newham ccg board part i · • 146- patient story and bhc review implications - completed. • 147-...

Newham CCG Board Part I

Meeting 8th February 2017 1.30pm – 3.20pm Committee Rooms Newham CCG 4th Floor Unex Tower, 5 Station Street, London E15 1DA

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ACRONYM MEANINGAC Audit CommitteeACC Acute Commissioning CommitteeA&E Accident & Emergency

APMS Alternative Provider Medical Services (a type of Primary care contract)AQP Any qualified providerBDG Board Development GroupBart's / BHT Barts Health NHS TrustBAF Board Assurance FrameworkBMA British Medical Association BCP Business Continuity PlanC&MCC Children & Maternity Commissioning CommitteeCCC Community Commissioning CommitteeCQC Care Quality CommissionCAG Clinical Academic group CCG Clinical Commissioning GroupCQRM Clinical Quality Review MeetingCQUINs Commissioning for Quality and Innovation (Payment Framework)CSU Commissioning Support Unit CHN Community Health Newham DirectorateCHS Community Health SystemsCPD Continuing Professional Development CCU Critical Care UnitDTOC Delayed Transfers of CareDoH Department of HealthDRSS Diabetes Retinopathy Screening ServiceDES Direct Enhanced ServiceDASL Drug and Alcohol Service in LondonELFT East London Foundation Trust

EMIS web Egton Medical Information Systems (System that records patient consults)

EPR Electronic Patient RecordEPCS Extended Primary Care ServiceEPCT Extended Primary Care TeamFOI Freedom of InformationGMC General Medical Council GMS General Medical Services (a type of Primary care contract)GP General PractitionerHoT Heads of Terms (Contract Summary)HWT HealthwatchICC Integrated Care CommitteeIMT Information Management and TechnologyIMCA Independent Mental Capacity AdvocateIG Information GovernanceITU Intensive Therapy Unit

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ITT Invitation to TenderKPI Key Performance IndicatorLD Learning DisabilityLD SAF Learning Disability Self-Assessment FrameworkLAP Local Area Partnership LAs Local AuthoritiesLCFS Local Counter Fraud SpecialistLES Local enhanced serviceLMC Local Medical Committee LAS London Ambulance ServiceLBN London Borough of NewhamMM Medicines Management MHCC Mental Health Commissioning CommitteeMPIG Minimum Practice Income GuaranteeNICE National Institute of Health and Care ExcellenceNUH Newham University HospitalNHSE NHS England NELCSU North East London Commissioning Support Unit NCCG Newham Clinical Commissioning GroupOOH Out of hoursPC Procurement CommitteePC Practice CouncilPCCC Primary Care Commissioning CommitteePALS Patient Advice and Liaison ServicePPE Patient and Public EngagementPPG Patient and Public GroupPREM Patient Reported Experience MeasurePROM Patient Reported Outcome MeasuresPMS Personal Medical Services (a type of Primary care contract)PCT Primary Care TrustsPHE Public Health EnglandQC Quality CommitteeQOF Quality Outcome Framework (Assessor Validation Reports)QIPP Quality, Innovation, Productivity and PreventionRAID Rapid Assessment Interface DischargeRAG Red, Amber, GreenRC Remuneration CommitteeRTT Referral to Treatment R&D Research & DevelopmentRLH Royal London HospitalSPR Service Program ReviewSPA Single Point of AccessTOR Terms of referenceTIC Transformation and Innovation Committee TDA Trust Development AuthorityTSCL Transforming Services Changing LivesTST Transforming Services TogetherUCWG Urgent Care Working GroupUCC Urgent Care CentreUCC Urgent Care Centre

WELC Waltham Forest, East London and City (Integrated Care Programme)

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Whipps X / WX Whipps Cross HospitalWTE Whole Time Equivalent

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Newham Clinical Commissioning Group Board Meeting Part I

Wednesday 8th February 2017 1:30pm – 3:20pm

Committee Rooms, 4th Floor Unex Tower 5 Station Street, Stratford E15 1DA

No. Time Item Page Author

1. Administration & Updates

1.1 1.30 – 1.45pm

Welcome, Introductions, Apologies and Declarations of Interest Verbal Chair

1.2 1.30 – 1.45pm

Minutes of the Part I meeting 14th December 2016 Chair

1.3 1.30 – 1.45pm

Part I Action Log Chair

1.4 1.30 – 1.45pm

Chair’s Actions Chair

1.5 1.45 – 2.00pm

Chief Officer’s Report S Gilvin

2. Patient & Public Engagement

2.1 2.00 – 2.10pm

Questions Verbal Chair

3. Strategic Items for Approval

3.1 2.10 – 2.30pm

Board Assurance Framework S Sanghera

3.2 2.30 – 2.45pm

Quality Report C Vyas

3.3 2.45 – 2.55pm

Finance & QIPP Report C Whitton

3.4 2.55 – 3.10pm

Constitutional change – recommendations of the Governance Working Group

S Sanghera

3.5 3.10 – 3.20pm

Governance – Conflicts of Interest / Gifts, Hospitality and Anti-Fraud and Bribery / Sponsorship Policies

S Sanghera

5. 2017-18 meetings schedule – to be advised

Date of next meeting – 12th April 2017

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14

15

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7485

89

Verbal

Statement of advice on declaring interests at NCCG meetings

Guidance • All attendees are asked to declare any interest they have in any agenda item before it is discussed or as soon

as it becomes apparent be that before or at the meeting. If during the course of a meeting an interest not previously declared is identified, this must be declared at that time.

• The record of a declared interest is the interest declared verbally at the meeting. An attendee cannot referto interests already declared on the register of interests or an interest already declared at a previous meeting. There is no such thing as an “ongoing” interest.

• The minutes of the meeting will detail all declarations made and any relevant responses and/or action taken.

Direct Financial Interest • If you have a direct financial interest in any matter on the agenda you must not participate in any discussion

or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter.

Indirect Financial Interest • You are required to make a verbal declaration of the existence and nature of any Indirect Financial Interest.

Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct.

Other Interest • You are required to declare an interest where a decision in relation to the business of the meeting might

reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members.

If in doubt you should assume that a potential conflict of interest exists.

Action upon declaration of an interest at a meeting • For direct financial interests you must leave the meeting for that item• For indirect financial interests and for other interests the action required will vary dependent upon the

interpretation of the extent and influence of the interest and may involve;o leaving the meeting,o remaining at the meeting and not voting or speaking,o remaining at the meeting and both speaking and voting

Chairs ruling • For the avoidance of doubt the Chairs decision on a declaration of interest and its management is final

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Item 1.2

Newham Clinical Commissioning Group (NCCG)

Minutes of the Part I meeting of the Board held on Wednesday 14th December 2016, 13.30pm- 16.30pm

Committee Rooms Unex Tower Stratford Present: Elected Voting Members Dr Prakash Chandra Chair Elected GP Representative Newham CCG Dr Stuart Sutton Deputy Chair Elected GP Representative Newham CCG Dr Muhammad Naqvi Joint Deputy Chair Elected GP Representative Newham

CCG Dr Ambady Gopinathan Elected GP Representative Newham CCG Dr Rima Vaid Elected GP Representative Newham CCG Dr Bapu Sathyajith Elected GP Representative Newham CCG Appointed Voting Members Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement

Newham CCG Andrea Lippett Lay Member Remuneration Newham CCG Fiona Smith Registered Nurse NCCG Hazel Trotter Practice Manager Representative Newham CCG Steve Gilvin Chief Officer Newham CCG Chad Whitton Chief Finance Officer Newham CCG Grainne Siggins Director of Adult Social Services LBN Newham CCG Appointed Non-Voting Members: Michael Rich Healthwatch Member Dr Ashwin Shah Co-opted Member Newham CCG In attendance: Selina Douglas Deputy Chief Officer Newham CCG Chetan Vyas Director of Quality & Development Newham CCG Satbinder Sanghera Director of Partnerships and Governance Newham CCG Mike Sims Board Secretary Newham CCG Dr Angela Wong Cancer Clinical Lead BHT Natalie Mizen Director of RTT Performance and Improvement Dee Parker Head of Performance Acute MDT WEL CCGs

1 Administration and Updates 1.1 Welcome, Introduction, Apologies for Absence & Declarations of Interest

1.1.1 1.1.2

The Chair welcomed all to the meeting. Apologies were given for:

• Dr Clare Davison Elected GP Representative Newham CCG

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1.1.3

• Rizwan Hasan Secondary Care Consultant Newham CCG • Meradin Peachey Director of Public Health LBN Newham CCG

There were no declarations of interest.

1.2 Minutes of the Part I meeting 12th October 2016

The minutes were approved as an accurate record of the meeting

1.3 Part I Action Log

1.3.1

• 144- Accountable Care System Board training has been planned -

completed. • 146- Patient story and BHC review implications - completed. • 147- Domestic Abuse training in Primary Care- planned - completed. • 148- Increase in children’s attendance at A&E; awaiting QTR 2 and 3 data-

outstanding. • 149- BAF changes- completed. • 150- Adult community DNA rate benchmarking- completed.

1.4 Chairs Actions

1.4.1 1.4.2 1.4.3 1.4.4

There were no actions to report. The Chair gave condolences on the recent passing of Sir Robert Dolan, ELFT, and John Lock, SLGC. The Chair asked Board Members to improve on attendance at Board Development session which had recently slipped. The Chair reminded officers that Board Reports must be issued in a timely manner.

1.5 Chief Officer’s Report

1.5.1 1.5.2

S Gilvin introduced a report for information updating the Board on: • Progress on the Contracting Round for 2017-19 • Revision of the Newham CCG Operating Plan for 2017-19 • GP Five Year Forward View • TST Programme • CQC Inspection of Newham University Hospital The Board raised the following issues; • GP Five Year Forward View- whether the £170,000 had been allocated was a total sum to cover the Vulnerable Practice Programme, the Practice Resilience Scheme and the Practice Development Programme. S Gilvin confirmed that this was the case. • That in terms of the contracting round with BHT there was clearly a significant risk to the existing proposed financial envelope if any arbitration process had to be invoked meaning savings would be required elsewhere. The Report was noted

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2 Patient and Public Engagement 2.1

2.1.1

Questions There were no questions to the Board from members of the public.

3 Strategic Items for Approval 3.1

3.1.1 3.1.2 3.1.3

London Health and Care Devolution

S Gilvin introduced a report for decision asking the Board to; 1. Note progress and the timescales to the next Devolution agreement for London, building on the commitments and priorities agreed in December 2015. 2. Review and provide any comments on the current proposals as they support specific Devolution Pilot requests and enable the potential to devolve certain powers across London partners, including CCGs. 3. Support the development of the final Devolution agreement(s) and delegate authority to a named individual (i.e. Newham CCG Chair) to agree and sign the agreement on behalf of the CCG. S Gilvin clarified that; • The report was being considered by all London CCGs in November and December. • The proposal was based upon a tripartite agreement between Local Authorities, Councils and the Mayor of London Office. • That the proposed memorandum of understanding (MOU) would not contain any governance authorities devolving existing powers. • That in terms of clear specific local impacts for Newham the proposal would have positive implications for estates and the prevention agenda by way of licensing powers. The Board requested that a commitment be sought to include, within the principles, a commitment to sustainable development that was linked to population growth. The Board agreed; To support the development of a final Devolution Agreement and delegate authority to the Chair to sign the final agreement on behalf of the CCG.

3.2 3.2.1 3.2.2

North East London Sustainability & Transformation Plan (NEL STP) S Gilvin introduced a report for information asking the Board to note and comment on a revised STP summary, an updated narrative and the updated eight delivery plans. The Board made the following comments; • That the STP Board should consider the development of a single statement

on consultation rather than different boroughs; commissioners or providers developing their own in isolation.

• That a lack of clarity still seemed to remain in relation to where decision or reports were being endorsed as opposed to approved.

• That STP signalled a shared responsibly for local health economies, moving away from traditional clear divisions between commissioners and providers, and that the CCG should be mindful of this in its overall commissioning approach going forward.

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3.2.3

• That the plan I would still benefit from a little more commentary on links to the Prevention agenda.

• That there remained some concern on the level of resources being set aside for public consultation.

The Board noted that a further report would be received in February. The Report was noted

3.3 3.3.1 3.3.2 3.3.4

Operating Plan Submission 2017-19 S Douglas introduced a report for discussion asking the Board to delegate authority for the final submission of the Operating Plan to the Chair of the Board and Chief Officer. S Gilvin advised that; • The CCG was still awaiting NHSE feedback on the first draft submission returned 24 November 2016. • The risk area for the CCG on constitutional standards were on achieving targets relating to first outpatient appointments by e- referrals and the provision of wheelchairs to children. • The risk areas for the CCG on achieving the 9 ‘Must Do’s’ were on A&E waiting times and Referral to Treatment Time (RTT) standard. The Board noted that; • Work was already underway with ELFT on ensuring compliance with the wheelchair target. • The new eating disorder services was designed to align with the required target times. The Board agreed; • To delegate authority for the final Operating Plan submission on 23 December 2016 to the Chair and Chief Officer

3.4 3.4.1 3.4.2

Governing Body Structure and Constitutional change S Sanghera introduced a report for decision asking the Board to; • Agree new terms of reference for Executive, Remuneration and Quality/ Performance/Finance Committees. • Delegate the Executive Committee to approve the terms of reference for the Commissioning Committee. Adults and Children Integrated Health and Care Boards and Better Care Fund Delivery Groups. • Agree other constitutional changes. S Sanghera clarified that; • In terms of the election process the proposal was to publish a list of eligible voters six months prior to election but produce a ‘fixed list’ three months before it took place. • That two further areas still required the Constitution Working Groups’ review; the methodology for rotation of retirement as well as maximum terms of office and the overall numbers and roll of Clinical Leads. • The Medicines Management Committee had dual reporting lines; to the Executive Committee in terms of delivery and the QPF Committee in terms of

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3.4.3

assurance. The Board made the following comments; • That the proposed changes now formalised within the structure relating to partnership working were welcomed. • That the current Executive Remuneration and Quality Committees should be permitted to make any final comments on the terms of reference proposed. The Board noted that a further report on outstanding items would therefore need consideration in the New Year. The Board agreed; • The recommendation for a revised Governing Body Structure. • The terms of reference for the Executive Remuneration and QPF Committees, delegating any final changes to those Committees. • To delegate authority to the Executive Committee to approve the terms of reference for the Commissioning Committee, Adults and Children Integrated Health and Care Boards and Better Care Fund Delivery Group. • The recommended Constitutional revisions

3.5 3.5.1 3.5.2

Newham CCG Board Assurance Framework (BAF). S Sanghera introduced a report for decision asking the Board to approve the current Risk Rating for the BAF, specifically asking the Board to review risks that had missed their actions/mitigation dates and or were currently rated as high risk;

• NHS Constitution Standards • Primary Care GP Federation • MSK, Children, Adults and Urgent Care Centre commissioning • Mental Health • Urgent Care

The Board made the following observations; • That the next version of the BAF and report should detail where risks are increasing or not improving, how and where that might impact upon other risks. (Action CCG151: S Sanghera) • That the BAF will require re mapping in relation to the revised governance structure. (Action CCG151: S Sanghera) • That the BAF should also indicate what the end of year projected rating is thought to be as well as current and target ratings. (Action CCG151: S Sanghera) • That the Board should hold a development session that would revisit its risk appetite position since this was currently not defined. (Action CCG152: C Vyas) The Board agreed; The current Risk Rating for the BAF

3.6

3.6.1

Finance & Qipp Report C Whitton introduced a report for decision asking the Board to approve the CCG month 7 financial report and position.

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3.6.2

C Whitton advised that; At Month 7 the CCG total resource allocation was £481,002,000 with planned expenditure, including reserves of £474,502,000 generating a surplus of £6,500,000 (1.5%). And the projected QIPP delivery was currently on track. The Board agreed; The Month 7 Finance Report

3.7 3.7.1 3.7.2 3.7.3 3.7.4

Quality Report S Sutton introduced a report for decision asking Board to approve the actions taken by Newham CCG or CSU on behalf of Newham CCG in relation to the Red and Amber RAG rated Quality Indicators reported on an exception basis and approve the assurances provided in relation to the other Quality matters. S Sutton reported the following as key underperforming areas for three main providers although referred to other provider indicators in the report as well; Barts Health Red rated areas • 17 Mixed Sex Accommodation breaches reported across Barts Health with 0 (zero) reported for Newham site • 33% of Amber Alerts were actioned within 10 working days and the report outlines the work being undertaken with the Trust • MRSA – rated as Red due to the zero tolerance approach adopted nationally on this, 4 case reported September none on the Newham site • Friends and Family Test A&E response rate is at 1.7% and the report outlining the actions taken by the Trust and CCG East London Foundation Trust – Mental Health Red rated areas • None reported East London Foundation Trust – Community Health Red rated areas • Safeguarding Children compliance Level 1 at 66% below the 85% target

S Gilvin clarified that CQC inspection results for Royal London and Whipps Cross Hospitals would be published on 15th December 2016 and that Newham University Hospital’s was expected to be published at the end of January. The Board requested that some form of benchmarking analysis against other CCGs for CQC inspection of GP Practices be made available if possible. (Action C Vyas) The Report was noted

3.8

3.8.1 3.8.2

Board Performance Framework including RTT deep dive S Douglas introduced a report for monitoring asking the Board to discuss the performance of providers in relation to a range of indicators contained with the report. The Board also received a presentation on BHTs Clinical Harm Review Process, including all 52 week breach patients from Dr A Wong and N Mizen.

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3.8.3 3.8.4

The Board commented that the system implemented by DR A Wong was clearly clinically robust as well as noting that BHT consultants were increasingly taking responsibility for the management of their own waiting lists. The Board noted it remained BHTs intention to introduce the Cerner Millennium Upgrade on the NUH site in 2017 which may present a potential risk to patient care and the CCG will discuss with BHT the risk management of this process. The Report was noted

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ITEM 1.3 - highlighed items represent a recommendation to remove from register

Action reference

Meeting date

Minute reference Action Owner Update

CCG148 12/10/20163.1.3

Report back on findings on why there has been a significant increase in children's attendance at A&E

S Sanghera Full data now received since last reported on in December and is under analysis

CCG151 14/12/2016

3.5.2

BAF and report to detail where risks are increasing or not improving, how and where that might impact upon other risks, remapping in relation to the revised governance structure and indicate what the end of year projected rating is thought to be as well as current and target ratings

S Sanghera

BAF cover report being revised to include:

- heatmap to demonstrate risk priorities- where risks are increasing/decreasing and the reason- end of year projection as well as current and orginal targets- BAF risks mapped against our strategic objectives to highlight some potential risk links and interdependencies.- BAF risks mapped against our revised governance structure ahead of a proposed 1 March 2017 go live date

CCG152 14/12/2016 3.5.2 Hold a development session that would revisit its risk appetite position C Vyas Planned for April 2017

Newhan CCG Board Action Log Part I - 8/2/17

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Board

8th February 2017

Title: Chief Officer’s Report

Agenda item: 1.5

Author: Steve Gilvin Chief Officer Newham CCG

Presented by: Steve Gilvin Chief Officer Newham CCG

Contact for further information:

Steve Gilvin Chief Officer Newham CCG

Date paper finalised: 1st February 2017

Action requested: Note the report

Executive summary: The report provides an update on work undertaken by the CCG team since the last Board meeting including:

• Progress on the Contracting Round for 2017-19 • Revision of the Newham CCG Operating Plan for 2017-19 • North East London STP • CQC Inspection of Newham University Hospital • Newham has its First CQC Rated Outstanding GP Practice • GP Five Year Forward View • Assessment of CCG’s Patient and Public Engagement • Flu Immunisation • Improving Access to Primary Care

How does this fit with Newham CCG Strategy:

The above areas of work relate to key objectives of the CCG in relation to quality and safety of commissioned services, public engagement, primary care development, and improving outcomes for our population.

Where has the paper been already presented?

N/A

Impact on risk: Key risks relating to these areas of work are contained within the Board Assurance Framework.

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Item 1.5

Newham CCG Board Meeting: 1st February 2017 Chief Officer Report

1. Progress on the Contracting Round for 2017-19

The CCG was able to meet the NHS England planning guidance requirement to agree two year contracts with our key NHS providers, covering the financial years 2017-18 and 2018-19 by 23rd December 2016. Contracts were successfully negotiated and agreed with Barts Health NHS Trust and East London Foundation NHS Trust for both mental health and community health services. The contracting round this year was undertaken in the context of the North East London Sustainability and Transformation Plan and the aim of achieving financial sustainability for all NHS providers in the STP footprint. Each contract was agreed with a number of assumptions regarding the levels of commissioner QIPP and provider CIPs. A mechanism has been agreed through the STP to jointly review these plans during February and March to provide mutual assurance around the levels of finance and activity that will flow through those contracts so that commissioner and provider positions are aligned.

2. Revision of the Newham CCG Operating Plan for 2017-19

The CCG submitted an updated Operating Plan on 23rd December 2016 in line with national guidance. The operating plan set out how the CCG will meet all of the 9 national must-dos: • Implement STPs to ensure the system is on track for full achievement by 2020-21 • Deliver financial control totals both at CCG and STP level • Ensure the sustainability of General Practice by implementing the General Practice

Forward View • Deliver the 4-hours A & E standard • Deliver the NHS constitution 18 week referral to treatment time standard • Improve cancer services including delivery of 62 day standard for beginnings treatment

and improving early diagnosis and one year survival rates • Deliver the Mental Health Five Year Forward View including standards in relation to

IAPT, dementia and treatment for psychosis • Improve outcomes for people with Learning Disabilities including the Transforming Care

programme • Improve quality in all NHS organisation particularly those in special measures

The CCG’s operating plan is compliant with delivering these programmes with the exception of the two national standards that Barts Health NHS Trust are currently not meeting – i.e. A & E waiting time standard which the Trust is failing due to the performance on the RLH and Whipps sites and Referral to Treatment Time standard where the Trust is not currently reporting due to data quality issues. The CCG agreed with the Trust a plan to move to return to reporting against the 18 week standard during Quarter 3 of 2017-18.

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3. North East London Sustainability and Transformation Plan

The North East London (NEL) STP developed a more detailed submission which was made on 21st October 2016. This version of the plan has now been published on the STP website along with a summary document. The STP is an umbrella plan which is based on delivery of the Transforming Services Together programme that the CCG has committed to delivering and our local Borough based plan. The emphasis has now switched to engagement with stakeholders on the content of the STP and delivery of the key components of the plan. A more detailed engagement plan is being developed. Newham CCG has begun local discussions in the Borough with partner agencies and will utilise our patient and public engagement platforms to engage on the plan. Further work is focused on the key themes in the plan including development of the transformation programmes based on the two devolution pilots and the Transforming Services Together programme, a North East London approach to delivery of the GP Five Year Forward View, and providers working together to improve productivity. There has also been work on the governance arrangements and a Memorandum of Understanding is currently being redrafted after partner organisations have been consulted. This will set out the arrangements for oversight of the programme.

. 4. CQC Re-inspection of Newham University Hospital

The CQC undertook a reinspection of the Newham University Hospital site in November 2016. The CQC report on the visit is expected in March 2017. The reports on the reinspections of the Royal London Hospital and Whipps Cross Hospital sites were published in January 2017. The Royal London rating has moved to a Requires Improvement rating from an Inadequate and whilst Whipps Cross Hospital has still been rated inadequate there are significant improvements in the rating of the majority of domains that demonstrate significant improvement in the quality of care provided at the site compared with the original inspection. An overall rating for the Trust will be reviewed in the light of the NUH rating when it is published during March.

5. Newham has its First CQC Rated Outstanding GP Practice

The CQC have just confirmed their assessment of the Woodgrange Medical Practice and have rated the practice as Outstanding. There are very few GP practices in London that have been given this judgment by the CQC and this is only the second practice in north East London to receive this rating. This is a testament to the hard-work and dedication of all of the GP, clinical and non-clinical staff at the practice and we have sent congratulations to the practice for this achievement. The report is expected to be published on the CQC website shortly.

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6. GP Five Year Forward View

Newham CCG is currently working to ensure that the allocation received to support the practice resilience programme outlined in the GP Forward View is committed n 2016-17. The resources received included allocations under the vulnerable practice programme, the practice resilience scheme and the practice development programme and total approximately £170,000 for 2016-17. The CCG, working in partnership with Newham Health Collaborative, was successful in bidding for funding through the GP Forward View resources for 28 practices to take part in the Productive General Practice programme. The CCG has been awarded early adopter status for NHS England’s Releasing Time for Care programme. This programme is designed to help practices release time for both clinical and non-clinical staff through a range of proven interventions to help release time for clinical work. Each practice will receive six hands-on sessions in practice plus four group-based learning sessions. This is an early example of how collaborative working between the CCG and NHC will secure support for General Practice in Newham.

7. Patient and Public Engagement

NHS England has assessed each CCG’s delivery of its statutory obligations in relation to both its collective and individual duty to involve patients and the public. Newham CCG received its assessment in January 2017 and has been rated “Good” for both its collective and individual duties. This continues Newham’s strong tradition of commitment to working with our local communities to ensure that patients and the public are involved in the planning and the delivery of health care.

8. Flu Immunisation Programme The annual flu immunisation programme runs until 31st January and the latest figures suggest that Newham GPs have again, for the third year running, achieved the best performance against the flu immunisation programme of all CCGs in London. The final figures will be known at the end of the month and will be published. The flu immunisation programme is particularly important as we come into that period of the winter when flu viruses are more prevalent and therefore the risk to health of older people and others in at risk groups is greatest. This is an important public health achievement which also impacts on the workload of primary and secondary care during flu outbreaks.

9. Access Offer As reported in December the CCG has received funding of over £500,000 from NHS England to develop extended hours access for General Practice. The CCG has invested these resources in a 6.30pm to 8pm Monday to Friday service and an 8 am to 8 pm Saturday and Sunday service across 2 hubs and this service is now live

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The service has been commissioned from Newham Health Collaborative working in partnership with the Newham GP Out of Hours Co-operative to deliver this scheme. The service is delivered from a range of sites spread evenly across the Newham footprint providing bookable appointments during the hours set out above. The expectation is that practices cover the bulk of core hours between 8 and 6.30 pm while a model of groups of practices providing appointments through a hub will cover the 6.30pm -8 pm period. This service opened from 1st December for the Monday to Friday extended hours in the evenings and the weekend service went live in January.

Steve Gilvin Chief Officer 1st February 2017

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Board 8 February 2016

Title: Newham CCG Board Assurance Framework (BAF)

Agenda item 3.1

Author: Jason Clarke, Information Governance & Risk Lead, Newham CCG Presented by: Satbinder Sanghera, Director of Partnerships & Governance Newham CCG


Satbinder Sanghera, Director of Partnerships & Governance, Newham CCG; [email protected]; 020 3688 2388

This Paper is for: Decision

Action required: The report highlights the following BAF risks that have missed their mitigation

actions / and or are currently high risk rated, for the Board to review and comment:

• NHS Constitutional standards • STP • Primary Care GP Federations • Adult Community Services and Urgent and Emergency Care re-

commissioning • Transforming Services Together – Care closer to home • Finance • Performance and activity levels of acute and non – acute provider

The report also asks the Board to note the changes to the risk scoring for the following risks:

• BAF.03, BAF.03.01, BAF.04, BAF0.4.01 and BAF.04.02

The Board is requested to note the proposed next steps identified in section 4. The Board is requested to approve the current risk ratings for the 2016/17 BAF.

Executive summary:

The Board is asked to approve the updates provided in relation to the key CCG strategic risks. The format of the report has been updated to include an indicator for each risk as to whether the risk is increasing or improving and also a projected year end rating is detailed in the narrative. These changes are in response to the discussion at the Board in December.

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mailto:[email protected]

Supporting papers: Appendix 1 – BAF Risk Review and Analysis report


Values: Accountability and responsibility


No previous presentation to any meeting.

Risk: A failure to operate a risk management system would expose the organisation to

the risk of inadequate governance arrangements and inadequate management and mitigation of the key risks that may hinder the CCG achieving its stated priorities.

Equality Impact: The CCG has a strong and unequivocal commitment to promoting equality for all

our communities. We believe that Newham CCG should be an exemplar of good practice and able to demonstrate consistently that we are innovative and at the forefront of pushing boundaries for greater equality. We think that our approach to patient and public engagement provides a blueprint for our work because our PPE work has now begun to be mainstreamed across all commissioning activity. We consider equalities to be integrally linked to quality and our PPE approach and over the next year we will be looking to how we can mainstream within quality and PPE, our equalities objectives. The CCG expects that the next stage of our PPE work will focus on a more flexible approach intrinsically linked to commissioning activities and that equalities will be central to that, likewise the work on quality processes and indicators and improvement will encompass equalities considerations. The CCG has reviewed the EDS2 (Equality Delivery System) that sets out the CCG’s Equality Objectives, undertake an equalities analysis of policies and services and set out the work that we will be undertaking with patient, stakeholders and providers. The Board has started the process to agree a revised Equalities Strategy will commit the CCG to SMART actions underlined with the approach identified above that will aim to ensure that equalities is embedded within the organisation. A key action will be to communicate to all commissioning committees their responsibility in relation to equalities impact assessments and targets and to monitor their compliance.

Following agreement of the plans and actions, the Director of Partnerships and Governance will provide a quarterly report to the Executive on progress and implementation.

Stakeholder engagement:

None.

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Financial Implications

CCG faces reputational and financial risks if risks identified in this paper are not sufficiently mitigated. Plans outlined in this paper address these issues however inherent financial risk remains.

1. Introduction and Background 1.1

Introduction The BAF is the primary mechanism by which the Board of NHS Newham CCG is appraised and updated on material risks which may affect the CCG’s ability to deliver its strategic objectives as set out in the Operating Plan.

2. Key Considerations 2.1 2.1.1 2.1.2 2.1.3 2.1.4

BAF heat map: The following heat map presents a visual projection of each BAF risk against our 5x5 risk matrix.

