nhs croydon clinical commissioning group governing … body/governing … · audit committee for...

NHS CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY

Meeting in Public

Tuesday 1 May 2018 2.00 – 4.00pm

Markee Room, Croydon Conference Centre,

Surrey Street, Croydon CR0 1RG

Croydon Clinical Commissioning Group Governing Body Meeting in Public

Agenda

Meeting: 1 May 2018, 2.00 – 4.00 pm Location: Markee Room Croydon Conference Centre, Surrey Street, Croydon

Members of the public are welcome to attend this meeting of Croydon CCG’s Governing Body meeting. There will be the opportunity to ask questions during the Open Space. Questions will be limited to one question, plus one supplementary question, per person.

Item Time Lead Enclosure

1 2.00 Apologies for absence Chair Verbal

2 Declaration of Interests

Chair Verbal

3 Minutes of the meeting held on 6 March 2018 - Action Log (no actions outstanding)

Chair Enclosure 1

4 Matters Arising

Chair Verbal

Standing Items

5 2.10 Joint Chair/Chief Officer Report For information

Agnelo Fernandes/

Andrew Eyres

Enclosure 2

Presentation

6 2.20 Improving Access to Psychological Therapies (IAPT) Stephen Warren

Presentation

Strategy

7 2.35 2017/18 Operating Plan – Final For discussion and noting

Stephen Warren /

Mike Sexton

Enclosure 3

Governance

8

2.45 Report from Integrated Governance & Audit Committee - Request for Delegated authority to Review Final

CCG Annual Report and CCG Annual Accounts 2017/18 and commend to Council of Members. For agreement

- Annual Report and Review of Committee Terms of Reference For noting

- Terms of Reference for Integrated Governance and Audit Committee For approval

Philip Hogan / Elaine

Clancy / Mike

Sexton

Enclosure 4 Enclosure 4 Appendix A Enclosure 4 Appendix B

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3.00 Report from Finance Committee - 2017/18 Finance Period 12 (March 2018) - 2017/18 QIPP Programme Period 12 (March 2018) - Contracting Portfolio Report (Month 11) - Finance Committee Annual Report 2017/18 - Review of Finance Committee Terms of Reference

For agreement

Roger Eastwood /

Mike Sexton/ Stephen Warren

Enclosure 5 Enclosure 5a Enclosure 5b Enclosure 5c Enclosure 5d Enclosure 5e

10 3.15 Report from Quality Committee - Month 11 Integrated Performance & Quality Report - Quality Committee Annual Report 2017/18 - Review of Quality Committee Terms of Reference

Amy Page / Elaine Clancy

Enclosure 6 Enclosure 6a Enclosure 6b Enclosure 6c

11

3.30 Report from Primary Care Commissioning Committee - Primary Care Commissioning Committee

Committee Annual Report 2017/18 - Primary Care Commissioning Committee Finance

Committee Terms of Reference For agreement

Roger Eastwood /

Mike Sexton/ Stephen Warren

Enclosure 7 Enclosure 7a Enclosure 7b

Chair’s Action For Ratification

12 3.40 Chair’s Action – Language Line Services For ratification

Martin Ellis Enclosure 8

13 3.45 Chair’s Action – Ophthalmology Contract Award For ratification

Stephen Warren

Enclosure 9

For Information

14 Minutes of the Integrated Governance & Audit Committee For information

Philip Hogan

Enclosure 10

15 Minutes of the Quality Committee For information

Amy Page Enclosure 11

16 Minutes of the Clinical Leaders Group For information

Agnelo Fernandes

Enclosure 12

17 Minutes of the Finance Committee For information

Roger Eastwood

Enclosure 13

18 Minutes of the Primary Care Commissioning Committee For information

Philip Hogan

Enclosure 14

19 Minutes of the South West London Committee in Common For information

Andrew Eyres

Enclosure 15

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20 Register of Interests and Register of Gifts & Hospitality For Information

Elaine Clancy

Open Space for Public Questions

21 3.50

Any Other Business

22 3.55 Any other business

Chair

Date of next Meetings in Public of

3 July 2018: 14.00 until 16.00 Markee Room, Croydon Conference Centre

A glossary of terms/abbreviations can be found at the back of the pack of papers

Copies of the papers can be found at www.croydonccg.nhs.uk

To then resolve to exclude the public from the remainder of the meeting on the grounds that publicity would be prejudicial to the public interest by reason of the confidential nature of the business

PART 2 – GOVERNING BODY MEETING IN PRIVATE

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DRAFT MINUTES

Date: Tuesday 06 March 2018 Time: 2:00pm – 4.00 p.m. Location: Markee Room, Croydon Conference Centre, Croydon

Present: In Attendance:

Governing Body Members ▪ Agnelo Fernandes (AF), Chair ▪ Tom Chan, Medical Director and GP

Governing Body Member ▪ Emily Symington (ES) GP Governing Body

Member ▪ Philip Hogan (PH) Lay Member

Governance and Conflict of Interest Guardian

▪ Roger Eastwood (RE) Lay Member - Finance

▪ Andrew Eyres (AE), Accountable Officer ▪ Mike Sexton (MS) Chief Finance Officer ▪ Stephen Warren (SW) Director of

Commissioning ▪ Elaine Clancy (EC) Director of Quality and

Governance ▪ Martin Ellis (MC) Director of Primary and

Out of Hospital Care ▪ Jon Norman (JN) Secondary Care

Consultant

▪ Rachel Flowers (RF) Director of Public Health, Local Authority

▪ Ben Smith (BS), Board Secretary

Apologies ▪ Emily Symington (ES) GP Governing Body

Member ▪ Amy Page (AP) Registered Nurse, Lay

Member

Apologies ▪ Barbara Peacock (BP) Director of

People, Local Authority ▪ Jai Jayaraman (JJ) Healthwatch Chief

Executive

Ref: 2018/03/01

1 Introduction and Apologies Action

1.1 1.2

Apologies were noted. Dr Agnelo Fernandes opened the meeting.

Ref: 2018/03/02

2 Declaration Of Interests

2.1 There were no other specific declarations of interest other than the generic interest of practicing GPs.

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Ref: 2018/03/03

3 Minutes of the last meeting

3.1 The minutes of the meeting held on 09 January 2018 were agreed subject to typographical errors correcting the following sections: 7.8 ‘Low hanging fruit’ 7.11 ‘Stephen Warren’

Ref: 2018/03/04

4 Matters Arising

4.1

CCG-195 Contract Portfolio Report – Stephen Warren reported back to the Governing Body after seeking clarification on the apparent variance from Kingston Hospital Croydon activity. The spike in the percentage change had been explained by small numbers around physio referrals. All other actions were noted to be closed.

Ref: 2018/03/05

5 Joint Chair/Chief Officer Report

5.1 5.2 5.3 5.4 5.5 5.6 5.7

Andrew Eyres and Dr Agnelo Fernandes presented the report. Members welcomed Paulette Lewis as the new Lay Member for PPI

to the Governing Body. Paulette has worked in Croydon for over 30

years, initially as a nurse and midwife, later going on to lead

successful community integration programmes.

Andrew Eyres reported that the extended One Croydon Alliance

agreement has been signed off by all partners. Agnelo Fernandes

drew attention to the short film publicising the effect the work of

integrated care ‘huddles’ has had on a local man’s life, released

online.

Andrew Eyres described the London devolution proposals and what

this would mean for Londoners, describing that NHS organisations

would stand to have more control, including around their estate

disposals and signals a willingness to work together.

Andrew Eyres gave an update on the Croydon Council work

following their OFSTED inspection of children services, noting the

recent report that the Council has authorisation to proceed with their

improvement plans.

It was noted that the Croydon Healthcare Services NHS trust had

received a recent Care Quality Commission inspection and a report

would follow.

Andrew Eyres reported that Jai Jayaraman had indicated that his

contract as Chief Executive of Healthwatch would be ending prior to

the next governing Body meeting. The Governing Body thanked Jai

Jayaraman for his commitment to improving healthcare in Croydon

and wished him well in his future endeavours.

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Ref: 2018/03/06

6 Social Prescribing Presentation

6.1 6.2 6.3 6.4 6.5

Martin Ellis introduced Kieran Houser, Head of Integrated Care who provided an overview of and the CCG’s aspirations for social prescribing; working with the third sector and voluntary sector to inform commissioning. Brian Dickens, a practice manager, and Sarah Burns, from CVA, presented their work on social prescribing in Thornton Heath and New Addington and Fieldway, respectively. Social prescribing involves referring people who attend GP surgeries to activities in the community, building community cohesion as well as promoting healthier lifestyles while reducing the number of formal interventions from traditional healthcare providers. Feedback from users has been very positive. 21 hubs have been set up across 7 GP surgeries and research has been commissioned to get an independent view of the programme’s success. Kieran Houser, CCG, described plans to extend social prescribing across Croydon. Following historical context given by Rachel Flowers, discussion centred on the importance of breaking down siloes to make the activities sustainable in light of the pressure on statutory agencies and the importance of demonstrating the return on investment through, for example, decreased prescribing costs. Jon Norman said that it was important to continue to build resilience for these activities alongside promoting the spread of the Social Prescribing concept across Croydon. Paulette Lewis noted that across Croydon there is a wide range of communities that must be acknowledged and that in her role as Lay Member, PPI she would look to see the communities being supported to take ownership of social prescribing activities.

Ref: 2018/03/07

7 Developing our Strategic and Operational Plans

7.1

Croydon CCG 2018/19 Operating Plan Stephen Warren provided a summary of the planning process for 2018/19 that would require a draft Operating Plan to be submitted by 3rd April 2018. The plan sets a strategic context and aligns with the continued Alliance Agreement. Stephen Warren described how the CCG is assessed against performance measures of the Improvement Assessment Framework (IAF) by NHS England and described that the p37 onwards in the pack details the key transformation programmes that will support continuous improvement against those measures, including: Out of Hospital Care, Planned Care, Mental Health transformation and Together for Health. Stephen Warren explained the Learning Disabilities transformation work supported by robust health checks.

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7.2 7.3 7.4 7.5 7.6 7.7

Agnelo Fernandes explained that the combination of plans presented are key to the CCG’s sight and influence over the Croydon Health and care system. Andrew Eyres added these follow engagement with Governing Body members in seminar time in November and had been fully endorsed as the right approach, informed by the learning from the strategic review commissioned with CHS from McKinseys. Some plans represent work in progress and will be brought back to future Governing Body meetings for approval. Andrew Eyres added that the financial position of the Croydon system remains paramount with an aim to get back to a sustainable position while ensuring patient outcomes are assured. The attached plans were described as communicating the CCG’s intention to extend both the partnerships and the scope of work of the Alliance; there was also an illustration of the Sustainability and Transformation Programme (STP) and timeframes of collaborative work. Mike Sexton introduced the draft finance position explaining that the paper was not a full set of plans but is a draft detailed paper. The main content is expected to remain stable but require a firming of the QIPP efficiency component. The draft strategic and operational plan for 2018/19 was presented. The CCG’s allocation for 2018/19 had been set at £500m, which includes modest 2.57% (£13m) growth in funding from last year. This includes funding for acute, community, mental health, prescribing, and corporate running costs. Mike Sexton described there is a Primary Care allocation showing 3.72% growth (£1.9m) – in line with the “GP Forward View”. All the primary care allocation and growth will be spent on GP primary care in line with GMS/PMS review, national pay award to primary care, list growth, premises improvements and out of hospital business case investment. Mike Sexton drew attention to the expenditure plan was listed and highlighted that these plans are not zero based but are instead based on forecast outturn including a set of assumptions including a £26m (£30m stretch) efficiency challenge. The CCG was described as planning to breakeven in 2018/19, dependent on a £26.4m QIPP programme. An update on the QIPP planning was presented. There was a discussion of the status of expected QIPP delivery shown on page 54 of the agenda pack. Mike Sexton acknowledged the scale of work ahead and noted that risk and contingency is weighted towards the beginning of 2018/19 with cumulative deficit mapped to into the plan. Mike Sexton said the plan will be presented again building on Primary Care and comparators for 2019/20. The Chair reminded Governing Body members of their responsibility

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7.8 7.9 7.10 7.11 7.12

for managing the budget and managing the risks in the wider health system, noting the scale of these. Agnelo Fernandes noted the number of ‘red’ risks on the QIPP list. Mike Sexton added that this is a reflection of the early state of plans and that these are being de-risked and that extended review by Deloittes had given good assurance on the approach. Andrew Eyres said he expected plans to begin cautiously but the CCG expects more projects to have a more amber/green coloured risk rating when it is presented for final sign off at March’s Governing Body meeting. Mike Sexton said the RAG rating was based on the methodology applied when the CCG has been externally reviewed. Mike Sexton said that project readiness is continuously improving and the CCG is in a better position than at the same stage in previous years. Andrew Eyres acknowledged that there is less ‘low handing fruit’ for efficiency savings, the task is large and harder so the solutions need to be more transformative, preventative and more integrated. Amy Page prompted a discussion of the specific diabetes plans and clarified the series of quality initiatives behind these. Martin Ellis noted that diabetes arrangements requires improvement despite little savings being achievable. Emily Symington asked what was meant by budgets coming out at a SW London level. Mike Sexton said the actual allocation directly for Croydon was the same, not shared, but the financial performance control totals set by NHS England on the STP and that the message has been one of ‘no further draw/deficit expectation’ with an ask for CCGs to break even in 18/19. Andrew Eyres said that these encourage thinking at a SW London scale to share benefits. Tom Chan asked whether management can continue to motivate staff with the unrelenting challenge. Andrew Eyres said that solutions are not exhausted and that public demand and implementing the Big Ideas identified in the Summer of 2017 provide fresh impetus and continued motivation. The Chair opened a discussion about the role of Governing Body members in supporting delivery of the plan. Amy Page said the CCG must continue to support bold plans and agreed with Andrew Eyres statement that the answers are to be found in the experiences of the people of Croydon. Stephen Warrant said the recent QIPP development session had been powerful while Roger Eastwood noted the importance of helping to break down barriers in support of the local hospital and said that the plans feel realistic and reasonable. Jai Jayaraman supported the view that the ideas need to come from the public and welcomed more activities like the upcoming diabetes workshop. The Governing Body: ▪ NOTED the approach to developing our Croydon health and

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7.13 7.14 7.15 7.16 7.17 7.18

care transformation plan, ▪ NOTED the 2018/19 financial plan and associated assumptions One Croydon Alliance: Extension of the Alliance Agreement Outcomes Based Commissioning Andrew Eyres asked Martin Ellis to present the paper on the One Croydon Alliance explaining that this is a summary of the first year of the work of the Alliance and contains a proposal to extend the agreement for a further 9 years. Martin Ellis explained that the Alliance, formed of the Croydon GP Collaborative, South London & Maudsley NHS Foundation Trust and Croydon Health Services NHS Trust, Age UK, Croydon Council (as both provider and commissioner) and NHS Croydon CCG represents Outcomes Based Commissioning for over 65s through an integrated health and care system. Martin Ellis said that the Alliance vision has always been to extend the model of care and approach adopted for over 65s if successful to other areas of the social care and health economy. Martin Ellis listed the achievements of the first year of the Alliance though the Living Independently for Everyone (LIFE) rehabilitation and re-ablement programme, that has an agreed single eligibility assessment and review process; the Integrated Care Networks (ICN) with an emphasis on Huddles proactively managing the care of people with complex health and care needs; and an Impact on activity and outcomes of the Alliance Out of Hospital Programme. Martin Ellis said that the case for extending the agreement for the further 9 years following the transition year had been at the Alliance Board in early December and was agreed. The governance arrangement was described as requiring each partner’s Board to approve the extension. Emily Symington asked what review points could or should be included and Andrew Eyres said breakpoints can be designed into the agreement. Members asked what alternatives are considered. Andrew Eyres advised that organisations are not compelled to integrate more deeply but that his opinion is this offers the opportunity to place management of risk closest to the appropriate partner and represents the best approach. Andrew Eyres said that any extension of scope of the Alliance programme would come back to Governing Body for ‘by item’ agreement. Tom Chan asked what the original rationale for a 10 year agreement had been. Martin Ellis replied that wholesale transformation takes time and that there was historically an 18 year turn on contracts and the timescales take account of this.

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7.19 7.20 7.21 7.22 7.23 7.24

There was a discussion prompted by a question from Jai Jayaraman of what changes a patient would experience from expansion of the Alliance scope to under 65. Andrew Eyres explained that it primarily enables the partnerships to work creatively without organisational barriers. The Chair asked voting members for a show of hands to indicate support for the recommendations proposed, first for the extension of the term of the Alliance agreement and then for the expended remit of the Alliance Agreement to over 65s. The vote was unanimous in support of the recommendations: The Governing Body AGREED the extension of the Alliance Agreement for a further 9 years from 1 April 2018; The Governing Body: AGREED to expand the remit of the Alliance Agreement to ensure the potential for whole population transformation for health and social care. Decisions to increase programme scope will be taken as part of the CCG’s decision making process. AGREED to Delegate to the Accountable Officer the signing of the final 9 year Alliance agreement on or around 1/04/2018. Any new or revised service contracts will be transacted in line with our Standing Financial Instructions and Scheme of Delegation. Strategic and Operational Planning - South West London Health and Care Partnership Andrew Eyres introduced the final paper in the strategy pack. The South West London strategy for health and care supports the NHS and wider partners across South West London where appropriate supported by individual, locally focused health and care plans. South West London Sustainability and Transformation Plan (STP) was published in November 2016, following significant engagement across South West London commissioners, providers and local authorities. Whilst implementation of local plans continues, a refresh is being undertaken in order to support even greater local planning and delivery. Andrew Eyres said that the local partnerships in SW London are represented by Croydon plus 3 other partnerships being Wandsworth & Merton; Kingston & Richmond; and Sutton. Andrew Eyres added that the need for coordination across acute services makes these plans especially relevant and said that a two-step approach to refreshing the South West London strategy for health and care had been undertaken: the first stage of which (ending in November 2017 set out the progress and next steps of the STP.

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7.25 7.26

Stage Two from December 2017 to June 2018 is concerned with developing “Local Health and Care Plans” for each of the four Local Transformation Boards (LTBs): For Croydon this will set the Croydon Transformation Board’s vision; model for health and care; local context and challenges; actions to address local financial and clinical sustainability issues and meet the health and care needs of the local population. We will co-produce these plans with local authorities and wider partners. Croydon’s health and care transformation plan will inform the South West London Sustainability and Transformation Partnerships refresh. Andrew Eyres explained that the strategy builds plans bottom up, establishing how collaboration will offer benefits. Andrew Eyres noted that there is an addition put forward as a proposal on the basis that Child and Adolescent Mental Health Services (CAMHS) needs collective tackling for improvements. The Governing Body: NOTED and endorsed the “South West London Health and Care Partnership: one year on” paper and the two-step approach to refreshing the South West London strategy for health and care that it describes

Ref: 2018/01/08

8 Governing Body Assurance Framework and Risk Register

8.1 8.2 8.3

Elaine Clancy presented the report. The Chair noted that the report was brought for assurance and asked whether there were particular aspects that the Integrated Governance & Audit Committee (IGAC) wished to bring to the Governing Body’s attention. Elaine Clancy confirmed that IGAC had reviewed the Strategic Risks on the Governing Body Assurance Framework as well as the Risk Register containing some operational risks at their July and November meetings. Two new Primary Care risks were highlighted as being worked through. IGAC would be requesting Executive Directors as senior risk owners to attend IGAC meetings on a scheduled basis to provide a spotlight on their respective risks. The Governing Body NOTED the Assurance Framework and Risk Register summary

Ref: 2018/01/09

9 2017/18 Finance Report: Period 8 (November 2017)

9.1 9.2

Mike Sexton presented the Report and in connection with the GBAF item above, explained that the finance report provides assurance through demonstrating focus and close monitoring of highest priority areas. NHS England has recognised the significant challenge to deliver £21m QIPP, and in the absence of other mitigation, has agreed that

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9.3 9.4 9.5

the CCG can report a £15m deficit (£6.9m planned deficit plus £8.1m unidentified QIPP). Members asked whether further action was contemplated that could bring further mitigation. Mike Sexton said that £21.2m QIPP had been de-risked with work alongside Deloittes but this did not extend to the £29.3m. There was a discussion about the time taken to gain this recognition. Mike Sexton explained that the CCG is under special measures and Directions and so there was a process that had to be followed whereby NHS England completed a review that endorsed his reporting to committees and agreed that the deficit will not be further mitigated this financial year. Mike Sexton noted financial recovery plan forming part of risk mitigation and noted that while CHC and QIPP are long recognised financial risks new prescribing risks associated with fluctuating drug prices have the potential for an updward trend to a further £2m pressure. Mike Sexton added that the Secretary of State authorises price concessions and while the CCG has little influence it can mitigate the risk through early warning and work in conjunction with the medicines optimisation team. Mike Sexton added that the exposure to these risks appears to be reducing following internal review of the Month 9 position. As Chair of Finance Committee, Roger Eastwood said he was content with the reporting and Amy Page observed that the latest reports appear to bear out the confidence of earlier estimates. The Governing Body:

• NOTED the CCG is reporting a year -to -date deficit of £7.2m (£2.7m adverse variance) and a forecast in -year deficit of £15.0m (£8.1m adverse variance). The year -to -date variance reflects two month s of the £8.1m not being delivered.

• NOTED the CCG continues to identify opportunities to mitigate risks against the original ambitious £21.2m QIPP programme.

• NOTED the consistent performance against the Public Sector Payment Policy (95% within 30 days) and cash management.

