governing body meeting in public agenda question ......sel integrated governance & performance...

Chair: Dr Krishna Subbarayan Managing Director: Neil Kennett-Brown Accountable Officer: Andrew Bland

Governing Body Meeting in Public

Date: Wednesday, 11th March 2020

Time: 1330-1400 Question and Answer Session

1400 – 1630 Governing Body Meeting Part 1

Venue: The Gallery, Woolwich Centre, 35 Wellington Street, Woolwich, SE18 6HQ

Chair: Dr Krishna Subbarayan, Chair of the Governing Body

Quorum: Seven voting members including four GP members.

AGENDA

QUESTION AND ANSWER SESSION Voting members of the Governing Body will join members of the public in the audience to listen to and answer questions

Time Presented by

i 1330 Welcome Richard Rice Governing Body Lay Member

ii 1330 Questions and answers Richard Rice

PART 1

Time Item Enclosure

Presented by

STANDING ITEMS

1 1400

Welcome and introductions Chair

2 1401

Apologies for absence Dr Vivienne Chai, Maria Hawes-Gatt and Dr Iynga Vanniasegarum.

Colin Nash

3 1402

Declaration of Interest a. To note declared interests b. To add new interests c. To identify potential conflicts of

Interest with the business on the agenda

A

Chair

FOR DISCUSSION

4 1405 Commissioning update

B

Robert Shaw

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STANDING ITEMS CONTINUED

5 1430

Minutes from the meeting held on 8th January 2020

C

Chair

6 1432

Action points from the minutes

D

Chair

7 1442 Chair’s Report Verbal Chair

8 1452 Managing Director’s Report

E

Neil Kennett-Brown

PRESENTATION

9 1507 SE London CCG System Reform and Borough Based Board arrangements after 1 April 2020

F

Neil Kennett-Brown

FOR DECISION

None.

FOR ASSURANCE

10 1530 Non Acute Performance and Quality Report -March 2020

G Rena Amin

11 1545 Finance Update – Month 10

H David Maloney

ITEMS FOR REFERENCE AND INFORMATION ONLY

12 1600 Confirmed minutes from Governing Body Committees:

i. Integrated Governance 11.12.19

ii. SEL Integrated Governance & Performance 31.1.20

iii. Patient Reference Group notes 1.10.19 and 19.11.19

iv. Primary Care Commissioning 27.11.19 v. Financial Investment Committee report

Ii

Iii

Iiii&iv Iv Ivi

13 1600 Any other business

Chair

14 1615 Questions from the public on agenda business only

Chair

15 1630

Date of next meeting in public The first meeting of the SE London CCG Governing Body will be on 21st May 2020. Timings and venue to be confirmed.

Thank you and farewell to NHS Greenwich CCG Followed by some light refreshments for all who attend.

Neil Kennett-Brown

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Enclosure A

Register of interests and their management - Cumulative 2019/20 Updated: February 2020

Members of NHS Greenwich Clinical Commissioning Group Governing Body

NAME Position/Role & Interests Date of meeting

Potential or actual area where conflict could occur

Action taken to mitigate risk

Andrew Bland Accountable Officer, NHS Greenwich CCG

Accountable Officer, NHS Bexley CCG

Accountable Officer, NHS Bromley CCG

Accountable Officer, NHS Lewisham CCG

Accountable Officer, NHS Southwark CCG

Accountable Officer, NHS Lambeth CCG

SE London Integrated Care Systems Lead

Partner is an NHSE contract Manager in NW London for Primary Care

Maggie Buckell Registered Nurse on the NHS Greenwich CCG Governing Body

Registered Nurse on the NHS Tower Hamlets CCG Governing Body

Director/Company Secretary Deborah Management Ltd (Residential Property)

Dr Vivenne Chai

GP Member of the NHS Greenwich CCG Governing Body

GP St Marks Medical Centre

Honorary Research Fellow at MARCH Centre (Maternal Adolescent Reproductive and child Health) and London School of Hygiene and

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overning Body-04/03/20





Tropical Medicine

GP Appraiser NHSE

Volunteer doctor for Doctors of the World (a non-governmental organisation)

Designated Medical Practitioner (Clinical Pharmacist Educational Supervisor – De Montfort University)

Dr Anuj Chaturvedi


GP Partner Triveni PMS

CQC Specialist GP Advisor

GP Appraiser NHS England

GP working at GP Hub Greenwich

GP working as out of hours doctor for Hurley Group

GP Trainer Sidcup VTS Scheme

Medical Director Healthclic Ltd

Clinical Director Woolwich Heritage Primary Care Network

Maria Hawes-Gatt (from 11.11.19)

Acting Director of Quality and Governance

Deputy Director of Quality, Patient Experience and Performance, Bexley CCG

Amana Humayun

Vice Chair of the NHS Greenwich CCG Governing Body, Chair of the Audit Committee and Conflict of Interest Guardian

Launching a cross-civil service initiative to partner civil servants as volunteers to non-profit organisations, which may include non-profit organisations in RBG, including Metro.

Work in Civil Service, in the Ministry of Justice, Home Office and OfGem

Neil Kennett-Brown Managing Director GB (Part 2) 1.5.19

Agenda item 11, Very Senior Manger’s Remuneration

As the GB were being asked to endorse a recommendation with regard to Managing Director’s pay, Mr Kennett-Brown left the meeting for the

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discussion and vote.

Managing Director Bexley CCG

Chair of Trustees, Fellowship Afloat Charitable Trust, Tollesbury, Essex

Trustee of the NHS Greenwich Charitable Funds, Charity Commission ref 1097722

Yvonne Leese (until 8.11.19)

Deputy Managing Director and Director of Quality

Deputy Managing Director and Director of Quality Bexley CCG

David Maloney Director of Finance GB (Part 2) 1.5.19

Agenda item 11, Very Senior Manger’s Remuneration

As the GB were being asked to endorse a recommendation with regard to Director of Finance pay, Mr Maloney left the meeting for the discussion and vote.

Director of Finance for Bexley, and Lewisham CCGs

Trustee of the NHS Greenwich Charitable Funds, charity Commission ref 1097722

Member of the Lewisham CCG Governing Body and the following sub Committees - Integrated Governance, Financial Investment and Primary Care Commissioning.

In attendance at the Lewisham CCG Audit Committee.

Member of the Bexley CCG Governing Body and the following sub Committees - Integrated Governance, Clinical Strategy and Primary Care Commissioning

In attendance at the Bexley CCG Audit Committee

Sarah McClinton (from 5.11.19)

Local Authority Member on the NHS Greenwich CCG Governing Body

Virginia Morley Director of Commissioning Strategy

Director, David Tovey & Virginia

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Morley Associates Ltd

Director of Commissioning Development NHS Bexley CCG

Usman Niazi

Chief Financial Officer

Partner works for NELCSU as SEL POD Director

Dr Adebisi Olunloyo GP Member of the NHS Greenwich CCG Governing Body

Salaried GP in Greenwich at Eltham Medical Practice

GP Appraiser for NHS England

Clinical Director, Eltham Primary Care Network

Simon Pearce (until 30.9.19)

Local Authority Member on the NHS Greenwich CCG Governing Body

Director of Health and Adult and Adult Social Care, Royal borough of Greenwich

Dr Ranil Perera (until 4.9.19)


Salaried GP, Conway PMS

Occasional triage work for Bexley Health Limited who manage the RMBS

Salaried GP at Bincote Road Surgery, Enfield

GP Appraiser NHS England

Clinical Director, Riverview Primary Care Network

Dr Janakan Ratnarajan GP Member of the NHS Greenwich CCG Governing Body

GP Partner at Blackheath PMS

Blackheath PMS have a 1/9th stake in

Meridian LLP and Meridian LLP hold a 1/4

th stake in Greenwich Health

Partner is a consultant in the Integrated City Planning Department at Arup, a private company that bid for

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government contracts.

