new governance and performance report - lambeth · 2014. 8. 28. · 1 integrated governance and...

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INTEGRATED

GOVERNANCE AND PERFORMANCE REPORT

NHS Lambeth Clinical Commissioning

Governing Body

SEPTEMBER 2014

Our Mission: Our Mission is to improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.

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Table of Contents

Introduction ................................................................................................................ 5

Corporate Risk Register, Heatmap and Board Assurance Framework ................. 6

1.0 Governance and Performance .......................................................................... 15

1.1 National CCG Assurance Framework 2014/15 ................................................... 15

1.2 Financial Duties .................................................................................................. 18

1.3 QIPP ................................................................................................................... 21

1.4 Top 8 Performance Measures 2014/15 ............................................................... 24

1.5 Performance Dashboards ................................................................................... 31

2.0 Integrated Children and Young People (including maternity) programme ... 32

3.0 Integrated Adults ............................................................................................... 36

3.1 Elective ............................................................................................................... 40

3.2 Long term conditions .......................................................................................... 44

3.3 Older People and Continuing Healthcare ............................................................ 46

3.4 Urgent care ......................................................................................................... 76

4.0 Integrated mental health care for adults .......................................................... 78

5.0 Staying Healthy (Led by London Borough of Lambeth) ................................ 84

6.0 Primary Care Development .............................................................................. 88

7.0 Enabler Programmes ........................................................................................ 95

7.1 Medicines Optimisation ....................................................................................... 95

7.2 Equalities ............................................................................................................ 99

7.3 Organisational Development ............................................................................. 101

7.4 ICT .................................................................................................................... 105

7.5 Engagement ..................................................................................................... 107

7.6 Communications ............................................................................................... 111

7.7 Estates .............................................................................................................. 115

Contents Contents

SECTION 1 OVERVIEW

SECTION 2 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES

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7.8 Workforce ......................................................................................................... 117

8.0 Governance and Assurance ........................................................................... 119

8.1 Provider Quality Report ............................................................................... 119

8.2 PALS and Complaints ................................................................................. 119

8.3 Serious Incidents ........................................................................................ 122

8.4 Quality Alerts ............................................................................................... 124

8.5 Freedom of Information (FOI) ..................................................................... 124

SECTION 3 QUALITY ASSURANCE

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NHS Lambeth CCG comprises of 48 member Practices across three localities. The NHS Lambeth CCG Governing Body is responsible for ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG Constitution and our principles of good governance. Membership of the Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and nominees from our key Lambeth partners. The Governing Body is supported by the Clinical Network of clinical leads for each area of work being taken forward. The purpose of the Clinical Network is to provide the CCG Board members with sound clinical advice on commissioning care services, clinical pathways and best practice. The Clinical network consists of care and clinical “subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists, opticians and social care colleagues.

This report sets out how NHS Lambeth CCG is performing against its agreed objectives under the leadership of the NHS Lambeth Clinical Commissioning Governing Body. It is a tool for providing assurance to the Governing Body that objectives are being delivered or, where performance is behind plan, that mitigating actions are in place to address performance improvement. The 2014-15 Business Plan sets out our key objectives as detailed below. This report provides an update against each of these business areas and strategic objectives.

Area of Business Strategic Objective

(i) Operational Delivery (SECTION 2) through our health programmes

To deliver our agreed five priority health programmes and effective high quality and safe care with robust operational risk and financial management.

(i) Governance & Assurance (SECTION 3)

To ensure systems and processes are in place to support individual, team and corporate accountability for delivering patient centred, safe, high quality care, within our resource limits.

Performance against corporate objectives is detailed within this report to provide a consolidated performance report. Performance is also reviewed at quarterly Lambeth Assurance meetings with the NHS England. The next meeting is on the 18th September 2014. A new Assurance Framework for CCGs across London was developed by NHS England for use during 2014/15 and into 2015/16. The key elements are incorporated within this report.

1 Introduction

SECTION 1 OVERVIEW

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The NHS Lambeth CCG Board Assurance Framework (BAF) is included along with a Heat Map showing key risks. The BAF and supporting Risk Register are living documents, updated monthly.

Lambeth Clinical Commissioning Group Corporate Risk Register Heat Map of current residual risks

Corporate Risk Register, Heatmap and Board Assurance Framework

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Corporate Risk Register There are currently 14 risks rated 12 or above as of August 2014. The Risk Register for 2014/15 has been updated and the risks have been mapped to the CCG’s 2014/15 corporate objectives. One risk has been removed from the Corporate Risk Register.

3A “Transforming Adult Mental Health Services via the Lambeth Living Well Collaborative Programme Risk / Risk of non-delivery of proposed Mental Health QIPP savings”. This overarching risk has been reviewed and separated into 10 more specific risks. Five of these new risks are on the Corporate Risk Register, as they all have a risk score of 12

3C “Risk to SLaM Contract – that the delivery of AMH redesigns fails to reduce relapse rates and use of beds”

3D “Risk that the roll out of LWN and CIS is delayed beyond September 2014”

3H “Risk to delivery of Programme objectives due to the impact of welfare reforms on people”

3J “Risk to delivery of Programme objectives due to Local Authority funding reductions”

3K “Risk that insufficient housing supply is available to support alliance/IPSA”

There are currently two risks with a score of 16:

2A (SO1RA) “Risk of failure to implement the Service Improvement Plan for

District Nursing”. This risk continues to be managed and monitored via close

working between the CCG and GSTFT. An action plan is in place regarding the

District Nursing Service

2E “Risk of not achieving the agreed access initiative performance levels

for RTT due to i.e. backlog of admitted patients waiting more than 18 weeks

(at KCH) and a number of patient waiting more than 52 weeks at different

providers” The actions to address this risk are led by the NHS SLCSU Acute

Contracts Team.

All risks over 12 have been reviewed and updated where required. All risks have robust action plans in place to address any gaps in assurance. A summary of key risks rated 12 and above over the following pages set out NHS Lambeth CCG’s Board Assurance Framework. The Board Assurance Framework for this report also notes the risks that are to be removed as evidence and assurance to the Governing Body. Areas that have been updated are noted in bold.

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Risks graded 12 or above and zero tolerance risks: updated information highlighted

Code 2014/15 (13/14)

Risk Summary Risk Score

Direction Risk Owner Key Actions

1A Safeguarding Children Risk [Zero Tolerance Risk]

12

Avis Williams-McKoy

Implement the accountability and assurance framework for safeguarding vulnerable children

2A Risk of failure to implement the Service Improvement Plan for District Nursing

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Liz Clegg GSTFT have requested that the CCG review the requirements for the Care Planning CQUIN in Q4 due to the demand on the workforce Comprehensive in depth reviews and risk assessments have been completed for each locality working with GSTFT nurse managers and Deputy HON Community Matrons have been moved from undertaking case management responsibilities in order to focus on supporting the district nursing teams with their clinical caseloads Phlebotomists are in place in 5 of the 7 localities since December 2013 A Consultation document to be launched to strengthen the clinical management and introduce the team leader role across both Lambeth and Southwark (Feb 2014) GSTFT participated in an NHS benchmarking exercise. This has now reported and the results clearly show that of the 51 services that participated in the benchmarking exercise, the GSTT community district nursing service maintains the national average levels of activity with the lowest number clinical wte staff. A request has been made to the CCG for investment in the District Nursing service as part of the 2014-15 commissioning round Recruitment Plan has been updated. GSTT have raised the District Nurse workforce challenges with NHS England and a London wide group is now meeting to agree a strategic way forward. Meeting held on 9/5/14 between Lambeth and Southwark CCG and GSTFT senior management to do stocktake on progress on the service improvement plan to date and the current level of risk, and to agree the next stage of District Nursing service redesign; Recruitment drives underway across UK and Europe. Community nurse improvement plan is in place which is being monitored at fortnightly conference calls and at GSTT core contract meetings Offering new Transitional Programme for nurses working in the community for the first time GSTFT will be presenting an update on progress to the CQRG November / December 2014

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Code 2014/15 (13/14)



2B Safeguarding Adults Risk [Zero Tolerance Risk]

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Alex McTeare

Implement the accountability and assurance framework for safeguarding vulnerable people Recruit designated doctor and designated nurse for adult safeguarding Influence NHSE contracts to include safeguarding training requirements Practices to nominate staff to attend 'Alerters' safeguarding training

2C Risk of not achieving the agreed access performance levels for A&E

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Bisi Aiyeleso

Recovery and Improvement Plan submitted to NHS England (July 2013) to be refreshed during 2014/15 Refresh of winter surge arrangements Divert policy in place Intelligence Conveyencing Appointment of SEL Urgent Care Project Manager, leading to more effective streamlining of processes. The Lambeth Alcohol Recovery Centre continues to be operational from St Thomas’ A&E

2D Risk of non-delivery of proposed A&E Admission Avoidance QIPP target

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Bisi Aiyeleso

Development of Recovery Plan as detailed in the Unplanned Care QIPP Performance Report (updated monthly) Recruitment required for locality staff to support the monitoring of plans and support practices with the delivery of their QIPP targets. Working with GSTT on developing redirection schemes from GSTT into primary care. ‘Yellow Man’ campaign over the summer and more extensive campaign planned for winter GP based in paediatrics A&E at weekends – short term project until the revised paediatric pathway can be implemented. This will rely on the building reconfiguration being completed. To scope what extended GP access could look like within Lambeth going forward during Q2 and Q3 2014/15.

2E Performance Levels for RTT Risk

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Harriet Agyepong

KCH outsourcing some elective activity to private providers to assist with the reduction of the backlog. Additionally more capacity has been made available on the Denmark Hill site and the Orpington site. KCH are also transferring some orthopaedic patients to GST for treatment. KCH has received allocation of additional RTT monies released nationally in July. Additional RTT activity to take place July – September, including additional outsourcing to private providers.

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Code 2014/15 (13/14)



3C Risk to SLaM Contract – that the delivery of AMH redesigns fails to reduce relapse rates and use of beds

12 NEW Denis O'Rourke

Monitor progress on a monthly basis. Whole system performance dashboard

3D Risk that the roll out of LWN and CIS is delayed beyond September 2014


Negotiate with existing (VCS/SLaM ) providers Re-profiling of services / resources to support roll out including CIS

3H Risk to delivery of Programme objectives due to the impact of welfare reforms on people


Link to financial resilience strategy and ensure access to EPC is sustained

3J Risk to delivery of Programme objectives due to Local Authority funding reductions


Link to financial resilience strategy and ensure access to EPC is sustained

3K Risk that insufficient housing supply is available to support alliance/IPSA


Joint planning with LA housing department including housing quota and new housing development Alliance negotiation process to include ability of provider to procure housing provision

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Code 2014/15 (13/14)



5A Risk of non-delivery of Elective Care Programme project milestones

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Bisi Aiyeleso

Development of Recovery Plan as detailed in the Planned Care QIPP Performance Report (updated monthly) Recruitment required for locality staff to support the monitoring of plans and support practices with the delivery of their QIPP targets.

7A Financial Planning and Strategic Approach Risk

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Christine Caton

5-year strategic plan (including SE London wide plan) produced and final 2-year operational plan is being implemented Work with LA partners to determine impact/risk associated with implementation of Better Care Fund from 2014/15 onwards. Use benchmarking, other data to provide evidence base for decision making and support implementation of robust KPIs and contractual levers. Focus on reporting to include recurrent underlying position. This is included as part of CCG assurance framework (ongoing) Commissioning Intentions have been developed into QIPP schemes whose delivery is overseen through individual programmes Governing Body, Finance and QIPP Working Group and Programme Boards oversight of operational plan in year. Acute contracts signed, mental health heads of terms agreed with contracts to be signed by Sept 2014. Finance and activity budgets by programme to be set by July 2014 and developed Q2 to Q3 2014/15. Next stage development of SEL strategic plan to take place with further submission during Sept 2014. Continuation of the work of the Clinical Leadership Groups. Enabling programmes are being established to drive delivery of programmes

7B Risk to CCG financial sustainability from QIPP delivery

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Christine Caton

CCG working through detailed risk management strategies/recovery plan to address projected financial risk and strategies leading into 2014/15 for recurring impact of under delivery of QIPP and activity over performance Business intelligence review to take place London-wide and locally during 2014/15. QIPP performance report to include quality and equality measures from July 2014 Integrated Governance Report is being reviewed to make provide focus on QIPP and overall programme delivery with final format to be delivered by November 2014.

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Zero Tolerance Risks: Safeguarding is an area where the Governing Body has suggested a zero tolerance for reporting. Within NHS Lambeth CCG no ‘zero tolerance’ risk is rated as greater than 12. The two Safeguarding risks (S07CA Safeguarding Adults and S07CB Safeguarding Children) are duplicated from the previous table, as they have risk scores of 12.

Code Risk Summary Risk Score

Direction

Risk Owner

Key Actions

1A Safeguarding Children Risk [Zero Tolerance Risk]

12

Avis Williams-McKoy

Implement the accountability and assurance framework for safeguarding vulnerable children

2B Safeguarding Adults Risk [Zero Tolerance Risk]

12

Alex McTeare

Implement the accountability and assurance framework for safeguarding vulnerable people Recruit designated doctor and designated nurse for adult safeguarding Influence NHSE contracts to include safeguarding training requirements Practices to nominate staff to attend 'Alerters' safeguarding training

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Board Assurance Framework

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1.0 Governance and Performance Summary

1.1 National CCG Assurance Framework 2014/15

The CCG Assurance Framework is designed to give assurance that CCGs are operating effectively to commission safe, high quality and sustainable services within their resources.

The NHS England London region uses a CCG Assurance Framework which sets out 6 broad ‘assurance domains’ which the CCG will be assessed against – allowing for sophisticated conversations to take place locally which results in a quarterly assessment (and follow up meeting). The assurance domains are as follows: Domain one: Are patients receiving clinically commissioned, high quality services? Domain two: Are patients and the public actively engaged and involved? Domain three: Are CCG plans delivering better outcomes for patients? Domain four: Does the CCG have robust governance arrangements? Domain five: Are CCGs working in partnership with others? Domain six: Does the CCG have strong robust leadership? The CCG and NHS England met on the 4th of June with the CCG receiving full assurance on all six domains as at quarter 4 2014/15. The next review meeting will take place on 18th September 2014.

Details highlighting latest 2014/15 performance against our National Constitution targets can be found on page 31. Quality Premium The ‘quality premium’ is intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. The quality premium will be paid to CCGs in 2014/15 – to reflect the quality of the health services commissioned by them in 2013/14 and in 2015/16 for performance measures relating to 2014/15.

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Quality Premium 2014/15

The quality premium paid to CCGs in 2015/16 – will reflect the quality of the health services commissioned by them in 2014/15. This will be based on six measures that cover a combination of national and local priorities. These are:

reducing potential years of lives lost through causes considered amenable to healthcare and addressing locally agreed priorities for reducing premature mortality (15per cent of quality premium);

improving access to psychological therapies (15 per cent of quality premium);

reducing avoidable emergency admissions (25 per cent of quality premium);

addressing issues identified in the 2013/14 Friends and Family Test (FFT), supporting roll out of FFT in 2014/15 and showing improvement in a locally selected patient experience indicator (15 per cent of quality premium);

improving the reporting of medication-related safety incidents based on a locally selected measure (15 per cent of quality premium);

The local measure agreed for 2014/15 will look at People with diabetes diagnosed less than a year who are referred in to structured education.

Quality Premium 2013/14 CCGs were measured against four national measures, all of which are based on measures in the NHS Outcomes Framework. These are:

reducing potential years of lives lost through amenable mortality (12.5 per cent of quality premium): the overarching objective for Domain 1 of the NHS Outcomes Framework;

reducing avoidable emergency admissions (25 per cent of quality premium): a composite measure drawn from four measures in Domains 2 and 3 of the NHS Outcomes Framework;

ensuring roll-out of the Friends and Family Test and improving patient experience of hospital services (12.5 per cent of quality premium), based on one of the overarching objectives for Domain 4 of the NHS Outcomes Framework;

preventing healthcare associated infections (12.5 per cent of quality premium), based on one of the objectives for Domain 5 of the NHS Outcomes Framework.