Ref: 2018/01/10

10 2017/18 QIPP Programme Report Month 9 (December 2017)

10.1 10.2 10.3

Mike Sexton presented the Report. Overall, the majority of the programme is on track to perform by the end of the year however the revised Forecast outturn of £20.5m is £0.7m short of the QIPP plan of £21.2m. Mike Sexton said he does not want this to slip further. At month 8, some projects had declared that they will be unable to

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10.4

meet their planned target within year. Some of this shortfall is being off-set by newly identified projects as well as minor over-performances in a few others Mike Sexton noted the Quality Highlight report coincides with the earlier presentation. The delivery of the Out of Hospital Business Case in reducing length of stay was identified to be essential. Mike Sexton was thanked for the Month 9 report and for the continued diligence of his team. The Governing body:

• NOTED that the CCG had delivered £10.9m of QIPP to date (based on actual data for M1 -7 plus a forecast for M8), against a plan of £12.3m,

• NOTED the CCG’s full year forecast outturn of £20.5 m against a target of £21.2m

• NOTED NHS England has recognised that the maximum QIPP that will be delivered is £21.2m and therefore the unidentified QIPP of £8.1m will not be resolved in 2017/18

• NOTED The overall risk status of the QIPP programme is currently rated Amber

• NOTED The Quality Spotlight Report on Medicines Optimisation.

Ref: 2018/01/11

11 Contracting Portfolio Report (Month 7)

11.1 11.2 11.3 11.4 11.5

Stephen Warren presented the Report Based on Month 7 data, the CCG has total forecast overspend on Acute contacts of £1.3m. Stephen Warren described the impact of the PSS (Prescribed Specialist Services) movement of NHSE activity to CCG and vice-versa on plans and actuals and of HRG4+ highlighted in section 2.1 of the report) Stephen Warren said the CCG has continued to see Over performance at Kings and St Georges in addition to that caused by the PSS movement while there is apparent underperformance at CHS. Stephen Warren described a work programme is underway on private-sector referrals. The variation team was described to be working to support practices and locums on awareness of the agreed pathways. Emily Symington observed Kingston starting to show a variance and asked if an explanation for the variance was known. Stephen Warren said that at a lower order of magnitude variation could be attributed to specific patients presenting but offered to investigate. Stephen Warren described the Quarter 1 Reconciliation and Year End Settlement as well as the Sepsis Counting and Coding Challenge. Feedback was given on a viral pneumonia admission audit undertaken in Selsdon and New Addington Practices.

Action: SW

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11.6

Amy Page asked whether there are projections of the impact of reducing non-urgent elective activity on year-end performance. Stephen Warren acknowledged that the work of the variation team had been important. While some technical issues were known, Stephen Warren indicated that hospitals do tend to plan to reduce elective work around winter time. The Governing Body:

NOTED the Contract Portfolio Report

Ref: 2018/01/12

12 Month 6 (September 2017) Integrated Performance and Quality Report

12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10

Elaine Clancy presented the Report. Elaine Clancy noted that in September data was showing good improvement in reducing referral to treatment (RTT) and there had been a decrease in infection control reports. Elaine Clancy reported that the CCG returned to compliance on diagnostic testing in September, after missing the standard since February, due to issues in echos at CHS. The non-compliance with 52 week waits had occurred in hospitals not in Croydon. A&E 4 Hour Wait – Elaine Clancy described that CHS had been very close to the A&E target but was challenged more recently by pressures experienced both locally and nationally Cancer Waiting Times – While cancer targets continue to be delivered well, occasional breaches tend to be complex. IAPT Access and Recovery – Elaine Clancy said that while the IAPT delivery was not at the desired level, the trajectory in September had improved Serious Incidents (SI) – CHS had reported 8 SIs in the period and SLAM reported 2 SIs. Neither Trusts reported any Never Events in the period. Elaine Clancy reminded members that the Quality team are now informed by Contract Quality Review Meetings for smaller providers and CUCA and added that the team are now sighted on any London Ambulance Services SIs affecting Croydon residents. Members asked about the impact of more recent winter pressures on RTT and elective activity. Elaine Clancy said that CHS reportedly cancelled no operations, only some diagnostic tests – according to plans While some long ambulance waits at CHS had come to the attention of the CCG, these were not at the level of trusts in the national press.

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12.11 12.12

Elaine Clancy said that it appeared that robust planning and social care support had somewhat mitigated CHS’s exposure to considerable winter pressures and that a walk-round in the week beginning 1/1/2018 gave the CCG Director of Quality and Governance confidence that the Trust was coping. Members were encouraged to recognise the contribution that having a flu-jab can make in reducing a common seasonal pressure on admissions. All but one member declared having had a flu-jab this winter. Andrew Eyres noted that a very good staff uptake was submitted in a for a return to the STP. The Governing Body: NOTED the Month 6 performance and quality report and actions taken within the period.

Ref: 2018/01/13

13 Patient and Public Engagement Report Quarter 2

13.1 13.2 13.3

Elaine Clancy presented the report. The PPI key activities during this period were: • Planned Care Transformation consisting of fieldwork, workshop and working groups, Equalities Impact Assessments and evaluation of patient lead involvement • Mental Health Voluntary Sector Review - Equalities Impact Assessment, fieldwork – meetings with providers and council • PPI Forum: Big Ideas workshop (presented previously to the Governing Body) to support development of future commissioning intentions • PPI Forum: Redesigning PPI structures - To co-design the CCG’s overall engagement structure to identify when and how we engage with Croydon residents. Elaine Clancy updated members that the advert for the Lay Member (PPI) had just closed and the CCG is due to shortlist and hoped a new appointment would be in post for the next Governing Body meeting. The Governing Body NOTED the report.

Ref: 2018/01/14

14 Minutes of the Integrated Governance and Audit Committee

14.1

The minutes were presented for information and there was no discussion. The CCG Governing Body noted the Minutes.

Ref: 2018/01/15

15 Minutes of the Committee in Common

15.1


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Ref: 2018/01/16

16 Minutes of the Clinical Leaders Group

16.1 The minutes were presented for information and there was no discussion. The CCG Governing Body noted the Minutes.

Ref: 2018/01/17

17 Minutes of the Finance Committee

17.1


Ref: 2018/01/17

17 Register of Interests and Hospitality

17.1

The register of interests and hospitality were presented and there was no discussion

The CCG Governing Body noted the Registers of Interest and Hospitality.

Ref: 2018/01/18

18 Open Space for Public Questions

No questions were submitted in advance of the meeting.

There was a question about whether the strategic plans being discussed represented a change to the planned care strategy and if the ‘rainbow approach’ previously illustrated would still apply.

Stephen Warren replied that sign-off is being arranged with CHS and the Croydon Transformation Board together with the associated pathways. Stephen Warren added that the same areas will be covered including diabetes and dermatology and that further updates will be provided through the planned care steering group.

Ref: 2018/01/19

19 Any Other Business

Agnelo Fernandes announced details of the Diabetes engagement event booked for Wednesday 17th January 2018; reservations on Event Brite.

Date of Next Meeting

Tuesday 6 March 2018 14:00 until 17:00, Croydon Conference Centre, Croydon for Meeting on Tuesday 6 December

Signed…………………………………………………….. Dated………………………………………………………

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING IN PUBLIC

1 May 2018

Title of Paper: JOINT CLINICAL CHAIR AND ACCOUNTABLE OFFICER REPORT

Lead Director Dr Agnelo Fernandes Clinical Chair Andrew Eyres Accountable Officer

Report Author Dr Agnelo Fernandes Clinical Chair Andrew Eyres Accountable Officer

Committees which have previously discussed/agreed the report

N/A

Committees that will be required to receive/approve the report

N/A

Purpose of Report For information and noting

Recommendation:

The CCG Governing Body is asked to receive the report for information.

Background:

This is the regular joint report of the Clinical Chair and Accountable Officer to update CCG Governing Body members on developments in the local health and care system and on wider policy issues and developments as appropriate. The report follows the regular format followed by the CCG, however, we always welcome your feedback on the format and content of the report in order to inform future reports.

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Joint Clinical Chair and Accountable Officer Report

Overview of Key Business Activities

The following summary highlights key meetings and events undertaken since the last Governing

Body (March 2018):

▪ Croydon Transformation Board, Alliance Board and, Delivery Group

▪ Croydon Professional Cabinet

▪ Croydon Health and Social Care Scrutiny Sub-Committee

▪ Croydon Health and Wellbeing Board

▪ South West London CCG Committee in Common

▪ South West London Clinical Chairs

Signing of Alliance Agreement

Our One Croydon Alliance, created so that over-65s need less time in hospital has been renewed for another nine years. The One Croydon Alliance focuses on giving residents with chronic conditions more joined-up

support to improve their independence and quality of life. So far 62% fewer patients have needed care packages six weeks after hospital discharge and around 450 residents spent less time in hospital, or none at all. The alliance made up of Croydon Clinical Commissioning Group (CCG), Croydon Council, Croydon Health Services NHS Trust, Croydon GP Collaborative, South London and Maudsley NHS Foundation Trust, and Age UK Croydon has signed a contract extension to have a wider remit, meaning eventually it will include further integration of services for people of all ages and disabilities in the borough. The work ranges from A&E, care assessments and support at residents’ homes to GP surgeries, where professionals involved in a person’s care can confidentially discuss their weekly joint treatment plan. Croydon Transformation Board update

The Croydon Transformation Board is made up of senior representatives from the six organisations

in the One Croydon Alliance Partnership namely; Croydon Council, NHS Croydon CCG ,Croydon

Health Services NHS Trust, Healthwatch Croydon, South London and the Maudsley NHS

Foundation Trust andCroydon GP Collaborative.

Jerry Cope has now been appointed as the new independent Chair for the Croydon Transformation

Board following a competitive process. Jerry, in his first meeting as Chair, and the group welcomed

Deborah McCluskey, Chair of Age UK Croydon, and Rachel Flowers, Director of Public Health, to

the Board.

A suite of Terms of Reference that include: the Croydon Transformation Board, the Alliance Delivery

Board, the Croydon Transformation Delivery Group and the Professional Cabinet were agreed. The

Terms of Reference will be reviewed again in June 2018 and once a year beyond that.

The One Croydon Alliance Programme Director, presented an update from the first year of One

Croydon. The 10 year partnership agreement was signed by all of the organisations at the end of

March and the Board thanked Rachel Soni and all the teams for their hard work to get to this

significant milestone.

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The Transformation Board is also beginning further work on population health management.

Population health management is a way of trying to describe the risks faced by a whole population

so that the health and care system can better plan for and manage those risks. This might be by

looking at geography, presenting health needs, communities or populations of interest, and not just

looking at the services already available in an area. The aim of this approach is so that One

Croydon can: improve quality of care and outcomes, manage cost and sustainability and engage

staff and local residents

The next meeting of the Croydon Transformation Board will be held in May 2018. Capital funding

We are pleased to hear that the CCG has received over £9m as part of the NHS capital funding announced in the Autumn statement. This is part of £760m capital funding, announced at the Autumn Budget, which has been allocated to the NHS for “service modernisation”. The money will support GP practices to develop out of hospital care through developing premises and IT to support collaborative working between health and care professionals, enabling them to anticipate the needs of those who are most at risk of going into hospital. The money will also be used to enable care homes to video call nurse practitioners 24/7 if they have a concern about a resident. This has been shown to significantly reduce workload on ambulance staff and GPs and reduce hospital admissions.

In addition, £2.15m has been awarded to the four acute trusts in South West London to improve procurement technology. Currently, each trust in South West London has its own procurement function with its own systems and processes. Everyone using the same technology will stop duplication, and help us get best value for money. The four acute trusts involved in the South West London Acute Providers’ Collaborative are: Croydon Health Services, Epsom & St Helier, Kingston and St George’s.

Croydon Health Services NHS Trust Leadership Changes

Croydon Health Services NHS Trust has recently announced that that John Goulston will retire as its Chief Executive at the end of the summer and that Jayne Black left her role as both Deputy Chief Executive and Chief Operating Officer at the end of April. John plans to retire on 30 September 2018, after 32 years in the NHS. He took on the role of Chief Executive of Croydon Health Services NHS Trust in May 2012 and has led a transformation of the Trust’s services during a period of unprecedented challenges for the NHS. This includes overseeing continued quality improvements and steering the Trust out of financial special measures. John was instrumental in adopting “Listening into Action” at the Trust – a way of working that empowers frontline staff to make the changes they want to improve care standards. Jayne Black joined the Trust in November 2014. A nurse by background, Jayne has held director roles in operations, strategy and transformation within acute and community healthcare trusts. Jayne has held senior nursing roles in surgery, medicine and critical care. We would like to thank both Jayne and John for their years of service to Croydon. We wish them all the best for their future endeavours. South West London CCG Committee in Common The South West London CCGs Committee in Common made two decisions at the meeting on 27 March 2018.

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1) Funding To Deliver Extended Access And Primary Care At Scale In 2018/19 additional funding for Extended Access has been allocated to SWL and how this additional funding will be allocated to each CCG in SWL. It is proposed that funding is shared across SWL on an equal pounds per head basis, which will be a significant uplift for Croydon. Croydon will get an increase on last year’s Extended Access funding of circa £1m giving total allocation of £2.036M for 2018/19. Plans for the use of these funds are currently being developed, overseen by the Primary Care Commissioning Committee.

2) Developing a South West London Individual Funding Requests (IFRs) Triage Process and

Panel The CCGs proposed to align the current IFR arrangements in SWL into a single IFR service for the population with a view to achieving greater consistency of decision making and other benefits of administration at scale. The proposal was to move to a single IFR Triage Panel that meets weekly; and move to a single SWL IFR Panel, with clinical representation from SWL CCGs that meets fortnightly. A shared IFR Appeals Panel will review the limited number of contested IFR decisions. Individual Funding Requests will be managed with a consistent approach for considering an individual’s exceptional characteristics that may make them eligible for procedures not normally funded. Croydon will continue to provide clinical input to the collective panel. CCG Annual Report and Annual Accounts Following review by the Integrated Governance and Audit Committee the CCG, the CCG has submitted draft Annual Report, Accounts and Governance reports to meet the National deadline of 24th April. Our thanks to all involved in turning around these important documents to a rapid timescale. Post Audit, the accounts will be submitted for approval at the CCG’s Council of Members. We will publish our final Annual Report and Accounts by mid-June and present it at our Annual General Meeting, to be held in September.

360 Degree Stakeholder Survey

The CCG 360 Stakeholder Survey is carried out each year by IPSOS Mori on behalf of NHS

England. The survey asks our member practices and partners across the NHS, the local authority

and voluntary sector a number of questions designed to determine how they view the CCG and our

teams. The results of this survey contribute to this through the CCG Improvement and Assessment

Framework; you can read more about this above.

We are really pleased to say that our results this year show a significant improvement from last year

and we would like to thank all our stakeholders for the part they have played in working together

across our member practices and with our key partners to improve health in Croydon.

We have had an overall increase in positive responses across all areas compared to last year. Our

results are also now consistently higher than the national average on the majority of responses.

CCG Staff Survey

Every year CCG staff are invited to take part in the national NHS Staff survey, conducted on behalf of the CCG by Picker Institute. This year the CCG response rate was 78.3%. Picker compare this year’s (2017) results with 2016 and national scores. Overall, the survey results were largely similar when compared with the results from 2016. A number of staff took the opportunity to comment on an improved culture/environment at the CCG; acknowledging the work that has been done following the last survey. A selection of comments is below:

• ‘The culture in the CCG has improved significantly in the last 6 months. Feels more like a team.’

• ‘Definitely improving as a place to work’

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• ‘There has been a significant improvement in this organisation over the last 12months and I believe that senior managers have looked to make changes which have made this a better environment to work in.’

Staff also identified a number of areas where we need to continue to improve.

We have drawn up a draft action plan with the Staff Forum aimed at improving across all of these

areas. For instance, we are drawing up a learning and development policy to address issues raised

and to support staff’s development needs, putting it at the core of the way we operate. A new in-

depth appraisal process is included in this which aims to fully support staff to maximise their

potential. This policy and process will both be implemented next year. We are developing the

CCG’s flexible working approaches including the use of improved technology to support working off

site.

The CCG will be announcing the latest winners of the quarterly staff awards at the Staff Briefing on

Thursday 26th April 2018.

Strategic Risk Update

A Board Assurance Framework, detailing high level strategic risks is provided for the Governing Body.

All risks on the full Risk Register are reviewed individually by risk owners, and high-level risks are

scrutinised by the Integrated Audit and Governance Committee.

Each risk is also regularly reviewed by the committee of the Governing Body with assigned

responsibility for overseeing its mitigation. The Integrated Governance and Audit Committee has

agreed that CCG’s Internal Auditors will support the improvement of the CCG’s Risk Management

process for next year by developing a map of our assurances

No additional strategic risks have been added since January 2018 meeting.

There are a total of 16 strategic risks on the Governing Body Assurance Framework which have been mapped against the strategic objectives as follows:

Objective Total Risks

15+ 5 - 12

1.

To commission high quality health care services that are

accessible, provide good treatment and achieve good patient

outcomes

7 2 6

2.

To reduce the amount of time people spend avoidably in hospital

through better and more integrated care in the community, outside

of hospital for physical and mental health

1 1 1

3. To achieve a breakeven position in year 2017/2018 and

sustainable financial balance by 2020/2021 3 3

4.

To support local people and stakeholders to have a greater

influence on service we commission and support individuals to

manage their care

1 1

5.

To have all Croydon GP practices actively involved in

commissioning services and develop a responsive and learning

commissioning organisation

2 2

16 6 10

The risk register, available on request, details the controls in place to mitigate these risks and the

assurances received by the Governing Body and its committees to have to confidence that these

controls are effective.

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GP CQC Visits

Since the last Governing Body meeting the CQC have issued inspection reports on 4 Croydon GP

Practices as follows;

Location Type Date of CQC visit

Date report published

Overall Rating Change to last visit

Shirley Medical Centre

Comprehensive 05/01/2018 8/3/18 Requires Improvement

↓

South Norwood Hill Medical Centre

Comprehensive 15/02/2018 29/3/ 2018 Good ↑

Queenhill Medical Practice

Comprehensive 06/02/2018 15/3/18 Good ↔

Coulsdon Medical Centre

Comprehensive 07/02/2018 18/4/18 Inadequate ↓

South Norwood Hill Medical Centre has moved from a rating of Inadequate to Good with the support of the CCG.

Coulsdon Medical Centre was inspected in February 2018 and was found to be “Inadequate”. The

CCG Primary Care team together with clinical leads are working closely with those Practices rated

“Requires Improvement” or “Inadequate” to ensure that robust action plans are in place to address

issues raised by the CQC.

Measles

Since the beginning of the year, London has seen over 250 cases of measles reported with at least

90 of those laboratory confirmed. This is compared to 243 reported cases of measles in London for

the whole of 2017.

Measles is a highly infectious viral illness that can lead to serious complications. Public Health

England urges parents and young adults to vaccinate against measles.

In Croydon, there have been 11 cases since the beginning of March both among children and

among adults. Croydon’s Director of Public Health, Rachel Flowers has written to local GPs,

schools and parents to inform them of the need for vaccination for children. The vaccination

schedule for children consists of two doses of MMR, one at 12 months of age and one at 3 years

and 4 months.

NHS 70

Governing Body members will be aware, the NHS turns 70 in 2018. Up and down the country, local

NHS organisations will be recognising this important milestone with events taking place throughout

the year. On the day of the birthday, Thursday 5 July, there will be two national celebrations of

thanks held for NHS staff, patient groups and volunteers.

Every NHS Clinical Commissioning Group has been allocated tickets for a service at Westminster

Abbey at noon and a choral concert at York Minster on the evening starting at 7pm. Agnelo

Fernandes and Andrew Eyres have been invited.

Our staff forum is planning our local celebrations. We are planning a day out locally where staff

members can come together with their families to enjoy the summer weather (hopefully!) as well a

few games of rounders and a picnic. We are also looking forward to marking the day itself on 5 July

with some tea and cake together with our partners across the health and social sector.

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY

1st May 2018

Title of Paper: Operational Plan 2018/19

Lead Director Stephen Warren Director of Commissioning Martin Ellis Director of Primary Care and Out of Hospital Care Mike Sexton Chief Finance Officer

Report Author Fouzia Harrington Associate Director: Strategy, Planning and Estates

Committees which have previously discussed/agreed the report.

None


None

Purpose of Report For Noting

Recommendation:

The Governing Body is asked: ▪ To note that the 2018/19 Operating Plan and Financial Plan were agreed by the

Governing Body in March 2018 ▪ To note the final powerpoint presentation of the 2018/19 Operating Plan, which

provides further detail on the plans ▪ To note the completion of the contracting round and the impact on our operating plan

Background:

Last year CCGs were required to have a 2 year Operating Plan 2017/18 – 2018/19. This year we are required to refresh the 2018/19 plans to reflect emerging national, London and South West London and local priorities. CCGs were required to submit an Operating Plan detailing finance, activity and QIPP plans

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to NHS England by 30 April 2018. Croydon CCG’s Operating Plan (appendix 1) builds on the NHS England requirement and includes local strategic context and our work plan for delivering our priorities for 2018/19. The Governing Body has been considering our strategic direction and our plans for 2018/19 at a number of recent Governing Body seminars. A final 2018/19 Operating Plan was subsequently received at the March Governing Body meeting. This paper provides sets out the changes since the previous version, the outcome of the contracting round and the key issues arising.