The above diagram highlights where key priority risks are, and the Board are asked to note the current position of each BAF risk and seek assurances that the direction of travel indicates that the risks are decreasing throughout the year. The following risks remain unchanged during 2016/17: BAF.01 Failure to meet NHS Constitutional standards – Current rating 16 (High) Management leads response: The Trust continues to fail to meet the A&E target and is not reporting against the RTT standard, whilst consistently meeting the Cancer and Diagnostic targets. The RTT standard is a major concern and the Trust are not expected to be in a position where they are able to return to reporting until the end of Q2 2017/18. The Trust has established a RTT Recovery Board where the CCG and NHS England and NHS Improvement are represented to review progress against their plan to improve data quality to be able to return to reporting and to

22

2.1.5 2.1.6 2.1.7 2.1.8 2.1.9

meet the standard. BAF.02 Failure to operationalise the STP to secure a financially sustainable balanced East London Health economy – Current rating 16 (High) Management leads response: The STP submitted in October 2016 has been agreed by the partners. The plan went to NHSE and NHSI on 21st October as originally proposed and the feedback from NHSE and NHSI has been positive to date with detailed feedback expected shortly. The MOU to support the STP governance arrangements has been drafted and is currently being consulted on with comments due by the end of January 2017. This is based on the work of the Governance sub-group. Operating plans have been agreed for 2017/19 and the STP programme are now triangulating the plans from partners. It is expected that this risk will be in position to decrease over the coming month. BAF.06 Failure to effectively integrate health & social care – Current rating 16 (High) Management leads response: The CCG is currently working jointly on the Building Healthy Communities programme with adult social care. The collaborative commissioning structure has been agreed by the Remuneration Committee. The CCG has developed a Better Care Fund Delivery Group forward plan and continues to make quarterly submissions to NHSE, which have been assured as Good. BAF.07.01 – Failure to develop a Primary Care Strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation – Primary Care – Current rating 16 (High) Management leads response: Primary Care development sessions have been held for the Board and regular reports are made to the Primary Care Commissioning Committee with progress in between reviewed by SMT. BAF.07.02 Failure to develop a Primary Care Strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation – GP Federation – Current rating 16 (High) Management leads response: The business case from the Newham Health Collaborative (NHC) was submitted and approved with conditions at the PCCC. NHC were unsuccessful in appointing a substantive Chief Executive following external recruitment exercises. Interim arrangements have been put in place to support the Federation and this includes a secondment of a senior CCG Finance team member. A package of support is currently being negotiated with NHC. BAF.08.02 Failure to deliver the stated TST benefits including quality and financial efficiency: - Care Closer to Home – Current rating 16 (High) Management leads response: TST has now been aligned with the Operating Plan and the STP. An interim internal delivery plan has been agreed whilst we await full implementation of the revised CCG resourcing structure for Commissioning.

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2.1.10 2.1.11 2.1.12

BAF.09.02 Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised – adults – Current rating 16 (High) Management leads response: Route to market for adults, children and urgent care centre is being presented to the February Board. BAF.09.03 Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised – UCC– Current rating 16 (High) Management leads response: The specification for UCC/111 is in final draft format. Preparation is in place to present to Part III Board in March/April 2017. Route to market for adults, children and urgent care centre is being presented to the February Board. BAF.09.04 Failure to transform services through re- commissioning (children, adults, UEC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised – MSK – Current rating 16 (High) Management leads response: The structured collaboration process has been agreed by the Board. Contract signing ad mobilisation scheduled for end Feb 17 with a go live date is set for 1 April 2017.

2.2 2.2.1 2.2.2

Risk direction of travel: The following risk ratings have been reduced since the last report: BAF.03 – Failure to effectively monitor performance and activity levels of acute and non-acute providers.

Reason for the change: The overall BAF risk 03 has been reduced in line with the supporting risks 03.01 and 03.02 which are both now a 12. BAF.03.01 – Failure to effectively monitor performance and activity levels of acute providers. The below image indicates the direction of travel for BAF 03.01.

Reason for the change: The implementation of the activity query notice (AQN) process has improved the robustness and accuracy of the monitoring process. This helps to inform the discussions held at the monthly SPR meetings which are chaired by the NHS Newham CCG Chief Officer. This risk is expected to achieve the year-end target risk rating of 8.

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2.2.3 2.2.4 2.2.5

BAF 04 – Failure to effectively monitor the quality of commissioned services for all healthcare providers

Reason for the change: The internal controls have been reviewed and some now fully effective as a result of the controls overtime demonstrating improvements. For example CQRMs are effective in highlighting areas of progress as well as areas for improvement. The CQRM holds providers to account and monitors progress to improve the quality of care being delivered. BAF 04.01 – Failure to effectively monitor the quality of commissioned services for Barts Health

Reason for the change: The internal controls have been reviewed and some are now regarded as fully effective as a result of the controls overtime demonstrating improvements. For example the CQRM reviews the progress made against the CQC Quality Improvement Plan and the meeting holds the provider to account on the delivery and impact of the Quality Improvement Plan for the Newham site. BAF 04.02 – Failure to effectively monitor the quality of commissioned services for East London Foundation Trust

Reason for the change: The internal controls have been reviewed and some are now regarded as fully effective as a result of the controls overtime demonstrating improvements. For example the CQRM has held the provider to account on Adults Mental Health re-admission rates, and as a result have seen improved performance in relation to the number of patients being re-admitted.

3.0 Risk alignment

3.1

The following table identifies which BAF risks are linked to each of our strategic objectives. This is a piece of work we are undertaking to ensure that the links and interdependencies between our BAF risks are appropriately identified. This will allow the Board to be assured that any associated impact of a risk increase or decrease to a BAF risk is appropriately considered by the relevant management lead:

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3.2

Strategic Objective BAF Risk

1. To ensure community health services are responsive, located at the heart of our communities and able to meet the current and future needs of the population.

BAF.04 BAF.07

2. To develop a primary care system that is modern, accessible and robust enough to care for the local population now and into the future.

BAF.03 BAF.04

3. To ensure our population can access effective, high quality urgent and emergency care in and out of hospital

BAF.03 BAF.04 BAF.05

4. To develop a strong and sustainable acute system that places the needs of the patient at the heart of its design.

BAF.04 BAF.05 BAF.08 BAF.09

5. To be central to a whole system approach working across traditional boundaries to effectively tackle health inequalities and make a positive impact on the health and social care economy of East London.

BAF.06 BAF.09

6. Staff and clinical leaders are equipped with the skills and expertise to enable the delivery of the CCG’s priorities and commissioning agenda.

BAF.11

7. To review and improve the existing governance structures to ensure they effectively support the delivery of our corporate and strategic objectives and our statutory duties.

BAF.01 BAF.02 BAF.10

The following table highlights our current BAF risks and the lead committee within the new governance structure. The lead committee will be responsible for assuring the Board that the risks are appropriately managed, the controls and actions in place are effectively monitored, managed and scrutinised.

BAF risk Lead committee

BAF 01 – Failure to meet NHS constitutional standards. Quality, Performance and

Finance Committee

BAF.02 – Failure to operationalise the STP to secure a

financially sustainable balanced East London Health

Executive Committee

26

Economy.

BAF.03 – Failure to effectively monitor performance and

activity levels of acute and non-acute providers.

Quality, Performance and

Finance Committee

BAF.04 – Failure to effectively monitor the quality of

commissioned services for all healthcare providers.


Finance Committee

BAF.05 – Failure to meet the CCG’s financial targets for

2016/17 and 2017/18.


Finance Committee

BAF.06 – Failure to effectively integrate health & social care. The Commissioning Committee

BAF.07 – Failure to develop a Primary Care Strategy that is

adequately resourced to service Newham residents and

secure a sustainable and viable GP Federation.

Primary Care Commissioning

Committee

BAF.08 – Failure to deliver the stated TST benefits including

quality and financial efficiency.

Commissioning Committee

BAF.09 – Failure to transform services through re-

commissioning (children, adults, UCC and MSK) and that

inter dependencies with NHS 111 and other re-

commissioned services are not realised.


BAF.10 – Failure to implement the improvements in agreed

corporate governance structure.

Executive Committee

BAF.11 – Failure to equip staff, the Board and clinical

leaders with the skills, knowledge and expertise to enable

the delivery of the CCG’s priorities and commissioning

agenda.

Executive Committee

When the BAF for 2017/18 is finalised, the new risks will be mapped against the committee structures and this will be highlighted in each update report to the Board.

4. Next steps

4.1 4.1.1

To ensure that we are continually developing our risk management approach with the CCG, work is currently ongoing in the following areas and we are undertaking the following actions: BAF 2017/18 We are currently undertaking a review of potential BAF risks for 2017/18 to ensure that the risks

27

4.1.2 4.1.3 4.1.4

identified are appropriate and the wording accurately reflects the risk to our potential inability to comply with our strategic objectives. However, this exercise will need further guidance from the Board to determine CCG priorities for 2017/18. Work is being undertaken with our Executive Leads to identify any new and emerging potential risks that may need to be reflected as part of our 2017/18 BAF and we are looking at the risks identified with other local CCGs to ensure that the nature, and number, of our BAF risks is consistent with other local health organisations. Risk appetite and tolerance: A risk appetite and tolerance matrix has been developed and will be taken to our upcoming Board development session to ensure that the Board are involved setting our risk appetite from 2017/18 onwards. This will ensure that the Board have a greater level of assurance regarding the effectiveness of our internal controls and how we undertake mitigating actions to effectively plug any identified gaps in control. Board development session Risk management and Board assurance has been included on our Board development forward planner. The aim of the session will be to ensure that the Board are adequately informed on how to implement the BAF in the most effective way in order to obtain the greatest degree of assurances that our risk management processes are effective and robust. Revised committee structures For risk management to be effectively embedded within the culture of the CCG, the Board should seek adequate assurances from its sub-committees that risk management is prioritised and managed. Committees should be scrutinising the risks linked to their individual work streams and escalating these appropriately when they become high risk and the Board should be sighted. Effectively risk management at committee level will ensure that the link between operational and strategic is developed and the Board are assured that the risk controls in place are fit for purpose. We are working to ensure that each Committee develops an annual forward plan that includes risk management.

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1

Board Assurance Framework

Document information

Version Version 4.0

Chair: Dr Prakash Chandra Accountable Officer: Steve Gilvin

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2

Contents

2. Purpose and Scope ........................................................................................................... 3

2.1 Board Assurance Framework ...................................................................................... 3

2.2 Risk Management Governance ................................................................................... 3

2.3 Strategic Objectives ..................................................................................................... 3

2.4 Risk Identifiers ............................................................................................................. 4

2.5 Newham CCG Risk Grading Matrix ............................................................................. 4

2.6 Risk Rating Matrix ....................................................................................................... 6

2.7. Common abbreviations used in the BAF ..................................................................... 7

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3

2. Purpose and Scope

2.1 Board Assurance Framework

The primary purpose of the Newham CCG Board Assurance Framework (BAF) is to:

1) Act as a mechanism for alerting and appraising the Board of the main risks to

achieving to the CCG in terms of achieving strategic objectives as set out in the

Operating Plan

2) List, evaluate and provide assurance to the Board regarding the mitigations in place

to the reduce the likelihood or impact of the risk

3) Summarise to the Board the remedial or proposed actions that further mitigate the

likelihood or impact of the risk

The BAF is also an important document for providing external assurance (to NHS England, Internal

Audit and patients and public) that the CCG is sighted on its risks and has a robust system of internal

control.

2.2 Risk Management Governance

Risk Management is embedded in Newham CCG’s Governance Structure:-

The Audit Committee is responsible for scrutinising the group’s Risk Management policies and procedures. Accountable to the group’s Board, the Committee provides the Board with an independent and objective view of the group’s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance.

The Executive Committee is responsible for approving internal control arrangements, risk sharing and pooling agreements.

The Chief Officer is responsible for approving the group’s arrangements for business continuity and emergency planning.

The Chief Finance Officer is responsible for approving the group’s Counter Fraud, Security Management and Risk Management arrangements.

The Governing Board is responsible for approving and monitoring the Board Assurance Framework.

2.3 Strategic Objectives

BAF risks have been linked to the core strategic objectives of Newham CCG, as outlined in the Newham CCG Operating Plan. These are:

1.1. To ensure community health services are responsive, located at the heart of our communities and able to meet the current and future needs of the population

31

4

1.2. To develop a primary care system that is modern, accessible and robust enough to care for the local population now and into the future

1.3. To ensure our population can access effective, high quality urgent and emergency care in and out of hospital

1.4. To develop a strong and sustainable acute system that places the needs of the patient at the heart of its design

1.5. To be central to a whole system approach working across traditional boundaries to effectively tackle health inequalities and make a positive impact on the health and social care economy of East London

1.6. Staff and clinical leaders are equipped with the skills and expertise to enable the delivery of the CCG’s priorities and commissioning agenda

1.7. To review and improve the existing governance structures to ensure they effectively support the delivery of our corporate and strategic objectives and our statutory duties

It is recognised that a number of BAF risks could be linked to more than one of the above strategic objectives.

2.4 Risk Identifiers

Each BAF risk will be assigned a unique risk identifier (number) linked to the applicable strategic objective.

2.5 Newham CCG Risk Grading Matrix

Risk Impact

Assessing the possible impact of a risk in conjunction with the likelihood of the risk occurring is used to determine the risk rating.

32

5

Risk Rating

Risk Category

High

(Risk Rating 15-25)

Medium

(Risk Rating 8-14)

Low

(Risk Rating 1-7)

High categorisation level risks are not acceptable under any circumstances as they will (i) be

highly likely to prevent the achievement of the corporate, principle and business objectives

and will damage the organisation’s reputation, politically and financially as well as creating a

significant and unacceptable response from stakeholders, (ii) impact on individual or

population health outcomes resulting in death. They require specific monitoring and

appropriate action plans at Board level to ensure that their impact is mitigated at the earliest

opportunity

Medium categorisation risks are generally not acceptable as they are likely to (i) cause much

disruption and efficiency losses to the achievement of corporate, principle and business

objectives, (ii) impact on individual or population health outcomes resulting in greater

chances of suboptimal health outcomes. They require specific monitoring and appropriate

action plans at individual directorate senior management level to ensure that their impact

does not increase to a higher risk level

Low categorisation risks are in general at an acceptable level of risk as they are (i) unlikely to

cause much disruption and efficiency losses to the achievement of corporate, principle and

business objectives, (ii) impact on individual or population health outcomes resulting in

some chances of suboptimal health outcomes. They are unlikely to require specific application

of resources and will be subject to on-going review and monitoring at a departmental /

functional level

Risk Category desription

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6

2.6 Risk Rating Matrix

The table below can be used to help to determine an appropriate risk rating. Examples are not exhaustive and are given to aid assessment only.

34

7

2.7. Common abbreviations used in the BAF

Below is a list of commonly used abbreviations that are found in the risk summary of the BAF. These are detailed below for ease of reference:

Barts/BHT Barts Health NHS Trust

BCP Business Continuity Plan

CEG Clinical Effectiveness Group (provider of primary care data quality and informatics and analytics services to the CCG and Newham GP Practices)

CCG Clinical Commissioning Group

COI Conflict of Interest

CQC Care Quality Commission

CQN Contract Query Notice

CQRM Clinical Quality Review Meeting

CQUIN Commissioning for Quality and Innovation

DES Direct Enhanced Service

DoH Department of Health

ELFT East London Foundation Trust (The provider of Community and Mental Health Services in Newham)

EPCT Extended Primary Care Team

EPCS Extended Primary Care Services

FBC Full Business Case

F&A Finance and Activity

FOI Freedom of Information

HoT Heads of Terms

HWBB Health and Wellbeing Board

IAPT Improving Access to Psychological Therapies

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8

IC Integrated Care

IG Information Governance

IM&T Information Management and Technology

ITT Invitation to Tender

KPI Key Performance Indicator

LA Local Authority

LAS London Ambulance Service

LBN London Borough of Newham

LD Learning Disability

LIS Local Incentive Scheme

LMC Local Medical Committee

NEL(CSU) North East London (Commissioning Support Unit)

NELIE North and East London Information Exchange (A web based commissioning analytics tool)

NHSE NHS England

NUH Newham University Hospital

OOH Out of Hours

PDP Personal Development Plan

PMC Practice Member Council

PPE Patient and Public Engagement

QIPP Quality, Innovation, Productivity and Prevention (a large-scale programme developed by the Department of Health to drive forward quality improvements in NHS care, at the same time as making up to £20 billion of efficiency savings by 2014/15)

RAID Rapid Assessment, Interface and Discharge

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9

RAG Red, Amber, Green (e.g. the status of a risk or performance indicator)

RAP Remedial Action Plan

RLH Royal London Hospital

RTT Referral to Treatment

SI Serious Incident

SLA Service Level Agreement

SMT Senior Management Team

SPG Strategic Planning Group

SPR Service Performance Review Meeting

TDA Trust Development Authority

TNA Training Needs Analysis

ToR Terms of Reference

UCC Urgent Care Centre

WEL Waltham Forest and East London (CCGs) – WEL CCGs are: Newham, Tower Hamlets and Waltham Forest. *WELC CCGs also includes City and Hackney CCG.

WHX Whipps Cross Hospital

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10

Risk Profile

Risk ID Objective Risk Summary Risk Owner Initial Risk

Rating Latest

Forecast Trend

End of Year

Target

Review Date

BAF.01 1.3 Failure to meet NHS Constitutional standards Steve Gilvin 16 16

8 26-Jan-2017

BAF.02 1.4; 1.5 Failure to operationalise the STP to secure a financially sustainable

balanced East London Health Economy Steve Gilvin 16 16

8 26-Jan-2017

BAF.03 1.4 Failure to effectively monitor performance and activity levels of

acute and non - acute providers Steve Gilvin 16 12

8 30-Jan-2017

BAF.03.01 1.4 Failure to effectively monitor performance and activity levels of acute providers

Ian Tritschler 16 12

8 24-Jan-2017

BAF.03.02 1.4 Failure to effectively monitor performance and activity levels of non - acute providers

Ian Tritschler 16 12

8 30-Jan-2017

BAF.04 1.4; 1.5 Failure to effectively monitor the quality of commissioned services for all healthcare providers

Chetan Vyas 16 8

8 01-Feb-2017

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11


Rating

Latest

Forecast Trend

End of Year

Target

Review Date

BAF.04.01 1.4; 1.5 Failure to effectively monitor the quality of commissioned services for Barts Health

Chetan Vyas 16 8

8 01-Feb-2017

BAF.04.02 1.4; 1.5 Failure to effectively monitor the quality of commissioned services

for East London Foundation Trust Chetan Vyas 16 8

8 01-Feb-2017

BAF.05 1.4 Failure to meet the CCG’s financial targets for 2016/17 and 2017/18

Chad Whitton 15 20

8 30-Jan-2017

BAF.06 1.5 Failure to effectively integrate health & social care Selina Douglas 16 12

8 30-Jan-2017

BAF.07 1.2

Failure to develop a Primary Care Strategy that is adequately

resourced to service Newham Residents and secure a sustainable and viable GP Federation

Selina Douglas 16 16

12 30-Jan-2017

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12


Rating

Latest

Forecast Trend

End of Year

Target

Review Date

BAF.07.01 1.2

Failure to develop a Primary Care Strategy that is adequately

resourced to service Newham Residents and secure a sustainable and viable GP Federation - Primary Care


12 30-Jan-2017

BAF.07.02 1.2 Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation - GP Federation

Steve Gilvin 16 16

12 30-Jan-2017

BAF.08 1.1; 1.4 Failure to deliver the stated TST benefits including quality and

financial efficiency Steve Gilvin 20 20

12 30-Jan-2017

BAF.08.01 1.1; 1.4 Failure to deliver the stated TST benefits including quality and financial efficiency: - Sustainable Hospitals

Steve Gilvin 16 12

8 30-Jan-2017

BAF.08.02 1.1; 1.4 Failure to deliver the stated TST benefits including quality and financial efficiency: - Care Closer to Home

Steve Gilvin 20 20

12 30-Jan-2017

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13


Rating

Latest

Forecast Trend

End of Year

Target

Review Date

BAF.09 1.1 Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised.


8 30-Jan-2017

BAF.09.01 1.1 Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111

and other re-commissioned services are not realised - children


8 14-Nov-2016

BAF.09.02 1.1 Failure to transform services through re- commissioning (children, adults, UEC and MSK) and that inter dependencies with NHS 111

and other re-commissioned services are not realised - adults


8 30-Jan-2017

BAF.09.03 1.1

Failure to transform services through re- commissioning (children,

adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - UCC


8 30-Jan-2017

BAF.09.04 1.1 Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - MSK


8 30-Jan-2017

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14


Rating

Latest

Forecast Trend

End of Year

Target

Review Date

BAF.10 1.7 Failure to implement the improvements agreed in corporate

governance structure

Satbinder

Sanghera 16 8

8 30-Jan-2017

BAF.11 1.6 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG’s

priorities and commissioning agenda

Chetan Vyas 15 8

6 25-Jan-2017

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15

BAF.01 Failure to meet NHS Constitutional

standards

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel

Steve Gilvin Executive Committee

Red

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 4 16 4 4 16 4 2 8 31-Mar-2017

Control Control Description Internal Assurance External Assurance Gaps in Control Status

BAF.01a NHS Standard Contract

The NHS Standard Contract provides a number of contract clauses to facilitate

the tracking of performance against NHS Constitutional Standards and incentivise delivery. This is now in the form of

issuing of Contract Performance Notices (CPNs). In 2016-17 , CCGS are unable to

to impose nationally mandated financially penalties as NHSE and NHS improvement have directed; use

perforamce against standards to determine access to STF.

a. Completed and signed Contract Documentation

b. SDIPs - STP trajectories - specific levels of performance, on

a monthly by month basis during 2016/17, against

Operational Standards in relation to provider performance against

Sustainable & Transformational Fund

Performance trajectories and assurance

statements. c. Remedial Action Plans (RAPs)

NHSE Assurance Data Quality Concerns

Agreed Data Quality Recovery Plan with trusts to improve Quality in

data especially in relation to RTT monitoring at

Monthly Standard meeting

Partially Effective

BAF.01b Contract

Review Group (CRG)

The CRG is a contractual requirement

between Commissioner and Provider – General Condition 8 (GC8). This is the

main contract meeting each month and is the forum for escalation of non-contract compliance, which includes a

provider not delivering the NHS Constitutional requirements.

a. CRG Terms of

Reference b. CRG Meeting Minutes.

C. Clinical Strategy Group

National Standards

Monthly Assurance Meeting

Oversight of estimated

RTT position, due to Trust not reporting

formally

Partially Effective

BAF.01c Urgent

Care Working group

Monthly meeting of Urgent Care working

group to oversea the delivery of A&E standards

a. System Review Group

(System Cabinet) b. Terms of Reference for

site level meetings. c. Meeting Minutes of site specific meetings.

d. Reporting packs produced by the Trust.

e. UC working group f. A & E standards

Partially Effective

BAF.01d RTT,

Diagnostics and Cancer Meeting

BAF.01d RTT, Diagnostics and Cancer

Monthly meeting

a. RTT, Diagnostics and

Cancer Monthly Meeting Terms of Reference. b. RTT, Diagnostics and

Cancer Monthly Meeting Minutes.

c. Reporting packs produced by the Trust.

Partially

Effective

BAF.01e

Performance Reports to Acute Commissioning

Committee

Reports produced by NEL CSU, for the

CCGs Acute Commissioning Committee, to advise group members on current provider performance against NHS

Constitutional Standards.

a. Weekly and Monthly

Performance Reports produced by NEL CSU. b. Specific deep dive

analysis sub reports c. Terms of reference

Fully Effective

BAF.01f

Performance Report to Board

CCG Board receives a performance

report which includes performance against the national standards for all the commissioned providers

a. High level summary

Performance Report submitted to the Board b. Additional reports

providing more granular analysis, forming a sub

report to 6a. c. WIP not fully effective

Partially

Effective

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16


BAF.01g BAF.01g Clinical Strategy

Group Meeting (CSG)

Meeting of the Clinical Chairs and Executive Directors of Waltham Forest,

East London and the City CCGs.

a. Terms of Reference for the CSG.

b. Meeting minutes for the CSG.

c. Adhoc reports to the CSG.

Partially Effective

BAF.01h

Commissioning Collaborative Committee (CCC)

Monthly meeting of the Barts Health

Contract lead CCGs Chief Officer, Waltham Forest, East London and the City CCGs Chief Finance Officers and

Associate CCGs Chief Finance Officers.

a. Terms of Reference for

the CCC. b. Meeting minutes for the CCC.

c. Adhoc reports to the CCC.

Partially Effective

Mitigating Action Due Date Assigned To Latest Note Status

BAF.01a Review of SDIP - June 01-Jul-2016 Agreed revised plan end of June and incorporated into contract

Completed

BAF.01ai External Assurance -

NHSE new governance

30-Sep-2016 Steve Gilvin There is a new delivery board in place.

Completed

BAF.01c A& E workshop - 29 June

29-Jun-2016 Held 29 June to agree a joint analysis action plan for Newham site. Agreed to do a further analysis of a wider cohorts of patients which

can be seen in UCC. Agreed to identify what pathways between GP and specialist area

can be prioritised for implementation, e.g. Gynae pathway. In the first instance CCG to identify a list specialty area for discussion, in

addition to those pathways noted at this meeting.

Summary of the meeting with the following headline actions:

Barts Health to submit to CCG a proposal with regard to skill mix at UCC front door, as a pilot.

Further deep dive into the HRG codes once primary care treatment codes have been identified.

CCG to explore GP registration process

CCG to investigation B&D patient flows

Agreed to identify what pathways between GP and specialist area can be prioritised for implementation, e.g. Gynae pathway. In the

first instance CCG to identify a list specialty area for discussion, in addition to those pathways noted at this meeting.

Completed

BAF.01ci Barts Health to submit to CCG a proposal with regard

to skill mix at UCC front door, as a pilot.

31-Oct-2016 Ian Tritschler Superseded as the contract is up for renewal. We are currently considering a revised service model moving forward.

Completed

BAF.01cii Further deep dive into

the HRG codes once primary care treatment codes have been

identified.

31-Oct-2016 Ian Tritschler This has been completed.

Completed

BAF.01ciii CCG to explore GP registration process

31-Oct-2016 Ian Tritschler This has been integrated into the STP strategy.

BAF.01civ CCG to investigation

B&D patient flows

31-Oct-2016 Ian Tritschler This has been completed.

Completed

BAF.01d Trust action : Barts Health Diagnostics & Cancer

31-Mar-2017 Barts Health continues to meet the Cancer and Diagnostic standards for 2016/17. On Track

BAF.01di Return to RTT

reporting & review of data quality

30-Sep-2016 Steve Gilvin CCGs have met with Barts Health, NHSE and NHS Improvement to

discuss progress. Discussions are currently ongoing regarding this.

Unlikely to be

Completed on Time

BAF.02 Failure to operationalise the STP to secure a financially sustainable balanced East

London Health Economy

Risk Owner Lead

Committee

Next Review

Date

Current RAG Status

Direction of Travel


Red

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17



4 4 16 4 4 16 4 2 8 31-Mar-2017


BAF.02a NEL Programme Board

the Programme board is responsible for the oversight of planned delivery.

This is made up of CO/CE of CCGs and Providers

Acceptable STP Plan to NHSE & NHS

Improvement The 5 CCGs/ providers put in £35k each

to support production of plan.

STP Plan submission Independent chair to facilitate discussions

appointed mid May

Partially

Effective

BAF.02b Development of STP Governance

Programme board has initiated an working group including lay members of trusts and CCGs to make

recommendations on STP governance.

MOU now drafted and being consulted on with comments due by the

end of Jan.

Partially Effective

BAF.02c STP leadership

workstream

A CE/CO is leading each of the workstreams with project management

support.

Working up further detailed plans for 17/18

for each project. Plans in place for 16/17.

Partially

Effective

BAF.02d Finance

workstream

The Finance Workstream has been

established to validate the financial model and plans to close the financial gap.

This involves DoFs from trusts and CFOs

from CCGs.

Agreeing Financial Plan Plan agreed with NHSE

and NHS Improvement

Partially

Effective

BAF.02e STP Executives

Madeup of the work stream leads Review progress of delivery

Partially Effective


BAF.02a Delivery of detailed

STP plan

21-Oct-2016 Steve Gilvin 1st draft submitted and initial feedback from NHS England and NHS

Improvement has been very positive. Completed

BAF.02ai Developing Operating plan for 2017/18 & 2018/19

24-Nov-2016 Steve Gilvin Operating plans for 2017/19 on 23/12/16. STP programme are now triangulating plans from all sectors.

Completed

BAF.02b Put in place the

working Group

30-Sep-2016 Steve Gilvin The working group is established, has met and has CCG

representation. Completed

BAF.03 Failure to effectively monitor

performance and activity levels of acute and

non - acute providers

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel

Steve Gilvin Executive

Committee 01-Jan-2017 Amber



4 4 16 4 3 12 4 2 8 31-Mar-2017


AC.01a Focus on

Demand Management initiatives

agenda for acute commissioning

committee

WEL Collaborative lead

by CSU

SLA with WEL

Collaborative and CSU

Partially

Effective

45

18

BAF.03.01 Failure to effectively monitor

performance and activity levels of acute

providers

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel

Ian Tritschler Executive

Committee Amber



4 4 16 4 3 12 4 2 8 31-Mar-2017


BAF.03.01a

Service Performance

Review Meetings (SPR)

Monthly SPR meetings now attended by

Trust CEO, and chaired by NHS Newham CCG Chief Officer, are held with Barts

Health to ensure robust discussions around performance with assurance reports provided to CCG on areas of

concern.

Monthly SPR meetings

with assurance reports

Partially

Effective

BAF.03.01b Site level CQC

Assurance meetings

Monthly Barts Health Site level CQC Assurance Group meeting with TDA,

NHSE and CCGs

Assurance meeting terms of reference, minutes and

action logs

Partially

Effective

BAF.03.01c

Demand management initiatives

Focus on demand management

initiatives at cluster level to review referrals where safe alternatives exist in the community. To review and discuss

with patients whether other acute providers could be used as an alternative

to Barts in light of 18 week RTT issues at the Trust.

a. Dashboard reports to

Cluster meetings. Terms of reference and minutes from meetings. Cluster

plans for 2016-17. Example practice plan

Feedback from clusters

required

Partially

Effective

BAF.03.01d NEL CSU Acute MDT

dedicated analytics support

NEL CSU provide a well-resourced contract management function for all

acute provider contracts with dedicated analytics, finance, performance and

contract functions. They provide a monthly analysis of performance, finance

and activity, and undertake deep dive analysis for specific areas of concern.