We are awaiting final confirmation of the data in these areas to determine the overall level of resource that the CCG can expect in as payment for the delivery of the 2013/14 Quality Premium.

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CCGs were also asked to identify three local measures based on local priorities such as those identified in joint health and wellbeing strategies. NHS Lambeth’s agreed local measures for 2013/14 were:

Diabetes controlled blood sugar - 70% of patients with diabetes who have an HbA1c of 8 or less (including QoF exceptions). This measure was met, 74.8% achieved.

CHD controlled blood pressure - 73% patients with hypertension in whom the last BP (measured in the preceding 9 months) is 150/90 or less (including QoF exceptions) This measure was met, 78.4% achieved.

Mental Health - 90% of users on new Care programme approach with a HoNOS assessment in the last 12 months. This measure was met, 100% achieved.

All three local measures were met.

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1.2 Financial Duties

To deliver financial control totals for resource and cash and support the delivery of statutory financial duties 2014/15

The CCG is required by statute to meet certain financial duties to ensure that public funds are used appropriately. CCGs are required not to exceed the revenue and capital resource limit in any one year and to have cash balances of less than £250k as at 31st March.

Lambeth CCG’s financial performance as at July 2014 is a surplus of £1,708k. This is in line with the CCG’s plan. The year end forecast is an underspend of £4,868k which is also in line with the CCG’s plan.

Running Costs budgets are breaking even at month 4, living within the £25 per head Running Cost allowance. We are forecasting a year end breakeven position for running costs.

The CCG’s annual cash limit as at the end of month 4 is £430.372m. Cash draw down is in line with plan.

Revenue Resource Limit

£'000 £'000

Month 4

Year to Date

Forecast

Year End

Expenditure

Total Income 143,457 430,372

Total Expenditure - CCG 141,749 425,504

Total Surplus/(Deficit) 1,708 4,868

1% 1%

Planned Surplus (Revised) 1,623 4,868

Variance Against Planned Surplus 85 0

£'000 £'000 £'000

Month 4

Year to Date

Cash Limit

Full Year

% Drawn

down Year to

Date

Cash Drawings - Plan 118,400 423,489 28%60400 388653

Cash Drawings - Actual and Forecast 118,400 423,489 28%

Forecast Underspend against Cash Limit 0 0 0

Cash Limit

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Annual

Budget

Budget Budget Actual

Variance

(over)/under

spend

Likely Case

Variance

(over)/under

Best Case

Variance

(over)/under

Worst Case

Variance

(over)/under

£'000 £'000 £'000 £'000 £'000 £'000 £'000

Acute 223,425 74,475 74,916 (441) (4,023) (416) (8,505)

Non Acute 128,345 42,782 42,420 361 391 665 (1,288)

Primary Care 42,093 14,031 13,868 163 477 802 87

Other 15,028 5,009 5,007 2 (6) 51 51

Total Commissioned 408,891 136,297 136,212 85 (3,162) 1,101 (9,655)

Reserves 13,181 4,394 2,771 1,623 8,030 8,030 8,030

Total Programme 422,072 140,691 138,983 1,708 4,868 9,131 (1,626)

Running Cost 8,300 2,767 2,767 0 (0) (0) (0)

Total CCG Expenditure 430,372 143,457 141,749 1,708 4,868 9,131 (1,626)

Planned Surplus 1,623 4,868 4,868 4,868

Variance Against Plan 85 0 4,263 (6,494)

Year to Date Forecast Outturn

SUMMARY BUDGETS - FINANCIAL POSITION JULY 2014/15

Performance Area Commentary

Year to

Date

Forecast

Outturn

Revenue Surplus

Lambeth CCG is reporting a surplus of £4.868m for the year ending

March 2015. This is in line with our target with delivering a 1%

surplus for the year.

Cash Limit

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

than £250k at month end). Lambeth CCG's cash balance as at the

end of July was £2k. The CCG expects to meet it's cash limit target

at the end of the year

QIPP

The CCG has achieved its month 4 QIPP target. The CCG is

forecasting 97.12% delivery of its annual QIPP target of £15.319m.

Commissioning

Performance

Commissioned services are underspending by £0.085m as at the

end of July. This forecast outurn position is £3.2m overspent.

Public Sector

Payment Policy

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

currently performing at 97.4% overall on numbers and at 99.5% by

value.

Running Cost

The CCGs running cost allowance is £8.3m. Running cost budgets

are breaking even as at the end of July. This is within its £25 per

head Running Cost allowance

Key Financial Performance Duties

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It is essential that the CCG maintains strong internal financial controls to enable it to achieve its statutory duties and have clean bill of audit health Actions being taken include:

Deliver 2014/15 Internal Audit Plan and ensure that recommendations are implemented. This is closely monitored by the CCG’s Audit Committee

Embed understanding across Governing Body Members/Head of Collaborative Forum of Internal and External Audit including the use of induction for new Governing Body Members.

Revised Standing Orders, Prime Financial Policies and Scheme of Delegation to best reflect needs of CCG and to support accountability through programme boards.

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1.3 QIPP The summary CCG position on QIPP is as reported below:

In 2014/15, QIPP savings initiative plans total £17.569 million. Service replacement costs total £2.250 million, resulting in a net QIPP of £15.319 million. The CCG is forecasting delivery of 97.12% QIPP or £14.878m in 2014/15.

For 2014/15 the majority of the CCG’s QIPP savings are either contractually agreed (integrated/acute contracts with the exception of £600k relating to the St Georges and other external contracts), have been identified (primary care and other commissioning) or have a strong track record of delivery with implementation plans and supporting resources in place (prescribing). For Mental Health QIPP schemes risk is being mitigated in several ways; QIPP is being built into contractual discussions (reduction in acute bed usage and rehabilitation redesign through an alliance contract) or the full year effect has already been delivered (continuing care). The CCG has also set aside contingency reserves or is using risk share to mitigate the in-year impact. Where QIPP has been contractually agreed it is particularly important that the CCG continues to work to reduce demand in areas of CCG led QIPP to minimize in year underlying over performance, to avoid the scope for Trusts to instigate a contractual re-opener during 2014/15 and to mitigate the potential impact on 2015/16 contracts. For non-local providers the risk associated with QIPP savings lies with the CCG.

PROJECT/SCHEME

QIPP

Programme

Planned

QIPP

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Acute - CCG led 4,556 1,519 1,319 (200) 87% 3,956 (600) 86.8% 3,589 (967) 78.8%

Acute - Trust Led 7,261 2,420 2,420 0 100% 7,261 0 100.0% 7,261 0 100.0%

Community - Trust Led 700 233 233 0 100% 700 0 100.0% 700 0 100.0%

Mental Health 2,800 933 701 (232) 75% 2,149 (651) 76.8% 2,149 (651) 76.8%

Prescribing 1,400 467 467 0 100% 1,400 0 100.0% 1,400 0 100.0%

Primary Care 300 100 100 0 100% 300 0 100.0% 300 0 100.0%

Non Acute & Other Schemes 552 184 184 0 100% 552 0 100.0% 552 0 100.0%

Total QIPP Savings 17,569 5,856 5,424 (432) 93% 16,318 (1,251) 92.9% 15,951 (1,618) 90.8%

Reprovision Costs (2,250) (750) (347) 403 46% (1,440) 810 64.0% (1,440) 810 64.0%

Total Net QIPP Savings 15,319 5,106 5,077 (29) 99% 14,878 (441) 97% 14,511 (808) 95%

Year to Date Final Outturn Underlying Position

QIPP DELIVERY FOR THE YEAR 2014/15

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The Finance and QIPP working group has been receiving monthly performance reports that track both financial and project milestone activity. Going forward the Finance and QIPP Working Group will continue to receive the QIPP Performance Report and programme dashboards but will focus on overview of contractual and underlying finance and activity delivery. The detail of project implementation, delivery, risks and development needs is to be considered at the appropriate programme board with assurance being provided to the Integrated Governance Committee through the Senior Responsible Officer and Clinical Lead. The table below, entitled QIPP Detailed Schemes, shows the contractual and underlying financial performance for the QIPP schemes including the project RAG rating. This can be summarised as follows:

Plan As at Month 4 As at Month 4 As at Month 4

£ £ £ £

QIPP - Year to Date 5,424 1,880 3,357 187

Number of Schemes 35 15 14 6

QIPP - Year End Forecast

Variance (1,251) 0 (288) (963)

QIPP - Year End Underlying

Variance (1,618) 0 (288) (1,330)

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QIPP – Detailed Schemes

PROJECT/SCHEME PROJECT/SCHEME

2014/15

TOTAL QIPP

PROGRAMME

Project

Delivery

RAG Plan Actual

Variance

Over/(Under) Variance

Variance


Variance


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

CCG Led Schemes - Acute Adults - Elective Service Redesign 144 48 48 0 0% 0 0% 0 0%Adults - Elective Trust Led Referrals for 1st Appointments 287 96 96 0 0% 0 0% 0 0%

Adults - Elective Reducing Variation 427 142 142 0 0% 0 0% 0 0%

Adults - Elective Reduction in Follow Ups 700 233 233 0 0% 0 0% 0 0%

Adults - Elective MCATTS 394 131 131 0 0% 0 0% 0 0%

Adults - Urgent Care Gracefield Gardens 367 122 122 0 0% 0 0% (367) 0%

Adults - Urgent Care Other Urgent Care - Primary Care and Other 388 129 129 0 0% 0 0% 0 0%

Adults Non Local CCG Led Schemes - St George's 300 100 0 (100) (100%) (300) (100%) (300) (100%)

Adults Non Local CCG Led Schemes - Externals 300 100 0 (100) (100%) (300) (100%) (300) (100%)

Other Internal Budget Review - guaranteed savings 1,250 417 417 0 0% 0 0% 0 0%Sub Total CCG Led Schemes - Acute 4,556 1,519 1,319 (200) (13%) (600) (13%) (967) (21%)

Trust Led Schemes - Acute Adults - Elective Outpatient First to Follow Ups 833 278 278 0 0% 0 0% 0 0%

Adults - Elective Excess Beddays 133 44 44 0 0% 0 0% 0 0%

Adults - Elective Consultant to Consultant Referrals 157 52 52 0 0% 0 0% 0 0%

Adults - Elective Daycase to Outpatient Procedures 147 49 49 0 0% 0 0% 0 0%

Adults - Urgent Care Emergency Admissions 1,467 489 489 0 0% 0 0% 0 0%

Adults - Elective Patient Transport 283 94 94 0 0% 0 0% 0 0%

Adults - Elective Other 2,991 997 997 0 0% 0 0% 0 0%

Adults - Urgent Care Integrated Care 1,250 417 417 0 0% 0 0% 0 0%

Sub Total Trust Led Schemes - Acute 7,261 2,420 2,420 0 0% 0 0% 0 0%

Trust Schemes Led Schemes - CommunityAdults GSTT Community 700 233 233 0 0% 0 0% 0 0%

Sub Total Trust Led Schemes - 700 233 233 0 0% 0 0% 0 0%

CCG/Trust Schemes Mental Health Adult Mental Health Redesign 767 256 256 0 0% 0 0% 0 0%

Mental Health Mental Health Mental Health Older Adults - Acute/HTT 150 50 50 0 0% 0 0% 0 0%Mental Health Rehabilitation Services 576 192 81 (111) (58%) (288) (50%) (288) (50%)

Mental Health Prescribing & Vocational Services 213 71 17 (54) (77%) (163) (77%) (163) (77%)

Mental Health Supported Housing 93 31 31 0 0% 0 0% 0 0%

Mental Health Other Client Groups 188 63 63 0 0% 0 0% 0 0%

Mental Health Specialist Commissioning 200 67 0 (67) (100%) (200) (100%) (200) (100%)Mental Health MHOA - Continuing Care 613 204 204 0 0% 0 0% 0 0%

Sub Total Mental Health - CCG Led 2,800 933 701 (232) (25%) (651) (23%) (651) (23%)CCG Led Schemes Medicines Mgmt SIP Feed Review 200 67 67 0 0% 0 0% 0 0%

Prescribing Medicines Mgmt Generic medications optimisation, LTCs 200 67 67 0 0% 0 0% 0 0%Medicines Mgmt Blood Glucose Strips 200 67 67 0 0% 0 0% 0 0%

Medicines Mgmt Respiratory 200 67 67 0 0% 0 0% 0 0%Medicines Mgmt High Cost Drugs and Models of Care 200 67 67 0 0% 0 0% 0 0%

Medicines Mgmt Medications Mgmt and Repeat Prescribing 400 133 133 0 0% 0 0% 0 0%Sub Total Prescribing - CCG Led 1,400 467 467 0 0% 0 0% 0 0%

CCG Led Schemes

Primary Care Primary Care Primary Care 300 100 100 0 0% 0 0% 0 0%

Sub Total - Non Acute & Other CCG Led 300 100 100 0 0% 0 0% 0 0%

CCG Led Schemes Other Other Client Groups 552 184 184 0 0% 0 0% 0 0%Sub Total - Non Acute & Other CCG Led 552 184 184 0 0% 0 0% 0 0%

Total QIPP Savings 17,569 5,856 5,424 (432) (7%) (1,251) (7%) (1,618) (9%)

Reinvestment Other Reinvestment (2,250) (750) (347) 403 (54%) 810 (36%) 810 (36%)

Net QIPP Schemes 15,319 5,106 5,077 (29) (0.57%) (441) (3%) (808) (5.27%)

Year To Date Forecast Outturn Underlying Position

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1.4 NHS England’s Top 8 Performance Measures 2014/15 Performance across London is challenged across a number of key areas. NHS England have identified 8 high profile measures which will be monitored through the assurance process. Performance for each of these areas is detailed below:

Top 8 summary

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1. A & E Waiting times – 4 hour Decision to Admit

Performance at GSTT remains on target achieving the 95% threshold. KCH (Denmark Hill) remains below the performance threshold in July, achieving 92.6%. There are a number of issues which are a cause of this performance including fluctuations in demand, acuity of patients, mental health issues, repatriation delays and discharges. The trust and commissioners have developed a revised recovery plan, which will link to the trust’s overall plans to better align the trust capacity across all its sites with the demand for services, in addition there have been further external reports from ECIST (Emergency Care Intensive Support Team) focusing on length of stay and overall care pathway productivity and efficiency. A number of enhanced and further actions are planned as a result of these. In addition there will also be a further 'Safer, Faster Hospital week' at Denmark Hill in September. Winter Planning NHS England has confirmed that winter monies will be available. Priority areas have been agreed with both commissioners and providers. An overview of the planned projects has been signed off across both Lambeth and Southwark this has been submitted to NHS England.