Key Issues:

2018/19 Operating Plan Since the 2018/19 Operating Plan presented in March the following have been included to provide more detail behind the plans: ▪ Activity shifts – slides 13 shows an planned reduction of approximately 64,500 acute

activity as a result of our transformational plans ▪ Improving Our Quality – slides 15-17 set out the approach to improving the quality of

the services we commission and our priorities for 2018/19. ▪ Primary Care Transformation – a transformation slide (slide 28) for primary care has

been included indicating our aspirations and plans for 2018/19 ▪ Commissioning work plans - Appendix 2 has been updated to reflect a whole

programme approach and includes: ▪ health, quality and system outcomes (aligned with QIPP) ▪ aligned national standards and Integrated Assessment Framework ▪ Continuing Health Care (to be added) These work plans form the basis of programme progress reports covering a summary picture of QIPP, performance and deliverables.

Finance and Activity Since the 2018/19 Operating Plan presented in March, the Croydon Health Services NHS Trust contract for 2018/19 has been signed. The Out of Hospital and Planned Care transformation activity shifts (a total reduction of £10.2m) has been included in the contract as well as an agreed risk share. Additional investment of £1million has been included to meet the new RTT national standard to ensure waiting lists by the end of March 2019 are not greater than those at March 2018. Continued negotiations are underway to ensure the signing of other contracts including Kings and St Georges to include our transformation plans. Taking into account the 2017/18 final outturn, and exit run rate, and the issues resolved through the contracting round, the overall CCG plan remains as agreed in March 2018 – plan for breakeven and parity on mental health investment, activity reserve and QIPP contingency in place to manage in year risks.

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The issue that is still being resolved is how the CCGs across SWL will contribute to the generation of a £7.4m in-year surplus for 2018/19. The CCG is committed to working collaboratively across SWL and will invariably need to plan for a small surplus, to be generated from additional QIPP/contingency. National Performance Standards The CCG plan indicates that all but one national standard will be met although work with providers is underway to ensure an improvement plan is in place. ▪ Children’s wheel chair waiting time – We are currently in the process of moving to a

new provider in the interim, prior to reprocurement. We will work with the new provider to agree a recovery trajectory and plans.

Governance:

Corporate Objective To commission integrated, safe, high quality service in the right place at the right time. To have collaborative relationships to ensure integrated approach To achieve financial balance in 2018/19 and 1% surplus is 2019/20.

Risks

Effective planning will support mitigating a risk of not delivering financial sustainability. Croydon has ambitious plans and a key risk is the organisational capacity and capability to develop and implement these at pace.

Financial Implications Forecasting delivery of financial targets and to achieve breakeven by 2018/19.

Conflicts of Interest None as part of this report, however there is potential conflicts of interest through the design and implementation of any system change. The OBC principles for working together will form the basis for taking this work forward.

Clinical Leadership Comments Clinical Leadership comments have been sought throughout the planning process and are implicit in our plans. This will continue as we develop our plans further.

Implications for Other CCGs The commissioning intentions reflect the South West London STP being taken forward across SWL CCG’s.

Equality Analysis None as part of this report, however equality impact assessments will be conducted as part

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of the development of transformational plans.

Patient and Public Involvement None as part of this report, however there has been extensive engagement activities such as the ‘Big Ideas’ events that continue to inform the development of plans going forward. There potential will be a focus on ‘issue’ specific engagement to further enhance plans.

Communication Plan The Croydon Communications and Engagement Steering Group will also develop a Strategy for engaging on a wider population programme and with other stakeholders.

Information Governance Issues None as part of this report, there will be information governance issues arising from potential sharing of data. The OBC Information Governance Framework will be built upon.

Reputational Issues

The Strategic report shows the key drivers for system wide deficits. Supporting the next steps demonstrate system wide appetite for significant transformation change to address the challenges.

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Croydon CCG Operating Plan Overview

2018/19

1

Through an ambitious programme of innovation and by working together with the diverse communities of Croydon and with our

partners, we will use resources wisely to transform healthcare to help people look after themselves, and when people do need care they will

be able to access high quality services

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2

Vision and Strategic Context Page 3

Introduction Page 4

Serving the People of Croydon Page 5

Our Focus for the Future - Challenges Page 6

Our Journey and Progress Over the Year Page 7

Responding to the Needs Page 8

Our Strategic Context Page 10

Our 2018/19 Plans: Finance Page 11

Our 2018/19 Plans: QIPP Schemes Page 13

Our 2018/19 Plans: Transformational Change Page 14

Improving Our Performance Page 15

Improving Our Quality Page 16

Improvement and Assessment Framework (IAF) Page 19

Appendix 1: Strategic Transformation Plans Page 20

Appendix 2: 2018/19 Work PlansAppendix 3: Constitutional StandardsAppendix 4: 2018/19 Financial Plan

Page 30Page 46Separate Document

Contents

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Our strategic vision, objectives and valuesFollowing a wide-reaching engagement process with a variety of stakeholders, we have reconfirmed our vision and developed organisational values. In addition we have revised our objectives for 2017/18. The strategic direction of travel is summarised below:

This vision and strategy is a product of understanding the needs of our population and the service challenges that we face. Croydon’s population is growing by 1% per year, with particular increases in younger people and with older people living longer. Given this, our priority areas that we aim to deliver on are:1. Reducing potential years of life lost

through amenable disease;2. Ensuring patients are treated in

the right place;3. Children and young people reach

their full potential;4. Early detection and intervention;

and,5. Positive patient experience.

The principles upon which we will deliver these priorities and indeed all areas we commission are that:• Prevention is better than cure;• When someone does become ill,

self management is the best option;• When a person does need

treatment they are seen in the right place at the right time; and,

• There is shared decision making between the patient and the health professional.

Patient focused Outcome focused Professional Ambitious

1.1 To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes

2.1 To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health

3.1 To achieve sustainable financial balance by 2017/18 and NHS business rules of 1% surplus by 2018/19

4.1 To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care

5.1 To have all Croydon GP practices actively involved in commissioning services and develop a responsive and learning commissioning organisation

Longer healthier lives for all the people in Croydon

Through an ambitious programme of innovation and by working together with the diverse communities of Croydon and with our partners, we will use resources wisely to transform healthcare to

help people look after themselves, and when people do need care they will be able to access high quality services

Vision

Objectives

Values

3

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4

• Rapid population growth• Proportionally more young people & older people• Obesity & associated long-term conditions• Achieving financial sustainability

Facing exceptional healthcare challenges

• Wider access to mental healthcare• Top quartile (UK) cancer care• Improved support to children and young people• Reduced waiting times for outpatients

Strong delivery of better healthcare

• Reduced variation in service provision• Faster access to consultants for critical illnesses• Development of improved care pathways• Development of Outcomes Based Commissioning

Continuous improvement in services

• Working across the healthcare economy to deliver the Sustainability and Transformation Plan (STP) for South West London/Croydon

• Leading the introduction of new models of care

Transforming healthcare in Croydon

• Tighter integration of health and social services across GPs, Council, CHS and other providers

• Services provided closer to patient’s homes• Greater support for living healthier lives

Improved outcomes for patients

• 7-day, 365 day Urgent Care GP Hubs across Croydon (April 2017)

• Extended primary care access – April 2017• Expanded Out-of-Hospital services

Better access to services

Introduction – health in Croydon

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Providinghealth careto a growing population of 400,000+ people

▪ 56 GP Practices providing a range of GP services, working together in 6 GP Networks

▪ Access to 3 GP Hubs, extended access, 1 Urgent Care Centre (incl. 24x7, 24-hour) and Minor Injuries and Ailments centre

▪ Croydon Health Services NHS Trust providing acute and community services and access to other London acute hospitals

▪ South London and Maudsley NHS Foundation Trust providing mental health services

Serving the people of Croydon

5

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6

Our focus for the future – challengesProviders▪ Croydon Health Services▪ South London and

Maudsley

▪ 56 GP practices ▪ GP Collaborative▪ Social Care▪ Voluntary sector

Areas of High Deprivation ▪ North of the borough▪ Fieldway▪ New Addington▪ Shrublands Estate, Shirley

Obesity Diabetes

SmokingHealth

Screening

Mental Health

Employment

Housing

Independent Living

Experience

Variation in Social care and Clinical Outcomes

LQS Delivery,

Children’s OFSTED

Performance

(A&E, IAPTs, Cancer, LAS, Care Homes)

Financial Gap (5 Years)

CCG = £38.8m

CHS = £34.2m

SLAM = £3.7m

NHSE(Primary Care) = NIL

LA Adult Social Care =£11.1m

Assessed Opportunities (5 Years) (PREVIOUS STP)

CCG = £17m

CHS = £23.5m

SLAM = £3m

NHSE(Primary Care) = NIL

LA Adult Social Care = £24m

Health and Well Being Care and Quality Finance and Efficiency

Vacancies

Workforce

Right Care, Right Place Mobility Capacity and Accessibility

Shared Records Fit for Purpose Incentives

Alignment

Information and Technology Estates Contracts

Population ▪ Population growth▪ Increasing deprivation ▪ Increasing black and minority

ethnic population

Inequality in life expectancy

Social Isolation

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Implementation Impact

Urgent care – 3 GP urgent care hubs, access to a wide range of urgent care services, incl. GP appts available from 8am to 8pm, 7 days a week

▪ Increasing awareness and use of GP hubs (37% increase in the number of visitors since opened in April 2017)

▪ Reduced unnecessary referrals to hospital by 4% and outpatient attendances by 2%. Despite activity underperformance there is a 2% increase in the cost of outpatient attendances. The majority of underperformance is in outpatient follow-up which attract a cheaper tariff

▪ Reduced non-elective activity by 2% (1% over on finance) and 9% reduction in A&E activity (1% over on finance), primarily urgent care attendances offset by over performance in A&E attendance.

▪ Increased access to primary care

▪ Improved patient reported access to GPs

Planned care – embedded 18 revised pathways

Out of Hospital and Outcomes based commissioning for over 65s – integrated community network, Personal Independence Co-ordinators, Integrated intermediate and rehabilitation services (LIFE)

Primary care and variation in treatment and care – Peer review of referrals, piloting a group consultation model to support patients with long-term conditions, introducing social prescribing giving a non medical referral option

Mental health – 24 hour crisis telephone line, 24 hour home treatment team

▪ Reduced the average length of stay for Croydon patients in a mental health bed from 58 to 35 days

▪ Reduced the number of delayed discharges (22 to 7 in November 2017) ▪ Reduced the number of patients in out of borough beds (36 to zero in

November 2017)

Child and adolescent mental health services – Single point of access introduced

▪ Children and young people aged under-18 with a diagnosable mental health condition receiving NHS community services treatment increased from 16.8% in 2015/16 to 32% in 2016/17

QIPP plans: £ 14.3m achieved 2016/17; £9.7m YTD and £21.2m forecast 2017/18 77

Our journey and progress over the year

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▪ The CCG will have an in-year resource limit of £561.2m, including programme (£500.6m), primary care (£52.3m) and

running costs (£8.4m). This includes growth of 3.59% on programme allocation and 3.72% on primary care

allocation.

▪ The CCG’s priority is to deliver its statutory duty for expenditure not to exceed its Resource Limit. To this end the

CCG has set a breakeven plan, relying on £26.4m QIPP efficiency schemes, and will increase MH expenditure by

0.59% (in line with total expenditure growth).

▪ Two key transformational programmes underpin the move to a sustainable position

- Out of Hospital: proactive and preventative strategy for transformed care in the home/community

- Planned Care: supporting the shift of care to primary and community care

▪ In addition to the normal planning risks on demand growth and QIPP delivery, there are on-going discussions across

SWL CCGs as to how the SWL CCG control total (£7.4m surplus) and MH Improvement Standard will be delivered

across CCGs. If Croydon CCG was to generate a £3.7m (0.75%) surplus as originally required and meet Mental

Health Improvement Standard (£1.6m) ,

the CCG would need to deliver a further

£5.3m QIPP efficiency (in addition to the 5%

identified). 8

Responding to the needs of CroydonAnnual Operating Plan Key Highlights – Finance

8

National Standards: Finance

IAF Financial Plan

IAF In-year financial performance

IAF Expenditure in areas with identified scope for improvement

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▪ Transformation of Out of Hospital: Phase 2 of the out of hospital transformation covering falls, end of life, care

homes, and others, developing plans for Phase 3

▪ Transformation of Planned Care: Implementation of nine revised pathways

▪ Primary Care: implementation of extended access in line with GP Forward View and GP standards; review of GP

contracts Support general practice in partnership wit the GP collaborative to develop new models of care to

support primary care at scale within networks.

▪ Urgent Care: 111 electronic booked appointments, improvement plan for Type 1 (Emergency Department), review

and re specification of admission avoidance and ambulatory care delivered at the Edgecombe Unit, delivery of core

24 standards and effective implementation of Croydon University Hospital mental health clinical support

▪ Mental Health: Improved access through community provision, earlier intervention, better support to children &

young people and driving parity of esteem within available resources

▪ Medicines Optimisation: Reducing medicines waste; support medicine processes within care homes; Support

clinicians, and residents of Croydon to adopt self-care strategies to keep themselves healthy and manage minor

conditions that are self-limiting.

▪ GP Estates and IT: delivering expanded health facilities meeting population growth and supporting the evolving

models of care with improved, IT-enabled patient access

▪ South West London Health and Care Partnership: working with CHS and other providers to implement the SW

London STP and achieve a sustainable health economy with improved health outcomes

9

Responding to the needs of CroydonAnnual Operating Plan Key Highlights – Services

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The Croydon Operating Plan is set within the framework of delivering

national priorities, the South West London Health and Care Partnership

and local priorities.

Croydon CCG, as well as our health and care partners, face significant

health and care needs and financial challenges. We are working together,

building on the success of the One Croydon Alliance, which previously

focused on the over 65’s, to deliver whole system transformation for the

whole population.

Our whole system transformation plans are outlined in appendix 1.

10

Our Strategic Context

1010

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11

Achieving Financial Sustainability

▪ Delivery of financial balance

by 2018/19

▪ Delivery of net £26.4m

savings in 2018/19 in

cooperation with its

providers. £1.6m of savings

for 2018/19 has yet to be

identified.

▪ Includes £8.2m overall

investment in better

healthcare for Croydon.

▪ Delivery of the STP

transformational goals in

activity shift to community,

Out-of-Hospital and primary

care.

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12

2018/19 Risks and Mitigations

Contracting Round Update:

Having concluded the 2018/19 contracting round, the CCG has managed to secure more QIPP

savings into contract than in prior years which reflects a wider commitment in the system to deliver real

change. Croydon Health Services contract includes new risk share arrangements that have been

agreed to incentivise both parties to deliver service change in emergency and planned care, including

a cap on emergency expenditure. The contingencies within the 2018/19 plan remain in place for

activity and QIPP risks. The key unfunded risk is the waiting list back log at St George’s and Kings.

The key risks the CCG must manage are:

• Slippage or failure to deliver agreed QIPP programme

• Identification of further £2m-£3m QIPP or other mitigations

• Secure recurrent funding for specialised commissioning transfers (£0.5m)

• Unfunded and unquantified waiting list backlog at St George’s Hospital and Kings Healthcare.

• Further patients being discharged under Transforming Care Programme (LD)

• NHSE undertaking to fund Short Supply Drug costs

• Demand for services being higher than modelled

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13

Area FocusSavings

2018/19 (£k)

Planned Care

Elective - “Choosing Wisely” project (formerly ECIs)Prevention & Public Health - Together for Health / Health Help Now app to better signpost to patients the most appropriate care resourceLong Term Conditions – improving self-care and preventative servicesService re-design including increasing community work and supporting primary care to manage patients

5,022

Emergency Care Proactive working to reduce demand through wider primary care and community services 7,427

Mental Health Demand management and service re-design 4,939

Prescribing Reducing waste, using bio-similar and improved procurement 2,910

Continuing Health Care Improving care plans and new systems for tighter financial management 3,000

Learning DisabilitiesClarification of commissioner responsibilities and improved care plans to support patients in the community 984

Finance CSU management fee reduction (SWL) & local negotiations 400

Unidentified 1,755

Total £26.4m

1313

Our 2018/19 Plans: QIPP Schemes Quality, Innovation, Productivity and Prevention Plans)

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Our 2018/19 Plans: Transformational ChangeThe existing model of care is disproportionately provided in the acute setting. This culminates in an unaffordable

health and social care system for Croydon. The outcomes people want are to be supported to self manage, prevent

admissions and have appropriate community provision that meets their needs. We plan to see a reduction of

approximately 64,500 in acute activity in 2018/19 due to transformational change.

14141414

2017/18CCG FOT

2018/19Underlying Trend

and Demographic

Growth

2018/19Transformational

Change

2018/19Policy Changes

2018/19 Annual Plan

Total GP Referrals (General and Acute) 77,219 1,029 -11,019 10,311 83695

Total Other Referrals (General and Acute) 44,004 634 -5,357 5,079 52301

Consultant Led First Outpatient Attendances 122,248 1,591 -16,376 15,390 125759

Consultant Led Follow-Up Outpatient Attendances 317,769 4,253 -16,239 14,044 333553

Total Elective Admissions 37,199 574 -1,418 0 37038

Total Non-Elective Admissions 38,687 1,399 -3,060 3,060 39663

Total A&E Attendances excluding Planned Follow Ups 170,395 2,444 -10,938 7,752 190160

64,407 reduction in Acute Activity in 2018/19

through transformational change

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15

Performance Indicator

Target 2016/17 2017/18 (Q4 forecast)

2018/19 Comment

Q1 Q2 Q3 Q4 FullYear



A&E 4-hour Wait

95% Increased demand mitigated by new local urgent care services

18-week RTT 92% Historically good CCG performance impacted by Kings/St Georges issues

Diagnostic Test Wait

1.0% Improved performance due to provider investment

Cancer 2-week wait

93.0% Continuation of current good performance

Cancer 62-daywait

85.0% Improved performance forecast due to improved sector wide processes

IAPT Roll-out 4.2% Investment made in Q4 2017/18 and carried forward to 2018/19.

CYP – Eating Disorders

95.0% Reflects CCG investment in MH 2015/16 and 2016/13

Children’s wheelchairs

100.0% Target moved from 92% in 2017/18 to 100% in 2018/19.

Annual Health Checks LD

N/A No target published in guidanceNew measure for 18/19

151515

Improving Our Performance A continuing record performance improvement for Croydon

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Our approach to improving the quality and patient safety of the healthcare we commission is based

on the principles of continuous quality improvement, aligned to three dimensions of quality within the

NHS:

▪ Clinical effectiveness – care which is delivered according to the best evidence as to what is

clinically effective in improving an individual’s health outcomes;

▪ Safety – care which is delivered so as to avoid all avoidable harm and risks to the individual’s

safety;

▪ Patient experience – care which looks to give the individual as positive an experience of receiving

and recovering from the care as possible, including being treated according to what that individual

wants or needs, and with compassion, dignity and respect”. (Quality in the new health system –

National Quality Board January 2013).

Croydon CCG works in close collaboration with our providers focusing on:

▪ Delivering continuous quality improvement which enhances quality and patient experience;

▪ Using a systematic approach to monitoring and improving quality with the patient at the centre.;

▪ Extracting and embedding learning from incidents, complaints, safeguarding, soft intelligence,

clinical reviews and audits;

▪ Incorporating learning and outcomes in our contractual schedules and processes;

▪ Promoting openness, transparency and candour throughout the local system to aid learning, in line

with best practice and national guidance;

▪ Maintaining a systematic approach to proactive and early identification of service quality failures.

16

Improving Our Quality

1616161616

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Croydon CCG will continue to build on the quality assurance work undertaken in 2017/18 including:

▪ Regular Clinical Quality Review Group (CQRG) meetings with Providers from whom we commission services to track

quality performance against nationally mandated and locally developed quality indicators including patient experience,

patient safety and provider effectiveness, performance and leadership. In 2017/18 we introduced the Primary Care CQRG

and Intermediate Contract CQRG meetings. In 2018/19 we intend to build on the assurance gained at these meetings and

establish additional CQRGs to monitor all AQPs.

▪ Regular review of Patient Safety Incidents – encouraging all providers to increase reporting of patient safety incidents

which is tracked and monitored at CQRGs. Holding regular Serious Incident (SI) Review meetings with main acute and

mental health Providers to review RCAs, approve action plans, share learning and agree to changes in clinical practice. In

2016/17, Croydon CCG in-housed Quality and SI services. In 2018/19 we will continue to build on the robustness of these

services.

▪ Quality Alerts – re-introduction and continued promotion of Croydon Quality Alert System (QAS) in 2017/18, encouraging a

reverse system of reporting from GP’s and acute and mental health providers. In 2018/19, we will continue to promote

QAS and explore purchasing a SWL wide system.

▪ In 2017/2018 we introduced the Primary Care Quality Dashboard, which is used to measure quality within Croydon GP

Practices, in line with delegated commissioning requirements. Following the recruitment of a Quality Nurse Advisor, we

Improving Our Quality

National Standards: Quality and Governance

DFV Healthcare acquired infections (HCAI) measure (MRSA)

DFVHealthcare acquired infections (HCAI) measure (Clostridium difficile

infections)

IAF Local digital roadmap in place

IAF Probity and corporate governance

IAF Staff engagement index

IAF Progress against workforce race equality standard

IAF Quality of CCG leadership

IAF Percentage of deaths which take place in hospital

DFV Mixed Sex Accommodation (MSA) breaches 1717171717

will work towards development of a Care Home Quality

Dashboard in conjunction with Croydon Local Authority in

2018/19, to measure the quality received by Croydon residents.