SLA with NEL CSU to provide monthly finance

and activity reports.

The CSU issue monthly activity query notices

(AQN) to challenge changes in activity reported by the Trust.

Partially Effective

BAF.03.01e

Dedicated Acute Collaborative

Commissioning Team

A dedicated Acute Collaborative

commissioning team (Director of Commissioning and Senior Finance

Support) works across WEL CCGs to work closely with the CSU Acute MDT.

MOU across the WEL

CCGs for Barts Collaborative Team.

Partially Effective

BAF.03.01f WEL

CCGs Acute Commissioning Collaborative

The WEL CCG Acute Commissioning

Collaborative reviews Barts Health performance and activity information and agrees jointly approaches to

managing performance issues

WEL CCG Acute

Commissioning Collaborative meetings. Terms of Reference,

Minutes and Action Logs. Newham Maternity

Quality Review Meeting Terms of reference.

Partially

Effective

BAF.03.01g

System Resilience

A WEL-wide System Resilience Group

(SRG) reviews capacity and surge requirements across the health system. Additional funding is agreed and

monitored for impact for specific target areas through the SRG and Newham

Urgent Care Working Group (UCWG).

Terms of reference and

minutes of SRG and UCWG meetings. Evidence of additional

investment for providers in resilience schemes.

Partially

Effective

BAF.03.01h Acute Commissioning Committee

The Newham Acute Commissioning Committee meets monthly to review contract activity and performance for

Barts Health through a set of reports provided by the NEL CSU.

Newham Acute Commissioning Committee terms of

reference, minutes and action log.

Partially

Effective

46

19


BAF.03.01i Urgent Care Centre SPR

meetings

Monthly SPR meetings for the new UCC contract held by Barts Health

Urgent Care Centre SPR meetings, ToR, minutes

and action notes. Bimonthly operational

meeting ToR.

Partially Effective

BAF.03.01j Clinical Forum meeting

This Forum allows the CCG (GPs & officers) to meet NUH site leadership

team and consultants to discuss and agree actions on a range of clinical and operational issues.

Minutes from Clinical Forum meetings.

Partially

Effective

BAF.03.01k NUH/CCG monthly management team

meeting

NUH site leadership team (Managing Director and Medical Director) meet with CCG executive team to discuss progress

with key operational issues and strategic programmes.

Action log from NUH/CCG meetings and biweekly meeting with NUH

Director of Operations.

Partially

Effective


BAF.03.01d <Clusters to

produce 16/17 demand management plans, (July 2016). Dashboards shared at cluster

meetings, (Aug 2016).

30-Dec-2016 Neil Hamer Practices/Clusters are rapidly developing referral management

processes to address demand management. These have been presented to Practice Council and other key meetings. On Track

BAF.03.01d(ii) Activity query notices

31-Mar-2017 On Track

BAF.03.02 Failure to effectively monitor

performance and activity levels of non - acute providers

Risk Owner Lead

Committee

Next

Review Date

Current

RAG Status

Direction of

Travel

Ian Tritschler Executive Committee

Amber



4 4 16 4 3 12 4 2 8 31-Mar-2017


BAF.03.02a Service

Performance Review Meetings

(SPR

Monthly SPR meetings for all non-acute providers, key providers are ELFT mental

health, ELFT Community services, St Joseph’s Hospice, Richard House,

Mildmay, to ensure robust discussions around performance with assurance reports provided to CCG on areas of

concern.

- SPR terms of reference. - Minutes and action logs

of meetings.

Partially

Effective

BAF.03.02b Demand

management initiatives

Focus on demand management initiatives at cluster level to increase

referrals from acute providers into community and primary care providers

where safe alternatives exist.

Partially Effective

BAF.03.02c NEL CSU dedicated analytics and

contract support

CSU provides a dedicated analytics for community contracts and a contract management function for 111, LAS, GP

OOH contracts. CSU provide a monthly analysis of performance, finance and

activity, and undertake deep dive analysis for specific areas of concern.

Monthly activity reports for mental health.

Partially Effective

BAF.03.02d Mental

Health Commissioning Collaborative

NEL CSU provide a contract

management function for Mental Health for Newham, Tower Hamlets and City & Hackney CCGs.

MOU across the ELC

CCGs for Mental Health Commissioning Collaborative Team.

Partially Effective

47

20


BAF.03.02e St Joseph’s Hospice

WEL CCG Commissioning

Collaborative

Quarterly SPR meeting for St Joseph’s Hospice across all WEL CCGs through

the Commissioning Collaborative

- St Joseph’s Hospice WEL CCG Commissioning

Collaborative ToR. - Minutes and action logs

Partially Effective

BAF.03.02f Commissioning

Committees

The Newham Community, Mental Health, Integrated Care, Maternity & Children’s

Commissioning Committees meet monthly to review contract activity and performance for ELFT and other non-

acute providers through a set of reports provided by CCG commissioning teams.

- Terms of reference. - Minutes and action logs

of Commissioning Committee meetings.

Partially Effective


BAF.03.02a (i) Service

Performanc eCSU to validate ELFT data against patient level minimum dataset, (July 16).

31-Mar-2017 Patrick Zola Meeting took place in December to clarify previously outstanding

issues on KPI reporting. Some issues still remain, primarily relating to EMIS web. On Track

BAF.03.02a (ii) ELFT to provide full set of new 16/17 KPIs, (Oct 16).

31-Mar-2017 Patrick Zola ELFT now reporting on 80% of KPIs. Some queries raised and a meeting is in place for Decmber to clarify outstanding issues. On Track

BAF.03.02b(i) Clusters to

produce 16/17 demand management plans, (July 2016)

28-Feb-2017 Neil Hamer Clusters have not yet produced demand management plans – this is

now being included as part of the Efficiency improvements under 10 High Impact changes as part of Making Time in General Practice. It

will be a focus area within the HEE IL plan.

On Track

BAF.03.02b(ii) Dashboards shared at cluster meetings, (Aug

2016).

28-Feb-2017 Neil Hamer Dashboards were shared at cluster meetings and with the Cluster leads On Track

BAF.03.02f Develop forward planners for each Commissioning Committee, (July

16)

31-Jul-2016 Ian Tritschler Forward planners developed, but will be revised in light of the wider committee re-structuring.

Completed

BAF.04 Failure to effectively monitor the quality of commissioned services for all

healthcare providers

Risk Owner Lead

Committee

Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas Executive Committee

01-Feb-2017 Amber



4 4 16 4 2 8 4 2 8 31-Mar-2017

BAF.04.01 Failure to effectively monitor the

quality of commissioned services for Barts

Health

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel

Chetan Vyas Executive

Committee 01-Mar-2017 Amber



4 4 16 4 2 8 4 2 8 31-Mar-2017

48

21


BAF.04.01a Monthly Oversight

and Assurance/ Clinical Quality

Review Meeting (CQRM)

Regular meetings with Barts Health (all sites) around quality and improvement.

Terms of Reference for Newham Oversight and

Assurance Meeting. Newham Oversight and

Assurance papers from meetings.

Performance monitoring arrangements.

Agendas and minutes of Barts Health and East

London Foundation Trust CQRM and SPR meetings.

Fully Effective

BAF.04.01b

Monthly Quality Intelligence Report

Monthly report on quality intelligence to

the CCG Quality Committee

Monthly Quality

Intelligence Report

Monthly serious incident

panel held with WELC.

Fully Effective

BAF.04.01c Key

Performance Indicator (KPI) Review Meetings

Regular meetings with Barts Health to

review performance against KPIs

Terms of Reference for

Barts Health KPI Review Meeting. Barts Health KPI Review

meeting papers.

Partially Effective

BAF.04.01d Newham site

Maternity Quality and performance group Meeting

Regualr mettings with Newham Site Maternity Team to review performance

and quality

Maternity Quality and Performance Sub Group

Meeting Papers.

Fully Effective

BAF.04.01e Amber Alert Process

Mechanism for GPs to report quality issues in relation to Barts Health.

Amber Alert reporting and response forms. Amber Alert database.

Fully Effective

BAF.04.01f Barts

Health Care Quality

Commission (CQC) visits

Regulator (CQC) visits to Barts Health

Partially Effective

BAF.04.01g

Quality Assurance (QA) Visits

Visits to wards by the CCG to observe

first hand the quality of care being delivered to patients.

Quality Assurance Visit

Framework. Quality Assurance Visit Reports and Action Plans.

Quality Assurance Visits

at Barts Health.

Partially Effective

BAF.04.01h WELC

Serious Incident (SI) Panel Meeting

Joint panel with WELC to review and

approve closure of Serious Incidents.

WELC SI panel Terms of

Reference. WELC SI panel papers.

Partially Effective

BAF.04.01i Quality

Leads Meeting

Regular meetings with WELC Quality

Leads and Teams

Terms of Reference for

the WELC Quality Leads Meeting.

Quality Leads papers of meetings.

Fully Effective

BAF.04.01j Commissioning for

Quality and Innovation

(CQUIN)

Proportion of healthcare providers' income conditional on demonstrating

improvements in quality and innovation in specified areas of patient care.

CQUIN Reports. Commissioning for Quality Framework.

Partially Effective

BAF.04.01k Quality Report to Board

Regular reports to the CCG Board around performance against quality

measures.

Quality Board Reports.

Fully Effective

BAF.04.01l CCG Quality Committee

CCG Quality Committee Quality Committee Terms of Reference. Quality Committee

papers.

Patient stories that go to the CCG Board.

Fully Effective

BAF.04.01m Director of Quality,

Chief Medical Director and Chief

Nurse meetings

Bi-monthly meeting between WEL CCGs, Director of Quality and Barts Health

Chief Medical Officer and Chief Nurse to discuss hot topics and quality issues.

Partially Effective

BAF.04.01p Serious Incidents

workshop

NHSE holding series of Serious Incident workshops with commissioners and

providers to improve the Serious Incident process

Partially Effective

Partially

Effective

BAF.04.01q Quality Surveillance Group

Attending regional quality surveillance group to share and gain intelligence regarding Barts Health quality matters

with Healthwatch, local authority and CCG colleagues.

Partially

Effective

BAF.06.01l Clinical

Harm Review Meetings

Regular Meetings with Barts Health to

review clinical harm of patients with long RTT and Cancer waits.

Partially Effective

49

22


BAF.06.01n IPIT site meetings

Improvement Plan Implementation (IPIT) Team Meeting with Newham

Hospital Leadership Team to monitor progress against delivery of

improvement plan

Partially Effective


BAF.04.01a Develop a forward plan for Monthly oversight

assurance & CQRM

30-Jun-2016

Completed

BAF.04.01a Monthly OA/CQRM, QA Visits, WELC SI Panles and Quality Leads Meetings

31-Mar-2017 Saem Ahmed CQC re-inspection on the Newham site and external clinical review also undertaken on Newham site. On Track

BAF.04.02 Failure to effectively monitor the

quality of commissioned services for East London Foundation Trust

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel

Chetan Vyas Executive

Committee 01-Mar-2017 Amber



4 4 16 4 2 8 4 2 8 31-Mar-2017


BAF.04.01p

Serious Incidents workshop

NHSE holding series of Serious Incident

workshops with commissioners and providers to improve the Serious Incident process

Partially

Effective

Partially Effective

BAF.04.02a Monthly Clinical

Quality Review Meeting (CQRM)

Regular meetings with East London Foundation Trust around quality and

improvement.

Terms of Reference for Community Health

Clinical Quality Review Meeting.

A Clinical Quality Review Meeting papers.

Agendas and minutes of East London Foundation

Trust CQRM and SPR meetings.

Fully Effective

BAF.04.02b

Service Performance Review Meetings

(SPR)

Regular meetings with East London

Foundation Trust to review performance against KPIs

Community Health

Service Performance Review Meeting Terms of reference.

Community Health Service Performance

Review meeting papers.

Agreed reporting through

contracts via KPI and Information Schedule reporting

Fully Effective

BAF.04.02c Amber Alert Process

Mechanism for GPs to report quality issues in relation to ELFT

Amber Alert reporting and response forms

Amber Alert database.

Partially Effective

BAF.04.02d Quality Assurance (QA) Visits

Visits to services by the CCG to observe first hand the quality of care being delivered to patients.

Quality Assurance Visit Framework. Quality Assurance Visit

Reports and Action Plans.

Quality Assurance Visits at ELFT.

Partially Effective

BAF.04.02e ELC Serious Incident

(SI) Panel Meeting

Joint panel with ELC to review and approve closure of Serious Incidents.

WELC SI panel Terms of Reference.

WELC SI panel paper.

Monthly serious incident panel held with ELC.

Partially

Effective

BAF.04.02f Quality Leads Meeting

Regular meetings with WELC Quality Leads and Teams

Terms of Reference for the WELC Quality Leads

Meeting. Quality Leads papers of meetings.

Fully Effective

BAF.04.02g Commissioning for Quality and

CQUIN reports. Commissioning for Quality Framework.

Partially Effective

50

23


Innovation (CQUIN)

BAF.04.02h Quality Report to Board

Regular reports to the CCG Board around performance against quality measures.

Quality Board Reports. Patient stories that go to the CCG Board.

Fully Effective

BAF.04.02i CCG

Quality Committee

CCG Quality Committee Quality Committee Terms

of Reference. Quality Committee

papers.

Fully Effective

BAF.04.02j Monthly Quality

Intelligence Report

Monthly report on quality intelligence to the CCG Quality Committee

Monthly Quality Intelligence Report.

Fully Effective

BAF.04.02k Consortia Quality Role

Consortia Quality Manager across City and Hackney, Tower Hamlets and Newham CCGs for a Trust wide oversight

and to share best practice.

Fully Effective

BAF.04.02l Development of

PROMs

CCG working with CHN ELFT to develop PROMS to demonstrate patient reported

outcomes

Partially

Effective


BAF.04.02a Monthly CQRM/ELC SI panel meetings

31-Mar-2017 Saem Ahmed Since April 2016/17 CQRMs and ELC SI panels have taken place. On Track

BAF.04.02d Develop a forward

plan on Quality Assurance (QA) Visits

31-Jul-2016 Saem Ahmed Forward Planner for QA visits at Community Health Services has

been completed.

Completed

BAF.05 Failure to meet the CCG’s financial

targets for 2016/17 and 2017/18

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel

Chad Whitton Executive Committee

01-Jan-2017 Red



5 3 15 5 4 20 4 2 8 31-Mar-2017


BAF.05a 2016/17 Finance and

Activity Plan

The CCG submitted a balanced Finance and Activity Plan for 2016/17 in line with

financial requirements to NHSE on 2016/17.

Balanced 2016/17 Finance and Activity plan

submitted to NHS England.

NHSE review

Fully Effective

BAF.05b 2016/17 Budget

Budget in line with the 2016/17 Finance and Activity Plan have been signed off

by all the budget holders and the Board in June 2016.

implementation of strengthened financial controls approved by the June Board

and the finalisation of the budget reductions agreed with Directors.

2016/17 budget signed off by budget holders and

the Board.

Partially

Effective

BAF.05c Monthly budget manager

and budget holder meetings

Monthly meetings are held with budget managers and budget holders to ensure

robust discussions and performance monitoring of potential financial risks on areas of concerns.

Notes to monthly budget managers and budget

holder meetings.

Partially Effective

BAF.05d Monthly financial reporting to NHS England

Detailed financial performance and financial positions are reported to NHS England via monthly returns.

Monthly Financial Position Return and Non-ISFE Return to NHS England.

Monthly Financial Position Return and Non-ISFE Return to NHS England

Partially Effective

51

24


BAF.05e CCG Finance

Committee

The Finance Committee provide assurance and advise the CCG’s

Executive Committee on all matters relating to finance and make

recommendations to the Executive Committee.

Finance Committee Terms of Reference.

Finance Committee Minutes of meetings and

action logs.

Partially Effective

BAF.05f CCG Audit

Committee

The Audit Committee is responsible for scrutinising the CCG’s financial policies and procedures, and providing to the

Board with an independent and objective view of the CCG’s financial systems,

financial information and compliance with laws, regulations and directions governing the CCG in so far as they

relate to finance.

Audit Committee Terms

of Reference. Audit Committee Minutes of meetings and action

logs.

Partially Effective

BAF.05g Finance report to the CCG

Board

The CCG Board receive regular finance report based on the latest financial

performance and budget management.

Board finance report.

Partially

Effective


BAF.05c Monthly Budget holder 31-Mar-2017 Lei Wei Budget holder meetings are on - going each month with a deep dive to to validate the expenditure run-rate and the success of

efficiency measures to address the financial challenges faced by the CCG.

On Track

BAF.06 Failure to effectively integrate health

& social care

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel

Selina

Douglas Executive Committee

Amber



4 4 16 4 3 12 4 2 8 31-Mar-2017


BAF.06a Development of an

agreed strategy for health and social care

integration across CCG, LB Newham

Adult Social Care and Children's Services.

Describes the direction of travel for the integration of health and social care

functions in line with the 2020 requirement set out in the Five Year Forward View

Agreed Strategy and Implementation plan

signed off by CCG and LBN.

Direction of Strategy is not yet drafted

Partially

Effective

BAF.06b

Development of Strategy for joint

commissioning of health and social

care services

Strategic plan for how health and social

care services will be jointly commissioned over the next 5 years

Programme plans for

Joint commissioning of children's services.

Single Point of Access in adult services and future

scope of adult community services procurement (Building Healthy

Communities)

Partially Effective

BAF.06c Joint Chair Integrated


Governance arrangements for the co-chairing of the IC committee

Integrated Commissioning

Committee Terms of Reference and Membership.

Partially

Effective

BAF.06d Better BCF Delivery monitors progress around Terms of Reference of Better Care Fund

Partially

52

25


Care Fund Governance &

Delivery Group

BCF the Better Care Fund Governance & Delivery

Group. Section 75 Agreement.

Submission to NHSE and quarterly assurance

reports

Effective

BAF.06e Health &

Well Being Board

Oversight group for health and social

care strategy and implementation

Health & Well Being

Board Terms of Reference.

Health and Well Being Strategy. Health and Well Being

Annual Work Programme – Forward Plan

Partially Effective

BAF.06f Public

Health MOU

Describes the range of services and

products provided to the CCG via LBN’s Public Health Team

Public Health

Memorandum of Understanding.

Partially Effective


BAF.06a Decision on how an

integration strategy will be developed and timeline, review of the PPL options on

integration paper, (Aug 16)

15-Feb-2017 Selina Douglas The structure for collaborative commissioning has been approved at

Remuneration Committee.

Completed

BAF.06d BCF Delivery Group forward plan

31-Jul-2016 Ian Tritschler CCG and LBN leads have met to draft a BCF Deliery Group forward plan which was discussed at the 8 August meeting On Track

BAF.06e Development of a

Prevention Strategy, (Sept 16). Development of a revsied JSNA,

(Sept 16).

18-Jan-2017 Ian Tritschler A final version of the Prevention Strategy will be presented to the

next Health and Wellbeing Board. On Track

BAF.06f MOU to be agreed with LBN, (July 16).

31-Jul-2016 Selina Douglas

Completed

BAF.07 Failure to develop a Primary Care

Strategy that is adequately resourced to service Newham Residents and secure a

sustainable and viable GP Federation

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel

Selina

Douglas Executive

Committee Red



4 4 16 4 4 16 4 3 12 31-Mar-2017

BAF.07.01 Failure to develop a Primary Care


sustainable and viable GP Federation -

Primary Care

Risk Owner Lead

Committee

Next

Review Date

Current

RAG Status

Direction of

Travel

Selina


01-Mar-2017 Red



4 4 16 4 4 16 4 3 12 31-Mar-2017

53

26


BAF.07.01a Deliver Outline for revision

of Strategy

Initial Board Dev. sessions to create vision – March & May 16.Strategic

Drivers reviewed at PCCC June, Draft content to July board, engagement &

consultation Aug/Sep & present to Sept PCCC Board

PCCC and NCCG Board. NHSE and TST , Audit, Public,

Partially Effective

BAF.07.01b

Effective utilisation and management of spend

Review of contractual spend as part of

monthly review of budgets, tracking of EPCS/LIS claims, ¼ly review of performance v KPI on APMS and 6m on

PMS

PCCC and NCCG Board

and TST Board.

NHSE and Public Inability to ascertain

background data /info

Partially Effective

BAF.07.01c Oversight of

Federation governance via

CCG

Regular reporting cycle to COO & CFO plus SMT by Interim CO of Federation.

Papers to PCCC

SMT and CCG Board.

Partially Effective

BAF.07.01d Control of pump priming funding

for Federation

Direct Business Case submission and application to CFO for approval

DoF SMT and CCG Board Federation Board and articles

Partially Effective


BAF.07.01a Outline Proposal on PC strategy June PCCC

01-Dec-2016 Neil Hamer 2 Board sessions have been held on Primary Care Strategy development

Completed

BAF.07.01b Monthly review of

budget with increased access to fig.

31-Mar-2017 Neil Hamer There are gaps in automated information gathering. Issue still

remains of insufficient data as access to Open Exeter is still outstanding.

Likely to be

Overdue

BAF.07.01c Regular (as a

minimum Monthly) review by SMT

01-Mar-2017 Neil Hamer Regular report to PCCC are done.

On Track

BAF.07.02 Failure to develop a Primary Care


sustainable and viable GP Federation - GP Federation

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel


Committee 01-Jan-2017 Red



4 4 16 4 4 16 4 3 12 31-Mar-2017


BAF.07.02a GP Federation

Meet Fortnighly - cluster rep Secured first contract award of Vicarage

lane Practice. Overseers - CCG Chair/ CO &

Programme Director

Newham Health Collaboration (NHC)

Capacity and Viability still uncertain

Partially Effective

BAF.07.02b Business Plan

The Federation has submitted a draft business plan.

Partially Effective


BAF.07.02a NHSE - Business Case to be reviewed &

determined by CCG

31-Oct-2016 Approved with conditions at PCC.

Completed

BAF.07.02b Recruitment 31-Mar-2017 Unsuccessful in initial recruitment attempt. CCG have seconded On Track

54

27


member of the Finance Team to help with the interim arrangements.

BAF.08 Failure to deliver the stated TST

benefits including quality and financial

efficiency

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel


Committee 01-Nov-2016 Red



5 4 20 5 4 20 4 3 12 31-Mar-2018

BAF.08.01 Failure to deliver the stated TST

benefits including quality and financial efficiency: - Sustainable Hospitals

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel


01-Dec-2016 Amber



4 4 16 4 3 12 4 2 8 31-Mar-2018


BAF.08.01a Acute Care Hubs

Trust to plan what the delivery plan will be like

Prioritised this year

Pilot of ambulatory care established in November

at the NUH site running 2 days a week.

Partially

Effective

BAF.08.01b TST

Programme Board

The TST Programme Board is a meeting

of clinical and managerial senior leadership of CCGs and the trust to provide oversight of the TST

programme.

Meet monthly -

CEO/Chairs.

Partially Effective

BAF.08.01c Strong Sustainable

Hospitals Board

Chaired by Barts Medical Director Meet monthly.

Partially

Effective


BAF.08.01a Meeting 20 June Develop a Business Case for

Acute Care Hubs

31-Oct-2016 Philippa Robinson Draft reviewed and further work is being undertaken to develop the plan. On Track

BAF.08.01b Ambulatory Care Pilot

31-Mar-2017 On Track

BAF.08.02 Failure to deliver the stated TST benefits including quality and financial

efficiency: - Care Closer to Home

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel


01-Dec-2016 Red

55

28



5 4 20 5 4 20 4 3 12 31-Mar-2018


BAF.08.02a

Financial and quality benefits

Programme to be evaluated and signed off by CCG

Board, so that minimum

standards can be set.

Financial and quality benefits plan to be

evaluated and signed off by CCG Board, so that minimum standards can be set,

and performance monitoring put in place.

Executive Committee.

Procurement Committee.

(i) TST Strategic steering

Board (ii) NEL STP

Internal assurance

Partially Effective

BAF.08.02b

Introduce Business case process

Internal business case process to be

adhered to with agreed minimum quality and financial outcomes

Partially

Effective


BAF.08.02a Validate centrally developed finance and activity

plan within the CCG

31-Mar-2017 Julie Van Bussel The CCG is currently working on the development of a strategic development plan (SDP), work is being undertaken to ensure the

TST programme links in, and therefore a refresh of finance and activity is required.

On Track

BAF.08.02b (i) Ensure CCG

delivery plan aligns with TST CCH PID's

31-Jul-2016 Julie Van Bussel A Prioritisation process has been developed and will be reviewed by

the end of October.

Completed

BAF.08.02b(ii) Produce timeline

of anticipated business case production.

31-Mar-2017 Julie Van Bussel The delivery plan has been completed and is aligned to

STP/Operating Plan. On Track

BAF.09 Failure to transform services through re- commissioning (children, adults, UCC and

MSK) and that inter dependencies with NHS

111 and other re-commissioned services are not realised.

Risk Owner Lead

Committee

Next Review

Date

Current

RAG Status

Direction of

Travel

Selina

Douglas Executive

Committee 01-Dec-2016 Red



4 4 16 4 4 16 4 2 8 31-Mar-2017

BAF.09.01 Failure to transform services through re- commissioning (children, adults,

UCC and MSK) and that inter dependencies

with NHS 111 and other re-commissioned services are not realised - children

Risk Owner Lead

Committee

Next Review

Date

Current RAG Status

Direction of Travel

Selina

Douglas Executive

Committee 01-Nov-2016 Amber

56

29



4 4 16 4 3 12 4 2 8 31-Mar-2017


BAF.09.01a

Engage General Practice/Practice

Council

To inform General Practice on the

changes taking place to Children’s health services and the relationship with

General Practice

Practice Council

presentations.

. Inform and consult NHS

England

Section 75 Agreement

with London Borough of Newahm

Partially Effective

BAF.09.01b Children &

Maternity Commissioning Committee

The main commissioning committee of the CCG for children to provide an input

and to assure themselves that the transformation is consistent with the CCG vision and approach

Children & Maternity Commissioning

Committee minutes and agendas.

Agree London Borough of Newham sign off for ITT

All procurement documentation

Partially

Effective

BAF.09.01c Board Development and Board meetings

For a key transformation Programme the CCG board need to be assured that the programme is on schedule and will

deliver the changes expected and required

Community and Integrated Care Commissioning

Committees minutes and papers.

Engage Future Generations

Contract Management arrangements

Partially

Effective

BAF.09.01d

Quality Committee

Quality Committee will need assurance

that quality indicators are being adhered to and that services will be safe.

Quality Impact

Assessment.

Validation process for

procurement with external representatives

Partially

Effective

BAF.09.01e

Integrated Children's Health Board

The Integrated Children's Health Board

is the joint management forum between LBN and the CCG and collectively own the operational transformation

Integrated Children's

Health Board minutes & papers.

Market bidders event

Partially Effective


BAF.09.01a Board Agreement -

July 2016

31-Jul-2016 Satbinder

Sanghera

Completed

BAF.09.01b B. Invitation to Tender Stage - July/August

2016

31-Aug-2016 Satbinder Sanghera

ITT published in July

Completed

BAF.09.01c Tender Evaluation - September 2016

30-Sep-2016 Satbinder Sanghera

The tender has been completed and we were unable to appoint.

Completed

BAF.09.01d Contract Award -

October 2016

31-Oct-2016 Satbinder

Sanghera

Action closed as we were unable to award the contract and the

tender process is now closed. Completed

BAF.09.01e Contract Starts - February 2017

28-Feb-2017 New contract is in operation On Track

BAF.09.01f BHC Procurement 31-Jan-2017 On Track

BAF.09.01g Negotiations with ELFT

31-Jan-2017 On Track

BAF.09.02 Failure to transform services

through re- commissioning (children, adults, UEC and MSK) and that inter dependencies

with NHS 111 and other re-commissioned services are not realised - adults

Risk Owner Lead

Committee

Next

Review Date

Current

RAG Status

Direction of

Travel

Selina


01-Jan-2017 Red



4 4 16 4 4 16 4 2 8 31-Mar-2017


57

30


BAF.09.02a CCG and LBN

Programme Board for Building

Healthy Communities

(BHC)

Oversight and assurance group for BHC programme

Programme Board minutes, decisions, risk

register and issues log.

NHSE assurance around process for competition

Partially

Effective

BAF.09.02b CG Executive Commitee

Senior oversight of the BHC programme Executive committee minutes and papers.

External validation of ITT submissions and financial costing of bids from

Consultancy/Audit firm

Partially Effective

BAF.09.02c Community and

Integrated Care Commissioning

Committees

Committees to agree care models and specifications for BHC services

Community and Integrated Care

Commissioning Committees minutes and

papers.

Partially Effective

BAF.09.02d CCG Board assurance

CCG Board to authorise approval to advertise procurement, approval of award of selected bidder

CCG Board or delegated subgroup to approve PQQ and ITT

documentation.

Partially Effective


BAF.09.02 a Review of scope of programme and clinical model

at Sept Board Development session

08-Feb-2017 Ian Tritschler Route to market going to Feb Board.

On Track

BAF.09.02b Programme plan

progress, risk register and issues log reviewed at each Programme board, (June 16).

SMT oversight of progress and risks, (June 16).

31-Mar-2017 Currently ongoing and subject to monthly updates and reviews.

On Track


through re- commissioning (children, adults, UCC and MSK) and that inter dependencies

with NHS 111 and other re-commissioned services are not realised - UCC

Risk Owner Lead

Committee

Next

Review Date

Current

RAG Status

Direction of

Travel

Selina


01-Jan-2017 Red



4 4 16 4 4 16 4 2 8 31-Mar-2017


BAF.09.03a Board

to approve procurement against

transformational Outcomes

Develop the specification/s and

procurement programme with a clear set of transformational outcomes.

i) UCWG, and (ii)

procurement group

UEC Network, NHSE

U&EC programme

Partially Effective

BAF.09.03b

Procurement Process

Procurement programme will measure

tender requirements using transformation outcomes in a quantifiable way.