2. RTT (Referral to Treatment Times – for Lambeth Patients)

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RTT– waiting more than 52 weeks, and still waiting (incompletes) 17 long waiters were at KCH 9 Bariatrics, 1 HpB (Hepato Pancreato Bilary surgery), 6 Neurosurgery, 1 Orthopaedics. Despite treating long waiters over the last 15 months the number of over 52 week waiters has increased due to the overall waiting list profile and demand and capacity pressures that have resulted in a constrained elective bed base at KCH – Denmark Hill, impacting particularly on neurosurgery, HpB and Bariatrics. As part of 2014/15 contract the CSU agreed revised trajectories to reduce 52 week waiters to 0 by end Q1. This trajectory has now been missed. Southwark CCG has written to the Trust on behalf of all commissioners raising concerns in this area. The Trust is required to produce regular evidence of reviewing long waiters from a clinical quality and outcomes perspective and supplies evidence of patient level treatment plans and tracking. The Trust has instigated a number of actions to improve the current position: Outsourcing to the private sector. Following agreed additional RTT funding from NHS E KCH will be outsourcing patients in Neurosurgery and Bariatric Surgery Orthopaedics is continuing to use spare capacity at GSTT with around 30 patients transferred a month, there is also increased use of the Orpington site as an elective Orthopaedic centre for KCH now expanding with Saturday lists HpB has 2 additional ring fenced critical care beds from the private ward, this has resulted in a reduction in waiters over the last 2 months Capacity changes and site services moves across KCH site to decompress DH and free up capacity. Opening of Infill Block 4 (Centenary Wing) and Orpington during 13/14 and August 2014 site moves. 3. Cancer (Lambeth Patients)

31 days - subsequent surgery Q1 performance relates to 3 patients not being treated within the required time frame. 1 treated at KCH (administrative) and 2 treated at GSTT, (administrative and capacity).

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62 day Standard This performance relates to 23 patients not being treated within the required time frame. 16 patients treated at GSTT, 6 KCH and 1 St Georges, 1 patient where the breach details are not yet available. 5 of the breaches waited over 100 days, all breaches over 100 days have RCA's completed. 62 day pathway performance is an issue across SEL, particularly in the case of tertiary referrals going in to GSTT. Internal performance at GSTT for Q1 was above the 85% target. A number of actions are happening across the SEL sector:

Department of Health Intensive Support Team (IST) has reviewed processes at GSTT for patients whose total journey is within GSTT. The IST has also separately reviewed all old South London Healthcare Trusts (SLHT) providers focussing on pathway access issues for 62 day patients who start their journey at the old SLHT and are referred to GSTT. The final report was received by trusts in December 2013 and the CSU has organised a review group to ensure recommendations from the report are taken forward. The first meeting was held in mid-January and has been held quarterly from that date. All trusts in SEL have produced Action plans in line with the IST recommendations, and as a sector SEL aims to meet the target by Q3 14/15. Monitoring of trust produced action plans occurs on a monthly basis in monthly performance meetings

4. Diagnostics (Lambeth Patients)

The number of Lambeth patients waiting at GSTT now within the standard is less than the <1% standard.

5. Health Visitors

This indicator is performance managed by NHS England.

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6. Improved Access to Psychological Therapies (IAPT)

Recovery rate is down on last quarter for the following reasons:

Fewer than expected numbers entering the service, more people moving to recovery and increase in the number of completing treatment.

An increase in severity (fewer people below caseness).

Recovery rate can vary from quarter to quarter but still be on target over a whole year.

Actions underway to address:

Recovery rates by therapist and diagnosis have been audited. Individual therapists have action plans in place supported by additional CPD and supervision.

People with post-traumatic stress disorder (PTSD) achieve lower than expected recovery rates. Specific training and additional supervision has been provided to high intensity therapists. A CQUIN is in place to improve outcomes for this group.

An audit exploring outcomes for people from BME groups found that BME groups experience a lower recovery rate than white people. This may be linked to the issues with PTSD mentioned above and further investigation is planned. Since the introduction of the waiting list initiative, waiting times are now within contracted tolerances.

7. Dementia

Lambeth’s estimated diagnosis rate for people with dementia for 2013/14 (based on provisional data) is 62%, 6th from the top of the performance table for all London CCGs. The standard for 2014/15 is 67%. Only one London CCG (NHS Islington) is currently meeting this standard (based on 2013/14 data).

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Lambeth CCG is working with Southwark and Lambeth Memory Service to send GPs a reminder of patients who have been diagnosed with dementia, together with guidance on how to register these patients. On-going work continues with the Clinical GP Lead for dementia to assist GP Practices with any issues they may have in registering patients with dementia. A communication plan is being developed to promote GPs registering patients with dementia, through the newsletters, Practice events and Practice Manager Forums.

8. Winterbourne View

Lambeth CCG are fully aware of the number of patients affected by the Winterbourne View programme, and arrangements are in place to support them and their families through the process of discharging them back into the community, where it is appropriate and safe to do so.

Lambeth CCG has identified sixteen patients that are affected by the programme. Of the sixteen patients, 11 are Sectioned under the Mental Health Act and the remaining 5 are informal patients Of the five who are informal (i.e the patient is admitted voluntarily, has consented to admission and cannot be treated without his or her consent)

4 are ready to move back into the community and we are aiming for all to move by December 2014.

Of the eleven patients that are sectioned under the MHA, 7 are ready to move back into the community and we are aiming for all to move by December 2014.

Of the sixteen patients SLAM identified three patients (in June) that were not identified to Lambeth CCG on previous returns. Of the three identified, 1 was previously admitted into a bed funded by NHSE, and therefore their return would have been forwarded to them.

Winterbourne - Key challenges NHS England is responsible for commissioning secure services – this includes high, medium and low secure services for people with learning disability and/or ASD, whether they are provided by the NHS or by independent sector providers. Locked units remain commissioning responsibility of CCGs. Lambeth CCG currently have four patients who transferred to NHSE in April 2013. Although the arrangements (financial and operational) have been agreed, there is on going risk to Lambeth CCG of the impact to budgets, due to the potential change of case management responsibilities being passed between NHS England and Lambeth CCG, as patients move into less secure provision that become the responsibility of Lambeth CCG.

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As the expenditure against patients who fall within the Winterbourne definition is relatively volatile, there is the risk of the budget pressure increasing. This risk is being monitored by the finance; working with commissioning to identify and manage the risk of further overspends. It is widely accepted that many of the patients affected by Winterbourne have very complex needs. Some may be too ill or possibly a danger to themselves or the public to be discharged back into the community. Some of who are in secure hospitals and will have longer term treatment plans.

Where it is agreed that a person should move into the community, it can take several months to find the right accommodation, work with families as some can be very resistance to less secure environments, and ensure all the necessary arrangements are in place to support them. For example, patients sometimes require a period of assimilation, with transition to the community, phased over a period of months.

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1.5 Performance Dashboards

The performance dashboard covers the National Constitution Standards as set out in the national 2014/14 Assurance Framework. The dashboard highlights where performance has been below the expected standard and highlights risks to future delivery.

Programme Dashboards All programme dashboards are being further developed to include planned activity levels, patient outcomes and equalities measures. These will be updated by the end of September 2014.

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2.0 Integrated Children and Young People (including maternity) programme

Responsible Director Maria Millwood, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)

Clinical Lead Dr. Sadru Kheraj

Programme Lead Emma Stevenson, Assistant Director Children & Maternity

Scope of business area The purpose of this business area is to lead the redesign of children’s and maternity services to achieve quality, and value for money services. This business area has strong links with the business areas on integrated mental health for adults, a modern model of integrated care and citizen participation and empowerment.

Objectives of business area

The objectives of this business area are to:

Redesign the child and adolescent mental health services

Implement the recommended London standards across child health services

Develop and implement integrated child health pathways

Implement Maternity standards and effective local pathways

Programme Assurance Statement

Assurance Status/Risks RAG Rating (Red/Amber/Green)

Is your programme delivering as planned – is it on target?

Yes Amber

What are the risks you have identified to date and how are you mitigating against these?

There are a number of dependencies on the delivery of other programmes, LEAP/Evelina/South East London Strategy. There is also a risk around the timing of

Green

SECTION 2 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES

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the local authority’s planning cycle in delivering an integrated programme. We are mitigating these by attending all other meetings and ensuring there is an integrated consistent commissioning led approach across each programme.

Please note that the performance dashboard below is currently under development. Key performance indicators and outcomes will be agreed by the end of September 2014.

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Q1 Key deliverables Progress update

Re-fresh the Integrated Early Intervention commissioning Strategy

Review of Strategy complete and is out for consultation at various forums between August 14th – Sept 12th

Achieve Level 2 BFI accreditation and improve breastfeeding rates at 6 months – end 2015, review May 15

Strategic Breastfeeding group meets monthly to monitor progress

BFI Co-ordinator in post

Audit of training and knowledge of staff being carried out in line with Level 2 requirements

Review and implement recommendations for improving standards in universal health provision; GP’s, Health visiting, School Nursing – through enhanced Healthy Child Programme – October 14

Refreshed Early Intervention Strategy sets out vision for improving integrated universal, targeted and specialist services, thresholds and referral pathways

Outcomes from the Health Visiting review are being implemented and monitored

A meeting to review interface between this programme and the Primary Care Improvement Programme is being arranged

Lambeth successful in Big Lottery Better Start bid (LEAP), securing £36m over 10 years, which will focus on developing enhanced Healthy Child Programme. Strong primary care element which is being worked up ready for implementation in Dec/Jan

Develop community perinatal mental health pathway– pilot June to October 2014

Pilot has been launched in Kennington ward

Review maternity workforce development to ensure early identification of risk (including social risk factors) – September 14

Health visitors have begun carrying out antenatal visits

Early identification of risk by Midwives is being worked up as part of the LEAP programme, for implementation Dec/Jan

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3.0 Integrated Adults Programme (Elective, Long term Conditions, Older People, Urgent Care)

Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)

Clinical Lead Drs. Ray Walsh, Lisa Le Roux, John Balazs & Hasnain Abbasi

Programme Lead Various – please see work streams

Scope of business area The purpose of this business area is to lead the redesign of adult’s health and social care services to achieve quality, and value for money services, promote independence and self-care. This business area has strong links with the business areas on integrated mental health for adults, a modern model of integrated care, primary care and citizen participation and empowerment.



To improve integrated services to provide better health and wellbeing outcomes for patients

High quality and cost effective health and care system

Delivery of financially sustainable health care system for Lambeth




Under delivery against RTT

target, 52 week waiters and

cancer waiting times.

Underlying over performance on

GP initiated and follow up

outpatient attendances.

Amber

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Risk of King’s failure to achieve

RTT and 52 week wait

targets. Plans in place for King’s

to recover position over the year.

Risk on outpatients mitigated

through contractual agreement

14/15 and work underway through

practices and in trusts to impact

on underlying activity position.

Amber

It should be noted that the Integrated Adults Dashboard is measuring activity by comparison to the previous financial year rather than against 2014/15 Plan. Work is taking place at the CSU to support a more detailed Point of Delivery (PoD) level of assessment against QIPP delivery against the CCG’s QIPP Plan on a monthly basis.

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3.1 Elective


Clinical Lead Dr. Hasnain Abbasi and Dr. Cathy Burton for Cancer

Programme Lead Bisi Aiyeleso, Assistant Director, Commissioning and Service Redesign Liz Clegg, Assistant Director, Older People and Client Groups for Cancer

Scope of business area The purpose of this business area is to move through a transitional phase where relationships with providers will expect innovation in the management of elective care projects. This business area has strong links with the business areas on Long Term Conditions project, Children’s Services, the work undertaken by Southwark and Lambeth Integrated Care (SLIC) and the GP Delivery Scheme.



To strive to achieve an approach to create solutions for service redesign and delivery with consistency across providers that are accessed by patients living in Lambeth

To create an outcome based approach to agreeing changes to the way in which services are delivered across primary, social, community and secondary care with impact expected in either late 2014/15 or 2015/16

To manage and mitigate in-year risk, whilst recognising minimal material impact

To reduce the number of people inappropriately seen in outpatients

To reduce inappropriate specialty specific follow up

To agree a consistent approach across Lambeth and Southwark where possible

To reduce variation in the GP referral patterns to outpatients

To agree contractual levers to treating patients referred correctly within a pathway

To agree whole pathway approaches within defined areas, including outcome based approaches to pathway management

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To transfer services to a community based model where appropriate

To reduce expenditure by making people responsible for their own health

To successfully tender Musculoskeletal Services for Lambeth

To address some of the Information Technology challenges to allow primary care clinicians to feel confident they have access to current guidelines.

Working with Lambeth Public Health validate the Fitness4Surgery Project in line with NICE guidance and to review the potential roll out of the project for implementation at the end of 2014/15 but full year effect 2015/16

To monitor the current adherence to the South East London Treatment Access Policy

Q1 Key deliverables Progress Update

Follow Up activity and referral management issues:

o Cost saving – Cost savings identified for 2014/15 in March 2014

o Redefining of budgets – April 14

Clarity on roles of the provider and the commissioner in terms of delivering appropriate patient care – Work ongoing

Cost savings attributed to follow up activity agreed negotiated within 2014/15 contract

Working with the acute contracting team agree a locally agreed approach to secondary funding and risk share - ongoing

Risk share elements included within the acute contract QIPP schemes e.g. reduction in consultant to consultant appointments and follow up appointments being led by the trusts, reductions in GP referred 1st appointments being led by the CCG

Patient involvement to shape redesign of services

Significant patient input into the Musculoskeletal service procurement. This included a patient representative on the steering group and within the procurement panel.

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and implementation of changes in identified pathway redesign work - ongoing

Engagement with a wide range of patients within the development of the service specification

Working with the acute contracting team ensure delivery of 18 week Referral to Treatment target for admitted, non-admitted care and diagnostic services along planned care pathways – work ongoing

System Resilience plan developed in conjunction with Southwark and Bromley CCGs. This details the strategy and service models within health and social care to support the delivery of performance targets including the 18 week referral to treatment targets.

Review variation in 2 week cancer referrals, encourage GPs to review and reflect on cancer referrals and new diagnoses of cancer to develop more effective referral behaviour. Increasing GP awareness of cancer, improved access to diagnostics supported by appropriate training in their use - ongoing

Macmillan GP supporting early diagnosis – implementation planning August 14.

Improving patient experience for out of hospital care particularly communication with patients and GPs about transition and needs at end of treatment and also when

PLT End of Life event September 14.

Macmillan community nurse working with practice nurses on survivorship support Macmillan community nurse working with interested practice staff, PPGs and Council

libraries for Macmillan Coffee Morning September 14

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patient entering palliative care phase; better and earlier recognition of transition to end of life. Contributes to NHS ambitions target – see operational plan

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3.2 Long term conditions


Clinical Lead Dr. John Balazs

Programme Lead Vanessa Burgess, Assistant Director, Medicines Optimisation

Scope of business area The purpose of this business area is to improve the quality and length of life of people with one or more long term conditions, and to promote the clinical and population behaviours which allow the right care to be delivered in the right setting. The LTCs work stream will work as a cross cutting theme, and will work with SLIC and other work streams especially mental health and older adults to include people with complex care needs or at risk of frailty and those at the end of life.



Improving quality and length of life for people with long term conditions by promoting consistent access to high value, patient-orientated outcome clinical interventions.

Empower personalization in patients with long term conditions through enriched clinical consultations – development of coordinated care, shared decision making, prevention, emotional support and self-management.

Focus on prevention and improve the recognition, diagnosis and interventions for improving care specifically in respiratory and cardiovascular disease including diabetes.

Reducing the need for unscheduled care and unnecessary out-patient activity for people with long term conditions by education and improving focus on prevention and self-management.

Work closely with SLIC, the urgent care and older adults work stream to support management of end of life identification and care.

Work closely with clinicians and the mental health programme to ensure that mental health needs of patients with long term conditions are incorporated into pathways.

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Q1 Key Deliverables Progress Update

To use local Public Health intelligence and scoping work underway as part of the Southwark & Lambeth Integrated care (SLIC) Long term conditions work stream to assess and create a set of priority needs and deliverables required to secure improvements to long term conditions for 2015/16 - October 2014

Underway and an interim report was presented at the SLIC resilience workshop in July.

To assess ongoing work from the cardiovascular, diabetes (including the legacy work from the diabetes modernisation initiative) and respiratory working groups to prioritise work plans and define deliverables and objectives for 2015/16 - December 2014

Underway and the public health scoping work when completed will inform an ongoing workplan.

To work with SLIC and other work streams and Programme Boards to define ownership of agreed priority needs and deliverables to give clarity on leadership and accountability for these - January 2015.

