lambeth clinical commissioning governing body...2016/01/20 · lambeth clinical commissioning...
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Lambeth Clinical Commissioning
Governing Body
Wednesday 20th January 2016
From 1.00pm - 4.00pm
The Foundry, 17 Oval Way, London, SE11 5RR
Location and directions:
Nearest Tube stations are Vauxhall or Oval. The Foundry is approximately a 10 minute walk from both stations. From Vauxhall Station head east towards South Lambeth Road, continue onto Kennington Lane and turn right onto Oval Way.
Pamela Handy, Support to LCCG, NHS Lambeth 1 Lower Marsh, Waterloo, London SE1 7NT
Tel: 020 3049 6785 E-mail: [email protected]
www.lambethccg.nhs.uk/news-and-publications/meeting-papers/governing-body
Page 1 of 159
NHS Lambeth CCG Governing Body Page 1 of 3
NHS Lambeth Clinical Commissioning Governing Body Wednesday 20th January 2016
1.00pm – 4.00pm The Foundry, 17 Oval Way, London SE11 5RR
AGENDA
Agenda Item No. and Time
Agenda Item Reference and Title Supporting Information
Agenda Item Lead
1 LCCG/GB/16/001 – Welcome and Introductions To include a verbal report from pre-meet discussions. - Adrian McLachlan
2 LCCG/GB/16/002 – Apologies for Absence The Governing Body is asked to note apologies for absence received in advance of the meeting.
- Adrian McLachlan
3 LCCG/GB/16/003 – Declarations of Interest The Governing Body is asked to be made aware of any declarations of interest on the agenda.
- All Members
4 LCCG/GB/16/004 – Register of Members’ Interests The Governing Body is asked to note the current register of interests.
Pages 5 to 13
Adrian McLachlan
5 LCCG/GB/16/005 – Draft minutes and action log from the meeting held on 4th November 2015 The Governing Body is asked to approve the minutes and actions arising from the meeting held on 4th November 2015.
Pages 14 to 30
Adrian McLachlan
Chair’s Action
6 LCCG/GB/16/006 – Chair’s Action The Governing Body is asked to:
Agree the final version Collaborative Agreement for devolution document and approves that this be signed by the Chair of the London-wide CCG Clinical Commissioning Council on behalf of Lambeth CCG with other London CCGs.
Pages 31 to 46
Adrian McLachlan
Chair and Chief Officer Reports
7 LCCG/GB/16/007 – Chair’s Report The Governing Body is asked to receive the Chair’s report for the period 5th November 2015 to 19th January 2016.
Pages 47 to 50
Adrian McLachlan
8 LCCG/GB/16/008 – Chief Officer’s Report The Governing Body is asked to receive the Chief Officer’s report for the period 5th November 2015 to 19th January 2016.
Pages 51 to 59
Andrew Eyres
Age
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NHS Lambeth CCG Governing Body Page 2 of 3
Agenda Item No. and Time
Agenda Item Reference and Title Supporting Information
Agenda Item Lead
Presentation
9 LCCG/GB/16/009 – Presentation The Governing Body is asked to receive a presentation from the Integrated Children and Young People (including maternity) programme.
Presentation Nandini
Mukhopadhyay
Items for Decision
10 LCCG/GB/16/010 – Draft Operational Plan: NHS Lambeth Clinical Commissioning Group Commissioning Intentions for 2016/17 The Governing Body is asked to agree the recommendations as set out in the paper.
To follow Andrew Parker/ Christine Caton
11 LCCG/GB/16/011 – Collaborative Framework The Governing Body is asked to agree the proposed Collaborative Commissioning Arrangements set out in this paper.
Pages 60 to 98
Una Dalton
12 LCCG/GB/16/012 – Appointment of Auditor Panel for the procurement of External Auditors by NHS Lambeth CCG The Governing Body is asked to approve the delegation of the responsibility of auditor panel to the Audit Committee.
Pages 99 to 102
Christine Caton
13 LCCG/GB/16/013 – Clinical Network update The Governing Body is asked to:
Receive the Clinical Network Report for the period
5th November 2015 to 19th January 2016.
Note the review of the Clinical Network and to seek views on proposed next steps.
Pages 103 to 106 To follow
Martin Godfrey
COMFORT BREAK
Receive Regular Reports
14 LCCG/GB/16/014 – Integrated Governance and Performance Report The Governing Body is asked to note:
2015/16 latest updates against Business Plan Objectives.
Latest update of the Board Assurance Framework and Risk Register.
Performance against NHS England’s Top eight Performance Measures and Constitution Standards.
Pages 107 to 109
Andrew Eyres
15 LCCG/GB/16/015 – 2015/16 Financial Position as at Month 9, December 2015 The Governing Body is asked to:
Note the 2015/16 financial position as at month 9.
Note the latest performance on NHS Lambeth CCG’s cash management strategy.
Pages 110 to 125
Christine Caton
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NHS Lambeth CCG Governing Body Page 3 of 3
Agenda Item No. and Time
Agenda Item Reference and Title Supporting Information
Agenda Item Lead
16 LCCG/GB/16/016 – Joint Director of Public Health Report The Governing Body is asked to note the Joint Director of Public Health Report covering the period October to December 2015.
Pages 126 to 141
Sarah Corlett
17 LCCG/GB/16/017 – Primary Care Development Programme update The Governing Body is asked to note developments and progress in Primary Care.
Pages 142 to 147
Hasnain Abbasi
Items for Information
18 LCCG/GB/16/018 – NHS Lambeth CCG Integrated Governance Committee Approved Minutes The Governing Body is asked to receive the approved minutes of the meeting held on 21st October 2015.
Pages 148 to 158
19 LCCG/GB/16/019 – Other Approved Minutes The Governing Body is asked to receive the approved minutes of the following meetings:
LCCG Safeguarding and LAC Working Group, 15th June 2015.
Lambeth Safeguarding Adults Partnership Board (LSAPB), 22nd June 2015.
LCCG Safeguarding and LAC Working Group, 14th September 2015.
Lambeth Safeguarding Adults Partnership Board (LSAPB), 23rd September 2015.
Lambeth Children and Families Strategic Partnership (CFSP), 23rd September 2015.
Primary Care Joint Committees (PCJC), 29th September 2015.
Lambeth Children and Families Strategic Partnership (CFSP), 11th November 2015.
Available at: www.lambethccg.nhs.uk/news-and-publications/meeting-papers/governing-body
Page 159
Any Other Business and next meeting date
20 LCCG/GB/16/020 – Any Other Business
21 LCCG/GB/16/021 – Next meeting Wednesday 2nd March 2016 1.00pm – 4.00pm Venue: TBC
The agenda and minutes of this meeting may be made available to public and persons outside of NHS Lambeth Clinical Commissioning Group as part of the CCG’s compliance with the Freedom of Information Act 2000.
Age
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1 V5
Report to the Governing Body
20th January 2016
Report Title
Register of Members’ Interests
Author(s)
Pamela Handy, Corporate Business Manager
Governing Body/Clinical Lead(s)
Adrian McLachlan, Chair of the LCCG Governing Body
Management Lead(s)
Una Dalton, Director of Governance and Development
CCG Programme
Governance
Purpose of Report
To receive assurance
Summary
The Code of Accountability requires all NHS bodies to declare interests, which are relevant and material to this LCCG Governing Body. Any changes in interests should be declared at the next Governing Body meeting following the change occurring. During the course of a Governing Body meeting, if a conflict of interest is established, the member concerned should withdraw from the meeting and play no part of the relevant discussion or decision.
Recommendation(s) The Governing Body is asked to note the current Register of Members’ Interests as at 13th January 2016.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
All legal, engagement, inequalities, financial and resource implications and any
potential or actual risks are set out in detail in the body of this report.
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Page 11 of 159
R
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Page 12 of 159
R
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. 13th
Jan
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13th
Jan
uary
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Page 13 of 159
NHS Lambeth CCG Governing Body Minutes Page 1 of 14
NHS Lambeth Clinical Commissioning Group (LCCG) Governing Body Minutes of the meeting held on Wednesday 4
th November 2015
1.00pm – 4.00pm Roots and Shoots, Walnut Tree Walk, London, SE11 6DN
Present:
Adrian McLachlan (AM) Governing Body Member, Chair
Hasnain Abbasi (HA) Governing Body Member, South West locality
John Balazs (JB) Governing Body Member, North locality
Christine Caton (CC) Governing Body Member, Chief Financial Officer
Helen Charlesworth-May (HCM)
Strategic Commissioning Director, London Borough of Lambeth
Sarah Corlett (SC) Consultant, Lambeth and Southwark Public Health
Andrew Eyres (AE) Governing Body, Chief Officer
Sue Gallagher (SG) Governing Body, Lay Member
Paul Heenan (PH) Governing Body, South West locality
Graham Laylee (GL) Governing Body, Lay Member
Lisa Le Roux (LLR) Governing Body, South East locality
Raj Mitra (RM) Governing Body, North locality
John Moxham (JM) King’s Health Partners, Co-opted Governing Body
Catherine Pearson (CP) Governing Body, Healthwatch
Ruth Wallis (RW) Joint Director of Public Health, Lambeth and Southwark
In Attendance:
Bisi Aiyeleso (BA) Joint Assistant Director, Service Redesign
Michelle Binfield (MB) Associate Director, London Borough of Lambeth
Una Dalton (UD) Director of Governance and Development
Martin Godfrey (MG) Clinical Network Lead
Pamela Handy (PHy) Corporate Business Manager (minutes)
Jenny Law (JL) Governing Body, LMC (In attendance)
Moira McGrath (MMcG) Joint Director, Integrated Commissioning, Adults
Maria Millwood (MM) Joint Director, Integrated Commissioning, Childrens
Andrew Parker (AP) Director of Primary Care Development
Emma Stevenson (EStv) Assistant Director, Children & Maternity
No. Agenda Item Action/date
1
2
3
LCCG/GB/15/125 – Welcome and Introductions
AM welcomed members of the public to the NHS Lambeth Clinical
Commissioning Group (LCCG) Governing Body meeting and all members of
the Governing Body were introduced.
AM welcomed and introduced Jackie Ballard, confirming her new role was an Associate Lay Member. LCCG’s three Population Health Improvement Fellows, Tehseen Khan, Paxton Green Medical Centre, Katherine Taylor, Beckett House Practice, and Alice
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No. Agenda Item Action/date
Wu, Streatham High Practice, were also introduced.
4
LCCG/GB/15/126 – Apologies for Absence
Apologies were received from:
Ami David, Governing Body, Nurse Member.
Nandini Mukhopadhyay, Governing Body, South East locality.
5
6
Update from LCCG Public Forum
AM summarised the main issues discussed at the public forum held in advance
of the meeting comprising:
Response to questions raised in media coverage on GP referrals process.
Withdrawal and reduction of services for people with hearing difficulties.
Breast cancer screening programme - recognition of the need for cancer screening to be offered to people over 70 years of age.
Televisions in practices - response to a previous discussion/request.
NHS 111 Procurement process update on progress.
Guy’s and St Thomas’ Hospital NHS Foundation Trust Stakeholder Governor role.
7
LCCG/GB/15/127 – Declarations of Interest
AM invited declarations of interest on all papers. Governing Body (GB)
members confirmed there were no additional declarations of interest other than
those set out in the Register of Members’ Interests.
8 LCCG/GB/15/128 – Register of Members’ Interests
The Governing Body noted the current register of member’s interests.
9
10
LCCG/GB/15/129 – Draft minutes and action log from the meeting held on 2nd September 2015 The minutes from the LCCG Governing Body meeting held on 2nd September
2015 were agreed as an accurate record.
AM reviewed the matters arising from 2nd September action log and noted that
all areas of work had been completed.
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No. Agenda Item Action/date
Chair’s Action
11
12
LCCG/GB/15/130 – Chair’s Action
The Governing Body received the following Chair’s Actions:
Agree the changes to the Financial Control Environment submission.
Agree the changes to the Involving People 2014-15 Report.
Both Chairs’ Actions were noted and ratified by the Governing Body.
Chair and Chief Officer Report
13
14
LCCG/GB/15/131 – Chair’s Report
AM presented the Chair’s Report for the period 3rd September 2015 to 3rd November 2015 and emphasised a number of items including:
Governing Body attendance at local partners Annual General Meetings (AGM).
Highlights from the LCCG AGM and Lammy Awards ceremony, where AM reported that over 200 attendees gathered to recognise and commend contributions made by Lambeth’s staff, carers and others, to Lambeth residents.
Changes to the Governing Body. AM informed the meeting that Hasnain Abbasi, had taken a decision to stand down from his role as elected clinical Governing Body member for South West locality. On behalf of the Governing Body AM thanked Hasnain Abbasi, for his valued contribution in the role, most notably his leadership of the Primary Care Development Programme and contribution to the Prime Minister’s Challenge. AM confirmed that LCCG had begun the selection and election process to recruit a replacement for the post which it was hoped to have completed by January 2016.
The Governing Body received the Chair’s November 2015 Report.
15
LCCG/GB/15/132 – Chief Officer’s Report
AE updated the Governing Body on the Chief Officer’s Report for November
with particular focus on the following key items:
Taking forward Health service transformation across London:
o AE outlined the context of NHS Five Forward View vision and the
London Health Commission’s Better Health for London report to the
Mayor of London published in October 2014. He shared highlights of
a One-Year-On event which he had attended to mark the first
anniversary of the Better Health for London publication.
o AE noted that collective feedback from the Mayor of London Boris
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No. Agenda Item Action/date
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17
Johnson, Simon Stevens, Chief Executive of NHS England and
Professor Lord Ara Darzi in relation to the past twelve months was
that significant progress had been made. AE invited members to
review the progress report Better Health for London One-Year-On.
o AE confirmed that London’s CCGs and NHS England (London) have
agreed a Transformation Programme to support these plans and
there would be opportunity to hear more about this work later in the
meeting (Healthy London Partnership report).
o London devolution proposals including a recommendation following
the Governing Body discussion and Comprehensive Spending
Review announcement, for the draft collaborative agreement to be
taken during November by Chair’s Action.
A Governing Body member posed a question in relation to whether the
devolution proposition would improve health and welfare and/or housing
prospects for London’s key workers. AE confirmed that there is nothing
specific in terms of social care. HCM stated that although housing is high
on the agenda a key issue is around homelessness.
Update on Care Quality Commission (CQC) Inspection visits:
o AE reported on outcomes of the King’s College Hospital (KCH) NHS
Foundation Trust inspection. AE noted that behind the headlines for
KCH is a positive story with a trajectory for improvement including an
action plan, which will be monitored by the KCH Clinical Quality
Review Group (CQRG).
o CQC inspection reports for Guy’s and St Thomas’ NHS Foundation
Trust (GSTT) and South London and Maudsley NHS Foundation
Trust (SLAM) are expected during December; an update will be
provided when these reports are published.
Action: AE to provide an update to the Governing Body on GSTT and
SLAM CQC inspection reports when these have been published.
The Governing Body received the Chief Officer’s report for the period 3rd September 2015 to 3rd November 2015.
Andrew
Eyres
Presentation
18
19
LCCG/GB/15/133 – Presentation
The Governing Body received a joint presentation from the Integrated Adults Programme by Dr Daniel Harwood (DH), Consultant Psychiatrist and Interim Clinical Director for Dementia London Strategic Clinical Network and Liz Clegg (LC), Assistant Director, Integrated Commissioning. The presenters delivered an update on dementia diagnosis and post-diagnostic support, describing the development of work to date and future plans
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No. Agenda Item Action/date
20
21
22
23
24
25
26
27
nationally, locally and London-wide. DH commended Lambeth for the good work being done throughout the borough and reported that Lambeth was ranked as the second highest performing London borough for dementia diagnosis rates (86%). DH highlighted concerns raised nationwide around the variation in quality and range of post-diagnosis support; however noted that several tools will be put in place during 2016 to help address these issues such as, dementia care guidance and a dementia performance scorecard. The presentation also highlighted the need for strategic use of partners and key stakeholders to improve dementia care. An illustration of areas that would benefit from this activity included joined up care through enhanced joint working between the Local Authority, voluntary and primary care service, also the role of Local Care Networks in helping Lambeth to become a dementia friendly borough. LC thanked Catherine Pearson, Chief Executive, Healthwatch Lambeth, who she said worked closely with LCCG, and who, was able to provide valuable feedback and insight of patients’ needs through their dementia engagement work with those living with dementia, their families and carers. This would help to inform and influence future service design/redesign. GL gave an example of the poor dementia care locally and Governing Body members discussed how we can encourage dementia friendliness across Lambeth, particularly within local Acute Trusts. LC recognised that although some progress had been made, further work was required to enable local Trusts to become dementia friendly. DH also confirmed that a working group had been set up to look at the dementia friendliness of Lambeth’s hospitals.
HCM commented that Lambeth has a strong dementia team and therefore she would like to see more in this area of work and strong integration across health care. The Governing Body also discussed the following key issues:
JB raised concern regarding the way in which referrals are currently completed (annual memory test) and asked how this could be improved. DH noted JB’s comments and said that he would consider the issue.
How to reduce variation in the quality of Lambeth’s dementia support offer. DH acknowledged that quality of dementia support is patchy and confirmed that SLAM is providing dementia training to nurses as part of an upskilling exercise, which DH said was a step in the right direction.
Recognition that this is a condition that lends itself to joined up working.
The role of Lambeth’s Local Care Networks, carers and families; also
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No. Agenda Item Action/date
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supermarket groups in increasing dementia friendliness and awareness. RM suggested how to encourage involvement of informal carers, particularly in times of increasing austerity.
LC reported that LCCG staff had undertaken dementia training and offered to arrange similar training for Lambeth practices and invited Local Care Network representatives interested in becoming dementia friendly to contact her.
CP said that Healthwatch Lambeth would also be happy to support practices in Lambeth to become more dementia friendly and other key stakeholders.
Care planning for people with dementia. HA suggested that a single care plan would reduce the challenges that multiple plans can introduce.
Use of datanet to identify forms of dementia and understanding of it. AM noted the importance of improving dementia friendliness across Lambeth and challenge was made to Lambeth’s three Local Care Networks to become the first dementia friendly network. On behalf of the Governing Body, AM thanked the team for their presentation.
Items for Decision
30
31
32
33
LCCG/GB/15/134 – Healthy London Partnership beyond 2015/16 AE set out the context and purpose of the paper, citing the Chief Officer’s report where an update on devolution had been outlined. He confirmed that a more comprehensive version of the paper and a ‘Better Health for London One Year On Report’ was also available on the LCCG website. AE noted that a good deal of work was taking place and there is evidence of real value across the current 13 programmes. This also involved planning for next year and he said that work around homeless patients’ needs which had been completed was a good example of the activities underway to review and refresh the scope of individual programmes to agree which should continue in the programmes. AE outlined how the proposed governance arrangement would work. This would include the establishment of two reference groups; a Clinical Oversight Group to maintain the integrity of clinical commissioning and an improvement leadership collaborative, to support discussion with partners. AE highlighted the pace at which programmes are being advanced and the progress made over last six months (IAPs, dementia and crisis concordat) stating that London is ahead in this work. SG commented that she welcomed the extension as a three year period as it would provide time for the HLP to make an impact. She expressed concern about whether there was sufficient rigour and holding to account to ensure that each programme has a deliverable that represents an opportunity to make a
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NHS Lambeth CCG Governing Body Minutes Page 7 of 14
No. Agenda Item Action/date
34
35
36
37
38
real difference for London. SG asked about whether the partnership can be used to influence supermarkets to do something innovative with wasted food. AE explained that food was not part of programmes at present and would feed back her comments to the group. CP asked for clarification about the national prevention report timescales for impact assessment and evaluation of interventions on alcohol, smoking and obesity. AE offered to check for any further update on timing for this work. Action: AE to enquire about the national prevention report timings (alcohol, smoking and obesity). The Governing Body:
Noted the progress to date of the Healthy London Partnership.
Agreed to support longer term commitment to the Healthy London Partnership for 2016/17 and 2017/18.
Agreed the proposed planning process and the financial planning assumption for 2016/17 and 2017/18.
Agreed proposed ongoing governance arrangements. The Governing Body agreed to Chairs Action for the final approval of the devolution agreement which will then be ratified at the January 2016 Governing Body meeting in public.
Andrew
Eyres
39
LCCG/GB/15/135 – NHS Lambeth Clinical Commissioning Group (CCG) Commissioning Intentions for 2016/17 AP and CC presented the Commissioning Intentions for 2016/17 and emphasised a number of key points:
An updated CCG Operational Plan is required for publication by April 2016. National planning guidance to support this work is expected during December 2015. As part of this work each of the programme boards are developing and prioritising commissioning intentions (CI). Programmes will also model the impact of CIs on QIPP (Quality, Innovation, Productivity and Prevention) for 2016/17.
AP noted that CI testing and prioritising work will be undertaken throughout November and a draft version Operational Plan will be produced by January 2016. The Governing Body will receive further updates in the intervening period before it is brought back to the Governing Body meeting in public in January 2016.
LCCG’s current five year financial structure. CC stated that as part of the planned financial refresh for 2016/17 to 2018/19 a number of actions are being taken which are likely to impact upon QIPP levels.
During December 2015 the Governing Body will discuss the draft financial envelopes including investment to deliver LCCG’s CIs.
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No. Agenda Item Action/date
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41
42
Prioritisation process design and scoring criterion.
Key milestones and dates for the 2016/17 Operational Plan. CC commented that significant work is required to be completed between November and early January 2016, including the development of a South East London Plan.
JB sought clarification in relation to the Nine Elm Vauxhall development and whether the estimated numbers of residents registered with Lambeth practices are actual or predicted. CC confirmed that the underlying population will be based on the ONS (Office of National Statistics) figures. JB observed that most Wandsworth residents on the border are already registered with Lambeth GPs and therefore significant change is unlikely. In response to a query regarding whether the planned activities should be reflected in the local co-commissioning plan and associated risk register, CC confirmed that the work would be cited on the relevant risk registers. The Governing Body:
Supported the proposed approach to delivering the 2016/17 Operational Plan.
Noted that each programme board is working up the commissioning intentions; including the impact on QIPP for 2016/17 and that they will recommend commissioning intentions to the Governing Body for agreement.
Noted the CCG’s prioritisation process.
Noted the timetable for delivering the 2016/17 Operational Plan.
43
44
45
46
47
LCCG/GB/15/136 – NHS Lambeth Clinical Commissioning Group Safeguarding/Child Protection Annual Report 2014/15 MM acknowledged and thanked everyone who had contributed to the production of the NHS Lambeth Clinical Commissioning Group Safeguarding/Child Protection Annual Report 2014/15. The report had been recently been reviewed and approved at the Integrated Governance Committee meeting and a report would be presented to a future Governing Body Seminar following the NHS England deep dive meeting. MM explained that the LCCG Safeguarding/Child Protection Annual Report 2014/15 outlines work undertaken during the past year, governance arrangements in place and future plans. A work plan covering 2015/17 activities across all designated areas provides details of the programme of work for 2015/17 (page 123 refers). The report provides assurance that LCCG’s Safeguarding and Child Protection arrangements for the period are compliant with the guidelines and its statutory responsibilities. MM highlighted the main issues in the paper including training and serious case reviews. MM noted that LCCG promotes learning from serious incidents
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No. Agenda Item Action/date
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49
50
51
52
and as such the Lambeth Safeguarding Children Board and Safeguarding Looked After Children working Group in partnership with other key stakeholders have been involved in two serious case reviews. The report was considered by the Integrated Governance Committee, who recommended that a number of Governing Body Seminary sessions related to adults and children’s safeguarding are arranged to highlight responsibilities. This is proposed to take place following NHS England’s deep dive meeting scheduled for November 2015. RM observed Lambeth’s London ranking for serious youth crime and the increase in this type of violent crime. RM described how a family member had been personally affected and asked whether more can be done by police to tackle this. MM said she would look into and liaise with RM on the matter. Action: MM to liaise with RM about serious youth crime in Lambeth AM commented that it would be helpful to know of any practices where safeguarding training has not been undertaken and therefore gaps. MM said she would raise AM’s query with the Safeguarding Board. Action: MM to raise with the Safeguarding Board how to report on gaps in safeguarding training for Lambeth GP practices. The Governing Body approved the Safeguarding/Child Protection Annual Report 2014/15.
Maria Millwood
Maria Millwood
53
54
55
56
LCCG/GB/15/137 – Lambeth Safeguarding Adults Partnership Board Annual Report MMcG outlined some of the work programmes undertaken over the period April 2014 to March 2015 and highlighted the work around adult protection led by Healthwatch Lambeth’s Hidden Voices project. She also spoke about a number of challenges, including implementation of the Mental Capacity Act and Deprivation of Liberties (DoLs). MMcG confirmed that a Governing Body training session incorporating DoLs was scheduled to take place in November 2015. MMcG reported that a substantial amount of positive work had been completed and improvements made over the past 12 months. She stated that further work particularly around recruitment, creation of a new safeguarding hub, serious case reviews and capacity issues is required. The Governing Body discussed the report and made a number of observations:
Provision of Adult Safeguarding training for GP surgeries in light of less funding was raised by HA. MMcG confirmed that she would look into the matter and update the Governing Body.
Action: MMcG to look into the position of future Adult Safeguarding
Training for Lambeth Practices.
Moira McGrath
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No. Agenda Item Action/date
57
58
.
Increased use of Deprivation of Liberties (DoLs) over the past year and the significant implications this has for primary care.
AM questioned whether the DoLs issue should be formally noted within LCCG as a risk. MMcG said that the matter could be raised as an issue although she anticipated that the legislative process would not be rapid; equally it would primarily apply to people in residential and nursing care. HCM commented that Lambeth Council is less adversely impacted by DoLs than the rest of the country which she said was due to being well prepared. HCM agreed that the issue should be placed on a risk register.
Considered best practice around the prevention of financial abuse to people living alone. CP described the role Healthwatch (Hidden Voices), Age UK and others play in addressing such matters and HCM confirmed that financial abuse is often the gateway to other elder abuse which she said that the Adult Safeguarding Board are looking into.
SC highlighted work being carried out in Southwark among people with learning difficulties and described people in the community who do not meet eligibility criteria for receipt of social care services, and are vulnerable in various ways. SC enquired whether these individuals could receive support from the financial resilience group for example. MM said that the matter could be raised at GB Seminar.
The discussion was concluded with a general acknowledgement that safeguarding is a universal issue that extends beyond people who are in receipt of services. AE reminded Governing Body members of our responsibility to provide the necessary safeguarding assurance and as such to keep these important reports (Adults and Children) on the agenda. The annual report for the Lambeth Safeguarding Adults Partnership Board was endorsed by the Governing Body.
Items for Discussion
59
LCCG/GB/15/138 – Integrated Governance and Performance Report AE presented the November 2015 Integrated Governance and Performance Report against five priority programmes. A number of issues were emphasised:
LCCG is now operating in the 2015/16 CCG Assurance Framework.
LCCG met with NHS England on 16th October to discuss Quarter 1 assurance. The written result of this is outstanding and a number of deep dive meetings with NHS England are planned. AE emphasised the need to ensure that where the CCG is measured on systems, that this accurately demonstrates work being carried out.
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NHS Lambeth CCG Governing Body Minutes Page 11 of 14
No. Agenda Item Action/date
60
61
62
63
64
Redesign of the Integrated Governance and Performance Report to allow for a more detailed description of risk (previous format focussed on scores of 12 and above).