Member of London Frailty Network and lead for the identification workstream

Member of the South London RCGP Governing Board

Member of Greenwich West PCN

Richard Rice

Lay Member on the NHS Greenwich CCG Governing Body

Trustee of the NHS Greenwich Charitable Funds, charity Commission ref 1097722

Dr Sabah Salman

GP Member on the NHS Greenwich CCG Governing Body

Salaried GP at Thamesmead Medical Associates

Robert Shaw

Chief Operating Officer

Chief Operating Officer for Bexley CCG

Son’s mother is a Director of Get it Right First Time, part of NHS Improvement

Involved in fund raising for Cancer charity network (BartsHealth Charity and UCLH Charity). This involves working with a variety of NHS and private sector organisations across the UK

Dr Vijay Sivapalan (until 26.9.19 - sabbatical until 31.12.19 then resigned)

GP Member on the NHS Greenwich CCG Governing Body

GP Partner, Sherard Road Medical Centre

Co-founder and Shareholder/ Clinical lead for Healthcare app providing

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private home visits in London

Wife Is a GP Trainee at Registrar Level at the Greenwich VTS Currently working at Ferryview

Dr Krishna Subbarayan Chair and GP Member on the NHS Greenwich CCG Governing Body

GP Principal Sherard Road Medical Centre

Shareholder GPCC less than 5%

Member of Greenwich Health LLP

Dr Greg Ussher Lay Member on the NHS Greenwich CCG Governing Body

Chief Executive Officer, METRO Charity

Chair, Trustee of the NHS Greenwich Charitable Funds, Charity Commission ref 1097722

Director, Translate Consultancy

Honorary Research Fellow University of Greenwich

Member of the Labour Party

Examiner Royal Society of Public Health

Director, Healthwatch Medway

Member, Sex Education Forum

Chief Executive Officer of Greenwich Action for Voluntary Services (GAVS)

SOGI Expert, Council of Europe.

Dr Iyngaran Vanniasegarum

Secondary Care Doctor on the NHS Greenwich CCG Governing Body

Director Russets Heath Care

Dr Jaisun Vivekanandaraja


GP Partner at the Vanbrugh Group Practice

Joint Director of an IT solutions company - Client Driven Solutions UK Ltd.

Steve Whiteman Director of Public Health, Royal

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Borough of Greenwich Public Health & Wellbeing and Member of the NHS Greenwich CCG Governing Body.

In attendance Colin Nash Corporate Secretary, NHS Greenwich Clinical

Commissioning Group

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Enclosure: B

Agenda item: 4

GOVERNING BODY

Title of paper: Commissioning update. Date of meeting: 11th March 2020.

Presented by: Robert Shaw Title: Chief Operating Officer & email contact: [email protected]

Prepared by: Jayne Mason, Irene Grayson, Deane Kennett, Colette Meehan, Nazmin Mansuria

Corporate Objective addressed by this paper (please select one or more with an X):

1. To commission safe, sustainable, efficient and affordable services to meet the health and wellbeing needs of the population of Greenwich and reduce health inequalities with particular focus on:-

Prevention (Start Well, Live Well), Mental Health, Frailty and Cancer;

x

2. To ensure the CCG’s position recovers to meet its financial and governance duties and performance standards;

x

3. To support the transformation of primary care to be resilient and thrive; x

4. To strengthen productive relationships with partners and the public to work as an integrated health and care system;

x

5. To actively engage with our communities to improve their experience of healthcare;

x

6. To play an active and influential role in shaping SE London and London wide commissioning.

x

Purpose of the report: The purpose of the report is to inform the Governing Body of the achievements in Commissioning over the last year before we transition into our new SEL CCG. Summary of actions, if any, following this meeting:

The Governing Body are asked to accept and support the summary provided in this paper.

Previous committee involvement: N/A

Recommendations to the Governing Body; The Governing Body are asked to accept and support the summary provided in this paper.

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Tab 2 200311 B Commissioning Update


(Please provide details below where Yes is indicated )

Impact on Governing Body Assurance Framework (x) Yes No N/A

Impact on Environment (x) Yes No N/A

Legal Implications (x) Yes No N/A

Resource and or financial implications (x) Yes No N/A

Equality impact assessment (x) Yes No N/A

Privacy impact assessment (x) Yes No N/A

Impact on current NHS Outcomes Framework areas (x) Yes No N/A

Patient and Public Involvement (x) Yes No N/A

Communications and Engagement (x) Yes No N/A

Impact on CCG Constitution (x) Yes No N/A

Attachments:

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1. Purpose of this paper

The purpose of this paper is to provide Greenwich CCG’s Governing Body with a summary of progress over the last year before we transition into SEL CCG. I would like to take the opportunity to acknowledge and thank the commissioning team within our CCG for all their work over the last year in delivering our achievements.

2. Unplanned Care

Joint Emergency Team plus (JET+) pathway – Multi-partner work is on-going to develop urgent step-up and early support discharge step-down support for patients in their own home. During the final quarter of 19/20, the service will bolster acute assessment skills and put in place enhanced nurse / therapy-led pathways. The service has launched a single point of access for all urgent community response services. We are in discussion with Oxleas and LGT regarding options to provide the medical staffing needed to expand the team further. The ED front door navigator nurse has been recruited and will be in post from 11th March. This will start to lay the foundations for the Home as a Priority (HaaP) initiative that we are now starting in Greenwich. An enhanced therapy model in Emergency Department (ED) was commissioned as a pilot in November 2019 to extend the therapy support for admission avoidance at QEH. The team’s evaluation demonstrates a saving of 100 admissions a month as a direct result of this intervention, with an increase in the number of direct referrals from ED to community teams. A Take home and Settle service was commissioned from Age UK to support the timely discharge of vulnerable patients from QEH. The service currently provides transport and settles around 50 vulnerable patients at home each month. Working with colleagues from the UCC and LGT, commissioners are supporting the development of a new streaming process and Same Day Emergency Care model at QEH, with a view to reducing the number of patients requiring emergency care and increasing the number receiving same day ambulatory care. Work has been undertaken to close the gap between current service provision and that expected by the Enhanced Health in Care Homes framework (EHCH). A gap analysis by key stakeholders identified the following priority areas that have been funded jointly by the CCG and RBG through BCF liquidity money for 2019/20:

Clinical training programme for care home staff to include key elements SALT / Hydration / Dysphagia / Medication side effects / First aid / wound management / Nutrition / Falls

Mental health crisis support for care home residents

Wider clinical support including end of life, tissue viability, podiatry, pharmacy, dietetics, diabetic specialist, dementia, Parkinson’s specialists for care home residents

Reablement through occupational therapist and physiotherapist End of Life:

Two Greenwich End of life events were held for Primary Care have been hugely successful and well attended. These brought together interested colleagues to share learning and hear from experts in the field including the London EOL Clinical Lead introducing the new GP QOF End of Life scheme and supporting toolkit, Director of Nursing from CMC to relaunch Co-ordinate My Care (CMC) in Greenwich, Hospice Consultant to discuss end of life prescribing.

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Hosted “Difficult conversations” training together with colleagues from across Bexley and Lewisham for our GP colleagues.

Introduced an incentive scheme for GPs who work with their patients to create anticipatory care plans that are shared with all local provider organisations via Co-ordinate My Care (CMC). It is a headlines and highlights summary, about patient needs and wishes, and makes these plans available to organisations who may only occasionally care for the patient and typically know nothing about them. Where Greenwich CCG patients have a CMC record, 19% die in hospital, compared to a national figure of 47% dying in hospital. Our aspiration is to achieve a rapid increase in the number of CMC records completed for Greenwich patients from a current level of ~50 per year to over 800 per year. At the current point in time we have had more CMC records created in the six months since the launch of the CMC incentive scheme than in the previous two years and there are currently 560 Greenwich patients with CMC records.