This work will be commenced when the above workplan is complete.

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3.3 Older People


Clinical Lead Dr. Lisa Le Roux

Programme Lead Liz Clegg, Assistant Director Older People and Client Groups

Scope of business area Lambeth CCG is one of a range of partners who form the Lambeth and Southwark Integrated Care Programme (known as SLIC). This three-year integrated care programme has been funded by a grant to the value of £10.2 million awarded by Guys and St Thomas’ Charity in March 2012.


The objectives of this business area are:

Older people will remain independent and are able to manage their health well with the right level of timely support and advice when they need it to remain at home

Fewer older people will be admitted to hospital or care home

Redesign of local health and social care systems supporting the shift from bed to community based care


Roll out of @home across Lambeth and Southwark achieving bed capacity of 100 beds by end of Q2 2014/15:

70 beds now operating with average bed occupancy of 75% in August to date. Reason for no achieving the number of beds has been staff recruitment. Posts have now been advertised 6 times. GSTT now doing recruitment drive in Ireland to attract staff.

Discussions underway through SLIC programme group on the final bed figure

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Recruitment and induction of staff to be working at 75% capacity (60-75 beds) – May 14

Work continues on the development of a model for the single point of access for @home, ERR, rehabilitation and reablement services. Test model to be presented at the September SLIC Operations Group

To review the impact of @Home and Enhanced Rapid Response on inpatient intermediate care services:

To set up steering group to oversee the work – June 14

To work with the provider and other stakeholders to scope out the review and agree timelines – June/July 14

Intermediate care review group in place

First stage of unit and patient audits have taken place

Provider and commissioner design of prospective three month audit of referrals to intermediate care Pulross Centre to start September 2014, including communication to referrers regarding required information on referral

Implementation of revised GP LES as part of Lambeth CCG Primary Care Incentive Scheme. This includes:-

Assessment and care planning

Care co-ordination and support (including attendance at CMDTs)

New scheme launched – April 14

Trajectories on percentage of HHAs undertaken and case managed cohort with access to and support from an Integrated Care Manager (ICM) to be

Lambeth and Southwark CMDT chairs event was held in July and was very well attended by Lambeth practices. The event was well received and regenerated enthusiasm and motivation for the SLIC Programme

Following the event the South East Locality CMDT meeting had 25 clinicians attend with 17 cases to discuss (highest numbers to date)

The South West Locality have requested information regarding numbers and funding allocation for the SLIC programme, with the intention to review the possibility of providing whole population coverage across the locality

The North Locality have appointed a Joint Chair for their MCDT meetings. The arrangement between Dr Cilla McGinn from Beckett House and Dr James May at Lambeth Walk

Emerging leaders in the north locality have expressed an interest in pooling resources to recruit to vacant case manager role

CCG Representatives/Project Portfolio Manager from SLIC have continued to attend a number of relevant meetings within the CCG/localities to promote the SLIC programme and the benefits of the scheme to their patients and answer any queries raised

48

agreed – end June 14 The CCG will continue to meet with SLIC implementation team regularly to closely monitor activity and produce a joint action plan if activity continues to be low in quarter 2.

To work with Lambeth Ageing Well Partnership (LAWP) to develop outline bid to GSTT Charity for development of prevention programme based on Warm and Well in Winter (WWW) model – July 14

Discussion started with GSTT Charity and SLIC regarding programme, outline for September LAWP meeting.

Development of Digital Directory of Services for Older People:

Directory developed and tested – May 14

Directory launched – June 14

Directory launched

Dementia:

Mental Health Support to Care Home Provider identified and SLA agreed – April 14

Commence recruitment – May 14

Agree roll out subject to staff availability – June – Sept 14

Lambeth and Southwark Specialist Mental Health Intervention Team Reference Group established and meeting quarterly. On target for the service to start in October.

Care Homes Work:

Development of joint Lambeth and Southwark Nursing Home Network - May 14

Ops Board approval – May 14

Lambeth and Southwark Care Homes Network (LSCN) established, second meeting in July. Next meeting in October.

Development of working practice between GPs supporting care homes and care home staff on reflection process to reduce emergency admissions.

Engagement with SLIC testing phase for improved transition of patients between care

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Testing phase – June – Oct 14 settings.

Improved clinical pathways: Falls management Full roll out subject to evaluation – May 14 Infection management development and testing of catheter passport – May 14 Development and testing of cellulitis and UTI checklists – May 14 Roll out of above subject to test- June 14 Malnutrition summit – June 14

July 14 – Catheter passport shared with LSCN and identified a care home to review use and practicality.

July 14 – Cellulitis and UTI checklists shared with LSCN for feedback to SLIC.

Malnutrition summit held in June 14.

Staff recruited to dietetic team to commence nutrition work. Testing model discussed at SLIC Operation Group in July but need further discussion with wider stakeholder.

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Southwark and Lambeth Integrated Care (SLIC)

The areas at risk in August 2014 are General Practice, @home and reablement, which will be discussed further below.

General practice

The General Practice workstream remains red rated for HHAs, ICMs and CMDTs due to the continued low level of activity and slow engagement.

Southwark – Contracts have now been awarded by the CCG to the North and South neighbourhood provider organisations. Levels of activity and benefits have now been agreed and signed off and delivery was expected to start formally in Q2 but has been delayed further due to neighbourhood organisations not yet having CQC registration.

Lambeth launched their GP Delivery Framework in April and all practices have now signed up. Activity and benefits have been agreed and signed off and full delivery was due to start from Q2, however remains low. There are signs that interest and engagement in Lambeth are improving following a successful engagement event on the 10th July led by the CMDT chairs.

@home @home is amber rated due to the initial steep activity trajectory, which requires a step change in referral patterns for this service across Lambeth and Southwark. However current growth in referrals is marked and encouraging and consistent with a new service. All Board members are asked to consider how @home can continue to be publicised within their organisations and beyond, in order to support an increase in referral rates. Reablement The data within this report demonstrates an improvement in reablement activity in both Southwark and Lambeth in the last month and therefore an upward trend, however the activity remains below target. This will be discussed within the August Operations Board Simplified Discharge May operations board signed off priority areas for 2014/15. These areas are now being developed in more detail and will be presented back to the September ops board.

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FIND Falls – Referral numbers in June and July have been higher than the target figure of 42 per month. The team are continuing to refine the triage process and are now focussing on supporting adherence to the classes. Infection – testing of catheter passport extended to community teams and care home. Nutrition –dietetic team is in post and developed detailed test plans, agree priority will be GPs and care homes. Dementia – team leader in post for specialist mental health intervention team for care, interviews planned for remaining team members. Care Homes Interview for care home interface role due to take place on 20th August, workshop planned for 10th September Alternative Urgent Response SLIC are engaged with the Urgent Care Working Group for Lambeth and Southwark to explore any potential further developments /

support. This includes linking up of any new TALK hotlines and supporting a better interface with LAS and SELDOC where

possible.

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System outcomes/benefits tracking

Status Current progress against

targets Explanation and root

causes of current trend

Action Being Taken

Action Responsible Date Due

Emergency Bed Days across GSTT and KCH

The emergency bed day moving average remains stable and slightly above target.

Both Southwark and Lambeth bed day usage volumes have reduced within month.

Emergency Discharges across GSTT and KCH

Target level needs to be

agreed.

Primrose

Carr

July

Board

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Contributing live interventions (older people model of care workstream)


targets Rationale

Mitigation Action Being Taken


Holistic Health Assessments

Overall HHA activity in GP surgeries, and in people’s homes, is still very low and dropped further in June

Information and feedback suggests this is down a number of possible factors o Practices have

suggested that a number of initiatives have needed their attention simultaneously, which has caused a workload issue i.e. NHSE DES for admission avoidance.

o Practices have not installed the new HHA templates in their clinical systems and so have not been able to do HHAs with patients

Practices in Southwark

• SLIC and CCGs have consulted and designed a new service specification and contract for SLIC work. This has better activity and outcomes measures and CCGs will now monitor and manage this. • Practices will now work collectively on national and local initiatives, given the obvious synergies, rather than this being seen as a distraction or conflicting issue. • CCGs are resending guidance sent out in May and June (templates, installation guides and practical support) and asking practices to commence work. • SLIC, CMDT Chairs and the CCGs are continuing to engage practices, localities and

Lambeth and Southwark CCGs (with SLIC support)

Q2 2014/15

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targets Rationale



seem to be waiting for neighbourhood organisations to commence work on their behalf

providers regarding the new contract and expectations. This also includes supporting existing arrangements while the transition to new contracts takes place. • There are now 3 new CMDT Chairs across Lambeth and 1 in Southwark which should further help with engagement of clinical leads and practices over the next few weeks. • SLIC held a large GP workshop and briefing session in July which was well attended, the aims of which were to re-ignite interest and answer questions

CMDT Chairs with SLIC support

July 2014

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targets Rationale



The Holistic Health Assessment template has now been reviewed and improved to make it easier for practices to assess and record outcomes. Sent out in May 2014

Dean Holliday

Complete

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targets Rationale



Care Management

A revised activity and benefits trajectory for Care Management was signed off by the Programme Board in June 2014 to take account of the commissioning and provider delays in Q1

Care Management across Lambeth and Southwark has not been provided systematically to date and remains a concern with low levels of activity, despite a small rise in June.

Previously tested centralised models of delivery by SLIC had not proved successful and instead GP Practices have been asked to

In Southwark GP practices have formed into neighbourhoods consistent with the current commissioning localities. These neighbourhoods will deliver SLIC services on a neighbourhood population basis from Q2. This means every eligible patient will be able to access these services no matter where they are registered in Southwark. Southwark CCG has neighbourhood managers working with the practices to implement and improve activity delivery of these services.

Southwark CCG (with SLIC support)

Q2 2014/15

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targets Rationale



establish their own services either at an individual, locality or neighbourhood level

SLIC is supporting Southwark and Lambeth CCGs and practices in developing care management capacity, in alignment with the CCG contracts.

Across Lambeth GP Practices and localities are looking at their delivery plans in conjunction with the CCG. All 3 localities are exploring locality wide working.

There are now 3 new CMDT Chairs across Lambeth and 1 in Southwark which should further help with engagement of clinical leads and practices over the next few weeks.

Lambeth CCG (with SLIC support) CMDT Chairs

Q2 2014/15 Q2

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targets Rationale



CMDT Meetings

A revised activity and benefits trajectory for CMDT discussions was signed off by the Programme Board in June 2014, to take account of the changes and limited activity in Q1 and the expectations for Q2,3,4 from practices.

There is still limited engagement from primary care in CMDT meetings which means people discussed remain below the anticipated levels

Southwark CCG expected this due to delay in 14/15 neighbourhood contracts.

In Lambeth there are signs of improvement as one CMDT locality had over 20 attendees and 17 cases in July

Wider improvements are vital to the success and impact of integrated working.

Issues driving this seem to be: o The need for an

improved contract that

Across Lambeth and Southwark GP practices and providers need to formulate and implement their delivery plans to improve joined up working and engagement with CMDT colleagues locally. SLIC and CCGs are supporting the development and implementation of these plans. New contracts are now in place and signed by practices or providers across both boroughs

Lambeth and Southwark CCGs (with SLIC support)

Q2 2014/15

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targets Rationale



remunerated and enabled engagement and representation (now in place).

o Work needed to help practices fully understand the short and longer term benefits to professionals and patients of joined up and collective working and planning of care (event in July 2014 CMDT Chairs).

o Gaps in CMDT chair leadership roles (now filled and there are 4 new CMDT Chairs across the 2 boroughs)

There have also been some noted gaps in attendance from provider partners at certain CMDTs in Q4 of 13/14 and the start of 2014/15 and this appears to be being driven by the lack of

A successful engagement event, led by the CMDT Chairs, took place in July 2014 which has developed a lot of interest from primary care and improved understanding of the rationale and application of the work

SLIC (with support from local LMC and clinical leads) has successfully identified 4 new CMDT Chairs to further improve the leadership and engagement

SLIC and CMDT Chairs continue to engage with partner provider organisation staff to explain the transition and maintain attendance at CMDTs.

Contracts are in place to release staff from every partner organisation every month for CMDTs.

CMDT Chairs Dean Holliday CMDT Chairs Dean Holliday

Q2 2014/15 July 2014 On-going Q1 2014/15

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targets Rationale



engagement from General Practice.

An alternative acute response


targets Rationale



Consultant Hotline and Hot clinic

The TALK hotlines and Hot Clinics continue to deliver good levels of activity and there have been improvements in June at both GSTT and KCH

Further developments are being explored including additional hotlines for other specialties.

The impact and outcomes of TALK are in the process of being

TALK and SLIC staff continue to promote the use of the service and a recent engagement event proved very successful as a promotional exercise for TALK and other services

A working group is reviewing how TALK could be further developed and is exploring including access to additional specialities and use by other professionals (LAS and SELDOC).

Dean Holliday / Anna Clough

Q2 2014/15

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targets Rationale



reviewed. Surveys from GPs suggest that TALK overall is delivering benefit and is meeting need and expectation.

SLIC is also now engaging with the joint Lambeth and Southwark Urgent Care Working Group to explore any other Alternative Urgent Response opportunities.

Dean Holliday / Anna Clough

On-going 2014

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targets Rationale



Enhanced Rapid Response

Referral rate continues to be high with an upward trend. The service continues to generate high volumes over capacity at times

Increase in demand has been predominantly from hospitals. Community referrals remain static.

Capacity continues to fluctuate, especially if numbers of double handed transfer patients are high

Recruitment is progressing but slowly.

Medicines management nursing needs and social care packages taking up more of capacity than desirable- delaying discharge /handover.

@home has been providing Southwark with

Increased funding for 2014/15 from CCG. This will assist with capacity. Further winter pressures funding secured. Aim to accept more double handed patients through SDT/ERR and employ pharmacy technicians to assist with medicines management.

Amanda Williams/ Cathy Ingram

Complete

Review required over how more community referrals can be generated.


July 14

ERR referrer leaflet to be recirculated to primary care by commissioners and practice visits to promote referrals Working with @home for practice visits etc.

Amanda Williams/ Cathy Ingram (Liz Clegg / Harprit Lally)

Complete 13/05/14

Referral pathways/ joint working with @home to be clarified.

Amanda Williams/ Cathy Ingram/?Cepta Hamm

30/05/14

Options for single point of

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targets Rationale



nursing support for medicines management.

access for ERR and @home being discussed.

Continuing to review demand and capacity, referral patterns and shift patterns. Increased staffing in Lambeth over weekends to meet demand. Planning to trial more on call staff in Southwark over weekends.


30/06/14

Full integration (and co-location if possible) with SDT/ICT being planned in Southwark (Lambeth already operating an integrated service), including refining referral pathways, implementing single point of access across both boroughs.


Clearer process for handover to Reablement to ensure rapid transfer and joint working with social care when appropriate.


30/05/14

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targets Rationale



@home

*Capacity vs. Utilisation is being worked on by GSTT Community team – this data will be included in the September board report.

Referrals have sharply increased for June and July.

Planned activity for @home has been re-profiled as discussed at the programme Board

Status of @home is amber because it is below original planned trajectory; this is largely due to recruitment, mobile working limitations and lead time necessary for referrers to fully utilise a new service.

July shows an increase of accepted new referrals, (from June from GSTT and Kings from Primary Care.

Majority of MDT team are in post, the main gap is band 6 & 7 nurses, though there is now 8 band 7s in

Priority is to recruit to a full establishment within team, lag period due to recruitment and induction process.

Amanda Williams / Karen Titchener

October 2014

In July average occupancy and contacts have increased. From GPs and hospitals and Further work continues with partners to highlight when there is spare capacity.

Amanda Williams/ Nicola Wise/ Karen Titchener

Two CNSs are based in GSTT acute and KCH; In June 2 Matrons worked full time in St Thomas’ to help increase the number of referrals and promote @home.

