for a provider to respond to.

Summary of Complaint Numbers

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Ma

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Ju

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Au

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No

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mb

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De

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mb

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Ja

nu

ary

Fe

bru

ary

Ma

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To

tal

New Complaints

2016/17

4 2 3 1 3 2 2 3 3 3 1 3 30

Complaints Closed

2 2 2 3 4 1 2 2 1 3 1 1 24

New Complaints

Quarter 1

9

Quarter 2

6

Quarter 3

8

Quarter 4

7 30

Complaints Closed

6 8 5 5 24

New Complaints

2015/16

3 1 4 2 1 4 2 2 1 0 3 2 25

Complaints Closed

5 1 4 1 2 3 3 2 1 1 0 2 25

New Complaints

Quarter 1

8

Quarter 2

7

Quarter 3

5

Quarter 4

5 8

Complaints Closed

5 3 6 3 5

New PALS

There were 15 new PALS in this quarter. This is a 35% reduction on the figures for new PALS received in the same quarter of 2015-2016. Of the new PALS cases recorded, four were for the CCG to provide a response to, four were from MPs and the CCG responded, five were for providers to action and two were from MPs for providers to respond to. Please note that the overall figure for PALS cases in this quarter also include MP related PALS cases. In this financial year there has been an 11% decrease overall in the number of PALS compared to 2015/2016.

126

Summary of PALS Numbers

Ye

ar

Ap

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Ma

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Ju

ne

Ju

ly

Au

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Se

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mb

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Oc

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No

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mb

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Ja

nu

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Fe

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Ma

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To

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New PALS

2016/17

8 7 10 3 4 4 4 1 6 6 3 6 62

PALS Closed

3 9 12 3 4 3 3 4 3 6 5 3 58

New PALS

Quarter 1

25

Quarter 2

11

Quarter 3

11

Quarter 4

15 62

PALS Closed

24 10 10 14 58

New PALS

2015/16

9 4 7 4 3 3 11 3 3 7 4 12 70

PALS Closed

12 2 9 3 3 5 7 4 4 8 10 0 67

New PALS

Quarter 1

20

Quarter 2

10

Quarter 3

17

Quarter 4

23 70

PALS Closed

23 11 15 18 67

The table below highlights whether the CCG was required to respond and also denotes how many complaints or PALS were received from MPs. Numbers Received

Qu

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CC

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rela

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nd

n

on

CC

G

rela

ted

CC

G re

late

d

No

n C

CG

rela

ted

CC

G a

nd

no

n C

CG

re

late

d

Complaint 10 8 2 19 13 3 9 15 5 4 19 1 42 55 11

MP Complaint 6 2 2 5 3 0 5 1 0 4 3 0 20 9 2

PALS 2 1 0 0 0 0 0 0 0 0 2 0 2 3 0

MP PALS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0

Total 18 11 4 24 16 3 14 16 5 8 24 1 64 67 13 4

127

The table below shows the number of complaints by trend. It should be noted some complaints could involve several of the subject areas and are noted as such. This will affect the total figures. The subject for CCG related concerns, with the most complaints in this quarter is commissioning. This is also reflected in the provider complaints. Complaint Trends