Commissioning of wheelchair service from Inspire Health in line with Bexley CCG Commissioning of seven day dressings service from Greenwich Health at four hub locations across Greenwich As part of the respiratory improvement plan we commissioned Chronic Obstructive Pulmonary Disease (COPD) diagnostic hubs and introduced the “MyCOPD” app for COPD patients. Further developments to come include consultant led virtual MDT outreach clinics to be held in GP practices to up skill primary care and commissioning of asthma action plan reviews by community pharmacists.

Commenced the re procurement of the Urgent Care Centre into Urgent Treatment Centres (UTCs) and Out of Hours services in partnership with Bexley Clinical Commissioning Group.

3. Primary Care

It has been a busy year for Primary Care in Greenwich with the commissioning of a new model of

care for Nursing Home support, the opening of 2 new Access Hubs covering Greenwich and

Charlton, introduction of the new Primary Care Network Contract, completing a 3 way GP practice

merger in Eltham, increasing the use of technology and progressing on improving estates.

We commissioned Malling Health Ltd (who provide GP services from the Clover practice in

Woolwich) to pilot a new model of care to 11 Nursing Homes across Greenwich. Historically GPs

from individual practices would provide sessional visits into the nursing homes. The new model

provides a multi-disciplinary team, consisting of GPs, Paramedics and a nurse going into the homes

to provide a proactive and re-active service to help reduce unnecessary transfers of elderly patients

into hospital and provide better support to both patients and staff within these homes. The pilot is

being monitored jointly between the CCG and Royal Borough of Greenwich.

Building resilience in General Practice is a key priority in Greenwich and is embedded in the CCG’s

Clinical Strategy 2018-2022. There is national recognition that small single handed practices are no

longer sustainable in managing the demand now being experienced. The CCG’s primary care team

actively work to support all our GP practices, and regularly review quality, performance and support

improvement, and we work informally with practices, and utilise formal contractual levers where

appropriate

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In November 2019 the Primary Care Commissioning Committee received a Business Case

for Eltham Park Surgery and Westmount Road Surgery in Eltham to merge with Eltham

Medical Practice. The business case was approved subject to certain conditions relating to

ensuring enough capacity would be in place to manage the increased list size of Eltham

Medical Practice from circa 17,000 to 24,500 patients. This merger enabled the single

handed GP partner from Eltham Park to take retirement and the single handed GP partner

from Westmount Road to become a salaried GP and reduce her clinical sessions. The

Eltham Park surgery premises have remained open to become a branch surgery of Eltham

Medical Practice so there is less disruption for patients. It is envisaged that more small

practices will adopt this approach in order to be able to continue to deliver good quality

primary care services.

On the 4th February 2020, the sole contractor of Briset Corner Surgery (list size 2,290 which

is the smallest practice in Greenwich) tendered his resignation notice to commissioners,

stating his intent to retire and to stop providing primary medical services from 31st March

2020. In 22nd May 2019 the CQC carried out an announced comprehensive inspection and

was rated ‘Requires Improvement’ for the quality of care. The practice was unable to provide

an action plan with the appropriate assurance against the domains highlighted. At Primary

Care Committee it was agreed to disperse the list. A capacity audit was carried out which

showed that there are 7 practices within a 1 mile radius of Briset Corner which share the

same or similar catchment area and all practices had capacity to take additional patients.

All seven practices have an overall CQC rating of ‘Good’.

A letter to patients informing them of the practice closure and information on local practices

and how to register was received by patients at the end of February 2020 – this was the

earliest this could be organised, and posters are on display in the surgery. Two patient

engagement events have been organised for the evening of 10 March and lunch time on 12

March at the surgery with the aim of providing support to patients in registering with a GP.

Due to the extremely tight timeframe in closing down the practice, the CCG has put

additional administrative resource into the practice to ensure the close down procedure is

completed effectively. In recognition that local practices will be asked to register patients

who live within their catchment area over a foreshortened period, the CCG will offer short-

term financial support of £20 per registered patient to Greenwich practices that are prepared

to increase their patient registered list by more than 1%.

Last summer there was public consultation with regard to access to primary care services for the

community in Horne Park Estate on the Eltham and Lewisham boarder. It was agreed to re-open the

facility which was previously known as ‘The Source’ to provide a nurse led Live Well service over 2

days as a pilot for 6 months. This has been a collaborative piece of work between the primary care

team and RBG and Charlton Athletic Community Trust. This would give patients access to live well

coach and wider Live Well services for this community. Greenwich Health have also been

interviewing for the nurse led sessions. We aim to open the service in April.

Use of technology: We are in the process of rolling out e-Consult to our 33 Practices which will be concluded by the end

of March 2020. This will allow all Practices to be able to offer electronic e-mail consultations to their

patients by April 2020. Patients will continue to book on line for face to face appointments and

order prescriptions, using the MyGP App, NHS App or the Patient Access App, but will also be able

to choose to have an e-mail consultation or choose to request a sick note, letter or other

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administrative service without having to go into the surgery. April 2021 should see Video

consultations added to this list of services. This programme of work is to support primary care in

meeting new national mandatory requirements from April 2020. Four Greenwich practices have had

all their patient records digitalised which has freed up valuable room within the practices.

Surgeries in Greenwich are part of an on-going programme to have their N3 Internet cables

upgraded as part of the National Health and Social Care Network Programme, which will allow

Surgeries to have faster and safer access to patient records and referral services during

consultations., This will also support their ability to offer e-mail consultations by April 2020 and

Video consultations by April 2021

Estates: We made significant progress in two of our major strategic developments, the re-design of Gallions

Reach Health Centre in Thamesmead and the new Kidbrooke Health and Wellbeing Centre.

Construction work on-site at Gallions is now expected to begin in summer 2020, with a completion

date in spring 2021. The Kidbrooke development has taken shape in collaboration with the Royal

Borough of Greenwich and an integrated model for health and the community is central to the

design.

The Local Estates Forum (LEF) scrutinises progress of these developments and a pipeline of new

proposals for re-developing Plumstead Health Centre and making more efficient use of some of our

more modern health facilities like Garland Road Medical Centre, Plumstead and Millennium Health

Centres and Greenwich Peninsula. The Forum includes Royal Borough of Greenwich planning and

the London-wide Healthy Urban Development Unit in assessing premises needs for health in the

longer-term, with a focus on areas of the borough with a concentration of new, and planned,

residential developments, such as Greenwich Peninsula, Central Woolwich and Charlton Riverside.

Access:

There are now 4 locations where patients can access primary care through the extended GP Access

Hubs between 4pm-8pm Monday to Friday and 8am-8pm weekends. Opening 2 new sites ensures

equity of access for patients across Greenwich. The four sites are Eltham Community Hospital,

Thamesmead Health Centre, Burney Street Practice Greenwich and Fairfield Health Centre

Charlton. In additional to GP services, the access hubs also offer a Nurse led Dressing Clinic to

support patients who require daily dressings and therefore negate the need for patients attending

hospital for this service at weekends.

GP contract:

NHS England and NHS Improvement and the BMA have agreed and published jointly an update to

the GP contract agreement 2020/21 to 2023/24. The main features of the new agreement include:

Major enhancements to the additional roles reimbursement scheme to help secure 26,000 additional practice staff

A raft of measures to aid GP recruitment and retention to help deliver 6,000 more doctors working in primary care

Improvements in access for patients: more people working in general practice will help achieve 50 million more appointments in general practice

Further improvements to the Quality and Outcomes Framework Reforms to vaccination and immunization arrangements to improve vaccination coverage A new, universal six to eight-week, post-natal check for new mothers Three new services in 2020/21: structured medication review and medicines optimisation;

enhanced health in care homes; and supporting early cancer diagnosis New incentives under the Investment and Impact Fund to increase uptake of learning

disability health checks, seasonal flu jabs, social prescribing referrals and improve specific aspects of prescribing

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The CCG’s primary care team is helping to ensure Greenwich GP practices are aware of these

changes.