Karen Titchener, CNSs

Work with general practice to ensure they are aware of referral criteria and remit of service.

Amanda Williams/ Karen Titchener

On-going

Dedicated single referral line for @home is working well. Review of referrer

Karen Titchener

Dec 2014

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targets Rationale



*Please note this graph also shows non- Southwark & Lambeth 65+ patients and KCH was included in ‘Other’ prior to May 14.

post/inducting leaving only 4 vacancies and 9 band 6 in post leaving 8 vacant posts

@home is One service – t wo bases which has improved productivity as there is a reduction in travel across the two boroughs.

Recruitment to the @home service in terms of band 6 and band 7 nurses has been slower than anticipated, mainly due to the re-profiling of the service skill mix. This may impact on the services ability to reach full capacity within the original timeline.

experience due.

Dedicated single referral line for @home is working well. Work in progress on infrastructure to support a unified point of access for all OOH services.

Cathy Ingram/ Emily King/ Fiona Martin

Significant progress by Winter 14-15

Skill mix and acuity is reviewed daily and additional band 7s have been recruited. A rolling programme of recruitment continues and will be supported by the new Business Support Manager from 12th May 14. Hospital based CNS posts are beginning to have an impact. An intensive period of PR about the service is being put in place across KHP June to September 2014.

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targets Rationale



Reablement

Southwark and Lambeth Reablement have a static trend overall and performance within April and May is significantly below target.

Southwark retrospectively revised their 13/14 figures at the end of March 14, this shows prior figures were underreporting by approximately 50%, this was due to missing some people who had a Section 5.

Lambeth now have a new Reablement provider “BS Project Services” who will be based at Akerman Road with Health Social Care staff. Lambeth are now starting the whole mobilisation process and hope to be fully operational by September 2014.

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targets Rationale



To note: Lambeth have revised their Dec 13 onwards figures due to a more accurate reporting system now being in place.

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Projects in design/ testing phases (older people workstream)

Better proactive identification of need and intervention

Status Current progress against targets Rationale Steps for next month

Care Homes

June 2011

Feb 2014 Oct 2014

Jan 2015

Outcome indicator/s

Emergency admissions 65+ from care homes

Interviews are planned for the 20th August for interface role.

Priority areas have been identified for testing and a four month plan is being developed.

Action: set up care home workshop for September

Maximising independence before LT care is finalised


Simplified Discharge

Simplified discharge The May Ops board signed off priority areas for 2014/15 which took into account the outcome of previous testing.

The three priority areas for further design and testing are:

1) The development of an options

Action: Scope and design future discharge model and an options appraisal on a unified point of access at discharge. This will be presented to the September ops board. Responsible: Simplified

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September

2014 March 2015

April.May 2015

Outcome indicator/s

Average length of stay for emergency admissions 65+ Improved patient/carer experience

appraisal for a unified point of access for patients with complex health and social care needs. 2) Development of a discharge model that incorporates shifting the balance of care from acute to community settings, ensuring people go home as early as possible, ensures people feel safe and supported at home and provides value based care. 3) Development of support for patients, families and carers in relation to discharge. Three test plans are currently being developed to address the above priorities. These are progressing well and are on target for the Sept ops board.

Discharge Core decision

making group, coordinated by

SLIC.

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Improved clinical pathways


Falls

July 2013 Aug 2013 July 2014 Oct 2014

Outcome indicator/s

Emergency admissions for falls, 65+

The project is rated amber due to the number of referrals that have been received during the test. The original plan had identified HHAs as the main source of referrals. To date there have been no direct referrals from HHAs. As a result new approaches to identify at risk clients are being tested. In June and July we have seen a marked increase in the number of referrals 45 in June and 62 in July. This suggests that the new marketing processes are having an effect. The increase in referrals has shown opportunities to refine the triage process. There is a current backlog of clients where the triage process needs completing. The project will now focus on support and adherence to the course.

Action: Team to focus on clearing the backlog of referrals Responsible: GSTT Community

Action: Identify new adherence methods to be used once clients are in classes Responsible: GSTT

Community and SLIC

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Infections

Aug 201 Sept 2013

May 2014

Dec 2014

Outcome indicator/s

Emergency admissions for infections, 65+

Catheter passport is currently being tested in both acutes. Testing will now be extended to community teams (2x district nursing teams) and in a care home setting.

Cellulitis and UTI check lists - EMIS template has been set for both checklists and is ready for testing.

Patient versions are being tested in both primary care and community settings. This guidance may feed into work with home care workers as early alerters.

Action: Print next version of catheter passport and distribute to teams with guidance.

Action: use EMIS templates as and when new patients come in with UTI & cellulitis (Simon Hassan)

Action: Conduct analysis on incidents and impact of community MRSA and decide whether this should be in scope of SLIC (Marie-Noelle Vieu).

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Improved clinical pathways

Status Current progress against targets Comment Steps for next month

Nutrition

June 2013 Aug 2013 July 2015 Oct 2015

Outcome indic ator/s

Emergency admissions with malnutrition 65+ Residential ca re package with malnutri ion n 65+

The team are now in post and have begun the detailed design work for the test interventions. They will move to Dulwich Hospital from September.

Phase 1 for Southwark will include working with GPs and care homes to reduce prescribing of oral nutrition supplements.

Action - Develop test plan to be shared with Southwark Medicines Committee.

Dementia

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July 2013 A g 2013 Sept 2015 Dec 2015

Outco me indicator/s

Emergency Admissions for conditions associated with Dementia + crisis episodes 65+ Residential care packages for people with Dementia 65+ and a carer

Digital Directory – majority of services are now in the directory, next step is to set up small focus group to seek further feedback.

Mental health support to care homes – team leader appointed, remaining team to be interviewed in August

MH Acute to community _revised proposal is to go to August Ops Board for approval for testing across one site for 6 months.

Better discharge pack to care homes – Discharge pack is being used on Henry with one month before evaluation. Feedback has indicated a further test to ensure community follow ups take place would be a next step.

Community delirium response – scoping meeting has taken place, a follow up meeting is planned for end of September with @home. Proposal is for a test in one nursing home and possible to link in with early alerter work with home care providers

Action: Set up focus groups (Age Uk Lambeth / SLIC)

Action: meeting GSTT to review handover test and plan for next stage (Helen Pettengell / Johnny Pigott)

Action: finalise business case of MH support from acute to community business case for August Ops Board.

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Continuing Healthcare

Responsible Director Moira McGrath, Director Integrated Commissioning (Older People)

Clinical Lead Dr. Lisa Le Roux

Programme Lead Liz Clegg, Assistant Director Older People and Client Groups

Scope of business area Evaluation of Continuing Healthcare pathways ensuring patient centred care.



To continue the roll out of Personal Health Budgets for patients deemed eligible for fully funded NHS Continuing Healthcare.

To continue with the National Retrospective Appeals work in accordance with Department of Health guidance, ensuring continued monitoring of the impact of the appeals.

To continue working with the London Purchased Healthcare Programme (LPP) in relation to further AQP developments.


Increasing the uptake of personal health budgets for patients identified as being eligible for fully funded NHS Continuing Health Care - ongoing

The provision of Personal Health Budgets (PHB) for individuals eligible for NHS Continuing Healthcare went live on 1st April 2014. During the first quarter a PHB with the provision of direct payments has been set up for two new CHC patients.

Continue the project to assess appeals for Previously Unassessed Period of Care (previously called Retrospective Continuing Healthcare Appeals) –

The process of gathering documentary evidence for the appeal cases continues.

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ongoing

To participate in further AQP tendering and to monitor current AQP contract for Continuing Healthcare placements – ongoing

Following the conclusion of the fourth phase of the process, a further two care homes with nursing in Lambeth have joined the contract, meaning seven of the ten Lambeth care homes with nursing are now part of the AQP contract.

To work with Southwark CCG and the Integrated Care programme to review the ‘Health Offer’ to nursing homes in Lambeth - ongoing

Lambeth and Southwark Care Homes Network (LSCN) established, second meeting in July. Next meeting in October.

Development of working practice between GPs supporting care homes and care home staff on reflection process to reduce emergency admissions.

Engagement with SLIC testing phase for improved transition of patients between care settings.

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3.4 Urgent Care

Responsible Director Andrew Parker, Director Primary Care Development

Clinical Lead Drs. Lisa Le Roux and Ray Walsh

Programme Lead Therese Fletcher, Assistant Director Primary & Community Care Commissioning Bisi Aiyeleso, Assistant Director Service Redesign

Scope of business area To ensure that patients can access urgent care services appropriately within Lambeth.



Enable patients to better manage their health and choose the most appropriate care settings through the provision of comprehensive communication and self-management strategies.

Develop innovative ways to improve access to general practice and offer patients consistent access to urgent and unscheduled care within primary care.

Urgent care provision to be effectively reconfigured to ensure patients can access the most appropriate care. An example of this being the reconfiguration of the front ended co-located Urgent Care Centre (UCC) within the Emergency Department (ED) on the St Thomas’ site, supported by effective signposting of patients.

Commission access to effective telephone advice.


Clinical Streaming/redirection: To continue to develop clinical streaming within the ED at the St Thomas’ site, to ensure patients can access the most appropriate element of urgent care – on-going.

Clinical Streaming in place in ED at GSTFT, whereby patients are directed to the most suitable area within ED, or redirected to a suitable alternative.

The GP Diversion Scheme continues to operate from St Thomas’s ED, whereby patients are redirected to a local GP.

Patient Experience Officer (PEO) is available within the reception area of St Thomas’s ED during weekdays to facilitate the transfer of patients via the GP Diversion Scheme, and also advise un-registered patients on how to register with a GP.

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Around 40% of the total numbers of patients seen within the ED at St Thomas’s Hospital are treated within the UCC.

Working with GSTFT to develop/ promote alternative pathways for patients to access rather than attending ED.

Continue to work with GSTFT to further develop the Lambeth Alcohol Reduction Centre (LARC) - ongoing.

The LARC continues to be operational on Thursday – Saturday (nights only), and provides a specific pathway for patients under the influence of alcohol.

The pathway has now been extended to include patients who also have an injury, with a view of extending it further to include patients who have ingested certain club drugs.

This project has enabled GSTFT to treat this patient group appropriately, and reduce the number of 4 hour breaches.

Review of Gracefield Gardens WiC - completed

o To review the Monday-Friday service (provided by Streatham High) and implement changes to the services in line with the agreed recommendation

o To review the weekend and bank holiday cover (provided by SELDOC) and implement changes to the service in line with the agreed recommendation.

The review of Gracefield Gardens WiC has now been completed, and the recommendation was for the current Walk-in service to continue during 2014/15 whilst a new model of Urgent/Unscheduled Primary Care is developed for the population of Lambeth. This recommendation was approved by the Governing Body at the Public Board meeting in July 2014

An Urgent Primary Care working group has been set up to scope out the new model of provision/access to Urgent Primary Care in Lambeth. The working group has Clinical Leadership, Health Watch, PPG Network, Medicines Optimisation and CCG Commissioner representation.

As part of the winter monies allocation for 2014/15 it has been proposed that a proportion of the funding will be allocated to providing extended access during winter. The three Localities in Lambeth have submitted a joint proposal, which has been approved for implementation during the winter.

Continue to work across SEL to develop a NHS 111 model which will be commissioned in the future.

London Ambulance Service (LAS) took over the NHS 111 service on 19th November 2013 on an interim basis until end of March 2015.

Development of the future specification and subsequent procurement has commenced for the provider of NHS SEL 111 service and should be complete in Q2 of 2015/16.

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4.0 Integrated mental health care for adults

Responsible Director Moira McGrath, Director of Integrated Commissioning (Older People)

Clinical Lead Drs Ray Walsh and Raj Mitra

Programme Lead Denis O’Rourke, Assistant Director

Scope of business area This business area aims to introduce three major structural changes to the system of care and support via the new “front door” – the Living Well Network which will provide help and support much earlier than the current system and provide a personalised and co-productive response via integrated multi-agency, multi-disciplinary teams and ensure that secondary care services, via the SLAM AMH redesign, are focused on early intervention and recovery and thereby reduce the “relapse” rates amongst the SMI population. The third element of system change relates to the proposed Integrated Personal Support Alliance which aims to radically transform NHS/social care rehabilitation services.



Improved health outcomes & experience for patients

Redesign of the local mental healthcare system supporting shift from acute to community

Strengthen individuals and communities capacity to self-manage at scale

Support a managed redirection of resources from secondary care to integrated care within primary care/community setting.

Programme Assurance Statement Assurance Status/Risks RAG Rating (Red/Amber/Green)


See below Amber


Risks are identified but mitigations have been put in place.

Green

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Programme Risks (Rating score - 1 – 10 (low – high risk to delivery)

Risk area Risk –

Delivery

Score

Mitigation

1 SLaM Contract – delivery of AMH redesigns fails to reduce relapse rates and use of beds

7 Monitor progress on a monthly basis. Whole system performance dashboard

2 Roll out of LWN and CIS is delayed beyond 9/14

4 Negotiate with existing VCS providers Re-profiling of services resources to support roll out. Utilise CIS underspend.

3 IPSA Alliance contract fails to proceed due to lack of alignment between partners and procurement rules

5 Joint adult CCG/LA commissioning/delivery meetings Selection negotiation process to test alignment Ongoing legal advice and support

4 Workforce culture change is slow to adapt to the need for co-productive/personalised approach

SLaM 7 ; LWN 2 ; Alliance/ IPSA 4

Extending the LWN AAP approach to SLaM redesign and IPSA Work with SLIC to develop competency framework for workforce requirements in relation to co-production/personalisation

5 System interface – perverse incentives, behaviours not addressed by new rules

5 Monitor via whole system dashboard and contract negotiation

6 Impact of welfare reforms on people 7 Link to financial resilience strategy and ensure access to EPC is sustained

7 LA social care management changes 5 Joint adult CCG/LA commissioning/delivery meetings Support LA with recruitment

8 LA funding reductions 7 Joint planning with LA and prioritise social care / social support and VCS investment in QIPP/OBB

9 Insufficient housing supply is available to support alliance/IPSA

6 Joint planning with LA housing department including housing quota and new housing development Alliance negotiation process to include ability of provider to

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Please note that the performance dashboard below is currently under development and in draft format. Key performance indicators and outcomes will be agreed by the end of September 2014.

procure housing provision

10 Limited peer support resources available 3 Re-commission existing PS initiative to support the growth of the full range of peer support i.e. informal, formal, web based platforms

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Q1 Key Deliverables Progress Update

Delivery of Living Well Network (LWN) roll out – April 2014

LWN (north hub) six month review report produced June 2014 highlights positive trend in terms of reduction in referrals to CMHT (Assessment and treatment).

Primary care community incentive scheme being rolled out; training sessions being set up; cases for transfer being identified; locality leads recruitment process commenced.

Plans for roll out to south of borough to be finalised by Sept 2014.

Building the LWN asset base workshop event 23/09/14.

Implementation of SLaM led AMH redesign programme – April 2014

Implementation commenced – core teams in place with training taking place, go live Sept 2014

Interface meetings held between LWN and SLaM to ensure effective joint working.

“Primary care clinical engagement with the AMH redesign” workshop being planned – Sept 2014.

Launch whole system alliance procurement - April 2014

The formal negotiation process to form an Integrated Personal Support Alliance (IPSA) agreement aimed at transforming current NHS/social care rehabilitations services commenced July 2014 with the aim of new service mobilisation from Oct 2014.

The strategic commissioning arrangement underpinning an alliance agreement are being worked up, this is likely to involve an initial Memorandum of Understanding between the CCG and Lambeth Council from October and a section 75 partnership agreement from April 2015.

A new service delivery model and implementation plan is being worked up within the IPSA which brings together Voluntary sector providers, social care, SLaM and commissioners with the aim of sign off, together with financial plan (and savings) by Sept 2014.