SUBJECT

Qu

arte

r

1

Qu

arte

r

2

Qu

arte

r

3

Qu

arte

r

4

To

tal

CC

G re

late

d

No

n C

CG

re

late

d

CC

G a

nd

no

n

CC

G re

late

d

CC

G re

late

d

No

n C

CG

rela

ted

CC

G a

nd

no

n

CC

G re

late

d

CC

G re

late

d

No

n C

CG

re

late

d

CC

G a

nd

no

n

CC

G re

late

d

CC

G re

late

d

No

n C

CG

rela

ted

CC

G a

nd

no

n

CC

G re

late

d

CC

G re

late

d

No

n C

CG

re

late

d

CC

G a

nd

no

n

CC

G re

late

d

ACCESS 0 1 1 4 4 0 2 3 1 1 0 0 7 8 2

CHC 8 1 1 11 3 0 5 1 4 3 1 0 28 6 5

COMMISSIONING 9 1 1 8 2 2 2 4 2 4 16 0 23 23 5

COMPLAINTS HANDLING

1 0 0 0 1 0 0 0 0 0 1 0 1 2 0

COMMUNICATION 1 1 1 1 1 0 0 2 0 0 1 0 2 5 1

ESTATES 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0

FOI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

GP 0 0 1 0 3 0 1 1 0 1 3 0 2 7 1

IFR 3 0 0 1 0 0 1 0 0 0 0 0 5 0 0

MENTAL HEALTH 3 1 1 4 1 0 0 2 0 0 1 0 7 5 1

PRESCRIBING 2 1 0 2 0 0 0 0 0 1 0 0 5 1 0

PROVIDER SERVICES

1 5 1 2 6 2 3 7 1 1 7 0 7 25 4

STAFF ATTITUDE 0 1 1 0 0 0 0 3 0 0 1 0 0 5 1

TRANSPORT 0 1 0 0 1 2 2 3 0 0 2 0 2 7 2

TREATMENT/CARE 0 1 0 1 2 0 2 4 0 1 3 0 4 10 0

Total 28 16 8 34 24 6 18 30 8 12 36 0 93 106 22

Public Health Services Ombudsman (PHSO) Decisions There is currently one case with the PHSO. The PHSO have been provided with copies of all of the case documentation and they are presently investigating. This case is about Continuing Healthcare funding. Further information will be available when the draft report by the PHSO is received.

128

7.2 Serious Incidents

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.

Incidents Requiring Investigation

In Quarter 4 2016/17 a total of 51 incidents were reported to the CCG via STEIS.

It is possible that SIs reported during this period may be de-escalated at a later date if found not

to meet the criteria following further investigation. One SI for SLaM has been de-esaclated since

it was reported. Therefore, 50 SI’s required evaluation as per Table 1.

Table 1: Q4 2016/17 Serious Incidents requiring investigation reported by provider

Provider Jan-17 Feb-17 Mar-17

GSTFT 13 8 20

KCH 1 1 3

SLaM 0 1 3 NOTE: GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust

GSTFT reported serious incident numbers are larger than KCH and SLaM as they include all

incidents. KCH SIs are only for Lambeth residents. All of the incidents reported by SLaM related

to Lambeth patients.

129

Table 2: Serious Incident categories by Provider for SI’s requiring investigation, Quarter 4 2016/17

STEIS Category GSTFT KCH SLaM

Slips/trips/falls meeting SI criteria 8 2 0

Surgical/invasive procedure incident meeting SI criteria 8 1 0

Treatment delay meeting SI criteria 7 2 0

Diagnostic incident meeting SI criteria 5 0 0

Confidential information leak/IG breach meeting SI criteria 3 0 0

Maternity/obstetric incident meeting SI criteria: baby 3 0 0

Apparent/actual/suspected self-inflicted harm meeting SI criteria 0 0 3

Environmental incident meeting SI criteria 1 0 1

Disruptive/aggressive/violent behaviour meeting SI criteria 0 0 0

Medication incident meeting SI criteria 1 0 0

Pressure ulcer meeting SI criteria 1 0 0

Sub-optimal care of the deteriorating patient meeting SI criteria 1 0 0

Pending review 2 0 0

Accident meeting SI criteria 1 0 0 NOTE: GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust; LCCG = Lambeth CCG

Of the incidents reported by GSTFT, all 41 required investigation.

The Serious Incident Framework requires that serious incident investigation reports are submitted to the

CCG within 60 working days of the incident reported on STEIS. Overall, 79% of reports from GSTFT and

25% from SLaM due for submission within the quarter were submitted on time.

The Serious Incident Framework allows the CCG twenty calendar days to evaluate a submitted serious incident investigation report. NHS Lambeth CCG evaluated 51% of submitted SI reports within the stated timeframe.

7.3 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.

One never event was reported by GSTFT in Q4. This was a wrong site surgery. 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.