GP network development:

The requirements in the NHS Long Term plan is very much about breaking down barriers between

providers and providing a more seamless service to patients. The Plan sets out the case for

enhanced primary and community care services with significant investment into primary care to

support the development of new primary care networks covering populations between 30-50,000

people. To underpin this change, in July 2019 the new national 5 year Primary Care Network

Contract (PCN) went live. We now have 6 PCNs covering all the GP registered population of

Greenwich. Each PCN elected a GP Clinical Director who takes leadership responsibility for

developing their network to focus on the health and wellbeing of their population. Funding has been

made available nationally to support this development and the CCG is providing bespoke support

within this area along with facilitated workshops to start developing relationships between primary

care, acute and community care providers, local authority and the voluntary sector who are key to

the PCN development. As part of this new contract, additional new roles are being funded to

support the workforce in general practice. These new roles are Clinical Pharmacists; Social

Prescribers; Physiotherapists; Physician Associates and Paramedics. We have already rolled out

social prescribers to each PCN who are contracted as part of the Live Well Greenwich programme

managed by Royal Borough of Greenwich Public Health and our PCNs are in the process of

recruiting clinical pharmacists jointly with LGT.

As part of the national PCN development programme, A PCN in Greenwich is participating in NHS

England’s Population Health Development Program which is a 20 week intensive programme in the

use of Public Health Management techniques to enable PCNs to understand their local population

and co-design services to meet their needs.

4. System and Organisational Development

We started our journey to create our System and Organisational Development capability. We

developed and achieved support from Greenwich Healthier Alliance in February. This builds on the

work, advised in November Governing Body following further focused individual stakeholder

sessions.

We have invested Organisational Development (OD) into our Primary Care Networks to help them

develop into their new roles.

5. Mental Health and Learning disabilities

Establishing a MH/LD team: One of our greatest achievements has been the establishment of the CCG’s Mental Health & Learning Disability team. At the start of 2018/19 both Children’s and Adult MH commissioners left the CCG leaving a significant gap in capacity. Since then we have successfully recruited and built a strong and capable team with a varied clinical skill mix.

Engagement: The Mental Health & Learning Disability Commissioning Team includes a Lived Experience team member whose outstanding work undertaken in collaboration with the CCG’s Communications and Engagement team, has led to them being approached to present at national webinars on

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Greenwich's outstanding practice for engagement. We had the opportunity to share our best practice with other CCGs as part of the national improvement support offer from NHSE. As a CCG we are delighted that Greenwich is on the map as a national exemplar in both areas now.

Learning Disabilities: At the beginning of the Transforming Care Programme (TCP) in 2016, the CCG had 13 people in a mental health hospital or Assessment and Treatment Unit. The CCG has managed to reduce the original 13 down to 0 through joint working with Community Learning Disability Team (CLDT), providers and the Royal Borough of Greenwich (RBG) commissioning team.

Adult Mental Health:

The key achievements as a result of initiatives developed using Mental Health Investment

Standards and Transformation funding in 2019/20 were as follows:

LAS Paramedic Car - Oxleas piloted an initiative with LAS that was so successful it is being

rolled out across London from January 2020 – mental health nurses and paramedic, working

together to triage whether person requires conveyance to ED.

MET Police MH Car - mental health nurses working with the police.

Home Treatment Team Support Vehicle – allows quicker response times to reaching vulnerable

people.

Peer Support in ED – ‘lived experience practitioners’ working alongside ED and liaison staff to

support person through ED.

In addition to the above Greenwich CCG continued to achieve and maintain one of the highest recovery rates in the country for people accessing IAPT services (57% against a 50% national target) as well as decreasing the Adult ASD waiting list from 50+ months to 17 months, which is a positive improvement in what is around 8 months of increased capacity, with further reductions expected in following months.

One of the key developments in 2019/20 was the start of discussions between Greenwich CCG and

RBG on exploring an alliance model to improve outcomes for the mental health and wellbeing in

Adults. A Mental Health Alliance Project Manager started in November 2019. In January 2020 the

inaugural Greenwich Mental Health Alliance Board (GMHAB) was convened. The GMHAB was well

attended and widely accepted as a great start to shaping our alliance approach for mental health in

the borough.

This is an exciting opportunity for the borough and the hope is that this work will initially focus on the

cohort of working age adults in residential and supported living placements. The Alliance project will

also review and make recommendations, working with Housing and the Voluntary and Community

Sector, to help keep people living independently. The Alliance will also seek to create a more

seamless service provision for service users, families and carers.

6. Children and Young People Asthma Care Plans:

In September 2019, Greenwich CCG developed an initiative to work with Pharmacies to complete

Asthma action plans through Greenwich Respiratory Improvement Collaborative.

Greenwich Respiratory Improvement Collaborative will target patients with asthma, COPD and ACO

within Greenwich CCG area over a period of 24 months. The service involves an initial structured

review and a follow up 6-8 weeks later if required with a suitably competent pharmacist / pharmacist

technician.

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This collaborative working project is likely to help ensure that patients and the NHS get better value

from the investment in medicines through objectives listed below:

Inhaler technique and assessment training for healthcare professionals and signed off as

competent

Structured reviews in line with national guidelines by the pharmacist

Patient centred inhaler technique assessment,

Optimisation of inhaled therapy by monitoring inhaled therapy usage and

Agreement of individualised management plan

Respite Provision:

On 30th November 2019 Oxleas NHS foundation trust executed the closure of Bluebell Respite Unit

in Wensley Close . This decision followed significant challenges with the continuation of the service

as a weekend only provision. As a result, a consultation was undertaken with families to inform the

re-shaping of the CCG respite offer in order to best meet the needs of children impacted.

Greenwich CCG will work with partners and families to co-design and co-produce a flexible offer of

support to better meet the children and young people and their family’s needs proving a more

personalised offer.

Children’s & Young People’s Palliative and End of Life Care Services:

Greenwich CCG has been successful in securing 4 year funding of £73,000 support and improve

provision for Children’s End of life care services. The CCG has worked closely with Demelza the

local hospice in partnership with clinical provider Oxleas Community Nursing Team to develop an

outreach service in the community to provide palliative care in the child’s own home.

Supporting the aims of the NHS Long Term Plan to boost “out of hospital” care, and reduce

pressure on emergency hospital services, the project will work towards the recommendations of the

NICE Guidance on end of life care for babies, children and young people.

Personal Health Budgets:

The NHS Long Term Plan sets out the requirement to accelerate the roll out of Personal Health

Budgets, enabling greater choice and control over planning and delivery of care. This development

mirrors other changes within the NHS, including the drive for shared decision-making and innovation

in the management of funds. Children’s Continuing Care Team have increased uptake for Personal

Health Budgets by 50% in comparison to the previous year.

Children and Young People Mental Health (including Child & Adolescent mental health

services (CAMHS)):

The NHS Long Term Plan has re-enforced the continued national commitments for CYP mental

health. We are currently implementing the NHSE Trailblazer pilot following a successful bid for

funding in 2019, this will increase the prevention and early intervention mental health support for

children and young people in a number of the Schools in Greenwich, through the introduction of

Mental Health Support Teams in Schools.

Alongside this we are undertaking the Anna Freud Link Programme to give all our schools and

colleges the confidence to identify children and young people in need of mental health support and

ensure professionals across the system are working together effectively.