Increased access to Integrated Talking Therapy Services (ITTS) including former IAPT programme – ongoing

Fewer than expected numbers entering the service, more people moving to recovery and increase in the number of completing treatment.

The service has redesigned its telephone triage so that it becomes an intervention in its own right, especially connecting people to a range of self-help materials, community

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resources and CBT workshops.

Delivery of the CCG target on numbers of people diagnosed with dementia

Working with SLMS memory service to send GPs a reminder of patients who have been diagnosed with dementia, together with guidance on how to register these patients

Working with the Clinical GP Lead for dementia to assist GP Practices with any issues they may have in registering patients with dementia

To have a communications plan to promote GPs registering patients with dementia, through the newsletters, Practice events, Practice Manager Forums etc.

Delivery of the National Dementia Strategy - ongoing

We are continuing to develop and monitor services for people with dementia and their carers against the objectives of the National Dementia Strategy. Many objectives have already been met, for example having a memory service and Dementia Advisors.

Redesign of continuing care and day care services – ongoing

So far we have met with the Alzheimer’s Society and the leads for the memory service and the CMHTs to discuss the care pathway and where there are any gaps etc. which need to be addressed.

We will continue to meet with a variety of statutory and non-statutory providers and members of the public to gain a full picture of the dementia care pathway

Further development of primary/secondary care pathway for people with dementia and their carers – March 2015

So far we have met with the Alzheimer’s Society and the leads for the memory service and the CMHTs to discuss the care pathway and where there are any gaps etc. which need to be addressed.

We will continue to meet with a variety of statutory and non-statutory providers and members of the public to gain a full picture of the dementia care pathway

Redesign of continuing care and day care services – ongoing

Lambeth and Southwark Specialist Mental Health Intervention Team pilot to commence in October providing support to care home staff for patients who no longer require specialist mental health continuing care but continue to have challenging behaviour

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5.0 Staying Healthy (Led by London Borough of Lambeth)

Responsible Director Maria Millwood, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)

Clinical Lead Dr. Raj Mitra

Programme Lead London Borough Lambeth

Scope of business area The local authority work plan will set out how the outcomes across Staying Healthy will be

achieved. A Staying Healthy Board that reports to the Health and Wellbeing Board has been

set up to agree joint plans and monitor delivery. The key plans for the year are:

Stop Smoking

Vascular Risk Prevention

Alcohol

Healthy weight

Baby Friendly Initiative

Promoting Breastfeeding

Healthy Living Pharmacies

Health & Wellbeing

Sexual health Primary Care:

To review the Public Health Enhanced Services contract (Primary Care) applying a standard assessment criteria and use findings to inform future service development with GP surgeries and Pharmacies

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The objectives of this business area are to support the delivery of the Health and Well Being strategy across Lambeth. In doing so Lambeth CCG has made some specific commitments listed below.




Yes Green


No Risks to delivery identified as yet, each deliverable to be risk assessed by the next report submission

Amber


CQUINs with acute providers relating to secondary care staff providing brief intervention and advice including signposting on smoking and alcohol (along the lines of a Making Every Contact Count - MECC intervention) and recording of smoking status on all patients – April 14

Progressive CQUIN alcohol IBA targets have been agreed with both GSST and KCH acute sites. Limited community settings are still being negotiated. Acute Quarter 1 results include:

GSST target 20% of Sarah Swift patients screened and offered brief intervention: 26.9% (n109) screened and 100% given appropriate intervention

KCH target 20% of MAU and ASU admissions to be screened for alcohol with 20% given ‘advice and information’: MAU 38.5% screened (of these 43.5% [n36] given advice & info). ASU 76% screened (of these 37.8% [n14] given advice & info).

Improve the quality of smoking cessation services

An initial meeting of the Stop Smoking review group will take place in early September, with a stakeholder engagement event to be arranged in early autumn.

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through ensuring good practice and promoting equitable access to quit - ongoing

Currently, £127,400 is invested in primary care, £169,136 invested in pharmacy and £733,939 is invested in the Lambeth Specialist Stop Smoking Service (LSSS). Total of £1,030,475

Lambeth Specialist Stop Smoking Service is part of the Community Health Services, GSTT address the local quit target by engaging with people who smoke, in particular those from populations at risk of ill health and supporting them to stop smoking.

The review of primary care, pharmacy and the Lambeth Specialist Stop Smoking Services will inform future commissioning intentions. Any revisions to future Specialist Stop Smoking Services will need to ensure equitable access to the whole population but will need to take account of local health inequalities.

Additionally, the Specialist Stop Smoking Service is working collaboratively with Commissioners to address the quality and outcomes of the lower performing GPs and Pharmacies in Lambeth. All GPs and Pharmacies have been informed about the Quality Improvement Plan and a work plan going forward will be developed by Commissioners and the Specialist Team.

Promoting Chlamydia screening across all sexual health services - ongoing

Chlamydia screening in Lambeth is still above both national and London rates for positivity and exceeding diagnostic target of 2400 positive young people under 25 years identified annually.

However there has been some reduction in both positivity and diagnosis, currently working with Public Health England to ensure we maintain performance and understand any issues that may have impacted on local coverage.

Currently scoping to expand access to Chlamydia screening for local vulnerable and high risk population.

Supporting the sexual heath commissioning team to develop community contracts with GP practices and pharmacists for long acting reversible contraception (LARC) and sexual health services -

As of the 1st of April 2014 our existing Provider base for all primary care enhanced sexual and reproductive health services have now transferred to the local authority public health contractual framework.

Sexual health Primary care service review is currently underway and findings will inform the draft Public health Enhanced Service specification aiming for implementation in 2015/16.

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ongoing

Increasing and mainstreaming HIV testing across all settings to reduce late diagnosis - ongoing

In conjunction with the primary care service review we are establishing a local working group to pilot HIV testing within community pharmacies. We expect this pilot to be delivered in conjunction with substance misuse and health checks. The pilot will be overseen by Public Health and Commissioning Leads

Campaign to increase awareness of cancer in disadvantaged groups specifically for colorectal and lung cancer - ongoing

Macmillan community nurse and Adults with Learning Disabilities (ALD) Team agreement to engage with Bowel Screening Programme for improved detection of colorectal cancer in ALD group.

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6.0 Primary care development

Responsible Director Andrew Parker, Director Primary Care Development

Clinical Lead Dr. Hasnain Abbasi

Programme Lead Therese Fletcher, AD Primary & Community Care Commissioning

Scope of business area This business area aims to transform Primary Care across the borough of Lambeth, by developing integrated models of primary care that are bottom-up, co-produced and clinically led. By investing in leadership and development, Primary Care can continue to drive innovation, and collaborate in new ways of working that take account of the local context and deliver more patient centred and integrated models of care.


The objectives of this business are:

Primary Care is better configured to deliver an increased range of services to patients and integrate with other services on a population health basis

Reduces variation in access and quality for local populations

Delivers demonstrable benefits in terms of quality and value for money

Makes primary care a more attractive place to work

Drives innovation and achieves both local and national strategic objectives

Reducing inappropriate GP Referrals

Case Management of frequent users of services

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Yes the Programme is currently on target. Please see risks below.

Amber

2014/2015 Primary Care Development Programme Board Risk Register - by Corporate Objective Operational

Lead Code Date

Identified Status Description Current

Impact Current

Likelihood Current

Risk Score

Direction of Travel

Actions Summary Last Review

Date

Next Review

Date

Target Date

Target Risk

Score

Bisi Aiyeleso 5A 11-Nov-2013

High Risk Risk of non-delivery of Elective Care Programme project milestones

Major Possible 12 Development of Recovery Plan as detailed in the Planned Care QIPP Performance Report (updated monthly) Recruitment required for locality staff to support the monitoring of plans and support practices with the delivery of their QIPP targets.

14-Aug-2014

12-Sept 2014

31-Mar-2015

8

Operational

Lead Code Date

Identified Status Description Current

Impact Current

Likelihood Current

Risk Score

Direction of Travel


Date

Next Review

Date

Target Date

Target Risk

Score

Therese Fletcher

5F 01-Apr-2014

Warning Risk of delays occurring when procuring sufficient management support

Moderate Unlikely 6

Primary Care Development Programme PID contains a complete list of the project resources required. Actions

1. List of Project Team and Roles to be completed as outlined in the PID (Therese Fletcher, due date 31/10/2014)

15-Aug-2014

12-Sept 2014

31-Oct 2014

3

Operational Lead

Code Date Identified

Status Description Current Impact

Current Likelihood

Current Risk

Score

Direction of Travel


Date

Next Review

Date

Target Date

Target Risk

Score

Therese Fletcher

5G 01-Apr-2014

High Risk Risk of failure to create a formalised and well supported Locality Network

Moderate Likely 12

Appointment of 3 Locality Managers to support practices and Locality Networks Completion of individual work stream activity plans Development of formal locality structure Actions

15-Aug-2014

15-Sept-2014

31-Mar-2015

3

90

1. Completion of individual work stream activity plans (Therese Fletcher, due date 31/10/2014) 2. Appointment of 3 Locality Managers to support practices (Therese Fletcher, due date 31/10/2014) 3. Completion of a formal structure for the Localities (Therese Fletcher, due date 31/10/2014)

Operational Lead



Current Likelihood

Current Risk

Score

Direction of Travel


Date

Next Review

Date

Target Date

Target Risk

Score

Therese Fletcher

5I 01-Apr-2014

Warning Risk that as Locality Networks develop new opportunities may develop for which there is limited or no funding

Minor Possible 6 Completion of work stream activity sheets Implementation of Communications plan Actions

1. Completion of work stream work plans (Therese Fletcher, due date 31/8/2014) 2. Completion and commencement of Communications plan (Therese Fletcher, due date 31/8/2014) - Complete

15-Aug-2014

12-Sept-2014

31-Aug-2014

4

Operational Lead



Current Likelihood

Current Risk

Score

Direction of Travel


Date

Next Review

Date

Target Date

Target Risk

Score

Therese Fletcher

5J 15-Jul-2014

Warning Risk of practices not signing up or engaging with the locality network and CCG activities

Minor Unlikely 4

Primary Care Communication plan drafted to ensure continued engagement. Appointment of 3 Locality Managers to support practices Clinical Leaders in localities will be appointed and act as advocates and champions to promote participation. Actions

1. Primary Care Programme Communications plan to be competed (Therese Fletcher, due date 31/08/2014) Complete 2. Appointment of 3 Locality Network Managers to support engagement from practices (Therese Fletcher, due date 31/10/2014) 3. Appointment of clinical leaders in localities (Therese Fletcher, due date 31/10/2014)

15-Aug-2014

12-Sept-2014

31-Mar-2015

2

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Implement Phase One of the GSTT Charity Bid, which supports transformation of Primary Care in Lambeth.

Phase one of the GSTT Charity Bid work will be completed on the 9th September 2014 when the final module of the Emerging Leaders Programme takes place. The evaluation report from Phase One will be shared with the Primary Care Development Programme on the 17th September 2014.

During Q1 the CCG also submitted their Phase Two proposal to the GSTT Charity for consideration and this has subsequently been approved. Phase Two is the opportunity to continue working with practices/localities in developing new models of Primary Care that ensures improved Health Outcomes for our patients.

Refresh NHS Lambeth CCG Primary Care Education Strategy for 2014/15 – June 2014

Refreshed Primary Care Education Strategy shared at the GB Seminar in July 2014. The final version for 2014/15 will go to the Public GB Board Meeting on the 3rd September 2014 for ratification.

Develop clear links between Primary Care Locality Networks and Clinical Network – July 2014

GP Locality Care Network roles have now been developed and will be shared at the Primary Care Development Programme Board on the 17th September 2014. Members of the Clinical Network and our Emerging Leaders have been instrumental in developing these roles, which include GP Clinical Lead, Pharmacy Clinical Lead and Nurse Clinical Lead.

Work with NHS England on development of GP premises to support improved quality of primary care – ongoing

NHS Lambeth CCG continues to meet with NHS England on a monthly basis to discuss estate issues relating to the development of high quality primary care. The CCG is supporting practices with navigation of the process and the relevant documents that need to be submitted to NHS England to progress development of the Primary and Community Care estate.

Working with the CSU IT team continue to develop GP information systems, including the roll out of EMIS Enterprise supported by South London

Approximately 75% of the Lambeth practices have returned their data sharing agreements, which supports implementation of the EMIS Enterprise, which is an opportunity for data to be collated and analysed at a central point so practices can be supported with further development of their Quality and Improvement Plans.

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Commissioning Support Unit IT services – July 2014

The DXS system was launched in July 2014. Eight practices are currently piloting the new system with scheduled roll out planned for November 2014

Develop Primary Care Locality Networks infrastructure - June 2014

Lambeth PPG Network has recently completed their scoping report, which indicates what support is required to ensure the PPG Network has the capacity and capability to work with the CCG to develop ‘Patient Hubs’ that support Care Navigation and communication between local patients and the Locality Care Networks in Lambeth

Recruitment is underway for three Locality Care Network Managers who will support development of a robust Locality Care Network infrastructure

There is a key stakeholder workshop due to take place in September 2014, which will inform the next steps for development of the Primary Care Locality Care Networks. Outputs from this workshop will be shared with the Primary Care Development Programme Board on the 17th September 2014

Working with the Information Team develop Programme Quality and Improvement dashboard - May 2014

The Programme Quality and Improvement dashboard was shared at the Primary Care Development Programme Board in July 2014. This has now been amended to include additional indicators that relate to Clinical Effectiveness, Patient Engagement and Patient Safety. The dashboard will form the basis of our regular monitoring of success of the Primary Care Development Programme

Develop a comprehensive Communication and Engagement Plan for the Primary Care Development Programme

The final version of the Communication and Engagement Plan has been approved by the Primary Care Development Programme Board in July 2014

The Primary Care team supported the collaborative engagement event in June 2014 and has subsequently co-produced a report from this event, which describes shared commitment from relevant stakeholders including Health Watch, Lambeth PPG Network and the CCG. The report is available on the CCG website.

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Enabler Programmes

7.1 Medicines Optimisation

Responsible Director Moira McGrath, Director Integrated Commissioning (Older People)

Clinical Lead Drs. Di Aitkin and Dr Sadru Kheraj

Programme Lead Vanessa Burgess, Assistant Director Medicines Optimisation

Scope of business area This business area ensures that Lambeth CCG commissions services which support patients to obtain the best value from their medicines, optimise their medicine taking and promote safe, effective use of medicines.


The objectives of this business cover:

Improved medicines optimisation

Improve the safety of medicines and reduce waste


Continue collaborative and integrated working with all 6 South London CCGs and acute/mental health trusts in SEL via the SEL Area Prescribing Committee (APC) by active participation in its work plan. Lambeth CCG also hosts the SEL APC on behalf of the other 5 CCGs - ongoing

Active collaborative engagement from Lambeth CCG in the Area Prescribing Committee continues. Summary of recent recommendations : June APC

SEL RED List – a red list has been produced and agreed of medicines which would generally be considered to be for hospital or specialist prescribing only. The list is published on the APC section of our website and will be supported by scriptswitch messages where appropriate. Acute trusts locally are also progressing implementation plans.

Ongoing pathway work includes inflammatory bowel disease management which is in its

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final stages of development. New Drugs Panel Recommendations

Ingenol Mebutate for Actinic Keratosis (AK) in adults - until January 2015, use should be restricted to secondary care. If new AK skin lesions form on a different area and use would be within the product license then GP prescribing would be appropriate if efficacy, safety and patient satisfaction with initial treatment were met.