Partially Effective


BAF.09.03a Agree procurement

approach for U&E

14-Dec-2016 Procurement approach to December Board. On Track

58

31


BAF.09.03a Board to approve procurement against

transformational Outcomes

14-Dec-2016 Satbinder Sanghera

Route to market to be taken to Feb Board.

On Track

BAF.09.03b Agree transformation criteria with

UCWG and procurement

14-Dec-2016 Scope to be presented to December Board

On Track

BAF.09.03b Agree transformation critieria with

UCWG and procurement group arrangements by 31 August

2016

14-Dec-2016 Scope agreed and going to Board in December.

On Track


through re- commissioning (children, adults,

UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned

services are not realised - MSK

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel

Selina


01-Dec-2016 Amber



4 4 16 4 3 12 4 2 8 31-Mar-2017


BAF.09.04a

Structured Collaboration

process is approved through a series of

gateways for governance,

clinical model, finance & activity,

and mobilisation

Assurance process to award contract Acute Commissioning

Committee minutes, CCG MSK Steering Group

minutes.

Partially

Effective

BAF.09.04b External consultancy

support through STO Healthcare

Additional expert consultancy support Outputs from Provider Collaboration workshops.

Partially

Effective


BAF.09.04a (i) Meeting with

Barts Health Executive team to agree Trust's commitment to the programme, (June 16)

30-Jun-2016 Ian Tritschler

Completed

BAF.09.04a (ii) Finance & activity model and asumptions to be drafted by provider

collaborative

28-Feb-2017 Ian Tritschler Contract signing and mobilisation by end of Feb 17.

On Track

BAF.10 Failure to implement the improvements agreed in corporate

governance structure

Risk Owner Lead

Committee

Next Review

Date

Current RAG Status

Direction of Travel

Satbinder Sanghera

Executive Committee

01-Dec-2016 Amber

59

32



4 4 16 4 2 8 4 2 8 31-Mar-2017


BAF.10a CCG

Constiution Working Group

The working group will develop options

for changes to the committee structure, constitution, role of clinical leads and

future of cluster leads

Constitution and

committee structures approved by the Board.

Consult LMC

Fully Effective

BAF.10b Practice Council

Practice Council will approve or not the Board’s recommendations to effect and

implement changes

Practice Council minutes.

New Terms of Reference agreed.

Seek Legal Services input

Fully Effective

BAF.10c Board

Meetings and Board Development

sessions

Board and Board Development will need

to consider the proposals of the Constitution Working Group and decide the recommendations to be made to

Practice Council

Board Development and

Board meetings minutes.

Inform and consult NHSE Revised clinical lead roles

Partially Effective

BAF.10d NHSE assurance

NHS England through quarterly assurance meetings will need to be

satisfied that all changes are consistent with national guidance on conflicts of interest and support transformation

NHSE assurance meetings and Domain

assessments. Review of Membership of

all committees approved.

Engage key partners such as LBN

Fully Effective


BAF.10b Consult LMC & Partners - August 16

31-Mar-2017 Satbinder Sanghera

Currently ongoing. Further discussions regarding clinical lead roles

Likely to be Overdue

BAF.10c Engage Member

Practices - August 16

31-Mar-2017 Satbinder

Sanghera

Engagement ongoing

Unlikely to be

Completed on Time

BAF.10d (i) i. Draft Constiutional

Changes - September 16

30-Sep-2016 Satbinder

Sanghera

Linked to the standing order changes being proposed to the

December Board meeting. Likely to be

Overdue

BAF.10d (ii) Practice Council/Board Approval -

October 16

08-Feb-2017 Satbinder Sanghera

Proposals will be made to the December and February Board meetings.

Unlikely to be Completed on

Time

BAF.11 Failure to equip staff, the Board and

clinical leaders with the skills, knowledge and

expertise to enable the delivery of the CCG’s priorities and commissioning agenda

Risk Owner Lead

Committee

Next

Review Date

Current RAG Status

Direction of Travel

Chetan Vyas Executive Committee

Amber



5 3 15 4 2 8 3 2 6 31-Mar-2017


BAF.11a Staff annual appraisals.

Annual review of performance against objectives.

Staff Appraisal forms.

Partially Effective

BAF.11b Actus

performance management

system

System to manage performance against

objectives on a regular basis

Actus Performance

System Reports.

Partially Effective

BAF.11c Staff Development Centre

Development Centre to identify talent and opportunties for CCG staff

Staff Development Centre Dates.

Procurement of provider to deliver Staff Development Centres

Partially Effective

60

33


External reports for individual members of

staff from the Development Centres

BAF.11d Staff

Conference

Celebration of success and future

priorities with CCG staff

Staff Conference on in

June 2016.

Partially

Effective

BAF.11e Board/clinical/clust

er leads development

sessions

Regular development sessions with Board/clinical/cluster leads development

sessions

Board Development Minutes and papers.

Partially

Effective

BAF.11f Board Development Programme

Development programmes for Board Specification Procurement of a provider to facilitate the programme

Partially Effective

BAF.11g

Governance review

Scope to be determined of review and

review undertaken of clinical leadership potentially impacted by the governance

review.

Constitution Working

Group minutes

Partially Effective


BAF.11c Staff training delivery of Development Centres

12-Aug-2016 Chetan Vyas Development Centres have been delivered to all permanent CCG staff, and feedback have been provided at one-to-one's with staff.

Completed

BAF.11ci Staff Training with

launch of staff development programme

23-Sep-2016 Chetan Vyas Staff programme launched in November 2016.

Completed

BAF.11d Develop Board/ Clinical & Cluster Leads Development

Schedule

28-May-2016 Chetan Vyas Development schedule has been developed.

Completed

BAF.11di Develop Board only development programme

30-Sep-2016 Chetan Vyas Board development programme developed and procurement completed November 2016

Completed

BAF.11f Board Development

Programme Session 1

31-Jan-2017 Chetan Vyas Session 1 delivered in January 2017.

Completed

61


Title: Quality Report

Agenda item 3.2

Author: Saem Ahmed, Newham CCG, Head of Quality and Development

Presented by: Dr Stuart Sutton, Newham CCG, Chair of Quality Committee


Chetan Vyas, Newham CCG, Director of Quality and Development, [email protected], 0203 688 2316

This Paper is for: Monitor

Action required: The Board are asked to:

NOTE the actions taken by Newham CCG or CSU on behalf of Newham CCG in relation to the Red and Amber RAG rated Quality Indicators reported on an exception basis. NOTE the assurances provided in relation to the other Quality matters reported on.

62

Executive summary:

The January 2017 Newham CCG Quality Report provides an update against the reported Quality Indicators for the 3 Providers from which Newham CCG commissions health services in addition to providing an update on other quality related matters. Barts Health Green rated areas • Amber Alerts acknowledged within target of 3 working days at 100% • Zero MRSA reported • 8 C.DIFF reported • Safeguarding Childrens Training Level 1 above the 85% target with 92% • Safeguarding Adults Level 1 above the 85% target with 89.6% • VTE Assessment at 99.50% above the 95% target • 22% FFT Maternity Response Rate above the target of 15% • 93.40% FFT Inpatient % recommended the service • 96.90% FFT A&E % recommended the service • 91% FFT Maternity % recommended the service • 90.70% FFT Outpatient % recommended the service Amber rated areas • Safeguarding Childrens Training Level 2 performance at 84.60% slightly

under the 85% target. • Safeguarding Childrens Training Level 3 level 3 performance at 83.90%

slightly under the 85% target. Red rated areas • 12 Mixed Sex Accommodation Breaches reported, however zero on the

Newham site. • 65% Amber Alerts actioned within target of 10 working days, below the

100% target. • FFT Inpatient Response Rate at 8.90% and A&E response rate at 2.20%

below the 15% target. All Red issues are being discussed with Barts Health and assurances are sought on improvement plans and trajectories through the Newham site CQRM meetings and Trust KPI review meetings. East London Foundation Trust – Mental Health Green rated areas • Amber Alerts acknowledged within target of 3 working days • Amber Alerts actioned within target of 10 working days • Zero MRSA reported in June against a threshold of zero • Zero C.DIFF reported in June against a threshold of zero • Discharge notification sent to GP within 48 working hours of patient

discharge is above the target of 95% with 98.30% • Adult inpatient re-admissions within 28 days at 4.90% which is below the

threshold of 7.5% • Smoking status of patients recorded electronically above the 80% target

with 99.50% • Child and Adolescent Mental Health Service DNA rates (CAMHS) below

the threshold of 15% with 4.90%, further information provided on the report

63

• Zero Mixed Sex Accommodation breaches reported

Amber rated areas • Older Community DNA rate is below the threshold of 10% with

performance at 10.30% • Adult Community DNA rates above the threshold of 10% with 13.9%,

further details of actions taken provided on the report • Reduction of medication errors through medicine on admission to hospital

is below the target of 95% with 90.70% • Clinical sharing information with GP slightly under the 90% target with

89.20%, further information provided on the report.

Red rated areas • None reported All Amber issues are being discussed with East London Foundation Trust and assurances are sought on improvement plans and trajectories through the East London Foundation Trust Clinical Quality Review Meetings East London Foundation Trust – Community Health

Green rated areas • Safeguarding Children compliance Level 2 at 87% above the 85% target • Safeguarding Children compliance Level 3 at 99% above the 85% target • No MRSA reported • No c.diff cases reported • VTE Assessments at 100% achieving the target • 100% of Cardiac Rehab patients surveyed were satisfied with the service

against a target of 85% • 80% of adults in Cardiac Rehab achieving independence three months

after entering care/rehab rate per 10,000 (%) against a target of 60% • 100% of Children in Physiotherapy Services who have shown

improvement on agreed Therapy Outcome Measures following direct intervention against a target of 80%

Amber rated areas • 76% of Children in Occupational Therapy Services who have shown

improvement on agreed Therapy Outcome Measures following direct intervention against a target of 80%

Red rated areas • Safeguarding Children compliance Level 1 at 78% below the 85% target • 66.70% of patients in Foot Health Service who have completed treatment

(closed) were satisfied with the service against a target of 80% Other Quality Matters • The Newham CQR/ Oversight and Assurance Meeting took place on 19

January 2017 and details are within the report • ELFT Community Health Services CQRM took place on 1 December

2016 and details are within the report • ELFT Mental Health Services CQRM took place on 8 December 2016 and

details are within the report

64

• Quality, safety and patient experience of London Ambulance Service, further details within the report

• Outcomes of July 2016 CQC inspections at the Royal London and Whipps Cross sites, further information within the report.

Supporting papers: None


Values: Collective clinical leadership Effective & collaborative communication Patient/Public voice throughout our decision making Transparency with our decision-making and leadership Accountability and responsibility Caring culture and behaviour Working with our partners to improve health outcomes

Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Reducing inequalities and improving accessibility Reducing quality variation Ensuring equity of Health and Wellbeing outcomes


Not presented to any meeting ahead of the CCG Board.

Risk: The risks in relation to Barts Health and East London Foundation Trust are

around non-delivery and these are reported on in the appended report. Newham CCG Board Assurance Framework reference BAF.06.

Equality Impact: This document relates to all Newham residents in the 9 protected characteristics

that are covered by the Equality Act 2010 and our Equality Duties.


No consultation has taken place nor is it required for this report.

Integrated Care Impact

A number of quality indicators will have an impact on Integrated Care and the report has been shared with the programme team.

Financial Implications No financial implications for this paper. For information only.

65

Quality Board Report

January 2017

66

Purpose

2

• The purpose of this report is to provide the CCG Board with an update on quality matters across our local Provider organisations.

• The report covers the following providers:

o Barts Health o East London Foundation Trust (Mental Health) o East London Foundation Trust (Community Health)

67

3

Key Headlines Barts Health ELFT (Mental Health) ELFT (Community Health)

• Amber Alerts acknowledged within target of 3 working days

• MRSA • C.DIFF • Safeguarding Childrens Training Level 1 • Safeguarding Adults Level 1 • VTE Assessment • FFT Maternity Response Rate • FFT Inpatient % recommended • FFT A&E % recommended • FFT Maternity % recommended • FFT Outpatient % recommended

• Amber Alerts acknowledged within target of 3 working days

• Amber Alerts actioned within target of 10 working days • MRSA • C.DIFF • Reduction of medication errors through medicines on

admission to hospital • Discharge notification sent to GP within 48 working hours

of patient discharge • Smoking status of patients recorded electronically • Adult inpatient re-admissions within 28 days • Child and Adolescent Mental Health Service DNA rates • Mixed Sex Accommodation Breaches

• Safeguarding Children compliance Level 2 • Safeguarding Children compliance Level 3 • MRSA • C.DIFF • VTE Assessments audit • Duty of Candour clearly presented on all responses

where harm is identified • % of Cardiac Rehab patients surveyed who were

satisfied with the service • Proportion of adults in Cardiac Rehab achieving

independence three months after entering care/rehab rate per 10,000 (%)

• % of Children in Physiotherapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention

• Safeguarding Childrens Training Level 2 • Safeguarding Childrens Training Level 3

• Adult Community DNA rates • Clinical sharing information with GP • Older Adult Community DNA rate

• % of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention

• Mixed Sex Accommodation Breaches • Amber Alerts actioned within target of 10 working

days • FFT Inpatient Response Rate • FFT A&E Response Rate

• Safeguarding Children compliance Level 1 • % of patients in Foot Health Service who have

completed treatment (closed) satisfied with the service

68

Quality Dashboard

4

• Some data for Barts Health is missing as the reporting timetable from Public Health England and NHS England means the data was not available at the time of authoring this report.

• The indicator for Mental Health where * is displayed is due to amber alerts not being reported by general practices. • No data available (ND) for Patients on CPA with diabetes, CHD, COPD HTN and obesity have completed annual physical health check • Barts Health Safeguarding Childrens Training Level 1 is at Trust-wide level, as site level data was not available at the time of authoring this report

Indicator Target/Threshold Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Mixed Sex Accommodation Breaches 0 43 29 42 27 12 16 12 18 17 17 12Amber Alerts acknowledged within target of 3 working days (Newham site) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%Amber Alerts actioned within target of 10 working days (Newham site) 100% 50% 82% 67% 50% 60% 80% 63% 55% 33% 76% 65%MRSA 0 2 2 0 1 2 0 0 1 4 4 0C.DIFF <82 6 0 0 7 4 3 6 8 4 0 8Safeguarding Childrens Training Level 1 (Newham site) 85% 95% 96% 96% 99% 99% 98% 96% 96.5% 91.30% 91.90% 92.00%Safeguarding Childrens Training Level 2 (Newham site) 85% 81% 82% 81% 87% 86% 87% 88.4% 90.2% 87.60% 83.10% 84.60%Safeguarding Childrens Training Level 3 (Newham site) 85% 72.50% 76.60% 80.00% 89.80% 81.60% 84.00% 78.60% 83.8% 85.10% 82.80% 83.90%Safeguarding Adults Level 1 (Newham site) 85% 94% 97% 97% 99% 99% 98% 96% 96% 88.90% 89.50% 89.60%Safeguarding Adults Level 2 (Newham site) 85% 81.40% 81.30% 80.20% 80.80% 80.00% 80.10% 82.90% 84.00% 80.30% 72.50% 77.60%VTE Assessment (Newham site) 95% 99% 99% 99% 99% 98% 100% 100% 99.3% 99.70% 99.70% 99.50%FFT Inpatient Response Rate (Newham site) 15% 8.5% 10.0% 12.0% 14.4% 4.8% 31.8% 10.6% 12.4% 14.90% 15.70% 8.90%FFT A&E Response Rate (Newham site) 15% 0.1% 0.5% 0.5% 0.7% 0.2% 5.9% 2.1% 2.7% 1.7% 2.50% 2.20%FFT Maternity Response Rate (Newham site) 15% 16.2% 29.0% 1.7% 37.8% 31.1% 32.3% 25.6% 21.1% 16.50% 18.20% 22.00%FFT Inpatient % recommended (Newham site) 80% 98% 94% 96% 97% 100% 92.1% 93.90% 93.40% 92.80% 94.61% 93.40%FFT A&E % recommended (Newham site) 80% 100% 92% 93% 92% 100% 83.2% 96.30% 86.90% 89.90% 96.95% 96.90%FFT Maternity % recommended (Newham site) 80% 92.00% 90.50% 96.00% 94.40% 92.26% 90.30% 95.50% 93.50% 96.04% 91.00%FFT Outpatient % recommended 80% 90.00% 92.80% 96.30% 91.80% 91.90% 85.30% 84.20% 90.30% 92.00% 91.41% 90.70%Serious Incidents Reported (Newham site) No target 6 5 3 6 6 7 4 1 3 4 11Never Events Reported (Newham site) No target 0 0 0 0 0 0 0 0 0 0 0

Adult Community DNA rates 10% 12.6% 15.0% 14.4% 16.0% 18.8% 14.9% 16.7% 16.2% 13.9% 12.80% 11.40%Amber Alerts acknowledged within target of 3 working days 100% * * * * * * 100% 100% 100% 100% 100%Amber Alerts actioned within target of 10 working days 100% * * * * * * 100% 100% 100% 100% 100%MRSA 0 0 0 0 0 0 0 0 0 0 0 0C.DIFF 0 0 0 0 0 0 0 0 0 0 0 0Reduction of medication errors through medicines on admission to hospital 95% 98.9% 97.7% 98.0% 69.0% 96.6% 95.2% 97.30% 91.70% 90.70% 94.10% 97.30%Clinical sharing information with GP 90% 89.5% 88.0% 88.6% 85.7% 80.2% 82.4% 86.50% 86.30% 88.00% 89.50% 89.20%Discharge notification sent to GP within 48 working hours of patient discharge 95% 97.3% 95.5% 96.8% 85.8% 88.7% 97.9% 97.90% 98.90% 97.20% 98.00% 98.30%Smoking status of patients recorded electronically 80% 98.9% 97.7% 98.1% 96.0% 97.1% 98.7% 98.3% 98.30% 99.10% 99.50% 99.50%Patients on CPA with diabetes, CHD, COPD HTN and obesity have completed annual physical health check 80% 87.6% 87.9% 81.8% 81.1% 85.8% 85.8% 81.8% 81.80% 78.40% ND ND Adult inpatient re-admissions within 28 days 7.5% 6.4% 8.3% 5.8% 10.7% 6.8% 4.6% 8.70% 8.20% 3.70% 10.00% 4.90%Child and Adolescent Mental Health Service DNA rates 15% 13.5% 16.0% 16.4% 14.5% 13.9% 15.2% 18.1% 16.00% 14.20% 9.60% 6.70%Older Adult Community DNA rate 10% 7.0% 6.2% 12.6% 8.9% 10.7% 9.1% 11.5% 10.80% 9.70% 10.50% 10.30%Mixed Sex Accommodation Breaches 0 0 0 0 0 0 0 0 0 0 0 0Serious Incidents No target 1 1 0 0 2 3 0 1 2 1 3Never Events No target 0 0 0 0 0 0 0 0 0 0 0

Indicator Target/Threshold Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Safeguarding Children compliance Level 1 85% 99% 99% 96% 98.1% 98.7% 100.0% 97% 49% 66% 94% 78%Safeguarding Children compliance Level 2 85% 80% 82% 81% 86.0% 88.7% 88.8% 93% 93% 91% 100% 87%Safeguarding Children compliance Level 3 85% 93% 93% 91% 90.5% 93.4% 97.0% 96% 96% 98% 90% 99%Amber Alerts acknowledged within target of 3 working days 100% 100% 100% 100% * 100.0% 100% 100% 100% 100% * *Amber Alerts actioned within target of 10 working days 100% 100% 100% 100% * 100.0% 100% 100% 100% 100% * *MRSA 0 0 0 0 0 0 0 0 0 0 0 0C.DIFF 0 0 0 0 0 0 0 0 0 0 0 0VTE Assessments audit 100% 100% 100% 100% 100.0% 100.0% 100.0% 100% 100% 100% 100% 100%Duty of Candour clearly presented on all responses where harm is identified 100% 100.0% 100% 100% 100% 100% 100%% of Cardiac Rehab patients surveyed who were satisfied with the service 85% 100.0% 100.0% 100% 100% 100% 100% 92%Proportion of adults in Cardiac Rehab achieving independence three months after entering care/rehab rate per 10,000 (%) 60% 75.0% 63% 65% 70% 48% 80%% of patients in Foot Health Service who have completed treatment (closed) satisfied with the service 80% 85.0% 100% 100% 100% 100% 66.70%% of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention 80% 86.0% 100.0% 95% 95% 79% 100% 76%% of Children in Physiotherapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention 80% 83.3% 100.0% 100% 100% 100% 100% 100%Serious Incidents No target 1 0 0 0 0 0 1 0 1 0 0Never Events No target 0 0 0 0 0 0 0 0 0 0 0

2015-16 2016-17

Barts Health - Newham site

Quarter 1 Quarter 3

East London Foundation Trust - Mental Health

East London Foundation Trust - Community Health

2015-16 2016-17

Quarter 2

69

5

Key Exceptions Indicator Perform.

Dec

Further intelligence Actions taken by CCG

Barts Health

Mixed Sex Accommodation Breaches

17 • Majority of these breaches occur at the Royal London site (8) and Whipps Cross site (4) no breaches from the Newham site.

• The Royal London site breaches come from the Adult Critical Care Unit.

• Action Plan in place for the Royal London site and is monitored at the Royal London site CQRM.

Amber Alerts actioned with 10 working days

65% • The Trust continues to not meet the 10 working day response time, however compared to previous years the number of days of delays have reduced.

• Remedial Action Plan (RAP) is in place to improve performance, the RAP is being monitored at the Newham site CQRM.

Safeguarding Childrens Training Level 2

84.60% • Performance for the Safeguarding training has declined. • This is due to while staff are being trained, further staff training expires,

hence the variation of achievement over the last few months. • A further break down by speciality was provided at the Barts Health KPI

review meeting. • Newham site is under the 85% target. • The Trust has a trajectory in place and reports progress against trajectory

on a regular basis. • Staff requiring training have been identified and are booked on to the

relevant training sessions.

• Continue to monitor progress at the Barts Health KPI review meeting.

• Various actions have been undertaken by the Trust to get to a sustained position, the actions promote further layer of accountability and scrutiny at a local level.

• Joint Health safeguarding sub-group and the CQRM seeking assurances around improving this performance

Safeguarding Childrens Training Level 3

83.90%

Safeguarding Adults Level 2

77.60%

FFT Inpatient and A&E Response Rate

Inpatient 8.90% A&E

2.20%

• Inpatient response rates improved in October with 15.70%, however declined in November (8.90%), A&E performance has been significantly low through the year.

• The main focus is around A&E targets which is seeing significantly low response rates.

• Remedial Action Plan (RAP) is in place to improve performance, the RAP is being monitored at the Newham site CQRM.

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6

Indicator Perform.

Dec

Further intelligence Actions taken by CCG

East London Foundation Trust (Mental Health)

Clinical sharing information with GP 89.20% • The data suggests continuous improvement against the previous reporting months and slightly under the 90% target with 89.20%.

• The Trust anticipates that performance will continue to improve over the coming months to achieve the target.

• The CCG continues to monitor progress at the Service Performance Review Meetings.

Adult Community DNA rates 13.9% • The Trust had submitted an action plan which was being monitored at the Service Performance Review Meeting.

• Over the last 5 months performance is showing a month on month improvement.

• Actions and performance continue to be monitored at Service Performance Review Meetings.

Older Adult Community DNA rate 10.30% • Performance is slightly above the 10%, the Service Performance Review Meeting continues to monitor this target.

• Actions and performance continue to be monitored at Service Performance Review Meetings.

East London Foundation Trust (Community Health)

Safeguarding Children Level 1 Compliance

78% • As reported previously technical issues with OLM system impacted on performance, however the Trust expects performance to improve over the coming months.

• Compliance will be monitored at the CQRM.

% of patients in Foot Health Service who have completed treatment (closed) satisfied with the service

66.7% • This is the first time performance has been below target since reporting.

• At this stage this is not considered to be a trend.

• CQRM is undertaking a deep dive of Foot Health at the February Community Health CQRM .

% of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention

76% • The Trust is currently under the 80% target. • At this stage this is not considered to be a trend or a

ongoing issue.

• The CCG continues to monitor progress at the Clinical Quality Review and Service Performance Review Meetings.

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7

Other quality matters Topic Subject Matter Summary

Barts Health/ Newham site Newham Clinical Quality Review (CQR)/ Oversight and Assurance Meeting

• The Newham CQR/ Oversight and Assurance Meeting took place on 19 January 2017. • The meeting discussed the following areas; o Maternity Deep Dive o Remedial Action Plan (RAP) for FFT, Duty of Candour, Amber Alerts and Complaints. o Analysis around complaints, Datix incidents and serious incidents.

East London Foundation Trust/ Community Health

Newham Community Health Clinical Quality Review Meeting (CQRM)

• The Community CQRM meeting took place on 1 December 2016. • The meeting discussed the following areas; o Cardiac Rehab Service Deep Dive o Accessible Information Standard o CQC Action plans o Improvement trajectory for waiting times o Performance against quality indicators

East London Foundation Trust/ Mental Health

Newham Mental Health Service Clinical Quality Review Meeting (CQRM)

• The Mental Health CQRM meeting took place on the 8 December 2016.. • The meeting discussed the following areas; o Quality Improvement around waiting times and DNAs. o Eating Disorder Service o CQC Action plans o Performance and assurance against quality measures.

London Ambulance Service (LAS)

Quality, safety and patient experience of London Ambulance Service

• The WEL CCGs are represented by the Director of Nursing, Quality and Governance from WFCCG at the London Ambulance Service CQRM and following recent discussions at the WELC and BHR Quality Leads meeting it was agreed that that our collective concerns regarding safety, quality and patient experience were escalated to the CQRM. They have also been formally escalated to NHSE and the Care Quality Commission.

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8

Topic Subject

Matter

Summary

Royal London Hospital CQC Report

CQC re-inspection

• The CQC inspected Royal London Hospital in July 2016. • The inspectors reviewed eight core services: Urgent and Emergency Care, Medicine (including older people’s services), Surgery , Critical Care,

Maternity and Gynaecology, End of Life Care, Services for Children and Young People and Outpatients and Diagnostics. • Overall the Royal London Hospital has improved from a rating of Inadequate in 2015 to Requires Improvement in 2016. • The table below shows the comparison between the 2015 and 2016 CQC report outcomes

• Full report can be found here http://www.cqc.org.uk/location/R1H12

Whipps Cross Hospital CQC Report

CQC re-inspection

• The CQC inspected Whipps Cross Hospital in July 2016. • The inspectors reviewed eight core services: Urgent and Emergency Care, Medicine (including older people’s services), Surgery , Critical Care,

Maternity and Gynaecology, End of Life Care, Services for Children and Young People and Outpatients and Diagnostics. • Overall there was improvement with no overall ratings deteriorating, Maternity and Gynaecology moved from Requires Improvemen t to Good and

Children’s and Young People services from Inadequate to Good. • The table below shows the comparison between the 2015 and 2016 CQC report outcomes Full report can be found here http://www.cqc.org.uk/location/R1HKH

Direction Direction Direction Direction Direction Direction

2015 2016 2015 2016 2015 2016 2015 2016 2015 2016 2015 2016

Medical Care Same Same Same Same Same Better

Urgent and Emergency Services Same Same Same Worse Better Same

Surgery Better Better Same Worse Same Same

Intensive/critical care Same Same Same Better Worse Same

Maternity and Gynaecology Worse Same Same Worse Worse Worse

Services for children and young people Better Better Same Same Same Better

End of Life Better Same Better Better Same Better

Outpatients Same Same N/A Same Same Better

Overall Better Better Same Worse Same Better

Overall Responsive Well-ledSafe Effective Caring

Direction Direction Effective Direction Direction Direction Direction

2015 2016 2015 2016 2015 2016 2015 2016 2015 2016 2015 2016

Medical Care Better Better Better Better Same Better

Urgent and Emergency Services Better Better Same Same Better Better

Surgery Same Same Same Same Same Same

Intensive/critical care Same Same Same Same Better Same

Maternity and Gynaecology Better Same Same Same Better Better

Services for children and young people Better Better Better Same Better Better

End of Life Better Better Better Worse Same Better

Outpatients Same Same N/A Better Same Same

Overall Same Better Better Same Same Same

Caring Responsive Well-ledOverall Safe

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http://www.cqc.org.uk/location/R1H12

http://www.cqc.org.uk/location/R1HKH


Title: Finance Report Month 9

Agenda item 3.3

Author: Lei Wei, Deputy Chief Finance Officer Newham CCG Presented by: Chad Whitton, Chief Finance Officer Newham CCG


Chad Whitton, Chief Finance Officer Newham CCG Lei Wei, Deputy Chief Finance Officer Newham CCG

This Paper is for:

Decision

Action required:

The Board is asked to • Note and approve the 2016/17 Month 9 Finance Report (Appendix 1) • Note the internal budget setting process and timetable for 2017/18. • Note progress in developing the 2017/18 QIPP programme.