130

7.4 Freedom of Information (FOI) NHS NEL Commissioning Support Unit (NEL CSU) provides a complete Freedom of Information service to NHS Lambeth CCG. This report covers requests made to CCG under the Freedom of Information Act 2000 (FOI(A)) in 2017/18 Quarter 1 to date (1 April 2017 to 30 June 2017). It also includes requests made under Environmental Information Regulations 2004 (EIR) and requests made under the Re-Use of Public Sector Information Regulation 2015 (RPSI). The number of requests received by the CCG is similar to the number of requests received by other CCGs for whom NEL CSU provides an FOI service, although at the lower end. The table below shows the number of requests received by month and by quarter for the financial year 2017/18. It also shows the number of requests received in 2016/17 for comparison. Table 1. Requests received

Total FOI Requests Received

Ye

ar

Ap

ril

Ma

y

Ju

ne

Ju

ly

Au

gu

st

Se

pte

mb

er

Oc

tob

er

No

ve

mb

er

De

ce

mb

er

Ja

nu

ary

Fe

bru

ary

Ma

rch

To

tal

37 27 19 15 26 22 14 23 19 28 25 10 265

2016/17

Quarter 1 83 Quarter 2 63 Quarter 3 56 Quarter 4 63 265

18 15 0 - - - - - - - - - 33

2017/18

Quarter 1 33 Quarter 2 - Quarter 3 - Quarter 4 - 33

*Please note that these statistics are correct as at 18 May 2017 and therefore do not provide a complete picture for the first quarter of the financial year. Performance Indicators Targets which are given within the Freedom of Information Act:

050

100150200250300350

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

ber

Oct

ob

er

No

vem

ber

De

cem

be

r

Jan

uar

y

Feb

rua

ry

Mar

ch

Accumulated Total

2013/14

2014/15

2015/16

2016/17

2017/18

0

10

20

30

40

50

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

ber

Oct

ob

er

No

vem

ber

De

cem

be

r

Jan

uar

y

Feb

rua

ry

Mar

ch

Monthly Total

2013/14

2014/15

2015/16

2016/17

2017/18

131

The FOIA states that applicants should be given a response within 20 working days. The Information Commissioner’s Office (ICO) good practice guidance suggests that at least a 90% response rate should be achieved (this threshold having been raised from 85% in March 2017). Table 2. Requests received

Compliance

Ye

ar

Ap

ril

Ma

y

Ju

ne

Ju

ly

Au

gu

st

Se

pte

mb

er

Oc

tob

er

No

ve

mb

er

De

ce

mb

er

Ja

nu

ary

Fe

bru

ary

Ma

rch

To

tal

Target 37 27 19 15 26 22 14 23 19 28 25 27 282

Compliant 37 25 18 15 24 22 14 23 19 28 25 27 277

Breached 0 2 1 0 2 0 0 0 0 0 0 0 5

% 100% 93% 95% 100% 92% 100% 100% 100% 100% 100% 100% 100% 98%

2016/17 37 27 19 15 26 22 14 23 19 28 25 27 282

Target

Q1

83

Q2

63

Q3

56

Q4

80 282

Compliant 80 61 56 80 277

Breached 3 2 0 0 5

% 96% 97% 100% 100% 98%

Target 18 15 0 - - - - - - - - - 33

Compliant 18 15 0 - - - - - - - - - 33

Breached 0 0 0 - - - - - - - - - 0

% 100% 100% - - - - - - - - - - 100%

2017/18

Target

Q1

33

Q2

-

Q3

-

Q4

- 33

Compliant 33 - - - 33

Breached 0 - - - 1

% 100% - - - 100%

Target – The total number of requests received

Compliant – The total number of requests responded to within the statutory time limit

Breached – The total number of requests not responded to within the statutory time limit

% - The percentage of the total number of request received which were responded to within the statutory time limit

The CCG has so far achieved a 100% response rate for 2017/18 Quarter 1. This is an excellent achievement which maintains the very high standard achieved in the previous two quarters and far exceeds the current good practice guidance suggested by the ICO. NEL CSU’s FOI Team continues to work hard with CCG staff to ensure the number of occasions on which the CCG are unable to respond within the 20 workings days is kept to a minimum

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