▪ In 2017/18 we introduced the Joint Impact Assessment Panel

(JIAP), which works with Croydon PMO Team, to support

transformational change and procurement of services ensuring

that care is delivered in the most efficient way possible in line

with consistent quality standards. All service redesign

programmes are reviewed to ensure that necessary challenge

and assurance is demonstrated before schemes or contracts

commence. JIAP will continue in 2018/19 ensuring continued

robust assurance.

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18

In alignment with the STP, the key levers for improving quality are:

▪ CQUINS: acute providers are incentivised to deliver transformation and improvement

▪ Quality Premiums: the CCG is incentivised to deliver transformation and improvement with a focus on primary care

CQUINS 2018/19

▪ CQUINS are being set at a national and at STP / Croydon level to a value of 2.5% of the CHS contract

▪ 1.5% is aligned to National standards (as below), 1% to successful implementation of locally-agreed transformation schemes

Quality Premiums 2018/19

▪ The CCG can select one local Quality premium in addition to the National schemes – to be determined

▪ The National CQUINS & Quality Premiums are shown below

CQUINs Quality Premiums

1. Improving Staff Health & Wellbeing

2. Reducing the impacts of serious infections

3. Improving physical healthcare to prevent premature mortality of people with serious mental illness (PSMI)

4. Improving services for people with mental healthneeds who present at A&E

1. Early Cancer Diagnosis

2. Access and experience

5. Transitions out of Children & Young People’s mental health services

6. Offering advice and guidance

Preventing ill health by risky behaviours – alcohol and tobacco

10. Improvement the assessment of wounds

3. Continuing Healthcare

4. Mental Health

11 Personalisation of care and support planning

12. Ambulanceconveyance

13. NHS 111 referrals 5. Bloodstream Infections

6. Local QP (Mental Health)181818

Improving Our QualityWorking across the NHS to deliver improvements in the quality of services

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19

The Improvement and Assessment Framework came in to effect from April 2016. To improve CCGs’

accountability to the public, performance against the indicators within the four domains of Better Health, Better

Care, Leadership and Sustainability are published on www.nhs.uk, along with overall ratings, in an ‘Ofsted-

style’ scale.

Within the range of indicators, six Clinical Priority

Areas have been designated, nationally as:

▪ Cancer

▪ Dementia

▪ Diabetes

▪ Learning Disabilities

▪ Mental Health

▪ Maternity

An improvement against the CCG’s baseline

assessment will be delivered through action plans

monitored through the Focused Performance

Group.

191919

Improvement and Assessment Framework The national CCG assessment framework, improving public accountability

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20202020

Appendix 1:

Strategic Transformation Programmes

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Aim: To increase preventative and proactive care through better delivery of integrated care

across health, social care, mental health and voluntary sector services.

21

Out of Hospital Transformation Programme (1)

Embedding initiatives implemented in

year 1 (2017/18):

▪ Integrated Community Networks and

huddles

▪ Living Independently for Everyone

(LIFE)

▪ Discharge to Assess

▪ Local Voluntary Partnerships

▪ Together for Health Programme

21212121

New initiatives for year 2 (2018/19) include:

▪ Transformation of falls services: Integrating falls into LIFE to ensure an

expanded ‘wrap-around’ falls service, alongside improved early identification,

enhanced preventative measures and community support

▪ End of Life Care Transformation: Integration with LIFE (discharge to assess

pathway 3), additional training programmes to reduce conveyances and avoidable

admissions, preparation for move to a coordination centre model

▪ Care homes: Implementation of an ‘Airedale’ style assistive technologies solution,

re-designing the model of GP cover for care homes, and development of a joint

strategic framework (between the CCG and LA) for commissioning care home beds

▪ Re-design of continence services

What have we achieved to date:▪ GP practices that implemented Integrated Community Network

show a decrease in overall non-elective admissions

▪ Where LIFE/ Discharge to Assess was implemented, there is a 20% reduction in Average Length of Stay

▪ The proportion of older people still at home after 91 days after discharge from hospital has increased and admissions to Nursing homes have decreased

Key outcomes:• Staying healthy, active and independent for as long as possible• Getting access to the best quality care so people can live how

they choose• Having support from professionals with specialist knowledge to

understand how health and social care affects individuals• Getting more care and support tailored to individuals’ needs• Being supported to manage long term conditions

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22

Shift from Reactive to Proactive Care

Current Service models

>32k NEL admissions>ALOS56 Escalation bedsIntermediate care bedsWinter Intermediate Care Beds

Monthly GP MDTs

Future New Model of Care<28k NEL admissions 0 Escalation bedsDecreased LOSHome based intermediate care & increased intermediate care

Enhanced MDTs with greater Multi- agency working and development of advanced care plans

Integrated Community Networks - Enhancing multidisciplinary teams working to provide one-to-one support in care planning, seamless coordination of care, and facilitation and promotion of self-care through the engagement and promotion of Community groups.

Living Independently For Everyone – providing integrated step-up and step-down reablement to reduce the need for hospital admissions, improved and speedier hospital discharges and reduced need for Care Homes placements.

Proposed Schemes

Increased GP involvement in proactive care

Improved support for care Homes

Holistic Assessment:-Health, Wellbeing, etc

Flexible provision of Care Packages according to need

Voluntary Sector and Preventative Services

Rapid Response

LAS

Community rehab

Reactive Proactive

CICS

Voluntary sector and Preventative Services

Out of Hospital Transformation Programme (2)

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232323

Planned Care Transformation Programme (1)

Aim: To transform local healthcare by introducing new pathways and models of care, whilst

promoting and embedding behaviour and cultural change across patients, public, and clinical

workforce.

Embedding initiatives implemented in

year 1 (2017/18):

▪ 18 revised pathways including a revised

MSK model of care

▪ GP peer review of patient assessment

▪ Specialist Advice and Guidance

▪ E-Referrals to GPs

Key outcomes:• More patients equipped to manage their own condition

• Better outcomes and experience for patients by improving access and avoiding duplications or procedures with no clinical value

• Reduction in potential years of life lost through amenable disease

• Right care delivered in the right place at the right time, delivered using an integrated approach resulting in better outcomes overall

What have we achieved to date:▪ Rolled out and embedded 18 revised pathways ▪ Revised MSK model of care (attaching physiotherapists to GP

practices) tested ▪ Introduced GP peer review peer of patient assessment▪ Implementing e-Referrals to GPs which combines electronic

booking with a choice of place, date and time for first hospital or clinic appointments

▪ Introduced the Specialist Advice and Guidance to improve access between clinicians in Primary and Secondary Care

▪ Revised ‘Choosing Widely’ thresholds

New initiatives for year 2 (2018/19) include:

By the end of February we will have signed off a single business case which

sets out ambitious activity reductions from acute to more appropriate care

settings:

▪ MSK

▪ Dermatology

▪ Ophthalmology

▪ Gynaecology

▪ ENT

▪ Cardiology/Respiratory

▪ Digestive Diseases

▪ Diabetes

▪ Anti-coagulation

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2424242424

Planned Care Transformation Programme (2)

Integrated model of care at locality level – this is how we envisage care being delivered.

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Aim: To support people to become active citizens in managing their own health and care

ensuring that individuals remain healthier for longer. People can make informed decisions

about their health and social care including decisions they make around lifestyle factors that

may be impacting on diseases and conditions that they may have or be at risk of developing.

25

Together for Health Transformation Programme

25252525

New initiatives for 2018/19 include:

▪ Scaling up social prescribing and developing the community resource through a Local Voluntary Partnership (LVP)

▪ Rollout of group consultations for other LTC

▪ Implementation of an Expert Patients Programme

▪ Health Help now further development increase is usage and using it s full potential

What have we achieved to date:

▪ Social prescribing – Thornton Heath Practice

▪ GP Group consultations piloted for diabetes

▪ Health Help Now App implemented

Key outcomes:

▪ Keeping people well for longer▪ Supporting an active and independent for as long as possible▪ Preventing disease; reduce the down the increase in Type 2

Diabetes across Borough; Lower prevalence of obesity & other lifestyle factors impacting health

▪ Better treatment adherence ▪ People empowered to take greater responsibility for their health▪ Improving health behaviours

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Aim: To prevent mental health problems and to ensure early intervention for those with

mental illness, through improved access to services , and care provided closer to home

where appropriate

26

Mental Health Transformation Programme

26262626


▪ By the end of June signed off the Mental Health and Well Being business case (through the Out of Hospital Business Case)

▪ Alternative pathways for crisis response and primary community based care

▪ Further reduction in occupied beds

▪ Continued implementation of the Child and Adolescent Mental Health (CAMHS) transformation plan. (Also identified as a South

West London priority)

▪ Improving Access to Psychological Therapies (IAPTS) rerun procurement


▪ About to award the mental health forensic contract ▪ Reduced the average length of stay for Croydon patients in a

mental health bed from 58 to 35 days▪ Reduced the number of delayed discharges (22 to 7 in

November 2017) ▪ Reduced the number of patients in out of borough beds (36 to

zero in November 2017)

Key outcomes:

▪ Better wellbeing and mental health▪ Fewer people develop mental health problems▪ More people with mental health problems will have a good

quality of life, fewer will die prematurely ▪ More people will have a positive experience of care wherever it

takes place• Improved health outcomes for patients with dementia • Working with Public Health to reduce the number of people

taking their own lives (national target of 10% reduction

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Aim: To support more people with a learning disability can live in the community, with the

right support, and close to home by making health and care services better.

27

Learning Disabilities Transformation Programme

27272727


▪ Service review outcome - Commissioning more integrated services between community LD team and social care and mental

health

▪ Transforming Care clients

▪ to discharge 4 into community based provision

▪ 7 clients to be discharged from specialist NHS provision into community based provision


▪ Implementing Transforming Care – moving from inpatient provision to community based care

▪ Annual health checks ▪ Service review completed

Key outcomes:

• Reduce health inequalities and premature deaths • Improved quality of life for people with LD• Improved access to wider healthcare services • More people live in the community, with the right support, and

close to home• Greater parity of access for people with LD to primary and

secondary care

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Aim: To improve the health outcomes for children and young people through prevention and

self care and improve families experience through more effective diagnosis and care of long

term conditions

28

Children and Young People Transformation Programme

28282828


▪ Developing a Children's transformation strategy for the development of community paediatrics

▪ Acute business case to reconfigure acute paediatrics sign off by end of February

▪ Continued implementation of the Maternity Services Transformation Plan


▪ Child and adolescent mental health services – Single point of access introduced

▪ Health visiting and school nursing review ▪ Implementing Best Start developments▪ GP advice and guidance

Key outcomes:

• Improvements in children’s physical and mental health including improved health outcomes for children with SEN and Disability

• Improvements in patient experience and reduced waiting times for statutory and other priority pathways

• Reduction in risk of significant harm to physical and mental health for children with long term conditions

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292929

Primary Care Transformation Programme

Aim: To develop primary care at scale to provide a consistent quality service to residents of

Croydon. Working to transformed primary care in line with the London Strategic

Commissioning Framework, the GP forward view, and the 10 high impact actions

Key outcomes:

▪ Sustainability and Resilience of General Practice

▪ A population health focussed approach to commissioning general practice

▪ Shared and varied workforce – addressing recruitment and retention challenges

▪ Ability to provide a wider range of services ‘closer to home’ for the population

What have we achieved to date:▪ Extended access: In addition to the 3 GP Hubs providing same

day pre-bookable and walk in access to a GP, we have commissioned 2 additional hubs offering additional pre-bookable routine appointments to the populations of Shirley and Woodside and Mayday and Thornton Heath. On-going negotiations to provide pre-bookable routine appts in the 3 GP hubs.

▪ GPFV ‘at scale’ Network Plans developed and service delivery commencing including Social Prescribing in 3 networks and employment of shared clinical resource across networks.


▪ GP Extended Access in top up hubs

▪ Roll out of online consultations

▪ Complete the LCS/PDDS review

▪ Development of primary care estates

▪ IT system interoperability and improved functionality

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30

Includes

1. Out-of-Hospital Transformation Integrated community networks, proactive and preventative care,

Living Independently for Everyone (LIFE) programme for care homes, intermediate care

2. Transforming Planned Care MSK / T&O (musculoskeletal, trauma and orthopaedics), genealogical, ENT (ear nose and throat),

ophthalmology, dermatology

3. Together for Health To improve patient outcomes and through actively promoting and encouraging prevention, self-care, self-

management and shared decision making

4. Transforming Primary Care Implementation of the London Strategic Commissioning Framework standards for primary care, the GP

forward view, and the 10 high impact actions. Support general practice networks in partnership wit the GP

collaborative to develop new models of care to support delivery of primary care at scale5. Urgent and Emergency Care 111 electronic booked appointments, improvement plan for Type 1 (Emergency Department), review and re

specification of admission avoidance and ambulatory care delivered at the Edgecombe Unit, delivery of core

24 standards and effective implementation of Croydon University Hospital mental health clinical support6. Maternity Pioneer programme – improving choice and personalisation for women accessing maternity services,

Better Births Recommendations: Developing Continuity of Carer; Improving Safety; Strengthening Perinatal

Mental Health provision and postnatal care. 7. Children & Young People Inpatient Paediatrics, PAU and Ambulatory Model, Childhood Obesity, CAMHS Local Transformation Plan

8. Mental Health Community, Acute and Crisis Care, Perinatal, Psychological Therapies, Diagnose Well, Support Well, Live

Well. Support Well – Carers Alliance, Transformation

9. Learning Disabilities Transforming Care and improving care in primary care

10. Diabetes Engagement / co-design activities with workforce and communities, South London education booking hub go

live, Procurement of integrated service11. Obesity Mapping adult weight management services, publish and disseminate adult weight management pathway,

procurement of agreed approach through diabetes business case

12. Cancer Prostate, Bowel Screening, Holistic Cancer Care Review, Cancer Waits

13. Continuing Health Care Reviewing processes for children and adult service users, developing and integrating a tracking and

monitoring system and a booking system, reviewing high cost Packages of Care

13. Medicines Management Prescribing Incentive Scheme launched and practice targets agreed , Business case for dietician developed

and approved, Implement recommendations from NHS consultation on OTC medicines

14. Enablers IT, Workforce, Estates, New Models of Care, Contracting vehicles including OBC,

Medicines Optimisation 3030

Appendix 2: 2018/19 Work Plans

30

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Sub-regional Groups: Intermediate Care


CCG Transformational Delivery Area: Transforming Out of Hospital Project sponsor: Martin Ellis

Project lead: Kieran Houser

Objectives Through an ambitious programme of innovation and by working together with the diverse communities of Croydon and with OneCroydon Alliance Partners, Croydon CCG

will use resources wisely to transform healthcare to help people look after themselves, and when people do need care, they will be able to access high quality services

Health

Outcome

Beyond 2018/19

• Staying healthy, active and independent for as long as

possible.

• Getting access to the best quality care so people can live

how they choose

• Having support from professionals with specialist knowledge

to understand how health and social care affects individuals

• Getting more care and support tailored to individuals’ needs

• Being supported to manage long term conditions

Quality

Outcome

2018/19

• Integrated networks and care coordination with improved access to support with

improved primary care delivery.

• Developing ‘My Life Plan’ supporting person-led preventative care planning in

the community

• Improved integration of pathways and agreed tariff costs e.g. AgeUK, Marie

Currie, St Christopher's

Activity

Outcome

2018/19

• A&E Reduction – 2,817 A&E activity

• Non-Elective Reduction – 2,913 spells

• Excess Bed Days – 4,243

Finance

Outcome

2018/19

• QIPP - £6.2 million net saving (OOH Phase 1 and Phase 2)

1

Q1 Q2 Q3 Q4

Begin roll-out of huddles

Begin implementation new

/expanded falls service

Roll-out of discharge to assess

for complex patients

Completion of Integrated Care

Network (ICN) implementation

Implement enhanced end of life

care services

Airdale model implemented in

care homes

New GP cover model in place

Roll-out of technology solutions

for care homes

Implementation of Continence

Service transformation

Begin implementation of

Community IV antibiotics

National Standards

IAF People with a long-term condition feeling supported to manage their condition(s)

IAF Injuries from falls in people aged 65 and over

DFV Percentage of children waiting more than 18 weeks for a wheelchair

IAF Management of long term conditions

DFV Total Non-Elective Spells

DFVDelayed Transfers of care per 100,000 population (attributable to NHS, social

care or both)

DFV Bed Days (Non-Elective Admissions)

IAF Delayed transfers of care per 100,000 population

IAF Population use of hospital beds following emergency admission

IAFInequality in unplanned hospitalisation for chronic ambulatory care sensitive

conditions

IAF Inequality in emergency admissions for urgent care sensitive conditions

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CCG Transformational Delivery Area: Transforming Planned Care Project sponsor: Stephen Warren

Project lead: Aarti Joshi

Objectives The planned care programme supports the vision of change set out in the NHS Five Year Forward Plan, SWL STP and local priorities including understanding and

considering the Croydon population health with the aim to improve health across the entire population, by supporting self-care, developing integrated clinical pathways,

supporting secondary care in shifting care into the community and primary care and delivering care according to best practice.

Health

Outcome

Beyond 2018/19

• More patients equipped to manage their own condition

• Better outcomes and experience for patients by improving

access and avoiding duplications or procedures with no

clinical value

• Reduction in potential years of life lost through amenable

disease

• Right care delivered in the right place at the right time,

delivered using an integrated approach resulting in better

outcomes overall

Quality

Outcome

2018/19

• Additional capacity and resources within primary and community care setting

ensuring better access to services across the borough.

• Better access for patients to services across the borough by bringing services

closer to the patient .

• An improved Primary care workforce profile to deliver the transformed services

for patients.

• Increased support and promotion of patient self-activation, Self-Care and shared

decision making.

• Increase in quality of patient experience through initiatives such as life coaching

/ patient champions

Activity

Outcome

2018/19

• Outpatient reduction – 65,612 outpatient activity

• Elective activity reduction - 1,416 of elective activity

• Non-Elective reduction – 107

• A&E Reduction – 71 A&E activity

Finance

Outcome

2018/19

• QIPP - £4.6 million net saving

2

Q1 Q2 Q3 Q4

Planned Care Business

Case Sign off

Market test and procure

Mobilise New models

MSK – Primary Care Based

Service

Dermatology – Integrated

Community Service

ENT & Gynae - Single Point

of Access

Dig Diseases – Nurse

Specialist Triage

National Standards

DFV Referral to treatment pathways

DFV Diagnostic test waiting times

DFV Cancelled Operations

DFV Number of 52 week referral to treatment pathways

DFV Total Bed Days

DFV Total Referrals made for a First Outpatient Appointment (General & Acute)

DFV Total GP Referrals made for a First Outpatient Appointment (G&A)

DFV Total Other Referrals made for First Outpatient Appointment (G&A)

DFV Consultant Led First Outpatient Attendances (Specific Acute)

DFV Consultant Led Follow-Up Outpatient Attendances (Specific Acute)

DFV Total Elective Spells (Specific Acute)

DFV Number of completed admitted RTT pathways

DFV Number of completed non-admitted RTT pathways

DFV Number of new RTT pathways (clock starts)

DFV NHS e-Referral Service (e-RS) Utilisation Coverage

IAF Utilisation of the e-referral service to enable choice at first routine elective referral

IAF Quality of life of carers

IAF Patients waiting 18 weeks or less from referral to hospital treatment

IAF Achievement of clinical standards in the delivery of 7 day services

IAF Adoption of new models of care 32

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CCG Transformational Delivery Area: Together for Health Project sponsor: Stephen Warren

Project lead: Michael Sutton

Objectives To improve patient outcomes and experience as well as creating conditions for a more financially sustainable local healthcare system, through actively promoting and

encouraging prevention, self-care, self-management and shared decision making (PSSSD) among the population to increase independence and responsibility around

health.