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Executive summary:

The CCG received details of its allocations in December and submitted a draft final Five Year Operating Plan on 18th May 2016. Changes to the CCG business requirements set by NHSE and the confirmation that no draw-down on the surplus would be allowed for 2016/17 has added an additional pressure of approximately £6.5 million. The Finance Team worked with budget holders to identify roll-over budgets from February 2016. To manage the additional financial pressures, the CCG is implementing an additional saving programme targeted at delivering at least £5 million further savings. The programme ensures that funding essential to deliver the key CCG objectives is made available, but this will be tightly managed and will need to be held within agreed cash envelopes. A five year QIPP Plan has also been developed. Significant locally based QIPP has been identified for 2016/17 with the bulk of savings being delivered through the Transforming Services Together (TST) programme in later years. In 2016/17 the QIPP target is £12.27million. There is no planned capital spend in 2016/17. The budget, together with the additional saving targets for 2016/17 has been signed off by senior management team and budget holders. Details on the financial plan, budgets, reserves and QIPP were agreed at the CCG Board meeting in June 2016. It is noted by the Board that there has been increasing financial challenges during the year, and to maintain the financial sustainability of the organisation, the Board approved a further set of savings measures on 9th November. A summary of the allocations and budgets, comparatives and the performance as at Month 9 is shown in the table below:

At 2016/17 Month 9 the CCG total resource allocation was £483,379,000 with planned expenditure, including reserves of £476,879,000 generating a surplus of £6,500,000 (1.5%). The projected QIPP delivery is currently on track. The CCG is also contributing to a North East London (NEL) Five Year Sustainability and Transformation Plan (STP). An initial version was submitted at the end of June with an update in September and the final plan submitted on 21st October. The CCG submitted the updated 2017/19 Operating Plan Financial Template on 23rd December 2016, reflecting all the contract values agreed during the national contract

Area 2015/16 Final Outturn

2016/17Annual Budget

2016/17Cumulative

Budget

2016/17Cumulative

Actual

Cumulative Variance

Projected Final Outturn

£'000 £'000 £'000 £'000 £'000 £'000Acute Services 228,311 237,254 177,950 177,880 (70) 237,069Mental Health 46,110 46,442 34,844 35,263 419 46,744Community Health 40,437 40,548 30,442 30,532 90 40,644Other Non-Acute 47,925 37,526 27,985 27,288 (697) 36,418Primary Care 101,285 98,264 74,024 74,280 256 99,158Reserves 0 9,429 0 0 0 9,429Running Cost 7,266 7,416 5,562 5,562 0 7,416Total Spend 471,334 476,879 350,807 350,805 (2) 476,879

Total Allocation (477,852) (483,379) (355,682) (355,682) 0 (483,379)

(Suplus)/Deficit (6,518) (6,500) (4,875) (4,877) (2) (6,500)

75

negotiation process. The Plan also aligns with the final NEL STP submission on 21st October 2016. The CCG is developing its 2017/18 QIPP programme in detail and this is described in Appendix 2. The CCG’s internal budget setting for 2017/18 started from December 2016, with refreshed guidance on process and timetable being communicated to all budget holders and budget managers on 13th December. It is expected that the budget will go through a process of challenge and rigour at the CCG Senior Management level. All the budget holders and budget managers are required to present their draft budget to the CCG Senior Management Review Panel by 17th February 2017. Finance team will work closely with budget holders and budget managers and support them in preparing the presentations and resolving queries arising from the Panel review. The final draft budget will be presented to the Panel by 24th March 2017 and signed off by 31st March 2017 to get ready for the April Board approval. The Board and Executive Committee will receive updates at each meeting. It is a Board duty for the CCG to manage within the resources provided to it and achievement of our financial targets will therefore be an overriding priority. The CCG is currently reporting a balanced financial position to NHSE. The successful implementation of our QIPP and savings programmes, combined with effective management of agreed budgets will be a key component of our ability to deliver this target.

Supporting papers:

Appendix 1 – Newham CCG Finance Report Month 9 2016/17. Appendix 2 – QIPP development 2017/18.


Values: Accountability and responsibility – Requirement to meet target surplus

Aims: Ensuring equity of Health and Wellbeing outcomes


The Month 9 financial position has been reviewed in detail by the Finance Committee and Executive Committee.

Risk: The Financial Plan and effective Financial monitoring, reporting and control (including the

QIPP programme) as identified in the Finance and Activity Plan is an essential component in identifying and managing financial risk and ensuring the CCG delivers its statutory financial requirements. The risk of failure to deliver this is identified specifically in BAF.05

Equality Impact:

Effective delivery of the financial plan will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham.


This report has been subject to no specific prior consultation but reflects any comments from NHSE scrutiny and assurance processes and any comments, queries or suggestions raised by CCG members, the Board or Newham residents in relation to earlier reports.

76

Financial Implications

The report provides a high level view of the CCG’s financial performance for 2016/17 and planned spending, QIPP and other savings programmes for 2016/21 to secure financial sustainability for the next five years.

77

3.3 - Appendix 1 Newham CCG Board – 8 February 2017

CCG 2016/17 Month 9 Outturn

Month 9 Outturn At 2016/17 Month 9 the CCG total resource allocation was £483,379,000 with planned expenditure, including reserves of £476,879,000 generating a surplus of £6,500,000 (1.5%). This is summarised in the table below.

A more detailed analysis of expenditure is given in the Month 9 Activity and Finance Report provided by CSU to relevant CCG Commissioning Committees and by the CFO to the Finance Sub-Committee (26 January 2017). The Month 9 Report was also considered by the January Executive Committee. Detailed budget analysis is provided and an update on the savings programme will be tabled for discussion at each meeting.

Area 2015/16 Final Outturn

2016/17Annual Budget

2016/17Cumulative

Budget

2016/17Cumulative

Actual

Cumulative Variance

Projected Final Outturn

£'000 £'000 £'000 £'000 £'000 £'000Acute Services 228,311 237,254 177,950 177,880 (70) 237,069Mental Health 46,110 46,442 34,844 35,263 419 46,744Community Health 40,437 40,548 30,442 30,532 90 40,644Other Non-Acute 47,925 37,526 27,985 27,288 (697) 36,418Primary Care 101,285 98,264 74,024 74,280 256 99,158Reserves 0 9,429 0 0 0 9,429Running Cost 7,266 7,416 5,562 5,562 0 7,416Total Spend 471,334 476,879 350,807 350,805 (2) 476,879

Total Allocation (477,852) (483,379) (355,682) (355,682) 0 (483,379)

(Suplus)/Deficit (6,518) (6,500) (4,875) (4,877) (2) (6,500)

Primary care service budget

Please note that for NHSE reporting purpose, the annual budget for acute services include 'acute reserves' which are the funding put aside from general reserves to specifically manage overspend on acute services. As at M9 , £3,838k is committed as 'acute reserves'

Acute service budget

Please note that for NHSE reporting purpose, the annual budget for primary care include 'Primary care Reserves' which are the funding put aside from general reserves to specifically manage overspend on primary care services. As at M9, £768k is committed as 'primary care reserves'

78

The table below shows the financial performance of the CCG’s main acute providers in Month 9 2016/17.

The increase in spend on the acute sector is currently projected 3.8% higher than the 2015/16 outturn. This continued net cash growth presents a significant constraint on investments in integrated care, primary care and other CCG priorities and a challenge to CCG financial sustainability. Collaborative programme management. Since inception the CCG has participated in collaborative arrangements including WELC risk share, Acute commissioning and Transforming Services Together. These arrangements are ongoing and are now in the process of being augmented by participation as a core element of the North East London STP. The Board has at various times provided approval for participation and agreed funding through the Annual budget setting process with detailed analysis, be it of programme or contract components reviewed in relevant service committees or the Executive Committee. However, following discussion at the Audit Committee it was agreed that in the light of continuing and expanding collaborative arrangements over the next period it would be appropriate for the Board to be informed of the CCG’s participation in such arrangements where there is a funding implication. Current CCG support and/or participation in arrangements in 2016/17 is summarised in the table below:

Acute over-performance 2015/16 Final

Outturn

2016/17 Annual Budget

2016/17 Projected

Final Outturn

2016/17 Projected

Final Variance

% Variance

on contract

% Variance on 15/16

FOT

£'000 £'000 £'000 £'000 % %Barts Healthcare 176,000 182,761 183,676 915 0.5% 4.4%Homerton 6,057 6,399 7,548 1,149 18.0% 24.6%Guys & St Thomas 2,612 2,775 3,412 637 23.0% 30.6%Moorfields 4,103 4,246 4,488 242 5.7% 9.4%BHRUT 3,680 4,076 3,701 -375 -9.2% 0.6%UCLH 4,008 4,700 4,972 272 5.8% 24.1%BMI 2,576 2,492 2,618 126 5.1% 1.6%Other 29,275 29,805 26,654 (3,151) -10.6% -9.0%Total Spend 228,311 237,254 237,069 (185) -0.1% 3.8%

79

QIPP In the Finance and Activity Plan the net QIPP Programme is £12,269,000, including £150,000 for Primary Care Commissioning. The delivery of QIPP savings in 2016/17 was crucial in enabling the CCG investment plans to be fully rolled out. In Month 9 the CCG reported projected achievement of £12,269,000 against the target as detailed below.

Collaborative Arrangement

Type of commitment 2016/17 Commitment £'000

Monitoring and control Lead Officer

Risk Share (NEL) NHSE require 1% uncommitted reserve holding

4,686 Held and identified in reserves. Any proposed move will be reported to Exec Committee and Board

CFO

Collaborative Commissioning Committee (CCC)

Acute Contracting, monitoring, reporting and performance management

225,305 Summarised in Month Board Report - Detail provided to Executive Committee, Finance Committee and Acute Committee.

CO

WEL TST Programme TST Programme Management and Service leads, CCC Management and CSU MDT.

1,050 TST Programme Board, WEL Joint Management Team and CCC (note CCG Board and Clinical leads engaged in TST programmes)

CO

NEL STP STP Programme Management to built full STP and provide STP (including financial plan to NHSE/I)

250 STP Programme Board participation and STP reports to Board.

CO

WEL TST Business Cases

Support for TST specific programmes (including IT)

750 TST Programme Board plus specific Business Case summaries to Board Members for input to budget holder (CO)

CO

MH Collaborative Commissioners

Joint Mental Health commissioning for ELFT

41,919 Mental Health Committee DCO

Service areas InitiativeAnnual target

£m Scheme details

Year to date target at M9

£m

Year to date at M9£m

Forecast outturn at M9

£m

Acute services Care Closer to Home (IC/PrimCare broad schemes) 2.00 TST assumptionsCare Closer to Home (specific schemes) 0.80 TST assumptionsIn Hospital (inc OP and Prod) 2.10 TST assumptionsUrgent Care - Projected additional saving 0.73 Saving target built in the agreed contract

5.62Community Health Services Community Contract - Rapid Response 0.75 Saving target built in the agreed contract

Community estates 0.30 Saving target built in the agreed contract1.05

Mental Health Services Mental Health - Triage Ward 1.45 Saving target built in the agreed contractMental Health Contract- Raid 0.30 Saving target built in the agreed contract

1.75Other Programme Services Better Care Fund 1.11 Saving target built in the agreed contract

Estate 0.80 Saving target built in the agreed contractTST PMO Programme 0.75 Saving target built in the agreed commitment

2.66Primary Care Co-Commissioning Primary Care List size 0.15 NHSE QIPP target and assumption

0.15Primary Care services Minor Ailments Transfer to NHSE 0.29 Saving agreed with NHSE

Prescribing 0.75 CCG's local schemes1.04

Grand Total 12.27 9.20 9.21 12.270.78 0.78 1.04

2.001.99

0.11 0.11 0.15

4.22 4.21 5.62

0.79

2.66

0.80 1.05

1.31 1.31 1.75

80

The 2016/17 QIPP performance will be monitored regularly by the Executive Committee. Further savings amounting to £5m were identified as part of the budget setting process. The CCG is struggling to deliver these fully and while it continues to target these it was acknowledged in the October report that further savings measures were required.

It was reported to the November Board the CCG faces a significant financial challenge a further savings target of £2.4m was approved. Financial controls are also being strengthened. The successful delivery of these targets will assist the CCG to deliver its business requirements and progress in achieving the targets will also be reviewed through the Executive Committee.

The projected delivery of the agreed programme is as follows:

An update on the progress of key schemes including referral management will be provided to the Board.

The Board should note that at this point in time all reserves are committed against anticipated required spending, including £1m identified for 2016/17 TST investments and £2m Primary Care Risk and Innovation Reserve.

The CCG is currently developing the 2017/18 QIPP programme. Progress on this is described in Appendix 2.

Capital There is no planned capital spending for 2016/17.

Additional Savings Scheme (Approved by November Board)

Target saving December January February March Variance from target

Notes

Interim/Contract staff review 500,000123,000 144,000 192,000 205,000 -164,000

Based on known agreements/plan

Permanent staff options - recruitment freeze, offer part-time or unpaid leave.

50,0005,000 10,000 15,000 20,000 0

To be determined against payroll

Clinical and Board sessional costs 200,00028,512 28,512 28,512 28,512 85,952

Based on response to Chair's letter

Building Income from additional letting/charging

10,00010,000 0

Discussions in progress

Referral Changes - TOPS - letter to GPs. 50,00010,000 20,000 20,000 0

Letter to GPs - Impact to be identified in February

Referral Changes - Path tests 80,000

6,000 4,000 6,000 18,000 46,000

£10,000 at M8 - Projection on increased use in Q4

Referral changes - all services - CATS, PN or Clin lead review

60,00010,000 20,000 30,000 0

Letter to GPs - Scheme rollout wef 12th December

Extract funding from TST/STP 50,000 50,000 0 To be negotiatedPrescribing 300,000

100,000 100,000 100,000 0Letter to practices 25th November.

Incentive scheme scheduling 900,000900,000 0

Payment confirmed but to be reviewed

Federation 300,000 0 300,000 To be determined in discussionTotal 2,500,000 162,512 306,512 381,512 1,381,512 267,952

Savings - Actual and Projected/Required

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QIPP Development and finalisation 2017/18 This paper updates the NCCG Board on progress in delivering the CCG QIPP requirement for 2017/18 and beyond. Background The November Executive Committee agreed a process for identifying QIPP for the 2017/21 period. This is approximately 2.5% per annum and can be summarised as follows: The QIPP requirement for the remaining period of the Five Year Forward View is currently as follows: 2017/18 - £13,377,000 2018/19 - £12,653,000 2019/20 - £13,008,000 2020/21 - £13,493,000 Total - £52,531,000 The key components of the process are as follows: Stage 1 Existing QIPP plan validation

Existing QIPP plans are refreshed, revalidated and assured through the agreed governance process Target completion end December 2016

Stage 2 Stakeholder generation

Budget holders and other key stakeholders are requested to identify QIPP ideas using a simple template. Following review an MDT will develop selected schemes for formal validation Target completion date – end January 2017

Stage 3 QIPP generation against target

The QIPP gap balance will be allocated as a target to Budget Holders via SMT. SMT leads will work with budget holders to identify QIPP efficiencies to meet the target. Target completion date – end January 2017.

82

Progress to date On 23rd December the CCG provided details of the 17/18 and 18/19 QIPP in the Operating Plan Financial Template as indicated below:

Additional detail was provided as shown in the attachment.

CCG Year Income/Expenditure Line QIPP Type Intervention descriptionRecurrent Saving

STP related (Y/N) STP solution

NHS Newham CCG 17/18 Acute contracts -NHS (includes Ambulance services) Transformational Service Re-design and Pathway Changes Referral management for optimising care pathways 4,951- To be confirmed TSTNHS Newham CCG 17/18 MH contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 3,094- To be confirmed InfrastructureNHS Newham CCG 17/18 CH Contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 1,238- To be confirmed InfrastructureNHS Newham CCG 17/18 Other Programme Services Transformational Service Re-design and Pathway Changes Diagnostic and TST schemes roll out 1,857- Yes TSTNHS Newham CCG 17/18 Community Base Services Transformational Service Re-design and Pathway Changes Optimising prescribing and other benchmarking (right care) 1,238- No n/aNHS Newham CCG 18/19 Acute contracts -NHS (includes Ambulance services) Transformational Service Re-design and Pathway Changes Referral management for optimising care pathways 5,061- To be confirmed TSTNHS Newham CCG 18/19 MH contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 3,163- To be confirmed InfrastructureNHS Newham CCG 18/19 CH Contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 1,265- To be confirmed InfrastructureNHS Newham CCG 18/19 Other Programme Services Transformational Service Re-design and Pathway Changes Diagnostic and TST schemes roll out 1,898- Yes TSTNHS Newham CCG 18/19 Community Base Services Transformational Service Re-design and Pathway Changes Optimising prescribing and other benchmarking (right care) 1,265- No n/a

25,030

List of QIPP Schemes

Brief explanation of Scheme Existing or NewRurrent or

Non recurrent Total scheme value

(pre-risk adjustment) Risk adjustment

Risk Adjusted QIPP

Investment to deliver QIPP* Net QIPP

Proportion phased into

second half of FY 17/18

Proportion built into contracts Rag Rating Note

Point of Delivery eg OP, NEL, EL

Decrease in activity

Reducing Unnecessary Dignostics (TST)

Reduction in GP direct access imaging and pathology requests via educational and behavioural changes

New Recurrent 2.1 -25% 1.6 0.0 1.6 50% 100%

Green

See business case Direct Access -7%

Outpatient Referral Management (ReFas)

Reduction in OP attendances via GP referral mgt processes

New Recurrent 0.7 0% 0.7 0.0 0.7 50% 100%Green

See business case OPFA -1%

ProductivityBHT productivity for C2C,Fups etc. Existing Recurrent 0.9 0% 0.9 0.0 0.9 50% 100%

GreenNEL -1%

MSK OP and DiagnosticsStructured Collaboration with gain/loss risk share. New Recurrent 1.4 0% 1.4 0.0 1.4 50% 100%

GreenOP 0%

Cardiology Rollout of 15/16 business case New Recurrent 0.3 0% 0.3 0.0 0.3 50% 0% Green OP n/a

Mental Health QIPP ProgrammeService efficiency through ward consolidation New Recurrent 0.6 0% 0.6 0.0 0.6 50% 100%

Greenn/a n/a

Mental Health OOS/NCA reductions Existing Recurrent 1.0 50% 0.5 0.0 0.5 50% 100% Red n/a n/a

Community ContractEfficiencies and service reconfiguration New Recurrent 0.8 0% 0.8 0.0 0.8 50% 100%

Greenn/a n/a

UCC/ED ReductionsRe-profiling of activity through triage as per UCC contract Existing Recurrent 1.5 25% 1.1 0.0 1.1 50% 100%

AmberDelivery of existing UCC contract targets ED n/a

Prescribing GP Programme Roll-out Existing Recurrent 1.0 0% 1.0 0.0 1.0 50% 0% Green n/a n/a

PrescribingAcute-based prescribing reduction programme Existing Recurrent 0.3 0% 0.3 0.0 0.3 50% 0%

GreenPart of WEL based initiatives n/a n/a

CCG PremisesAsset utilisation - CCG estate including deleg and CHN Existing Recurrent 1.0 0% 1.0 0.0 1.0 50% 0%

Greenongoing n/a n/a

PMO consolidation TST and CCG New Recurrent 1.5 0% 1.5 0.0 1.5 50% 0% Green ongoing n/a n/aOther Inc CSU SLA Existing Recurrent 1.0 30% 0.7 0.0 0.7 60% 10% Amber ongoing n/a n/a

Total 14.1 12.4 0.0 12.4

* Note these are the costs of investment and reprovision and not the N/R costs of project management

Net QIPP RAG definitions10.1 Green 81%1.8 Amber 15%0.5 Red 4%12.4

83

The initial trawl of staff response has been returned and is currently being reviewed for further development. In total £2.276 new QIPP has potentially been identified. A review of the proposals has identified a number of key areas for further action including:

• TST Diagnostics • Cardiology • Prescribing • ReFas Demand Management • Dermatology/Community Ophthalmic

A decision matrix and a business case format have been developed and these will be tabled at the meeting. Next Steps • A QIPP Group has been established (Selina, Wayne, Chad, Lei) that meets bi-weekly to oversee progress (Chetan will be brought in for prescribing). • Initial options are being reviewed and best options will be followed up. • Targets are being provisionally identified to ensure QIPP coverage as part of the budget setting round. This will be initially discussed with budget

holders and will be applied subject to progress in identifying QIPP. • A detailed analysis and review will be undertaken at the 31st January SMT and an detailed position with progress on key targets provided to the

February Executive Committee. Concerns/Risks • Currently the initial ideas require significant development and this will be undertaken in targeted approach that reflects capacity and vfm. • The budget round is primarily designed to ensure overall financial position is manageable rather than simply a QIPP target so a safety net not an

alternative. However, the intention is to ensure that budgets are set to deliver financial sustainability regardless of whether QIPP is fully delivered. • As yet there is limited focus on years beyond 17/18. This needs to be developed, particularly as a number of schemes may require a longer gestation to

achieve maximum effectiveness. • The CCG will continue to be required to deliver data to NHSE (eg Triangulation of expectation and QIPP risk due 27th Jan). It will be important to ensure

fully worked up schemes are synthesised with information provided to NHSE.

84

Newham CCG Board

08 February 2017 Title: Governing Body Structure and Constitutional Change Agenda item: 3.4

Author:

M Sims Board Secretary Newham CCG

Presented by:

S Sanghera Director of Partnerships and Governance Newham CCG


S Sanghera Director of Partnerships and Governance Newham CCG , [email protected]; 020 3688 2388


☒

Monitor

☐

Discuss

☐

Information

☐

Action required:

• Agree the recommended constitutional changes in relation to; Rotation of Retirement for Board members Maximum Terms of Office for Board members The Constitutional position of the Lay Vice (Deputy) Chair

Executive summary: • Board agreed a series of changes for a revised Governing Body structure

and constitutional changes at its December 2016 meeting • Board was advised that the Constitution Working Group was still yet to

consider some final recommendations which would need to be returned in February for decision.

• This report asks Board to consider those changes; o Rotation of Retirement for Board members o Maximum Terms of Office for Board members o The Constitutional position of the Lay Vice (Deputy) Chair

Supporting papers:

• None


. Values:

• Collective clinical leadership. • Effective & collaborative communication. 85


• Patient/Public voice throughout our decision making. • Transparency with our decision-making and leadership. • Accountability and responsibility.

Aims:

• Improving health outcomes through developing models of integrated care and focusing on prevention.

• Reducing inequalities and improving accessibility. • Reducing quality variation.

This report has been presented at: • No previous meeting

Risk: BAF.10 - Failure to implement the improvements agreed in corporate

governance structure Equality Impact:

• The Constitution sets out the CCG’s obligations in relation to equalities and diversity including compliance with the Equality Act 2010. The revised structure must incorporate the CCG’s public sector equality duties three aims to be able to support the CCG’s commitment to reduce health inequalities. The memberships of Committees should also reflect the CCG’s long held commitment to PPE.

Stakeholder engagement: • Constitution Working Group (CWG) – January 2017

Financial Implications: •

1. Proposed changes 1.1 1.1.1 1.1.2 1.1.3 1.1.4

Rotation of Retirement Board has agreed rotation of retirement for GP Members only on the Board CWG proposed to establish a 4 and 4 split of the 8 cluster seats with elections each alternate 2 years but retaining 2 year terms of office i.e. • Group 1 – 4 retirements / elections in 2018 • Group 2 - 4 retirements / elections in 2019 then • Group 1 – 4 retirements / elections in 2020 • Group 2 - 4 retirements / elections in 2021 And so forth Given there will shortly be 2 vacancy elections in Clusters South 1 and South 2 GWG proposed these two constituencies should logically be included in Group 2 i.e. no retirements until 2019 Consequently GWG needed to recommend which 2 further constituencies are included in

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1.1.5 1.1.6 1.2 1.2.1 1.2.2 1.2.3 1.2.4 1.2.5 1.2.6

Group 2 and therefore which 4 will therefore be in Group 1 Options considered; By area – choose 2 more “south” constituencies or 2 more “north” areas for group 2, or by some other geographical logic By volunteer – consult the remaining 6 GP Board members and ask if they intend to retire in 2018 and use this as the constituency template for rotation going forward in terms of the 4 and 4 split By drawing lots – if none or if there are up to three volunteers for retirement in 2018 then draw lots from those who have not volunteered for however many retirements are required – then use this as the constituency template for rotation going forward in terms of the 4 and 4 split CWG recommended that the six existing GP Board Members should be approached informally to determine the four constituencies that will be classified in Group 1. If no consensus can be obtained then lots should be drawn as required to determine the constituencies. This would then fix the rotation of the eight clusters in two groups that would be written into the Constitution. Maximum Terms of Office Generally it is recognised that having maximum terms of office is part of a good governance model along with rotation to ensure there is appropriate balance on a Board between continuity and change. Who would be affected - CWG proposed a maximum term of six years’ service for all the following Board Members; • Elected GP Members • Lay members • Secondary Care Consultant • Registered Nurse • Co-opted members • Elected Practice Manager Member • Elected Practice Nurse Member A Six Year Term - It is proposed that this means six years not just 6 consecutive years but any 6 years i.e. a break in service followed by a return of a further 2 years is only permissible if only 4 years or less have already been served. Additionally where a board member retires from office before the end of an existing 2 year term then any return to office would require consideration of the time already served Lay members, Secondary Care Consultant and Registered Nurse appointments - It is proposed that these posts remain on 2-year terms but that the Board has the option to extend them by two lots of 2 years each two years following expiry of the original 2 years i.e. 2 original years plus maximum of further 4 years. Rotation of these appointments occurs by default given contracts are agreed and expire on different cycles Date of implementation – CWG considered the relative merits or recommending any retrospective implementation date ; For – without retrospective implementation the CCG Board will have permitted its members to, theoretically, remain on the Board for a period of 10 years since 2013 Against – current board members have taken their posts based on the current constitutional position that there is no maximum term of office – theoretically they may not have stood for appointment had this not been the case CWG recommended that implementation should be retrospective for all relevant Board members, effective from the date the CCG was formally authorised on 1st April 2013 although the effective date for GP members would be 31st June 2013 to synchronise with the GP election cycle. 87

1.3 1.3.1 1.3.2

Constitutional position of Lay Vice (Deputy) Chair The current wording of the Constitution vests the post of Lay Vice (Deputy) Chair specifically in the role of the lay member for PPE although this is not an NHSE statutory requirement and the NHSE template constitution does not stipulate this. CWG therefore recommended this should be amended to state that the role of the Deputy Lay Chair would be a Chair appointment in line with the appointments of the Joint and Joint Deputy Clinical Chairs which would be therefore logical in terms of how the CCG appoints all its deputy posts on the Board as well as being more equitable.

2. Next Steps 2.1 • Consultation with Practice Council

• Consultation with LMC • Approval of NHSE sought

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Newham CCG Board

08 February 2017 Title: Conflict of Interests Policy/ Gifts, Hospitality and Anti - Fraud and Bribery Policy

/ Commercial Sponsorship Policy Agenda item: 3.5

Author:

M Sims Board Secretary Newham CCG

Presented by:

S Sanghera Director or Partnerships & Governance NCCG


S Sanghera Director of Partnerships & Governance; [email protected]; 020 3688 2388


☒

Monitor

Discuss

Information

Action required:

• Approve the Conflict of Interests Policy, Gifts, Hospitality and Anti - Fraud and Bribery Policy and Commercial Sponsorship Policy

• Approve Audit Committee’s recommendation for failure to comply with the requirement to complete regular Declaration of Interest returns for Board members, Clinical and Cluster Leads

Executive summary: • Asks the Board to consider the recommendations of the Audit Committee in

relation to revisions to the Conflict of Interests Policy/ Gifts, Hospitality and Anti - Fraud and Bribery Policy and a new Commercial Sponsorship Policy primarily based on guidance issued by NHSE in June 2016.

• Asks the Board to approve Audit Committee’s recommendation for failure to comply with the requirement to complete regular Declaration of Interest returns; i.e. that where Board Members, Clinical or Cluster leads fail to complete declarations within an appropriate timescale that CCG pay should be suspended.

Supporting papers:

a) Appendix A - CCG Conflicts of Interest Policy b) Appendix B - Gifts, Hospitality and Anti - Fraud and Bribery Policy c) Appendix C - Commercial Sponsorship Policy

How does this fit with Newham CCG

. Values: 89


Strategy: • Transparency with our decision-making and leadership. • Accountability and responsibility.

Aims:

• Reducing inequalities and improving accessibility. • Reducing quality variation.

This report has been presented at: • Audit Committee 19/1/17

Risk: • Failure of the organisation to adopt a workable and transparent model for

decision making in terms of the management of conflicts gifts, hospitality and sponsorship risks commissioning decisions being made which are potentially prejudicial or corrupt or perceived as such.

Equality Impact:

• The Constitution sets out the CCGs obligations in relation to equalities and diversity including compliance with the Equality Act 2010.


• Audit Committee 19/1/17

Financial Implications: • The potential additional cost if the proposed sponsorship policy is approved

is under £22,000 and as such would be affordable within the existing budget framework. The potential cost will be reviewed on a six monthly basis and any requirement for additional support be brought forward for discussion at the Executive Committee

1. Introduction and Background 1.1 1.2 1.3

New NHSE Guidance

In June 2016 NHSE updated the statutory guidance following the previous iteration in December 2015. The CCG had already revised its policy in March 2016 and the revisions proposed to the policy now reflect the requirements stipulated in the June revision. The key features of the new guidance from the previous version are; Conflicts of Interest • An extended scope of the definition of interests, in particular introducing detail on the

potential conflict of secondary employment and personal interests • Extending the requirement for declarations to be made by all CCG staff or office

holders as well as GP Partners in Practices and the requirement to refresh them six monthly as opposed to three monthly

• The appointment of a Conflicts Guardian (Lay Member) • The requirement for an annual internal audit of conflicts management and its review

by the Audit Committee • The requirement to ensure the Lay Member Chair of Audit is not also the Lay Chair

of the Primary Care Commissioning Committee • Online annual mandatory training for all CCG staff or office holders as well as GP

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1.4 1.5 1.6

Partners in Practices

Gifts

• All gifts offered to CCG staff, Board Members, Clinical Leads and Cluster Leads and to Member Practices by suppliers or contractors must be declined whatever the value and declared.

• Gifts from other sources should also be declined if it give rise to perceptions of bias or favouritism. Only exception is gifts less than £10 in the form of stationery, calendars, dairies, etc.

• All cash gifts must be declined and declared.

Hospitality

• Modest hospitality can be accepted as long as it is on the same basis provided by the CCG (tea, coffee, refreshments). This kind of hospitality does not need to be declared unless offered by suppliers or contractors (currently or prospectively).

• Hospitality that goes beyond being modest should not be accepted such as : o Value over £25 and o Offers of foreign travel and accommodation

• In some circumstances this could be accepted but express prior approval should be sought. However, particular caution should be exercised where hospitality is offered by suppliers or contractors (currently or prospectively). All offers should be declared and recorded.