Areas of highest risk within the risk register, Board Assurance Framework/Risk Heatmap were identified including cancer which AE confirmed are being managed as discussed in the Public Forum.
AE confirmed that a copy of the complete report is available on the CCG website. The draft report had been reviewed and discussed at the Integrated Governance Committee meeting on 21st October 2015. RM questioned whether LCCG measures the quality of Guy’s and St Thomas’ NHS Foundation Trust (GSTFT) in-patient/out-patient discharge letters. JB confirmed that some diagnostic work had been carried out to understand the underlying problem (data issue) and agreed that the frequency and content requires further improvement. A working group is investigating these issues. AM recommended that the matter should be formally noted as an issue and should be considered at the GSTFT CQRG (Clinical Quality Review Group). Action: JB to raise issues regarding patient discharge communication with GSTFT CQRG. The Governing Body noted:
2015/16 latest updates against Business Plan Objectives.
Latest update of the Board Assurance Framework and Risk Register
John Balazs
Receive Regular Reports
65
67
68
LCCG/GB/15/139 – 2015/16 Financial Position as at Month 6, September
2015
CC summarised the 2015/16 Financial Position as at month 6, September 2015
report including the latest performance on NHS Lambeth CCG’s cash
management strategy and noted the following key points:
LCCG is underspent by £3.807m as at 30th September 2015 and is
forecasting a year end surplus of £7.612m in line with the plan.
LCCG is forecasting that it will achieve 100% delivery of its QIPP (Quality,
Innovation, Productivity & Prevention) target in 2015/16.
CC reported that continuing care continues to remain a pressure and she confirmed that ongoing discussion of the matter including through the Finance and QIPP Working Group. The Governing Body noted:
Noted the 2015/16 financial position as at month 6.
Noted the latest performance on NHS Lambeth CCG’s cash management
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No. Agenda Item Action/date
strategy.
69
70
71
72
73
74
75
LCCG/GB/15/140 – Joint Director of Public Health Report SC presented the Joint Director of Public Health Report setting out a number of
key areas of activity:
Joint Strategic Needs Assessment - male life expectancy rate in Lambeth
was reported to be improving and borough differences in demographic
figures for Lambeth and Southwark were noted.
South East London Illegal Tobacco ‘Keep it Out’ Campaign with a focus
improvement in smoking prevalence rate (19.9%). SC explained that the
work had been focussed on addressing illegal tobacco within specific
communities which was a key factor in the tobacco control interventions.
Stoptober Campaign - SC shared how new legislation introduced on 1st
October 2015 would help to support this year’s campaign.
Update on Infection control. SC highlighted an issue around antibiotic
resistance and the challenges this presents to Public Health (PH)
internationally; confirming that Medicine Management teams are
supporting with this work. SC continued to illustrate the positive impact of
the annual flu immunisation on wider infection control activities.
Bowel Cancer Screening pilot and noted the previous discussion in the
earlier Public Forum meeting.
AM reaffirmed the importance of the flu jab and encouraged people who have not done so to be immunised. SG recommended that any available prescribing best practice information should be included on the LCCG website. MG commented that he would welcome the opportunity to use some of Prime Ministers Challenge Fund money to improve health checks amongst people with Learning Difficulties. It was noted that Self Care Week 2015 was scheduled to take place later in November (16th – 22nd November). The theme is ‘Self Care for Life’ and the governing body, particularly clinical members were asked to raise awareness of this with Lambeth GP practices.
The Governing Body noted the Director of Public Health report for the period
covering the period July to September 2015.
76 LCCG/GB/15/141 – Clinical Network Report
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NHS Lambeth CCG Governing Body Minutes Page 13 of 14
No. Agenda Item Action/date
77
78
79
MG updated Governing Body members on the Clinical Network report highlighting key activities including: Development of the Clinical Network (CN) focussed on a CN event on 19th November and a soft re-launch of the Network. MG said that he was keen to ensure the Network was working to full capacity to support LCCG and that a number of actions was being taken to achieve this such as annual reviews, improved control of this year’s budget, two new leads (including a cancer lead) to join the CN over the next two weeks. MG suggested sharing of key roles with Southwark CCG. Lambeth Expert Panel ‘Ask the Lamberts’ process. MG confirmed that a monthly list of questions would be collected commencing on 1st December 2015. The Governing Body noted the Clinical Network report for the period 3rd September 2015 to 3rd November 2015.
Items for Information
80
81
82
83
84
LCCG/GB/15/142 – Primary Care Development Programme update HA presented an update on the Primary Care Development programme and highlighted a number of key areas:
Establishment of a multi-stakeholder LCN (Local Care Network) enabling forum. HA shared outputs from its first meeting and described some of the multi-agency projects underway.
Go live of hubs with at least one patient referral from 46 of the 47 practices at the end of October 2015.
Review of Prime Minister Challenge Fund and ongoing discussion with NHS England regarding how the money might be used. HA said it is hoped that this will be finalised by April 2016 although he recognised that this could take longer to achieve.
SG said that she welcomed the report and posed a question in relation to expectations of LCNs and clarification was sought as to whether proposals would be developed by the Primary Care Programme Board. HA explained that there would be benefit to standardisation and for proposals to cut across all programmes. At present this would be around sharing learning about what is best practice and how this can be replicated. AE commented that consistency would come out of the commissioning intentions and as we work with the provider group. AP said SG comments had previously been acknowledged. As such a task and finish group was looking at this area and development of the necessary processes. The Governing Body noted developments and progress in Primary Care.
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No. Agenda Item Action/date
85 LCCG/GB/15/143 – NHS Lambeth CCG Audit Committee Summary The Governing Body noted the summary report of items discussed at the Audit
Committee meeting held on 16th October 2015.
86 LCCG/GB/15/144 – NHS Lambeth CCG Audit Committee Approved Minutes The Governing Body noted the approved minutes of the meeting held on 17th August 2015.
87 LCCG/GB/15/145 – NHS Lambeth CCG Integrated Governance Committee Approved Minutes The Governing Body noted the approved minutes of the meeting held on 19th August 2015.
88
LCCG/GB/15/146 – NHS Lambeth CCG Engagement, Equalities and Communications Committee Approved Minutes The Governing Body noted the approved minutes of the meeting held on 3rd June 2015.
89 LCCG/GB/15/147 – Other Approved Minutes The Governing Body received the approved minutes of the following meetings:
Lambeth Children and Families Strategic Partnership (CFSP), 11th May 2015.
Lambeth Borough Prescribing Committee (LBPC),
18th May 2015.
Primary Care Joint Committees (PCJC), 11th June 2015.
South East London Area Prescribing Committee (APC), 30th June 2015.
Health and Wellbeing Board, 8th July 2015.
SE London CCGs’ Clinical Strategy Committee, 16th July 2015.
Lambeth Borough Prescribing Committee (LBPC), 20th July 2015.
Available at: www.lambethccg.nhs.uk/news-and-publications/meeting-papers/governing-body
90 LCCG/GB/15/148 – Any Other Business No other business was reported.
91 LCCG/GB/15/149 – Next meeting
Wednesday 20th January 2016 1.00pm – 4.00pm Venue: The Foundry, Rooms 4,5 and 6, 17 Oval Way, London SE11 5RR
The agenda and minutes of this meeting may be made available to public and persons outside of NHS Lambeth Clinical Commissioning Group as part of the CCG’s compliance with the Freedom of Information Act 2000.
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Page 46 of 159
1 V5
Report to the Governing Body
20th January 2016
Report Title
Chair’s Report
Author(s)
Adrian McLachlan, Chair of the LCCG
Governing Body/Clinical Lead(s)
Adrian McLachlan, Chair of the LCCG
Management Lead(s)
N/A
CCG Programme
Governance
Purpose of Report
For information
Summary
To highlight the Chair’s activity and updates from localities over the period 5th November 2015 to 19th January 2016.
Recommendation(s) The Governing Body is asked to receive the Chairs Report for the period 5th November 2015 to 19th January 2016.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG?
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
All legal, engagement, inequalities, financial and resource implications and any
potential or actual risks are set out in detail in the body of this report.
E
nc 0
07 -
Cha
ir R
epor
t
Page 47 of 159
2 V5
Chair Report January 2016
Welcome to 2016. We enter the final quarter of the 15/16 financial year with all the
work that brings in keeping delivery on track and wrapping up the end of the year, at
the same time as we have important planning and negotiating for the 16/17 year to
come. It does feel different, in that the financial pressures will be even more
challenging, and our relationships, learning and development over nearly three years
as a CCG, will be particularly tested.
Governing Body Updates
Following a selection process and mandate of support from member practices in the
locality, I am pleased to note that Martin Godfrey has been successful and will start as
one of the southwest locality clinical leads when Hasnain Abbasi steps down after the
governing body meeting today. I would like to welcome Martin to the team; he brings
both local knowledge as a GP, and experience in our clinical Network as well as wider
experience in communicating about health. I would also like to thank Hasnain, who
has been a valued member of the governing body, and provided great leadership, in
particular in the Primary Care Development Programme, as we have seen the
emergence of GP federations and the foundation for Local Care Networks.
It has been a long process looking to recruit to the secondary care doctor role on the
governing body, and it is therefore great to be able to note that following interviews,
we have, jointly with Southwark, offered the role to Michael Khan, who is a consultant
and Associate Professor of Medicine at University of Warwick University Hospitals of
Warwick and Coventry NHS Trust, and he has accepted.
Events to note
On 6th November, Guys and St Thomas Community Services held an awards
ceremony, recognising the contributions of individuals and teams and celebrating with
music and food. It was a great evening, and felt very good to be a part of a celebration
of the great work and the spirit of those working in community health services.
On 8th November, I once again attended Lambeth’s Armistice Day celebration at
Streatham War Memorial, laying a wreath on behalf of the CCG and the NHS in
Lambeth. This is an impressive occasion with about 80 different groups or
organisations present, representing the breadth of our local population, coming
together in quiet appreciation of sacrifices made, and a hope for future peace.
Over the last couple of months, there have been a number of meetings of the sponsor
board for Southwark and Lambeth Integrated Care, as it approaches the end of its
existing funding from Guys and St Thomas Charity. We have reviewed the progress
made, and the significant achievements in delivering care closer to home for frail older
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people, demonstrated by impact on emergency admissions, residential placements
and positive feedback from people who have received the different elements of the
integrated offer. We have reflected on the difficulties we have faced in attempting
major system change across two boroughs and the complexity of multiple
stakeholders, which will be examined further in our formal evaluation. And, we have
looked to evolve the design of future joint working and agreed the important points of a
collective wish to continue to work together where this is the right scale and supported
by a Strategic Partnership, and to reinforce the importance we attach to and the
support we will all lend to the development of Local Care Networks.
On 25th November, the Governing Body had day of protected time away together, to
allow room for thinking and discussing how we can work most effectively, recognising
the challenging national and local context. Thanks to the team within the CCG who
facilitated and supported, and I would like to offer appreciation of those who
contributed to what were important conversations, which I hope have set us up to be a
stronger collective voice in health and care locally.
On 9th December, the Lambeth Patient Participation Group Network held their AGM,
which as well as doing the formal business, provided a platform to launch a resource
pack to support the development of effective PPGs. I was invited to join the
proceedings and to give a brief talk on the CCG perspective on developments that
would be of interest or relevance, and then took part in a good discussion about how
best to mobilise the patient voice at practice level and how this may become more
effective as we work more closely together at locality level.
The Health Improvement Network board met on 11th December. We heard a
presentation on the progress within the dementia workstream, and had discussions
about how as a network we can increase the impact of innovation and diffusion across
South London, in support of the ambitions of the Five Year Forward View, and what
links can be made between the three Academic Health Science Networks across
London with joint work such as Digital Health London.
On 15th December, the Living Well Collaborative held the latest of our big, borough
wide events, bringing together about 150 people, updating on our progress with
system changes towards the delivery of our big three outcomes, hearing about the
progress of the Black Wellbeing Commission, learning from the experience of others
in the Open Dialogue approach in Mental Health and spending time in workshops
going into more detail of co-creating the future of the Living Well Network.
On January 12th, I was able to attend a meeting held in the House of Commons, led
by Dilip Joshi, chair of Lambeth Southwark and Lewisham Local Pharmaceutical
Committee, hosted by Rt Hon Kate Hoey MP, and hearing from Di Aitken, Gill Vickers
and Nicola Kingston on perspectives on community pharmacy and how to make the
best use of limited resources, delivering innovation through collaboration.
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Lambeth CCG was one of four CCGs shortlisted for the Clinical Commissioning Award
at Health Business Awards, with the ceremony held on 3rd December. We weren’t the
winner on this occasion, and congratulations to Southport and Formby CCG.
And finally to note, there was a winter quiz at Lower Marsh, raising money in support
of world mental health day, brilliantly themed around the Mad Hatters Tea Party. In the
evening, we managed to raise £414.94 for the Mental Health Foundation. And the
winners? Management Team plus one governing body chair. A great evening, testing
our knowledge, and reinforcing what a great team we have working at Lower Marsh.
Coming Up
We will be holding an All Practice Event and Members’ Forum on 28th January, where
we will be discussing Commissioning Intentions, the Personal Medical Services
Contract Review for General Practice and the development of Local Care Networks.
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Report to the Governing Body 20th January 2016
Report Title
Chief Officers Report
Author
Andrew Eyres, Chief Officer
Governing Body Lead
Andrew Eyres, Chief Officer
Management Lead
Andrew Eyres, Chief Officer
Clinical Lead
N/A
CCG Programme
N/A
Purpose of Report
For information
Summary
To highlight key issues, not included in Lambeth Clinical Commissioning Group Governing Body papers over the period from 4th November 2015 to 19th January 2016.
Recommendation(s)
The Governing Body is asked to receive the Chief Officer’s report for the period from 4th November 2015 to 19th January 2016.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance against any of the risks identified in the Board Assurance Framework?
N/A
All legal, engagement, financial and resource implications and any potential or actual risks are set out in this report.
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Report to the Governing Body
January 2016
Chief Officers Report
1. Lambeth CCG Development
The CCG participated in the 2015/16 National Staff Survey which enables us to benchmark
our progress with a wider pool of NHS organisations and demonstrates an ambition to build
on our reputation as an employer of choice. I am delighted to confirm that we have
received a final response rate of 90% from our staff. The Picker Institute have supported us
with this work and we will receive a report setting out the detail of staff responses later this
month, including how we compare to other CCGs across the country. We will update
Governing Body members in due course.
The Annual CCG 360° Stakeholder Survey will be conducted in early 2016. The national
Survey is an integral part of the CCG annual assessment and provides an opportunity for
all CCGs and their stakeholders to consider questions about how they work together and
how their working relationships can be further improved to ensure the best possible
outcomes for local people. As in previous years we will work with the team coordinating the
Survey to gather in the views of our Member Practices and of our key stakeholders.
2. Commissioning Support Services
South East London CCGs have collectively agreed the need to “test the market” using the
national framework for commissioning support services, the Lead Provider Framework, to
ensure that we have robust commissioning support services in the future. On 8th January
2016, we launched the South East London Invitation to Tender (ITT) for GP IT and CCG IT
services. This work builds on work across south east London to develop a clear
specification for the services we require in this area. The deadline for responses to the ITT
from suppliers is 5th February 2016 after which evaluators from the CCGs will review
responses. We will keep Governing Body members updated on this work over the coming
weeks.
3. Taking forward system-wide transformation
The NHS Five Year Forward View set out a vision for how the health service in England
needs to change over the next five years if it is to close the widening gaps in the health of
the population, the quality of care and the funding of services. Planning guidance from
NHS England and other national bodies, following the Government’s Comprehensive
Spending Review, was published on 23rd December 2015 in order to inform NHS planning
for 2016/17 and beyond. Individual CCG 2016/17 allocations were published on 8th
January 2016.
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Over the next months’ CCGs are required to produce two separate, but connected, plans;
A five year Sustainability and Transformation Plan (STP) which is a place-based
plan to address the Five Year Forward View to be developed in partnership with
NHS commissioners, providers and local authorities across a wider geography than
just Lambeth (in our case likely to be South East London). Access to transformation
funding from 2017-18 onwards will rely on having a robust STP plan.
A one year organisation-based Operational Plan for 2016/17 that is consistent with
the emerging STP and which addresses key deliverables in the next financial year
including financial balance plus general practice, A&E, cancer, mental health and
other access standards.
The first draft of our 2016-17 Operating Plan will need to be submitted on the 6th February
with the STP following by the end of June. A full report on the development of Lambeth
CCGs forward commissioning plans, in the light of this national guidance and working with
our partners, is included separately within the Governing Body papers.
4. Integration, collaboration and devolution in London
The aspirations of London’s NHS and local government partners are set out in Better
Health for London, following the work of the London Health Commission, with the aim to
make London the healthiest major global city within 10 years. CCGs across London, along
with NHS England, have agreed a Transformation Programme to support our ambition.
This is overseen by the London-wide Transformation Group and comprises a suite of
thirteen programmes to address system-wide improvement, whilst recognising that change
will be delivered in individual boroughs, across boroughs and city-wide. At the November
Governing Body meeting in public the CCG confirmed its continued commitment to this
programme. London-wide programme planning remains underway by CCGs and the
programme teams in line with wider CCG plans and final proposals will be brought to the
CCG Governing Body for sign off.
As previously discussed by the Governing Body and following extensive review by all 32
London CCGs, by London Councils and by the GLA, agreement has been reached to work
closely together to go further and faster in integration and collaboration and using
devolution as a tool to achieve this. National bodies, NHS England, Public Health England
and central government have agreed to support this agenda by being active partners and
demonstrating their commitment to health and care devolution in London. The London
Health and Care Collaboration Agreement was signed on 15th December 2015 with the
parties to the Agreement being;
All 32 London Clinical Commissioning Groups,
All 33 local authority members of London Councils
The Mayor
NHS England
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Public Health England
The London Health Devolution Agreement has also been signed by these parties and in
addition central government partners.
At the core of the agreements are a focus on greater health and care integration; deep
action on prevention and maximising the value from health and care estate. The
agreement confirms an enabling approach whereby those boroughs and CCGs who want
to take forward pilots to bring central powers to a lower level would be able to work within
an overall London-wide collaborative framework. This would allow others the option to take
up the approach if it proves successful and beneficial.
The key elements of the agreement are that;
i) Given the size of the London system three levels of action will be needed: borough
(local); multi-borough (sub-regional); London-wide (regional).
ii) The agreement is underpinned by the principle of subsidiarity. This means that decisions
should always be taken at the most local appropriate level and aggregated up to multi-
borough or London-wide only as needed.
iii) London’s health and care system is highly complex. We have a large number of health
and care organisations and population and patient flows occur with frequency across local
boundaries. For these reasons London will be running pilots to test different elements of
health and care devolution at different geographical levels.
Through Better Health for London, London already has a high level plan for improving
health making it fairly unique in England. All London partner organisations have committed
to delivering on the 10 aspirations to promote health and wellbeing set out in Better Health
for London: Next Steps and in doing so, deliver on the NHS Five Year Forward View.
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If decisions about London are made within the London system, they will respond more
closely to the challenges and opportunities of our city and population. We plan to test how
this works in practice through devolution pilots with the ambition to scale up across the city.
For Londoners we expect this to mean a more effective, streamlined health and care
service, greater support to stay as healthy as possible, for as long as possible, and
ensuring health and care resources are used most efficiently.
London will begin by testing different elements of greater integration, collaboration and
devolution in different parts of the system through a series of pilots. The pilots will develop
detailed cases for new devolved powers, resources and authority in partnership with
government and national bodies. It will produce faster transformation than can be achieved
in the current system. Through the pilots, devolution may be secured both for the pilots
themselves and also for other parts of London, contingent on these areas also developing
suitable plans, delivery and governance arrangements. The five London devolution pilots
will explore four themes:
Greater care integration at sub-regional geography – Barking & Dagenham,
Havering and Redbridge (Outer North East London)
Estates planning at sub-regional geography – Barnet, Camden, Enfield, Haringey,
Islington (North Central London)
Local care integration at borough level – Hackney (including the Borough of
Hackney and City & Hackney CCG) and Lewisham
Preventing ill health at a borough level – Haringey
Oversight and support to the proposals will remain through the London Health Board,
chaired by the Mayor and supported by all the key London health partners.
5. Operational Resilience
Accident and Emergency 4 Hour wait Standard: The Lambeth and Southwark Urgent
Care Working Group continues to provide oversight and support to the delivery of local
urgent care services with a focus on ensuring performance continues to be delivered
through the busiest winter months. Whilst GSTT benchmarks well against most London
Trusts the 95% 4 hour A&E standard has not been consistently met since quarter
1 Performance has been driven by higher levels of acuity, the impact of the A&E rebuilding
programme and overall capacity constraints. The Trust has initiated actions to increase
hospital capacity and is reviewing available capacity in the ERR and @home services to
support admissions avoidance. Capacity in intensive care is being reviewed and a
dedicated space for the frailty unit has been identified. The Trust has an established winter
planning group to have oversight of this work.
Kings performance at Denmark Hill has been below the expected improvement trajectory of
returning to the 95% target. Work is underway to mitigate current challenges in four key
areas;
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ED Recovery Plan, work streams cover in hospital and out of hospital.
Out of hospital care services, including maximising the utilisation of OOH services
and improving mental health pathways
Hospital demand and capacity plan implementation (actions to address bed
capacity).
Winter planning initiatives, Lambeth and Southwark CCGs have
funded specific schemes along with mainstream contract funding for winter planning.
Our Winter Communications Campaign: Since October, the CCG has been running a
winter communications campaign which supports the national NHS England winter
campaign Stay Well This Winter. The campaign is designed to ease pressure on the
healthcare system over the winter period. The campaign has a focus on supporting people
to stay well, encouraging people to look after themselves, and use pharmacies as a first
port of call when appropriate. The campaign was designed to;
Increase uptake of flu vaccination
Encourage better self care by older people and those with long term conditions
leading to fewer unplanned admissions this winter
Support better use of the primary and urgent care system to reduce attendances at
A&E and relieve pressure on the system this winter
Reduce inappropriate use of antibiotics.
We have supported national and regional advertising and marketing on the campaign with
the roll out of a toolkit for GP practices which included posters, leaflets and messages for
websites. In addition we have sent information to pharmacies, local hospitals, Lambeth
Council and voluntary organisations to share with local people, as well as in the local media
through our Dr Know column and using social media.
We are further supporting the winter campaign this month with the launch of the Health
Help Now website and app to help people in Lambeth understand where they should go for
treatment, especially when they need support in a hurry, late at night or at the weekend.
The app can be downloaded by searching ‘Health Help Now’. It is also available online at
www.healthhelpnow-nhs.net, and helps people check their symptoms and find the best
place for treatment and showing which nearby services are open. We are also planning
patient roadshows at a handful of practices over the next month where we will provide
information about the winter campaign and Health Help Now.
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Planning for Junior Doctors strike action: The CCG has worked with local provider
teams to ensure assurance was provided for the impact of the Junior Doctors strike on the
12/13th January. This included hospital, community and mental health providers identifying
speciality cover, re-planned elective activity and assurances on emergency care provision
during the strike period. The CCG has also worked with primary care to ensure that
capacity was available during the strike period should the impact of this lead to an increase
in demand for primary care.
Cancer 62 Day waits: The 62 day cancer standard was not met in October with
performance for Lambeth of 83.3% (against a standard of 85%).This performance related
to 7 patients not treated within the required time, with all breeches relating to patients
completing their treatment at GSTT. The Trusts internal performance improvement is
linked to increased robotic capacity for urology and the Trust now has additional capacity in
place to offer patients robotic surgery within 62 days for those patients referred to GSTT
from other providers within agreed pathway timelines. Overall Trust performance
improvement is linked to reducing late referrals from other providers. A system wide
recovery trajectory, which includes Lewisham and Greenwich Trust NHS Trust and Kings is
being developed with an expectation of improvement to recover the overall standard.
Commissioners are working closely with all south east London Trusts through the refreshed
Cancer System Leadership Group, to agree and monitor performance against improvement
trajectories, including ensuring that agreed timed pathways are adhered to and that
avoidable delays eliminated. Regular weekly dialogue with Trusts is in place to review
patient level reporting and address individual patient pathways.
6. CQC visits to South London and the Maudsley and to Guy’s and St Thomas’ NHS
Foundation Trusts
Many congratulations to South London and Maudsley NHS Foundation Trust (SLAM) who
recently achieved a ‘good’ overall rating by the Care Quality Commission (CQC) with some
services rated as ‘outstanding’. More than 100 inspectors visited services across the Trust
in September and judged services to be “safe, effective, caring, responsive and well led”.
The CQC inspected 71 wards, teams and clinics across all the trust’s sites and reported
that staff were very caring, professional and ‘worked tirelessly to support patients’. They
praised the trust for involving patients in the running and decision making about services,
leading to changes across the services. We have circulated the report to all members of the
Governing Body. For further information please visit SLAM’s website.
The outcome of the CQC inspection visit to Guy’s and St Thomas’ NHS Foundation Trust is
still awaited from the CQC.
There were no inspection reports published for Lambeth General Practices from October to
December however two inspections have been published in January with Vassall Medical
Centre and the Vale Surgery both rated by the CQC as Good overall.
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7. Our Engagement with patients and the public
We have now received formal feedback from NHS England following a recent review of our
engagement processes with patients and the public. NHS England confirmed a rating of
overall ‘good, with multiple elements of outstanding’ for our work in this area. They have
particularly highlighted our work in the following areas;
Demonstrating an awareness of the population including those defined by protected
characteristics and prevalent health conditions
Linking the vision of engagement to the CCG’s vision
Showing how we engage with a diverse and wide range of patient groups, networks
and partners.
Many thanks to Raj Mitra, as our Clinical Lead and Catherine Flynn, Engagement Manager
who continue to lead this work through the membership of the Engagement, Equalities and
Communication Committee.
8. Lambeth Safeguarding Children Board, new Chair appointed
Mr Andrew Christie will join Lambeth as the new chair of the Lambeth Children’s
Safeguarding Board. He will join the Borough on a phased basis and will take up the role
permanently in May 2016. Andrew is an experienced DCS who has many years of leading
and challenging strategic change in children’s services in inner London. Since 2011 he has
been the first Director of Children’s Services to have responsibility for leading across three
local authorities in the tri-borough arrangement between Westminster, Hammersmith and
Fulham and Kensington and Chelsea. I would like to thank Mr Paul Curran, our interim
chair, who has done a fantastic job in making a real step change within the LSCB over
recent months.
9. Strategic Estates Planning
On 18 June 2015 the Department of Health published new guidance for Clinical
Commissioning Groups (CCGs), NHS England, Community Health Partnerships and NHS
Property Services on developing estates strategies.
To deliver the Five Year Forward View (FYFV) and address the financial challenges the
NHS faces we need to work with a greater degree of flexibility and cooperation. We need
to fully rationalise the estate; maximise the use of facilities; deliver value for money
and improve the patient experience by ensuring all health and social care partners work
together.
CCGs were required to produce a draft Local Estates Strategy (LES) by 31December
2015. Community Health Partnerships (CHP) were appointed to work with NHS Lambeth
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CCG and across South East London CCGs to develop the LES, working with partners such
as LB Lambeth, our local acute and mental health providers, patients and the public.