Health

Outcome

2018/19

▪ Keeping people well for longer

▪ Supporting an active and independent for as long as

possible

▪ Preventing disease; reduce the down the increase in

Type 2 Diabetes across Borough; Lower prevalence of

obesity & other lifestyle factors impacting health

▪ Better treatment adherence

▪ People empowered to take greater responsibility for

their health

▪ Improving health behaviours

Quality

Outcome

2018/19

• Increased referrals into Behaviour Change Services for physical activity from primary

care / % participants who are more active as a result of the intervention

• Increased self-care knowledge amongst Croydon residents

• Increased number of people attending prevention, self-care, self-management and

Shared Decision

• 6 New sign-posting hubs opened to support patients

• 15 new Local Health Initiatives now live

• Social prescribing becoming available

• Improvements to health help now app to support patients to get faster, more reliable

outcomes

Activity

Outcome

2018/19

• Reducing activity in secondary care and increased

used in community and voluntary sector

• Reduced use of A&E for patients with Long Term

Conditions such Diabetes

Finance

Outcome

2018/19

• QIPP –N/A

3

Q1 Q2 Q3 Q4

Roll out of diabetes Group

Consultations

Implement Expert Patient

Programme

Review and expand the Make

Every Contact Count

Review and expand Health Help

Now App

Review and Expand on Social

Prescribing

National Standards

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CCG Transformational Delivery Area: Transforming Primary Care Project sponsor: Martin Ellis

Project lead: Ruth Frost

Objectives To develop primary care at scale to provide a consistent quality service to residents of Croydon. Working to deliver transformed primary care in line with the London

Strategic Commissioning Framework, the GP forward view, and the 10 high impact actions

Health

Outcome

Beyond 2018/19

• Population level commissioning of General Practice services

– using a Primary Care Networked approach working with

other providers to deliver more services ‘closer to home’

• Improved Self Care through Social Prescribing – preventing

unnecessary GP and Hospital appointments and

admissions

• Improved management of LTCs outside of acute setting

• Improved quality – CQC ratings, CQRS, QOF etc

• Proactive, coordinated, and accessible care

• Reduction in variation through revised PMS/LCS/PDDS

contract

• Improved sustainability & resilience of primary care

Quality

Outcome

2018/19

• Availability of appointments (95%)

• Improved patient satisfaction

• 100% of population have access to GP services 8 days a week

• Improve quality – CQC ratings, CQRS, QOF etc

• Proactive, coordinated, and accessible care

• Increased capacity in primary care

• Use of technology to increase patient self care

• Reduction in variation through revised PMS/LCS/PDDS contract

• Improved sustainability & resilience of primary care

Activity

Outcome

2018/19

• Increased activity in community and primary careFinance

Outcome

2018/19

• Increased investment (£x) in general practice through GP Forward View

• QIPP – N/A

4

Q1 Q2 Q3 Q4

Completed GP Extended

Access

Roll out of online

consultations

Complete the LCS/PDDS

review

Edgridge Road Re-

procurement completed

Maturing at scale approach

to managepopulation health

GPFV investment to improve

sustainability and resilience

National Standards

IAF Patient experience of GP services

IAF Primary care (extended) access

IAF Primary care workforce

DFV Extended access at GP services

GPFV GP Forward View

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CCG Transformational Delivery Area: Urgent and Emergency Care Project sponsor: Stephen Warren

Project lead: Alison O’Grady

Objectives To deliver a functionally integrated 24/7 Urgent Care service for Croydon. Providing public access to the right treatment, in the right place, first time. This service will

include NHS 111, GP Out of Hours, Urgent Care Centres, community services, ambulance services, social care and emergency departments. To collaborate to deliver high

quality, clinical assessment, advice and treatment with all services having access to patient records.

Key

Milestones

1. Delivery of core 24 standards and effective implementation of CUH MH clinical support

2. Review and re specify admission avoidance and ambulatory care delivered at the Edgecombe Unit

3. Application of ‘best practice improvement guidance

Health

Outcome

TBC Quality

Outcome

2018/19

• a seamless service and high quality care for our patients (1-5)

• Increase opening and access points plus improve the care given. (1,2,5)

• Reduce the confusion to patients plus improve patient care and access (1,2)

Activity

Outcome

2018/19

• Reduced unnecessary admissions (4,5)

• Reduced ED Attendances (1,2)

• Reduced length of stay of NEL Admissions (3,4,5)

• Increased performance against 4 hour target (1-5)

• Assessments within 1 hour (Emergency) or 14 hours

(Urgent) (3) Hospital Bed Provision (3,4,5)

Finance

Outcome

2018/19

TBC

5

Q1 Q2 Q3 Q4

Implement 111 electronic

booked appointments for

urgent care services

Implement improvement plan

for Type 1 (Emergency

Department)

Review and re specify

admission avoidance and

ambulatory care delivered at

the Edgecombe Unit

Delivery of core 24 standards

and effective implementation

of CUH MH clinical support

National Standards

DFV A&E waiting times – total time in the A&E department

DFV Ambulances - Proportion of calls closed by telephone advice

DFV Ambulances - Proportion of incidents managed without need for transport to A&E

DFV Ambulances – Proportion of calls closed by telephone advice

DFV Ambulances – Proportion of incidents managed without need for transport to A&E

DFV A&E – 12 hour waits for admission via A&E

DFV Urgent operations cancelled for a second time

DFV Ambulance handover times

DFV Delayed Transfers of Care (attrib. to NHS, social care or both)

DFV Bed Days (Non-Elective Admissions)

DFV Total A&E Attendances

IAF Inequality in unplanned hospitalisation-chronic ambulatory care sensitive conditions

IAF Inequality in emergency admissions for urgent care sensitive conditions

IAF Achievement of milestones in the delivery of an integrated urgent care service

IAF Emergency admissions for urgent care sensitive conditions

IAF Percentage of patients admitted, transferred or discharged from A&E within 4 hrs

IAF Ambulance waits

IAF Delayed transfers of care per 100,000 population

IAF Population use of hospital beds following emergency admission

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CCG Transformational Delivery Area: Maternity Project sponsor: Stephen Warren

Project lead: Sam Taylor, Jane McAllister

Objectives • To improve choice and personalisation of maternity services so that all women have a personalised care plan and are able to make informed choices about their

maternity care

• To provide consistent information across SWL about choices in maternity services ,through the roll out of the ‘My Maternity Journey’ booklet and service provider

training

• To increase the availability of home births and midwife-led care

• To improve continuity of carer access so that more women receive continuity of the person caring for them during pregnancy, birth and postnatally

• To further improve the safety of maternity care through full engaging in the implementation of the NHS Maternity and Neonatal Quality Improvement Programme

• To increase early access to maternity services

• To strengthen both perinatal mental health services and post natal services provision

Health

Outcome

Beyond 2018/19

• Progress towards the target of a reduction in rates of

stillbirths, neonatal and maternal deaths and brain injuries

caused during, or soon after birth, of by 50% by 2025

Quality

Outcome

Beyond 2018/19

• Increased numbers of women booking for services earlier (at 12+6) from 72% to

80% (TBC)

• Reduction in numbers of women smoking at deliver from 9% to 7% (TBC)

Activity

Outcome

2018/19

• Increase the number of women who have a personalised

care plan from 25% to 100% (TBC)

• Increase the number of births in midwife-led settings from

20% to 30% (includes both home births and deliveries in

midwifery-led units) (TBC)

• Continuity of Carer access increased from 3% to 20% by

March 2019

Finance

Outcome

2018/19

• QIPP – N/A

6

Q1 Q2 Q3 Q4

Roll out of ‘My Maternity

Journey’ and personalised

care plans

Develop continuity of carer

model and pilot

Continue implementation of

Saving Babies Lives’ care

bundle

Engage Primary Care services

in Maternity Transformation

objectives

Map existing PNMH services.

Commence the development of

an integrated pathway

National Standard

IAF Maternal smoking at delivery

IAF Neonatal mortality and stillbirths

IAF Women’s experience of maternity services

IAF Choices in maternity services

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CCG Transformational Delivery Area: Children and Young People: Children’s Health Project sponsor: Stephen Warren

Project lead: Amanda Tuke

Objectives • Improve health outcomes through self-care and prevention

• Improve health outcomes for children with SEN and Disability and other vulnerable groups

• Improve families experience through more effective diagnosis and care of long term conditions

• Manage long term conditions as far as possible out of hospital

• Divert Children and Young People from attending Emergency Departments (where appropriate)

• Minimise time Children and Young People spend in hospital (where appropriate)

• Improve quality of patient experience

• Delivery of year 4 and 5 milestones for Local Transformation Plan for mental health services including national guidance objectives

• Evidence of local progress to transform CYPs mental health services is published in refreshed joint agency Local Transformation Plans aligned to STPs.

• Ensure that an additional CYP receive treatment from NHS-commissioned community services (32% above the 2014/15 baseline)

• Deliver the 2020/21 waiting time standards for children and young people’s eating disorder services of 95% of patient receiving first definitive treatment within

four weeks for routine cases and within one week for urgent cases.

• Ensure that by 2020/21, inpatient stays for children and young people will only take place where clinically appropriate – building on New Models of Care

Health

Outcome

Beyond 2018/19

• Improved children’s physical and mental health including

improved health outcomes for children with SEN and

Disability

• Improvements in patient experience and reduced waiting

times for statutory and other priority pathways

• Reduction in risk of significant harm to physical and mental

health for children with long term conditions

Quality

Outcome

Beyond 2018/19

• Improved patient experience and reduced waiting times for statutory and other

priority pathways

• Reduced risk of significant harm to physical and mental health for children with

long term conditions

Activity

Outcome

2018/19

• Reduction in A&E attendance.

• Shift of level 1 Critical Care to CHS

Finance

Outcome

2018/19

• QIPP - £160,000 from realigning community paediatrician clinics and staffing.

• Further savings to be identified through development of strategy.

7

Q1 Q2 Q3 Q4

Saving options for children’s

community medical service

agreed

Agree vision and strategy for

children’s health following

engagement

Implement agreed

information, advice and

guidance initiatives for GPs

Develop LAC CAMHS

pathway in place (in place

2019/20)

National Standard

IAF Percentage of children aged 10-11 classified as overweight or obese

IAF Children and young people’s mental health services transformation

DFV Percentage of CCGs with adequate provision of health based places of safety

DFVPercentage of CCGs building sustainable, system wide, transformation to deliver

improvements in children and young people’s mental health outcomes.

DFV Improve access rate to CYPMH

DFVWaiting times for Urgent and Routine Referrals to Children and Young People

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CCG Transformational Delivery Area: Mental Health Project sponsor: Stephen Warren

Project lead: Marlon Brown

Objectives To prevent mental health problems and to ensure early intervention for those with mental illness, through improved access to services , and care provided closer to home

where appropriate

Health

Outcome

Beyond 2018/19

▪ Better wellbeing and mental health

▪ Fewer people develop mental health problems

▪ More people with mental health problems will have a good

quality of life, fewer will die prematurely

▪ More people will have a positive experience of care

wherever it takes place

• Improved health outcomes for patients with dementia

• Working with Public Health to reduce the number of people

taking their own lives (national target of 10% reduction)

Quality

Outcome

2018/19

• Effective community and primary care based services

• Effective community crisis and liaison services to ensure people only receive

inpatient care when required

• People receive care closer to home and no inappropriate Out of Area Placement

• Integration of MH with primary care social care and other local services

• Better care for families and patients suffering from dementia

• Hospital admission avoidance

• Perinatal mental health improved integrated pathway under development

Activity

Outcome

2018/19

• Reduced Occupied Bed Days from Acute Inpatient beds of

4000

• Reduced Length of Stay

• Zero out of areas placements for acute overspill patients

Finance

Outcome

2018/19

• QIPP - Savings to be generated by re-procurement of IAPT to provide a more

efficient service

8

Q1 Q2 Q3 Q4

Re-procure IAPT service to

meet national targets

Implement Enhanced Primary

Care Service to GPs manage

mental health in Primary

Care

Mobilise reprocured

forensics pathway

Mental health community

services review completed

Implement Crisis Café for

A&E admissions avoidance

Enhanced Memory Service

pathway implemented38

National Standard

DFV IAPT roll-out

DFV Estimated diagnosis rate for people with dementia

DFV IAPT recovery rate

DFV Mental health measure – Care Programme Approach (CPA)

DFV IAPT Waiting Times (6 weeks)

DFV IAPT Waiting Times (12 weeks)

DFV Psychosis treated with NICE care package within 2wks of referral

DFV Effective on-site 24/7 urgent and emergency liaison mental health service

DFV Percentage of local crisis resolution and home treatment teams

IAF Improving Access to Psychological Therapies recovery rate

IAF People with first episode of psychosis treated within 2 weeks of referral

IAF Crisis care and liaison mental health services transformation

IAF Out of area placements for acute mental health inpatient care

IAF Estimated diagnosis rate for people with dementia

IAF Dementia care planning and post-diagnostic support

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CCG Transformational Delivery Area: Learning Disabilities Project sponsor: Stephen Warren

Project lead: Suzanne Culling

Objectives To support more people with a learning disability can live in the community, with the right support, and close to home by making health and care services better.

Key

Milestones

• Completion of Croydon Joint Learning Disability Commissioning Strategy by April 2018

• Completion of JSNA by September 2018

• Transforming Care Partnership : two main work streams to inform the delivery of objectives by March 2020 :

o Development of a crisis house to support

o Develop Positive behaviour support academy in sector

• Commissioned pathways - review and amend specialist contracts with CHS and SLAM to provide additional resources to support providers and prevent admissions

• Development of LD Mortality review Steering group

Health

Outcome

Beyond 2018/19

• Reduce health inequalities and premature deaths

• Improved quality of life for people with LD

• Improved access to wider healthcare services

• More people live in the community, with the right support,

and close to home

• Greater parity of access for people with LD to primary and

secondary care

Quality

Outcome

2018/19

• Provision of awareness training of heath needs affecting people with LD

• Increase uptake of Annual health checks and numbers on GP LD registers

• Improved quality of life for people with LD

• Improved access to wider healthcare services

• Greater parity of access for people with LD to primary and secondary care

Activity

Outcome

2018/19

• Discharge remaining individuals in Transforming care cohort

to appropriate community placements

• Reduction in in patient usage for people with learning

disabilities

Finance

Outcome

2018/19

• QIPP - £984K net saving

9

Q1 Q2 Q3 Q4

Transforming Care

Annual Health checks

Contract review and variation

as appropriate

Market development

National Standards

DFV Reliance on inpatient care for people with a learning disability and/or autism

DFV Inpatients without a review in the last 26 weeks

DFVProportion of people with a learning disability on the GP register receiving an

annual health check

IAF Reliance on specialist inpatient care for people with a learning disability

and/or autism

IAFProportion of people with a learning disability on the GP register receiving an

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CCG Transformational Delivery Area: Diabetes Project sponsor: Stephen Warren

Project lead: Deborah Causer

Objectives To deliver an integrated care system approach to diabetes which provides:

• High quality, specialist-led services as close to where people with diabetes live as possible

• Co-ordinated services without duplication or gaps

• An emphasis on self-care and self-management, recognising different priorities and needs within our communities.

• Embedding partnership working with the community and voluntary sector

• A focus on prevention and early identification.

Health

Outcome

Beyond 2018/19

• Reduced complications from diabetes

• Reduced estimated prevalence of undiagnosed diabetes

2018/19

• Improvements in HbA1c (diabetes)

Quality

Outcome

2018/19

• People with diabetes who attend a diabetes structured education programme

within 12 months of diagnosis

• Care processes and treatment targets (National Diabetes Audit ) – increase :

• People with diabetes receiving all care processes (%)

• People with diabetes meeting all three treatment targets (%)

Activity

Outcome

2018/19

• Reduction in length of stay for people with diabetes

(irrespective of speciality)

• Reduction in non-elective / emergency activity

• Reduction of outpatient activity

• Increased delivery of care in primary/community care

settings

Finance

Outcome

2018/19

• QIPP - Diabetes QIPP of £500K has been achieved in 2016/17. Limited financial

impact is anticipated in 2018/19 .

• Programme currently benefits from national transformation funding (2016/7 to

2018/19)

10

Q1 Q2 Q3 Q4

Specialist inpatient nurse and

specialist podiatrist in post

Agree scope of business case /

procurement

South London education

booking hub go live

Business case sign off

Procurement of integrated

service

Mobilisation of integrated

service

Development of measurable

outcomes/ KPIs

National Standards

IAF

Diabetes patients that have achieved all the NICE recommended treatment targets:

Three (HbA1c, cholesterol and blood pressure) for adults and one (HbA1c) for

children

IAFPeople with diabetes diagnosed less than a year who attend a structured education

course

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CCG Transformational Delivery Area: Obesity: Weight Management Project sponsor: Stephen Warren

Project lead: Deborah Causer

Objectives To commission an integrated weight management service which provides NICE compliant tier 3 and tier 4 bariatric surgery to patients who meet ECI criteria.

To ensure the tier 3 and 4 pathways are integrated with tier 1 and 2 services.

Health

Outcome

Beyond 2018/19

• Weight loss and reduction in BMI

• Improvements in HbA1c (diabetes)

• Improvements to diet and uptake of Improvements to co-

morbidities and weight

• Improved mental health and wellbeing

• Improving depression scores

Quality

Outcome

Beyond 2018/19

• Patient satisfaction with service

• Improving outcomes for bariatric surgery (Tier 4 services)

Activity

Outcome

Beyond 2018/19

• Reduction in medication usage

• Reduction in need for Tier 4 (bariatric) surgery

• Reduction in frequency of other health appointments

Finance

Outcome

Beyond 2018/19

• QIPP – N/A

• STP proposals indicate that an integrated tier 3 and 4 weight management and

bariatric surgery service could provide SWL CCGs the opportunity to negotiate a

reduction in add-on costs in the tier 4 pathway.

11

Q1 Q2 Q3 Q4

Mapping adult weight

management services

Publish and disseminate

adult weight management

pathway

Diabetes / weigh

management procurement

approach agreed

Diabetes business case sign off

Procurement of agreed

approach through diabetes

business case

Transition and mobilisation of

integrated diabetes service

National Standards

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CCG Transformational Delivery Area: Cancer Project sponsor: Stephen Warren

Project lead: Mike Sutton

Objectives To work with key providers in conjunction with RM Partners Cancer Vanguard to implement the Cancer Delivery Plan locally and across SWL STPs. The vision is to

achieve world-class cancer outcomes for the population by 2020/21. Areas of focus include:

• Improving survival, experience and quality of life through earlier diagnosis.

• Improve the quality of life for people living with and beyond cancer, ensuring that it is managed across all health and social care.

• Ensure stratified follow ups are in place across key specialities and to increase the volume where appropriate aligned to national guidance

Key

Milestones

• Develop and implement new lung and pleural pathway by end of March 2018

• Deliver Macmillan GP training event by end of March 2018

• Deliver Secondary Care education and training across key specialities by end of March 2018

• Roll out two week rule Electronic referral Service booking across by end of March 2018

• Implement shadow monitoring for 28 day diagnosis timelines by the end of April 2018

• Develop and implement Head and Neck pathway by beginning of June 2018

• Roll out FIT in bowel cancer screening programme to be completed by October 2018

• Achieve 62% staging target by the end of 2018/19

Health

Outcome

2018/19

• Improved clinical outcomes, leading to longer life

• Enhanced life after cancer

Quality

Outcome

2018/19

• Earlier Diagnosis

• Greater patient satisfaction

Activity

Outcome

2018/19

• Income - limited change from current trajectory

• Activity – limited change from current trajectory

Finance

Outcome

2018/19

• QIPP – N/A

12

Q1 Q2 Q3 Q4

Implement Pleural and Lung

Pathways

Implement shadow

monitoring for 28 day

Diagnosis

Develop head and neck

pathway

FIT bowel cancer screening

National Standards

DFV One-year survival from all cancers

DFV Cancer two week waits

DFV Two week wait for Breast Symptoms

DFV Cancer 31 day wait (first definitive treatment)

DFV Cancer 31 day wait for subsequent treatment (surgery)

DFV Cancer 31 day wait for subsequent treatment (drug regime)

DFV Cancer 31 day wait for subsequent treatment (radiotherapy)

DFV Cancer 62 day waits (first definitive treatment) GP referral

DFV Cancer 62 day waits (first definitive treatment) Screening

DFV Cancer 62 day waits (first definitive treatment) Consultant Upgrade

IAF Cancers diagnosed at early stage

IAFPeople with urgent GP referral having first definitive treatment for cancer within 62

days of referral

IAF One-year survival from all cancers

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CCG Transformational Delivery Area: Continuing Health Care Project sponsor: Elaine Clancy

Project lead: Rachael Colley

Objectives To develop and sustain a team that provides a quality service

To ensure timely and robust assessments that reflects the needs of our clients and which are in line with the national framework for CHC, whilst also upholding financial

integrity and responsibility

Key

Milestones

• Review processes for children and adult service users

• Develop and integrate tracking and monitoring system

• Develop and integrate working systems with other stakeholders

• Develop and integrate booking system to support achievement of KPIs

• Improve and sustain enhanced performance in line with the NHSE and local KPIs

• Review high cost Packages of Care

Health

Outcome

2018/19

• Improved decision making in a timely manner

• More joined up working with key stakeholders to ensure

seamless transfer between services

Quality

Outcome

2018/19

• Achievement of 28/7 assessment KPI

• Achievement of <12/52 KPI

• Reduction of complaints/appeals

• Achievement of local KPI for patient decision letters

Activity

Outcome

2018/19

• Achievement of Decision Support Tool location KPIFinance

Outcome

2018/19

• Savings of £3million

13

Deliverables Q1 Q2 Q3 Q4

Review processes for children and

adult service users

Develop and integrate tracking and

monitoring system and, develop and

integrate booking system to support

achievement of KPIs

Improve and sustain enhanced

performance in line with the NHSE

and local KPIs

Review high cost Packages of Care

National Standards

IAF Personal health budgets

IAF People eligible for standard NHS Continuing Healthcare

DFV Personal Health Budgets

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CCG Transformational Delivery Area: Medicines Optimisation Project sponsor: Stephen Warren

Project lead: Louise Coughlan / Claudette Allerdyce

Objectives To ensure that patients get best quality and value from the investment in medicines made by the CCG and the wider NHS.

Key

Milestones

1. 2018/19 medicines optimisation workplan and prescribing incentive scheme (PIS) approved.

2. PIS launched and annual practice visits to agree practice targets completed

3. Business case for dietician developed and approved .

4. Dietician appointed to support nutritional reviews in at risk patients in particular care home patients.

5. Implementing recommendations from the NHS consultation on reducing prescribing of OTC medicines, including amending the existing minor ailment service.

Health

Outcome

2018/19

• Improved medicines optimisation in people with long term

conditions, so as to keep people well and at home, thus

reducing admissions and readmissions.

• Reduced prescribing of items which have low clinical

effectiveness.

Quality

Outcome

2018/19

• Reduced waste and the inappropriate or unwarranted variation in prescribing.

• Greater promotion and support of the self-care agenda to empower people to be

more in control of their own health.