Sponsorship

• A process of prior approval of acceptance of sponsorship • Publication of sponsorship accepted and rejected

2. 2.1 2.2

Revisions to the Changes to the Conflict of Interests Policy/ Gifts, Hospitality and Anti - Fraud and Bribery Policy

The changes made as a result of the guidance have been highlighted in these two existing policy at Appendices A and B • Conflict of Interests Policy - changes highlighted in red • Hospitality and Anti - Fraud and Bribery Policy - text highlighted in lime green represents

an addition and text highlighted in sky blue represents a deletion. Audit Committee reviewed the policies on 19th January 2017 and, overall, felt the proposed revisions appropriately reflected the requirements stipulated in the revised guidance

3. 3.1 3.2 3.3

Escalation process - failure to comply with the requirement to complete regular Declaration of Interest returns At its meeting on 19th January 2017, Audit Committee received a report which reviewed the CCG’s compliance with its own Conflicts of interest Policy and the guidance issued in June 2016. As part of that report the Committee was asked to recommend an escalation process for Board Members, Clinical or Cluster leads who failed to complete declarations of interest updates within an appropriate timescale. The Committee noted that two clinical leads had failed to comply with a series of requests to update their conflicts of interest forms. The Committee is therefore recommending to the Board a process which would involve the suspension of pay in the event that such returns are not received in a timely manner. It is proposed that the determination of the “appropriate timescale” is made by the Director of Partnerships and Governance and would, of course, involve a process of evidencing officer attempts to secure the return. 91

4. 4.1 4.1.1 4.2 4.2.1 4.2.2 4.2.3 4.2.4 4.3 4.3.1

Commercial Sponsorship Policy Context Newham CCG already has a sponsorship policy that relates specifically to the issue of sponsorship and medicines management. It does not, however, have a corporate sponsorship policy for matters other than medicines management. A corporate sponsorship policy was therefore presented to the Audit Committee for consideration which addressed both pharmaceutical and any other form of possible sponsorship. The Policy presented to Audit Committee Most typically the issue of sponsorship as it has existed to date for the CCG has involved requests from pharmaceutical organisations as provider organisations to be permitted an “audience” with primary care practitioners through the CCG meeting structure (Practice Council, Cluster Meetings, education sessions) where presentations have been made in return for the provision of refreshments The proposed policy presented to the Audit Committee had been framed in such a way as to continue to permit sponsors an audience with CCG members (remembering this includes GP Members) but placed a new significant emphasis on the requirement for the CCG to have to assure itself that no significant advantage was being conferred on the provider as a sponsor in doing so. The Audit Committee was, however, advised that it may wish to take the view that a more risk averse approach was required meaning that any form of sponsorship by providers or potential providers should not be permitted at commissioner events at all given that;

• Typically providers approached the CCG to offer sponsorship as opposed to the CCG offering the opportunity to allow sponsorship to all providers and hence there was not a fair and equitable system allowing similar access to all providers at events.

• As a matter of principle, the CCG as a commissioning body should remove itself from the risk of being perceived as conferring an advantage on an existing or potential provider

The Audit Committee concluded that, subject to a review of the overall financial value of typical sponsorship for the CCG, and assuming this value was not significant, the CCG should adopt a policy which did not permit sponsorship with providers or potential providers as a matter of principle Financial Value A summary of the annual value of sponsorship that the CCG may need to pay for at events is;

• Practice Council - £3,300 CCG Practice Council meetings - pharmaceutical companies until recently were permitted to provide stands within the restaurant room before the meeting at these sessions in return for payment direct to the onsite catering company at NUH. This practice has been suspended and the CCG is currently paying for the catering. The CCG had no control over which companies provided sponsorship at the sessions and this was determined by BHT staff on site.

• Primary Care Education sessions - £15,000 Pharmaceutical companies until earlier this financial year were permitted to make presentations at these sessions in return for payment direct to the onsite catering company at NUH. This practice has been suspended and the CCG is currently paying for the catering. The decisions on which organisation can present at the meetings was taken by the CCG and recorded in the CEPN Team.

• Cluster meetings - £1,700 Pharmaceutical companies are permitted to make presentations prior to the 92

4.4 4.4.1 4.5 4.5.1

commencement of these meetings in return for the provision of light refreshments. The decisions on which organisation can present at the meetings is taken by the CCG made is recorded in the Primary Care Team.

• Other events – Diabetes MDT meetings - £1,500 Pharmaceutical companies are permitted to make presentations prior to the commencement of these meetings in return for the provision of light refreshments. The decisions on which organisation can present at the meetings is taken by the CCG made is recorded in the Long Term Conditions Team.

The GP Federation Audit Committee made the point that in fact the most appropriate forum for sponsorship would be in a “provider to provider” relationship between pharmaceutical companies and Newham Health Collaborative i.e. potential sponsors should be referred to NHC in terms of seeking an audience with primary care practitioners. Proposed Policy Given that the opportunity cost of the value of financial value of sponsorship is relatively low the Policy being recommended to Board by Audit Committee advises that sponsorship should not be considered by the CCG as a matter of principle as a commissioning organisation. Having said this, there is risk that in adopting such a policy there may be some loss of knowledge or awareness in terms of medicines management issues to the CCG both in terms of staff and employed clinicians.

5. 4.1

Next Steps Advise staff, NHC and primary care practitioners of the CCG’s policy.

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CONFLICT OF INTERESTS POLICY V0.7 (December 2016) CONTENTS

1 Purpose

2

2 Scope

2

3 Policy Statement

3

4 Responsibilities

3

5 The Declaration of Interest

4

6 Register of Declarations of Interest

5

7 Declarations of Interests at meetings

5

8 Interests and gifts

5

9 Equality and Diversity Statement

6

10 Advice, Training and monitoring compliance and effectiveness of the Policy

6

Appendix 1 Conflicts of Interests – Proforma Appendix 2 Pro forma to be used when commissioning services from GP

practices, including provider consortia, or organisations in which GPs have a financial interest

Appendix 3 Frequently asked questions Appendix 4 Potential Conflicts – Scenarios to consider Appendix 5 Case Studies of conflicts

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1. Purpose 1.1 This policy sets out how NHS Newham Clinical Commissioning Group will manage

conflicts of interest arising from the operation of the group’s Board, Committees, Transformation Programmes and working groups. The aim of this policy is to protect both the organisation and the individuals involved from any appearance of impropriety and demonstrate transparency to the public and other interested parties.

1.2 The Board of NHS Newham Clinical Commissioning Group have ultimate

responsibility for all actions carried out by staff and committees throughout the clinical commissioning group’s activities. This responsibility includes the stewardship of significant public resources and the commissioning of healthcare to the community. The board will therefore ensure the organisation inspires confidence and trust amongst its patients, staff, partners, funders and suppliers by demonstrating integrity and avoiding any potential or real situations of undue bias or influence in the decision-making of the Clinical Commissioning Group (CCG).

1.3 This conflict of interest policy respects the seven principles of public life promulgated

by the Nolan Committee. The seven principles are:

selflessness integrity objectivity accountability openness honesty leadership.

1.4 The CCG has a legal obligation in accordance with its constitution and terms of

establishment created by the NHS Commissioning Board, and to avoid situations where there may be a potential conflict of interest.

2. Scope 2.1 This policy applies to all employees and appointed individuals who are working for

NHS Newham Clinical Commissioning Group and members of the CCG Board, Committees and Transformation Programmes and any other decision making groups.

2.2 Anyone contracted to provide services or facilities directly to the Clinical

Commissioning Group will be subject to the same provisions of this policy in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

2.3 The policy should be read in conjunction with the following documents, which also set

out generic guidelines and responsibilities for NHS organisations and General Practitioners in relation to conflicts of interests:

NHS Newham CCG Constitution Standing Orders, Reservation and Delegation of Powers and Standing

Financial Instructions Code of conduct for NHS Managers 2002

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Appointments Commission: Code of Conduct and Code of Accountability The Healthy NHS Board: Principles for Good Governance General Medical Council: Good Medical Practice 2006 National Health Service (Procurement, Patient Choice and Competition) (No

2) Regulations 2013 National Health Service Act 2006 (as amended by the Health & Social Care

Act 2012) NHSE Guidance issued in December 2014 NHSE Revised Statutory Guidance issued in June 2016

2.4 NHS Newham Clinical Commissioning Group will ensure that all employees,

contractors and decision-makers are aware of the existence of this policy. The following will be undertaken to ensure awareness:

introduction to the policy during local induction for new starters to the

organisation, whether a Board Member, Clinical Lead, Cluster Lead or an employee

annual reminder of the existence and importance of the policy via internal communication methods

annual reminder to update declaration forms sent to all Board members, Clinical Leads, Cluster Leads, GP Partners and CCG staff

2.5 Staff should also refer to their respective professional codes of conduct relating to the

declaration of conflicts of interest. 2.6 We collectively agree the following in relation to managing conflicts of interest

when CCGs commission from member practices:

If CCGs are doing business properly (needs assessments, consultation mechanisms, commissioning strategies and procurement procedures), then the rationale for what and how they are commissioning is clearer and easier to withstand scrutiny. Decisions regarding resource allocation should be evidence-based, and there should be robust mechanisms to ensure open and transparent decision making.

CCGs must have robust governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians.

CCGs should assume that those making commissioning decisions will behave ethically, but individuals may not realise that they are conflicted, or lack awareness of rules and procedures. To mitigate against this, CCGs should ensure that formal prompts, training and checks are implemented to make sure people are complying with the rules. As a rule of thumb, ‘if in doubt, disclose’

CCGs should anticipate many possible conflicts when electing/selecting individuals to commissioning roles, and where necessary provide commissioners with training to ensure individuals understand and agree in advance how different scenarios will be dealt with.

It is important to be balanced and proportionate – the purpose of these tools is not to constrain decision-making to be complex or slow.

3. Policy Statement

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3.1 This policy supports a culture of openness and transparency in business

transactions. All employees and appointees of NHS Newham Clinical Commissioning Group are required to:

ensure that the interests of patients remain paramount at all times be impartial and honest in the conduct of their official business use public funds entrusted to them to the best advantage of the service,

always ensuring value for money ensure that they do not abuse their official position for personal gain or to the

benefit of their family or friends ensure that they do not seek to advantage or further, private or other

interests, in the course of their official duties. 3.2 The CCG recognises that:

A perception of wrongdoing, impaired judgement or undue influence can be as detrimental as any of them actually occurring:

If in doubt, it is better to assume the existence of a conflict of interest and mange it appropriately rather than ignore it;

For a conflict of interest to exist, financial gain is not necessary. 3.3 NHS Newham Clinical Commissioning Group will view instances where this policy is

not followed as serious and may take disciplinary action against individuals as appropriate.

3.4 Appendix 3 of this policy sets out in greater detail Newham CCG’s definition of

interest and what to do if a conflict of interest arises for Members of the Board, clinical leaders and employees. This policy should also be read in conjunction with the Procurement Policy that sets out the CCG procurement process, register of procurement decisions and compliance with procurement law and best practice.

4. Responsibilities 4.1 It is the responsibility of all staff employed or appointed by the NHS Newham Clinical

Commissioning Group and those serving in a formal capacity to ensure that they are not placed in a position which creates a potential conflict between their private interests and their CCG duties.

4.2 NHS Newham Clinical Commissioning Group needs to be aware of all situations

where an individual has interests outside of his / her Contract of Employment or other involvement with the CCG, where that interest has potential to result in a conflict of interest between the individual’s private interests and their CCG duties.

4.3 All decision-makers must therefore declare relevant and material interests to the

NHS Newham Clinical Commissioning Group upon appointment, when a new conflict of interest arises, or upon becoming aware that the CCG has entered into or proposes entering into a contract in which they or any person connected with them has any financial interest, either direct or indirect.

5. The declaration of interests

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5.1 All persons appointed by the CCG are required to declare any relevant and material interests, and any gifts or hospitality offered and received in connection with their role in the clinical commissioning group.

5.2 CCG has arrangements to ensure individuals declare any conflict or potential conflict

in relation to a decision to be made by the group as soon as they become aware of it, and in any event within 28 days. The CCG will record the interest in the registers as soon as they become aware of it.

5.2 Interests that may impact on the work of the CCG and should be declared include (including a family member, spouse or partner):

No member of the CCG’s Governing body may lead or have an executive role

in a provider organisation (for example, defined as a GP primary care network or federation or GP OOH Coop) or have a material interest (e.g. shareholder of more than 5% of the nominal share capital) in that provider organisation. This would not exclude their practice from joining a primary care network/federation/provider, or another member of their practice team having a leadership role within the network/federation/provider. No member of the CCG’s Governing body could be an office holder of the Local Medical Committee

any directorships including non-executive directorships held in private companies or public

limited companies (with the exception of those of dormant companies) of companies likely to be engaged with the business of the clinical commissioning group

ownership or part ownership of companies, businesses or consultancies which may seek to do business with the CCG

previous or current employment or consultancy positions voluntary or remunerated positions, such as trusteeship, local authority

positions, other public positions membership of professional bodies, mutual support organisations or a

position of trust in a charity or voluntary organisation in the field of health and social care

investments in unlisted companies, partnerships and other forms of business, major shareholdings (more than £25,000 or 1% of the nominal share capital) and beneficial interests

gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months

receipt of research funding / grants from the CCG or related parties interests in pooled funds that are under separate management (any relevant

company included in this fund that has a potential relationship with the CCG must be declared)

formal interest with a position of influence in a political party or organisation current contracts with the CCG in which the individual has a beneficial interest any other employment, business involvement or relationship or that of a

spouse or partner that conflicts, or may potentially conflict with the interests of the CCG

any other conflicts that are not covered by the above. 5.3 Where individuals are unsure whether a situation falling outside of the above

categories may give potential for a conflict of interest they should seek advice from the Chief Officer. However, the individual is advised that if in any doubt they should declare an interest.

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5.4 Managers of NHS Newham Clinical Commissioning Group must ensure members of

staff are aware of the policy and process to be followed. 5.5 It is the responsibility of all employees and appointees to familiarise themselves with

this policy and comply with the provisions set out in it. 5.6 If you are not sure what to declare, or whether/when your declaration needs to be

updated, please contact the Chief Officer for guidance. 5.7 The Declaration of Interests proforma with guidance for completion is attached at

Appendix 1. 6. Register of Declarations of Interests 6.1 NHS Newham Clinical Commissioning Group has established a Register of

Declarations of Interest, which is held by the Chief Officer. The Register is available on the CCG Internet Pages and is also available for public inspection.

6.2 Declarations of interest made by CCG group members are published within the

CCG’s annual report. 6.3 The Register of Declarations of Interest will be reported to the CCG Audit Committee

annually. 6.4 All CCG Board members, Committee members and Programme Board members,

CCG Members (GP Partners) and all staff will be required to complete a Declaration of Interests proforma (Appendix 1). Where there are no interests to declare a nil return is required. The CCG will ensure that, as a matter of course, declarations of interest are made and regularly confirmed or updated. This includes the following circumstances:

On appointment: Applicants for any appointment to the CCG or its governing body are asked to declare any relevant interests. When an appointment is made, a formal declaration of interest proforma is required to be made and recorded. At meetings: All attendees are asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interests are recorded in minutes of meetings. Six Monthly: Newham CCG asks all Board Members, Clinical Leads, Clusters Leads, GP Partners and all employees to update their declaration of interest details on a six monthly basis so that their register of interests is accurate and up to date. On changing role or responsibility: Where an individual changes role or responsibility within a CCG or its governing body, any change to the individual’s interests should be declared

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On any other change of circumstances:

Wherever an individual’s circumstances change in a way that affects the individual’s interests (e.g. where an individual takes on a new role outside the CCG or sets up a new business or relationship), a further declaration should be made to reflect the change in circumstances. This could involve a conflict of interest ceasing to exist or a new one materialising.

6.5 All individuals who have a conflict should declare this as soon as they become

aware of it, and in any event not later than 28 days after becoming aware. 7. Declarations of Interests at meetings 7.1 The agenda (both public and confidential agenda) for meetings of the CCG Board

and also of its committees will contain a standing item at the commencement of each meeting, requiring members to declare any interests relating specifically to the agenda items being considered. If during the course of a meeting, an interest not previously declared is identified, this shall be declared. The minutes of the meeting should detail all declarations made and any relevant responses and/or action taken.

7.2 The Chief Officer shall endeavour to ensure that reports for consideration by the

Board, Committees or Transformation Programmes will identify potential conflicts of interest.

7.3 Board, Committee and Transformation Programmes members must be specific when

declaring interests. They should state which agenda the potential conflict of interest relates to and the nature of that conflict. Where an interest is significant or when the individual or a connected person has a direct financial interest in a decision, the individual should not take part in the discussion or vote on the item and should consider leaving the room when the matter is discussed. The Chair of the meeting may ask that a member leaves the room if they have a significant interest or a direct financial interest in a matter under discussion. Where the Chair has made a declaration of interest they should not Chair for that particular item.

7.4 If there is any doubt as to whether an interest should be declared, a declaration

should be made and / or advice sought from the Chief Officer. 7.5 All agendas of Board meetings, committee meetings and transformation programmes

will include the following paragraphs under the declaration of interest item: Financial Interest If you have a direct financial interest in any matter on the agenda you must not participate in any discussion or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter.

Non-financial Professional Interest The CCG Policy requires you to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these

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interests in any matter when they apply may be in breach of the Policy and Code of Conduct.

A decision in relation to that business might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members. Non-financial personal interests The CCG Policy requires you to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct.

A decision in relation to that business might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members. Indirect interests The CCG Policy requires you to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct. For further advice about these matters please contact the Director of Partnerships & Governance.

8. Interests and gifts 8.1 Interests and gifts will be recorded on the register of interests and register of gifts and

hospitality, which will be maintained by the Chief Officer. The register will be accessible by the public and inspection of the register of board members interests will be encouraged, as appropriate.

8.2 Board members should not use confidential information acquired in the pursuit of

their role to benefit themselves or another connected person. 9. Equality and Diversity Statement 9.1 The organisation is committed to ensuring that it treats its employees fairly, equitably

and reasonably and that it does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. An Equality Impact Assessment has been completed for this policy.

9.2 If you have any concerns or issues with the contents of this policy or have difficulty

understanding how this policy relates to you or your role, please contact in the first instance the Director of Partnerships and Governance.

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10. Advice, Training and monitoring compliance and the effectiveness of the Policy

10.1 The policy will be reviewed annually by the Audit Committee to ensure it remains fit

for purpose 10.2 All those required to comply with the Conflicts of interest policy will be required to

undertake mandatory conflicts management training as directed by NHSE as well as being reminded of the policy and register of interests management process at least annually

10.3 The Chair of Audit Committee will act as the appointed CCG Conflicts of Interest

Guardian. The Guardian will support the Director of Partnerships and Governance in respect of providing advice on conflicts of interest cases, overall conflicts of interests management and training

10.3 The Director of Partnerships & Governance and the Conflicts Guardian will review

register entries on a regular basis and take any action necessary as highlighted by the review.

10.4 The Audit Committee will review the Declarations of Interest Register at least

annually to consider if further advice should be offered to all or individuals who are required to declare interests. The Audit Committee will also receive an annual review of conflicts management as part of the CCG’s Internal Audit programme.

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Appendix 1 Conflicts of Interests – Proforma Please complete the form and return to the address below:

Name:

Position:

Please detail below any relevant and material interests as listed overleaf (further guidance is available in the Conflicts of Interest Policy) Type of Interest

Details

Personal interest or that of a family member, close friend or other acquaintance?

Roles and responsibilities held within member practices

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Directorships, including non-executive directorships, held in private companies or PLCs.

Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG.

Shareholdings (more than 5%) of companies in the field of health and social care.

Positions of authority in an organisation (e.g. charity or voluntary organisation) in the field of health and social care.

Any connection with a voluntary or other organisation contracting for NHS services.

Research funding / grants that may be received by the individual or any organisation they have an interest or role in.

Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role within the CCG.

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To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly and no longer than annually. I give my consent for the information to be used for the purposes described in the constitution and the Conflict of Interest Policy, and published accordingly.

Signed:

Date:

Where interests change or new interests are identified this form must be updated and returned to the Accountable Officer. Return to: Guidance Note for Completion of the declaration form

This form must be completed by all CCG members on appointment and updated as interests change or new interests are identified. It should also be completed by any employees, persons serving on all committees and other decision-making groups and as soon as a potential conflict of interest is identified or if requested by the Accountable Officer as part of the annual review of interests. “Relevant and material interests” are defined as: any directorships including non-executive directorships held in private companies or

public limited companies (with the exception of those of dormant companies) of companies

likely to be engaged with the business of the clinical commissioning group ownership or part ownership of companies, businesses or consultancies which may

seek to do business with the CCG previous or current employment or consultancy positions

Newham CCG, Unex Tower, 4th Floor 5 Station Street Stratford E15 1DA London

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voluntary or remunerated positions, such as trusteeship, local authority positions, other public positions

membership of professional bodies, mutual support organisations or a position of trust in a charity or voluntary organisation in the field of health and social care

investments in unlisted companies, partnerships and other forms of business, major shareholdings (more than £25,000 or 1% of the nominal share capital) and beneficial interests

gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months

receipt of research funding / grants from the CCG or related parties interests in pooled funds that are under separate management (any relevant company

included in this fund that has a potential relationship with the CCG must be declared) formal interest with a position of influence in a political party or organisation current contracts with the CCG in which the individual has a beneficial interest any other employment, business involvement or relationship or that of a spouse or

partner that conflicts, or may potentially conflict with the interests of the CCG any other conflicts that are not covered by the above. Where individuals are unsure whether a situation falling outside of the above categories may give potential for a conflict of interest they should seek advice from the Accountable Officer. Appendix 2

Proforma to be used when commissioning services from GP practices, including provider consortia, or organisations in which GPs have a financial interest.

NHS Newham Clinical Commissioning Group

Service:

Question Comment/Evidence

Questions for all three procurement routes How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and estimated benefits?

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How does it reflect the CCG’s proposed commissioning priorities? How have you involved the public in the decision to commission this service?

What range of health professionals have been involved in designing the proposed service?

What range of potential providers have been involved in considering the proposals?

How have you involved your Health and Wellbeing Board? How does the proposal support the priorities in the relevant joint health and wellbeing strategy?

What are the proposals for monitoring the quality of the service?

What systems will there be to monitor and publish data on referral patterns?

Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available?

Why have you chosen this procurement route?

What additional external involvement will there be in scrutinising the proposed decisions?

How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision making process?

Additional question for AQP or single tender (for services where national tariffs do not apply) How have you determined a fair price for the service?

Additional question for AQP only (where GP practices are likely to be qualified providers)

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How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for single tenders from GP providers What steps have been taken to demonstrate that there are no other providers that could deliver this service?

In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?

What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

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Appendix 3 Frequency Asked Questions What is a conflict of interest? Conflicts arise when the interests of the Board, Committee or Transformation Programme members, or persons connected to them, are incompatible or in competition with the interests of the clinical commissioning group. Such situations present a risk that decisions could be made based on these external influences, rather than the best interests of the patients and public on whose behalf they are commissioning services or considering service redesigns.

A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. The individual does not need to exploit his or her position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur.’

For a commissioner, a conflict of interest may therefore arise when their judgment as a commissioner could be, or be perceived to be, influenced and impaired by their own concerns and obligations as a provider.

A conflict is something which compromises, or may compromise, a decision maker’s professional judgement. Conflicts can be directly financial (for example, a commissioner has a financial interest in a provider), non-financial professional (for example, an advocate for a group of patients, GPSI) or non-financial personal (for example, a voluntary sector champion or provider).

The most common types of conflicts of interest include:

Financial interest Non-financial professional interest Non-financial personal interests Indirect interests

Regulation 6 (1) prohibits the award of a contract where there is a conflict or potential conflict between the interests of those involved in commissioning the service and the interests of those providing it which affects or appears to affect the award of the contract.

Financial interest This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being: A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

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A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. A management consultant for a provider. This could also include an individual being: In secondary employment (see below); In receipt of secondary income from a provider; In receipt of a grant from a provider; In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). The General Medical Council’s guidance is clear in that: You must be honest in financial and commercial dealings with employers, insurers and other organisations or individuals. In particular: “before taking part in discussions about buying or selling goods or services, you must declare any relevant financial or commercial interest that you or your family might have in the transaction.”

Additionally, the General Medical Council’s guidance on managing conflicts of interest states: “If you have financial or commercial interests in organisations providing healthcare or in pharmaceutical or other biomedical companies, these interests must not affect the way you prescribe for, treat or refer patients”.

Non-financial professional interests This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is: An advocate for a particular group of patients; A GP with special interests e.g., in dermatology, acupuncture etc. A member of a particular specialist professional body (although routine GP membership of the RCGP, British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE); A medical researcher. GPs and practice managers, who are members of the governing body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

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Non-financial personal interests This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is: A voluntary sector champion for a provider; A volunteer for a provider; A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; Suffering from a particular condition requiring individually funded treatment; A member of a lobby or pressure group with an interest in health. Indirect interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above) for example, a: Spouse / partner Close relative e.g., parent, grandparent, child, grandchild or sibling; Close friend; Business partner. A declaration of interest for a “business partner” in a GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim). Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG. Secondary employment CCG will take all reasonable steps to ensure that employees, committee members, contractors and others engaged under contract with them are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engage in, any employment or consultancy work in addition to their work with the CCG. The purpose of this is to ensure that the CCG is aware of any potential conflict of interest. Examples of work which might conflict with the business of the CCG, including part-time, temporary and fixed term contract work, include:

Employment with another NHS body; Employment with another organisation which might be in a position to supply

goods/services to the CCG; Directorship of a GP federation; and Self-employment, including private practice, in a capacity which might conflict with

the work of the CCG or which might be in a position to supply goods/services to the CCG.

It is a requirement that individuals obtain prior permission to engage in secondary employment, and reserve the right to refuse permission where it believes a conflict will arise which cannot be effectively managed.

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When may a conflict of interest arise? Conflicts of interest may arise where an individual’s personal, or a connected person’s interests and/or loyalties conflict with those of the clinical commissioning group. Such conflicts may create problems such as inhibiting free discussion which could:

result in decisions or actions that are not in the interests of the clinical commissioning group and the public it was established to serve

risk the impression that the clinical commissioning group has acted improperly. It is not possible, or desirable, to define all instances in which an interest may be a real or perceived conflict. It is for each individual to exercise their judgement in deciding whether to register any interests that may be construed as a conflict. Individuals can seek guidance from the Chief Officer, but may decide to declare when in doubt. The CCG policy is that to avoid any unnecessary conflict of interest, that no elected member of the CCG’s governing body or elected cluster lead could lead or have an executive role in a provider organisation or have a material interest (e.g. shareholder) in that provider organisation. This would not exclude their practice from joining a primary care network/federation/provider, or another member of their practice team having a leadership role within the network/federation/provider. Conflicts that affect or appear to affect the integrity of an award Even if a conflict of interest does not actually affect the integrity of a contract award, a conflict of interest that appears to do so can damage a commissioner’s reputation and public confidence in the NHS. Regulation 6 of the Procurement, Patient Choice and Competition Regulations therefore also prohibits commissioners from awarding contracts in these circumstances. As well as affecting the decision to award a contract and to which provider, a conflict of interest may affect a variety of decisions made by a commissioner during the commissioning cycle in a way that affects, or appears to affect, the integrity of a contract award decision taken at a later point in time. For example, conflicts of interest might affect the prioritisation of services to be procured, the assessment of patients’ needs, the decision about what services to procure, the service specification/design, the determination of qualification criteria, as well as the award decision itself. Conflicts might arise in many different situations. A conflict could arise where a CCG is deciding whether to procure particular services from GP practices in the area or from a wider pool of providers, or where it is deciding whether to commission services that would reduce demand for services provided by GP practices under the NHS General Medical Services contract. Depending on the circumstances of the case, there may be a number of different ways of managing a conflict or potential conflict of interest in order to prevent that conflict affecting or appearing to affect the integrity of the award of the contract. It will often be straightforward to exclude a conflicted individual from taking part in decisions or activities where that individual’s involvement might affect or appear to affect the integrity of the award of a contract. The commissioner will need to consider whether in the

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circumstances of the case it would be appropriate to exclude the individual from involvement in any meetings or activities in the lead up to the award of a contract in relation to which the individual is conflicted, or whether it would be appropriate for the individual concerned to attend meetings and take part in discussions, having declared an interest, but not to take part in any decision-making (not having a vote in relation to relevant decisions). It is difficult to envisage circumstances where it would be appropriate for an individual with a material conflict of interest to vote on relevant decisions. Where it is not practicable to manage a conflict by simply excluding the individual concerned from taking part in relevant decisions or activities, for example because of the number of conflicted individuals, the commissioner will need to consider alternative ways of managing the conflict. For example, depending on the circumstances of the case, it may be possible for a CCG to manage a conflict affecting a substantial proportion of its members by:

involving third parties who are not conflicted in the decision-making by the CCG, such as out-of-area GPs, other clinicians with relevant experience, individuals from a Health and Wellbeing Board or independent lay persons; or

inviting third parties who are not conflicted to review decisions throughout the process to provide on-going scrutiny, for example the Health and Wellbeing Board or another CCG.

Whether a conflict of interests affects or appears to affect the integrity of a contract award (such that the commissioner may not award the contract) will depend on the circumstances of the case. The list of factors in the box below is not exhaustive, but covers some of the core factors that a commissioner is likely to need to consider in deciding whether it is appropriate to award a contract. Conflicts that affect or appear to affect the integrity of a contract award: Examples of factors that a commissioner is likely to need to consider in deciding whether or not it can award a contract:

the nature of the individual’s interest in the provision of services, including whether the interest is direct or indirect, financial or personal, and the magnitude of any interest;

whether and how the interest is declared, including at what stage in the process

and to whom;

the extent of the individual’s involvement in the procurement process, including, for example, whether the individual has had a significant influence on service design/specification, has played a key role in setting award criteria, has been involved in deliberations about which provider or providers to award the contract to and/or has voted on the decision to award the contract; and

what steps have been taken to manage the actual or potential conflict (or

example, via an external review of the decisions taken throughout the procurement process, including whether a conflict of a member of a CCG has been dealt with in accordance with the CCG’s constitution.

Why have a conflicts of interest policy for clinical commissioning group members?

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The board, and individual directors, of an NHS entity have a legal obligation to act in the best interests of the organisation, in accordance with the organisation’s governing document, and to avoid situations where there may be a potential conflict of interest. As such, there are requirements for members to register personal financial and non-financial interests which may be perceived as conflicting with that overriding duty. Benefit to clinical commissioning group: With proposed responsibility for approximately 60% of the NHS budget, clinical commissioning groups need to operate effectively and efficiently and with an appropriate level of transparency to ensure accountability. It is essential for maintaining public trust and confidence that clinical commissioning groups work within a robust ethical framework, and are seen to act in accordance with the high standards expected of healthcare professionals. Conflicts of interest may present problems in the form of:

inhibiting free discussion resulting in decisions or actions that are not in the interests of the clinical

commissioning group, public and patients risking the impression that the clinical commissioning group has acted improperly.