In the Local Estates Strategy we set out the CCG’s commissioning intentions, including the
development of local care networks. We are assessing the fitness of the estate available to
deliver our Strategy drawing on a wide range of data about the condition, value and
utilisation of the estate that the CCG commissions. We recognise that as it stands the LES
is a work in progress and over the next two months we will be working with internal and
external partners across the local health and care economy to:
Update the draft LES filling gaps that have been identified in the information
available so far
Fully understand the implications of our Five year Strategy on our current estate
strategy and consider our short, medium and long term options
Develop and agree an implementation plan for getting us from where we are now in
terms of estates to where we would like to be with fully worked up workstreams
Identify appropriate bids against the Primary Care Transformational Fund (by 29th
February) in collaboration with the three GP Federations
Incorporate the estate's strategy into our overall 2016/17 operating plan
The updated strategy and implementation plan will be developed through engagement with
a broad range of CCG and partner colleagues from across South East London to ensure
that it we use our combined estate to best deliver the health and care aspirations of ‘Our
Healthier South East London’ Five Year Strategy. The developing strategy will be
presented for consideration and sign off through the joint Primary Care Development
Committee in advance of final sign off by the CCG Governing Body.
10. South London 2015 Innovation Grants and Recognition Awards
I was delighted to attend the third annual ceremony for the South London Health Innovation
Network (HIN) and Health Education South London Awards, having been part of the earlier
judging process. The event highlights the very best projects and initiatives in innovation
and workforce development across south London and is a great way to celebrate
achievement. The Recognition Awards celebrate success, talent and innovation in teams
or individuals who are leading the way in delivering excellence. The Innovation Grants
recognise innovation and educational excellence in South London across five categories;
Patient Safety, Proactive Care, Developing the Whole Workforce, Learning from Patient
Experience and Involvement and Integrated Care. Full details of the winners and
shortlisted candidates can be found on the HIN website.
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Report to NHS Lambeth Governing Body
20th January 2016
Report Title
Collaborative Framework
Author(s)
Una Dalton, Director of Governance and Development
Governing Body/Clinical Lead(s)
Andrew Eyres, Chief Officer
Management Lead(s)
Una Dalton, Director of Governance and Development
CCG Programme
All programmes
Purpose of Report
To receive assurance
Summary
The proposed Collaborative Commissioning arrangements outlined in this paper describe how the six CCGs in South East London will work in partnership in such a way to maximise the benefits for all patients in South East London on a number of areas in order to deliver a sustainable and high quality healthcare system. The collaborative arrangements seek to:
provide a framework for overseeing the implementation of collaborative arrangements including but not limited to the Our Healthier South East London strategy;
identify areas that would benefit from a common approach by the six CCGs in South East London with the aim of improving services for patients;
provide a forum at which clinical leaders and managers can discuss commissioning and other issues;
facilitate collective decision-making, where appropriate;
provide a forum for taking collective actions and making collective decisions where appropriate;
provide a forum to share ideas, innovation and best practice;
provide a framework for agreeing risk sharing provisions between the six CCGs in South East London.
The paper describes how we plan to work together to influence and formulate joint strategy and policy in South East London; and at an operational level how we will look to work in partnership to implement our joint strategic and local priorities through effective commissioning from the major
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providers in SEL. Each of the six CCGs in South East London are individually responsible, and shall remain responsible, for the performance and exercise of their statutory duties and functions for commissioning NHS funded services to meet the needs of their population.
Recommendation(s) The Governing Body is asked to agree:
The proposed Collaborative Commissioning Arrangements set out in this paper.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
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Collaborative Framework
Agreed between
NHS Bexley Clinical Commissioning Group;
and
NHS Bromley Clinical Commissioning Group;
and
NHS Greenwich Clinical Commissioning Group;
and
NHS Lambeth Clinical Commissioning Group;
and
NHS Lewisham Clinical Commissioning Group;
and
NHS Southwark Clinical Commissioning Group.
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1. Status of this framework ...................................................................................... 4
2. Definition and interpretation ................................................................................. 4
3. Executive summary ............................................................................................. 4
3.1. Purpose ......................................................................................................... 4
3.2. Collaboration aims ........................................................................................ 5
3.3. Expected behaviours of the six CCGs in South East London ....................... 6
4. Mechanisms for collaboration .............................................................................. 7
5. Model for strategy, business planning and organisational performance .............. 7
6. Hosting arrangements ......................................................................................... 8
7. Financial Risk Share ............................................................................................ 8
8. Leaving the Collaborative .................................................................................... 9
9. Joining the SEL Collaborative .............................................................................. 9
10. Grievance and Alternative Dispute Resolution (negotiation and mediation) .. 10
11. Termination of Framework .............................................................................. 11
12. Variations ....................................................................................................... 11
13. Agreement ...................................................................................................... 11
14. Signatories .................................................................................................. 11
1. Appendix ............................................................................................................ 13
2. Appendix – collaborative governance structure ................................................ 14
2.1. Decision-making and process for holding one another to account .............. 14
2.2. Summary Committee and Group Purpose .................................................. 14
2.2.1. Strategic Committees and Groups ............................................. 14
South East London Committee in Common for Strategic Decision Making ................................................................................................ 14
Clinical Strategy Committee ................................................................ 14
Our Healthier South East London programe. ...................................... 15
2.2.2. Delivery Committees and Groups .............................................. 15
South East London Chief Officers Group, ........................................... 15
South East London Director Groups ................................................... 15
System Resilience Group (SRGs): ..................................................... 15
South East London Area Prescribing Committee ................................ 16
Primary Care Joint Commissioning Committees ................................. 16
2.2.3. Engagement and Consultation Committees and Groups ........... 16
Clinical Advisory Group....................................................................... 16
Stakeholder Reference Group ............................................................ 16
Clinical Executive Group ..................................................................... 16
2.2.4. Advisory and collaborative bodies .............................................. 17
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3. Appendix– collaboration in commissioning ........................................................ 19
3.1. Collaborating in acute commissioning ......................................................... 19
3.1.5. Local CCG led ............................................................................ 19
3.1.6. Services delivered by ECS ......................................................... 20
3.1.7. CCG collaborative activity .......................................................... 20
Lead commissioner arrangements ...................................................... 21
Roles and responsibilities ................................................................... 21
Mechanisms for collaboration ............................................................. 24
3.2. Collaborating in non-acute commissioning .................................................. 24
Community services and mental health .............................................. 24
Appendix B ............................................................................................................. 26
4. Appendix - Managing Financial Risk across South East London CCGs ............ 26
4.1. Introduction and Context ............................................................................. 26
4.2. Framework for Financial Risk Management across SEL CCGs .................. 27
CCG Specific Local authority and other key partner Financial Risk Management ........................................................................................................... 28
4.3. Current and potential risk sharing areas: .................................................... 28
Shared CCG contracting approaches with providers ......................................... 28
Shared approach to CCG risk sharing for commissioned services .................. 29
4.4. Financial risk due to the cost to CCGs of the implementation and transition period of the provider reconfigurations arising from the dissolution of South London Healthcare Trust (SLHT) including implementation of the community based care transformation programme / Local Care Networks and internal CCG QIPP programmes ................................................................................................ 33
5. Appendix - Glossary .......................................................................................... 35
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1. Status of this framework
1.1. This collaborative framework is made between NHS Bexley Clinical Commissioning Group and NHS Bromley Clinical Commissioning Group and NHS Greenwich Clinical Commissioning Group and NHS Lambeth Clinical Commissioning Group and NHS Lewisham Clinical Commissioning Group and NHS Southwark Clinical Commissioning Group collectively known as “the six CCGs in South East London” or “the Collaborative”
1.2. The collaborative is not an organisation or legal entity, the individual CCGs
are the statutory organisations responsible for commissioning healthcare in their area, the framework stems from each of the constitutions of the six CCGs in South East London.(see appendix 1)
1.3. Whilst this framework records the intentions of the six CCGs in South East
London in relation to partnership working, the provisions of this agreement are not intended to be legally binding and the framework shall not give rights or liabilities to any of the six CCGs in South East London.
1.4. This framework replaces the framework for collaboration agreed between the
six CCGs in South East London agreed in August 2012
1.5. The six CCGs in South East London are sovereign bodies held accountable by the public, to their membership and NHS England
2. Definition and interpretation
2.1. In this framework, unless otherwise stated, the meanings are as set out in Appendix 5 (Glossary).
2.2. A reference to the singular shall include the plural and vice versa and
reference to a gender shall include any gender.
3. Executive summary
3.1. Purpose
3.1.1. The Collaborative Commissioning arrangements outlined in this paper
describe how the six CCGs in South East London will work in partnership in such a way to maximise the benefits for all patients in South East London on a number of areas in order to deliver a sustainable and high quality healthcare system. The collaborative arrangements seek to:
provide a framework for overseeing the implementation of collaborative arrangements including but not limited to the Our Healthier South East London strategy;
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identify areas that would benefit from a common approach by the six CCGs in South East London with the aim of improving services for patients;
provide a forum at which clinical leaders and managers can discuss commissioning and other issues;
facilitate collective decision-making, where appropriate;
provide a forum for taking collective actions and making collective decisions where appropriate;
provide a forum to share ideas, innovation and best practice;
provide a framework for agreeing risk sharing provisions between the six CCGs in South East London.
3.1.2. It describes how we plan to work together to influence and formulate
joint strategy and policy in South East London; and at an operational level how we will look to work in partnership to implement our joint strategic and local priorities through effective commissioning from the major providers in SEL.
3.1.3. Each of the six CCGs in South East London are individually
responsible, and shall remain responsible, for the performance and exercise of their statutory duties and functions for commissioning NHS funded services to meet the needs of their population.
3.2. Collaboration aims
3.2.1. This document describes a framework for overseeing the
implementation of collaborative arrangements including but not limited to the Our Healthier South East London strategy and commissioning arrangements for healthcare contracts; non-healthcare contracts; collaborative functions outside of commissioning support services risk and benefit sharing.
3.2.2. In determining the collaborative arrangements, clinical and
management leaders from the six CCGs in South East London have designed a model that:
establishes specific arrangements for collaborative working;
delivers Our Healthier South East London;
works with other partners, CCGs and NHS England at a London-wide level to take forward a transformation programme in response to the Better Health for London aspirations developed by the London Health Commission;
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works with local partners and in particular the local authority at borough level;
works between boroughs, recognising that commissioning challenges and priorities will require the direct collaboration of a group of CCGs to achieve specific strategic goals;
identifies hosting arrangements for any centralised functions necessary for strategic delivery (appendix 3).
3.2.3. The six CCGs in South East London are clear that individual CCGs will:
adhere to statutory requirements and guidance to ensure compliance with applicable laws and standards including those governing procurement, data protection and freedom of information;
work towards ensuring that the commissioning ambitions and intentions of one another are met;
oversee; manage; and account to one another for performance of their respective roles and responsibilities set out in this framework;
seek to develop the collaborative so as to achieve the full potential of the relationship;
share information, experience, materials and skills to learn from one another where relevant and develop effective working practices, work collaboratively to identify solutions, eliminate duplication of effort, mitigate risk and reduce cost;
have arrangements that are responsive, flexible, resilient and sustainable;
have arrangements that provide continuity and stability throughout any transition; and the model enables the six CCGs in South East London to:
tailor commissioning support to meet local requirements
adapt as requirements change in future years
meet the requirements placed upon CCGs for primary care improvement, amongst others
support and enable joint working with local authorities
develop towards a level of commissioning that is equal to best practice
3.3. Expected behaviours of the six CCGs in South East London
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3.3.1. In defining this collaborative framework, the six CCGs in South East London have identified acceptable behaviours to facilitate good working relationships; these include at all times to:
act in good faith towards one another;
act in a timely manner;
communicate openly about concerns, issues or opportunities relating to collaboration;
adopt a positive outlook and to behave in a positive, proactive manner in relation to the collaboration;
act in an inclusive manner with regards to the collaboration;
comply with the Nolan principles of public life;
manage conflicts of interest in accordance to each CCGs constitutional arrangements.
4. Mechanisms for collaboration
4.1.1. The collaborative governance structures at the date of this agreement are subject to change but are outlined in appendix 2, the structure will facilitate the ability of the six CCGs in South East London to:
share and align strategic priorities and to share best practice on issues that are of common interest to more than one CCG;
create formal and shared committees of the relevant CCG governing bodies to allow decision making at scale;
gain collective assurance on the quality and performance of the commissioned services of shared providers; and
plan, co-ordinate and deliver collective work programmes.
4.1.2. The collaborative governance structures as at the date of this agreement are subject to change but are outlined in appendix 2, the structure will facilitate the ability of the six CCGS in South East London to:
5. Model for strategy, business planning and organisational performance
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5.1.1. To deliver the Our Healthier South East London Strategy, Better Health for London and meet the challenges set out in the NHS Five Year Forward View, the six CCGs in South East London will work with other NHS commissioners in partnership with patients; Public Health England (London); London councils; the Mayor of London; Greater London Authority; and the voluntary sector (third sector) in establishing and delivering the programme ‘Preventing ill health and making Londoners healthier’.
5.1.2. All the six CCGs in South East London will maintain local resources for
strategy, business planning and organisational performance, to lead the development of statutory planning requirements such as integrated plans, operating plans, QIPP (quality, improvement, prevention and productvity) plans and Joint Strategic Needs Assessment (JSNA) (in partnership with local authorities and working with the Health and Wellbeing Boards).
5.1.3. The Six CCGs in South East London will work collaboratively to ensure
that on call cover is provided for all the CCGs. The on-call directors will have the ability to act on behalf of all CCGs when on call.
6. Hosting arrangements
6.1.1. All parties to this agreement have agreed to fund a programme office for the collaborative work of the six CCGs in South East London and to share financial and other risks in relation the creation, running and closing of the programme office.
6.1.2. The programme office will initially be hosted by NHS Southwark CCG (to be reviewed on an annual basis)
7. Financial Risk Share
7.1.1. South East London CCGs are collaborating to mitigate and effectively manage financial risks, working together and with other health partners and public sector organisations. Agreed risk sharing approaches have been used effectively and will be kept under continuous review each year to ensure that they incentivise good performance, avoid untoward incentives and can demonstrate best stewardship practice in the use of resources.
7.1.2. It is recognised that risk is best managed by those best able to address
the specific risk. As such there is no single place that financial risk management will best be delivered. A range of risk management approaches are encompassed within our overall risk sharing framework including actions through:
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Individual CCG financial controls and governance through budgetary and other risk and contingency management frameworks;
Risk sharing with local commissioning partners, including local government, such as through joint commissioning arrangements;
Risk sharing with providers through contractual agreements to incentivise service change and QIPP delivery;
Risk sharing and pooling across CCGs to reflect approaches to share risk in specific commissioned services and to support the delivery of shared programmes; and
Mutual financial aid to support delivery of individual CCG financial targets in the short term, assist recovery and sustain on-going strategic direction without destabilising the health economy.
7.1.3. Full details are contained in appendix 4
8. Leaving the Collaborative
8.1.1. A CCG may withdraw its membership from the Collaborative, by giving notice not less than six months prior to 31 March of each year; notice must be in writing to the chair of the Clinical Strategy Committee (CSC).
8.1.2. If a CCG gives notices of its withdrawal from the Collaborative, the said
CCG will continue to be entitled to all its rights; (including representation on the Chief Officer’s Group and South East London Committees) and be bound by all its obligations, indemnities, contributions to the operational costs, including financial risk element up to 31 March of the financial year notice was served.
8.1.3. However, it shall not be entitled to vote on any of the SEL committees
in respect of any strategy, contract (s) or service(s) that has implication beyond the 31 March in the financial year notice was served.
9. Joining the SEL Collaborative
9.1.1. A new CCG may join the Collaborative where boundary changes warrants the new CCG joining.
9.1.2. Inclusion will be considered in the first instance by the Chief Officers
Group (COG) which will make a recommendation to the chair of the CSC.
9.1.3. Provisos:
the new CCG agrees to be bound by the terms of this framework
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the CCG is not being administered by NHS England because of performance issues
formal approval of a new member joining the Collaborative requires all of the six governing bodies to approve.
9.1.4. If approved, the new CCG member: will be eligible for immediate
representation on the Chief Officer’s Group, South East London committees, receipt of South East London committee papers and be bound by all its obligations, indemnities, contributions to the operational costs, including financial risk element up to 31 March of the financial year; pro rata from the month of being formally approved to join; and thereafter full years costs as determined by the six CCGs in South East London.
9.1.5. It shall be entitled to vote immediately on any of the collaborative
committees in respect of any strategy, contract (s) or service(s).
9.1.6. The new CCG member may join at any time in the year.
10. Grievance and Alternative Dispute Resolution (negotiation and mediation)
10.1.1. Any grievance or dispute arising in the way the Collaborative is
operating shall be resolved in accordance with the process set out in 10.1.3 and associated bullet points.
10.1.2. The SEL CSC will have no jurisdiction over a commissioning
decision taken by a CCG that differs from a decision of another CCG member of the group. The grievance and disputes process should be restricted to matters relating to the operation of the Collaborative, including agreed roles of each party.
10.1.3. The following is the process which aims for local resolution prior
to external mediation and external adjudication.
The parties in dispute shall escalate the grievance or dispute in the first instance to the Chief Officers Group (COG).
The COG shall within 21 operational days from the date the grievance or dispute is lodged consider potential approaches to achieve a resolution:
Where a resolution agreement has been achieved this will be communicated to parties concerned.
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Where the COG is unable to achieve a resolution then within five operational days, the COG shall inform the CSC to mediate via the Chair of the CSC.
If the CSC is unable to achieve a resolution then within five operational days, the chair of the CSC shall arrange for an external independent party to mediate.
The mediator will meet with the parties and work to gain resolution to the grievance or dispute. Where there is agreement, the mediator will set out the agreement in writing and each party shall sign the agreement.
Where agreement cannot be reached at or following mediation, the Parties will submit to the binding decision of the NHS England - London Director. The decision of the NHS England - London Director will be recorded in writing and signed as binding by all parties.
11. Termination of Framework
11.1.1. This framework may be terminated at any time by majority agreement by the six CCGs in South East London.
12. Variations
12.1.1. This framework may only be varied by the agreement of all the governing bodies of the six CCGs in South East London
12.1.2. Where the variation is not agreed by governing bodies it will be
withdrawn.
13. Agreement
13.1.1. The arrangements for this collaborative framework have been designed and established by the CCGs Chief Officers and approved in accordance with their individual governance arrangements
13.1.2. The following CCG Chief Officers are signatories to this
agreement.
14. Signatories
CCG Chief officer Date
Bexley Name:
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Signature:
Bromley Name:
Signature:
Greenwich Name:
Signature:
Lambeth Name:
Signature:
Lewisham Name:
Signature:
Southwark Name:
Signature:
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1. Appendix
1.1. References to constitutions
CCG Reference in collaborative agreement
Reference in CCG Constitution
Bexley Paragraph 1.2 Clause 6.10.5
Bromley
Greenwich
Lambeth
Lewisham
Southwark
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2. Appendix – collaborative governance structure The role of the Collaborative is to make recommendations to the individual Governing Bodies of the CCGs on matters relating to the services where a collaborative approach is likely to benefit patients and/or the functioning of the individual CCGs. Each CCG acknowledges that decisions will only be taken by the individual Governing Body of each CCG, taking into account the recommendations of the Clinical Strategy Committee (CSC), and any such recommendations of the Collaborative are not binding unless, or until, ratified by each individual CCG, or the South East London committee in common for strategic decision making as appropriate.
2.1. Decision-making and process for holding one another to account
2.1.1. The committees outlined below are governed by agreed terms of
reference and the provisions of their respective members’ CCG constitutions. In general terms the CCGs aim is to always achieve collective decision-making in a collaborative manner through consensus. The six CCGs in South East London will have a collective responsibility to resolve and minimise any local challenges or disproportionate impact of CCG wide decisions on any one CCG.
2.2. Summary Committee and Group Purpose
Terms of reference can be found on the South East London Website www.ourhealthiersel.nhs.uk/
2.2.1. Strategic Committees and Groups
South East London Committee in Common for Strategic Decision Making
The committee’s purpose is strategic decision making, with particular reference to Our Healthier South East London strategy, as a prime committee of the respective CCGs Governing Body. The role of the Committee in Common is to take decisions on behalf of the CCGs; decisions will be taken in public by the representatives of the respective CCG and will be taken only after consideration of the issues by the CCG Governing Body and the engagement of the CCG membership.
Clinical Strategy Committee
The Clinical Strategy Committee (CSC) will discuss and lead thinking on pan borough strategic clinical issues across the six CCGs in South East London and to
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advise and make recommendations to the SEL Committee in Common for Strategic Decision Making and other relevant CCG decision making bodies. The role of the CSC will be to develop, agree and oversee commissioning strategy across south east London to improve health outcomes and increase safety, effectiveness and experience of services within available resources.
Our Healthier South East London programe.
The Our Healthier South East London programme shall report into the clinical strategy committee.
2.2.2. Delivery Committees and Groups
South East London Chief Officers Group,
This group can make decisions based on the scheme of delegation passed to individual chief officers by individual CCG constitutions and provides an effective forum to provide coherent and consistent involvement in all matters concerning collaborative working across the six CCGs in South East London or pan London. .
South East London Director Groups
The following collaborative groups report directly to the COG on current and emerging issues; the groups are non-decision making, but will make recommendations to the COG on financial; commissioning; quality; and governance matters: Chief Finance Officers (CFO) Group Director of Commissioning (DOC) Group Director of Quality (DoQ) Group Governance Leads Group (GLG)
System Resilience Group (SRGs):
Group – Bromley, Lambeth & Southwark Group – Bexley, Greenwich & Lewisham The SRGs work collaboratively across the health and social care system to oversee the delivery of statutory performance targets for elective and non-elective care. The group(s) will provide a forum for the whole system to work together strategically to ensure that robust and complimentary plans are in place which help deliver continuous improvement. The SRG will be the body that provides assurance to NHS England on matters relating to performance, demand and capacity plans and usage of non-recurrent funding such as winter resilience funding.
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South East London Area Prescribing Committee
The Area Prescribing Committee (APC) is accountable to the SEL Clinical Strategy Committee – with a nominated Lead Clinician and Lead Chief Officer identified from within the six CCGs in South East London. The APC will be advisory to the six CCGs in South East London, however the six CCGs in South East London will uphold APC recommendations except in exceptional circumstances; The role of the APC includes providing advice on implementation of best practice around medicines, including NICE guidelines and technology appraisals to encourage rapid and consistent implementation.
Primary Care Joint Commissioning Committees
The six CCGs in South East London have established six Primary Care Joint Commissioning Committees (PCJC), (joint with NHS England but meet concurrently with each other), These committees are a prime committee of the respective CCGs Governing Body; they will work jointly with NHS England to carry our functions relating to the commissioning of primary medical services under section 83 of the National Health Service Act 2006.
2.2.3. Engagement and Consultation Committees and Groups
Clinical Advisory Group
An external Clinical Advisory Group is likely to be established, at a later stage in the programme, to ensure that any proposed clinical changes are designed in a manner which ensures wide ranging clinical engagement in service design and alignment with national and London-wide quality standards; and that clinical services will be safe and sustainable both during transition and post implementation.
Stakeholder Reference Group
For advice and oversight in relation to engagement on the development of the Commissioning Strategy, in order to ensure that the views of patients, service users, the public and their representatives are heard and acted upon.
Clinical Executive Group
The Clinical Executive Group (CEG) supports the SEL Partnership Group by providing oversight of clinical design work, assurance and management of interdependencies across the individual clinical leadership groups. It acts as a conduit for the management and escalation of clinical risks across the programme.
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2.2.4. Advisory and collaborative bodies
The Our Healthier South East London programme links to a number of existing statutory, advisory and collaborative bodies. Relationships have been established with these groups as appropriate as part of mobilisation and on-going delivery. Health and Wellbeing Boards (HWBs) provide oversight, advice and input into the programme at borough level, focused on improvement of the health and wellbeing of their local populations, reducing health inequalities, and encouraging joined up working across commissioners. As well as being engaged and involved in the co-development of the Commissioning Strategy, ensuring alignment with local Health and Wellbeing Strategies, Health and Wellbeing Boards have agreed Better Care Fund plans. Health Overview and Scrutiny Committees (HOSCs) will provide local scrutiny and review in line with statutory requirements under the Local Government Act 2000 and Health and Social Care Act 2012. The programme links to local Healthwatch teams in each borough to ensure that proposals developed as part of the Commissioning Strategy take account of the voices of consumers and those who use local health and social care services. The constitutions of the six CCGs in South East London allow for the establishment of further joint committees and working groups of their governing bodies that will allow them to discharge their functions effectively, should the need arise. Additional forums may need to be developed on specific strategic or commissioning issues or directives from NHS England. In addition the six CCGs in south east London will work collaboratively in a number of other groups including but not limited to Clinical Quality Review Groups, Contract Management boards and for specific projects
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3. Appendix– collaboration in commissioning The Six CCGs in South East London will procure external commissioning support (ECS) as agreed from time to time, the current support
3.1. Collaborating in acute commissioning
3.1.1. As with all areas of commissioning, acute commissioning will be
owned, provided and led by the Clinical Commissioning Groups with strong support from commissioning support arrangements. In their development of commissioning intentions the six CCGs in South East London will use their collaborative arrangements to ensure alignment of intentions and consistent, coherent interaction with major providers.
3.1.2. In acute commissioning and contracting, the collaboration will be
underpinned by the use of multi-disciplinary contracting teams and lead arrangements for providers.
3.1.3. Multidisciplinary contracting teams draw together the clinical leadership
of CCG, key representatives from the ECS acute contracting multi-disciplinary team (i.e. contracting, performance management, information), and the CCG commissioning teams (including medicines management).
3.1.4. In this way respective CCGs acute contracts will be managed by a
team comprising:
Multi-disciplinary team from ECS
Clinical leads from the major CCG commissioners (by spend) including one acting as lead
Senior management leads from CCG commissioning teams (reflecting lead arrangements)
A summary of key roles and responsibilities is set out below:
3.1.5. Local CCG led
3.1.5.1. All six CCGs in South East London have a senior manager who
is responsible for co-ordinating the monitoring and management of the CCG’s total acute portfolio and providing robust and expert professional advice and guidance to the CCG on the commissioning of acute services. A ‘head of acute contracting’ will be employed by the ECS with strong lines of communications to the six CCGs in South East London but will be predominantly based in the local CCG where agreed and will draw support from the acute multi-disciplinary team in ECS to ensure the provision of timely,
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comprehensive and systematic support to manage the annual cycle of commissioning and contracting activity.
3.1.5.2. Each of the six CCGs in South East London provides clinical
leadership, chairing contract management and quality meetings and leading the annual acute negotiating process. Local clinicians provide expertise, for example in the completion of clinical audits, review of care pathways and medicines management.
3.1.6. Services delivered by ECS
3.1.6.1. South East London CCGs have agreed to purchase acute
contract management support from the ECS. As a result, CCGs will have a dedicated multi-disciplinary acute contracting team, comprising dedicated leads for acute contracting, finance, performance, and information. This team will be directly employed by the ECS, and will support the overall delivery of the commissioning cycle by:
Supporting annual and on-going contract negotiations
Co-ordinating contract management including challenging over performance, performance targets, quality standards, KPIs and acute QIPP and demand management schemes
Delivery of robust claims management
Supporting the lead commissioners role
Advising on impact of service redesign, CQUIN or QIPP proposals on acute contracts
Translating service redesign, CQUIN & QIPP plans into acute contracts
3.1.7. CCG collaborative activity
3.1.7.1. The six CCGs in South East London have agreed to act as “lead
commissioner” for all London CCGs, for one or more trusts which are geographically located within the six CCGs in South East London, liaising closely with the other CCGs’ acute contract management teams to ensure that all CCGs achieve maximum leverage across all trusts in South East London and Dartford and Gravesham NHS Trust.