Link for further information : http://www.lambethccg.nhs.uk/news-and-publications/meeting-papers/south-east-london-area-prescribing-committee/Pages/default.aspx

Develop co-production and patient engagement in medicines via active patient participation in Prescribing Committees and working groups, via HealthWatch, GP practice patient groups and expert patient forums - ongoing

The diabetes patient forum was consulted to consider the needs of the patient in choosing the right blood glucose test strip and meter.

Pathway redesign in Inflammatory Bowel Disease on the use of biologics has started a patient engagement pathway mapping exercise.

Contribute to the development of shared decision making and concordance interventions around medicines by joint working on polypharmacy with SLIC and practices - phase 1 complete by 31 March 2015

Improve the safety of medicines and reduce waste by working with practices to improve repeat prescribing systems and share

Three launch events highlighting Polypharmacy and Medicines Adherence have been successfully delivered. Messages around the complexities, the steps in tackling Polypharmacy and the essence of high quality Medicines Adherence were collaboratively delivered by SLIC representatives, GPs and Integrated Community Care Pharmacists. Implementation of the tools and templates continues.

Three Repeat Prescribing System Events are planned for October 2014. Training has been successfully secured with Medical Protection Society (MPS). MPS will incorporate examples of negligence claims to illustrate the risks involved of a poor repeat prescribing system and time for small group discussions to enable shared learning.

http://www.lambethccg.nhs.uk/news-and-publications/meeting-papers/south-east-london-area-prescribing-committee/Pages/default.aspx

http://www.lambethccg.nhs.uk/news-and-publications/meeting-papers/south-east-london-area-prescribing-committee/Pages/default.aspx

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best practice – phase 1 complete by 31 March 2015

Initial steps towards combating medicines waste through reviewing whole system inefficiencies has begun with gaining feedback and identifying problem areas.

Secondary care QIPP delivery – work in partnership with acute providers to enable high cost drugs management - ongoing.

Specifically to optimise London Procurement Programme initiatives with GST and KCH, explore specialist prescribing of complex medicines where appropriate and pathway review of biologics and VEG-f drugs (see QIPP plan for output and dates)

Medicines Optimisation Performance Framework incorporating LPP KPIs has been agreed across Kings Health Partners. Awaiting Q1 reporting against these KPIs from acute providers.

Audit returns on biologics and VEG-f drugs have also been specified within the Performance Framework. Awaiting progress from acute providers.

Act as Medicines Safety Officer for Lambeth CCG, improving learning from incidents and encouraging reporting culture - ongoing

Examples of medicines errors related to repeat prescribing systems will be incorporated into the Repeat Prescribing Events.

Engage with Community Pharmacists as key public health and medicines experts in the community and utilise the skills of community pharmacists locally to improve medicines optimisation - ongoing

Initial discussions with Local Pharmaceutical Committee have been scheduled to develop collaborative working.

Liaise with Pharmaceutical Industry partners to provide a contact point for collaborative working - ongoing

Ongoing to support projects as required.

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Promote personalisation in the medicines agenda – in all initiatives consider self-management, prevention, coordinated care and patient engagement - ongoing

Polypharmacy and Medicines Adherence tools consist of a patient questionnaire to engage in patients to move towards empowering the patients on their medicines.

Cost effective choice in Blood Glucose Test Strips encompasses: choice of strip; frequency of testing; recording and reporting of results; self-management of hypoglycaemic episodes; adhering to DVLA regulations. These elements empower the patient to self-manage their condition.

Deliver key requirements around medicines from other work streams and commissioning projects in Lambeth CCG and Lambeth borough as required - ongoing

Scoping the implementation of NICE Guideline on the Managing Medicines in Care Homes which involves matrix working with the Older Adults workstream, SLIC and Health and Social Care agencies. Starting point is being scoped to commission specialist care home pharmacist medicines reviews.

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7.2 Equalities

Responsible Director Una Dalton, Director Governance and Development

Clinical Lead Dr. Paul Heenan

Programme Lead Kathryn MacDermott, Assistant Director PMO, Transformation & QIPP

Scope of business area This business area covers the equalities strategic priorities and is responsible for ensuring that the CCG complies with its equalities duties as set out in the Equalities Act.


The objectives of this business area are to ensure that Lambeth meets all its equalities objectives as set out in its equalities strategy.


Equalities strategy –

September 2014

The CCG is in the process of commissioning support to deliver an Equality Delivery Scheme and Equality Impact assessment of its new 5 year plan. The aim is to have a draft of the EDS and EIA outcomes for the November Governing Body seminar with final versions for the January Governing Body. The CCG Equalities strategy will follow on from this work.

Establish an information system for the reporting of progress against equalities objectives – September 2014

Data sources identified

Review equalities action plans across programmes – September 2014

The existing equalities assessment checklists have been collated and initially reviewed. The EIA will include a more detailed assessment of existing equality plans.

Complete an EDS2 The EDS2 assessment is currently being commissioned. The deadline for completion is

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assessment of the existing equalities objectives – September 2014

now January 2015.

Provide advice and support to the programmes on evidence based outcomes and interventions – ongoing

Programmes are currently identifying equalities objectives.

Liaise with Lambeth Public Health team and ensure appropriate input to programmes of work - ongoing

Lambeth Public Health a key partner in the EDS2 and EIA.

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7.3 Organisational Development


Clinical Lead Dr. Adrian McLachlan

Programme Lead Janie Conlin / Lucy Day, Joint AD Organisational Development

Scope of business area This business area is responsible for the development of the CCG Governing Body, staff and GP membership.


The objectives of this business area are to support the CCG to be an efficient, expert and innovative commissioning organisation. This includes maximizing the effectiveness of:

our people; in particular Governing Body, member practices and staff

our strategy; where we are heading/what we want to deliver) and

our processes; how we do things

The deliverables below sets out initial priorities in terms of organisational development for 2014/15, which will be developed in line with emergent information such as, 360 degree stakeholder feedback, staff survey and CCG assurance feedback.

Q1 Key deliverables for ‘our people’

Progress Update

To continue to develop a highly effective Governing Body:

Support regular Governing Body development sessions

GB awaytime held on 14th May. Key actions arising included;

Need to develop agreed definition for clinical leadership (actioned).

Need to confirm roles and responsibilities for programmes and consider clinical capacity (including network) – definitions developed, to be tested with programmes.

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(first one in May 14)

Collate staff survey and 360 survey results relating to GB/leadership - June/July 14

All individuals are to take responsibility for own behaviour (listen, engage, challenge, be collaborative, be clear when debate closed) and invest in giving and receiving constructive feedback.

GB to undertake more work on stakeholder relations.

Reports taken to the July Governing Body meeting in public on the results of the Staff Survey and 360 Stakeholder Survey and associated next steps. The Staff Survey results were discussed at the Developing and Advancing Staff (DAS) meeting in June and the group recommended that there is a focus on supporting staff to get the most out of the appraisal process.

To build on the existing clinical leadership of our Member Practices:

Provide OD support to Clinical Network and Primary Care directorate to embed the Locality Networks – ongoing

Ensure OD content of practice portal appropriately populated - May 14 and ongoing

The All Practice Event on the 8th July was based around localities. The groupwork sessions were led by emerging leaders to embed locality networks and encourage ownership from practices. The Clinical Network stall identified members of the network and included a case study focussing on diabetes. The orientation pack for the Clinical Network, containing guidelines on processes has been uploaded onto the practice portal. Locality leads and the Clinical Network have been invited to attend Personal impact training in September / October 2014. The practice portal is being used to convey information such as the Governing Body elections and outcomes for the South West locality and the All Practice event (invitations and event write up).

To support staff in delivering the priorities of the CCG:

Provide OD input to the Developing and Advancing

DAS are meeting monthly and focussing on priorities identified in staff survey including appraisals, developing the programme for All Staff Events and a proposal for staff to buy additional leave.

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Staff work plan - ongoing

Q1 Key deliverables for ‘our systems’

Progress Update

Define and agree OD support needs to the five programmes and to the broader programme management arrangements - May/June 14

Support the five programmes to maximise effective working arrangements across managerial and clinical commissioning roles - ongoing

Development needs discussions undertaken for each of the programmes. This has led to work to clarify roles and responsibilities for Governing Body Clinical Leads, clinical network leads, SROs and AD programme leads. Role definitions to be tested with the programme leads during Q2. In addition, interactive workshops to improve the effectiveness of chairing meetings have been commissioned to run in September. We have also developed a shared understanding of what it means to be clinically led – further work to raise awareness of this will be undertaken. The staff away time on 31st July considered how enablers can operate to support programmes (and others) more effectively. This included the need for programme budgetary framework (in progress), leaner IT systems (e-invoicing will be implemented) and showcasing of good practice and sharing more explicitly what enablers can offer.

Q1 Key deliverables for ‘our processes’

Progress Update

Lead on identified areas of the CCG review of ways of working such as the admin review and CCG decision making processes – May 14

Ensure delivery of any OD related recommendations arising from internal audits - ongoing

Ensure the way we work reflects our strategic

Consultation report completed and circulated to staff. Report contained a range of actions around staffing structures and ways of working which will be reported to Management Team. Admin review completed – Admin staff aligned to programmes and standardised processes agreed. The staff away time focussed on strategic priorities and behavioural changes needed to deliver our aims and objectives. Monitor progress via DAS.

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priorities and our values - ongoing

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7.4 ICT

Responsible Director Christine Caton, Chief Financial Officer

Clinical Lead Dr Adrian McLachlan

Programme Lead Jeremy Burden and Graham Crawford and Jeremy Burden Business Intelligence & ICT, South London Commissioning Support Unit (CSU)

Scope of business area This business area covers both business information support and information systems. This business is provided to Lambeth CCG by South London CSU.


The overall aim of the IM&T enabler work stream is to ensure that good quality clinical information is accessible in an integrated shared clinical record and to ensure that information systems are available to support the clinical business needs of NHS Lambeth Clinical Commissioning Group. A robust IT infrastructure needs to be in place to enable this to happen.


Work with partners (including SE London CCGs, SLIC) and making best use of available revenue and capital resources to develop IT systems that support the delivery of integrated care.

The CCG is working with the CSU ICT team to develop a project initiation document to spend £250k of 2014/15 capital funding for health and social care integration work. The PID is due for completion by 5th September 2014. This is in addition to the use of the GPIT revenue funding.

The CCG is working with the SLIC information team to take forward local projects to enable interoperability of information systems.

The CCG’s Business Intelligence review is due for completion by December 2014. A group is being set up including CCG, CSU and Local Authority staff to undertake a

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This involves achieving a consistent and accessible approach to IT and information including:

Shared definitions and standards

Sharing of patient data and health information across providers

Use of a virtual patient record

baseline assessment of information systems and to map these against information requirements to meet the needs of our Operational and Strategic Plans. This will also feed into work being done London-wide and through the development of the SE London Strategic Plan as one of its key enabling workstreams.

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7.5 Engagement


Clinical Lead Dr. Raj Mitra

Programme Lead Catherine Flynn, Head of Engagement

Scope of business area This business area is responsible for ensuring that the CCG fulfills statutory duties and delivers on its commitment to involve patients, members of the public, local communities and relevant stakeholders in all areas of its work.


The objectives of this business area are set out within the CCG’s Communications and Engagement Strategy and are intended to support the ongoing engagement of the CCG with Lambeth citizens. Specific communications and engagement objectives for the CCG as a whole are to:

1. Build public and stakeholder confidence in the CCG and its leadership 2. Meaningfully engage with patients, carers and communities to ensure their systematic

involvement in the commissioning of health services for local people 3. Encourage strong clinical engagement from constituent practices and wider local

professional groups to ensure that clinical insights have a tangible impact and add value to the commissioning process

4. Make sure we have open and transparent governance and leadership in our CCG 5. Promote equality and provide evidence for the Equality Delivery System for protected

groups through our work and publication of equality objectives


Build skills and knowledge of staff, governing body and membership

Continuing participation on PPV/PiC training and support programme advisory group; CCG self-assessment of training and development needs for staff and governing body; co-design of 4 training courses, in partnership with the Consultation institute:

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Plug GB, staff and membership into design of London-wide PPV and PiC programmes – April to June 14

Promote other potential training or development opportunities through staff bulletin and intranet - ongoing

Coaching and modeling good practice in engagement planning and delivery through programme development – April to June 14 and ongoing

‘Foundations in Engagement for Health and Care Services’; ‘How to Measure the Impact on Engagement on the Ground’; ‘Engagement through the Commissioning Cycle’ and ‘Empowering Patients to Participate’ - four CCG staff took part in pilot training sessions

Manage relationships with key stakeholders – HealthWatch, Health and Wellbeing Board, Scrutiny; schedule regular / periodic meetings and briefings to ensure they are informed and engaged (ongoing- bi-monthly with HW; quarterly with HWB; ad-hoc with Scrutiny); CCG induction for new HWB/Scrutiny members post election - September 14

Input into induction of new Scrutiny members (June);

1 Scrutiny meeting (July 2014 – KCH proposals);

CCG and SEL Strategies to HWB (June) and CCG participation in HWB review (July)

Ongoing liaison with HealthWatch

Promote opportunities for participation through CCG website and partner websites and use website to feedback

Design of new ‘Get Involved’ page complete

Use of CCG website to promote SEL strategy engagement

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outcomes of engagement

Maintain ‘get involved’ section of CCG website - ongoing

Support other staff to promote opportunities for participation through use of CCG and partner websites - ongoing

Support public participation in work of CCG Governing Body (meetings and membership)

Promote public forum (rename stakeholder pre-meets) via communications in local media and through local networks - bi-monthly and ongoing;

Support clinical/programme leads to develop patient stories and involve lay people/patients appropriately in meetings (e.g. as presenters) - bi-monthly and ongoing

June public forum and Governing Body meeting promoted and well-attended

Develop and support programme engagement

Provide legal and policy guidance to programme leads - June 14

Develop programme-level proposed framework for

Plans in place in most areas from June, detail to be worked up in most;

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engagement - June 14

Develop engagement plans for 2014-15 with programme leads – May to June 14

Strategy: support further engagement on Lambeth and SE London Strategies as required - ongoing

BLHD continues – primary care meeting with HealthWatch and PPG Network (June)

SEL Strategy promoted on CCG website and at Lambeth Country Show (July)

Assurance and reporting: provide assurance to governing body and NHS England (annual report on engagement) - ongoing

Annual report on engagement drafted – to go to Sept Governing Body

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7.6 Communications



Programme Lead Kate Radcliffe, Communications & Engagement Lead, South London Commissioning Support Unit (CSU)

Scope of business area This business area covers internal and external communications support. This business is provided to Lambeth CCG by South London CSU.


The objectives of this business area are set out within the CCG’s Communications and Engagement Strategy and are intended to support ongoing engagement of the CCG with member practices, Lambeth citizens and other key stakeholders. Specific communications and engagement objectives for the CCG as a whole are to:

1. Build public and stakeholder confidence in the CCG and its leadership 2. Meaningfully engage with patients, carers and communities to ensure their systematic

involvement in the commissioning of health services for local people 3. Encourage strong clinical engagement from constituent practices and wider local

professional groups to ensure that clinical insights have a tangible impact and add value to the commissioning process

4. Make sure we have open and transparent governance and leadership in our CCG 5. Promote equality and provide evidence for the Equality Delivery System for protected

groups through our work and publication of equality objectives


Website:

Support strategic use of the We completed a major piece of work to re-structure the site and refresh the content of

all three platforms. A number of CCG staff have now been trained to upload content to

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public facing website, practice portal and staff intranet - ongoing

Maintain the CCG website site as required - ongoing

Continue to review the site and opportunities to develop it to support CCG objectives - ongoing

Work with CCG leads to develop new content on a project basis and ensure that content is regularly reviewed and kept up to date - ongoing

the sites. We also supported the primary care team in developing the GP app.