We are successfully achieving the national Access Rate targets for CYP mental health, working

closely across STP to ensure we meet future targets. The digital mental health offer for young

people has been strengthened through the successful piloting of Kooth, an online counselling and

resource platform. There has been a high rate of access from the young people in Greenwich,

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https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

alongside other South East London boroughs. Commissioning of this service will continue across

SEL.

Perinatal Mental Health:

The CCG in partnership with Oxleas NHS Foundation Trust, Bexley CCG, and Bromley CCG

successfully bid for funding from the Perinatal Development Fund to set up a perinatal mental health

service. This service went live in February 2019 and is delivering a trust-wide specialist perinatal

community service with a hub and spoke model.

7. QIPP QIPP delivery remains on track with yearend forecast for 2019_2020. I would like to thank the Bexley Greenwich and Lewisham team for their support in delivering our QIPP. We are continuing to work with South East London colleagues in delivery of system development and transformational change in 2020_2021 and beyond.

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Enclosure C

DRAFT MINUTES OF THE GOVERNING BODY (BUSINESS)

MEETING (PART 1)

8 January 2020

Rooms 4&5, Woolwich Town Hall PRESENT:

IN ATTENDANCE:

Dr Krishna Subbarayan (KS) Governing Body Chair NHS Greenwich CCG

Maggie Buckell (MB) Registered Nurse NHS Greenwich CCG

Dr Vivienne Chai (VC) GP Member NHS Greenwich CCG (for part of the meeting)

Dr Anuj Chaturvedi (AC) GP Member NHS Greenwich CCG (for part of the meeting)

Amana Humayun (AH) Vice Chair and Lay Member

NHS Greenwich CCG

Neil Kennett-Brown (NK-B) Managing Director NHS Greenwich CCG

Sarah McClinton (SM) Local Authority Nominee Royal Borough of Greenwich

Usman Niazi (UN) Chief Finance Officer NHS Greenwich CCG (for part of the meeting)

Dr Debisi Olunloyo (DO) GP Member NHS Greenwich CCG (for part of the meeting)

Bridget Pratt (BP) Deputy Director of Quality, Performance and Governance

NHS Greenwich CCG (for Ms Hawes-Gatt)

Richard Rice (RR) Lay Member and Chair of the Primary Care Commissioning Committee

NHS Greenwich CCG

Robert Shaw (RS) Chief Operating Officer NHS Greenwich CCG

Dr Iynga Vanniasegarum (IV) Secondary Care Doctor NHS Greenwich CCG

Dr Jaisun Vivekanandaraja (JV)

GP Member NHS Greenwich CCG

Steve Whiteman (SW) Director of Public Health Royal Borough of Greenwich

David Maloney (DM) Director of Finance NHS Greenwich CCG

Devina Maru GP Trainee Observing

Colin Nash (CN) Corporate Secretary (Minutes) NHS Greenwich CCG

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001/2020 WELCOME AND INTRODUCTIONS

Dr Subbarayan welcomed those attending the meeting.

002/2020 APOLOGIES FOR ABSENCE

Andrew Bland, Dr Jan Ratnarajan, Dr Vijay Sivapalan and Greg Ussher.

DECLARATION OF INTERESTS

003/2020 a. To note declared interests The Governing Body NOTED the Register of Interests.

004/2020 b. To add new interests None.

0052020 c. To identify potential conflicts of interest None.

006/2020 MINUTES FROM THE MEETINGS HELD ON 6th NOVEMBER 2019

The minutes of the last meeting were APPROVED.

007/2020 ACTION POINTS FROM THE MINUTES

The Governing Body considered the actions in Enclosure C. All were either on the agenda or had been completed with the exception of:- 15/19 – Mr Shaw reported that 26% of Urgent Care Centre (UCC) attendees were subsequently seen in the Hospital Emergency Department and 4.8% of these were subsequently admitted as an in-patient. The increase in UCC attendances between 2018 and 2019 could not be attributed to any single reason apart from some occasional spikes in activity when access to similar services in Bexley was not available. This action was closed. 16/19 – Mr Shaw reported that there was no specific monitoring of the on-going condition of patients who received the Take Home and Settle Service; although all such patients were contacted on the day after, to check if they required any further support. This action was closed.

008/2020 CHAIR’S REPORT

Dr Subbarayan was pleased to report that Dr Jonty Heaversedge has been unanimously supported, by the new SEL CCG clinical lead members of the SEL CCG Governing Body, as the new chair of the SEL CCG. Dr Robert Davidson would fill the vacancy this created as a Southwark Borough GP clinical lead on the Governing Body.

Dr Subbarayan and Dr Salman had been elected by their Greenwich GP colleagues to be the Greenwich GP clinical leads

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on the SEL CCG Governing Body.

In addition the following had been successful in being appointed to the three lay member roles on the new Governing Body:-

Lay member for Governance & Audit: Ms Shelagh Kirkland

Lay member for Patient and Public Involvement: Ms Joy Ellery

Lay member for Primary Care Commissioning: Mr Peter Ramrayka

Organisational development work was also underway to ensure close links between the CCG and its component boroughs and vice versa and to ensure the patient voice was heard at both SEL and borough level.

Dr Subbarayan reiterated that despite this period of change, the CCG must continue to ensure it was delivering the best possible health services for local people.

009/2020 MANAGING DIRECTOR’S REPORT

Mr Kennett-Brown took the Governing Body through his written report covering the following headings:-

i. System wide transformation and ii. Winter and system preparedness.

He then referred to Appendix one – Greenwich Borough Based Board (BBB) and south east London CCG merger briefing paper and highlighted the following points. The BBB and local authority would work closely together ensuring commissioning plans were aligned, although budgets would remain separate. Mr Rice enquired how decisions affecting Greenwich only would be made in the new structure. Mr Kennett-Brown replied that it was envisaged that recommendations would be developed locally and, where necessary, approved at SE London level. Dr Salman noted that some bids for resources to be used locally were dependent upon their being effective a mechanism for ensuring the local patient voice was being heard. It would be necessary to ensure this continued within the SE London structure. Dr Subbarayan highlighted the good progress being made with local authority colleagues to develop an aligned commissioning strategy through the Healthier Greenwich Alliance group.

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Dr Chaturvedi and Dr Olunloyo joined the meeting. The Governing Body NOTED the report.

010/2020 ADDITIONAL ITEM – VOTE OF THANKS

On behalf of the Governing Body, Dr Subbarayan thanked both Ms Humayun and Dr Chai for their enormous contribution to the Governing Body and wished them well as they began their maternity leave.

PRESENTATION

011/2020 THE SE LONDON INTEGRATED CARE SYSTEM (ICS) RESPONSE TO THE NHS LONG TERM PLAN (LTP)

Mr Kennett-Brown referred to the paper briefing the Governing Body on progress towards finalising the SE London and Greenwich response to the NHS Long Term Plan. He noted that the Greenwich Commissioning Strategy was consistent with the Long Term Plan and the ICS response followed a similar direction of travel. The priorities for service transformation by 2023/24, listed on page 2 of the cover sheet, were to integrate community care, reduce pressure on urgent and emergency care, improve planned care outcomes and performance, deliver better outcomes for major health conditions and to deliver financial savings and achieve financial sustainability. The changes envisaged, particularly around the integration of community based care and the shift towards preventative and personalised services, would need to be embedded through borough level partnerships. In Greenwich these were being developed through the Healthier Greenwich Alliance and their vision, aims and priorities to transform care (together with those for the other five SE London boroughs) were included within the full draft response document on the Our Healthier SE London website at: https://www.ourhealthiersel.nhs.uk/Downloads/SEL%20LTP%20RESPONSE/SEL%20ICS%20response%20to%20the%20LTP%20second%20draft_Jan%202nd%20website%20upload.pdf Dr Vanniasegarum enquired why it was thought the five priorities in the ICS response could be better achieved by a single CCG. Mr Kennett-Brown replied that working together would enable greater progress to be made in areas such as prevention. He also noted that a high proportion of SE Londoners received most of their healthcare within SE London as a whole, rather than within their resident borough. This often meant their experience of health services could only be improved by working across a SE London footprint. Mr Shaw cited the example of diabetes, where service improvement was currently hampered by the service provider having to work with three separate CCGs, each with their own requirements. Dr Vanniasegarum noted that changes in primary care would be essential to the achievement of the other goals within the ICS