3.1.7.2. In order to deliver the major benefits of inter-CCG collaboration
to maximise scale and leverage with the large acute Trusts; CCGs recognise that they will need to work together to:
share CCG commissioning intentions and service re-design priorities to identify areas of common interest and difference
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align priorities and agree collective negotiation strategies with provider trusts where applicable to support the achievement of better outcomes, improved quality and value for money
co-ordinate dialogue with provider trusts to maximise impact by ensuring that they speak with a single voice
improve efficiency by avoiding multiple conversations with providers where possible
Lead commissioner arrangements
3.1.8. The lead commissioner will be charged with leading the delivery and
performance management of a provider trusts contract, on behalf of a lead CCG and its associate CCGs. This lead role will be performed with the full support of the multi-disciplinary team described above for each contract. The geographical spread of south east London provider trusts and the proportion of spend between CCGs has led to an agreement that clinical commissioners and their CCG leads will participate, alongside the lead, in contract negotiation, quality and performance meetings (see table below).
3.1.9. These arrangements will require the coordination of a number of
different relationships including the Chief Officer for escalation, senior managers, clinicians, and commissioning support staff of the lead CCG, and also those of its key associate CCGs.
3.1.10. Table 1 - Sets out the current lead commissioning
responsibilities. Table 1
Provider Lead CCG Key Associate SEL CCG in contract teams
Guy’s and St Thomas’ NHS Foundation Trust
NHS Lambeth CCG NHS Southwark CCG NHS Bromley CCG
King’s College Hospital NHS Foundation Trust
NHS Southwark CCG NHS Lambeth CCG NHS Bromley CCG NHS Bexley CCG
Lewisham and Greenwich Hospital NHS Trust
NHS Lewisham CCG (Lewisham CCG strongly collaborates with Bexley CCG)
NHS Bexley CCG NHS Greenwich CCG
Dartford and Gravesham NHS Trust
NHS Bexley CCG
NHS Bromley CCG NHS Greenwich CCG
Roles and responsibilities
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3.1.11. Table 2 - Summarises the broad roles and responsibilities for
the lead commissioner (working with other major commissioning CCGs by contract spend) and the ECS. It is recognised that lead CCGs will also need to work with a range of associate CCGs and will need to sign a consortium agreement in advance of annual negotiations which define their responsibilities to one another. This agreement will set out arrangements for quoracy and decision making between CCGs as well as a process for dispute resolution.
Table 2
Lead CCG (with support from ECS)
Key Associate CCG ECS
Setting and coordinating commissioning intentions and where applicable a collaborative approach for trust wide commissioning intentions while being mindful of the intentions of associate CCGs
Share commissioning intentions and play active part in dialogue between CCGs
Co-ordinate dialogue between lead CCG and associate CCGs to align priorities, set direction and work to agreed working lines Provide robust and professional advice on the commissioning of acute services
Lead on contract negotiations, agreeing final terms and conditions after due consultation with associate CCG
Support contract negotiation meetings and provide information on a timely basis
Support CCGs to translate commissioning intentions and priorities into signed acute contracts, while ensuring lead CCG is appropriately facilitated to lead negotiations and agree terms & conditions acceptable to all parties
Manage the performance against contract reporting back to associate CCGs on a regular basis. Consult with associate CCGs to agree pro-active management action to rectify performance or variances to plan
Support performance management process and also provide information and intelligence to inform performance management
Ensuring lead CCG is appropriately facilitated to manage performance and ensure management action both Trust wide and on behalf of all CCGs Monthly monitoring reports against contractual targets and validates price and activity (claims management), underpinned by analysis and interpretation of issues and trends
Co-ordinate clinical dialogue and decision
Share views on a timely basis on individual
Provide advice and recommendations to
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making on investment and disinvestment in services. Sign-off decisions and monitor and review outcomes, reporting back to CCGs
investment and disinvestments, based on local circumstances
support decision-making on suitability, feasibility and affordability of proposed service changes Negotiating contract variation where applicable
Share QIPP, CQUIN and Local Incentive Schemes (LIS) to a timetable to enable input from Associate CCGs
Input into QIPP, CQUIN and LIS schemes discussions in a timely manner Associates to provide their own QIPP schemes to ensure inclusion in the contracts
Facilitate process for Lead and associate CCGs to submit QIPP schemes and ideas for CQUINs Report on QIPP and CQUIN schemes to support contract negotiations To provide details of productivity efficiencies required from providers before contract negotiations start Facilitate development with providers
Lead negotiation with the Trust on in year financial settlement , taking into account individual associate CCGs concerns
Respond on a timely basis to information prepared by ECS to enable lead to negotiate an in-year financial settlement
Provide robust financial reports and analysis Co-ordinate in-year financial settlement, preparing settlement proposals for discussion with associate CCGs and leading negotiation with the Trust, taking into account individual associate CCGs concerns
Chair the monthly Clinical Quality Review Group (CQRG). Oversee Serious Incident (SI) and co-ordinate SI review process, with input from clinical leads from relevant CCG and disseminate learning
Play a part in CQRG proportionate to overall share & stake in contract Provide clinical expertise to support SI reviews and clinical audits
On-going reporting against quality, safety indicators and co-ordinate clinical audits
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Mechanisms for collaboration
3.1.12. At an operational level it is expected that each lead CCG will
establish mechanisms to co-ordinate dialogue between associate CCGs and the provider Trust, with support and input from the ECS. One size will not fit all, and arrangements will need to be tailored to deal with individual Trust circumstances and the available time of local clinicians. However each multi-disciplinary contract team will lead contract negotiation, performance and quality meetings across any given contract year.
3.2. Collaborating in non-acute commissioning
3.2.1. Non-acute commissioning will be owned, provided and led by the
CCGs. In their development of commissioning intentions CCGs in south east London will use our collaborative arrangements to ensure alignment of intentions and consistent and coherent interaction with major providers.
3.2.2. The six CCGs in South East London has established leadership and
capacity for the commissioning and contracting of mental health and community services and for the redesign of community based care. Each CCG will work with their respective local authority and be responsible for commissioning services, contract management and pathway redesign. As such, in all circumstances, commissioning responsibility for community based care remains with respective CCGs and there is a limited level of commissioning support provided directly by the ECS.
Community services and mental health
3.2.3. Arrangements for the commissioning and contracting of community
services reflect the current provider landscape and has required the collaboration of CCGs, particularly where current and major providers of care are shared (much of the provision of community services is now secured through integrated service provision).
3.2.4. To this end The six CCGs in South East London work in collaboration
to commission and contract these services, outlined in the table below, aligning commissioning intentions, business plans and establishing a consistent approach to contracting, undertaken collectively.
Table 3
Community Services Provider
Borough Commissioning Arrangements
Guy’s and St NHS Lambeth CCG Lambeth and Southwark CCG
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Thomas’ NHS Foundation Trust
NHS Southwark CCG Commissioning teams and clinical leads (working in partnership)
Lewisham and Greenwich NHS Trust
NHS Lewisham CCG Lewisham CCG Commissioning team and clinical leads working with access to ECS Acute contracting team (integrated contracting across acute and community)
Oxleas NHS Foundation Trust
NHS Greenwich CCG
Greenwich CCGCommissioning team and clinical leaders
Oxleas NHS Foundation Trust
NHS Bexley CCG
Bexley CCG Commissioning team and clinical lead
Bromley Healthcare NHS Bromley CCG Bromley CCG
Mental Health Provider
Borough Commissioning Arrangements
South London and the Maudsley NHS Foundation Trust
NHS Lambeth CCG NHS Southwark CCG NHS Lewisham CCG
Lambeth, Southwark and Lewisham CCG Commissioning teams and clinical leads (working in partnership plus link to NHS Croydon CCG)
Oxleas NHS Foundation Trust
NHS Greenwich CCG NHS Bexley CCG NHS Bromley CCG
Greenwich, Bromley and Bexley CCG Commissioning teams and clinical leaders (working in partnership)
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Appendix B
4. Appendix - Managing Financial Risk across South East London CCGs
4.1. Introduction and Context
The six CCGs in South East London are collaborating to mitigate and effectively manage CCG financial risks across the SPG, working together and with other health and social care partners and public sector organisations. Each of the six CCGs in South East London retain individual accountability for the management of the CCGs financial risk. This is overseen and assured through each CCGs own governance arrangements reporting to CCG Governing Bodies in order to ensure that CCG financial statutory duties are met and that the CCGs financial objectives in support of their health strategies are achieved. Annual approaches to financial risk management will be informed by CCG Chief Financial Officers, who will advise the CCG chief officers. Agreed risk management approaches will be reviewed each year by CCG chief financial officers, to ensure that they incentivise good performance, avoid untoward incentives and can demonstrate best practice stewardship in the use of resources. It is recognised that risk is best managed by those best able to address the specific risk. As such there is no single place that financial risk management will best be delivered. A range of risk management approaches are encompassed within our overall risk management framework including actions through:
Individual CCG financial controls and governance through budgetary and other risk and contingency management frameworks
Risk sharing with local commissioning partners, including local government, such as through joint commissioning arrangements
Risk sharing with providers through contractual agreements to incentivise service change and QIPP delivery
Risk sharing and pooling across CCGs to reflect approaches to sharing risk in specific commissioned services and to support the delivery of shared programmes
Risk sharing and pooling across CCGs and NHS England to reflect approaches to sharing specific risks e.g. national CHC risk pool
The six CCGs in South East London designing and implementing the Our Healthier South East London programme in South East London. In addition to driving efficiencies within providers, this requires a level of investment funding from within CCGs to transform community and primary care based integrated services. This will include double running and implementation costs. In line with national planning requirements, SEL CCGs have agreed to plan for 1% of RRL non recurring each year to 2016/17 to be used to further develop and
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implement the CBC transformation programme, recognising that there may be other calls on this funding.
The six CCGs in South East London, in line with London planning requirements, each planning for 0.15% of RRL non recurring each year to 2016/17 to be set aside towards the implementation of the London Health Commission recommendations
Mutual Financial Aid to support delivery of individual CCG financial duties in the short term, assist recovery and sustain on-going strategic direction without destabilising the health economy. Each year each CCG will set aside 0.25% of its revenue resource limit for this purpose and hold this as a specific non-recurrent reserve.
4.2. Framework for Financial Risk Management across SEL CCGs
We have defined through our financial risk management approaches a clear and stratified approach, as follows:
Financial risk managed by individual CCGs and through local shared joint commissioning arrangements
Financial risk managed through collaborative CCG risk management commissioning arrangements
Financial risk managed through Mutual Financial Aid arrangements to ensure all CCGs in SEL can collectively support each other to achieve their annual financial duties, in a way that supports the South East London health economy to support sustainable underlying financial balance
Financial risk managed collectively over 4 years arising from the cost to CCGs of the implementation and transition period of the provider reconfigurations arising from the dissolution of South London Healthcare Trust across SEL. This includes implementation of the Community Based Care transformation programme / Local Care Networks and internal CCG QIPP programmes.
Approaches and arrangements to each of these elements of our Framework are set out below: Financial risk managed through individual CCGs and through local shared joint commissioning arrangements Each CCG has financial reporting and risk management arrangements in place around key areas of expenditure. This is part of normal business to meet individual commissioning outcomes and targets. For these areas the CCGs will share information, and good practice, but will manage the financial risk individually often working with borough partners. The scale of these approaches varies depending on the nature of the commissioning budget and exposure to risk. Examples include:
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CCG Specific Provider Financial Risk Management
Individual risk management arrangements agreed within some NHS providers
Risk management arrangements between CCGs and Community services providers (e.g. Guys and St Thomas’ FT, Lewisham and Greenwich Trust, Oxleas FT) around specific services or agreements to manage demand growth and its impact.
Individual agreements around a key local service, or its redesign.
Risk management arrangements on forensic/complex placements with SLAM and Oxleas
CCG Specific Local authority and other key partner Financial Risk Management
Specific pooled or aligned budgets, and associated risk management arrangements, through s75 and/or s256 shared commissioning arrangements with NHS providers and/or Councils, for example for Better Care Fund plans.
Agreed handling, through local Partnership arrangements, to manage shared resources, such as substance misuse shared programmes, to address in partnership changes in available resources across commissioners.
Joint approaches, with local government social care commissioners, to commissioning from private sector providers, for example addressing voids in nursing home contracts.
Financial risk managed through collaborative CCG risk management commissioning arrangements CCGs already have in place a wide range of effective risk sharing arrangements to support the shared commissioning of specific services and programmes, or to reflect shared contracting arrangements negotiated with providers. Some of these operate at a South East London wide level whilst others operate across groupings of CCGs, often reflecting shared contracting approaches with specific providers or shared programmes of work. CCGs will continue to evaluate the effectiveness of our approaches and consider further opportunities to better manage risk through common approaches with providers or to smooth impact where financial impact is unpredictable across CCGs. These will be reviewed through the development of our annual Operating Plans and commissioning intentions, and through contract negotiation strategies developed by our shared CCG led contracting teams with providers. In doing so the appropriate level of commissioner financial risk will be reviewed, for example between CCG contracting partners e.g. LSL/BBG, BSL/BGL, SEL or beyond SEL.
4.3. Current and potential risk sharing areas:
Shared CCG contracting approaches with providers
Acute contract pressures on tertiary services with hospital providers
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Acute contract pressures on elective and emergency activity with hospital providers
Delivering key national performance and outcome standards and CQUINs
Management of the impact of changes in national contracting models
Implementation with providers of service transformation initiatives, such as through integrated care approaches
Supporting the introduction of new drugs on a trial or full basis Shared approach to CCG risk sharing for commissioned services
Implementation of shared CCG initiatives and programmes, including transformational QIPP and community based care programmes such as 111, integrated care programmes etc.
High cost low volume services with unpredictable demand.
Specialised services overspend.
Supporting the introduction of new drugs on a trial or full basis.
London-wide or other network based implementation of new strategic improvement initiatives.
Continuing healthcare.
Supporting organisational change and transition across the health system, including the implementation of local care networks and infrastructure improvement such as shared information systems
Specific organisational risks such as the impact of mental health investigations
Mutual Financial Aid (MFA) across CCGs CCGs recognise that it is in the interests of the whole South East London health economy for all commissioning organisations to be in a position of underlying financial balance, and able to meet 1% surplus in line with national planning expectations, with robust affordable plans in place to address service transformation, health improvement and to manage growing demand for services. Through our collaborative working CCGs have developed shared approaches to strategic planning aimed at supporting the ambitions of six CCGs in South East London and addressing the challenges they face. This includes implementation of the Our Healthier South East London programme, including the community based care transformational plans. Risks to CCG Financial Positions There are a number of new and emerging financial risks to CCG purchasing power that previous approaches to risk management in South East London did not fully mitigate. These include:
Adequacy of delegated primary care commissioning allocations
Adequacy of delegated specialised commissioning allocations
Uncertainty in future specialised commissioning payment rules and geographic risk arrangements
Loss/non return of CCG surpluses
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Higher than planned transfers of NHS resources to councils
Impact of other CCG deficits
Impact of NHS England deficits
Impact of provider deficits
Impact of council deficits
Higher than planned investment required in CCG, SEL and London strategies
Future CCG income uncertainty, including uplifts
Future national tariff reduced price efficiencies and trust agreement to tariff efficiencies.
The six CCGs in South East London acknowledge that in the short to medium term any individual CCG may require mutual financial aid to ensure they can deliver their annual financial statutory duties. The 6 CCG chief financial officers will collectively review and operate the Mutual Financial Aid (MFA) rules each year and advise chief officers on the application of the risk reserve. This will include reviewing CCG pressures that justify support, the proportionality of planning approaches and existence of credible recovery plans where appropriate. Each year each CCG will plan to set aside 0.25% of its revenue resource limit for this purpose and hold this as a specific non-recurrent reserve for the SEL collective risk management agreement. The pool will be operated South East London wide and not individual CCG to individual CCG. Principles of Mutual Financial Aid (MFA)
1. Applies to all 6 SEL CCGs 2. MFA is applicable to support the delivery of statutory financial duties with the
intention that each SEL CCG delivers its statutory breakeven duty at each year ending 31 March
3. Each CCG contributes equitably to a SEL CCG risk reserve each year, unless this would prevent any CCG achieving its expected plan (i.e. business rules or breakeven)
4. Each South East London CCG plans to deliver its statutory breakeven duty each year at 1 April unless NHSE has agreed a plan that allows a CCG to deviate from these)
5. A CCG’s own risk reserve is the first call before requesting MFA
6. CCG financial plans and forecasts will be openly shared with transparency 7. The pool will be operated South East London wide and not individual CCG to
individual CCG. 8. Arrangements commence from CCGs’ 2015/16 plans. All previous
arrangements are managed outside of this MFA agreement. Based on the principles of MFA, any assistance with achieving target balance (and surplus positions) should be short term, i.e. up to 5 years. Any CCG receiving mutual financial aid will need to have a recovery plan in place agreed with the partners setting out assurance as to how financial recovery will be delivered.
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Where possible CCGs will offer support to other SEL CCGs to achieve planned surplus positions, but this will be managed outside of this agreement, and any terms of support given will be negotiated separately to this framework.
MFA Rules - Creation of Risk Reserve
1. Each CCG will plan a fixed contribution of 0.25% of opening recurrent total
RRL each year. 2. The 0.25% is in addition to NHSE required planning rules on reserves and
contingencies and also any common planning rules agreed by London CCGs and South East London CCGs.
3. The terms pertaining to the application of the 0.25%, from the risk reserve, in order to deliver a CCG’s breakeven position (planned or actual) will be discussed and considered collectively by the six CCG’s Chief Financial Officers annually as part of the Operational Planning process
4. A CCG’s own MFA risk reserve is the first call to delivering a breakeven plan before requesting MFA.
5. The risk reserve will be managed as a virtual pooled fund. Unutilised reserves within CCG plans will be held as a reserve within the originating CCG.
MFA Rules - Application of Risk Reserve
1. To be able to access funds (other than the CCG’s own 0.25%): a. CCG operating plans must comply with NHS England
business/planning rules (excepting limiting any surplus requirement to breakeven or where NHSE has agreed that a CCG may deviate from these); and
b. CCG operating plans must comply with any NHSE London/London CCG common planning rules; and
c. CCG operating plans must comply with any South East London CCG common planning rules; and
d. CCG operating plans must deliver a minimum 2% net QIPP plan; and e. CCGs must demonstrate a proportionate local planning approach; and f. CCGs must share a credible recovery plan where appropriate.
2. The first call by any CCG against the risk reserve will be from its own 0.25% (a CCG needing to use its own risk reserve must inform the other 5 CCGs immediately this is known). Thereafter utilisation of the South East London risk reserve will be calculated in proportion to CCG’s contributions subject to point 5. below.
3. Where MFA is required in year to support year end forecast breakeven positions, CCGs must first fully utilise all local reserves and flexibilities.
4. Where MFA is requested in-year to support year end forecast breakeven positions, CCGs must request this ahead of Month 8 CCG financial reporting deadlines, in order that individual CCG Month 8 reported positions may be “fixed” as the expected year end positions.
5. For the avoidance of doubt MFA will not be applied from any supporting CCG’s 0.25% risk reserve if that would result in the supporting CCG to fail to deliver its financial targets (i.e. planned surplus) or planned surplus position.
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6. Unutilised balances month 8 will be retained by the originating CCG. Scenarios covered by MFA rules SEL Chief Financial Officers will collectively oversee the application of these MFA arrangements. This will include reviewing CCG plans and positions to establish justifications to access MFA, the terms of access (reviewed annually) considering future year implications of financial positions and advising Chief Officers on potential actions to deliver financial targets for scenarios that are specifically excluded from these arrangements. Stage MFA requested
Cause Scenario Possible Outcome Note
Draft Operating Plan
To agree breakeven plan
Less than requesting CCG’s own 0.25% reserve
Apply in part or full requesting CCG’s own 0.25% risk reserve up to breakeven
*
Draft Operating Plan
To agree breakeven plan
Greater than requesting CCG’s own 0.25% reserve and less than aggregate of all CCGs’ 0.25% reserves
Apply in full requesting CCG’s own 0.25% risk reserve and apply in part or full the other CCGs’ 0.25% risk reserves, up to breakeven, in proportion to their risk reserve contributions
Draft Operating Plan
To agree breakeven plan
Greater than sum of all CCGs’ 0.25% reserves
CFOs to review in conjunction with NHSE and advise COs
In year before Month 8
To deliver breakeven position at year end
Less than remaining balance of requesting CCG’s own total reserves
Apply in part or full remaining balance of requesting CCG’s own total risk reserve up to breakeven
In year before Month 8
To deliver breakeven position at year end
Greater than remaining balance of requesting CCG’s own total reserves and less than remaining balance of aggregate of other CCGs’ 0.25% reserves
Apply in full remaining balance of requesting CCG’s own total risk reserves and apply in part or full the remaining balance of other CCGs’ 0.25% risk reserves, up to breakeven, in proportion to their risk reserve contributions
In year before Month 8
To deliver breakeven position at year end
Greater than sum of remaining balance of requesting CCG’s own total reserves and remaining balance of aggregate of other CCGs’ 0.25% reserves
CFOs to review in conjunction with NHSE and advise COs
**
* scenario applies to Bexley CCG in 2015/16 ** scenario not fully mitigated by MFA arrangements. Chief Financial Officers to review and advise Chief Officers
Example If any CCG(s) cannot deliver a breakeven plan the SEL CCGs’ MFA risk management arrangements will apply as follows:
1. Apply part or all of the 0.25% risk reserve, held by the CCG requiring support, to ensure a breakeven plan can be met.
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2. Apply part or all of the aggregate risk reserves held by the remaining (e.g. 5) CCGs to the CCG(s) requiring support to meet a breakeven plan, in the same proportion as the remaining CCGs’ risk reserve contributions
3. If the sum of CCG planning shortfalls to breakeven is greater than the sum of the six CCGs’ 0.25% risk reserves, the Chief Financial Officers shall review and advise the Chief Officers (in liaison with NHSE).
Illustrative Source of Funds 2015/16 to 2019/20
Scenarios not covered by MFA rules Any support requested that is designed to create a planned or in year forecast position more favourable than breakeven is not covered by the MFA provisions. In such cases, on a case by case basis, the six South East London CCG Chief Financial Officers will review causes for support, impact, potential solutions, future year consequences and terms of support and make recommendations to Chief Officers. The terms of any financial support provided in these cases will be determined by the applicable CCGs and not by these risk management arrangements.
4.4. Financial risk due to the cost to CCGs of the implementation and transition period of the provider reconfigurations arising from the dissolution of South London Healthcare Trust (SLHT) including implementation of the community based care transformation programme / Local Care Networks and internal CCG QIPP programmes
Impact of SLHT solutions for 2013-14 onwards on each of the 6 CCGs. South East London CCGs contributed £4.7m to the cost of the Transaction Agreements between NHSE, TDA and Providers in relation to Trust acquisitions arsing from the dissolution of South London Healthcare Trust. This £4.7m, together with the planned costs of the CCG Community Based Care transformation programmes across South East London, has been sourced over the 4 years 2013/14 to 2016/17 from 1% non-recurrent CCG reserves to support strategic change, specifically CBC, and fund transitional cost pressures.
201516 201617 201718 201819 201920
Assumed 2% uplift for illustrative puposes only 1.02 1.02 1.02 1.02
SOURCES OF FUNDS £m £m £m £m £m
Bexley - 0.25% SEL risk reserve 0.706 0.720 0.735 0.749 0.764
Bromley - 0.25% SEL risk reserve 1.028 1.049 1.070 1.091 1.113
Greenwich - 0.25% SEL risk reserve 0.877 0.895 0.912 0.931 0.949
Lambeth - 0.25% SEL risk reserve 1.112 1.134 1.157 1.180 1.204
Lewisham - 0.25% SEL risk reserve 0.999 1.019 1.039 1.060 1.081
Southwark - 0.25% SEL risk reserve 0.972 0.991 1.011 1.031 1.052
TOTAL SOURCES 5.694 5.808 5.924 6.043 6.163
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This approach has been agreed by all SEL CCGs, and will be considered alongside the development of CCG Commissioning Strategy Plans, Commissioning Intentions and annual Operating Plans. Implementation of the community based care transformation programme / Local Care Networks and internal CCG QIPP programmes The six SEL CCGs have been working as a Strategic Partnership Group to develop ‘Our Healthier South East London’. Community based care and Local Care Networks underpin this strategy and as such their development and implementation is vital across all South East London CCGs. The South East London CCGs therefore agree to work together on implementation to ensure equity of service across SEL and enable delivery of the strategy.
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5. Appendix - Glossary
Alternative Dispute Resolution
The process whereby The six CCGs in South East London resolve disputes short of litigation
ASHN
Academic Health Science Networks (ASHN); The Health Innovation Network is the AHSN for South London. HIN connect academics, NHS commissioners and providers, local authorities, patients and patient groups, and industry in order to accelerate the process of innovation and spread of innovative ideas and best practice across large populations
CCG
Clinical Commissioning Group (CCG) are NHS membership organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England, they are clinically led
Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London
The CLAHRC investigates the best way to make tried and tested treatments and services routinely available University-based researchers, health professionals, patients and service users’ work together to make this happen.