Benefit to members: Decisions made under a conflict of interest may be legally challenged and could result in personal liability for the board member. There are clear benefits to be derived from establishing, and adhering to, a conflict of interest policy to protect both the organisation and the individuals involved from any appearance of impropriety. Benefit to the public: For public trust and confidence to be maintained both real and perceived conflicts need to be acknowledged and managed. Where the conflicts of interest policy requires members to withdraw from meetings, the Chief Officer should take care to ensure that edited minutes are provided to that member to ensure that any information related to the matter in question is not disclosed, and to avoid presenting any further instances of conflict, real or perceived. Any conflicts of interest policy should be accompanied by policies on receiving gifts and hospitality and anti-bribery procedures. All policies should be publicly available along with a regularly updated register of interests and gifts, offered and accepted, for board members and staff. Maintaining public trust and confidence will be essential if the public and patients are to believe that the NHS arrangements are working on their behalf. The General Medical Council’s Good Medical Practice: Duties of a Doctor states that: “Patients must trust doctors with their lives and health……You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions”. What to do if you face a conflict of interest CCG has arrangements to ensure individuals declare any conflict or potential conflict in relation to a decision to be made by the CCG as soon as they become aware of it, and in

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any event within 28 days. The CCG will record the interest in the registers as soon as they become aware of it. All CCG members are required to declare their interests in relation to any items on the agenda at the start of each Board, Committee or Transformation Programme meeting. Where the conflict is material to the discussion that member shall withdraw from discussions pertaining to that agenda item, the conflict and the action will be recorded in the minutes of the meeting and the register of interests updated accordingly. A flowchart is attached as Appendix 4 to provide further guidance on potential conflicts and the action to take in those circumstances. It is the responsibility of the Chief Officer to monitor quorum and advise the chair accordingly to ensure it is maintained throughout the discussion and decision of the agenda item. Should the withdrawal of the conflicted director result in the loss of quorum, the item cannot be decided upon at that meeting. Where permitted under the clinical commissioning group’s constitution or the conditions of its establishment, the board has the power to waive restrictions on any clinical professional board member participating in board business, where to authorise such a conflict would be in the interests of the clinical commissioning group. The application of a waiver can, therefore, be used in the following situations:

the CCG member is a clinical professional providing healthcare services to the clinical commissioning group that do not exceed the average for other practices and NHS entities commissioned to provide services by the clinical commissioning group; or

where the CCG member has a pecuniary interest arising out of the delivery of some professional service on behalf of the clinical commissioning group, and the conflict has been adjudged by the chair and the governance lay member not to bestow any greater pecuniary benefit to other professionals in a similar relationship with the clinical commissioning group.

Where the chair and the governance lay member have approved the use of the waiver, the chair must have discussed it with the Chief Officer before the meeting. In such circumstances where the waiver is used, the board member:

must disclose his/her interest as soon as practicable at the start of the meeting may participate in the discussion of the matter under consideration; but must not vote on the subject under discussion.

The minutes of the meeting will formally record that the waiver has been used, and that this policy and the governing document provisions have been observed in managing that authorised conflict. Where a member has withdrawn from the meeting for a particular item, the Chief Officer will ensure that the minutes for that member do not contain such information that may compound the potential conflict, but do not unnecessarily disadvantage the member in their performance of their functions and legal responsibilities. Decisions taken where a board member has an interest In the event of the Board, Committee or Transformation Programme having to decide upon a question in which a member has an interest, all decisions will be made by vote, with a simple majority required. A quorum must be present for the discussion and decision; interested

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parties will not be counted when deciding whether the meeting meets quorum. Interested members must not vote on matters affecting their own interests, even where the use of the waiver has been approved by the Chairman and used. All decisions under a conflict of interest will be recorded by the Chief Officer and reported in the minutes of the meeting. The report will record:

the nature and extent of the conflict an outline of the discussion the actions taken to manage the conflict use of the waiver and reasons for its implementation.

Where a member benefits from the decision, this will be reported in the annual report and accounts, as a matter of best practice. All payments or benefits in kind to members will be reported in the clinical commissioning group’s accounts and annual report, with amounts for each board member listed for the year in question. Independent external mediation will be used where conflicts cannot be resolved through the usual procedures. Breaches of this policy Breaches of the policy may result in the member being removed from office in line with the constitution. The CCG will also report all breaches of this policy to the appropriate professional body so that the CCG is acting responsibly and in accordance with the principles of good corporate governance. Managing contracts If you have a conflict of interest, you must not be involved in procuring, tendering, managing or monitoring a contract in which you have an interest. Monitoring arrangements for such contracts will include provisions for an independent challenge of bills and invoices, and termination of the contract if the relationship is unsatisfactory.

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Appendix 4

Potential Conflicts of Interest

Scenarios to consider as a CCG Commissioning

Committee Member,

CCG Employee, and/or

CCG Board Member

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Scenario

Is a director of a provider arm company in the locality

Has a shareholding or other beneficial interest in a provider

arm company

Action Required

CCG Board Member OR Clinical /Cluster Lead or

Employee of CCG

Has a family member, spouse or

partner with an interest in a provider arm company

Board Member or Clinical/Cluster Lead or Employee

should be excluded from any decision making process or any discussion relating to any of the

given scenarios

Has a beneficial interest in an organisation/company providing or

bidding for services to the CCG

Has a family member, spouse or partner with a beneficial interest in

an organisation/company providing or bidding for services to

the CCG

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HIGH

LOW

Scenario Conflict Level Action Required

Is a director of a provider arm company Scenario not permissible

Is a director or has a family member being a shareholder or having any beneficial interest in

an organisation/company providing services to the CCG

HIGH

The individual should be

excluded from any assessment or decision in relation to commissioning services

CCG Governing Board

Member

Has a family member, spouse or

partner who is a director of a provider arm company

MEDIUM Assessment of conflict and

appropriate management of conflict during relevant decision

making process

Is a shareholder in a provider arm company

No immediate action required. Although some management is

required, e.g. assessment of bids

Has a family member, spouse or partner who is a shareholder in

a provider arm company

LOW No immediate action required

Works as an employee for a provider such as Barts or ELFT for less than 4 sessions pw

LOW No action required 119

Appendix 5 – Case Studies of Conflict of Interest

Two particular types of interest not considered to be a material interest:

Non-financial or personal conflicts

These happen where members receive no financial benefit, but are influenced by external

factors. For instance:

• To gain some other benefit, such as reputational advantage or influence in their

personal or professional relationships

• Awarding contracts to friends or personal business contacts.

Conflict of loyalties

Governing body members, committee members and GP member practices may have

competing loyalties between the CCG, to which they owe a duty, and some other person or

organisation, including their GP practice, professional bodies and patients. Individuals

should avoid using any knowledge gained in other roles to influence decisions so as to

acquire a competitive advantage over other service providers.

The following are examples of potential conflicts of interest scenarios.

Examples

A member of the Board staff of X CCG is asked to participate in arranging the

commissioning of cardiology services in X and be part of the Board meeting to make a

decision about that service. The member of staff has a spouse who works in the cardiology

department of X University NHS Foundation Trust from which the CCG commissions

services. In these circumstances the board member is conflicted and will need to disclose

the personal relationship. The CCG will then arrange for the conflict of interest to be

managed.

Board Members who work as employees (not in an Executive capacity) for providers (ELFT,

Barts, NELFT) that the CCG holds contracts with for a small number (a small proportion of

their working week, for e.g. a day a week) of sessions.

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Material Interest

Conflicts can arise from personal or professional relationships with others, e.g. where the

role or interest of a family member, friend or acquaintance may influence an individual’s

judgement or actions, or could be perceived to do so.

For a commissioner, a conflict of interest may therefore arise when their judgements as a

commissioner could be, or be perceived to be, unduly influenced and impaired by their own

concerns and obligations as a provider. In the case of a GP involved in commissioning, an

obvious example is the awareness of a new contract with a provider in which the individual

GP has a financial stake. However, the same considerations and the approaches set out in

this guidance apply when deciding whether to extend a contract.

Interests may be pecuniary or non-pecuniary and those which should be regarded as

‘relevant and material’ are defined as:

• Role and Responsibilities held within member practices

• Directorships, including non-executive directorships held in private companies or public

limited companies (with the exception of those of dormant companies)

• Ownership or part ownership of companies, businesses or consultancies which may seek

to do business with the CCG

• Significant share holdings in organisations which may seek to do business with the CCG.

• Membership of or a position of trust in a charity or voluntary organisation in the field of

health and social care

• Receipt of research funding / grants from the CCG

• Interests in pooled funds that are under separate management (any relevant company

included in this fund that has a potential relationship with the CCG must be declared)

• Formal interest with a position of influence in a political party or organisation

• Current contracts with the CCG in which the individual has a beneficial interest

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• Any other employment, business involvement or relationship or those of a spouse or

partner that conflicts, or may potentially conflict with the interests of the CCG. Further

relationships may also be of relevance, for example if a sibling, parent, child or relative has

an interest in a potential provider of services.

In the event that an individual is still not clear if this constitutes a material interest, the

individual should seek the advice of lay members.

Scenarios

Adapted from the RCGP/NHS Confederation brief on managing conflicts of interest

September 2011

Scenario 1

Three GPs who are members of the governing body of a CCG have recently bought a small

number of shares in Company X – a company set up by an investor and 16 local GP

practices to provide community health services. Company X has recently paid for two local

GPs to be trained as GPs with a special interest (GPwSIs) in gynaecology and has agreed to

invest in the extension of a local surgery (where a commissioning group lead is a partner)

and in purchasing ultrasound equipment so that a new GPwSI service can be set up.

The CCG has recently begun developing its strategic commissioning plan, which sets out its

intention to see a shift of up to 30 per cent of outpatient gynaecology services from acute

hospitals to community-based settings over the next three years. The CCG intends to

develop a specification for these community services to be delivered by Any Qualified

Provider.

Discussion

Although the GPs are not major shareholders in GP Provident, a conflict clearly exists as

they could have made personal financial gain as a result of the CCG’s commissioning

strategy.

There is also a possibility that there could be a perception of actual wrongdoing. The CCG

has to consider whether Company X has been given a competitive advantage over other

providers or if these individuals have put themselves in a position to make a financial gain –

due to access to insider knowledge about local commissioning intentions – and if it has put

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sufficient measures in place to avoid or remedy this. The individuals concerned should have

declared their interest in Company X when they bought the shares, and again at any

meeting when the CCG began to discuss its commissioning strategy.

The CCG should have a policy that clearly identifies circumstances under which members of

the governing body should not participate in certain activities and considers the material

nature of any conflict and whether the individuals could successfully discharge their

responsibilities. The governing body will need to consider whether this policy requires them

to exclude these members from certain decisions about the commissioning strategy, even if

this means removing three key decision-makers from a central part of the group’s business.

Even if not excluded from discussion of the strategy, these individuals may well be excluded

by the group’s policies from being involved in the development of the gynaecology service

specifications (other than to the extent any other potential supplier might be involved in such

service planning), or from any subsequent contract monitoring. CCGs may wish to consider

whether or not involvement with a provider company likely to develop services and bid for

contracts in this way is compatible with being a CCG governing body member at all, as this

scenario is likely to arise again.

Scenario 2

The diabetes lead of a CCG has been working on a community diabetes project for two

years and has a plan to reduce diabetes outpatients activity by 50 per cent and to reinvest in

education, patient education, more specialist nurses and community consultant sessions.

A cornerstone of this new service is a proposal to fund local practices for providing additional

services, previously provided in secondary care, to improve prevention, identification and

management of diabetes within primary care.

Discussion

Rather than benefiting a particular organisation, in this scenario all GP practices/primary

care providers in the area could potentially benefit from the proposals being developed by

the CCG, at the expense of existing secondary care providers.

The CCG may have to deal with the perception and challenge that it is favouring its

members. However, this may be an appropriate commissioning decision, provided the CCG

can demonstrate that:

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• it is possible and appropriate to reduce the number of people being referred to

hospital for the management of diabetes and related complications;

• it is expected to improve overall patient experience and outcomes;

• the benefits of having the service provided by GP practices – and integrating it with

the services they already provide for registered patients – are so compelling that

there are no other capable providers

The CCG should have set out and communicated the case for change and the rationale for

the proposed service model clearly and transparently using the “code of conduct” template

before taking, or recommending, the final decision to proceed.

When developing its diabetes commissioning strategy, the CCG should consult on, and then

be absolutely clear about, who will have the opportunity to provide the service model. This

should be consistent with its existing commissioning strategy and procurement framework

and with the joint health and wellbeing strategy of the relevant Health and Wellbeing Board.

Other qualified providers should be given the opportunity to provide those elements of the

new service model not specifically embedded in general practice, for example, specialist

nursing and community-based consultant sessions.

Scenario 3

Dr X is the chair of a CCG. She is married to Mr Y who is a Director for Health R Us, a

company that has developed risk stratification software designed to enable primary care

providers to identify vulnerable patients at risk of going into hospital and help them to put

measures in place to address this.

Health R Us has offered to supply the software to Dr X’s CCG free of charge for one year to

help develop it. It will then be offered at a discounted price because of the work that the

group would have done in developing it and acting as a demonstration site.

Discussion

There is no immediate financial gain to Dr X and Mr Y from the decision to accept the

software free of charge for a year. However, there is potential future gain to Mr Y (and

therefore to his wife) as the clinical director of a company that could profit from a product that

his wife’s CCG has helped to develop, and from a preferential position as an incumbent

supplier to that group.

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Dr X should declare an interest and she should exclude himself from any decision-making

about this project.

Any decision subsequently taken by the CCG should depend on whether or not the product

on offer would help it to achieve an existing, stated commissioning objective (that is to say

the CCG should not accept it just because it is on offer), and whether or not the deal being

offered was in line with the CCG’s existing policies for partnership working, joint ventures

and sponsorship.

If the CCG has a clear, prioritised commissioning strategy and policies for working with other

organisations from the outset, this decision should be fairly straightforward.

There is a question as to whether or not the group should accept this offer at all. Although it

may meet an explicit commissioning objective, it may not be appropriate even then to accept

the offer without some analysis of whether other companies might be willing or able to offer

the same or better. The concern is not necessarily about the personal relationships involved,

but more generally about whether this is an acceptable way for a public body to do business.

Scenario 4

Dr A is a member of a CCG with a longstanding interest in and commitment to improving

health and social care services for older people. She has worked closely with local

geriatrician, Dr B, for many years, including working as her clinical assistant in the past.

They have developed a number of service improvement initiatives together during this time

and consider themselves to be good personal friends.

Recently, they have been working on a scheme to reduce unscheduled admissions to

hospital from nursing homes. It involves Dr B visiting nursing homes and doing regular ward

rounds together with community staff. It has been trialled and has had a measure of success

which has been independently verified by a service evaluation. They would now like to

extend the pilot, and the foundation trust that employs Dr B has suggested that a local tariff

should be negotiated with the CCG for this ‘out-reach’ service.

The CCG has decided instead to run a tender for an integrated community support and

admission avoidance scheme, with the specification to be informed by the outcomes of the

pilot.

Discussion

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Due to her own involvement in the original pilot, association with the incumbent provider and

allegiance to her friend and colleague, Dr A has a conflict of interest. She should not be

involved in developing the tender, designing the criteria for selecting providers or in the final

decision making even though she is a local expert. If the CCG has clear prompts and

guidelines for its members, this should be obvious to Dr A, who should decide to exempt

herself.

If the CCG is clear at the outset about its commissioning priorities and strategy and its

procurement framework (setting out what kind of services would be tendered under what

circumstances), its decision to tender for the service should not come as a surprise to the

trust, or to the individuals involved.

CCGs need to ensure that they do not discourage providers, or their own members, from

being innovative and entrepreneurial by being inconsistent or opaque in their commissioning

decisions and activities.

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Gifts, hospitality and anti – fraud and bribery Policy V0.4 (December 2016)

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Contents 1 Purpose and scope ................................................................................................................ 3

2 Responsibilities ..................................................................................................................... 3

3 Definitions .............................................................................................................................. 6

3.1 Gifts ................................................................................................................................. 6

3.2 Hospitality ....................................................................................................................... 6

4 Guiding documentation ......................................................................................................... 7

4.1 The Bribery Act 2010 ........................................................................................................... 7

4.2 Pharmaceutical Companies ................................................................................................ 7

5 Policy ...................................................................................................................................... 8

5.1 Introduction ..................................................................................................................... 8

5.2 Policy statement .................................................................................................................. 8

5.3 Guide to Gifts and Hospitality – Refusal and Acceptance ........................................... 9

5.4 Gifts from patients / members of the public ............................................................... 10

5.5 Gifts from Office holders or work colleagues. ............................................................ 10

5.6 Guide to other Hospitality/Offers of Hospitality - Refusal and Acceptance .............. 10

6 Gifts and Hospitality Register ............................................................................................. 12

7 Penalties ............................................................................................................................... 12

8 Fraud and Corruption .......................................................................................................... 12

9 Bribery Act ........................................................................................................................... 13

9.1 What is the Bribery Act? .............................................................................................. 13

9.2 When did it come into force? ....................................................................................... 13

9.3 Why is it relevant to NHS organisations, professionals and staff? ........................... 13

9.4 Why is it relevant to the NHS Protect? ........................................................................ 13

9.5 What is bribery? ............................................................................................................ 13

9.7 Who can be prosecuted under the Bribery Act? ........................................................ 14

9.8 Who will investigate and prosecute these new offences? ......................................... 14

9.9 What penalties can be imposed? ................................................................................. 14

9.10 What can NHS organisations do to comply? .............................................................. 15

9.11 What is meant by ‘adequate procedures’? ................................................................. 15

9.12 Is there any guidance on what constitutes adequate procedures? .......................... 15

9.13 What should I do if I suspect bribery is occurring? ................................................... 15

Appendix 1: The Nolan Principles ............................................................................................. 16

Appendix 2: Register of Gifts and Hospitality Declaration Form ............................................. 17

Appendix 3: Scenarios and case studies………………………………………………………….....17

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Introduction

Managing conflicts of interest appropriately is essential for protecting the integrity of NHS Newham Clinical Commissioning Group from perceptions of wrong doing or impropriety including all groups relating to commissioning, contracting and procurement processes and where decision making is required by those members’. The CCG must meet the highest level of transparency to demonstrate that conflicts of interest are managed in a way that does not undermine the probity and accountability of the CCG.

This policy sets out the approach that the CCG will implement to identify, manage and record any potential or actual conflicts of interests that may arise as part of the commissioning of healthcare for Newham CCG. This policy is issued in accordance with statutory guidance under Sections 14O and 14Z8 of the National Health Service Act 2006 (as amended by the Health and Social care Act 2012). The act sets out clear requirements for CCGs to make arrangements for managing actual and potential conflicts of interests, to ensure they do not affect, or appear to affect, the integrity of the CCGs decision making processes. These requirements are supplemented by procurement-specific requirements in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. This policy has been drafted with consideration given to the NHS England Guidance on Co-Commissioning, released in December 2014. The revised statutory guidance for CCGs updated in June 2016 has been incorporated.

This policy should be read in conjunction with the CCG’s Constitution, the CCG’s Conflicts of Interest Policy and Sponsorship Policy. The CCG will ensure that North and East London Commissioning Support Unit (CSU) and other Contractors are aware of the contents of this policy if applicable.

1 Purpose and scope The purpose of this policy is to provide guidance to staff and office holders on the action that can, or should, be taken in the event that they are offered gifts and/or hospitality, make it clear where the boundaries of acceptable conduct lie and to protect the property and finances of the NHS and of patients in our care. NHS Newham CCG does not tolerate fraud and bribery within the NHS. This policy applies to all employees of NHS Newham Clinical Commissioning Group (NCCG), any staff who are seconded to NCCG, contract and agency staff and any other individual working on NCCG premises. This Policy also applies to NCCG Office Holders, e.g. Members of the Governing Board and its Committees/Sub-Committees including all groups relating to commissioning, contracting and procurement processes and where decision making is required by those members The CCG will ensure that North and East London Commissioning Support Unit (CSU) and other Contractors are aware of the contents of this policy if applicable. Where an individual fails to comply with this policy disciplinary action may be taken in accordance with the CCG’s Disciplinary Policy and its Constitution. The CCG’s disciplinary policy is located on the staff intranet and on the CCG’s website

2 Responsibilities Party Key Responsibilities Director of Partnerships & Governance

• Monitor and ensure compliance with this policy. • Advising staff / Office Holders on the contents of this

policy.

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• Providing guidance for staff / Office Holders on refusal or acceptance for gifts or hospitality.

• Maintaining a central register of gifts and hospitality.

• Receive declarations for inclusion in the Gifts and

Hospitality Register.

• Ensure that this policy is compliant with pertinent legislation and guidance.

All Managers • Ensuring that their staff are aware of, and adhere to, this

policy. • Make declarations of receipt of gifts or hospitality where

required.

• Provide advice and guidance to staff on the receipt of gifts / hospitality in the first instance, and

• Consult the Director of Partnerships & Governance

where additional guidance is required. All Staff • Ensuring they are aware of, and follow this policy.

• Make declarations of receipt of gifts or hospitality where

required in consultation with their line manager. • Refuse gifts, inducements or hospitality other than items

of modest value. • Staff with authority to commit expenditure must declare

any relevant and material interests. • Do not use your official position for private gain. • Respect confidentiality of business information. • Act in accordance with the seven Nolan principles (See

Appendix 1) on standards in public life: selflessness, integrity, objectivity, accountability, openness, honesty and leadership.

Local Counter Fraud Specialist

• The LCFS’s role is to ensure that all cases of actual or suspected fraud and bribery are notified to the Chief Financial Officer and reported accordingly.

• Investigation of the majority cases of alleged fraud

within NCCG • The LCFS will regularly report to the Chief Financial

Officer on the progress of investigations and when/if referral to the police is required.

• The LCFS and the Chief Financial Officer, in conjunction

with NHS Protect, will decide who will conduct

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investigations and when/if referral to the police is required.

Office Holders • The NCCG Governing Board has also determined that

Office Holders (e.g. members of Committees/Sub-Committees) must comply with this policy.

Commissioning Leads and Procurement Leads

Lay Member for Governance and Audit Chair

General Practitioners (GPs)

Commissioning Leads and Procurement Leads and any staff leading on any relevant procurements within the CCG must ensure that bidders, contractors and direct service providers adhere to this policy, and that

the service re-design and procurement processes used by the CCG reflect the procedures set out in this policy.

The Chair of the Audit Committee has a lead role in ensuring that the Governing Body and the wider CCG behaves with the utmost probity at all times. The Chair of Audit Committee oversees key elements of governance including the appropriate management of conflicts of interest. In addition they will provide a view of the working of the CCG with a strategic and impartial focus and will take the Chair’s role for discussions and decisions where the Chair has made a declaration of interest and has to withdraw from a meeting due to the conflict.

Following guidance from The General Medical Council (GMC) the CCG will ensure that any GPs with a responsibility for or involvement in

commissioning of services must:

• Satisfy themselves that all decisions made are open, fair and transparent and comply with legislation.

• Keep up to date and follow the guidance and codes of practice that govern the commissioning of services.

• Formally declare any interest that they, or someone close to them, including their business partner, or their employer has in a provider company.

• Take steps to manage any conflict between their duties as a GP and their commissioning responsibilities, for example by excluding themselves from the decision.

• Take steps to manage any conflict between their duties as a GP and their commissioning responsibilities, for example by excluding themselves from the decision making process and any subsequent monitoring arrangements.


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3 Definitions 3.1 Gifts A gift is defined as any item of cash or goods, or any service, which is provided for personal benefit, free of charge or at less than its commercial value. All gifts of any nature offered to CCG staff, board and committee members and individuals within GP member practices by suppliers or contractors linked (currently or prospectively) to the CCGs business should be declined, whatever their value. The person to whom the gifts were offered should also declare the offer to the Director of Partnerships & Governance so the offer which has been declined can be recorded on the register. Gifts offered from other sources should also be declined if accepting them might give rise to perceptions of bias or favouritism, and a common sense approach should be adopted as to whether or not this is the case. The only exceptions to the presumption to decline gifts relates to items of little financial value (i.e., less than £10) such as diaries, calendars, stationery and other gifts acquired from meetings, events or conferences, and items such as flowers and small tokens of appreciation from members of the public to staff for work well done. Gifts of this nature do not need to be declared. Any personal gift of cash or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or representing the CCG) must always be declined, whatever their value and whatever their source, and the offer which has been declined must be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality and recorded on the register. Examples of the kind of gifts which might be made/offered include: Stationery items such as pens, notepads, calculators, or carrier bags, food or confectionery, particularly chocolates and biscuits, flowers or plants, ornaments, mugs, wines and spirits, articles of clothing, jewellery or watches, tickets for cultural or sporting events, discounted rates for hire or purchase, free publications and cash. 3.2 Hospitality A blanket ban on accepting or providing hospitality is neither practical nor desirable from a business point of view. However, individuals should be able to demonstrate that the acceptance or provision of hospitality would benefit the NHS or CCG. Modest hospitality provided in normal and reasonable circumstances may be acceptable, although it should be on a similar scale to that which the CCG might offer in similar circumstances (e.g., tea, coffee, light refreshments at meetings). A common sense approach should be adopted as to whether hospitality offered is modest or not. Hospitality of this nature does not need to be declared to the Director of Partnerships & Governance, nor recorded on the register, unless it is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business in which case all such offers (whether or not accepted) should be declared and recorded. There is a presumption that offers of hospitality which go beyond modest or of a type that the CCG itself might offer, should be politely refused. A non-exhaustive list of examples includes:




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• Hospitality of a value of above £25; and • In particular, offers of foreign travel and accommodation. There may be some limited and exceptional circumstances where accepting the types of hospitality referred to in this paragraph may be contemplated. Express prior approval should be sought from a senior member of the CCG (e.g. the Director of Partnerships & Governance or equivalent) before accepting such offers, and the reasons for acceptance should be recorded in the CCGs register of gifts and hospitality. Hospitality of this nature should be declared to the Director of Partnerships & Governance and recorded on the register, whether accepted or not. In addition, particular caution should be exercised where hospitality is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business. Offers of this nature can be accepted if they are modest and reasonable but advice should always be sought from a senior member of the CCG (e.g. the the Director of Partnerships & Governance or equivalent) as there may be particular sensitivities, for example if a contract re-tender is imminent. All offers of hospitality from actual or prospective suppliers or contractors (whether or not accepted) should be declared and recorded. Covers a wide spectrum and can include: Free meals, drinks, receptions, meetings sponsored by drug companies, hospitality tents at shows, exhibitions or conferences, music and cultural events, sport and leisure events, particularly golf competitions, use of company facilities, hotel accommodation and holidays. 4 Guiding documentation The key piece of legislation governing this policy is the Bribery Act 2010. This is summarised below: 4.1 The Bribery Act 2010 Under the Bribery Act 2010 it is a criminal offence to: • Bribe another person by offering, promising or giving a financial or other advantage to induce

them to perform improperly a relevant function or activity, or as a reward for already having done so, and

• Be bribed by another person by requesting, agreeing to receive or accepting a financial or other advantage with the intention that a relevant function or activity would then be performed improperly, or as a reward for having already done so.

These offences can be committed directly or by and through a third person and, in many cases, it does not matter whether the person knows or believes that the performance of the function or activity is improper. It is, therefore, extremely important that staff adhere to this and other related documentation (See Associated CCG documentation) when considering whether to offer or accept gifts and hospitality and/or other incentives. 4.2 Pharmaceutical Companies All private companies must now adhere to the Bribery Act 2010. Where pharmaceutical companies are involved, inducements and hospitality must comply fully with the Medicines (Advertising) Regulations 1994 (regulation 21 ‘Inducements and hospitality’. Any person who contravenes regulation 21(1) is guilty of an offence, and liable, on summary conviction to a fine not exceeding £5000, and on conviction on indictment to a fine, or to imprisonment for a term not exceeding two years, or both. Anyone contravening regulation 21(5) is also guilty of an offence and is liable, on summary conviction to a fine not exceeding £5000’. The





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Medicines Control Agency (MCA) Guidelines on Promotion and Advertising set out the standards to be followed. If an offer received is contrary to the above, details should be sent to the Director of Partnerships & Governance who will take up the matter with the company concerned.

5 Policy 5.1 Introduction NCCG manages a large commissioning budget. It is therefore imperative for office holders to not place themselves in a position where it appears their judgment has been compromised through the acceptance of inappropriate gifts or hospitality. In some circumstances the acceptance of a gift from an organisation or individual could appear to influence the action of a member of staff and compromise the member of staff’s position. This is because a gift is never really a gift; there is always an element of mutuality. The standards that the public demand from their office holders are high and the great majority of people in public life meet those high standards. However it is imperative that a clear policy outlining where the boundaries of acceptable conduct lie is made available. This policy sets out some guiding principles covering the acceptance of gifts and hospitality, including references to interests in contracts. It does not provide for every eventuality and, therefore, staff/Office Holders should not hesitate to seek advice from their Line Manager or the Director of Partnerships & Governance. The action of all CCG staff and Office Holders must not give rise to, or foster the suspicion that they have been, or may have been, influenced by a gift or consideration to show favour or disadvantage to any person or organisation. Staff/Office Holders must not allow their judgement or integrity to be compromised in fact or by reasonable implication. NCCG is committed to taking all necessary steps to counter fraud and bribery. To meet its objectives, it has adopted the seven-stage approach developed by NHS Protect: • the creation of an anti-fraud culture • maximum deterrence of fraud • successful prevention of fraud which cannot be deterred • prompt detection of fraud which cannot be prevented • professional investigation of detected fraud • effective sanctions, including appropriate legal action against people committing fraud and

bribery, and • effective methods of seeking redress in respect of money defrauded. NCCG will take all necessary steps to counter fraud and bribery in accordance with this policy, the NHS Anti-Fraud Manual, the policy statement ‘Applying Appropriate Sanctions Consistently’ published by NHS Protect and any other relevant guidance or advice issued by NHS Protect. 5.2 Policy statement As a general rule the CCG believes that:

Gifts or offers of hospitality must be refused if there could be any doubt about the propriety of accepting them.