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response. Mr Kennett-Brown agreed and believed that the establishment of Primary Care Networks (PCNs) would assist in securing the improvements in primary care performance that were necessary. Dr Salman noted the importance of digital technology in enabling services to increase their capacity and work in a more integrated way. She also highlighted that the recruitment and retention of staff would be essential to deliver the ambitions in the ICS response. Mr Kennett-Brown agreed. As an illustration of how cooperation with other CCGs had enabled some long standing issues to be addressed, Dr Subbarayan noted that the CCG’s close working relationship with Bexley CCG had enabled all GP practices within the same Primary Care Network, to use the same IT operating system. Dr Vivekanandaraja added that from April some GP Practices will be able to offer e-consultations. Mr Shaw emphasised the importance of working across organisational boundaries to make the improvements in health care the CCG wished to see. Ms Humayun welcomed the parallels between the Greenwich strategy and the ICS response to the LTP and, in response to her question, Mr Kennett-Brown confirmed that Greenwich should continue to focus on the four clinical and two enabling priorities set out in the Greenwich Strategy.

Governing Body members suggested no amendments to the Healthier Greenwich Alliance page in the draft ICS response in the meeting and this would be the text included, unless Mr Kennett-Brown received any further comments before 1700 on Friday 10th January 2020.

ALL

FOR DECISION

012/2020 AMENDMENT TO THE AUDIT COMMITTEE TERMS OF REFERENCE

Mr Maloney referred to the paper asking the Governing Body to approve an amendment to the Audit Committee terms of reference to permit a suitably qualified person from outside the CCG to chair the committee in the absence of the regular chair. This change was necessary to enable Ms Kirkland, Audit Committee Chair of Lewisham CCG, to undertake the role once Ms Humayun commenced her maternity leave. The change proposed was set out in the amended terms of reference. The Governing Body APPROVED the amendment.

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FOR ASSURANCE

013/2020 NON ACUTE PERFORMANCE AND QUALITY REPORT – JANUARY 2020

Ms Pratt referred to the report focusing on the non-acute areas of performance, safety and quality. This had already been considered by the Integrated Governance Committee. She took the Governing Body through the areas of improvement and deterioration since the last report, summarised on the cover sheet. In response to a question from Dr Subbarayan, Ms Pratt replied that staffing issues at Oxleas NHS Foundation Trust had raised at tri borough performance meeting and the Oxleas Clinical Quality Review Group (CQRG). At these meetings the CCG had received assurance from Oxleas about their plans to address these issues. Dr Chai enquired about vacancy rates at the Trust. Ms Pratt replied that Oxleas had agreed to give figures broken down by department so the effect on services could be more accurately judged and more effective remedial action taken. In response to a question from Dr Vanniasegarum, Dr Subbarayan replied agreed that workforce issues within community services could best be addressed by allowing staff to work across organisational boundaries through different ways of working. As an example of this, Mr Kennett-Brown added that within mental health the South London Alliance had committed itself to developing staff passports. He also noted that cooperation between commissioners and providers was a key theme in the NHS Long Term Plan.

Referring to the Diabetes Overview, Mr Rice enquired how many patients were taking up the opportunities for structured education in diabetes. Mr Shaw agreed to furnish him with this information.

RS

The Governing Body NOTED the report.

014/2020 FINANCE UPDATE – MONTH 7

Mr Niazi referred to the report, noting that at Month 7 the CCG was underspent by £2,100k, in line with its planned year end surplus target of £3,600k. Mr Maloney added that the Month 8 position and an early review of Month 9 were also consistent with achieving the year end surplus. The main financial challenges were to ensure the overspend on the Continuing Healthcare (CHC) budget did not worsen. The CHC team were working with the local authority to minimise any unnecessary costs and work was on going at SE London level to maximise savings opportunities. Work was also ongoing to maximise delivery of the CCG’s CHC QIPP savings target, much of which was back loaded to the second half of the financial year.

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Ms Humayun noted that the CHC risks were common across CCGs in SE London and illustrated the balance that had to be struck between delivering personalised care and a balanced budget. Dr Subbarayan enquired about financial planninged for the 2020-21 financial year. Mr Niazi replied that SE London plans incorporated national assumptions and since December each borough was reviewing its local plan. These would be confirmed through the appropriate approval process. In response to a question from Mr Rice, Mr Maloney confirmed that the CCG was on track to deliver its management cost saving by year end. The Governing Body

NOTED the budgets and position for the Programme Budgets and the Running Costs as at end of October 2019.

NOTED the forecast position for the year for both Programme Budgets and the Running Costs.

NOTED the CCG’s risk position.

NOTED specifically the risk assessed forecast for the CCG’s overall financial position.

015/2020 QUALITY, INNOVATION, PRODUCTIVITY AND PREVENTION (QIPP) DELIVERY UPDATE 2019/20 – MONTH 8 FOR BGL AND GREENWICH

Mr Shaw took the Governing Body through the report summarising the current position with regard to those QIPP schemes that were the responsibility of Bexley, Greenwich and Lewisham (BGL) CCGs and Greenwich CCG alone. The following points were highlighted. At Month 8 BGL schemes were expected to deliver 85% of target savings, or £33.4m; and Greenwich schemes 84% of target savings, or £10.8m. There remained a risk to the delivery of the QIPP savings associated with Unplanned Care and Continuing Healthcare. A summary of the actions being taken to secure delivery was set out on page 2 of the report. In response to a question from Dr Subbarayan, Mr Shaw replied that QIPP plans for 2020/21 would build upon plans in the current year and would look to take advantage of SE London wide opportunities presented by the new CCG. The Governing Body NOTED the report.

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Mr Niazi left the meeting.

FOR DISCUSSION

016/2020 COMMISSIONING UPDATE

Mr Shaw took the Governing Body through the report providing an update on the status of commissioning within Greenwich under the headings of prevention, unplanned care, primary care, system and organisational development, planned care and mental health. The following points were highlighted. Urgent and emergency care developments included a successful pre market engagement event for Urgent Treatment Centre procurement on 6th December. The focus was to inform prospective providers of the CCG’s preference for alliance working. This had been positively received by providers and it was intended to present business cases to the relevant CCG committees in January 2020. Within Primary Care the draft outline specifications for Primary Care Network Directly Enhanced Services (DES) was published on 24 December 2019. The main focus in planned care had been on the delivery of the Referral Access Service (RAS). This went live for 10 specialties in Lewisham and Greenwich NHS Trust and had been positively received. He thanked all involved, particularly Mr Reith, Dr Vivekanandaraja and the LMC. With regard to mental health, Mr Shaw was pleased to report the appointment of Ms Eleanor Johnston as a dedicated project lead for the development of a mental health alliance. In response to a question from Dr Subbarayan, Mr Shaw replied that the CCG would be reviewing the DES specification in detail to get a rounded view and would consider all potential funding streams for them. He noted that the proposals were in line with the CCG’s direction of travel. The greatest challenge would be securing the necessary physical resources to deliver the DES rather than funding. Dr Chaturvedi added that PCNs were supportive of the DES concepts. With regard to unplanned care Mr Kennett-Brown enquired about the High Intensity User Programme. Mr Shaw replied that this targeted resources at the “front door” of the Emergency Department at Lewisham and QEH, with the aim of reducing admissions. He noted that on some days the numbers attending the QEH Emergency Department exceeded the numbers attending Guys and St Thomas’s and the hospital’s performance had to been in the light of the pressures it faced. The Governing Body NOTED the report.