Collaborative
Working partnership between South East London CCGs (NHS Bexley CCG; NHS Bromley CCG; NHS Greenwich CCG; NHS Lambeth CCG; NHS Lewisham CCG; and NHS Southwark CCG)
Collaborative Commissioning
The collaborative approach to commissioning undertaken by SEL
Committee in Common
The six CCGs’ joint committees will meet in common, though respective CCGs joint committee will retain individual decision-making authority
Commissioning
The contract(s) entered by The six CCGs in South East London and a provider(s) of NHS
External Commissioning Support arrangements
Arrangements put in place through separate services contracts by CCGs to support the delivery of their commissioning functions
Health Education England
England’s health and healthcare people service; responsible for the education, training and personal development of every member of staff, and recruiting for values
Health Innovation The Health Innovation Network is the Academic Health
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Network Science Networks (AHSN) for South London AHSNs connect academics, NHS commissioners and providers, local authorities, patients and patient groups, and industry in order to accelerate the process of innovation and spread of innovative ideas and best practice across large populations
London Clinical Commissioning Group
There are 32 Clinical Commissioning Groups (CCGs) in London [Appendix F]. Each CCG is a statutory NHS body with its own governance arrangements; they are responsible for meeting the health needs of their populations and their main focus is on local issues London CCGs work together in order to discharge some of their responsibilities namely: To manage collective commissioning arrangements. To liaise with other London wide organisations such as the NHS England (London), Mayor’s office and London Councils To work in partnership with the NHS England (London) to plan, and to manage strategic change which cross CCG boundaries To promote shared learning to improve performance To coordinate other activities as required
London Clinical Senate
The Clinical Senate is a multi professional advisory body, which brings together a broad range of health and social care professionals with patients and careers The Senate supports development of London’s health services and the delivery of safe, sustainable, high quality and cost effective care, by providing independent, strategic advice to commissioners, supporting them to make the best decisions about health care for the populations they serve
London Health Commission
The London Health Commission is an independent inquiry established in September 2013 by the Mayor of London. The Commission, chaired by Professor the Lord Darzi, examined how London’s health and healthcare can be improved for the benefit of the population. On 15 October 2014, the London Health Commission published its Better Health for London report to the Mayor of London
NHS Commissioning Board
The NHS Commissioning Board (NHS CB) was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the NHS Commissioning Board has used the name NHS England for operational purposes
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Nolan Principles
The Committee on Standards in Public Life (Nolan Committee) has set out seven principles of public life which it believes should apply to all in public service. The following are the seven principles of conduct that underpin the work of public authorities including CCGs: Selflessness Integrity Objectivity Accountability Openness Honesty Leadership
Programme Office (PO)
Central support structure, designed to provide assistance and support delivery of ‘Our Healthier South East London’ strategy
Provider The provider of services to a (CCG(s) including both heath care services to patients and ancillary commissioning support functions
Public Health England Public Health England is an executive agency of the Department of Health in the United Kingdom that began operating on 1 April 2013. Its formation came as a result of reorganisation of the National Health Service in England outlined in the Health and Social Care Act 2012. It took on the role of the Health Protection Agency, the National Treatment Agency for Substance Misuse and a number of other health bodies
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Page 1 of 1
Report to the Governing Body
20 January 2016
Report Title Appointment of Auditor Panel for the procurement of External Auditors by NHS Lambeth CCG
Author(s) Christine Caton - Chief Financial Officer
Governing Body/Clinical
Lead(s)
Graham Laylee
Management Lead(s) Christine Caton – Chief Financial Officer
CCG Programme All programmes
Purpose of Report For decision
Summary
This report informs the Governing Body of the requirement for the CCG to procure external audit services from 2017/18. It explains the introduction of the Local Audit and Accountability Act 2014 and outlines the role of auditor panels in the procurement process.
Recommendation(s) The Governing Body is asked to approve the delegation of the responsibility of auditor panel to the Audit Committee.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention
focused
Integrated
Consistent
Innovative
Deliver best
value
Does this report provide assurance in relation to the following areas of responsibility
for the CCG?
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
7A – Financial Planning and Strategic Approach Risk
All legal, engagement, inequalities, financial and resource implications and any potential or actual risks are set out in detail in the body of this report.
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1
Appointment of Auditor Panel for the procurement of External Auditors by NHS Lambeth CCG Introduction This paper updates the Governing Body on the process for procuring external audit services following the abolition of the Audit Commission and makes recommendation for the approach to be taken by the CCG to deliver the new requirements. Background External auditors are responsible for audit of the CCG’s annual financial statements and are required to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness (Value for Money) in its use of resources. The Audit Commission was previously responsible for the centralised system of appointing external auditors to local authorities and the health service bodies. The Local Audit and Accountability Act 2014 (the 2014 Act) brought significant change to the local public audit regime by replacing these centralised arrangements with a system that allows each body to make its own appointment. Although the Audit Commission was abolished on 31 March 2015, existing audit services will remain in place up until 2016/17. These contracts are managed by a ‘transitional body’, Public Sector Audit Appointments Ltd (PSAA), a Local Government Association company set up for the purpose. PSAA is responsible for:
Regulating auditors’ work
Monitoring quality
Managing audit relationships
Making any new auditor appointments
Approving any non-audit work
Setting audit fees PSAA appointed BDO LLP as external auditor for NHS Lambeth CCG with effect from 1 April 2015. These arrangements will remain in place until 2016/17 as the new approach to external audit begins in 2017/18. Auditor Panels Under the 2014 Act, CCGs and NHS Trusts must have an ‘auditor panel’ to advise on the appointment of their external auditors. As the 2017/18 appointment must be made by the end of the preceding year, that is, by 31 December 2016, auditor panels need to be in place early in 2016. This appointment can be for longer than a year, but there must be a new appointment process at least once every 5 years. An auditor can be re-appointed for further terms. The external audit firm must be eligible for appointment in line with the requirements of the Financial Reporting Council (FRC). Two or more external auditors can be appointed to audit the accounts and in such cases, the auditors may act jointly or separately.
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2
The 2014 Act specifies that all local public bodies covered by the legislation must have auditor panels to advise on the selection, appointment and removal of external auditors, and on maintaining an independent relationship with them. The only exception to this would be if a body decided to make the appointment via a ‘collective procurement’, such as through a sector-led body. There are no current proposals for such a body in the NHS sector. The auditor panel’s key role is to check that:
The procurement and selection of external auditors are appropriate
The relationship and communications with the external auditors are professional
Conflicts of interest are effectively dealt
The auditor panel will have a role in establishing and monitoring the CCG’s policy on the awarding of non-audit services. The CCG must consult and take account of the auditor panel’s advice on the selection and appointment of the external auditor. The advice given by the panel must be published and, should the CCG not follow that advice, the reasons for not doing so must also be published. The auditor panel will need to be quorate to take a decision. For this to be the case independent members must be in the majority and there must be at least 2 independent members present or 50% of the auditor panel’s total membership, whichever is the highest. The CCG’s Governing Body should decide how it appoints its auditor panel. The panel must be either:
A specially established panel OR
An existing committee, sub-committee or panel provided it agrees to comply with the provisions applying to auditor panels.
The auditor panel should have its own terms of reference, which are agreed by the Governing Body. If it was decided that the Audit Committee forms the auditor panel then the Committee’s terms of reference would need to be updated to reflect its additional responsibilities. The auditor panel must have a minimum of three members, and must have a majority of members who are independent and non-executive members of the governing body. The chair of the panel must also be independent and a non-executive member of the governing body. The chair of the governing body cannot be the chair of the auditor panel. The CCG’s Governing Body is responsible for making the decision about the membership and chair of the panel. The chair of the auditor panel will be required to provide a report to the Governing Body about the activities and decisions of the panel. If the panel is the Audit Committee, the report must be separate to the minutes of the Audit Committee. It is expected that guidance on the procurement of external audit services will be provided by the Department of Health in early 2016.
Page 101 of 159
3
Proposal It is proposed that the Audit Committee performs the function of the auditor panel. The current membership of the Audit Committee meets the requirements of an auditor panel. This proposal was discussed with the Audit Committee at its meeting on 16 October. Following discussion with the Audit Committee chair it was agreed to recommend to the Governing Body that the Audit Committee undertakes the role of the audit panel on behalf of the CCG. NHS Lambeth CCG is in discussion with the other South East London CCGs about a joint approach to the procurement of external auditors. This requires each organisation’s governing body/auditor panel to approve and agree the service specification. Recommendation The Governing Body is asked to approve the delegation of the responsibility of auditor panel to the Audit Committee.
Enc
012
- A
ppoi
ntm
ent o
fA
udito
r P
anel
Page 102 of 159
1
Report to the Governing Body 20th January 2016
Report Title
Clinical Network update
Author(s)
Dr Martin Godfrey
Governing Body/Clinical Lead(s)
Una Dalton
Management Lead(s)
Dr Martin Godfrey
CCG Programme
Clinical Network
Purpose of Report
Update on activities since last GB meeting
Summary
This report will focus on:
- Face to face Network meeting in November - Recruitment - Budget
Recommendation(s) The Governing Body is asked to Receive the Clinical Network
Report for the period 5th November 2015 to 19th January 2016
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
Enc
013
- C
linic
al N
etw
ork
Dev
elop
men
t upd
ate
Page 103 of 159
2
Lambeth CCG Clinical Network Update January 2016
A. Face to Face meeting: 19 November (Roots and Shoots) Attendance: 27 clinical leads 1. Facilitated discussion led by Lucy Day on perceived achievements within
individual work-plans
Q. 1 What are you most proud of achieving in the Clinical Nework over the last 12 months?
Actively supporting talking therapies development
in Lambeth
GP Delivery Framework development
Support in creating the three Federations -
existing and holding contract
Supporting education for Health Care Assistants
and Supervision
Achieving an enhanced profile for student nurses
Live register of mentors –students and nurses.
Practice Nurse course
Establishing a support network for nurses with
increasing quality. R&R for Practice Nurse and
Clinical Supervisors
Well Centre – Sustainably funded
Submission of emerging leaders GSTT bid
Clinical Network itself, Pharmacies now key
partner in delivery of care.
Integration of pharmacies
Regular sessions – pharmacy and GP meetings
Patient profiling –DataNet, imp. Leaders in
integration
Demo data for health inequalities – depression as
part of the Mental Health role
Individual report – delays 2WW – escalated as
incident
LD health checks
Prime Ministers Challenge Fund
Hospital passports
Q.2 What is your aspiration for and from the Clinical Network?
Breakdown inter-professional barriers, training
opportunities – broad range of healthcare
professionals.
Mentorship and coaching – inter-professional and
disciplinary access for all .
Page 104 of 159
3
Understanding and ideas
Achievable actions – no gobbledegook
Enhanced influence on respiratory dialogue
between providers
Network members know each other better
Help CCG become change management ready
Common approach to what we do – new
members – what and how we do in
multidisciplinary way. Gold standards
Increase in understanding of roles and
integration
Knowing more about external network / Borough /
learning to increase patient care.
Tap into best practice
Help to continue to break down barriers in parts of
care.
Informed commissioning
Bring ‘coal face experience’ into
commissioning
Better support for cancer and EOLC-
diagnostic, screening + survivorship
Information sharing / talent pool.
Honorary members. Increase awareness.
Attract new nurses – pay structure, terms and
conditions – maternity pay etc.
Inform commissioning, design services
Impact on services
Improve as resource for CCG, Federations, 2oC
Make things work better for patients
Increase role of practice nurses
Resource to Federations for advice
Weekly update / website news
Improved Metrics to demonstrate success
Influencing PMS reviews
2. Update on Networking initiatives ( Shelley Whitaker) a. Twitter b. NHS networks discussion forums
3. Expert Panel (Ask the Lamberts)
c. Unanimous endorsement
4. Overview of changes happening within Lambeth (Adrian Mclachlan) d. Local Care Networks e. PMS f. Federations
Enc
013
- C
linic
al N
etw
ork
Dev
elop
men
t upd
ate
Page 105 of 159
4
5. Feedback: 95% met or exceeded expectations
B. Recruitment a. Mydhili Chellappa recruited as new cancer lead b. Frances Wedgewood recruited as new lead for LEAP c. New Integrated Mental Health Adults Locality Lead (SW) now being
recruited d. New Quality Lead needed by March 2016 e. Antimicrobial Committee member (on hold) f. Caldicott deputy role (on hold)
C. Cancer lead a. Problems developing due to loss of Macmillan funding in April b. Meeting planned to discuss – to include Anthony Cunliffe
D. Expert Panel (Ask the Lamberts)
a. Launching January
E. Annual Reviews and work plans a. 30% of leads now through this process
F. Budget
a. £50-£100K overspend for 2015/16 (see report)
Page 106 of 159
1
Report to NHS Lambeth Governing Body
20th January 2016
Report Title
Integrated Governance & Performance Report
Author(s)
Jo Steranka, Interim Performance and Information Manager
Governing Body/Clinical Lead(s)
Andrew Eyres, Chief Officer
Management Lead(s)
Andrew Parker, Director of Primary Care Development
CCG Programme
All programmes
Purpose of Report
To receive assurance
Summary
The January 2016 Report reflects performance for quarters 1 - 3 against our 2015/16 Business Plan objectives including performance against our 5 priority health programmes, which are:
Integrated Children and Young People
Integrated Adults
Integrated Mental Health Care for Adults
Staying Healthy
Primary Care Development Dashboards reflecting key performance indicators are used to help monitor the delivery of the programmes. Dashboard review is under way through the programmes; further developments are to be expected. The Governing Body is supported by the Integrated Governance Committee and its sub groups in assuring performance delivery and issues of quality and safety. Clinical Leads and Senior Responsible Officers report on their Health Programme to each Integrated Governance Committee meeting, with key measures included for each programme within the Integrated Governance and Performance Report. The Integrated Governance and Performance Committee reviewed the draft Integrated Governance and Performance Report on the 16th of December 2015. Key risks are refreshed on a monthly basis and reflected within the Board Assurance Framework and Risk Register. The Board Assurance Framework and the Risk Register have been updated to reflect the position as at mid-December 2015. One risk has been removed. All risks have robust action plans in place to address any gaps in assurance. The CCG attended a month 6 stocktake meeting with NHS England on 15 November and received a letter regarding the outcome on 24 December. The meeting emphasised in particular key challenges regarding the sustainability of the cancer and RTT constitutional standards for certain pathways and noted the processes in place to address these going forward.
Enc
014
- In
tegr
ated
Gov
erna
nce
and
Per
form
ance
Page 107 of 159
2
The Integrated Governance and Performance Report can be found at the following link: http://www.lambethccg.nhs.uk/news-and-publications/meeting-papers/governing-body/Pages/default.aspx
Key messages from this Report are as follows:
NHS Lambeth CCG’s Board Assurance Framework and Risk Heatmap identify the current highest risk to the delivery of the CCG’s Business Plan objectives as follows:
RTT performance standards
Cancer performance standards
Service Improvement Plan for District Nursing
A&E 4 Hour Wait performance standard
Impeded delivery of the SEL Strategy due to workforce issues.
Impeded delivery of the SEL Strategy due to information system issues.
Insufficient resources to continue Access Hubs beyond March 2016
NHS England’s Top 8 Performance Measures and Constitution Targets for 2015/16: These are summarised in the table below and reported in more detail in the body of the Report.
As at month 9 (December 2015) Lambeth CCG is reporting financial performance as a surplus of £5.715m. The year-end forecast is an underspend of £7.622m which in line with our planned target of delivering a minimum 1% surplus.
Recommendation(s) The Governing Body is asked to note:
2015/16 latest updates against Business Plan Objectives
Latest update of the Board Assurance Framework and Risk Register
Performance against NHS England’s Top 8 Performance Measures and Constitution Standards
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
As outlined in Risk Register.
Page 108 of 159
3
Na
tio
na
l C
on
sti
tuti
on
Pri
ori
ties
an
d N
HS
En
gla
nd
’s T
op
8 P
erf
orm
an
ce
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su
res
fo
r 2
015
/16
.
Th
e d
ash
bo
ard
hig
hlig
hts
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orm
ance a
gain
st
the e
xp
ecte
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tand
ard
.
OP
std
14
/15
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ttu
rn
14
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std
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ul-
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g-1
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84
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83
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81
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94
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94
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93
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92
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92
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92
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Ca
t A
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ed
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ca
lls r
esp
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within
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ins
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t A
re
sp
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within
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9 m
ins
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nce
lled
Op
era
tio
ns N
ot R
esche
dule
d W
ithin
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Da
ys
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PT
Acce
ss fig
ure
s a
re fro
m the
Pro
vid
er.
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me
ntia
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gno
sis
Ra
te
Tra
nsfo
rmin
g C
are
(P
lea
se
se
e p
ag
e 3
9 in the
re
po
rt fo
r th
e b
rie
f)
He
alth
Vis
ito
rs (P
lea
se
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e p
ag
e 3
7 in the
re
po
rt fo
r th
e b
rie
f)
Ca
nce
r 6
2 d
ays
(G
P r
efe
rrra
l)
1.8
%
Imp
rove
d A
cce
ss to
Psyc
ho
log
ica
l The
rap
ies
Pro
po
rtio
n o
f p
atie
nts
tha
t finis
he
d a
co
urs
e o
f tr
ea
tme
nt w
ho
re
ce
ive
d
the
ir fir
st tr
ea
tme
nt a
pp
oin
tme
nt w
ithin
6 w
ee
ks o
f re
ferr
al
50
%
Pro
po
rtio
n o
f p
eo
ple
und
er
ad
ult
me
nta
l illn
ess s
pe
cia
litie
s o
n C
PA
who
we
re fo
llow
ed
up
within
7 d
ays
of d
ischa
rge
fro
m p
syc
hia
tric
in-p
atie
nt ca
re
Ca
nce
r 6
2 d
ays
(re
ferr
al N
HS
scre
enin
g)
Ca
nce
r 6
2 d
ays
(firs
t d
efinitiv
e -
Co
nsulta
nt)
Mix
ed
-se
x a
cco
mm
od
atio
n
Clo
str
idiu
m d
ifficile
(C
.Diff)
ca
se
s
MR
SA
ba
cte
rae
mia
Am
bula
nce
re
sp
onse
tim
es (
So
uth
Ea
st
Lo
nd
on)
NH
S H
ea
lthche
cks
Ca
t A
(R
ed
1)
ca
lls r
esp
onse
within
8 m
ins
Da
ta n
ot
yet
ava
ilab
le
Mo
nth
ly d
ata
no
t a
vaila
ble
Pro
po
rtio
n o
f p
atie
nts
tha
t finis
he
d a
co
urs
e o
f tr
ea
tme
nt w
ho
re
ce
ive
d
the
ir fir
st tr
ea
tme
nt a
pp
oin
tme
nt w
ithin
18
we
eks o
f re
ferr
al
Na
tio
na
l P
rio
riti
es
in
clu
din
g T
op
8 P
erf
orm
an
ce
Me
as
ure
s
RT
T A
dm
itte
d
RT
T N
on-a
dm
itte
d
RT
T In
co
mp
lete
pa
thw
ay
(mo
st re
ce
nt)
Dia
gno
stic W
aits >
6 w
ee
ks
52
we
eks w
aite
rs (
inco
mp
lete
pa
thw
ays
)
A&
E w
aits (
GS
TF
T)
Ca
nce
r 2
we
eks (
GP
re
ferr
al)
Ca
nce
r 2
we
eks (
bre
ast sym
pto
ms)
Ca
nce
r 3
1 d
ays
(firs
t d
efinitiv
e)
Ca
nce
r 3
1 d
ays
(sub
se
que
nt -
surg
ery
)
Ca
nce
r 3
1 d
ays
(sub
se
que
nt -
dru
g)
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ays
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se
que
nt -
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ioth
era
py)
Enc
014
- In
tegr
ated
Gov
erna
nce
and
Per
form
ance
Page 109 of 159
Page 1 of 1
Report to the Governing Body
20 January 2016
Report Title 2015/16 Financial Position as at Month 9, December 2015
Author(s) Sabera Ebrahim - Head of Finance and Business
Governing Body/Clinical
Lead(s)
Graham Laylee, Hasnain Abbasi, Nandini Mukhopadhyay
Management Lead(s) Christine Caton – Chief Financial Officer
CCG Programme All programmes
Purpose of Report To receive assurance
Summary
NHS Lambeth is underspent by £5.715m as at 31 December 2015 and is forecasting a year end surplus of £7.622m.
Recommendation(s) The Governing Body is asked to:
Note the 2015/16 financial position as at month 9.
Note the latest performance on NHS Lambeth CCG’s cash management strategy.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention
focused
Integrated
Consistent
Innovative
Deliver best
value
Does this report provide assurance in relation to the following areas of responsibility
for the CCG?
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
7A – Financial Planning and Strategic Approach Risk
7B – QIPP and Acute Over-performance Risk
All legal, engagement, inequalities, financial and resource implications and any potential or actual risks are set out in detail in the body of this report.
Enc
015
- M
9 F
inan
ce R
epor
t
Page 110 of 159
Fin
anci
al R
epo
rt f
or
the
per
iod
A
pri
l 20
15
to
Dec
emb
er 2
01
5
Enc
015
- M
9 F
inan
ce R
epor
t
Page 111 of 159
1.
Key
Per
form
ance
Du
ties
Key
fin
anci
al p
erfo
rman
ce in
dic
ato
rs fo
r La
mb
eth
CC
G d
raw
n f
rom
th
e N
HS
Op
erat
ing
Fram
ewo
rk a
re:
•A
chie
vem
ent
of
a 1
% s
urp
lus
•R
un
nin
g co
st s
pen
d n
ot
to e
xcee
d r
un
nin
g co
st a
llow
ance
•
To r
emai
n w
ith
in t
he
CC
G c
ash
lim
it
•A
chie
vem
ent
of
the
no
tifi
ed
cap
ital
res
ou
rce
limit
•
Paym
ent
of
invo
ices
wit
hin
30
day
s Fo
r 2
01
5/1
6 L
amb
eth
CC
G is
pla
nn
ing
to d
eliv
er a
su
rplu
s o
f £
7.6
m. T
o s
up
po
rt t
he
del
iver
y o
f th
is f
inan
cial
po
siti
on
an
in y
ear
QIP
P p
rogr
amm
e o
f £
9.8
m (
gro
ss)
has
bee
n e
stab
lish
ed
wit
h d
eliv
ery
bei
ng
mo
nit
ore
d v
ia t
he
Pro
gram
me
Man
agem
ent
Off
ice.
A
s at
mo
nth
9, t
he
year
to
dat
e p
osi
tio
n is
a s
urp
lus
of
£5
.7m
wh
ich
is li
ne
wit
h p
lan
.
Page 112 of 159
2. S
um
mar
y
P
erf
orm
ance
aga
inst
sta
tuto
ry d
uti
es
R
even
ue
Res
ou
rce
Lim
it:
As
at m
on
th 9
, th
e C
CG
is r
epo
rtin
g a
year
to
d
ate
surp
lus
of
£5
.71
5m
. Th
e fo
reca
st o
utt
urn
fo
r th
e ye
ar is
a s
urp
lus
of
£7
.62
2m
. W
ith
in t
his
po
siti
on
, th
e C
CG
is f
ore
cast
ing
an
un
der
spen
d o
f £
36
1k
agai
nst
its
Ru
nn
ing
Co
st
targ
et.
Cas
h L
imit
: Th
e C
CG
has
dra
wn
do
wn
£3
42
.0m
as
at m
on
th
9. T
he
CC
G p
lan
s to
kee
p w
ith
in it
s m
axim
um
ca
sh d
raw
do
wn
lim
it a
nd
th
e ta
rget
of
hav
ing
less
th
an 1
.25
% o
f it
s M
arch
dra
wd
ow
n a
s a
cash
bal
ance
at
year
en
d.
QIP
P:
The
CC
G is
fo
reca
stin
g th
at it
will
ach
ieve
10
0%
o
f it
s Q
ual
ity,
Inn
ova
tio
n, P
rod
uct
ivit
y &
P
reve
nti
on
(Q
IPP
) ta
rget
in
20
15
/16
.
Mon
th 8
-
Nove
mbe
r
Chan
ges
Mon
th 9
-
Dece
mbe
r£'
000
£'00
0£'
000
Issu
ed B
udge
ts -
Prog
ram
me
430,
221
23
743
0,45
8
Issu
ed B
udge
ts -
Adm
in (R
unni
ng C
ost)
7,48
9
33
67,
825
Rese
rves
5,77
5
34
56,
120
Plan
ned
Surp
lus
7,61
2
0
7,61
2
Tota
l Allo
catio
n45
1,09
7
918
452,
015
Sum
mar
y of
Bud
gets
-Dec
embe
r 20
15
Enc
015
- M
9 F
inan
ce R
epor
t
Page 113 of 159
3. D
ash
bo
ard
Dec
emb
er 2
01
5
Key
Mes
sage
s
•Th
is t
able
sh
ow
s th
e p
erfo
rman
ce o
f th
e C
CG
ag
ain
st t
ota
l allo
cati
on
re
ceiv
ed e
xclu
din
g an
y ca
rry
forw
ard
su
rplu
s.
Inco
me
&
Exp
en
dit
ure
In Y
ea
r A
llo
ca
tio
n£
'00
0
Co
re 2
01
5/1
6 A
llo
ca
tio
n4
44
,32
3
All
oca
tio
n o
f P
rio
r Y
ea
r Su
rplu
s8
0
Sh
are
of
NH
S m
an
da
te f
or
20
15
/1
6
44
4,4
03
Exp
en
dit
ure
Fo
reca
st
Exp
en
dit
ure
44
4,4
03
Fo
reca
st u
nd
er/
(ov
er)
sp
en
d a
ga
inst
in y
ea
r a
llo
ca
tio
n-
Pe
rfo
rma
nce
ag
ain
st
15
/16
co
re
all
oca
tio
n(8
0)
Ma
de
up
of:
Pla
nn
ed
use
d o
f p
rio
r ye
ar
su
rplu
se
s
(ag
ree
d d
raw
do
wn
)(8
0)
Oth
er
in y
ea
r u
nd
er/
(ov
er)
sp
en
d
ag
ain
st r
eso
urc
e l
imit
0
To
tal
sh
are
of
NH
SE
ma
nd
ate
fo
r
20
15
/16
44
4,4
03
R
etu
rn o
f re
ma
inin
g p
rio
r ye
ar
su
rplu
s/(
de
ficit
)7
,61
2
To
tal
All
oca
tio
n p
lus
his
tori
c
surp
lus/
(de
ficit
)4
52
,01
5
Fo
reca
st
Su
rplu
s/(
de
ficit
) a
ga
inst
tota
l
all
oca
tio
n7
,61
2
Ta
rge
t a
dd
itio
na
l su
rplu
s re
qu
ire
d t
o
me
et
bu
sin
ess
ru
les
-
In Y
ea
r P
erf
orm
an
ce
Cu
mu
lati
ve
(h
isto
ric)
surp
lus/
(de
ficit
)
Page 114 of 159
3. R
even
ue
Bu
dge
ts
Key
Mes
sage
s
•Th
e m
on
th 9
yea
r to
dat
e p
osi
tio
n is
a s
urp
lus
of
£5
.71
5m
wh
ich
is li
ne
wit
h p
lan
. Th
e fo
reca
st
ou
ttu
rn f
or
20
15
/16
is
exp
ecte
d t
o b
e a
surp
lus
of
£7
.62
2m
.
•Th
e ye
ar t
o d
ate
and
fo
reca
st p
osi
tio
n is
b
ased
on
late
st f
inan
cial
in
form
atio
n w
her
e av
aila
ble
. W
her
e in
form
atio
n is
no
t ye
t av
aila
ble
th
e p
osi
tio
n is
b
ased
on
kn
ow
n r
isks
m
ain
ly r
elat
ing
to
po
pu
lati
on
an
d in
cid
ence
fa
cto
rs a
nd
QIP
P.
Best
Cas
eW
orst
Cas
e
Plan
Actu
alPl
an
Actu
al
Varia
nce
(Adv
/Fav
)
Varia
nce
(Adv
/Fav
)
£'00
0£'
000
£'00
0%
£'00
0£'
000
£'00
0%
£'00
0£'
000
Reso
urce
Allo
catio
n
Prog
ram
me R
esou
rce
327,
593
32
7,59
3
-
0%44
4,19
0
444,
190
0
0%0
0
Runn
ing C
ost R
esou
rce
5,86
8
5,
868.