• Delivery of better integrated care between CHS, primary care and local

community pharmacists so that patients receive care that is genuinely seamless.

Activity

Outcome

N/A Finance

Outcome

2018/19

• QIPP - £2.2m net saving

• Further savings of £960K is identified through review process.

14

Q1 Q2 Q3 Q4

Prescribing Incentive

Scheme launched and

practice targets agreed

Business case for dietician

developed and approved

Dietician appointed to

support nutritional reviews

Implement recommendations

from NHS consultation on

OTC medicines

National Standards

IAF Anti-microbial resistance: appropriate prescribing of antibiotics in primary care

IAFAnti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics

in primary care

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CCG Transformational Delivery Area: Enablers PROJECT IT, Workforce, Estates, New Models of Care, Contracting vehicles incl. OBC

Project sponsor: CCG Directors

Project leads: Simon Lee, Simon Keen, Martin Ellis, David Boothroyd

Objectives To deliver the enabling foundations for the delivery of the CCG Annual Operating Plan 2018/19 across IT, Workforce, Estates, New Models of Care and contracting

vehicles including OBC

Key

Milestones

• IT: delivery of pan SWL STP IT enabling projects (care record integration, practice wireless, pc video consultations by end 2018/19

• Delivery of flexible working change and IT enablement by end Q2 2018/19

• Workforce: completion of a further review of workforce planning to support the new models of care and Primary Care Transformation across 2018/19

• Estates: delivery of ETTF schemes for East Croydon and New Addington by end 2020/21 and support the premises Improvement Grant process

• New Models of Care: to be developed as part of the Out-of-Hospital programme

Quality

Outcome

Beyond 2018/19

• More joined up services allowing people to live

independently, stay at home for longer and are better suited

to the needs of the people that use them

• Incentivised proactive health and wellness management

across the population, improve outcomes and user/patient

experience

• Use health and social care resources more effectively

Quality

Outcome

Beyond 2018/19

• Improved patient access to healthcare

• Improved healthcare productivity

• More attractive place to work (recruitment, retention)

• Improved capacity and capability in primary care

Activity

Outcome

These are enabling programmes. The financial impacts are

shown in the delivery plans above

Finance

Outcome

• Income: see delivery plans in previous slides

• Activity: see delivery plans in previous slides

• Reduced estates costs

15

Q1 Q2 Q3 Q4

IT: pan SWL IT projects

implementation

Flexible working

implementation

Workforce review in

conjunction with SWL and

providers

Estates: ETTF/IG

implementation

National Standards

IAF Local strategic estates plan (SEP) in place

IAF Sustainability and Transformation Plan

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46464646

Appendix 3: Constitution Standards (1 of 2)

Area Measure Target 2018/19 Plan

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

A&E waits (E.B.5)

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

95% 90.1% 90.0% 92.5% 95.0%

RTT 18 Weeks (E.B.3)

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral

92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

Diagnostic test waiting times (E.B.4)

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

Cancer waits - two-week wait (E.B.6 – 7)

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

93% 94% 93% 93% 94% 94% 94% 94% 94% 94% 94% 94% 93%

Cancer waits - 31 days (E.B.8 – 11)

Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers

96% 96% 96% 96% 96% 96% 96% 97% 96% 97% 96% 96% 96%

Maximum 31-day wait for subsequent treatment where that treatment is surgery

94% 94% 95% 95% 95% 95% 94% 95% 95% 94% 95% 94% 95%

Maximum 31-day wait for subsequent treatment where that treatment is anti-cancer drug regime

98% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy

94% 96% 96% 96% 96% 96% 96% 94% 96% 95% 96% 96% 96%

Cancer waits - 62 days (E.B.12 – 14)

Maximum two-month (62-day) wait from urgent GP referral to first definitive treatment for cancer

85% 86% 86% 86% 86% 86% 86% 86% 86% 86% 86% 86% 86%

Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers

90% 90% 90% 90% 91% 91% 90% 91% 91% 100% 91% 90% 90%

Maximum 62-day wait for first definitive treatment following a consultant's decision to upgrade the priority of the patient (all cancers)

- 87% 88% 88% 88% 88% 87% 88% 88% 86% 88% 87% 88%

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Appendix 3: Constitution Standards (2 of 2)

Area Measure Target 2018/19 Plan

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Dementia (E.A.S.1)

Percentage diagnosis rate (over 65s) 66.7% 67% 67% 67% 67% 67% 68% 68% 68% 68% 68% 68% 68%

IAPT (E.A.3 and E.A.S.2)

IAPT Access proportion 4.75% 3.5% 3.5% 4.2% 4.75%

IAPT Recovery Rate 50% 52.6% 52.8% 53.1% 53.6%

Mental Health Waiting times (E.H.1_A1, E.H.2_A2

Proportion of patients waiting 6 weeks from referral to entering a course of IAPT treatment

75% 93.7% 93.7% 93.7% 93.7%

Proportion of patients waiting 18 weeks from referral to entering a course of IAPT treatment

95% 98.1% 98.1% 98.1% 98.1%

Early Intervention in Psychosis (EIP). 2 weeks from first referral for suspected psychosis referral to NICE-recommended package of care

53% 63.0% 61.5% 60.0% 57.1%

Children & Young People Mental Health Services (E.H.9 – 11)

Improve Access Rate to CYPMH 32% 33.9%

Waiting times for routine referrals for eating disorders – 4 weeks

95% 100.0% 100.0% 100.0% 100.0%

Waiting times for urgent referrals for eating disorders – 2 weeks

95% 100.0% 100.0% 100.0% 100.0%

Primary Care (E.D.14)

CCG weighted population benefiting from extended access to GP services (evening and weekends)

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

E-Referral Coverage (E.P.1)

Proportion of patients referred by GPs to first consultant led outpatient appointment via e-referral system

100% 80% 90% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Personal Health Budgets (E.N.1)

Total number of personal health budgets (PHB) both new and existing

- 125 150 175 200

Children’s wheelchairs (E.O.1)

Proportion of children’s equipment that was delivered within 18 weeks of being referred

100% 46.2% 53.8% 61.5% 76.9%

Learning Disabilities (E.K.3)

Annual health checks delivered by GPs for people on the Learning Disability Register

80.1% 54.4%

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Glossary of Terms

Abbreviation / Term Expansion / Explanation

Vanguard Sites NHS sites that take a lead on the development of new ways of delivering patient care (often termed models of care) that will act as the

template for the NHS moving forward and the inspiration to the rest of the health and care system.

LTCs Long Term Conditions (e.g. diabetes, COPD [chronic obstructive pulmonary disease])

STPs Sustainability and Transformation Plans – Croydon in in the Southwest London STP grouping

Sub-Regional Group Croydon as a sub-group of the South West London STP group

PAU Paediatric Assessment Unit

IP In Patient

OP Out Patients

MH Mental Health

CAMHS Children and Adolescent Mental Health Services

CYP Children and Young People

LDs Learning Disabilities

1c FU 1st cancer appointment follow up

Choosing Wisely An umbrella term promoting informed decision making by patients as to the best way to managed their needs though an informed and shared

decision process with their medical professional

QIPP Quality and Productivity Programme (aligned to efficiency improvement programmes in the CCG)

CIP Cost Improvement Programmes (aligned to efficiency improvement programmes in providers)

ETTF Estates and Technology Transformation Fund (a major investment initiative by NHS England to support improvements in GP premises and IT

in support of the GP Forward View initiative (https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf))

NHSE NHS England

OBC Outcome Based Commissioning – a strategic initiative by the CCG, Croydon Council and CHS to provide improved and integrated care for the

over 65s in Croydon

UEC Urgent and Emergency Care (encompasses A&E and the new Urgent Care Centre at Croydon University Hospital , the GP Hubs at East

Croydon, Purley and New Addington, and the Walk In Centre at Edridge Road)

MSK Muscular and Skeletal

IAPT Improving access to psychological therapies

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1 May 2018

Title of Paper: REPORT FROM THE CHAIR OF THE INTEGRATED GOVERNANCE

AND AUDIT COMMITTEE

Lead Director Philip Hogan, Lay Chair, Integrated Governance and Audit Committee

Report Author Elaine Clancy, Director of Quality & Governance Ben Smith, Board Secretary


N/A


CCG Governing Body

Purpose of Report For approval

Recommendation:

The Governing Body is asked to note: ▪ The annual review of the Committee and its Terms of Reference ▪ Note the Terms of Reference of the Committee have been reviewed and the

recommendation, subject to Committee review, is that they should be adopted with

the minor amendments for a further year.

The Governing Body is asked to agree:

▪ To Delegate authority to the Integrated Governance and Audit Committee for the review of the Final CCG Annual Report 2017/18 and Final Annual Accounts and to recommend their approval to the Council of Members.

Executive Summary:

The Integrated Governance Committee is a Committee of the Governing Body but also provides oversight reporting of the handling of Quality Risks and Financial Risks from the Quality Committee and Finance Committee respectively.

The Committee is required by the constitution to review its Terms of Reference annually and to update them as required. The Terms of Reference also state that a report of the Committee’s work and achievements should be compiled annually and presented to the Governing Body.

The Integrated Governance Committee has met on five separate occasions and fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and

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duties of the Committee and it is recommended that they be renewed for the year 2018/2019. Key Papers: The papers on the agenda on 19th April 2018 were:

• CCG Review of Committee and Terms of Reference (attached)

• Timetable For 2017/18 Annual Accounts

• CCG Draft Annual Report 2017/18 including Draft Annual Governance Statement

• CCG Draft Annual Accounts 2017/18 (Presentation)

• Review of Committee Terms of Reference (Finance, Quality and Primary Care Commissioning Committees)

• Annual Report from Internal Audit 2017/18 & Head of Internal Audit Opinion

• External Audit Plan 2018/19

• Draft Annual Governance Statement

• Register of Interests and Decision Log

The committee met on Thursday, 19 April 2018, and reviewed these papers. The Draft CCG Annual Report and Draft CCG Annual Accounts for 2017/18 were received and reviewed. Members were advised of the Annual Report timetable that includes the requirement that the Draft Annual Report would be submitted to NHS England by Midday Friday 20th April 2018 and the Draft Annual Accounts by 5pm on Monday 23rd April 2018. Both deadlines were met. The final submission deadline is 25 May 2018 (Friday) and Approval of Annual Accounts is reserved by the CCG Membership. The Committee was advised that in previous years the Governing Body has held an additional meeting to review the final version of both papers The Integrated Governance and Audit Committee has a meeting scheduled for Monday 21st May 2018 ahead of a Council of Members meeting to be held on Thursday 24th May 2018 with a view to final submission ahead of the 25th May 2018 deadline (via the online portal). The Committee agreed to seek delegated authority from the Governing Body to review the Final Annual Report and Final Annual Accounts and to recommend their approval to the Council of Members.

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Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes.

Risks Failing to make appropriate preparations for the Annual report, Annual Accounts or Annual Governance Statement would place the CCG at a reputational risk, initially, principally with its auditors and authorising bodies such as NHSE.

Financial Implications There are no budgetary provisions made within this paper or in respect of this process, nor are there anticipated to be any budgetary implications.

Conflicts of Interest No conflicts of interest have arisen or been recorded to date.

Clinical Leadership Comments Not applicable

Implications for Other CCGs Not applicable

Equality Analysis Not applicable

Patient and Public Involvement Not applicable

Communication Plan To be made available to Governing Body members

Information Governance Issues

Not applicable

Reputational Issues Failure to manage quality, financial and conflict of interest issues effectively would attract adverse attention from patients, the public and NHS England.

Report Author: Ben Smith

Email address: [email protected]

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CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY

1 May 2018

Title of Paper: INTEGRATED GOVERNANCE AND AUDIT COMMITTEE ANNUAL

REPORT

Lead Director Elaine Clancy Director of Quality and Governance

Report Author Ben Smith, Board Secretary


n/a


CCG Governing Body

Purpose of Report For Agreement

Recommendation:

The Governing Body is asked to : ▪ NOTE the content of the draft Annual Report of the Integrated Governance and Audit

Committee for 2017/18. ▪ APPROVE the Terms of Reference of the Committee for a further year, subject to

consideration of the following change: - required attendance of the Accountable Officer to ‘by invitation’

Background:

The Integrated Governance and Audit Committee (IGAC) is constituted as a standing Committee of the CCG’s Governing Body and has responsibility for oversight, on behalf of the Governing Body, for delivery of high quality and safe commissioned services. The Committee has primary responsibility for monitoring and reviewing financial and other risks and associated controls, corporate governance and financial assurance and is authorised by the Governing Body to investigate any activity within its terms of reference. The Committee is required by the Constitution to review its Terms of Reference annually and to update them as required. The Terms of Reference also state that a report of the Committee’s work and achievements should be compiled annually and presented to the Governing Body. The Integrated Governance and Audit Committee has met on 6 separate occasions and fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2017/18.

Key Issues:

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The Governing Body is asked to note the content of the IGAC Annual Report and reviewed Terms of Reference.

Governance:

Corporate Objective To develop as a mature membership organisation

Risks Failing to make appropriate preparations for such a report would place the CCG at a reputational risk, initially, principally with its auditors and authorising bodies such as NHSE.









Not applicable

Reputational Issues This report documents the CCG’s oversight of governance, internal control and assurance over the preceding year. Failure to produce such a report would be contraindicative to the principles of good governance such as ensuring openness and transparency in order that stakeholders can have confidence in the decision-making and management processes of the CCG.

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INTEGRATED GOVERNANCE AND AUDIT COMMITTEE

ANNUAL REPORT 2017/18

1. Introduction

The Integrated Governance and Audit Committee (IGAC) is constituted as a standing Committee of the CCG’s Governing Body and has responsibility for oversight, on behalf of the Governing Body, for delivery of high quality and safe commissioned services. The Committee has primary responsibility for monitoring and reviewing financial and other risks and associated controls, corporate governance and financial assurance and is authorised by the Governing Body to investigate any activity within its terms of reference.

To support the undertaking of its duties, the Governing Body has established the Finance and Quality Committees which provide assurance to the Integrated Governance and Audit Committee on their portfolios.

2. Functions The Committee provides a number of functions which are set out in its Terms of Reference as follows:

Responsibilities of the Integrated Governance and Audit Committee

Fulfilled Evidence

An independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the CCG’s activities (clinical and non-clinical).

Section 4.2

Assists the CCG in discharging its statutory functions All

Provides assurance of independence for external and internal audit

4.1.5

Ensures that appropriate standards are set and

compliance with them is monitored, in non-financial, non-

clinical areas that fall within the remit of the IGAC

4.3.1 4.4.1

Monitors corporate governance (e.g. Compliance with

Constitution, Standing Orders, Prime Financial Policies,

maintenance of Registers of Interests).

4.2.1 4.2.11

4.2.12 4.2.13

Receives reports providing an overview and assurance of the CCG's position against key performance, quality and safety and financial metrics (via the appropriate quality and finance committees), and recommends action to the Governing Body where the committee believes appropriate mitigating steps are not in place.

4.2.13 4.4.1

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3. Membership

The membership of the Committee is as follows:

Helen Pernelet (to May 2017) Lay member/Vice Chair (chair) Philip Hogan (from June 2017) Lay Member/ Vice Chair (chair) Roger Eastwood Lay Member Amy Page Lay Member, Registered Nurse Governing Body GP Members Invited In attendance Elaine Clancy Director of Quality and Governance Mike Sexton Chief Finance Officer Nick Atkinson Internal Audit, RSM Matthew Dean External Audit, Grant Thornton UK LLP Sarah Ironmonger External Audit Manager, Grant Thornton UK LLP Mike Harling Head of Counter Fraud and Payment Verification Paula Swann (to June 2017) Chief Officer Andrew Eyres (from July 2017) Accountable Officer ▪ A quorum shall be two lay members and two executive members in attendance.

During 2017/2018 attendance was as follows:

Record of Members’ attendance

Attended : Apologies Received:

Non-Attendance:

Not in post

Name

21

Apr

19

May

28

Jul

24

Nov

29

Jan

Members:

Helen Pernelet Lay Member, Governance & PPI (chair 19 May)

Philip Hogan Lay Member, Governance & CoI Guardian (Chair)

100.00%

Roger Eastwood Lay Member, Finance

100.00%

Amy Page Registered Nurse, Governing Body Member

100.00%

In Attendance:

Elaine Clancy Director of Quality & Governance

100.00%

Mike Sexton Chief Finance Officer

80.00%

Andrew Eyres Accountable Officer

0.00%

Paula Swann Chief Officer

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4. Achievements

The Committee considered the following during 2017/18 financial year and achieved the outcomes as detailed:

4.1 Governance:

4.1.1 Reviewed and agreed the Committee Terms of Reference. 4.1.2 Reviewed the 2016/17 Annual Governance Statement, Annual Accounts and

(draft financial versions) Annual Report. 4.1.3 Recommended the 2016/17 Annual Report and Accounts to the Council of

Members and Governing Body. 4.1.4 Amended the Terms of reference to include the Auditor Panel function. 4.1.5 Recommended award of the internal audit and counter fraud contract 4.2 Assurance:

4.2.1 Had oversight of the internal audit programme for 2016/17, including reviewing internal audit reports and recommendations, and receiving assurance on follow up actions. 4.2.2 Received and reviewed Service Auditor Reports from the NEL Commissioning Support Unit. 4.2.3 Regularly receives and reviews internal and external audit reports. 4.2.4 Received and reviewed the Head of Internal Auditor’s Opinion. 4.2.5 Received regular reports from the Local Counter Fraud Specialist. 4.2.6 Received reports on Information Governance. 4.2.7 Agreed the standard Letter of Representation. 4.2.8 Received and noted the Consistency Statement. 4.2.9 Adopted the Accounting Policies. 4.2.10 Received the Annual Audit Fee Letter 4.2.11 Received Reports on Conflicts of Interests. 4.2.12 Review of tender waivers and special payments. 4.2.13 Received minutes of the Finance Committee. 4.3 Risk Management:

4.3.1 Regularly reviews and challenge strategic risks via GBAF and risk reports

4.4 Quality:

4.4.1 Received regular reports from the Quality Committee.

5. Terms of Reference

The Integrated Governance and Audit Committee is obliged to review its Terms of Reference annually to ensure that they remain fit for purpose. The Committee, through this report has done so and considers that they remain relevant and adequately reflect the functions of the Integrated Governance and Audit Committee and recommends that their current format be adopted for the year 2018/19.

Andrew Eyres, Accountable Officer replaced Paula Swan, Chief Officer in July 2017. Andrew Eyres’ works two days a week in Croydon and these do not coincide with Quality Committee meeting dates. The Accountable Officer has not attended the Committee in 2017/18.

Report Author: Ben Smith Email address: [email protected] Date: 13 April 2017

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Last updated April 2017 CCG Integrated Governance and Audit Committee

TERMS OF REFERENCE CROYDON CCG INTEGRATED GOVERNANCE AND AUDIT

COMMITTEE

1. Authority

1.1. The committee is constituted as standing committee of the CCG’s Governing

Body. Its constitution and terms of reference shall be as set out below, subject to amendment at future Governing Body meetings. The committee has no executive powers in addition to those delegated in these terms of reference.

1.2. The committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any member of staff or member of the CCG and all members of staff who are directed to co-operate with any request made by the integrated governance and audit committee (IG&AC).

1.3. The committee is authorised by the Governing Body to obtain outside legal or other independent professional advice. The committee is authorised by the Governing Body to request the attendance of individuals and authorities from outside the CCG with relevant experience and expertise if it considers this necessary or expedient to the carrying out of its functions.

1.4. The committee will have primary responsibility for monitoring and reviewing

financial and other risks and associated controls, corporate governance and financial assurance. The Committee also has responsibility for oversight, on behalf of the Governing Body, for delivery of high quality and safe commissioned services.

1.5. To support the undertaking of its duties the Governing Body has established

Committees which will provide assurance to the Integrated Governance and Audit Committee on their portfolios as follows:

- a finance committee providing regular oversight of issues related to

financial management and QIPP delivery - a quality committee providing regular oversight of the delivery of high

quality and safe commissioned services 1.6. These terms of reference and the composition of the IG&AC will accord with

any published national guidance.

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2. Purpose

2.1. The Governing Body is responsible for ensuring effective internal control including:

▪ exercising its functions effectively, efficiently and economically

▪ complying with such generally accepted principles of good governance as are relevant to it

▪ managing the CCG’s activities in accordance with statute, regulations and guidance

▪ establishing and maintaining a system of internal control to give

reasonable assurance that assets are safeguarded, waste or inefficiency avoided and reliable financial information produced, and that value for money is continuously sought.

2.2. The committee shall provide the Governing Body with a means of

independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the CCG’s activities (clinical and non-clinical). In addition the IG&AC shall:

▪ assist the CCG in discharging its functions under paragraph 2.1 above

▪ provide assurance of independence for external and internal audit

▪ ensure that appropriate standards are set and compliance with them is monitored, in non-financial, non-clinical areas that fall within the remit of the IG&AC

▪ monitor corporate governance (e.g. Compliance with Constitution,

Standing Orders, Prime Financial Policies, maintenance of Registers of Interests).

2.3. To receive reports providing an overview and assurance of the CCG's position

against key performance, quality and safety and financial metrics (via the appropriate quality and finance committees), and recommend action to the Governing Body where the committee believes appropriate mitigating steps are not in place.

3. Membership

3.1. The committee shall be composed of two lay members of the Governing Body, at least one of whom should have recent and relevant financial experience and not less than 2 executive Member Representatives.