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017/2020 2019 EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE (EPRR) ASSURANCE REPORT

Mr Kennett-Brown referred to the paper setting out the outcome of the 2019 EPRR review. He was pleased to note that the CCG achieved full assurance and did not have any significant actions to address. He thanked Mr Beard who had led the CCG’s EPRR response for this successful result. Mr Rice enquired about the reference to “Green with comments” at items 12 and 18. Mr Kennett-Brown replied that the CCG was required to ensure on call mangers were aware of the sections in the SEL DoC Handbook critical care capacity. The Governing Body CONSIDERED AND ACCEPTED THE ASSURANCE OUTCOME. Dr Chai left the meeting.

FOR REFERENCE AND INFORMATION ONLY

018/2020 CONFIRMED MINUTES FROM GOVERNING BODY COMMITTEES

i. Audit Committee 19.9.19 ii. Integrated Governance 9.10.19

iii. SEL Integrated Governance & Performance 30.8.19, 27.9.19 and 1.11.19

iv. Patient Reference Group notes 3.9.19 v. Summary report from the December meeting of the

SEL Integrated Governance & Performance Committee vi. Financial Investment Committee report

The Governing Body NOTED the minutes and reports.

019/2020 ANY OTHER BUSINESS

None.

020/2020 QUESTIONS FROM THE PUBLIC ON AGENDA BUSINESS ONLY

These questions were recorded in a separate document.

021/2020 DATE OF NEXT MEETING

The next meeting in public was scheduled for 8th January 2020 from 1400-1630 (Questions and Answers 1330-1400).

022/2020 RESOLUTION TO MOVE TO PART 2 OF THE MEETING

The Governing Body APPROVED the motion that, in accordance with section 1(2) of the Public Bodies (Admissions to Meetings) Act 1960, representatives of the press and members of the public now be excluded from the meeting, because publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.

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ACRONYMS All acronyms are explained within the body of the text at the point they first occur. 3



Enclosure D

Draft ACTIONS FROM – GOVERNING BODY – PART 1

Date 08.01.20.

Ref Minute number

Action Action owner

To be completed by

Comments

ACTIONS BROUGHT FORWARD

None.

ACTIONS FROM THE MEETING

ICS response

17/19 011/2020 Make any responses to the ICS response to the LTP by Friday 10th January

ALL Completed

Non Acute Performance and Quality Report

18/19 013/2020 Report to Mr Rice on the uptake of the structured education programme by diabetic patients

RS

As soon as possible.

Colin Nash 20.01.19

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Enclosure E Managing Director’s report

Governing body meeting in public Wednesday 11 March 2020

1. System-wide transformation

1.1 Our Healthier South East London Our Healthier South East London (OHSEL) is the Integrated Care System (formerly known as the Sustainability and Transformation Partnership) for south-east London. The Our Healthier South East London Board met in public on 29 January and received an update on the south-east London Integrated Care System (ICS) response to the NHS Long Term Plan. Board meeting papers, which include the south-east London response to the Long Term Plan, are available online. The board endorsed the updated and final version of the published response and approved the next steps. The next steps include:

a) Continue developing the glossary to accompany the final document, to support lay members in understanding the content of the response.

b) Continue development of a public-facing summary of the Long Term Plan response, testing the draft content with members of the patient and public advisory group as part of this process.

c) Hold a co-designed workshop with representatives from voluntary and community organisations to support strengthening relationships between those organisations and the ICS, thereby acting on feedback received through engagement exercises undertaken in summer 2019.

Appointment of south-east London ICS chair Richard Douglas CB has been appointed as the chair of the south-east London ICS. Richard has worked across the Department of Health and NHS. During his time at NHS England and Improvement he has worked in non-executive roles and in both phases of his career he chaired executive committees, board committees to facilitate system coordination at a national level. Most recently, he has held the position of associate non-executive director at NHS England. Community urgent response services From April 2020, urgent community response teams will be introduced by the NHS in south-east London to help support older people to stay in their own homes and avoid hospital admissions under a new scheme. The initiative forms part of a £14 million national NHS programme, with south-east London selected as one of seven areas in the country – and the first in London – to deliver this new

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standard of care for elderly people across all six boroughs (Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark). The teams will give those who need it fast access to a range of qualified professionals who can address both their health and social care needs, including physiotherapy and occupational therapy, medication prescribing and reviews and help with staying well-fed and hydrated. The urgent care response programme, which represents the first standard of its type for community services in the country, seeks to:

Provide an assessment in a patient’s home if they are in a crisis, within two hours of referral by a GP or other health or social care worker.

Provide an intermediate care response to a patient within two days of referral (is offered for up to six weeks to support people be discharged from hospital, or to help avoid them needing to be admitted to hospital in the first place).

Improve care for people with complex needs in the community, including primary care.

Support the NHS’ Long Term Plan to support England’s ageing population and those with complex needs.

South-east London population health management programme The ICS has been accepted successfully on to the NHS England/Improvement population health management development programme – a 20-week programme that will support building capability across the ICS system (e.g. within commissioners and providers, primary care networks and their community partners) to make informed, data-driven decisions that enable teams to act together (across the NHS, local authorities, public services, voluntary sector, communities, and local people). Population health management improves the health of a population by using data to plan and deliver care more effectively. It includes segmenting and stratifying the population at a system, borough and neighbourhood level to understand better the health needs of these populations. The first stage of the programme is a data readiness phase, which will identify (or create) a suitable linked (single source of truth) data set. This will bring together data from across the system (primary care, secondary care, mental health, community and social care). A primary care network has been chosen for each of the six place-based/boroughs in south-east London; participation in the 20-week programme and the resulting work (and its future spread) will be a key development area for addressing the health inequalities that exist across and within local communities. The evaluation model used by the programme has been well developed in previous national waves. The approach is to undertake a series of ICS-level ‘design to action’ workshops where system leaders, analytics teams, public health and primary care network teams come together to share and learn. The approach followed is:

Kick-off ICS workshop introducing the programme and the population health management approach

Targeting at-risk population cohorts

Data-driven intervention design

Monitoring and measuring interventions and outcomes

Closing the loop through feeding back lessons learned

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1.1.2 OHSEL supports national apprenticeships week Our Healthier South East London and South West London Health & Care Partnership, with support from Health Education England, are working to find ways to promote and maximise the benefits of apprenticeships in health and social care organisations across south London. The aim is to help key provider partners to meet the government apprenticeship targets and use levy funds effectively, for the benefit of their current and future workforce. In south-east London, OHSEL has brought providers together to share good practice and innovation and develop and promote collaboration. The gifting or transfer option allows providers to transfer up to 25 per cent of their levy fund to smaller, health and social care organisations, such as GP practices, local charities and other organisations in the local community, such as schools. As a result, the overall levy spend is increasing and partners are planning to increase the take-up of apprenticeship programmes and numbers during this year. 1.2 South-east London system reform Significant work is underway to prepare for the single south-east London CCG, which will be in place from 1 April, including putting in place shadow governance arrangements for the new governing body and its committees during quarter four, and establishing the new staff structures. The development of the local borough-based board continues. The board held its first ‘shadow’ meeting on 6 February where they discussed governance arrangements and work plans. 1.3 Healthy London Partnerships (HLP) update HLP is a collaboration of NHS organisations in London, including CCGs, Health Education England, NHS England, NHS Digital, NHS Improvement, provider trusts, the Greater London Authority, the Mayor of London, Public Health England and London Councils. Their latest updates include information on:

The London Health Podcast – HLP has launched its own podcast, which focuses on some of the key health and care challenges facing the capital

Mental health – HLP’s children and young people’s team held a successful workshop for around 100 health and care professionals and then supported the week itself across its duration on social media, read more.