4
00%
7,82
5
7,
825
00%
00
Tota
l Res
ourc
e Al
loca
tion
33
3,46
2
333,
462
00%
45
2,01
5
452,
015
00%
00
Prog
ram
me
Expe
nditu
re
Acut
e20
1,66
2
201,
254
40
90%
268,
883
26
9,16
4
(281
)(0
%)6,
011
(3,4
72)
Men
tal H
ealth
51,8
96
53
,445
(1,5
49)
(3%)
69,1
94
71
,260
(2,0
66)
(3%)
(1,7
03)
(2,3
89)
Com
mun
ity H
ealth
14,8
72
15
,267
(395
)(3
%)19
,830
20,3
43
(5
13)
(3%)
(447
)(8
78)
Cont
inui
ng C
are/
Free
Nur
sing
Care
1
1,04
1
11,
820
(780
)(7
%)
14,
721
1
6,37
9 (1
,658
)(1
1%)
(1,0
50)
(3,2
67)
Prim
ary C
are
3
3,22
4
32,
860
364
1%
44,
299
4
3,68
8 61
11%
1,19
883
Othe
r Pro
gram
me C
osts
incl
udin
g Cor
pora
te
8,00
2
7,
081
921
12%
1
0,32
3
9,
046
1,27
712
%(2
3)(4
46)
Tota
l Pro
gram
me
Cost
s
320,
697
32
1,72
7 (1
,029
)(3
2%)
42
7,25
0
429,
880
(2,6
30)
(62%
)
3,9
85
(10,
369)
Runn
ing C
ost
Pay
2,78
2
3,
027
(246
)(9
%)3,
709
4,06
6
(3
57)
(10%
)(3
57)
(357
)
Non
Pay
3,08
7
2,
570
517
17%
4,11
6
3,
398
718
17%
718
718
Tota
l Run
ning
Cos
t
5,
868
5,59
8 27
146
1%
7,
825
7,46
4 36
146
2%
3
61
3
61
Rese
rves
incl
udin
g
cont
inge
ncy
1,18
7
42
2
764
64%
9,32
8
7,
050
2,27
824
%1,
063
1,06
3
Tota
l CCG
Expe
nditu
re
32
7,75
3
327,
747
60%
44
4,40
3
444,
393
1
0 0%
5
,410
(8
,944
)
Surp
lus
5,70
9
5,
715
610
%
7,
612
7,62
2
10
13%
13
,022
(1
,332
)
EXEC
UTIV
E SUM
MAR
Y - F
OR TH
E PER
IOD
ENDI
NG 3
1st D
ECEM
BER
2015
Varia
nce (
(Adv
)/Fav
)
Year
to D
ate
Varia
nce (
(Adv
)/Fav
)
Fore
cast
Out
turn
Enc
015
- M
9 F
inan
ce R
epor
t
Page 115 of 159
4. Q
IPP
Su
mm
ary
•Q
IPP
sav
ings
init
iati
ve
pla
ns
tota
l £9
.81
1m
. Se
rvic
e R
epla
cem
ent
cost
s to
tal £
95
0k,
re
sult
ing
in a
net
QIP
P
of
£8
.86
1m
.
•Th
e C
CG
is f
ore
cast
ing
10
0%
del
iver
y o
f it
s Q
IPP
tar
get
in
20
15
/16
.
PRO
JECT
/SCH
EME
QIP
P
Prog
ram
me
Plan
ned
QIP
P
QIP
P
Deliv
ered
Varia
nce
Ove
r/(Un
der)
%
Deliv
ery
QIP
P
Deliv
ered
Varia
nce
Ove
r/(Un
der)
%
Deliv
ery
£'000
£'000
£'000
£'000
£'000
£'000
Acut
e 5,
264
3,94
83,
948
010
0%5,
264
010
0.0%
Com
mun
ity -
Trus
t Led
438
329
329
010
0%43
80
100.
0%
Men
tal H
ealth
2,42
51,
819
1,45
0(3
69)
80%
2,20
6(2
19)
91.0
%
Pres
crib
ing
1,29
697
297
20
100%
1,29
60
100.
0%
Prim
ary
Care
208
156
156
010
0.0%
208
010
0.0%
Non
Acut
e &
Oth
er S
chem
es18
013
513
50
100%
180
010
0.0%
Tota
l QIP
P Sa
vings
9,81
17,
358
6,99
0(3
69)
95%
9,59
2(2
19)
97.8
%
Repr
ovis
ion
Cost
s(9
50)
(713
)(3
44)
369
48%
(731
)21
976
.9%
Tota
l Net
QIP
P Sa
vings
8,86
16,
646
6,64
60
100.
0%8,
861
010
0.0%
QIP
P DE
LIVE
RY F
OR
THE
YEAR
201
5/16
Year
to D
ate
- Dec
embe
r 201
5Fo
reca
st O
uttu
rn
Page 116 of 159
5. A
cute
•A
t m
on
th
9,
Lam
bet
h
CC
G
is
sho
win
g a
year
to
d
ate
un
der
spen
d
of
£4
09
k w
ith
a
fore
cast
of
£2
81
k o
vers
pen
d a
t ye
ar e
nd.
•Th
e ye
ar
to
dat
e p
osi
tio
n
is
bas
ed
on
m
on
th
8
SLA
M
info
rmat
ion
, p
lus
a n
um
ber
of
adju
stm
ents
w
her
e SL
AM
re
po
rtin
g d
oes
n
ot
yet
refl
ect
con
trac
tual
ar
ran
gem
ents
o
r in
clu
de
agre
ed c
hal
len
ges.
• F
ore
cast
yea
r-en
d p
osi
tio
ns
are
bas
ed
on
th
e
year
to
d
ate
po
siti
on
s an
d f
ore
cast
fo
rwar
d,
incl
ud
ing
exp
ecte
d
seas
on
alit
y an
d e
xpec
ted
gro
wth
in
act
ivit
y as
th
e ye
ar p
rogr
esse
s. M
uch
of
the
in-y
ear
risk
on
th
e ac
ute
/ co
mm
un
ity
bu
dge
t is
co
nta
ined
b
y th
e ag
reem
ent
of
blo
ck-t
ype
con
trac
tual
ag
reem
ents
w
ith
G
STT
and
KC
H,
no
tin
g h
ow
eve
r th
at
reo
pen
er
clau
ses
rem
ain
w
ith
in b
oth
co
ntr
acts
.
Expe
nditu
rePla
nAc
tual
Plan
Actu
al
£'000
£'000
£'000
%£'0
00£'0
00£'0
00%
Guys
& St
Thom
as H
ospit
al NH
SFT
99,32
8
99
,328
00%
132,4
37
13
2,437
00%
Kings
Coll
ege H
ospit
al NH
SFT
53,52
1
53
,521
00%
71,36
1
71,36
1
00%
St Ge
orge
s Hea
lthca
re N
HSFT
14,51
9
14
,502
170%
19,35
9
19,76
8
(409
)-2%
Lewi
sham
Hea
lthca
re N
HST
1,361
1,4
14
(53)
-4%1,8
15
1,902
(8
8)-5%
Lond
on A
mbula
nce S
ervic
e8,8
26
8,826
(0
)0%
11,76
8
11,76
8
(0)
0%
Chels
ea &
Wes
tmini
ster N
HST
2,066
2,2
51
(185
)-9%
2,754
3,0
61
(307
)-11
%
Croy
don H
ealth
care
NHS
T2,4
27
2,429
(2
)0%
3,236
3,3
04
(68)
-2%
Othe
r Acu
te Se
rvice
Agr
eeme
nts
8,670
8,8
80
(210
)-2%
11,56
0
12,09
1
(531
)-5%
Cont
ract
ed A
cute
SLA'
s19
0,718
191,1
50
(4
33)
0%25
4,290
255,6
93
(1
,403
)-1%
Othe
r Exc
lusion
s1,9
70
1,738
23
112
%2,6
26
2,318
30
812
%
Non C
ontra
ctual
Activ
ity2,5
55
2,635
(8
1)-3%
3,406
3,5
14
(108
)-3%
Othe
r Acu
te6,4
20
5,729
69
111
%8,5
60
7,640
92
111
%
Tota
l Acu
te 2
015/
16
201
,662
201
,254
4
09
0.20
%
26
8,88
3
26
9,16
4 (2
81)
-0.1
0%
Varia
nce (
(Adv
)/Fav
) Va
rianc
e ((A
dv)/F
av)
Year
to D
ate
Fore
cast
Outtu
rn
ACUT
E SER
VICE
S - FI
NANC
IAL P
OSITI
ON D
ECEM
BER
2015
/16
Enc
015
- M
9 F
inan
ce R
epor
t
Page 117 of 159
6. N
on
Acu
te
The
No
n-A
cute
po
siti
on
is
sho
win
g an
ad
vers
e
vari
ance
o
f £
2.7
24
m
as
at
mo
nth
9
an
d
is
pro
ject
ed t
o o
ver-
spen
d b
y £
4.2
37
m a
t y
ear
end
.
The
key
vari
ance
s at
Mo
nth
9 a
re:
•W
ith
in m
enta
l hea
lth
ser
vice
s,
we
hav
e o
vers
pen
ds
in a
cute
inp
atie
nt
acti
vity
(4
81
k)an
d a
du
lt s
pec
ialis
t se
rvic
es (
£3
58
k)
•IP
SA A
llian
ce c
on
trac
t is
ove
rsp
end
ing
and
w
e h
ave
incl
ud
ed o
ur
shar
e o
f th
e o
vers
pen
d (
£5
45
k )i
n D
ecem
ber
as
we
app
roac
h t
he
con
trac
t to
lera
nce
. We
are
cu
rren
tly
agre
ein
g m
itig
atin
g ac
tio
ns.
•C
hild
ren
an
d A
do
lesc
ent
men
tal h
ealt
h
serv
ices
(C
AM
HS)
is s
ho
win
g an
ove
rsp
end
o
f £
18
0k
to 3
1st
Dec
emb
er a
nd
is f
ore
cast
to
ove
rsp
end
by
£2
41
k.
•C
on
tin
uin
g C
are
is a
sig
nif
ican
t ri
sk a
cro
ss
a n
um
ber
of
clie
nt
gro
up
s. A
t m
on
th 9
we
are
rep
ort
ing
an o
vers
pen
d o
f £
78
0k
and
a
fore
cast
ove
rsp
end
of
£1
.6m
. O
vers
pen
ds
are
mai
nly
in P
hys
ical
Dis
abili
ty c
lien
ts d
ue
to in
crea
sed
car
e p
acka
ges
for
exis
tin
g cl
ien
ts a
nd
an
incr
ease
in n
ew c
lien
ts (
5)
wit
h v
ery
hig
h c
ost
car
e p
acka
ges
(££
1m
).
•Le
arn
ing
Dis
abili
ty b
ud
get
is s
ho
win
g an
o
vers
pen
d o
f £
50
3k
to D
ecem
ber
an
d
fore
cast
ove
rsp
end
of
£6
71
k. A
co
mb
inat
ion
of
incr
ease
d c
lien
ts a
nd
in
crea
sed
co
sts
is c
on
trib
uti
ng
to t
his
.
•N
CA
sp
end
has
incr
ease
d s
ign
ific
antl
y
bas
ed o
n Q
2 I
P a
nd
OP
act
ivit
y re
ceiv
ed in
D
ecem
ber
, in
clu
din
g fr
om
Cam
den
an
d
Islin
gto
n a
nd
Oxl
eas
. W
e ar
e w
ork
ing
wit
h p
rovi
der
s o
n t
his
issu
e.
Expen
diture
Plan
Actua
lPla
n Ac
tual
£'000
£'000
£'000
%£'0
00£'0
00£'0
00%
Menta
l Hea
lth51,
896
53,445
(1,
549)
-3%69,
194
71,260
(2,
066)
-3%
Conti
nuing
Care
11,041
11,
820
(780)
-7%14,
721
16,379
(1,
658)
-11%
Comm
unity
Healt
h - Be
tter C
are Fu
nd8,3
82
8,4
57
(75
)-1%
11,176
11,
277
(100)
-1%
Comm
unity
Healt
h - Ca
re Pa
thway
1,473
1,358
115
8%1,9
63
1,7
96
16
89%
Comm
unity
Healt
h - Ch
ildren
Servi
ces1,0
72
1,1
50
(78
)-7%
1,429
1,534
(104)
-7%
Comm
unity
Healt
h - Le
arning
Disab
ilities
1,390
1,892
(503)
-36%
1,853
2,524
(671)
-36%
Comm
unity
Healt
h - Pa
lliativ
e Care
973
886
879%
1,297
1,181
116
9%
Comm
unity
Healt
h - Ot
her
1,583
1,523
594%
2,110
2,031
794%
Total
Non
Acu
te S
ervic
es
77,80
9
80,53
2 (2,
724)
-4% 1
03,74
5 1
07,98
2 (4,
237)
-4%
Forec
ast Ou
tturn
Year
to Da
te
Varia
nce
((Adv
)/Fav)
Varia
nce
((Adv
)/Fav)
NON
ACUT
E SE
RVIC
ES - F
INAN
CIAL
POS
ITIO
N DE
CEMB
ER 20
15/16
Page 118 of 159
7. P
resc
rib
ing
& P
rim
ary
Car
e •
Pre
scri
bin
g ex
pen
dit
ure
is
un
der
spen
din
g b
y £
51
4k
as a
t m
on
th 9
bas
ed o
n t
he
last
sev
en
mo
nth
s o
f d
ata.
Th
e ye
ar e
nd
fo
reca
st is
an
un
der
spen
d o
f £
78
6k
•Th
e G
P D
eliv
ery
Sch
eme
is
fore
cast
to
un
der
spen
d b
y £
11
2k.
Th
is is
bas
ed o
n t
he
late
st a
sses
smen
t o
f P
rim
ary
care
Acc
ess
exp
end
itu
re, a
n
un
der
- co
mm
itm
ent
of
£2
0k
on
th
e M
enta
l Hea
lth
Co
mm
un
ity
Ince
nti
ve s
chem
e o
ffse
t b
y an
d
ove
r-co
mm
itm
ent
agai
nst
Old
er
Peo
ple
’s S
LIC
inco
me.
•W
e a
re f
ore
cast
ing
an
ove
rsp
end
of
£6
3k
on
th
e Lo
nd
on
Am
bu
lan
ce S
ervi
ce 1
11
Sc
hem
e b
ased
on
7 m
on
ths
dat
a an
d a
n o
vers
pen
d o
f £
43
k o
n
the
Ad
vice
an
d H
and
ling
serv
ice
pro
vid
ed b
y SE
LDO
C.
•Th
e M
ino
r A
ilmen
ts S
chem
e (M
AS)
is o
vers
pen
din
g w
ith
in
loca
l pri
mar
y ca
re s
chem
es.
Expe
nditu
rePl
anAc
tual
Plan
Ac
tual
£'00
0£'
000
£'00
0%
£'00
0£'
000
£'00
0%
Pres
crib
ing
27,0
63
26
,548
514
2%36
,083
35,2
97
78
62%
Loca
l Prim
ary
Care
Sche
mes
688
71
8
(30)
-4%
918
95
8
(40)
-4%
GP D
eliv
ery
Sche
me
Netw
ork
Role
s76
1
695
67
9%1,
015
926
89
9%
GP D
eliv
ery
Sche
me
2,53
1
2,
631
(99)
-4%
3,37
5
3,
487
(112
)-3
%
Out
of H
ours
404
42
7
(23)
-6%
539
56
9
(30)
-6%
111
Serv
ice
736
82
0
(84)
-11%
982
1,
088
(107
)-1
1%
Oth
er P
rimar
y Ca
re
(incl
udin
g GP
IT)
1,04
0
1,
021
192%
1,38
7
1,
362
252%
To
tal
Pri
ma
ry C
are
3
3,22
4
3
2,86
0 36
41%
44,
299
43,
688
611
1%
Fore
cast
Out
turn
Year
to D
ate
Varia
nce
((Ad
v)/F
av)
Varia
nce
((Ad
v)/F
av)
P
RIM
ARY
CARE
SER
VICE
S - F
INAN
CIAL
PO
SITI
ON
DEC
EMBE
R 20
15/1
6
Enc
015
- M
9 F
inan
ce R
epor
t
Page 119 of 159
8. R
un
nin
g C
ost
•Th
e C
CG
has
a d
uty
to
sta
y w
ith
in it
s £
22
.50
per
hea
d
run
nin
g co
sts
allo
cati
on
of
£7
.8m
. Th
e 2
01
4/1
5 Q
ual
ity
Pre
miu
m o
f £
33
6k
has
bee
n t
o
ou
r ad
min
bu
dge
ts t
his
mo
nth
.
•A
s a
t m
on
th 9
, we
are
rep
ort
ing
a ye
ar t
o d
ate
un
der
spen
d o
f £
27
1k
and
yea
r en
d fo
reca
st o
f £
36
1k
un
der
spen
d.
•Th
e o
vers
pen
d o
n S
trat
egy
and
D
evel
op
men
t an
d P
rim
ary
Car
e an
d P
erfo
rman
ce r
elat
e m
ain
ly
to t
he
use
of
inte
rim
sta
ff
cove
rin
g va
can
t p
ost
s.
•O
ther
rec
har
ges
rela
te t
o t
he
ho
stin
g o
f th
e O
ffic
e o
f Lo
nd
on
C
CG
s.
Expe
nditu
rePl
anAc
tual
Plan
Ac
tual
£'000
£'000
£'000
%£'0
00£'0
00£'0
00%
Acco
unta
ble
Offic
er/B
oard
218
214
4
2%29
1
285
6
2%
Chai
r & N
on E
xecs
245
232
13
5%32
7
317
9
3%
Clin
ical L
eads
50
38
12
23%
66
55
1117
%
Finan
ce2,
793
2,
613
180
6%3,
724
3,45
3
27
07%
Corp
orat
e Af
fairs
794
833
(3
9)-5
%1,
059
1,14
4
(8
5)-8
%
Stra
tegy
& D
evel
opm
ent
647
722
(7
6)-1
2%86
2
944
(8
1)-9
%
Prim
ary C
are
& Pe
rform
ance
536
682
(1
46)
-27%
715
92
2
(208
)-2
9%
Inte
grat
ed C
omm
issio
ning
246
264
(1
8)-7
%32
8
343
(1
4)-4
%
Othe
r Rec
harg
es34
0
-
34
010
0%45
4
-
454
100%
Tota
l Cor
pora
te
5,86
8
5,
598
271
5%
7,82
5
7,
464
361
5%
Fore
cast
Out
turn
Year
to D
ate
Varia
nce
((Adv
)/Fa
v)
Varia
nce
((Adv
)/Fa
v)
RUNN
ING
COST
S -
FINAN
CIAL
POS
ITIO
N TO
DEC
EMBE
R 20
15/1
6
Page 120 of 159
9. F
inan
cial
Ris
ks a
nd
Mit
igat
ion
s
Acu
te C
on
trac
ts
•A
ctiv
ity
Dem
and
– P
op
ula
tio
n a
nd
dem
and
gro
wth
was
fac
tore
d in
to t
he
Op
erat
ion
al P
lan
. Res
erve
s h
ave
bee
n e
stab
lish
ed t
o p
rovi
de
a fu
nd
ing
sou
rce
for
incr
ease
d d
eman
d in
20
15
/16
.
•Q
IPP
– F
or
loca
l pro
vid
ers
QIP
P r
equ
irem
ents
are
em
bed
ded
wit
hin
th
e st
art
con
trac
t va
lues
. Th
e C
CG
w
ill c
on
tin
ue
to w
ork
to
red
uce
dem
and
to
min
imis
e u
nd
erly
ing
ove
r p
erfo
rman
ce.
No
n A
cute
•
The
tota
l QIP
P r
equ
irem
ent
for
SLaM
is £
1.3
m in
20
15
/16
, net
of
savi
ngs
del
iver
ed t
hro
ugh
th
e In
tegr
ated
Per
son
al S
up
po
rt A
llian
ce a
gree
men
t. A
ran
ge o
f ag
reem
ents
hav
e b
een
mad
e in
th
e SL
aM
con
trac
t to
mit
igat
e ag
ain
st Q
IPP
un
der
del
iver
y.
•O
ther
ris
ks r
elat
e to
co
nti
nu
ing
care
clie
nts
an
d c
om
ple
x ca
re f
or
pat
ien
ts w
ith
Lea
rnin
g D
isab
iliti
es f
or
wh
ich
a r
ange
of
mit
igat
ion
s h
ave
bee
n id
enti
fied
.
Oth
er B
ud
gets
an
d R
ese
rves
•
CC
G b
ud
gets
incl
ud
e 1
% n
on
rec
urr
ent
fu
nd
s an
d o
ther
res
erve
s se
t as
ide
to s
up
po
rt d
eliv
ery
of
the
pla
nn
ed s
urp
lus
for
20
15
/16
as
wel
l as
the
req
uir
ed 0
.5%
co
nti
nge
ncy
res
erve
Enc
015
- M
9 F
inan
ce R
epor
t
Page 121 of 159
10
. Cas
h P
osi
tio
n a
nd
Deb
tors
•
The
cash
dra
win
gs p
osi
tio
n o
f th
e C
CG
is
sho
wn
in
th
e f
irst
ta
ble
.
•Th
e cl
osi
ng
ban
k b
alan
ce a
s at
31
st D
ecem
ber
was
£2
16
k.
•Th
e se
con
d t
able
sh
ow
s th
e d
ebto
rs p
osi
tio
n.
As
at 3
1st
D
ecem
ber
, to
tal
deb
tors
was
£
15
.83
1m
.
Ca
sh
dra
wd
ow
n
Mo
nth
ly
Dra
wd
ow
n
£0
00
s
Cu
mu
lati
ve
Dra
wd
ow
n
£0
00
s
Pro
po
rtio
n o
f
An
nu
al
Ca
sh
Re
so
urc
e
Lim
it
KP
I -
1.2
5%
of
ca
sh
ba
lan
ce
as
dra
wd
ow
n
£0
00
s
Actu
al
mo
nth
en
d
ca
sh
ba
nk
ba
lan
ce
£0
00
s
CC
G
Ta
rge
t
£0
00
s
Ap
ril
31
,00
0
31
,00
0
7.5
%3
88
23
52
50
Ma
y3
3,2
50
6
4,2
50
1
5.6
%4
16
32
72
50
Jun
e3
2,5
00
9
6,7
50
2
3.7
%4
06
10
42
50
July
26
,00
0
12
2,7
50
30
.1%
32
5
1
67
25
0
Au
gu
st
34
,50
0
15
7,2
50
38
.5%
43
1
2
77
25
0
Se
pte
mb
er
35
,00
0
19
2,2
50
47
%4
38
93
25
0
Octo
be
r3
1,0
00
2
23
,25
0
5
4%
38
8
4
02
50
No
ve
mb
er
34
,50
0
25
7,7
50
62
%4
31
77
25
0
De
ce
mb
er
46
,00
0
30
3,7
50
70
%5
75
21
62
50
Acc
ou
nts
Rec
eiva
ble
Su
mm
ary
NH
S N
on
NH
S To
tal
£
'00
0
£'0
00
£
'00
0
Tra
de
Rec
eiva
ble
s
18
3
89
5
1,0
78
N
HS
Rec
ble
s <1
Yr-
CH
C R
isk
Po
ol
0
0
-
P
rovi
sio
n fo
r ir
reco
vera
ble
deb
ts <
1Yr
0
-1
54
-1
54
P
rep
aym
ents
& A
ccru
ed In
com
e
9,8
39
5
,09
7
14
,93
6
Vat
Rec
eiva
ble
s
0
-64
-6
4
Oth
er R
ecei
vab
les
0
3
5
35
Tota
l
10
,02
2
5,8
09
15
,83
1
Page 122 of 159
11. D
ebto
rs
•A
ged
Deb
tors
•
The
char
t sh
ow
s th
e cu
rren
t an
alys
is o
f th
e ag
e o
f o
uts
tan
din
g d
ebto
rs a
s at
31
st D
ecem
ber
.
•N
HS
Lam
bet
h C
CG
age
d
trad
e d
ebto
rs t
ota
l £
1.0
6m
co
mp
ared
to
£
1.0
7m
at
the
end
of
No
vem
ber
20
15
.
Enc
015
- M
9 F
inan
ce R
epor
t
Page 123 of 159
12
. Bet
ter
Paym
ent
Pra
ctic
e C
od
e
•U
nd
er t
he
Bet
ter
Paym
ents
P
ract
ice
Co
de
(BP
PC
), C
CG
s ar
e ex
pec
ted
to
pay
95
% o
f al
l cr
edit
ors
wit
hin
30
day
s o
f th
e
rece
ipt
of
invo
ices
. Th
is is
m
easu
red
bo
th in
ter
ms
of
the
to
tal v
alu
e o
f in
voic
es a
nd
th
e
nu
mb
er o
f in
voic
es b
y co
un
t.
•
Du
rin
g D
ecem
be
r 2
01
5,
Lam
bet
h p
aid
97
.07
% o
f in
voic
es
by
cou
nt
and
99
.57
% o
f in
voic
es
by
valu
e w
ith
in t
he
30
day
s o
f th
e r
ecei
pt
targ
et.
•
Cu
mu
lati
vely
to
Dec
emb
er
20
15
, La
mb
eth
pai
d 9
4.2
0%
of
invo
ice
s b
y d
ate
and
99
.12
% o
f in
voic
es
by
valu
e w
ith
in t
he
30
day
s o
f re
ceip
t ta
rget
.
BE
TT
ER
PA
YM
EN
T P
RA
CT
ICE
CO
DE
2015-1
6
NH
SN
ON
-NH
ST
OT
AL
NU
MB
ER
S F
OR
TH
E M
ON
TH
To
tal
nu
mb
er
of
inv
oic
es p
aid
in
th
e m
on
th2
56
93
71
,19
3
Nu
mb
er
of
inv
oic
es p
aid
wit
hin
ta
rge
t2
53
90
51
,15
8
Nu
mb
ers
%a
ge
fo
r th
e m
on
th98.8
3%
96.5
8%
97.0
7%
VA
LU
ES
FO
R T
HE
MO
NTH
(£000s)
To
tal
va
lue
of
inv
oic
es p
aid
in
th
e m
on
th3
9,0
09
9,9
41
48
,95
0
Va
lue
of
inv
oic
es p
aid
wit
hin
ta
rge
t3
9,0
05
9,7
36
48
,74
1
Va
lue
%a
ge
fo
r th
e m
on
th99.9
9%
97.9
4%
99.5
7%
CU
MU
LA
TIV
E N
UM
BE
RS
TO
TH
E M
ON
TH
To
tal
nu
mb
er
of
inv
oic
es p
aid
YT
D2
,45
38
,49
21
0,9
45
Nu
mb
er
of
inv
oic
es p
aid
wit
hin
ta
rge
t2
,42
97
,88
11
0,3
10
Nu
mb
ers
%a
ge
Cu
mu
lati
ve
99.0
2%
92.8
0%
94.2
0%
CU
MU
LA
TIV
E V
ALU
ES
TO
TH
E M
ON
TH
(£000s)
To
tal
va
lue
of
inv
oic
es p
aid
YT
D2
68
,59
95
4,2
12
32
2,8
11
Va
lue
of
inv
oic
es p
aid
wit
hin
ta
rge
t2
68
,25
55
1,7
28
31
9,9
82
Va
lue
%a
ge
Cu
mu
lati
ve
99.8
7%
95.4
2%
99.1
2%
De
c-1
5
Page 124 of 159
•Th
e St
atem
ent
of
Fin
anci
al
Po
siti
on
, pre
sen
ts t
he
fin
anci
al p
osi
tio
n o
f th
e C
CG
at
a g
iven
dat
e. It
is
com
pri
sed
of
thre
e m
ain
co
mp
on
ents
: as
sets
, lia
bili
ties
an
d e
qu
ity.