3.2. A quorum shall be two lay members and two executive members in attendance.

3.3. The committee shall be chaired by a lay person member.

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4. Attendance

4.1. The Accountable Officer, Chief Financial Officer, Director of Quality and

Governance and Head of Internal Audit shall generally attend routine meetings of the IG&AC.

4.2. A representative of the external auditors and a representative of the Local Counter Fraud Service may normally also be invited to attend meetings of the IG&AC.

4.3. Members of the Governing Body and/or staff and executives shall be invited to attend those meetings in which the IG&AC will consider areas of risk or operation that are their responsibility.

4.4. The IG&AC may ask any or all of those who normally attend but who are not

members to withdraw to facilitate open and frank discussion of particular matters.

4.5. The CCG chair may be invited to attend meetings of the IG&AC as required. 4.6. Member Representatives will be invited to attend meetings of the IG&AC.

4.7. The CFO shall designate a CCG secretary to the IG&AC who will provide

administrative support. The duties of the CCG secretary in this regard include but are not limited to:

▪ agreement of the agenda with the chair of the IG&AC and attendees

together with the collation of connected papers

▪ taking the minutes and keeping a record of matters arising and issues to be carried forward

▪ advising the IG&AC as appropriate

▪ reviewing every decision to suspend the standing orders.

5. Frequency of Meetings

5.1. Meetings shall be held at least four times per year with additional meetings convened where necessary.

5.2. The CCG Chair and Accountable Officer should be invited to attend, at least annually, to discuss with the IG&AC the Annual Accounts and the process for assurance that supports the Annual Governance Statement.

5.3. The committee members shall be afforded the opportunity to meet at least once per year with the External and Internal Auditors with no others present.

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6. Duties

6.1. Internal control, risk management and counter fraud

▪ To ensure the provision and maintenance of an effective system of financial risk identification and associated controls, reporting and governance.

▪ To maintain an oversight of the CCG’s general risk management structures, processes and responsibilities, including the production and issue of any risk and control-related disclosure statements.

▪ To review the adequacy of the policies and procedures in respect of all

counter-fraud and anti-bribery work.

▪ To review the adequacy of the CCG’s arrangements by which CCG staff may, in confidence, raise concerns about possible improprieties in matters of financial reporting and control and related matters or any other matters of concern.

▪ To review the adequacy of underlying assurance processes that indicate

the degree of achievement of corporate objectives and the effectiveness of the management of principal risks.

▪ To ensure the adequacy of policies and procedures for ensuring

compliance with relevant regulatory, legal and conduct requirements. 6.2. Internal audit

▪ To review and approve the internal audit strategy and programme, ensuring that it is consistent with the needs of the organisation.

▪ To oversee on an ongoing basis the effective operation of internal audit in respect of: ▪ adequate resourcing ▪ its co-ordination with external audit ▪ meeting mandatory NHS internal audit standards ▪ providing adequate independence assurances; ▪ having appropriate standing with the CCG ▪ meeting the internal audit needs of the CCG.

▪ To consider the major findings of internal audit investigations; the

Governing Body’s response and their implications and monitor progress on the implementation of recommendations.

▪ To consider the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.

▪ To conduct an annual review of the internal audit function.

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6.3. External audit

▪ To make a recommendation to the Governing Body in respect of the appointment, re-appointment and removal of an external auditor. To the extent that that recommendation is not adopted by the Governing Body, this shall be included in the annual report, along with the reasons that the recommendation was not adopted.

▪ To discuss with the external auditor, before the audit commences, the nature and scope of the audit, and ensure co-ordination, as appropriate, with other external auditors in the local health economy. This should include discussion regarding the local evaluation of audit risks and assessment of the CCG associated impact on the audit fee.

▪ To assess the external auditor’s work and fees on an annual basis and,

based on this assessment, make a recommendation to the Governing Body with respect to the re-appointment or removal of the auditor. This assessment should include the review and monitoring of the external auditor’s independence and objectivity and effectiveness of the audit process in light of relevant professional and regulatory standards.

▪ To oversee the conduct of a market testing exercise for the appointment

of an auditor at least once every (five) years and, based on the outcome, make a recommendation to the Governing Body with respect of the appointment of the auditor.

▪ To review external audit reports, including the annual audit letter,

together with the Governing Body’s response, and to monitor progress on the implementation of recommendations.

▪ To develop and implement a policy on the engagement of the external

auditor to supply non-audit services.

▪ To consider the provision of the external audit service, the cost of the audit and any questions of resignation and dismissal.

6.4 Auditor Panel ▪ To act as the Auditor Panel to make recommendation to the Governing

Body to choose an external auditor. ▪ Advise on the selection and appointment of an external auditor

(responsibility for the actual procurement and appointment remains with the Governing Body).

▪ Check that procurement and contract arrangements are appropriate. ▪ If appropriate, advise on any liability limitation agreements suggested by

the external auditor. ▪ Ensure the maintenance of ongoing independent relationships and that

communications with external auditors are professional. ▪ Ensure that any conflicts of interest are effectively dealt with. ▪ Advise on the purchase of ‘non-audit services’ from the auditor. This

may include the approval of any policy on the purchase of non -audit services from the local auditor.

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▪ Advise on the removal of the external auditors. ▪ The Chair of the Auditor Panel must provide a report to the Governing

Body about the Auditor Panel activities and decisions. 6.5. Integrated Governance

▪ To oversee the integrated governance of the CCG and give the Governing Body assurance, through regular review and scrutiny of the Board Assurance Framework that the CCG has sufficient controls in place to manage the significant risks to achieving its strategic objectives and that these controls are operating effectively.

▪ To develop, review and use an effective assurance framework to guide the IG&AC’s work which meets the Governing Body’s requirements. This will include utilising and reviewing the work of the internal audit, external audit and other assurance functions as well as reports and assurances sought from members of the Governing Body and other investigatory outcomes so as fulfil its functions in connection with these terms of reference.

▪ To review the CCGs arrangements for and progress with matters of

information governance ▪ To receive assurance, from the committees on the delivery of quality

standards, finance and QIPP, progress on health programmes and on the delivery of excellent patient experiences within commissioned services.

6.6 Annual accounts review

▪ To review the annual statutory accounts, before they are presented to the Governing Body (who will in turn provide them to NHS England in accordance with statutory requirements), to determine their completeness, objectivity, integrity and accuracy. This review will cover but is not limited to:

▪ the meaning and significance of the figures, notes and significant

changes ▪ areas where judgment has been exercised ▪ adherence to accounting policies and practices ▪ adherence to the requirements and any directions given to the

CCG by NHS England ▪ explanation of estimates or provisions having material effect ▪ the schedule of losses and special payments ▪ any unadjusted statements ▪ any reservations and disagreements between the external

auditors and the Governing Body which have not been satisfactorily resolved.

▪ To review the annual report before it is submitted to the Governing Body

and presented to Members of the CCG at the Annual General Meeting of the CCG, to determine completeness, objectivity, integrity and accuracy. The Governing Body will provide the annual report to NHS England in accordance with statutory requirements.

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▪ To review all accounting and reporting systems for reporting to the

Governing Body, including in respect of budgetary control. 6.7. Standing orders, Prime Financial Policies and standards of business

conduct ▪ To review on behalf of the Governing Body the operation of, and

proposed changes to, the standing orders and prime financial policies, the constitution, codes of conduct and standards of business conduct; including maintenance of registers.

▪ To examine the circumstances of any significant departure from the requirements of any of the foregoing, whether those departures relate to a failing, an overruling or a suspension.

▪ The Committee will specifically be advised of:

▪ tender waivers authorised on behalf of the Governing Body ▪ any debts proposed for write-off (these will be reviewed in the

first instance at the Finance Committee) ▪ any special payments or losses (these will be reviewed in the

first instance at the Finance Committee). The committee will receive this information by reporting of relevant minutes

• To review the scheme of delegation at least annually.

6.8. Other ▪ To ensure the CCG is working towards the delivery of its priority to

reduce health inequalities in access and the outcomes of healthcare

▪ To review performance indicators relevant to the remit of the IG&AC.

▪ To examine any other matter referred to the IG&AC by the Governing Body and to initiate investigation as determined by the IG&AC.

▪ To annually review the accounting policies of the CCG and make

appropriate recommendations to the Governing Body.

▪ To consider the outcomes of significant reviews carried out by other bodies which include but are not limited to regulators and inspectors within the health (and social care) sector and professional bodies with responsibilities that relate to staff performance and functions.

▪ To review the work of all the other committees of the CCG in connection with the IG&AC’s assurance function.

7. Reporting

7.1 The minutes of all meetings of the IG&AC shall be formally recorded and

submitted, together with recommendations where appropriate, to the Governing Body. The submission to the Governing Body shall include details of any matters in respect of which actions or improvements are needed. This will include details of any evidence of potentially ultra vires, otherwise unlawful or improper transactions, acts, omissions or practices or any other important

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matters. To the extent that such matters arise, the chair of the IG&AC shall present details to a meeting of the Governing Body in addition to submission of the minutes.

7.2 The IG&AC will report annually to the Governing Body in respect of the fulfilment of its functions in connection with these terms of reference. Such report shall include but not be limited to functions undertaken in connection with the effectiveness of risk management within the CCG; the integration of and adherence to governance arrangements and any pertinent matters in respect of which the IG&AC has been engaged.

7.3 The CCG’s annual report shall include a section describing the work of the

IG&AC in discharging its responsibilities.

8 Review

8.1 The terms of reference of the IG&AC shall be reviewed by the Governing Body at least annually. This should take into account new guidance and developments in good governance practice.

9 Required Frequency of Attendance by Members

9.1 Members of the IG&AC must attend at least 75% of all meetings each financial year but should aim to attend all scheduled meetings.

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1 May 2018

Title of Paper: REPORT FROM THE CHAIR OF THE FINANCE COMMITTEE

Lead Director Roger Eastwood, Lay Chair, Finance Committee

Report Author Mike Sexton, Chief Finance Officer Ben Smith, Board Secretary


N/A


CCG Governing Body


Recommendation:

The Governing Body is asked to note: ▪ The annual review of the Committee and its Terms of Reference ▪ The Finance Report (M12) and QIPP Report (M12), in particular the CCG delivered a

£19.9m deficit in line with its forecasts and delivered £21.2m (4.3%) efficiency savings. ▪ The Contracting Report (M11)

The Governing Body is asked to agree the following changes to the Terms of Reference for the Finance Committee: ▪ Delegate responsibility to Finance Committee for the approval of procurement decisions

on behalf of the Governing Body ▪ Membership section: Accountable Officer has an “open invitation” to attend. ▪ Membership section: update formal titles of Governing Body Members

Executive Summary:

The Finance Committee is a Committee of the Governing Body and also provides oversight reporting to the Integrated Governance and Audit Committee (IGAC) (in its position of oversight for CCG internal control and governance). It has been established to ensure a robust financial strategy is in place and to oversee the organisation-wide system of financial management, working with IGAC to ensure viability, effectiveness and financial probity within the CCG.

The Finance Committee has met on 13 separate occasions since January 2017 and fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2018/19

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with two amendments shown by tracked changes in Appendix B. Key Papers: The paper on the agenda are:

• Review of Committee and Terms of Reference (attached)

• Finance Report (Month 12)

• QIPP Report (Month 12)

• Contracting Report (Month 11) The committee met on Monday, 23 April 2018, and reviewed these papers. The key highlight at the end of the year is the delivery of a £13.9m deficit in line with the forecasts and original CCG plans. Underpinning this result, is the delivery of an unprecedented level of QIPP efficiency savings of £21.2m (4.3% of annual allocation). This result puts the CCG in an excellent position to follow through and deliver the 2018/19 financial plan that was agreed in March 2018. In 2018/19 we will be seeking to deliver £26.4m QIPP to deliver an in-year breakeven position. It should be noted that there are on-going discussions across South West London CCGs to agree how the sectors £7.4m surplus will be delivered and the split across CCGs.

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Governance:











Not applicable




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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

1 MAY 2018

Title of Paper: 2017/18 FINANCE: PERIOD 12 (MARCH 2018)

Lead Director Mike Sexton Chief Finance Officer

Report Author Edward Odoi Chief Management Accountant


Senior Management Team – 24 April 2018 Finance Committee – 23 April 2018


Clinical Leaders Group – 2 May 2018

Purpose of Report For discussion and noting

Recommendation:

The Governing Body is asked to: ▪ Note the CCG is reporting an in-year deficit of £13.9m (£7.0m adverse variance: £8.1m

unidentified QIPP and the £1.7m Short Stock Drugs (NCSO) pressure offset by £0.5m Category M benefit and £2.4m (0.5% System Risk Reserve).

▪ Note the commendable performance against the Public Sector Payment Policy (95% within 30 days) and cash management.

▪ The delivery in 2017/18 places the CCG in an excellent position to deliver its 2018/19 financial plan.

Background:

Financial Performance Targets and Duties

▪ For 2017/18, NHSE set financial performance targets at STP level i.e. SWL CCGs as a group have a target of an in-year £4.6m surplus. The implied target for Croydon CCG was breakeven.

▪ NHSE did, however, recognise the significant challenge facing Croydon CCG and agreed an in-year target deficit of £6.9m (cumulative deficit of £61.4m), based on a 6% (£29.3m) QIPP for 2017/18;

▪ Under the Health and Social Care Act, the CCG has a general statutory obligation to contain expenditure within its allocated resources;

▪ The above duties are enshrined in the CCG’s constitution.

▪ The CCG has a duty to use resources for the purposes intended and to demonstrate

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value for money;

2017/18 Financial Plan

▪ The CCG has agreed detailed financial plans which include £21.2m QIPP. This was delivered in full.

Key Issues:

Financial Performance ▪ The CCG is reporting an outturn of £13.9m deficit, recognising the £8.1m unidentified

QIPP and the £1.7m Short Stock Drugs (NCSO) pressure offset by £0.5m Category M benefit and £2.4m (0.5% System Risk Reserve)

Governance:

Corporate Objective To achieve financial balance by 2018/19

Risks N/A

Financial Implications Month 8 forecast has been delivered Month 8 QIPP forecast has been delivered.

Conflicts of Interest No specific conflicts of interest.

Clinical Leadership Comments Clinical Leadership Group is supporting the delivery of the QIPP and transformation programme.

Implications for Other CCGs Croydon CCG works closely with the other SWL

CCGs as part of the SWL STP.

Equality Analysis All QIPP and expenditure programmes are

required to have an EIA, compliance monitored

by the PMO.

Patient and Public Involvement All service redesign, QIPP projects and

expenditure reductions must meet the requisite

PPI requirements.

Communication Plan The 2017/18 Financial Position and QIPP Programme have been share in the public domain and with stakeholders.


Restrictions on access to patient level activity data limiting the ability of CCG to review provider performance and to monitor some QIPP schemes.

Reputational Issues

The CCG delivered a £13.9m deficit finance position.

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Finance Report –March 2018 (Month 12)

Mike Sexton - Chief Finance Officer

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Contents

1. Finance Scorecard

2. Key Indicators

3. Summary Financial Position (incl QIPP)

4. Acute Services

5. Mental Health, Community, and Primary Care Services

6. Prescribing

7. Other Programme Services and Running Costs

8. Statement of Financial Position

9. Appendices

- Revenue Resource

-Analysis of Aged Debt

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1. Finance Scorecard – March 2018

Financial Strategy Financial Performance

• The CCG has refreshed its 5-Year Financial Model

from 2017/18 – 2021/22 and agreed with Croydon

Transformation Board partners.

• 2018/19: Breakeven, 2019/20: 1% surplus

• The QIPP challenge to deliver break even in

2018/19 is ££26.4m (assuming £21m in 2017/18).

• The CCG has identified £24.7m towards the

£26.4m, with £1.7m to be identified.

• Joint working through the Croydon Alliance is

supporting the delivery of integrated schemes.

• The CCG reports an in-year finance position of

£13.9m deficit (£68.3m cumulative) against the

financial target of £6.9m (£61.4m cumulative) in line

with M8 reporting and the original detailed plan.

• The £13.9m forecast deficit recognises the £8.1m

unidentified QIPP and the £1.7m Short Stock Drugs

(NCSO) pressure offset by £0.5m Category M

benefit and £2.4m (0.5% System Risk Reserve).

• CCG did not achieve the £6.9m deficit NHSE

target.

Financial Governance Financial Risk

• In addition to the Internal Audit programme, the

following reviews have reported in the last year:

- NHSE independent review of revised forecast

outturn (recognition of CCG assessment of

outturn)

- Deloitte review of 2018/19 QIPP progress

(Green on governance and favourable

readiness rating)

- CHC Audit Report: Limited assurance

• The accounts for the year are now closed.

• The accruals estimates for acute, prescribing, CHC,

and primary care are prudent estimates of

expenditure and so financial risk is minimal.

• The exit run rate into 2018/19 is in line with that

already assumed in the 2018/19 financial plan.

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2. Key Indicators – March 2018

Financial Performance

Target/ Indicator

Measure Target Previous ForecastM11

Current ForecastM12

Revenue

Resource Limit

(RRL)

CCG Original Plan /

NHSE M8 Forecast

(£15.0m) +

NCSO

(£17.2m) (£13.9m)

NHSE Set Target (In Year) (£6.9m) (£17.2m) (£13.9m)

Statutory Duty (In-Year) Breakeven (£17.2m) (£13.9m)

Statutory Duty (Cumulative) Breakeven (£71.7m) (£68.3m)

Capital Resource

Limit (CRL)

Stay within CRL £0.4m £0.4m £0.4m

Cash Forecast Stay with Cash Forecast* £562.7m £562.5m £555.7m

Better Practice

Payment Policy

Payment of valid invoices within 30

days

95% NHS: 96.78%

Non-NHS:

97.13%

NHS: 96.94% Non-

NHS: 97.19%

Cash Balance % of initial drawings in bank

account at end of the month

1.25% 4.8% 0.9%

QIPP/

CEP

Delivery of Identified Programme

Savings

£21.2m £20.7m £21.2m

Unidentified Programme Savings £8.1m - -

Running Costs Stay within running cost envelope. £8.4m £8.1m £8.3m

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Forecast Outturn Changes

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The CCG is reporting a full year deficit of £13.9m (£7.0m adverse variance representing £8.1m - unidentified

QIPP, £1.7m – Short Stock Drugs (NCSO) pressure, offset by £0.5m Category M benefit and £2.4m - 0.5%

System Risk Reserve as agreed with NHSE).

Month

M11

Forecast

Outturn

2017-18

Final

Outturn

Control

Total

Variance

£m £m £m

M09 FOT (15.0) (15.0) (6.9) (8.1)

Short Stock Drugs (NCSO) Pressure (2.2) (1.7) (1.7)

Sub-total M12 (17.2) (16.7) (6.9) (9.8)

0.5% System Risk Reserve 2.4 2.4 - 2.4

Category M 0.4 0.5 - 0.5

M12 FOT (14.4) (13.9) (6.9) (7.0)

NHSE Adjustments

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3a. Month 12 Financial Position Summary – March 2018

➢ The CCG is reporting an outturn deficit of £13.9m

(£7.0m adverse variance representing the £8.1m

unidentified QIPP and £1.7m Short Stock Drugs

(NCSO) pressure) offset by £0.5m Category M

benefit and £2.4m (0.5% System Risk Reserve). .

➢ NHSE team carried out a detailed review in

November 2017 and recognised the CCG’s

revised forecast deficit.

➢ Note the excellent performance against the Public

Sector Payment Policy (95% within 30 days) and

cash management.

6

Plan Outturn

£m £m £m %

Acute Services 300.0 303.7 (3.7) -1.2%

Mental Health Services 53.2 53.7 (0.5) -1.0%

Community Health Services 37.2 36.6 0.6 1.7%

Continuing Care Services 35.4 36.1 (0.7) -2.1%

Primary Care Services 52.4 51.7 0.7 1.3%

Primary Care Co-Commissioning 50.4 49.9 0.4 0.9%

Other Programme Services 14.8 18.6 (3.8) -26.1%

Running Cost/Exclusions 8.4 8.3 0.1 1.4%

Total Expenditure 551.7 558.7 (7.0) -1.3%

Revenue Resource Limit 490.3 490.3 0.0 0.0%

Cumulative Financial Position: Surplus/(Deficit) (61.4) (68.3) 7.0 -11.4%

Prior Years Financial Position: Surplus/(Deficit) (54.5) (54.5)

In-Year Financial Position: Surplus/(Deficit) (6.9) (13.9)

Variance

Annual

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3b Month 12 QIPP Summary – March 2018

Programme Full Year

Planned

Savings (£m)

Full Year

Actual Savings

(£m)

Full Year

Variance

(£m)

Planned Care transformation 4.3 0.7 (3.6)

Planned Care 16/17 FYE 2.9 3.6 0.7

Out of Hospital 3.9 3.3 (0.6)

Mental Health 4.2 3.9 (0.3)

Medicines Optimisation 1.7 2.6 0.9

Complex Funding 3.8 4.7 0.8

Stand alone 0.3 2.5 2.1

Sub-total 21.2 21.2 (0.0)

Unidentified QIPP 8.1 0.0 (8.1)

Total 29.3 21.2 (8.1)

The forecast £21.2m QIPP has been delivered in full against the identified £21.2m plan.

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4a. Acute Services

CROYDON HEALTH SERVICES

The reported position is £2.0m underspend. Performance

was down across most points of delivery including

elective and emergency admissions. It should be noted

that A&E attendances are above plan reflecting sub-

optimal impact of the new Urgent Care services.