Website statistics:

April: number of visits to the website and portal - 4,516 number of unique visitors - 1,827

May: number of visits to the website and portal - 4,554 number of unique visitors - 1,829

June: number of visits to the website and portal - 5,129 number of unique visitors - 2,008

Stakeholders:

Provide support for face-to-face and written briefings for MPs and councilors - ongoing

Continue regular communications via the stakeholder bulletin - ongoing

Through the CSU communications and digital teams we are in the final stages of developing a new web-based tool that will make it easier to produce e-bulletins. The next bulletin is currently being prepared.

Media:

Ensure the CCG provides timely responses to media enquiries and advise on handling of enquiries -

This continues as part of day-to-day work: We provided communications support for eight issues including a serious incident and including responding to media enquiries, planning media lines and advice on handling.

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ongoing

Draft monthly Dr. Know column - ongoing

Social media:

Encourage individual projects to consider use of and include plans for effective use of Twitter and other social media as tools for directing followers to the website for more information and distributing key messages - ongoing

Continue to promote monthly campaigns using Twitter to direct traffic to the CCG website - ongoing

The monthly promotions work is significant in raising the profile of the CCG on Twitter and directing people to the CCG website. The CCG Twitter account currently has 5,816 followers and we tweet an average of three times a day as well as monitoring and responding to tweets.

Publications:

Support the CCG to meet its pledge to use easy to understand language in everything we write - ongoing

Produce a fortnightly staff bulletin that reinforces the CCG’s goals and desired ways of working - ongoing

We continue to offer advice and support to CCG staff for example when producing literature, documents and website content. There is always more to do to make our communications clearer and we will continue to review how we can do better.

Campaigns:

Develop monthly news Each month, we refresh the monthly promotions content on the website. We produced

news articles, web banners and tweet campaigns on the following:

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articles and web banners as part of monthly promotions campaigns - ongoing

Support planning and delivery of wider CSU-led campaigns such as winter and summer - ongoing

CCG anniversary

Bowel cancer awareness

Lung cancer awareness

Dementia awareness

Dying matters

Mental health awareness

Sickle Cell awareness

Hepatitis awareness

Strategic communications:

Support the development of systematic and strategic communications across the CCG’s five programmes – ongoing

Ensure plans are developed jointly with partner organisations where relevant - ongoing

Support programmes to deliver communications, prioritising as necessary - ongoing

We have made progress in this area. The primary care development programme has developed a communications plan and two projects within this programme are actively planning their communications. There is still work to do to develop plans for the other programmes. The communications leads of partner organisations in Lambeth and Southwark have started to work together to improve communications about the SLIC programme and to plan for campaigns such as flu and winter.

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7.7 Estates

Responsible Director Christine Caton, Chief Finance Officer


Programme Lead Therese Fletcher, AD Primary & Community Care

Scope of business area This business area is responsible for ensuring maximum use of the CCG commissioned estate across Lambeth.


The purpose of the Estates enabling work stream is to make sure that we are getting value for money from the estate we commission and that this estate supports the delivery of effective and high quality new models of healthcare provision.


Work with NHS Property Services and NHS England on assessing need for GP estates developments – ongoing

CCG working with NHSPS to confirm schedule of 2014/15 property charges and take action to reduce existing void spaces and maximise all commissioned space.

West Norwood Health and Leisure Centre: Practical Completion date was achieved on 24th June 2014. Primary Care care services (Knights HIll Surgery) became operational during August

2014

Community Services and KCL Dental School are on site from September 2014. Key Performance Indicators have been developed to ensure maximum impact on

benefits realisation of the centre

18 volunteers have been recruited to support implementation of the KPIs

Integration Manager has been appointed to achieve the benefits of integration across Health and Leisure at the West Norwood Health and Leisure Centre

Referral Pathways between Health and Leisure are currently being developed

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Implementation of operational plan underway GP Suite 2 procurement strategy is currently being discussed with NHSE Community engagement plan has been developed in partnership across all

stakeholders

Nine Elms and Vauxhall (NEV)

Joint Project Manager has been appointed to support Wandsworth and Lambeth CCGs with the NEV Project

Programme Board has been set up and Terms of Reference agreed

Strategic Outline Case (SOC) shared with the Governing Body Members in March 2014. Concerns were raised based on some assumptions made including GP Capacity, Community Capacity and Urgent Care provision and a formal response was sent from the Governing Body to the NEV Project Senior Responsible Officer at NHS England to consider.

To monitor, review and oversee the delivery of the Action Plan of the Sustainable Development Management Plan – ongoing

CCG new ways of working involves productivity improvements that promote sustainable working practice (e.g – SBS invoicing system)

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7.8 Workforce



Programme Lead Carol Yorrick , HR Business Partner, South London CSU

Scope of business area To purpose of this business area is to ensure the provision of an effective Human Resource service to staff and managers across the organisation.



Ensure that Managers and Staff across the CCG have access to up to date advice and support on all matters relating to the recruitment, management and development of staff within the CCG.

Our Human Resources services are provided by South Commissioning Support Unit and we have a named Business Partner, Carol Yorrick who is on site two days a week providing support to managers and staff within the CCG. Our payroll and pensions service is provided through PCS, an outsourced provider.

Our workforce profile is as follows:

Established posts

Established posts (wte)

In post headcount (excl NEDs)

In post wte

56 51.3 51 46.3

In terms of staff turnover, in the past month we have had one new starter.

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Current recruitment activity is set out below:

Job Title Department Pay

Band Job Type Interview

Date

Content Project Co-ordinator

Primary Care Development 6 Permanent 19/08/2014

Director of Primary Care Development Primary Care 9 Permanent Appointed

Primary Care Pharmacist Medicines Optimisation 7 Permanent 10/09/2014

Senior Business Administrator

Governance and Development 5 Fixed term Advertising

Locality Care Network Manager

Primary Care Development 8a Permanent 04/09/2014

We currently have three employees on maternity leave, one who is due to return to work over the next few months and one employee on a secondment; this is due to expire in November 2014.

There are currently no live employee relations cases. In terms of sickness absence there are currently two staff members on long term sickness. The absence is being managed by their line manager with support from HR, in conjunction with occupational health. Sickness absence will continue to be monitored to identify any trends and changes, and to determine whether any further action is required.

The Developing and Supporting Staff group continues to meet and this month will be focussing on next steps following the CCG awaytime held in early August. In addition the group will focus on the development of a suite of new employment policies over the next few months. The Governance and Development team have offered to meet all programmes to determine their requirements for the corporate enablers including workforce, PMO, OD, engagement, equalities and admin support.

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8.1 Provider Quality Report

The Q1 2014/15 Provider Quality Report provides information on key quality issues and action plans, patient experience, patient engagement issues – specific to Lambeth CCG, quality alerts and clinical visits and audits pertaining to our main healthcare providers. This can be found via the following link: http://www.lambethccg.nhs.uk/news-and-publications/meeting- papers/governing-

body/Pages/default.aspx

8.2 PALS and Complaints

Twelve PALS enquiries and 10 complaints were received during July 2014. Compared to the figures for July 2013, there is a 30% increase in the number of complaints recorded and a 25% decrease in the number of PALS cases recorded. All complaints within Q1 (n=9) were responded to within 25 working days. For July seven complaints have been closed and the three that remain open are still within the 25 working day timescale.

Month PALS Complaint Grand Total

April 13 2 15

May 9 5 14

June 10 2 12

July 12 10 22

Grand Total 44 19 63

Of the 10 complaints received in July 2014 only three were related to the CCG. Half the complaints were raised by MPs on behalf of constituents. All were acknowledged within two working days of receipt. There were no Ombudsman cases. Most complaints continue to be received via email or letter and most PALS queries are raised by telephone.

SECTION 3 Quality Assurance

http://www.lambethccg.nhs.uk/news-and-publications/meeting-%20%20papers/governing-body/Pages/default.aspx

http://www.lambethccg.nhs.uk/news-and-publications/meeting-%20%20papers/governing-body/Pages/default.aspx

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The three CCG complaints related to commissioning decisions and assessment/ eligibility concerns. The other seven complaints related to GPs, Mental Health Trust, Acute Trust, various services and dental. Over the past four months only four of the 19 complaints have specifically related to CCG services and nine of the 44 PALs.

Themes

July 2014 Complaint and PALs themes

4

1 1 1

2

1 1 1

2

3

1 1

3

00.5

11.5

22.5

33.5

44.5

PALS

Complaint

The most common themes for complaints recorded in July 2014 were ‘Treatment’ and ‘Assessment/Eligibility’. The most common theme for PALS cases recorded in July 2014 was ‘Access’.

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Complaint Themes: April – July 2014

PALs Themes: April – July 2014

0

2

4

6

8

10

12

Apr-14 May-14 Jun-14 Jul-14

Assessment /EligibilityCommunication

CommissioningDecisionsAccess

Treatment

0

2

4

6

8

10

12

14

Apr-14 May-14 Jun-14 Jul-14

OtherPrescribing / MedicationsEstates / FacilitiesComplaint handlingTransportPolicy & ProcessReferralsCase updateContact informationAssessment / EligibilityCommunicationCommissioning DecisionsAccessTreatment

Over the last four months ‘access issues’ continue to be the commonest issue raised followed closely by treatment issues. Access issues relate specifically to GP appointments, acute and community services and access to a specialist mental health clinic. Treatment issues concerned the delivery of GP care and involved the CCG being copied into a complaint sent to the NHS Health service Ombudsman about various NHS services (GPs and hospitals). The complainant was thanked for including the CCG in the correspondence.

Over the last four months ‘access issues’ continue to be the commonest issue raised. This is similar to complaint themes.

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8.3 Serious Incidents The definition used both nationally and in the recent NHS SEL Serious Incident Reporting Policy and Procedure for serious incidents is: ‘out of the ordinary and unexpected incidents or events resulting in:

i. Unexpected or avoidable death of one or more patients, staff, visitors or members of the public; ii. Serious harm where the outcome requires life-saving intervention, permanent harm or shortens life expectancy or results in

prolonged pain or psychological harm; iii. A serious risk to the organisation’s operations and its ability to provide care or service; iv. Allegations of abuse; v. Adverse media coverage or public concerns about the organisation or wider NHS; vi. One of the core set of ‘Never Events’.

It should be noted that when viewing Serious Incident data that evidence suggests that high reporting organisations are high performing organisations. The National Patient Safety Agency noted that, 'Consistently high reporting levels tend to be a mark of high reliability organisations. Research shows that organisations with high and consistent levels of incident reports are more likely to demonstrate other features of a stronger safety culture such as high NHS Litigation Authority ratings’ (Nov 2009). Incidents Requiring Investigation In Q1, 2014/15 a total of 77 Serious Incidents were reported. Of these, 10 were subsequently de-escalated. Incidents are only de-escalated if it is agreed by the CCG and provider that the incident should be reported by another provider, e.g. if a patient is admitted with a pressure ulcer that occurred at a different hospital, that hospital must then report the Serious Incident and complete the investigation. This is done to prevent any ‘double-counting’ of incidents. 22 incidents reported were closed without an investigation report required. Serious Incidents can also now be closed on STEIS by the CCG if it is agreed that a report is not required, e.g. for a pressure ulcer incident where a patient is admitted to an acute Trust and there has been no previous involvement / care package provided by community services. This is only done when confirmation has been received by the CCG that an appropriate care package has now been put in place and safeguarding referrals have been completed

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The remaining 45 incidents required an investigation, as noted by provider in the following table. Table 1: Serious Incidents Requiring Investigation Reported by Provider, Q1, 2014/15 – Lambeth residents only for KCH and SLaM, all patients for GSTFT

Provider

GSTFT KCH SLaM Other TOTAL

April 2014 19 3 2 1 25

May 2014 10 4 1 0 15

June 2014 5 0 0 0 5

TOTAL 34 7 3 1 45 NOTE: GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust

The categories of the Serious Incidents that Required an Investigation, by Provider, are as in the table below:

Table 2: Serious Incidents Reported - by Provider, by Incident Category, Q1, 2014/15 – Lambeth residents only for KCH and SLaM, all patients for GSTFT

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

StEIS Category GSTFT KCH SLaM Other TOTAL

Accident Whilst in Hospital 1 1

Child Death 1 1

Failure to Act Upon Test Results 1 1

Maternity Services - Maternal unplanned admission to ITU 1 1

Maternity Services - Intrauterine death 1 1

Pressure Ulcer Grade 3 11 1 12

Pressure Ulcer Grade 4 4 1 5

Safeguarding Vulnerable Child 1 1

Serious Incident by Inpatient (not in receipt) 1 1

Slips / Trips / Falls 12 1 13

Sub-optimal care of the deteriorating patient 1 1

Surgical Error, Wrong Site Surgery 1 1

Suspected Suicide 2 2

Unexpected Death (General) 3 3

Unexpected Death of Inpatient (in receipt) 1 1

TOTALS 34 7 3 1 45

ProviderThe pressure ulcers highlighted in the table are total numbers and not just attributable cases to the provider noted. The number of pressure ulcers reported that required an investigation report for GSTFT for Q1 was the same as for the previous Q4. There were 18 in Q2 2013/14 and 15 in Q1 2013/14.

Queries have been raised by the CCG via the GSTFT Clinical Quality Review Group (CQRG) regarding possible under-reporting of patient falls Serious Incidents, that have resulted in a serious or permanent injury. Work is ongoing to ensure that all incidents that should have been reported are reported and investigated.

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Never Events

Definition: ‘serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented by healthcare providers’.

There was one Never Event reported in Q1, 2014/15. It was a ‘Surgical Error, Wrong Site Surgery’ incident reported by GSTFT, that occurred on 1 May 2014. A patient was having a tooth extraction (upper left molar) with intravenous sedation. Prior to the extraction, the tooth was correctly identified, the site confirmed and the correct equipment selected for the procedure. The wrong tooth was extracted (upper right molar). The incident is being investigated. All serious incident issues reported are followed up at ongoing provider Serious Incident Monitoring meetings for each provider. These meetings are chaired by a Clinical Commissioner or the CCG Clinical Quality Lead and include a review of current reported serious incidents and signed-off once there is assurance about the implementation of action plans. The process for review and closure of Grade 2 Serious Incidents and Never Events has been reviewed and the Terms of Reference for the Serious Incident review group amended to include input from NHS England in this process.

8.4 Quality Alerts The latest QUIC report for the period March to May 2014 was presented to the July CQRG meeting for GSTT. A Trust response to QUIC issues during Q1 2014/15 will be discussed at the August CQRG for Guys and St Thomas’ NHS Foundation Trust. A link to the July report is: http://www.lambethccg.nhs.uk/Practice-Portal/resources/quic/Documents/QUIC%20report%20March%20to%20May%202014%20FINAL.pdf

8.5 Freedom of Information (FOI)

There were 66 FOI requests received for Q1 2014/15 with 100% responded to within the 20 working day standard. Under the FOI Act 2000, a public authority may refuse to comply with a request if it falls under information which the Act classifies as exempt. There were no requests where information was withheld from applicants this quarter. Of the 66 requests received, 60 of these were round robins where the same request was asked of other CCGs. The following table lists NHS Lambeth CCG specific requests

http://www.lambethccg.nhs.uk/Practice-Portal/resources/quic/Documents/QUIC%20report%20March%20to%20May%202014%20FINAL.pdf

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Subject of Request Type of Applicant making the request

GP practice IT Systems Media

Structure Charts Individual (x 2) Commercial organisation (x 1)

Mental health commissioning Individual

Children’s Wheelchairs Individual

Main subjects of FOI requests by subject Number of requests

Services commissioned 21

CCG Board/ structure information 10

Finance information 9

Primary care information 7

Prescribing formularies/Medicines Management information 6

Mental health information 5

Corporate information 3

Commercial organisations and the media make up 51% of requests followed by individuals (33%). The information Commissioner has not informed South London Commissioning Support Unit that any decisions to exempt or withhold information from applicants made to NHS Lambeth CCG have been referred to his office.