•Th
e ta
ble
set
s o
ut
the
po
siti
on
as
at 3
1st
Dec
emb
er
20
15
. •
The
stat
emen
t sh
ow
s a
net
lia
bili
ty p
osi
tio
n o
f £
19
.42
5m
13
. Sta
tem
ent
of
Fin
anci
al P
osi
tio
n
Clo
sin
g B
ala
nc
e
2016
2015
D
ec-1
5
AD
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1 V5
Report to the Governing Body
20th January 2016
Report Title
Director of Public Health Report – Lambeth & Southwark
Author(s)
Dr Ruth Wallis, Director of Public Health (Lambeth and
Southwark)
Governing Body/ Clinical Lead(s)
Management Lead(s)
CCG Programme
Purpose of Report
For information
Summary
This is a quarterly report of the Director of Public Health to the
Lambeth & Southwark Clinical Commissioning Groups and
the Lambeth & Southwark Health and Wellbeing Boards.
This report covers the following work streams:
Review of Public Health
National Child Measurement Programme (NCMP)
NHS Health Checks
Tuberculosis
Sexual Health
Health: A Lambeth Co-production (HALC)
Teenage pregnancy
Annual Report: Improving Public Health in Lambeth
and Southwark 2013-2015
Recommendation(s) The Governing Body is asked
To note the Director of Public Health Report covering the period October to December 2015.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG?
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
All legal, engagement, inequalities, financial and resource implications and any potential or
actual risks are set out in detail in the body of this report.
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Lambeth and Southwark Public Health
Director of Public Health: Dr Ruth Wallis
Public Health in
Lambeth and Southwark
Director of Public Health Report
October – December 2015
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Introduction
This is the quarterly report of the Director of Public Health for Lambeth and Southwark for the third
quarter of 2015-2016. The report is for the London boroughs of Lambeth and Southwark, and
Lambeth and Southwark Clinical Commissioning Groups, as well as for all Health and Wellbeing Boards
partners.
The aim of the quarterly reports is to update partners on some of the activities of the Lambeth and
Southwark specialist public health team, work being done in partnership, and to provide information
about public health issues relevant to Lambeth and Southwark, including alerting people to areas of
concern or risk.
This quarter, summaries are on; the councils’ review of the specialist Public Health function, the
National Child Measurement Programme (NCMP), NHS Health Checks, Tuberculosis, Sexual Health,
Health is Everyone’s Business, Teenage pregnancy, and a new publication; Improving Public Health in
Lambeth and Southwark 2013-2015.
Comments and suggestions for future issues are welcome. Please contact
1. Review of the Public Health function in Lambeth and Southwark
Following the Health and Social Care Act (2012) and the transition of public health responsibilities to
local government in 2012-13 Lambeth and Southwark councils agreed to a shared public health
service. This operating model has Southwark Council acting as employer and host of the service on
behalf of other partners. Over the summer of 2015 Lambeth and Southwark Councils conducted a
brief review of the shared public health function. Following this both councils decided that they
wished to have two separate public health departments from April 1st 2016.
In preparation for arrangements to implement the change, the public health team embarked on a
process internally to review their understanding of the requirements for delivery of a high quality,
efficient and strategic public health service and how two new departments might align most
effectively to priorities of the two councils and the CCGs. The aim was to identify risks and
opportunities of different models of working informed by experience and the literature, to develop a
preferred approach and to promote a strong vision of public health for the future. The work has taken
account of the substantial financial constraints in the system but acknowledged the continued
ambition of the councils and CCG partners to promote the health and wellbeing of their populations
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and reduce health inequalities.
By undertaking a SWOT (strengths, weaknesses, opportunities and threats) analysis of different
models an approach with a discrete specialist team headed by a Director of Public Health was
considered the most likely to be sustainable and effective and the most capable to deliver a quality
assured product. However the approach to working with partners will need to be relational rather
than hierarchical and look to achieve alliances through working directly with others across
professional and organisational boundaries. Portfolios of public health staff will need to align with
priorities in the Lambeth Community Plan, Southwark Council Plan, Health and Wellbeing Strategies
and CCG Commissioning Strategies. Where CCGs and Councils look to operate in a more integrated
way this will offer opportunities for public health to work efficiently especially in health and social care
commissioning.
The work provides the basis for a business case and as background to anticipated consultation on
proposed structures for two new departments. The intention is to have further discussions with
partners and colleagues to assist the development of priorities and working arrangements in both
boroughs in the future.
2. National Child Measurement Programme (NCMP) – Results 2014 -15
The National Child Measurement Programme (NCMP) is an annual measure of height and weight of
children in Reception (aged 4-5 years) and Year 6 (aged 10-11 years) in state maintained primary
schools across England. Information gathered as part of the programme enables local planning and
delivery of services for children. The information also supports population-level analysis of trends in
growth patterns and obesity and provides an opportunity to increase public and professional
understanding of healthy weight in children. The NCMP provides good quality data for the child excess
weight indicators in the Public Health Outcomes Framework, and is an important part of the
Government’s approach to tackling child obesity.
The results of the 2014/15 (academic year) NCMP were published in November 2015. The table shows
the latest figures. Lambeth and Southwark continue to have higher levels of obesity and excess weight
than the London and national average in both Reception and Year 6
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Table 1. National Child Measurement Results (2014/15): Lambeth, Southwark, London and England
Area Underweight Healthy weight Overweight Obese
Excess Weight (Overweight and
Obesity)
Year Yr R Yr 6 Yr R Yr 6 Yr R Yr 6 Yr R Yr 6 Yr R Yr 6
Lambeth 1.0% 0.8% 74.3% 57.7% 13.4% 14.6% 10.5% 27.2%
23.9%
41.8%
Southwark 1.6% 1.1% 72.0% 55.3% 13.4% 15.7% 13.0% 27.9%
26.4%
42.7%
London 1.5% 1.6% 75.4% 60.7% 12.0% 14.6% 10.1% 22.6%
22.2%
37.2%
England 0.9% 1.4% 76.5% 65.1% 22.5 14.2% 9.5% 19.1%
21.9%
33.2%
Obesity in Reception year in Lambeth decreased from 12.2% in (2013-14) to 10.5% (2014-15). In
Southwark, the obesity rate in Reception decreased slightly from 13.2% in (2013-14) to 13.0% (2014-
15). In London the Reception obesity rate reduced from 10.8% (2013-14) to 10.1% (2014/15) in line
with a similar reduction across England.
In Lambeth the rate of obesity in Year 6 has increased from 25.4% (2013-14) to 27.2% (2014-15). The
Southwark obesity rate in Year 6 has also increased from 26.4% (2013-14) to 27.9% (2014-15). In
London, there was a slight increase from 22.4% (2013/14) to 22.6% (2014/15). Southwark has the
highest proportion of obese Year 6 children in the country.
For excess weight, the proportion of Reception Year children in Lambeth decreased from 24.8% (2013-
14) to 23.8% (2014-15). In Southwark, Reception Year excess weight has also decreased from 28%
(2013-14) to 26.4% (2014-15).
The proportion of Year 6 children with excess weight has increased in Lambeth from 41.2% (2013-14)
to 41.8% (2014-15). In Southwark, there has been a slight decrease from 43.8% (2013-14) to 43.6%
(2014-15). However, Southwark still has the highest proportion of Year 6 children with excess weight
in the country.
3. NHS Health checks Programme trends and outcomes from 2012/13- 2014/15
The NHS Health Check programme is one of the mandated programmes to be delivered by local
authorities as part of the Health and Social Care Act 2012. The NHS Health Check Programme is a five
year rolling programme with twenty percent of the eligible population aged 40-74 years being offered
a cardiovascular check each year. Of the twenty percent offered a cardiovascular check, seventy-five
percent are expected to have completed a health check, based on Department of Health targets. The
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table summarises performance in Lambeth and Southwark.
Table 2: Number of patients completing a cardiovascular health check annually in Lambeth and Southwark between April 2012 and March 2015
Borough 2012/13 2013/14 2014/15
Southwark 6,259 6,995 8,788 ( 42%)
Lambeth* 4,228 4,667 5,383 (28%)
*These may be an underestimate of actual figures as not all data is uploaded into Health Check Focus system
Where screening was provided
Most patients had their cardiovascular health checks completed by their general practitioner (see
Figure 1). The Health Checks outreach team was used more significantly in Southwark than in Lambeth
to complete checks (this team focuses on promoting uptake in populations who maybe less likely to
respond to the invitation to attend for a health check). Over time, the proportion of checks being
carried out by GPs has increased in Southwark and decreased in Lambeth.
NB 323 checks were done by the outreach team in Lambeth (5%) but this is too small to show on the
scale above.
Figure 1: Breakdown of cardiovascular checks by provider
020
40
60
80
10
0
12/13 13/14 14/15 12/13 13/14 14/15
Lambeth Southwark
GP Outreach Team
Pharmacy
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Detection of Cardiovascular Risk Factors
The Health Checks programme was able to detect several risk factors for cardiovascular disease among
the population screened, as shown in Figure 2. Over 20% of the population screened annually in both
Lambeth and Southwark were identified as being obese (BMI>30) and approximately 1% of those
screened were newly diagnosed with diabetes mellitus as a result of the programme. The percentage
detected with 20% CVD (cardiovascular disease) risk and hypertension decreased over this period and
will be reviewed.
Figure 2: Percentage of patients screened that were found to have the following respective risk factors for cardiovascular disease; 20% Cardiovascular Disease Risk (Based on QRISK21); Obesity (BMI>30); Hypertension (140mmHg/90mmHg); Diabetes Mellitus (HbA1c>6.5%)
1 Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk
in England and Wales: prospective derivation and validation of QRISK2. BMJ.2008;336 (7659):1475-82.
010
20
30
40
50
60
70
80
90
10
0
12/13 13/14 14/15 12/13 13/14 14/15
Lambeth Southwark
20% CVD Risk Obese
Hypertension Diabetes
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Table 3. Proportion of people screened with 20% Cardiovascular Disease risk; Obesity; Hypertension,
or Diabetes Mellitus
Lambeth Southwark
2012/13 2013/14 2014/15 2012/13 2013/14 2014/15
20% CVD Risk 7.7 5.8 3.7 8.1 6.2 5.7
Obesity 19.7 21.4 20.4 26.9 23.9 24.6
Hypertension 17.4 11.8 9.0 19.8 14.8 11.0
Diabetes 1.3 0.7 1.0 1.4 1.0 1.1
People who are identified as being at risk are;
1) offered lifestyle advice and may be offered a referral to a behaviour change programme
2) referred to their GP if a long term condition is diagnosed, for further treatment.
Prescribed medication among people detected as at risk of cardiovascular disease
The outcomes of referral to a GP with either cardiovascular risk above 20%, or hypertension are
shown in Figure 3. The percentage of patients prescribed medication to reduce cardiovascular risks
increased over the duration of the programme in both Lambeth and Southwark. This will result in
fewer deaths and less ill health from cardiovascular disease.
Statins
In 2012/13, 17.5% of patients identified with a 20% CVD risk were prescribed a statin in Lambeth and
7.5% of such patients were prescribed a statin in Southwark. By 2014/15 however this percentage had
increased to 49.3% and 43.6% respectively. It is important to note that during this period new
cardiovascular guidance from NICE (National Institute of Health and Care Excellence) did reduce the
cardiovascular risk threshold (as calculated by QRISK21) above which a statin was recommended from
20% to 10%2. Nevertheless, a greater adherence and propensity to prescribing of a statin is evident.
Anti-hypertensives
Among people identified as hypertensive at screening, the proportion prescribed anti-hypertensive
therapy increased in Lambeth and Southwark during the study. By 2014/15, 20.0% in Lambeth and
2 The National Institute for Health and Care Excellence. NICE clinical guideline 181: Lipid modification:
cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of
cardiovascular disease. Available from http://www.nice.org.uk/guidance/cg181 accessed online 7 October 2015.
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25.9% in Southwark were on medication to reduce their blood pressure and cardiovascular disease
risk,al though this is likely to be lower than optimal therapy. Under- recording may be an issue.
Figure 3: Percentage of patients with appropriate statin and anti-hypertensive prescribing in those detected with a 20% or higher cardiovascular disease risk and/or those diagnosed with hypertension (>140/90 mm Hg).
0
10
20
30
40
50
60
70
80
90
100
12/13 13/14 14/15 12/13 13/14 14/15
Lambeth Southwark
Statin Prescribed Anti-Hypertensive Prescribed
Perc
enta
ge g
iven
dru
g In
terv
en
tion
Screening for smoking and those at risk from alcohol intake
In total, 6,466 smokers and 4,516 individuals at risk of harmful alcohol intake (FAST Positive or AUDIT-
C positive3) were newly identified as part of the health checks programme across Lambeth and
Southwark between 2012 and 2015 (Figure 4). The proportion of these who then received targeted
intervention is highlighted in Figure 5. The percentage of smokers referred annually for interventions
to reduce/stop smoking in Southwark increased to 17.2% in 2014/15. However, in Lambeth, smoking
referrals decreased from a high of 14.2% in 2013/14 to 7.0% in 2014/15. The percentage of patients at
risk of harmful alcohol intake who received advice or referral also increased annually in both Lambeth
and Southwark. In 2012/13, 54.5% of those at risk of harmful alcohol intake in Lambeth and 16.6% of
those in Southwark received lifestyle advice or were referred on to help with reducing alcohol intake.
By 2014/15 this had increased to 73.7% in Lambeth and 37.1% in Southwark.
3 Public Health England. PHE Alcohol Learning Resources. Available from
http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/?parent=4444&child=4570 accessed online 7 October 2015.
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Figure 4: Percentage of people screened identified as smokers or at risk of harmful alcohol intake
Figure 5: Percentage of people screened identified as smokers or at risk of harmful alcohol intake
referred or given lifestyle advice for alcohol consumption
More information on other lifestyle advice offered to people receiving cardiovascular health checks
will be reported on at a later date.
0
10
20
30
40
50
60
70
80
90
100
12/13 13/14 14/15 12/13 13/14 14/15
Lambeth Southwark
Smokers detected Harmful alcohol intake detected
Perc
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0
10
20
30
40
50
60
70
80
90
100
12/13 13/14 14/15 12/13 13/14 14/15
Lambeth Southwark
Smoking referral Advice or referral for excess alcohol intake
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4. TB update
Latent TB testing and treatment programme
Tuberculosis (TB) is an infectious disease caused by bacteria belonging to the Mycobacterium
tuberculosis complex. TB usually affects the lungs, but can affect other parts of the body, such as the
lymph nodes (glands), the bones, and the brain. Infection with the TB organism may not develop into
TB disease and the infection can stay latent for several years. Most TB is curable with a combination of
specific antibiotics, taken for at least six months. TB is much less common than in years past but
during the 1990s to 2005 the UK experienced a progressive increase in TB cases, and incidence (ie rate
of new cases) has stabilised at a relatively high level since then.
The ‘Collaborative Tuberculosis Strategy for England: 2015 to 2020 (PHE, NHS England, 2015)’ was
published in January 2015. It recommends that newly arrived migrants aged 16-35 years from
countries with high TB incidence (PHE, 2014) are identified, screened and treated if found to have
latent Tuberculosis (LTB).
This recommendation is based on these factors:
- Most cases of TB in the UK arise from reactivation of latent TB infection (LTBI)
- Latent TB screening among migrants is cost-effective
- The higher the incidence in the country of origin and the more recent the individual’s arrival in
England, the higher the risk of TB reactivation.
- Drug induced liver injury caused by the LTBI treatment increases and treatment benefits decrease
with age. Therefore LTBI screening and treatment will be offered to people aged 16-35 years.
NHS England will offer financial support to develop the new pathway. Lambeth & Southwark CCGs
have applied for funding for 2015-16 and 2016-17 as they are amongst the 59 CCGs nationally
considered a priority for introducing latent TB testing of new migrants. Local TB rates are ≥20/100,000
and local TB notifications represent ≥0.5% of the total England TB numbers.
The LTBI screening will be phased in starting with practices located in areas of high concentration of
migrants from high risk countries and /or with high numbers of detected active TB cases. LTBI
screening will be offered to newly registered patients aged 15-35 years who have arrived in the past 5
years from countries with high risk of TB. This first phase will be evaluated at the end of the first year
of implementation. Learning will inform future development of LTBI screening and treatment.
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5. Sexual Health
Lambeth has the second highest and Southwark the fourth highest rates of sexually transmitted
infections (STIs) in England. This is thought mainly due to the high proportion of the very diverse
population who are young and, or mobile. This demography, combined with improved service access
following modernisation mean there is a high demand for sexual and reproductive health services
(SRH).
Lambeth and Southwark have had considerable success in reducing teenage pregnancy and late
diagnosis of HIV, and of increasing chlamydia testing (another reason for the high rates of STIs). Rates
of sexually transmitted infections continue to rise however and both boroughs continue to have high
levels of risky sexual behaviours, shown by high reinfection rates and rates of syphilis and
gonorrhoea. Abortion and repeat abortion rates also remain high, indicating a need for improved
access to contraceptive services and in particular long acting reversible methods.
Given the high levels of need and high activity levels of SRH services and the requirement to make
significant savings, work is going on to transform services for the future. The aim is to increase access
to STI testing through online services and enhance contraceptive and STI testing and treatment in
primary care and pharmacy.
This will be supported by a London wide programme to procure an online ‘partner notification system’
and a London online service which will direct people to the most appropriate local service (online,
pharmacy, primary care and clinic).
6. Working with local authorities to make health everybody’s business
The Public Health team have been working with senior staff across departments in the two
councils to support colleagues to take a population health approach to their work and look for
opportunities to improve health and wellbeing outcomes through council core business.
In Lambeth, Health: A Lambeth Co-production (HALC) started in November after planning and
design with senior Council commissioners to ensure it was pitched appropriately. Two
sessions have been held, and evaluation has been positive. Participants have identified an
understanding of the wider determinants of health, statistics on health outcomes in Lambeth,
and information on the relative disease burden on different populations as being valuable.
They have expressed interest in learning more about public health in early years, resilience,
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and addressing the wider determinants of health through efforts around engagement. The
course will finish in Spring 2016.
Southwark Council’s existing Leadership and Management Development Programme (LMDP)
has offered an ideal opportunity for senior staff to learn about population health through
additional Healthy Futures Masterclasses delivered by the Public Heath team. These were
held in September and November 2015, with three groups attending sessions. Attendees are
working on projects about obesity, alcohol and new psychoactive substances, and physical
activity. The aim is for participants to work with public health colleagues to understand the
impact on the population, underlying factors, current strategies and the potential for council
core functions to make a difference. Further LMDP groups are expected to participate in
masterclasses and projects in 2016.
7. Teenage Pregnancy
Under 18 conceptions for Quarter 3 2014 increased in both Lambeth and Southwark compared with
the same quarter in 2013.
Lambeth
Lambeth under 18 conceptions
2014 third quarter data for Lambeth was published by ONS on 24th November 2015 and shows:
The quarterly rate of under-18 conceptions was 30.2 per 1000 girls aged 15-17. That is a 61%
increase since the same quarter in 2013.
The number of under-18 conceptions was 32, twelve more conceptions than the same quarter in
2013.
The rolling quarterly average is 32.5 conceptions per 1000 girls aged 15-17 which represents a
10% increase since previous rolling average.
The rolling quarterly average for England is 23.3 and 21.4 for London
Under 18 conceptions in Lambeth increased in this quarter, this is the third quarter in 2014 that
conceptions have increased
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Figure 6. Lambeth under 18 conceptions by quarter
Figure 7. Lambeth under 18 conceptions by year
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Southwark
Southwark under 18 conceptions
2014 third quarter data for Southwark which was published by ONS on 24th November 2015 shows:
The quarterly rate of under-18 conceptions was 33.7per 1000 girls aged 15-17. That is a 32%
increase since the same quarter in 2013.
The number of under-18 conceptions was 34, eight more conceptions than the same quarter in
2013.
The rolling quarterly average is 29.1 conceptions per 1000 girls aged 15-17 which represents an
8% increase since previous rolling average.
The rolling quarterly average for England is 23.3 and 21.4 for London under 18 conceptions in
Southwark increased in this quarter.
Figure 8. Southwark under 18 conceptions by quarter
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Figure 9. Southwark under 18 conceptions by year
Although overall it can be seen that over a long period of time under 18 conceptions have reduced
substantially the recent increases are of concern especially as the annual rates remain higher than
London and England in both boroughs. Annual 2014 under 18 conception data will be available in late
February 2016.
8. Annual Report: Improving Public Health in Lambeth and Southwark 2013-2015
A Report on the work of the Lambeth and Southwark Public Health Team over the past couple of years
is now available. The Report summarises some of the achievements, current work and future plans of
the team. Two years on from the transition of public health responsibilities to local government, some
good progress has been made. There is much to be proud of in terms of public health successes. The
Lambeth and Southwark Public Health Team have been able to take forward some excellent
programmes of work with local authority colleagues that tackle the underlying causes of ill health and
inequality as well as continue to support health and social care commissioning colleagues. Life
expectancy continues to improve and deaths in infancy are reducing but there remains considerable
work to do. Over the next few months, the Lambeth and Southwark Public Health Team will undergo
major re-structuring but we intend to continue to support partners to promote the health and
wellbeing of Lambeth and Southwark people and to reduce inequality. To receive a copy please
email [email protected]
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Report to the Governing Body
20 January 2016
Report Title
Primary Care Development Programme Update
Author(s)
Lesley Connaughton, Primary Care Development Manager, NHS Lambeth CCG
Governing Body/Clinical Lead(s)
Dr Hasnain Abbasi
Management Lead(s)
Andrew Parker, Director of Primary Care Development
CCG Programme
Primary Care Development
Purpose of Report
For information
Summary
The transformation of Primary Care in Lambeth is now in its second year and this paper updates the CCG Governing Body on progress.
Recommendation(s) The Governing Body is asked to note developments and progress in Primary Care.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here
All legal, engagement, inequalities, financial and resource implications and any potential or
actual risks are set out in detail in the body of this report.
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Primary Care Development Programme
Update Paper
NHS Lambeth CCG Governing Body Public Board Meeting
13 January 2016
Introduction This paper provides an update to the Governing Body on the work in the Primary Care
programme.
PMS Reviews Early discussions regarding the PMS reviews are taking place with a small task and finish group which includes the CCG, NHS England, Federation Directors and the LMC. Further engagement will take place over the next few weeks and will be included as part of locality meetings, the Governing Board in public, the All Practice Event, LMC meeting, and Health & Well-being Board. Further consideration of high level commission intentions will take place at the Primary Care Joint Committee on the 11th February followed by the submission to NHS England on the 18th February 2016. CQC Visits The CCG has been informed that 11 practices will be inspected by the Care Quality Commission (CQC) during the first quarter of 2016. Practices will be notified 2 weeks before the date of their visit. All practices will be inspected by the end of October 2016. All Practices inspected to date have been rated as at least good overall. Local Care Record The Local Care Record is gaining momentum as we move towards the first practices ‘going live’ on the shared system. 62 practices across Lambeth and Southwark have signed-up to the Local Care Record. It is envisaged that the remaining 18 practices yet to sign for Lambeth will be keen to sign up once the system is live and they can see the benefits of the Local Care Record and their patients
55 of the 62 practices have been configured and the EMIS ‘patch’ applied
Four information/training sessions for Practice Managers on LCR and an IG ‘Refresher’ has been offered with over 60 attendees covering 44 individual practices. A public event on was hosted on the November 18 2015, which was well attended with over 50 attendees and featured a range of brief presentations from clinical leads from acute, mental health and primary care. This was followed by an open Q&A session which resulted in very favourable feedback.
Fair Processing Notices have been circulated to all GP practices to display in their reception
areas
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Prime Ministers Challenge Fund
The hubs offer daytime, evening and weekend appointments to patients of Lambeth GPs
from 8am to 8pm Monday to Friday, and 10am to 6pm at weekends. Patients are offered a
GP consultation face to face, or on the telephone, or see a practice nurse. Patients’ book
appointments at the hubs, on the day or in advance, through their own GP practice if
appointments are not available within their own practice, and by ringing the out of hours
service SELDOC.
The GP Access Hubs are located at Clapham Family Practice, South Lambeth Road
Practice, Knights Hill Surgery, and Streatham High Practice. They are provided by the
Lambeth GP Federations with funding from the Prime Minister’s Challenge Fund and NHS
Lambeth CCG.
As well as improving access for people with more acute illnesses, the pilot will free up
capacity for practices to spend more time with people with long term conditions and frail
older people.
The 4 GP Access Hubs launched in late 2015 as a pilot scheme to help patients to access
primary care appointments at more convenient times continue to operate. Analysis for
week commencing 4th January 2016 shows 3 out of the 4 hubs are running at 82% of
capacity or above.
After discussions with the CCG, it was agreed that over the Christmas period 2 hubs would
be operational to offer appointments to Lambeth registered patients and weekly data shows
an average 23% uptake over that period.
Individually practice utilisation continues to be varied and will be carefully monitored but the
continued take up compares favourably with other pilot schemes across the country.
It is expected that lessons will be learned during the six month pilot phase about the pattern
of patient demand and methods of provision that will refine the service model and the
capacity to be commissioned for 2016/17 following preparation of a business case.
The Prime Minister’s Challenge Fund Steering Group is exploring further initiatives to
improve access, using the remaining non-recurrent PMCF budget. One major theme is to
increase the use of digital interactions between patients and their surgery, both innovative
approaches and in using methods that are already available. These would have the benefits
of providing more timely and convenient access to primary care, whilst being more resource
efficient for practices.
GSTT Charity Fund – Transforming General Practice Provision
The latest phase of the Lambeth and Southwark Primary Care Transformation Programme,
funded by Guy’s and St Thomas’ Charity (GSTC) has now commenced. Following the
award of £470k across Lambeth and Southwark CCGs, the organisational development
provider Healthskills was selected.
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A launch event held in October helped to define the programme of support which is now
being delivered, in the context of live organisational development activities for the three
Lambeth GP Federations, and the two in Southwark.
A further bid is expected to be focused on developing leaders for the Local Care Networks.
Local Care Networks Providers, commissioners and service users continue to work on developing Local Care
Networks (LCNs), recognising that local people and organisations can view LCNs and their
potential benefits from different perspectives. The Local Care Networks are based on local
providers across health and social care focused on the needs of local communities. NHS
Lambeth CCG is keen to ensure these Local Care Networks continue to be developed from
the bottom up with citizen input. The CCG also recognises that in order for LCNs to be
effective they need to have co-produced governance and leadership arrangements.
A multi-stakeholder LCN Enabling Forum was established as a ‘task and finish group’ to support LCN development across the two boroughs and met 3 times up to December 2015. The output of that process was the development of a LCN ‘starter kit’ – about to be launched. Each LCN has now appointed an Interim Chair until the end of March 2016. The Lambeth LCNs have each held sessions to review progress and plan future initiatives.
The following multi-agency projects are underway, and new areas are being developed,
connecting with the Our Healthier South East London Strategy’s key topics:
South West:
Current project running:
Community asset mapping for people with a long term condition, for example
mental health.
Developing projects:
Children and Young People – including how to make practices friendlier to
younger people, and improving emotional resilience with schools.
Health Living, focusing on the care navigator role.
Living with a Long Term Condition
South East:
Current projects running:
Safe and Independent Living - enabling wider health and wellbeing referrals.