Good Thinking has launched a new animated video drawing on the patient journey of looking for new ways to help improve mental wellbeing and what to do if someone is affected by mental health.

The London perinatal mental health networks held their sixth annual conference on 6 February, bringing together more than 173 guests including, lived experience experts, midwives, student midwives, psychiatrists, pharmacists, nurses and other health professionals from across the region.

A new £1 million project is being launched to support London’s ambition to become the first city in the world to stop new HIV infections and make preventable deaths from HIV a thing of the past.

For more information on the programmes of work supported by HLP, please visit www.healthylondon.org.

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1.4 ‘Shaping places for healthier lives’ programme Royal Borough of Greenwich has successfully been selected to take part in stage two of the ‘shaping places for healthier lives’ programme, which takes place later this month. The expressions of interest process was very competitive with submissions from 110 councils. The submissions were scored by representatives from the Health Foundation and the LGA with steering group sign-off of the final recommendation. Royal Borough of Greenwich and its local partners, which includes the CCG, submitted an expression of interest to support the development of Thamesmead. The ‘shaping places for healthier lives’ programme aims to create the conditions for better health by funding local partnerships to take system-wide action on the wider determinants of health. The projects selected have to demonstrate a coordinated approach to improving health and addressing health inequalities in local communities through creating conditions for better health. Five proposals will be picked in the summer of 2020 to receive £100,000 per year for a three-year programme.

1.5 Changes within the system 1.5.1 Care Quality Commission (CQC) published inspection report on King’s College Hospital NHS Foundation Trust (KCH) Emergency Departments (ED) On 18 February, the CQC published a report on the outcome of a follow up inspection on the EDs at KCH undertaken in November 2019. The inspection was undertaken to review progress made by the trust following inspections undertaken in January and February 2019 (results published in June 2019). The latest inspection report is available from the CQC website. This new inspection found that although some improvements had been made at the Denmark Hill ED, there were further improvements to be made and the department retains its requires improvement rating. The Princess Royal University Hospital ED continues to be rated as inadequate. The CQC did recognise that work had been undertaken to respond to the concerns previously raised, but that further work was required to demonstrate clear sustainable results. Providing high quality, safe and responsive services to patients in south-east London is CCGs’ top priority and leaders will continue to work closely with the trust board and NHS regulators to ensure that KCH provides the best possible care to local people. The leadership of the trust is fully committed to ensuring appropriate action to address the issues raised. This includes a clear commitment to ensuring the safety and wellbeing of patients and the delivery of expected standards in terms of patient care and safety alongside the leadership and behaviours required to secure this. The CCG is committed to working with the trust to provide challenge and seek assurance on the trust’s progress in making the required improvements.

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https://www.cqc.org.uk/provider/RJZ

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1.5.2 Proposed move of Moorfields Eye Hospital’s City Road services The proposal to move Moorfields Eye Hospital, University College London’s Institute of Opthalmology and Moorfield’s Charity to a new site at St. Pancras in London has been approved. NHS Camden CCG on behalf of those CCGs across England that commission services from Moorfields City Road site, in partnership with NHS England/Improvement specialised commissioning (London), consulted between 24 May and 16 September 2019 on a proposal to relocate services from Moorfields Eye Hospital’s City Road site to St Pancras. This new-build centre will bring together excellent eye care, ground-breaking research and world-leading education in ophthalmology. This project will be a partnership between Moorfields Eye Hospital and University College London (UCL) Institute of Ophthalmology (IoO). Moorfields Eye Hospital and UCL will sell the current land at City Road, and all proceeds of the sale will be reinvested in a multi-million pound development on land available at the site of St Pancras Hospital, just north of King’s Cross and St Pancras stations in central London. During the consultation around 4,600 contributions were received, of which 1,511 were completed consultation surveys. People also gave their feedback in other ways including emails, discussion groups, phone calls, letters and via the virtual assistant on the consultation’s website. The outcome report is available online. 1.5.3 Non-Executive Director (NED) opportunity There is a vacancy for a NED at Lewisham and Greenwich NHS Trust. The ideal candidate will need to have a genuine commitment to patients and the promotion of excellent healthcare services. The closing deadline is 13 March. More information, including the application documents, is available from the NHS Improvement website. 2. Planned and urgent care update 2.1 Tackling frailty in Greenwich On the 3 February a new, single access number was launched in Greenwich to give GPs, London Ambulance and other healthcare professionals direct access to the Joint Emergency Team (JET), who can contact a wide range of community services to support frail patients at home. This improves services for patients and saves time for practice teams. Services include: a two-hour response for urgent assessments; oral antibiotic treatment (where a GP has prescribed this); falls; exacerbation of chronic obstructive pulmonary disease Chronic (COPD), where the patient is not already known to the COPD team; blocked indwelling urinary catheters; emergency packages of care; and breakdown of informal carer arrangements.

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https://oriel-london.org.uk/consultation-documents/https://improvement.nhs.uk/news-alerts/ned-lewisham-and-greenwich-nhs-trust/

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JET will provide two to seven days of treatment and manage referrals on to other longer-term community and social care services where the patient requires this. This Greenwich project is part of south-east London’s successful bid for national accelerator ICS status, which brings with it some additional funding to expand existing community urgent response services further. 2.2 Procuring urgent care services in Bexley and Greenwich The contracts for urgent care services, which are provided by Greenbrook Healthcare in Greenwich and the Hurley Group in Bexley, are due to expire later this year. In December, NHS Bexley and Greenwich CCGs held a pre-market engagement event to assess the appetite of potential providers to commission Urgent Treatment Centres (UTCs) in both boroughs. A number of providers and interested stakeholders attended the event to learn more about the procurement and to network. The feedback from this session, as well as patient insight, has helped to develop a service specification to ensure CCGs commission the very best service for patients. Both NHS Bexley and Greenwich CCGs recently approved a joint business case, which signals the commencement of the procurement process. The procurement advertisement is live on the Official Journal of the European Union (OJEU) website and the invitation to tenders will be reviewed and moderated throughout March and April. Final approval of the contract award is anticipated to be agreed by the NHS South East London CCG governing body in May. It is anticipated that the new provider will formally commence from October 2020. Patients will continue to access urgent care from two UTCs in Bexley and from one UTC in Greenwich. CCGs continue to work with patient groups and Healthwatch in Greenwich and Bexley to ensure that patients are engaged and involved throughout this process. 3. Patient engagement 3.1 NHS Greenwich Charity - Small grants The Greenwich small grants programme which we launched in 2019 with the NHS Greenwich Charitable Trust has delivered impact to services supporting child and adolescent mental health and we have appreciated the partnership approach from our local voluntary and community sector. We are delighted to extend the programme both in terms of budget and reach this upcoming year, to include projects that support the achievement of all our strategic priorities. The fund plays an important part in ensuring that residents of Greenwich are involved in decisions about their own health and wellbeing. METRO GAVS our appointed programme administrator are currently sifting through over 30 exciting applications, and the announcement on which are successful is expected later this month. 3.2 National presentation on engagement Our communications and engagement team will lead a one hour national presentation this month, to share our best practice approach in engagement to other CCGs, providers and

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https://www.ojeu.eu/https://www.ojeu.eu/

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community and voluntary sector partners across the country. We were delighted to be invited to showcase our work, following our outstanding green star rating from NHS England for public participation in 2019. 3.3 Healthwatch Greewnch – survey underway

governing body meeting in public agenda question ......sel integrated governance & performance...

Documents