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If in any doubt at all as to whether or not to accept gifts or hospitality, staff/Office Holders should immediately seek the advice of their Line Manager or the Director of Partnerships & Governance. 5.3 Guide to Gifts and Hospitality – Refusal and Acceptance The following flow charts outline NCCG’s policy and procedure with regard to gifts and hospitality; including from patients and colleagues.

Has the offer of a ‘Gift’ or ‘Hospitality’ to a member of staff, board member or clinical/cluster lead or individuals within GP member practices come from a supplier or contractors (current or prospective) linked to the CCG’s business (whatever the value)commercial company, charity or voluntary body or individuals in the process of

No Yes

Has the offer of a ‘Gift’ or ‘Hospitality’ come from another source that might give rise to perceptions of bias or favouitism commercial company or business formally requesting to be

added to NCCG’s list of tenders for approved works?

No Yes

Is the gift from a patient/member of public given as ‘Thank you’ or an acknowledgement for services performed during the course of NCCG work?

No Yes

Is the ‘gift’: cash (including gift vouchers) or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend mneetings whilst in a capacity working for or representing the CCG)

paid holidays, and/or use of company flats or facilities?

No

Yes

Is the gift less than £120?

You do not need to register on the Gifts and Hospitality Register. Offers of gifts by a company to NCCG or a members of staff/Office Holder, such as calculators, mugs, ornaments or books, may be accepted where the notional value is under £120 providing it is for use at work. Such gifts tend to bear the company’s name or insignia and can, therefore be regarding as being in the nature of advertising matter

No Yes

The gift must be refused and declare the offer in the

regsiter














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The CCG document ‘THCCGCGO0020 Register of Gifts and Hospitality Declaration Form’ is attached as Appendix 2 to this document and is available on request from the Director of Partnerships & Governance. If in any doubt at all as to whether or not to accept gifts or hospitality, staff/Office Holders should immediately seek the advice of their Line Manager or the Director of Partnerships & Governance. 5.4 Gifts from patients / members of the public Offers of gifts (e.g. flowers, chocolates, etc. but not cash/gift vouchers) by members of the public to staff may be accepted where the notional value is less than £120 when given as acknowledgment for services performed in the course of their work. Whilst such gifts do not have to be declared, the CCG records them as a means of providing a balance to complaints. They should, therefore, be reported. If in any doubt at all as to whether or not to accept gifts or hospitality, staff/Office Holders should immediately seek the advice of their Line Manager or the Director of Partnerships & Governance. Where an individual believes they have been offered a generous gift to secure preferential treatment for a patient the gift should both be refused and declared, and the Director of Partnerships & Governance should be informed.

5.5 Gifts from Office holders or work colleagues. Gifts given by Office Holders/work colleagues to other Office Holders/work colleagues are, of course, acceptable and do not have to be declared. If in any doubt at all as to whether or not to accept gifts or hospitality, staff/Office Holders should immediately seek the advice of their Line Manager or Director of Partnerships & Governance. 5.6 Guide to other Hospitality/Offers of Hospitality - Refusal and Acceptance The Bribery Act 2010 does not prevent companies from providing hospitality provided it is ‘reasonable’ and ‘proportionate’. The CCG will, therefore, continue to receive offers. The CCG approach to accepting hospitality is summarised below:

You must register any gift or in the register for gifts and hospitality





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Is the offer of hospitality a working breakfast, a working lunch or dinner integral to a meeting, training event, presentation, conference, seminar or similar event where the attendance is in

NCCG’s interest?

No Yes

Is the offer of hospitality, a lunch, dinner, reception or comparable function organised by an embassy, cultural organisation, professional

equivalent, where attendance is in NCCG’s interest?

Yes This is acceptable and does

not need to be declared

Is the offer of hospitality an offer to attend a private, social or sporting function?

No

Yes

This should be refused if they go beyond modest or a type that the CCG itself

might offer. This includes hospitality of a value of above £25 and in particular

offers of foreign travel and accommodationonly be accepted only when these are part of the life of the

community or where NCCG should be seen to be represented

No

Attendance at relevant company sponsored conferences is acceptable where it is clear that the hospitality is corporate rather than personal and any possible purchasing decisions are not compromised. However, prior approval is required. When receiving authorised hospitality, staff/Office Holders should be particularly sensitive as to its timing in relation to decisions which NCCG may be taking affecting those providing the hospitality. However, account must be taken of the nature of the relationship between NCCG and the organisation concerned and the scale of the hospitality offered. If there is any doubt the offer should be declined. All other offers of hospitality should be declared to your line manager, or the Director of Partnerships & Governance who will recommend refusal or acceptance. If refusal is recommended, then arrangements should be made for the hospitality to be refused at the earliest opportunity with an appropriate explanation.

There is no further action required



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6 Gifts and Hospitality Register The Gifts and Hospitality Register is maintained by the Director of Partnerships & Governance. Particular mention should be made if:

• The Gifts/Hospitality were offered to, or received by, staff/Office Holders in any part of a procurement process, and

• The Gifts/Hospitality were offered by companies, or other organisations, with which the

CCG has a contractual, grant giving or regulatory relationship, or is actively considering such a relationship.

7 Penalties This policy describes conduct which staff/Office Holders are expected to observe. Failure to do so could render an individual liable to disciplinary proceedings and may lead to criminal proceedings under the Bribery Act 2010. Fraud is defined as if fraud and /or corruption are suspected, the matter must be reported immediately to the CCGs Local Counter Fraud Specialist of the Chief Finance Officer. Contact details for these individuals can be found on the CCG’s webpage.

8 Fraud and Corruption If fraud and /or corruption are suspected, the matter must be reported immediately to the CCGs Local Counter Fraud Specialist of the Chief Finance Officer. Contact details for these individuals can be found on the CCG’s webpage. Alternatively, staff may report any suspicions via the Whistleblowing Policy.

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9 Bribery Act 9.1 What is the Bribery Act? The Bribery Act 2010 reforms the criminal law of bribery, making it easier to tackle this offence proactively in the public and private sectors. It introduces a corporate offence which means that commercial organisations will be exposed to criminal liability, punishable by an unlimited fine, for negligently failing to prevent bribery. It repeals the UK’s existing anti-corruption legislation – the Public Bodies Corrupt Practices Act 1889, the Prevention of Corruption Acts of 1906 and 1916 and the common law offence of bribery – and provides an updated and extended framework of offences to cover bribery both in the UK and abroad. A copy of the Act can be found here: http://www.legislation.gov.uk/ukpga/2010/23/contents Accompanying explanatory notes and other publications can also be found on the NHS Protect intranet: http://www.nhsbsa.nhs.uk/3354.aspx 9.2 When did it come into force? The Bribery Act received Royal Assent in April 2010 and came into force on 1 July 2011. 9.3 Why is it relevant to NHS organisations, professionals and staff? 9.3.1 Professionals and staff For the purposes of the Bribery Act, a ‘trade’ or ‘profession’ is considered a business. This means that, whether individually or in partnership, GPs, pharmacists, dental practitioners, opticians, finance professionals, etc. will also be subject to and personally liable under the Bribery Act. 9.4 Why is it relevant to the NHS Protect? The remit of NHS Protect includes preventing, detecting and investigating fraud and bribery in the health service. It is stated in the Standards for Providers that both offences must be tackled. 9.5 What is bribery? Bribery is generally defined as giving someone a financial or other advantage to encourage that person to perform their functions or activities improperly or to reward that person for having already done so. 9.6 What are the key provisions of the Bribery Act? The Bribery Act sets out four offences: Section 1 - Offering, promising or giving a bribe to another person to perform a relevant ‘function or activity’ improperly, or to reward a person for the improper performance of such a function or activity. Under the Bribery Act, a ‘relevant function or activity’ is any function of a public nature or any activity connected with a business, performed in the course of a person’s employment or performed by or on behalf of a body of persons, whether corporate or unincorporated, which meets one or more of the following conditions:

• a person performing the function or activity is expected to perform it in good faith

• they are expected to perform it impartially

• they are in a position of trust by virtue of performing it.

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Section 2 - Requesting, agreeing to receive or accepting a bribe to perform a function or activity improperly, irrespective of whether the recipient of the bribe requests or receives it directly or through a third party, and irrespective of whether it is for the recipient’s benefit. Section 7 - Failure of a commercial organisation to prevent bribery (the corporate offence). This is a ‘strict liability’* offence and an organisation can be found guilty of ‘attempted’ or ‘actual’ bribery on the organisation’s behalf. It should be noted that Section 1 or section 6 needs to be proven for a section 7 offence to apply. Section 14 – Offering or receiving a bribe or bribing foreign official. This section applies if an offence under sections 1, 2 or 6 is committed by a body corporate.

* Strict liability offences do not require proof of intention or recklessness – in other words, it is not necessary for the prosecution to show that the company intended to make the bribe in bad faith, or that it was negligent as to whether any bribery activity took place.

9.7 Who can be prosecuted under the Bribery Act? Any individual associated with an organisation who commits acts or omissions forming part of a bribery offence may be liable for a primary bribery offence under the Act or for conspiracy to commit the offence with others – including, for example, their employer. Likewise, a senior management or Governing Body member who consented to or connived in a section 1 or 6 bribery offence will, together with the organisation, be liable for the section 7 ‘corporate offence’ under the Act. 9.8 Who will investigate and prosecute these new offences? No proceedings for an offence under the act may be commenced in England and Wales except by or with the personal consent of the Director of Public Prosecutions, the Director of the Serious Fraud Office or the Director of Revenue and Customs Prosecutions. 9.9 What penalties can be imposed? An offence under section 1 (bribing another person) or section 2 (being bribed):

• A person guilty of an offence under these sections is liable, on summary conviction (i.e. if tried in a magistrates’ court) to imprisonment for a term not exceeding 12 months (subject to section 11(4)(a)), a fine not exceeding the statutory maximum, or both. On conviction on indictment (i.e. in Crown Court), they are liable to imprisonment for a term not exceeding 10 years, a fine, or both.

• Any person associated with the organisation in question (this could be an agent or

subsidiary of the organisation as well as an employee) who is guilty of an offence under these sections is liable, on summary conviction, to a fine not exceeding the statutory maximum and on conviction on indictment to a fine.

An offence under section 7 (failure of commercial organisations to prevent bribery):

• An organisation guilty of an offence under this section is liable, on conviction on indictment, to a fine. (NB: Even if an organisation has delegated the relevant activities a named individual, it remains responsible for them.)

A ‘twin-track’ approach can be used to take action against an individual under section 1 and an organisation under section 7 simultaneously.

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9.10 What can NHS organisations do to comply? An organisation will have to show that it has implemented ‘adequate procedures’ designed to prevent individuals associated with that organisation from engaging in bribery in order to avoid liability. 9.11 What is meant by ‘adequate procedures’? This relates to relevant compliance protocols and procedures that a commercial organisation can put in place to prevent bribery by individuals associated with it. This might include training, briefing or new internal procedures. The adequate procedures will constitute a ‘complete defence’ for an organisation. Under the Bribery Act, a person is considered to be associated with a commercial organisation if they perform services for it or on its behalf. This person can be an individual or an incorporated or unincorporated body. 9.12 Is there any guidance on what constitutes adequate procedures? The Bribery Act requires the Secretary of State for Justice to publish guidance about procedures that relevant commercial organisations can put in place to prevent individuals associated with them from engaging in bribery. The two pieces of guidance were published in April 2011. The full guidance can be found at http://www.justice.gov.uk/guidance/docs/bribery-act-2010-guidance.pdf whilst the quick-start version can be found at http://www.justice.gov.uk/guidance/docs/bribery-act-2010-quick-start-guide.pdf. NHS Protect has also issued guidance as part of its Bribery Act guidance and training package. These documents are available on the NHS Protect secure extranet. 9.13 What should I do if I suspect bribery is occurring? Staff should report any suspicions or allegations of bribery immediately to one of the following:

• their Local Counter Fraud Specialist • their organisation’s whistleblowing function • the relevant regional Area Anti-Fraud Specialist • the NHS Fraud and Corruption Reporting Line (0800 028 40 60) or the online fraud

reporting form • at www.reportnhsfraud.nhs.uk

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http://www.justice.gov.uk/guidance/docs/bribery-act-2010-guidance.pdf

Appendix 1: The Nolan Principles The Nolan Committee set out ‘Seven Principles of Public Life’ which it believed should apply to all in the public service. These Principles have been adopted by the CCG Governing Body. The principles are: Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. Leadership Holders of public office should promote and support these principles by leadership and example.

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Appendix 2: Register of Gifts and Hospitality Declaration Form

Register of Gifts and Hospitality Declaration Form

[Period]

Please ensure that one of these forms is completed for each and any instance of gifts, hospitality, consultancies, sponsorship, and support for travel, education and training. Please refer to the Policy on gifts and hospitality for guidance on what should be declared. Name of Declarer:

Describe below acceptance of the offer. Include a value if known. Examples may include support from a commercial company for travel to a conference, payment for consultancy advice, or invitations to sporting events or meals. Casual gifts and modest hospitality are regarded as being valued at no more than £20* and declarations for this are not required. *

Details of provider/company Was the offer accepted or declined?

Reason for acceptance/refusal Disposal method eg gift has been donated to charity

I certify that the information I have given in this declaration form is correct and to the best of my knowledge. Should it later be discovered that I have given false information in order to obtain an advantage, I understand that my employment could be terminated by dismissal and that I may be subject to criminal investigation. Declarer signature Date Name and title Please note that if there is any likelihood of a conflict of interest, you must discuss the issues with your line manager who should co- sign this form before it is sent into the Director of Partnerships

& Governance

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Scenario 1

A GP is also a member of the CCG Governing Body, and sit on the panel for making procurement decisions. The CCG tenders for paediatric services, and the practice partner of the GP has a financial interest in one of the providers bidding for work.

Threats

• The GP member has failed to declare the business interest of their GP partner. Were they to then influence the procurement process to award the contract to their business partner, it could be construed that they have abused their position in order to make a gain for another.

• The GP member has declared the interest of the business partner, but is still allowed to hold decision-making powers in the procurement process. If the business partner is then awarded the contract this could lead to accusations of favouritism in the process and a challenge on the fairness of the process.

Solution

First and foremost, the GP member should be required to declare all interests held by themselves or their business partners and spouses, which have relevance to the health sector, in line with the CCG policy. Secondly, there should be a clear process for linking declarations of interest to the procurement process, and declarations of individuals involved in the procurement process should be checked each time a procurement involving those individuals is undertaken.

The CCG should also remove the GP member from any decision-making process. The GP member may be able to add value to the procurement process from a technical point of view, but should not be part of the final decision-making process. Their contribution to the process should be clearly noted throughout by the CCG.

If technical expertise is required in the procurement process, but the only person able to offer the expertise is the individual with the conflict, the CCG can consider seeking the expert advice from a source unconnected to the CCG (essentially seeking consultancy services).

Utilising an independent expert further protects the CCG from any future challenge from any party who may wish to challenge the decision making process as to the award of any contract. Additionally the CCG can demonstrate that it has acted fairly and transparently and applied adequate procedures in line with Ministry of Justice guidance.

Scenario 2

A contracts manager for a CCG is involved in the process of tendering for the design of a new corporate logo. The tender process has not been completed and no final decision has been made. The manager and a colleague have been invited by one of the companies tendering, to a rugby game. For the past few years the colleague, in their own time, has been regularly attending design workshops offered by the company. The colleague is not on the tender panel, nor are they involved in the decision-making process for that tender. The Contracts Manager, however, will be.

Threats

• Even though the colleague is not involved in the tender process, they may be perceived to have influence as they have an association with one of the companies tendering, and work in the department that will be determining the outcome of the tender.

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• The contracts manager is in a decision-making position and acceptance of hospitality from one company, and not others, may be construed as influencing their ability to be impartial in carrying out their public duty to award the tender.

Solution

The contracts manager and their colleague should follow the CCG policy relating to gifts and hospitality which they are bound by. To avoid any perception of a conflict of interest, it would be wise for the colleague to disclose their previous association with the company to the CCG. It is also advisable for the offer of gifts and hospitality to be declared to the CCG by both individuals in advance of acceptance, so that challenge can be made if required, and a determination as to whether the offer can be accepted can be made independently.

If the contracts manager accepts the hospitality, the CCG should request that the contracts manager restrict their involvement by refraining from being part of the decision-making in the tender process.

This enables the CCG to demonstrate they have considered any undue influence on the process and have acted accordingly to ensure a fair and transparent process.

Scenario 3

A procurement process is underway to award contracts for a number of community physiotherapy services. One of the potential providers approaches a GP with a large influence within the CCG. The provider offers to pay for the use of the GP’s practice to undertake the physiotherapy services, in exchange for the awarding of a number of the contracts. The provider has actually put forward a strong tender to the CCG for the contracts, and has a good chance of successfully winning a percentage of the contracts.

Threats

• If the approach from the provider is not reported to the CCG or the Local Counter Fraud Specialist by the GP, and the provider who sought to influence the procurement outcome is awarded contracts, there may be allegations made that the procurement process is not fair and that individuals have received incentives to reach a decision. These allegations would cause serious damage to the CCG’s reputation, even if the GP had not exercised any influence over the process.

• Regardless of the strength of the provider’s tender bid, by making inappropriate offers of incentives, the provider has demonstrated they are not adhering to the Bribery Act 2010 and therefore could be considered as an unsuitable provider.

Solution

The GP should immediately report the approach to the CCG and/or the Local Counter Fraud Specialist. The CCG should allow the LCFS to make enquiries to determine whether there is any substance to the allegation of ‘offering a bribe or incentive’, to influence the behaviour of the GP. Depending on the outcome of the LCFS enquiries, a decision should be made by the CCG as to whether to exclude the provider from the tender process.

If the GP fails to report the offer of a bribe, and this subsequently comes to light, the CCG should direct the LCFS to investigate both parties accordingly.

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Real-Life Case Studies

Since the implementation of the Bribery Act there have been three successful prosecutions in the United Kingdom as follows:

• The first case concerned Munir Patel, 22 who was handed a three-year prison term for bribery and ordered to serve six years concurrently for misconduct in a public office. He helped more than 50 offenders avoid prosecution in exchange for sums of up to £500 in relation to speeding fines and other court related matters.

• The second case concerned Mr Mawia Mushtaq, who became the first person to be successfully prosecuted under the Act for offering (as opposed to receiving a bribe). Having failed a driving test before an Oldham Council licensing officer necessary to secure a taxi licence, Mr Mushtaq offered the sum of £200 (later increased to £300) if the result of the test were changed to a pass. The officer was not so easily corrupted as Mr Patel. He refused the bribe and reported the matter to his manager and later the police. Mr Mushtaq was sentenced to 2 months imprisonment, suspended for 12 months.

• The third case concerned a Mr Yang Li. Mr Li, a Masters student at the University of Bath, was unsatisfied with the 37% mark he was awarded for a 12,000 word essay; the pass mark was 40%. He was given three options by his professor: appeal the mark; resubmit the essay; or withdraw from the course. Mr Li proposed a fourth option. He placed £5,000 on the table, stated that he was a “businessman” and told the professor he could keep the money if the mark was raised. The professor refused. As Mr Li replaced the money in this pocket, he dropped an imitation firearm on the floor, which had presumably been brought as a back-up in case his first attempt at coercion was unsuccessful. The police were called in and Mr Li was prosecuted. In April 2013, Mr Li was jailed for 12 months (both for the attempted bribery and for possession of an imitation firearm) and ordered to pay £4,800 in costs.

Parallels can be drawn with these cases which relate to NHS services, for example those staff involved in the Procurement cycle being offered lavish ‘entertainment’ prior to a tender to persuade them to choose a particular supplier/contractor above another.

The individual responsible would no doubt suffer similar consequences as the persons named above, however the corporate offence of failing to prevent bribery could also be implied if the CCG has not taken adequate procedures to mitigate against its risk of ‘negligently failing to prevent a bribe’.

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Newham CCG Commercial Sponsorship Policy

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Version: 1 Date ratified: Name and dept of originator/author: Sab Sanghera Director of Partnerships &

Governance Name of responsible committee Audit Committee Date issued: January 2017 Review date: December 2017 or issue of new

legislation Target audience: All staff working within or on behalf of

Newham CCG and GP Practice Members

Document Control Information

Version control table Date of Issue Version Number Status January 2017 V1 Table of revisions

Date Section Revision Author –

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Contents

Page

1 Introduction

2 Background

3 Key Principles

4 Arrangements for the rejection of offers of sponsorship

5 Responsibilities

6 Code of Conduct

7 Management Arrangement

8 Breaches of Policy

9 Equality & Diversity

Appendices

Appendix A – Code of Conduct

Appendix B – Commercial Sponsorship Rejection Form

Appendix C – Equalities Impact Assessment

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1 Introduction and Definition Clinical Commissioning Groups (CCGs) are increasingly being offered Commercial Sponsorship particularly from within the Pharmaceutical Industry. This policy sets out Newham CCG’s policy and associated Code of Conduct in relation to commercial sponsorship. This policy is in response to Commercial Sponsorship Ethical Standards for the NHS – published by the Department of Health (DoH) in November 2000 which requires NHS Organisations to produce local policies in relation to commercial sponsorship as well as the revised statutory guidance to CCGs on Managing Conflicts of Interest published in June 2016 Commercial Sponsorship’ is defined as including, “NHS funding from an external source, including funding of all or part of the cost of a member of staff, NHS research, staff and member practice training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs, (including trips abroad), provision of free services and buildings or premises.” Typically sponsorship is most likely to involve the sponsorship of a single one-off “event” although this policy also refers to “projects” where a longer term sponsorship arrangement might be undertaken. The arrangements outlined within this policy apply to all staff employed by Newham CCG. The Department of Health Guidance also requires Independent Contractors to put into place similar local arrangements. Independent Contractors should refer to their professional bodies for guidance. GPs should also refer to the BMA guidance “Ensuring Transparency and Probity”. May 2011. This policy should be read in conjunction with the following policies: • Gifts Hospitality anti- Fraud and Bribery Policy • Conflicts of Interest Policy

2 Background It is recognised that that there can be mutual benefit in sponsorship arrangements with organisations external to the NHS, but only if they are agreed within a framework with the necessary safeguards and checks. Limited finance and management resources mean that the potential availability of financial and other support is attractive to the NHS. Specifically the Association of the British Pharmaceutical Industry (ABPI) Code of Practice allows pharmaceutical companies to commit up to 9% of their total resources to educational work with NHS organisations, so significant resources are available for appropriate projects from this source alone. There are, however, concerns that in accepting sponsorship from companies whose primary aim is to make profits, the quality of patient care may be compromised and priorities may be distorted by sponsorship agreements which look attractive in one part of the NHS, but may lead to increased costs or poorer care of patients in other parts of the service. Commercial Sponsorship Ethical Standards for the NHS requires NHS bodies to have formal arrangements, with clear policy statements, codes of practice in working with sponsors, and codes of conduct for Clinical Commissioning Group (CCG) members and staff. These

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arrangements need to be in line with the Standing Orders, Scheme of Reservation and Delegation of the organisation. 3 Key Principles Newham CCH has decided that, as a commissioning organisation, offers of sponsorship from any provider or potential provider of any health goods or service or other form of good or service should not be accepted as a matter of principle for the following reasons;

• As a commissioning body there is the risk that commissioning decisions may have

been made on a partial basis where sponsorship has been permitted • As a commissioning body there is the risk of a perception that commissioning

decisions may have been made on a partial basis where sponsorship has been permitted

• The CCG as a commissioning body should remove itself from the risk of being

perceived as conferring an advantage on an existing or potential provider • The CCG as a commissioning body cannot reasonably assure itself that the acceptance of

sponsorship will not confer a position of advantage for the sponsor over other providers of goods or services. Typically

• The practice of sponsorship as it most commonly exists for the CCG involves requests

from pharmaceutical organisations as provider organisations to be permitted an “audience” with primary care practitioners through the CCG meeting structure (Practice Council, Cluster Meetings, Education Sessions) where presentations have been made in return for the provision of refreshments. Typically providers approached the CCG to offer sponsorship as opposed to the CCG offering the opportunity to allow sponsorship to all providers and hence there would not be a fair and equitable system allowing similar access to all providers to events.

4 Arrangements for the rejection of offers of sponsorship 4.1 Offers of sponsorship for a project or event will be rejected and that rejection recorded. 4.2 All CCG Staff and members should record the offer of sponsorship and its rejection

using form Appendix B. 4.3 Forms should be passed to the Director of Partnerships and Governance will

record the rejection of the offer of sponsorship on the CCG Sponsorship register. The originating officer should advise the organisation from where the offer of sponsorship originated that the offer will be recorded on the CCG’s Sponsorship Register.

4.4 The Register is retained as a list of all of sponsorship made and rejected with effect

from the adoption of this policy.

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5 Responsibilities Accountable Officer The Chief Officer has overall accountability and responsibility for implementation of this policy. The Chief Officer has delegated responsibility for day-to-day management of this policy to the director of Partnerships & Governance Director of Partnerships and Governance The Director of Partnerships and Governance is responsible for: • Advising staff, office holders and GP Member Practices on the contents of this policy • Ensuring adequate records are established in terms of the forms where sponsorship has

been offered and rejected • Maintaining the Commercial Sponsorship Register, ensuring it is open for public inspection

and scrutiny and its publication on the CCG website • Preparation of the Commercial Sponsorship Annual Report and presentation to the

Governing Body. • Decisions on the management of breaches of the policy • Policy renewal Director of Quality & Development The Director of Quality & Development is responsible for: • Ensuring in particular that the medicines Management team are aware of and comply

with this policy Directors of Service • Directors of Service must ensure divisional staff are aware of the provisions set out within

this policy and that it is implemented within their teams, in particular the Primary Care team in relation to Cluster Events and other primary care events.

Employees All staff are responsible for following the policy and for declaring any matter covered within the confines of this policy. 6 Code of Conduct 6.1 The Code of Conduct in relation to sponsorship for CCG officers, office holders and

CCG members, who are not subject to professional codes, is attached at Appendix A. 7 Management Arrangements 7.1 The Register and reporting arrangements

A register of sponsorship agreements rejected will be maintained by the Director of Partnerships & Governance. The register will be open to inspection by the public and will be maintained on the CCG website. The register will record those proposals which

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were submitted and rejected. The Director of Partnerships & Governance will make an annual report to the CCG Governing Body each year.

8 Breaches of Policy 8.1 Employees are reminded that breaches of rules, including breaches of policy, could be

regarded as misconduct under the CCGs Disciplinary Procedure and/or as criminal activity which will be reported to the Local Counter Fraud Specialist/Local Security Management Specialist and/or police accordingly.

9 Equality and Diversity Statement 9.1 Newham CCG is committed to ensuring that all patients, employees and members of

the public are treated fairly, equitably and reasonably and that it does not discriminate against individuals or groups on the basis of their ethnic or national origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation, social and employment status or domestic circumstances.

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Appendix A

CODE OF CONDUCT

Staff employed by Newham CCG, members of the CCG and anyone undertaking work on behalf of the CCG should follow the following principles and abide by any professional codes of conduct in relation to matters of sponsorship; • Act impartially in all their work; • Refuse sponsorship of any kind as it may reasonably be seen to compromise their

personal judgement or integrity, or seek to exert influence to obtain preferential consideration.

• Declare and register the rejection of sponsorship of any kind.

• Declare financial or personal interest in any organisation with which they have to deal, and

be prepared to withdraw from those dealings if required, thereby ensuring that their professional judgement is not influenced by commercial considerations;

• Not misuse their official position or information acquired in the course of their official duties, to further their private interests or those of others;

• Beware of bias generated through sponsorship; where this might impinge on professional

judgement, fair competition and impartiality;

• Adhere to the rejection process for sponsorship applications and ensure rejection forms

are recorded on the CCG Sponsorship Register.

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Appendix B

Sponsorship Rejection Form

1 Details of CCG member making the rejection

Print Name Signature

Date

2 Details of project or event being for which sponsorship was offered:

3 Proposed Sponsor

Organisation

Nature of business

Address

Contact name

Tel number

4 Value of sponsorship – financial or “in kind” (if refreshments, estimate the value per head for the audience)

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5 Date sponsorship was rejected and how the sponsor was advised ( email / phone / in person)


Date

11 Date Rejection Form received by Director of Partnerships & Governance (or DCO / CFO in their absence)

• Rejection received -


Date

THE FORM MUST BE SIGNED & RETRNED TO THE DIRECTOR OF PARTNERSHIPS & GOVERNACE AT NEWHAM CCG BY THE SPONSOR

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NCCG Equality Impact Assessment Jan 2017

Title of policy or service Commercial Sponsorship Policy

Name and role of officers completing the assessment

Mike Sims board Secretary Newham CCG

Date assessment started/completed January 2017

1. Outline Give a brief summary of your policy or service

• Aims • Objectives • Links to other policies, including

partners, national or regional

To ensure that clinical and professional decisions are always be made in the best interests of patients and the service and that involvement of a commercial sponsor should not compromise the CCG or any member of staff/officer/ member in undertaking their duties

• Links to following policies: • Gifts and Hospitality anti fraud and corruption Policy • Declarations of Interest Policy • Standing Orders

Scheme of Reservation and Delegation

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2. Gathering of Information This is the core of the analysis; what information do you have that indicates the policy or service might impact on protected groups, with consideration of the General Equality Duty.

What key impact have you identified?

What action do you need to take to address these issues?

What difference will this make?

Positive Impact

Neutral impact

Negative impact

Human rights Age Carers Disability Sex Race Religion or belief Sexual orientation Gender reassignment Pregnancy and maternity

Marriage and civil partnership (only eliminating discrimination)

Other relevant group

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Please provide details on the actions you need to take below. 3. Action plan

Issues identified Actions required How will you measure impact/progress Timescale Officer

responsible None identified

4. Monitoring, Review and Publication When will the proposal be reviewed and by whom?

Lead Officer Director of Partnerships and Governance Review date: January 2018 or before if legislation/ statutory

guidance is revised

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