Locality Geriatrician
Wound Dressing
Developing projects:
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Paediatric asthma
Frequent attenders
Patients with multi-morbidity
North:
Current projects running:
Portuguese community project
Primary Care Navigators, starting with diabetes
Developing projects:
Projects on the theme of “loneliness”
A further topic to be decided
As part of the review of integration ambitions across Lambeth and Southwark, further
clarification of the ‘askes for LCN’s’ is in the process of being finalised for 16/17
Patient and Public Engagement Update
In collaboration with Lambeth Health Watch and the Lambeth PPG Network, the Primary
Care Development team in NHS Lambeth CCG is continuing the development of the
Community Voice as an integral element of our Local Care Networks. Work is continuing to
provide some practical solutions as to how we achieve the agreed vision and ensure it is a
critical friend to commissioners and providers. Progress and developments will be
discussed at the LCN strategic stakeholder forum meeting.
GP Delivery Framework 2015/16
For Year 2 of the GP Delivery Framework (2015/16) the CCG continued with the packaged
a series of previous enhanced services into a single Local Incentive Scheme. This was
contracted individually with each of Lambeth’s then 47 GP practices using a short form of
the national standard contract.
A further specification for Children’s services has now been circulated to practices as part of
the overall Framework. This focuses on paediatric asthma (both improving the quality of
diagnosis, and improving the quality of care through reviews) and on education sessions for
professionals on childhood obesity.
A mid-year review of the original specifications has recently taken place and the
conclusions for each of the specifications will be discussed at the Primary Care Programme
Board in January 2016
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Next Steps in Primary Care Co-Commissioning
In March 2015 NHS England confirmed their approval of the proposal including governance
arrangements that support Primary Care Joint Committee meeting in Common between
South East London CCGs and NHS England...
Alongside key operational decisions required at a borough level, the main emphasis of this
committee remains the preparation for the implementation of the PMS review process
Recommendation The Governing Body is asked to note the update on the Primary Care Development Programme. If you require any further information on the Primary Care Development Programme, please contact Andrew Parker, Director of Primary Care, and NHS Lambeth CCG. Andrew Parker Director of Primary Care Development NHS Lambeth CCG
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Integrated Governance Committee
Minutes of the Meeting held on 21st October 2015, 13:00-17:00 Room 407, 4th Floor, 1 Lower Marsh, Waterloo, SE1 7NT
Present:
Graham Laylee (GL) Governing Body member: Lay Member, (Chair)
John Balazs (JB) Governing Body member: North Locality
Raj Mitra (RM) Governing Body member: North Locality
Lisa LeRoux (LL) Governing Body member: South East Locality
Hasnain Abbasi (HA) Governing Body member: South West Locality
Adrian McLachlan (AM) CCG Chair
Christine Caton (CC) Chief Financial Officer
Una Dalton (UD) Director of Governance and Development
Moira McGrath (MMc) Director of Integrated Commissioning (Adults)
Maria Millwood (MMw) Director of Integrated Commissioning (Children)
Andrew Parker (AP) Director of Primary Care Development
Catherine Pearson (CP) Chief Executive, Lambeth Healthwatch
Pippa Pritchard (PP) Governance Manager
In Attendance:
Ciara Hanson (CH) Senior Business Support Administrator
Tahseen Khan (TK) GP Fellow
Alice Wu (AW) GP Fellow
Marie Vieu (MV) Public Health Consultant, Lambeth & Southwark Public Health [agenda item 15/091]
No. Agenda Item Action for / date
1
LCCG/IGC/15/084 – Welcome and Introductions The Chair welcomed all to the meeting and introductions were made.
2
LCCG/IGC/15/085 – Apologies for Absence Apologies were received from: Sue Gallagher (SG) Governing Body member: Lay Member Ami David (AD) Governing Body member: Nurse Board Member Nandi Mukhopadhyay (NM) Governing Body member: South East Locality Paul Heenan (PH) Governing Body member: South West Locality John Moxham (JM) Co-opted Governing Body member, King’s Health Partners Andrew Eyres (AE) Chief Officer Ruth Wallis (RW) Joint Director of Public Health Sarah Cottingham (SCt) Acute Contracting, South East Commissioning Support Unit Sarah Corlett (SC) Consultant in Public Health Anne Middleton (AM) Assistant Director Governance and Quality Jo Moore (JM) Partner – Customer Accounts, South East Commissioning
Support Unit
3
LCCG/ IGC/15/086 – Declaration of Interests – In Agenda Items No declarations of interest in agenda items were made. A single register of interests is being developed across all Committees and Programmes.
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LCCG/IGC/15/087 – Recording of Meeting / Minutes The Committee was asked to note that this meeting may be recorded to support the minute taking process and to make the Chair aware of any confidential items that were not for minuting / recording.
Standing Agenda Items
5
LCCG/IGC/15/088 – Draft minutes of the meeting held on 19 August 2015 The minutes of the meeting held on 19 August 2015 were agreed as an accurate record.
6
7
LCCG/IGC/15/089 – Action Log/Matters Arising The action log was received and the updates noted. It was agreed that the ‘deep dive’ into the London Ambulance Service will be brought to the Seminar meeting in November.
Programme Updates
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LCCG/IGC/15/090 – Integrated Governance and Performance Report August 2015 and Programme Updates GL outlined the changes to the Programme Updates section of this meeting: each meeting, there will be a ‘deep dive’ into two of the programmes, with space for questions relating to the other programmes. The ‘deep dive’ will consider whether the programmes are on track, discussing any issues. Integrated Governance and Performance Report (Q1&2) UD presented the draft Integrated Governance and Performance Report and highlighted the following points:
The CCG attended the Q1 asssurance meeting with NHS England on 16th October at which positive feedback was received. NHS England will provide a letter stating their level of assurance. The assurance meeting will become less frequent, taking place twice a year in the future.
Simon Weldon from NHS England visited St Thomas’s Emergency Department to look at current systems.
Positive work on Dementia.
A new 62 day cancer wait group has been established.
A safeguarding deep dive will take place in November (see agenda item 15/099).
Board Assurance Framework: Since the circulation of the papers, there were two changes to the risk register from the Primary Care Programme Board.
o Windows 7: this risk has been downgraded from a score of 16 to 12 as the project is nearing completion, though the issues raised as a result of the project have not been downgraded. All GP complaints are being escalated to the CSU. There was some discussion about current IT issues and how these are being dealt with.
o Prime Minister’s Challenge Fund Access Hub: this risk has been upgraded from a score of 12 to 16 to flag the issue with sustainability.
JB queried whether the CQC Inspection results at KCH should be reflected in the CCG risk register, as although we are not the main commissioner, they are an
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No. Agenda Item Action for / date
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12
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important provider. It was noted that all target risks and their financial position are already refected in the Board Assurance Framework, although the quality risks are not – these are being monitored through the relevant CQRG. GL noted that some of the risks from the Staying Healthy risk register were not reflected in the Corporate risk register. It was noted that the Staying Healthy Programme Board is a Partnership Board of which the CCG is a member, and that it does not have accountability for the Staying Healthy budgets. This is the responsibility of the Local Authority. There was some discussion around the risk of Local Authority budget cuts and their effect on the Staying Healthy Programme. It was suggested that the overall Local Authority budget issues be added to the risk register. MMw and RM to review this. Integrated Children and Young People (including Maternity) Programme – Deep Dive MMw gave an update on the programme and highlighted the following points:
The programme is on target to deliver it’s commissioning intentions.
Risks: o Responsibility around safeguarding children. o The dependency of the Programme on other programmes – CHPYP
(formerly known as Evelina) and LEAP. In order to mitigate this, work that can be completed on the Primary Care Delivery Scheme and redesign work on pathways is also underway.
o Child & Adolescent Mental Health Service (CAMHS) Early Intevertion services waiting lists. A comprehensive plan has been put in place, but it is expected that the recovery period will be 18-24 months. A major investment of transformation funds has been received by the CCG for the CAMHS service (£200k for eating disorders and £600k for other CAMHS services).
Dashboard: o The dashboard is being redeveloped and was discussed at length at
the last Programme Board meeting. The indicators included on the dashboard reflect the outcomes that the programme is trying to achieve, but more work is needed to make it fit for purpose.
o The targets of MH1 and MH2 will be changed to be in line with the plan.
o There was some discussion around the use of the ‘spark line’ graphs. MMw noted that added intelligence is needed around how the indicators are formed and what trends are showing.
o JB suggested that all of the programme dashboards be formatted the same, however this would be impractical due to the dashboards being at different stages.
o MMw outlined the programme board’s plans for RAG rating the dashboard.
Areas of concern: o Some of the teenage pregnancy indicators are not on target and are
being addressed in conjuction with the Staying Healthy Programme. o There are overspends in children’s continuing care which are being
addressed with the finance team. AM queried how we can be sure that the right children (i.e. those most at risk) are picked up in the Vitamin D scheme. MMw confirmed that sub-sets of data are
Maria Millwood / Raj Mitra
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available which show this is the case. AM queried whether there was any work happening around the e-red-book. MMw to investigate and bring an update to the next meeting. GL queried the reason behind the significant decline in the results of the friends and family test at GSTT in Quarter 2. MMw to investigate and bring an update to the next meeting. GL queried whether work on the London Maternity Standards was progressing at the speed projected across South East London (SEL). MMw confirmed that work is progressing more slowly than expected. MMc gave an update from an SEL meeting on 20th October. JB noted that at both the GSTT and KCH CQRG meetings, there were presentations on maternity. The GSTT one addressed their poor caesarean section rates and work in hand to address this, as well as the London Quality Standards. JB noted that none of the Trusts in London are achieving the London Quality Standard relating to consultant cover. Staying Healthy Programme – Deep Dive RM noted that the main risk is the Public Health budget cuts – currently the Local Authorities are deciding how to implement those cuts. MMw outlined the possible options and historical background. The impact to services will not be known until the cuts are announced, though there is no timetable available. JB queried how much influence the Local Authority will have in what happens to the Public Health Team, given that it is managed by Southwark. It was confirmed that there will be joint decision as there is a Memorandum of Understanding between the two Boroughs. The impact on the team will most likely include holding and reviewing vacancies. MMw outlined the commissioning plans being developed, which will ‘take out’ up to 25% of the funding. RM noted that London-wide GUM negotiations also need to be considered as these are drawing towards a conclusion. Other risks include an outbreak, which could happen at any time and is therefore rated as a medium risk. RM outlined the current performance, with reference to the dashboard. It was noted that the data is very old (2013), however this is the only data available for comparison.
Repeat terminations – this is trending downwards, but still higher than the national average.
Treatment for non-opiates – this is improving, but still rated red. JB noted that the target was set on a national average, indicating that this may be unfair due to the numbers of drug users in the borough.
Prison treatment starts – there has been no data available since 2012/13. JB noted that at a recent meeting with NHS England, it was indicated that the CCG may be asked to become involved in the care at Brixton Prison. The CCG have offered to provide advice, but suggested that Wandsworth CCG might be in a better
Maria Millwood
Maria Millwood
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26
27
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position to co-commission this, as St Georges Hospital manage the contract for Wandsworth Prison. However, we understand Wandsworth CCG have also turned down the offer to co-commission, noting the differences in the prison populations. The Committee decided that they would see information about the Prison if it was available, but would not devote agenda time to discussing it, as the proportion of Lambeth and Southwark residents is low. MMw noted that AE had expressed concerns over the lack of involvement of the CCG as a question was expected at the safeguarding deep dive in relation to responsibilities around prisoners. MMc outlined the work being led by the Council at the request of NHS England. JB noted two areas that should continue to be monitored by the CCG: the diversion scheme in the Courts; and the SLaM IAPTs service (Talking Therapies). AM queried if sufficient links were being maintained between Satying Healthy and General Practice. AP noted the co-attendance at the Programme Boards. MMc highlighted the Medicines Optimisation link to the Staying Healthy Programme Board through work on Long Term Conditions (LTCs) and healthchecks. There is also recruitment for a commissioning post in Primary Care. MMw noted the importance of the other Programme Boards impacting on the Staying Healthy agenda and Health and Wellbeing Board. There is a challenge around embedding Staying Healthy in all of the other Programmes. UD queried how far work had progressed around determining the function of the Programme Board and it’s reporting arrangements. MMw confirmed that facilitated development time had been used to consider the Health and Wellbeing Strategy refresh. More work is needed to address concerns around governance, including structure, role and membership. Clear communications between the Health and Wellbeing Board and other programmes is vital. MMw noted that one of the challenges faced by the Programme Board has been the administration of it, as few people are contributing to the agenda. Resetting the remit of the Health and Wellbeing Board should improve this issue. Further discussion of the Programme’s issues will take place when the Health and Wellbeing Board refresh is brought to the Governing Body Seminar in November. Integrated Adults Programme LL raised that End Of Life Care was not formally a part of any dashboards. MMc confirmed that some work that had been completed, noting that the key metric would be ‘preferred place of death’. There was some discussion about the importance of proactive end of life care. MMc noted that identifying people who may need proactive care has been aided by the Holistic Health Assessments (HHAs). The ‘personalised approach’ is being used where people are identified. This is being picked up by the End of Life Strategy Group. AM asked for an explanation of the @home and Enhanced Rapid Response (ERR) scorecards. MMc noted that a deep dive into these will be brought to the next Committee in Common meeting. These schemes are on track and are impacting emergency admissions. There has also been positive feedback from clinicians to date. MMc flagged that cancer waits continue to be a risk at GSTT. Trust wide, we are
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not assured of delivery recovery of the target by March. The Trust are planning to deliver internally (this includes Lambeth patients). Detailed work with the Trust and NHS England is on-going. RM queried whether the CCG are achieving our quality premium targets. From the latest assessment for 2015/16, CC confirmed that we expect to deliver 70% of the targets. CC to bring a more detailed update to a future meeting. Integrated Mental Health for Adults Programme MMc confirmed that there is no longer a Mental Health Programme Board, as the Committee in Common has taken over Mental Health and Older People. The GP+ scheme (formerly known as CIS) is behind target and work is being developed with SLaM and practices. There was some discussion around downgrading the target to make it more ‘realistsic’ but it was noted that the same ‘slow start’ occurred with the introduction of the diabetes schemes. MMc to find out the process for GPs to recommend patients for the GP+ scheme. There was some discussion of the issues at SLaM with disconnect between hospital teams, community teams and GPs, as well as the work being done on this. Primary Care Development Programme The Terms of Reference have been updated as the Programme Board is now split into two parts: part A, a developmental session; and part B, a joint commissioning session, which includes discussions with NHS England around the co-commissioning agenda. One of the main pieces of work has been the Prime Ministers Challenge Fund (PMCF) – work is now taking place on sustainability. AP summarised the upcoming PMS review, and the effects that it will have on Lambeth CCG and the practices. HA asked whether the cancer referrals should be removed from the current scheme following the recent media coverage. UD confirmed that a paper on how the media coverage was handled has been prepared and will be brought to a teleconference. Several clinical members and CP shared their experiences of patient reactions to the coverage. AM suggested that a message be shared with member practices updating them on the CCG position. It was agreed that this should be picked up at the Governing Body Teleconference, as well as the question of what (if anything) should be done to refine this year’s scheme. AP noted that the Health and Wellbeing Board have asked for an update on Primary Care commissioning in order to assess what their role is in supporting it. Enablers Estates: CC gave a brief update on estates, noting that a workshop was held on 15th October. A SEL workshop was held on 17th October, from which the Strategic Estates Plan for Lambeth will be developed. Additional support for two days a week has been put in place to support the work on the plan. Workforce: An Event will be held on 22nd October about the development of the Community Engagement Partnership Network (CEPN). A formal reporting
Christine Caton
Moira McGrath
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No. Agenda Item Action for / date
arrangement for all of the enablers needs to be set up to feed into the Primary Care Programme Board.
Items for Noting
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43
44
LCCG/IGC/15/091 – LSL Infection Control Committee Annual Report MV summarised the LSL Infection Control Committee Annual Report and offered to circulate a paper on the anti-microbial criteria in the Code of Practice. JB and MV to discuss information not being received by the Infection Control Team from Viapath. GL queried how Lambeth compares to other Boroughs for Infection Control. OV offered to send this information, though cautioned that many cases are reported which should not be, therefore potentially skewing the data. The Committee noted the LSL Infection Control Group Annual Report.
John Balazs
Standing Agenda Items
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46
47
48
LCCG/IGC/15/092 – Finance Report and Finance and QIPP Update CC presented the Month 6 Finance Report and highlighted the following points:
We are on track to deliver the suplus of £7.6m.
Discussions are on-going regarding the KCH and Primary Care positions.
Non-acute pressures include continuing care, inpatient mental health beds, and adult and childrens specialist mental health services (eating disorders).
Additional resource has been received for CAMHS. We are forecasting delivery of our QIPP, though a significant proportion of this is contained in the block arrangement.
Prioritisation is being considered, especially around redirection schemes and PALS.
CC outlined what was discussed at the Finance and QIPP Meeting:
The Committee in Common report
Data quality issues – Jo Steranka is developing this
It was agreed to review the terms of reference given the changed focus of discussions
The Financial Control Environment, approved at the last meeting, has been revised following the NHS England review. AM raised the issue of overperformance at GSTT and predicted overperformance at KCH, querying the risk of a contractual reopener. Discussions are taking place with KCH to understand the position. GSTT are also in deficit for the first time and are being kept under review. It was noted that Sarah Cottingham, Head of Contracting stated that this will be a bigger issue for our strategic position next year. Investments will need to be considered to determine whether they are ‘worthwhile’.
Items for Discussion
49
LCCG/IGC/15/093 – SECSU update UD outlined the procurement process of the Lead Provider Framework nationally for current CSU services:
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No. Agenda Item Action for / date
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CCG and GP IT: procure immediately
Multi-disciplinary team: retain (in house of possible with Southwark and Bromley)
All other services: ‘Press pause’ and make sure that we are clear on the risks
We would like to retain a South East London approach where possible. UD outlined the risks associated with the process:
in-housing not being a ‘real’ option
the costs associated with each of the services
the stranded costs associated (i.e. hidden costs)
the current financial position of the CSU (risk of higher prices if we extend our contracts)
procurement falling in the contracting round
if VAT is payable on some or all of the services UD updated Committee members on the financial issues associated with the CSU – they are projecting up to £5m deficit this year. The six SEL CCGs need to agree how this issue should be represented on our risk register. UD suggested that the CSU leads and finance leads meet to decide this. A regular update on the CSU position to be brought to this meeting. CC noted that we are expecting a reduction in our running cost target which is likely to be significant. It was confirmed that the vast majority of the CSU services are included in the running costs. The Committee agreed to support the proposed CCG position, recognising that this may make it necessary to break from SEL.
Una Dalton
Items for Approval
55
LCCG/IGC/15/094 – Health and Safety Policy This was brought as a refresh of the existing Policy. The Committee approved the sign up to the Health and Safety Policy.
56
LCCG/IGC/15/095 – Safeguarding Through Commissioning Policy This was brought as a refresh of the existing Policy. The Committee approved the Safeguarding Through Commissioning Policy.
57
LCCG/IGC/15/096 – Data Protection Protocol This was brought to the Information Govenance Steering Group (IGSG) and is required as a part of the IG Assessment. The Committee approved the Data Protection Protocol.
58
LCCG/IGC/15/097 – Privacy Impact Assessment Procedure This was brought to the Information Govenance Steering Group (IGSG) and is required as a part of the IG Assessment. The Committee approved the Privacy Impact Assessment Procedure.
59
LCCG/IGC/15/098 – Primary Care Programme Board Terms of Reference This has been refreshed to take account of the Programme Board being split into
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No. Agenda Item Action for / date
two Parts. It was approved at the Primary Care Joint Committee and Audit Committee. The Committee approved the Primary Care Programme Board Terms of Reference.
Items for Noting
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LCCG/IGC/15/099 – Safeguarding Assessment Meeting Update MMw outlined preparations for the safeguarding deep dive due to be held on 17th November. JB queried whether KCH’s poor performance on the uptake of Adult Safeguarding Training was our risk or Southwark’s risk. It was confirmed that this is our risk and should be dealt with through our assurance processes. LL noted that it was difficult to find Adult Safeguarding Training for GPs. The CCG are seeking to recruit a GP to lead on Adult Safeguarding issues. The Committee noted the Safeguarding Assessment Meeting Update.
64
65
LCCG/IGC/15/100 – Ban the Fax Briefing Paper All faxing will cease by the end of March 2016 and the CQRG are considering the implications for Primary Care will respond to the deadline. Every form on DXS has had the fax number removed. The Committee noted the Ban the Fax Briefing Paper.
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LCCG/IGC/15/101 – Safeguarding Working Group Annual Report – Children MMw presented the SLAC Working Group Annual Report, including preparations for the unannounced CQC inspection, ongoing work on three Serious Case Reviews and supporting the Safeguarding Board to prepare for its Ofsted Inspection. MMw noted that issues raised in the Serious Case Reviews showed similar learning – that the transfer of information from health partners to other professionals involved needs improvement. There was some discussion of the learning from the Serious Case Reviews. GL suggested that a longer session on safeguarding be scheduled with Avis Williams-McKoy, Nurse Consultant Designated Nurse Child Protection for a future Seminar. There was agreement that the Governing Body should be kept informed and up to date on safeguarding matters, so time will be dedicated to this in the November Seminar. UD noted that as well as the upcoming deep dive, the Governing Body will receive PREVENT training at the November Seminar as a part of Adult Safeguarding Training. MMw to bring the LSCB Annual Report to a future meeting. The Committee noted the Safeguarding Working Group Annual Report – Children.
Maria Millwood
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LCCG/IGC/15/102 – Adults Safeguarding Annual Report MMc presented the Adults Safeguarding Annual Report, noting:
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NHS Lambeth CCG Integrated Governance Committee (IGC) Minutes Page 10 of 11
No. Agenda Item Action for / date
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Due to the Care Act, adult safeguarding now has an equivalent status to children’s safeguarding, though it is newer, and thus less developed.
London-wide work is being undertaken around Pressure Ulcers due to the increasing number of referrals.
A new Safeguarding Interim Chair is in place and will be reviewing the Adults Safeguarding Board.
There have been two Serious Case Reviews in the last three years and issues raised have been around learning difficulties and older people.
The Committee in Common decided to put further CCG resource into additional pharmacy support and support to home care.
There have been some specific issues around depravation of liberty discussed at the Adults Safeguarding Board due to a significantly increased caseload.
Nationally, there is also an issue around the use of the Mental Capacity Act.
One issue that has been challenging has been deciding if it is appropriate to intervene when patients have capacity but could be putting themselves or others at risk (e.g. hoarders).
JB queried whether making a safeguarding referral leads to the individual being in a safer, better place and the risks to them being carefully analysed. MMc confirmed this is considered at the Adults Safeguarding Board. CP noted that the Hickey Voices project has encouraged patients to come to Healthwatch to discuss the process. Qualitative data is reviewed by the PADEC Group (a sub-group) who then hightlight any issues to the Adults Safeguarding Board. The Committee noted the Adults Safeguarding Annual Report.
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LCCG/IGC/15/103 – EPRR Compliance with Core Standards Submission to NHS England UD presented the report, confirming the arrangements for emergency planning. The CCG do well in this area and are well supported by the CSU. The Committee noted the EPRR Compliance with Core Standards Submission to NHS England.
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LCCG/IGC/15/104 – Business Continuity Management Plan Audit Report UD presented the report, which sets out the lessons learnt from the incident involving plumbing at 1 Lower Marsh. The Committee noted the Business Continuity Management Plan Audit Report.
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LCCG/IGC/15/105 – Reporting Sub-groups Updates and Summary of Issues Raised at most recent meetings The Committee noted the reporting sub-groups updates and summary of issues raised at most recent meetings.
Any Other Business
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LCCG/IGC/15/106 – Any Other Business Potential for further media interest UD highlighted that there could be further media interest in an issue reating to the 111 service where a father of a young child rang the 111 service and the call was not managed appropriately. This issue has had significant interest from NHS England and a formal complaint has been made. The Secretary of State was
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NHS Lambeth CCG Integrated Governance Committee (IGC) Minutes Page 11 of 11
No. Agenda Item Action for / date
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briefed on this issue and it was confirmed that the child involved was a resident of Lambeth. An investigation is underway and the expected result is that of ‘human error’. A paper will come to a future meeting with the lessons learnt. Lambeth Walk Christmas Party RM asked that the date for the CCG Christmas Party be confirmed as soon as possible. Hasnain Abassi AM announced that HA has asked to step down from the Governing Body. Thanks were extended to HA for all of his work as a Governing Body Member. HA has agreed to remain in post until a replacement can be found. This news will be communicated more widely to staff and members shortly as the recruitment process begins.
For Information Only
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LCCG/IGC/15/107 – Approved Minutes from Reporting Groups Subgroup Approved minutes of
Children's Safeguarding and LAC Working Group (SLAC) 15.06.15
Information Governance Steering Group 23.07.15
Finance and QIPP Working Group 24.06.15, 19.08.15
LSL Infection Control Committee 19.06.15
Serious Incident Review Group (SIRG) 12.06.15
Health and Safety Working Group -
Children and Maternity Programme Board 06.07.15, 03.08.15
Integrated Commissioning Adults Programme Board -
Mental Health Integration Programme (MHIP) Board -
Staying Healthy Programme Board 10.07.15, 14.08.15
Primary Care Development Programme Board 15.07.15 PLEASE NOTE: For all Approved Minutes from Reporting Groups, please go to http://nww.lambethccg.nhs.uk/ReallyUseful/Pages/IGC%20Papers.aspx
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LCCG/IGC/15/108 – Dates and times of future meetings Dates and times of future meetings and deadlines for the receipt of reports / papers are as below Date Time / Venue Deadline for
papers Presenter
16 December 2015
1.00pm–5.00pm Room 407, Lower Marsh
4 December 2015
KCH to be invited to attend
17 February 2016
1.00pm–5.00pm Room 407, Lower Marsh
5 February 2016
SLaM to be invited to attend
The agenda and minutes of this meeting may be made available to public and persons outside of NHS Lambeth Clinical Commissioning Group as part of the CCG’s compliance with the Freedom of Information Act 2000.
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1 V5
Report to the Governing Body
20th January 2016
Report Title
Minutes of Committees
Author(s)
Pamela Handy
Governing Body/Clinical Lead(s)
Dr Adrian McLachlan
Management Lead(s)
Una Dalton
CCG Programme
Governance
Purpose of Report
For information
Summary
The Governing Body is asked to receive the approved minutes of the following meetings which are available at: www.lambethccg.nhs.uk/news-and-publications/meeting-papers/governing-body
LCCG Safeguarding and LAC Working Group,
15th June 2015.
Lambeth Safeguarding Adults Partnership Board (LSAPB), 22nd June 2015.
LCCG Safeguarding and LAC Working Group, 14th September 2015.
Lambeth Safeguarding Adults Partnership Board (LSAPB), 23rd September 2015.
Lambeth Children and Families Strategic Partnership (CFSP), 23rd September 2015.
Primary Care Joint Committees (PCJC), 29th September 2015.
Lambeth Children and Families Strategic Partnership (CFSP), 11th November 2015.
Recommendation(s) The Governing Body is asked to note for information the agreed
minutes of external committees received within the period
5th November 2015 to 19th January 2016.
Does this report provide assurance to support the vision for the CCG?
People centred
Prevention focused
Integrated
Consistent
Innovative
Deliver best value
Does this report provide assurance in relation to the following areas of responsibility for the CCG
Legal
Engagement
Risk
Financial
Inequalities
Please include relevant risk references here All legal, engagement, inequalities, financial and resource implications and any potential or actual
risks are set out in detail in the body of this report.
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