KING’S COLLEGE

The reported position is £3.0m overspend. The main

drivers of over-performance are Critical Care, HASU and

Emergency.

PRIVATE PROVIDERS (BMI HEALTHCARE/RAMSEY

HEALTHCARE)

The reported position is £1.3m overspend. There has

been an increase in first and follow up outpatient

appointments from April 2017. Elective activity is stable.

The specialities that have seen a significant increase

include T&O, Gastroenterology, Pain, Diagnostics,

Urology and Gynaecology. The increase in referrals is

across all GP networks.

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Plan

Memo

Better

Care

Fund

Revised

2017/18

Annual

Budget

Outturn Var

£000s £000s £000s £000s £000s

Guys + St Thomas NHS FT 7,811 8,463 652

Kings College Hosp NHS FT 18,902 21,886 2,984

Moorfields Eye Hosp FT (100) 10,546 11,106 560

Royal Marsden NHS FT 4,096 5,119 1,023

St Georges' NHST (149) 25,077 26,727 1,650

Univ College London FT 1,747 1,770 23

Croydon Health Serv NHST 172,020 169,976 (2,044)

Epsom + St Helier NHST 9,694 9,183 (510)

Epsom + St Helier NHST - SWLEOC 5,256 4,583 (673)

Surrey & Sussex NHST 5,320 5,879 559

London Ambulance Service 14,583 14,583 0

CROYDON URGENT CARE ALLIANCE (CUCA) (590) 6,241 5,402 (839)

GP Roving Service (part of CUCA) 459 459 459 -

BMI Healthcare 3,358 4,267 909

RAMSAY HEALTH CARE UK 496 850 354

Other Providers - - 11,256 10,136 (1,120)

QIPP Not In Contract (5,530) (4,265) - 4,265

Acute Growth Contingency 4,344 - (4,344)

Acute NCA 3,038 3,300 262

Total Acute Services (6,369) 459 299,977 303,690 3,712

COST CENTRE NAME

FULL YEAR

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4b. Acute Point of Delivery (POD)

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Acute POD

Plan @

M11

Actual @

M11 Variance To

CCG Plan

£m £m £m

Elective £42.28 £40.70 £1.58

Emergency £68.64 £70.95 -£2.31

Non-Elective £6.47 £6.40 £0.07

Maternity Pathway £27.54 £26.14 £1.40

A&E £21.00 £21.34 -£0.34

Out Patient 1st £16.98 £16.85 £0.13

Out Patient Follow Up £17.54 £18.95 -£1.41

Out Patient Procedure £9.78 £10.57 -£0.79

Unbundled Diagnostics £5.13 £4.69 £0.44

Critical Care £9.54 £10.43 -£0.89

Direct Access £9.52 £8.54 £0.99

Drugs & Devices £9.68 £9.39 £0.29

Other £16.27 £15.53 £0.74

PTS £2.06 £2.13 -£0.06

CQUIN £5.43 £6.09 -£0.67

Total £267.85 £268.68 -£0.83

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5. Mental Health, Community, and Primary CareMental Health (including Learning Disabilities):

The Mental Health Overspend reflects an underspend of £270k in

relation to inpatient bed days at SLaM whereby we reduced activity

below plan which resulted in a repayment to the CCG through the

agreed risk share. The underspend was offset by increased activity

with NCA contracts and in particular at MH organisations bordering the

borough of Croydon. The CCG is investigating this with a view to

repatriation back to SLaM.

Community Health Services:

The CCG was successful in clawing back funding which was earmarked

for cardiology pathways that were not implemented which accounts for

£226k of the underspend. Other underspends are mainly in respect of

Dermatology and Gynae intermediate contracts where performance was

lower than planned. Both contracts are being procured in 2018/19.

Continuing Health Care:

The overspend is largely driven by historic claims for CHC care and an

increase in patients in the last quarter for Funded Nursing Care.

Primary Care / Delegated-Commissioning:

Prescribing expenditure is in line with plan, including the £1.7m cost

pressure on Short Stock Drugs.

The Practice Transformation Support funds (Enhanced Access)

contribute to the funding of 3 GP Hubs in the CUCA contact (reported in

Acute services).

The Primary Care Delegated Commissioning position is underspent by

£0.4m, which is offset by over spends on GP IT costs and community

based services (LESs).

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Budget

Outturn

Var

£000s £000s £000s £ 000s £ 000s

Mental Health Services

MH Contracts - NHS (4,145) 1,898 43,103 43,000 (103)

MH Contracts - Other Providers (102) 303 2,383 2,216 (167)

MH - Other (878) 150 7,102 7,267 164

MH - NCAs - - 573 1,227 654

Total Mental Health Services (5,125) 2,351 53,161 53,710 549

Community Health Services

CH Contracts - NHS 1,480 3,612 29,745 29,354 (391)

CH Contracts - Other Providers (539) 2,943 7,464 7,210 (254)

Total Community Health Services 941 6,555 37,208 36,564 (645)

Continuing Care Services

Continuing Care Services (2,607) - 29,616 29,556 (60)

Funded Nursing Care - - 5,784 6,572 788

Total Continuing Care Services (2,607) - 35,401 36,129 728

Primary Care

Prescribing (1,693) 110 45,153 45,087 (66)

Community Based Services (495) 2,560 4,898 5,110 212

Practice Transformation Support - - 1,084 130 (954)

GP IT Costs - - 1,281 1,418 137

Total Primary Care (2,188) 2,670 52,417 51,744 (672)

Primary Care Delegated-Commissioning - - 50,382 49,948 (434)

FULL YEAR

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6. Prescribing Expenditure Trend and Update

Price concessions aside, the prescribing would be on plan (see yellow line). However, a national

supply shortage of certain drugs has lead to national Price Concessions (NCSO) being agreed. The

cost pressure for Croydon CCG is estimated at circa £1.7 for 2017/18. This has been reflected in the reported full year financial position.

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7. Other Programme Services and Running Costs

➢ Other Programme Services: OBC, NHS 111,

Service Redesign, NHS Property Services Ltd

recharge, Safeguarding and Marie Stopes

➢ Unidentified QIPP: £8.1m adverse variance is

now recognised by NHSE

➢ The mandatory contingency (0.5% / £2.5m)

reserve has been be released to manage

financial pressures on other budget lines.

➢ The running costs budget is £8.4m.

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Plan

Memo

Better

Care

Fund

Revised

2017/18

Annual

Budget

Outturn

Var

£000s £000s £000s £ 000s £ 000s

Other Programme Services

Better Care Fund - 9,011 9,011 8,845 (166)

Other Programme Services 310 254 7,319 8,334 1,016

Unidentified QIPP (8,096) - (8,096) - 8,096

Contingency - (0.5%) - - 2,455 - (2,455)

1% Non Recurrent - - 4,072 1,430 (2,641)

Total Other Programme Services (7,786) 9,265 14,760 18,610 3,850

Running Costs

NHS NELCSU SLA - - 3,508 3,542 34

NHS Croydon CCG - Pay - - 3,915 3,740 (175)

NHS Croydon CCG - Non Pay - - 967 990 23

Total Running Costs - - 8,391 8,272 (118)

FULL YEAR

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8. Statement of Financial Position▪ The Statement of Financial Position (as at 31st March

2018) is summarised in the adjacent table. The net

working capital position (net £41.8m liability) reflects

£50.3m of creditors offset by debtors and prepayments

of £8.6m. The £4m increase in creditors is driven by

normal timing issues in the new delegated primary care

expenditure (£50m annual)

▪ The Balance Sheet is showing a £420k cash balance.

The actual balance in the bank account was £424k; the

difference was due to a BACS payment at the end of

the month that cleared through the bank accounts the

following day.

▪ Included within prepayments is £2.1m relating to the

Maternity WIP and included within accruals is £3.4m

relating to Partially Completed Spells.

▪ A significant element of the accrued liabilities relates to

prescribing (£7.6m) and NHS activity which has yet to

be billed. The balance relates to non-SLA expenditure

and contingencies.

▪ The value of the CCG’s net Fixed Assets as at 31st

March 2018 is £471k (this includes £392k of Capital

funding the CCG received in 2017/18 for Corporate IT

- SWL Agile - Azure/Cloud/O365 roll-out).

13

Opening Closing

01/04/2017 31/03/2018

(£000s) (£000s)

Non-Current Assets

Fixed Assets 118 510

Accumulated Depreciation 39

Net Fixed Assets 118 471

Current Assets

Cash 286 420

Accounts Receivable 4,839 5,597

Maternity Work in Progress 2,481 2,114

Total Current Assets 7,606 8,130

TOTAL ASSETS 7,724 8,601

Current Liabilities

Accounts Payables 43,102 46,919

Partially Completed Spells 3,361 3,385

Accrued Liabilities - 49

Total Current Liabilities 46,463 50,353

Tax Payers Equity

General Fund (38,739) (41,752)

Total Tax Payers Equity (38,739) (41,752)

TOTAL EQUITY & LIABILITIES 7,724 8,601

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9. Appendix 1 - Revenue Resource Limit

The Revenue Resource Limit

(RRL) is the statutory

expenditure limit for the CCG

on revenue expenditure.

The total revenue resource limit

for 2017/18 is £490.3m

(including Running Costs).

The cash funding for the CCG

(Maximum Cash Drawdown) is

based on the RRL (£490.3m),

but also includes funding for

historic deficit adjustment

(£54.5m) and in-year deficits

(£13.9m).

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Month

Notified

Recurrent Non

Recurrent

Total Recurrent Non

Recurrent

£m £m £m £m £m £m £m

Confirmed Baseline Allocations

2016/17 Opening Recurrent Allocation 467.0 467.0 47.8 514.9

2016/17 Recurrent Funding Allocated in Year 0.2 0.2 0.2

Growth

Baseline 2.57% 12.0 12.0 12.0

Final Growth - 5.32% 2.5 2.5

IR Changes 1.1 1.1 1.1

HRG4 Changes 2.1 2.1 2.1

479.3 3.3 482.5 0.0 50.4 0.0 532.9

Running Costs Allocation 0.0 8.4 8.4

Total Allocations 479.3 3.3 482.5 8.4 50.4 0.0 541.3

Additional/Anticipated Allocations

Brought Forward Deficit (54.5) (54.5) (54.5)

Surplus/Deficit Carry Forward - 1617 Final Outturn M03 0.1 0.1 0.1

Featal Medicine Transfer M03 0.2 0.2 0.2

Epsom and St Helier transfer Cykotene budget M03 0.0 0.0 0.0

Liaison and Diversion/CYP Co-commissioning M03 0.1 0.1 0.1

Paramedic Rebanding Additional Funding 2017-18 M03 0.3 0.3 0.3

Acute hospital urgent & emergency liaison mental

health services M03 0.1 0.1 0.1

Market rents adjustment M03 0.4 0.4 0.4

Transfer NHCN - CCG funding from programme to

running costs M03 0.0 0.0 0.0

Acute hospital urgent and emergency liaison

mental health services M04 0.1 0.1 0.1

Additional Month 5 IR Changes M05 0.0 0.0 0.0

HLP Contribution M07 (0.5) (0.5) (0.5)

Revised London Levies M07 (0.2) (0.2) (0.2)



Charge Exempt Overseas Visitor (CEOV)

Adjustment M08 1.1 1.1 1.1

Additional Mth09 IR Changes M09 0.0 0.0 0.0



CYP IAPT Trainee staff support costs M11 0.0 0.0 0.0

SWL Capital Amendments M12 0.0 0.0 0.0

Primary Care Additional/Anticipated Allocations

GPFV Reception and clerical training M03 0.0 0.0 0.0

NHS WiFi M03 0.0 0.2 0.2

HSCN - GP funding & CCG funding M03 0.0 0.1 0.1

Training Care Navigators and Medical Assistants M03 0.0 0.1 0.1

Transfer NHCN - CCG funding from programme to

running costs M03 0.0 (0.0) (0.0)

General Practice Extended Access 17/18 M05 0.0 1.0 1.0

Primary Care - 2016/17 -Write back M12 0.0 0.3 0.3

2017/18 Q2-4 claim for reimbursement of eligible

scheme costs M12 0.0 0.0 0.0

Total Additional/Anticipated Allocations 0.3 (52.9) (52.6) 0.0 0.0 1.7 (51.0)

Total Allocations 479.5 (49.6) 429.9 8.4 50.4 1.7 490.3

Programme Allocation Running

Cost

Allocation

Total

Allocation

Primary Care Medical

Allocation

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GOVERNING BODY 1 May 2018

Title of Paper: 2017/18 QIPP PROGRAMME – MONTH 12 (March) REPORT

Lead Director Mike Sexton, Chief Finance Officer

Report Author Kate Archer, Head of PMO


QIPP Operational Board (QOB) – 23 April 2018 Finance Committee – 24 April 2018 Senior Management Team – 24 April 2018


Clinical Leaders Group – 2 May 2018 Quality Committee – 21 May 2018

Purpose of Report For information and noting

Recommendation:

The Governing Body is asked to note the following:

▪ The significant improvement during 2017/18 in quality and productivity of services

through prevention, and service innovation and transformation.

▪ The full delivery in 20-17/18 of the consequent financial efficiency benefits £21.2m.

▪ The £26.4m schedule of schemes for 2018/19, of which £1.7m is still to be identified.

Background:

The QIPP programme is a range of initiatives to deliver quality and outcome benefits to patients, and consequential financial benefits, through Quality improvement of services, Innovation in delivering healthcare, Productivity improvement, and Prevention of disease and illness. The clinically-led QIPP programme is expected to improve care for patients by reducing the need for high-cost hospital care. The 17/18 QIPP programme has been built around six primary programmes that collectively identify a total of £21.2m:

1. Out of Hospital transformation 2. Planned Care transformation 3. Mental Health transformation 4. Complex Funding transformation 5. Medicines Management transformation 6. Stand Alone projects

Key Issues:

• Significant improvement in the quality of care for patients.

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Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve sustainable financial balance by 2020/21.

Risks

The programme has been completed for 2017/18. The lessons learned for the next year’s schemes are noted.

Financial Implications

Delivery of our QIPP target is a vital contribution to achieving the agreed deficit.

Conflicts of Interest

No specific conflicts of interest.

Clinical Leadership Comments The CCG Medical Director chairs the QIPP Operational Board (QOB) alongside the Chief Finance Officer as Business co-chair. The CCG Chair attends most QOBs. Each QIPP scheme has an identified GP Lead.

Implications for Other CCGs

The CCG is fully engaged with the South West London (SWL) STP process. The PMOs across SWL meet regularly to share ideas and align approaches.

Equality Analysis

All projects are conducting Equality Impact Assessments as they move through the development lifecycle.

Patient and Public Involvement

Patients are included at programme board level, supporting the developments of QIPP schemes both currently and for the future.

Communication Plan Each project manager develops their own bespoke Communication and Engagement plan as part of project planning.


Monitoring of some schemes is impaired by the inability to access patient level data.

Reputational Issues

QIPP programme delivery is critical in addressing CCG authorisation conditions and directions.

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2017/18 QIPP – MONTH 12 (March) REPORT

1 EXECUTIVE SUMMARY

Context

1.1 The QIPP programme is a range of initiatives to deliver quality and outcome benefits to patients, and consequential financial benefits, through Quality improvement of services, Innovation in delivering healthcare, Productivity improvement, and Prevention of disease and illness. The clinically-led QIPP programme is expected to improve care for patients by reducing the need for high-cost hospital care.

1.2 The 17/18 QIPP programme has been built around six primary programmes that collectively identify a total of £21.2m:

• Out of Hospital transformation

• Planned Care transformation

• Mental Health transformation

• Complex Funding transformation

• Medicines Management transformation

• Stand Alone projects Summary of Quality Improvements

The following are brief highlight of how the clinically change programmes have delivered quality benefits:

1.3 The Out of Hospital programme has successfully implemented frequent MDT huddles in

every practice in Croydon to manage complex patients closer to home. The rapid integration through the LIFE project and roll out of discharge to assess has resulted in the 600+ patients referred to this team spending less time in an acute bed than they would have previously.

1.4 The AMH OBD project continues to reduce activity from 2,500 OBDs in Apr-17 within the Mental Health programme steadily decreasing to 1,710 in Feb-18. The average length-of-stay in beds has reduced from an average of 83 in Apr-17 to 33 in Jan-18. This initiative has helped to ensure that patients do not stay in hospital longer than they need to while supporting them to be successfully discharged with reduced delay.

1.5 The Medicines Optimisation programme provided extended information and support on the provision of information for patients and GP’s around Vitamin D, Gluten Free products and Infant Milk. This is to ensure that medication is used correctly for the right people at the right time. This is further supported by Practice Support Pharmacists working closely alongside GP’s.

1.6 The Planned Care Transformation programme has seen significant quality improvements within the MSK Pilot scheme. Particularly with regards to reduced outpatient demand in secondary care, support for GPs / AHPs via huddles to manage complex patients’ care which has resulted in improved patient management. The latest evidence-base (Escape Pain) has aided support care delivery (increased innovation). This is supported by detailed KPI data.

1.7 The 16/17 Planned Care programme also saw significant quality improvements within the ECI project. There was a 50% reduction in knee arthroscopy activity and a significant reduction in knee replacement procedures.

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Consequent Financial Benefits

1.8 To meet the financial deficit control total of £6.9m, the CCG has required to deliver £29.3m of efficiency saving through its QIPP programme. In response to this, six detailed programmes of work were developed totaling £21.2m, with £8.1m unidentified.

1.9 During M7 there was an external review of the CCG’s financial position. Following the review, NHSE recognised that the £8.1m unidentified QIPP would not be resolved in 2017/18 and therefore the QIPP forecast was reduced to £21m

1.10 The report covers M12 forecast outturn position; utilising the knowledge of savings made in months 1-11 and, with a strong pattern of project performance emerging, high confidence to predict an accurate M12 position.

1.11 The outturn is reported as £21.2m, 100% in line with the £21.2m plan.

1.12 A formal lessons learned exercise and project closure will commence imminently.

Lessons Learned

There are number of key issues arising from the 17/18 programmes that will be taken as key lessons for 18/19. These inlcude the following:

1.13 Stability of Project Delivery Teams

Staff turnover has been an historic issue for Croydon CCG which has hindered the success and continuity of some projects. The PMO team have therefore lead an extensive substantive recruitment campaign in order to improve recruitment and retention. A number of interviews have been arranged to fill various roles within the organisation. The PMO team will also be heavily involved in internal handovers to retain project continuity going forward.

1.14 Clinical Leadership Engagement

The depth of clinical leadership and availability of clinical leads remains an on-going challenge given the breath of transformation that the CCG is driving forward with. A review of the clinical lead process is currrently being underway and a full stock-take of gaps in clinical leadership is being identified by PMO for 18/19 projects.

1.15 Early Warning Signs of Slippage

The requirement to identify and act on early warning indicators will be embedded in all projects. The PMO team will conduct periodic health checks with programme leads for 18/19 to establish realistic progress made against plans. This will result in ealier intervention within the development of the programmes and will also give programme leads an opporunity to inititate alternative plans in order to meet their QIPP target.

1.16 Programme Success – Lessons to Learn!

Whilst a wider review will be undertaken, the Medicines Optimisation team have again signficantly overperformed their QIPP target. This was aided by sound planning and engagement, well established relationships with GP’s as result of having a stable team and retaining organisational memory when there have been changes and persistent and adpative approach to delivering better outcomes for patients. The CCG will consider how the approach of the team can be extended in programmes areas that need to improve delivery.

2 PROGRAMME REPORTING

Data gathering

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Reporting for QIPP relies on a number of data sources. The status of each relevant for M12 reporting

is as follows:

• SUS data provided by CSU was made available on time. This provides accurate figures for M11 and project managers estimate M12.

• Prescribing: data is provided on a two month delay and, therefore, month 12 figures are not yet available. Month 10 has now been confirmed and other figures reported are based on forecast.

NHS England (NHSE) submission

The following graph illustrates the current status of the programme, presenting the actual cumulative savings as reported to NHS England from M6 to present day against the original plan.

Graph 1 – Actual savings/forecast per month against original plan

3 PROGRAMME PERFORMANCE

Month 12

The following table illustrates the position of each programme, and the entire QIPP portfolio, as reported at the end of M12. Graph 2 illustrates the same.

Table 1- Programme summary at month 12

Programme Planned cumulative M12 savings (£m)

Actual cumulative M12 savings (£m)

Variance (£m)

Variance (%)

Planned Care transformation 4.3 0.7 (3.59) -83%

Planned Care 16/17 FYE 2.9 3.6 0.65 22%

Out of Hospital 3.9 3.3 (0.57) -15%

Mental Health 4.2 3.9 (0.31) -7%

Medicines Optimisation 1.7 2.6 0.87 51%

Complex Funding 3.8 4.7 0.81 21%

Stand alone 0.3 2.5 2.12 Total 21.2 21.2 0.0

Graph 2 - Programme summary at month 12

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Although the overall the savings target was met, some programmes underperformed and were offset by contributions from other areas. Of most significance was the Planned Care transformation programme, forecast to contribute £4.3m towards the target but due to substantial delays in implementation only delivered £700k which was largely attributable to previous years’ work continuing to impact outpatient attendances.

As a whole the Mental Health programme underperformed against plan (by 7% or £310k) largely due to responsible commissioner reclaims being less than the original opportunity. Overall the Out of Hospital programme underperformed by £570k (15%) largely due to minor delays in implementation of the Out of Hospital plan.

Other programmes worked hard to mitigate against the above forecast underachievement, which resulted in the following success:

• Medicines Optimisation QIPP projects collectively overperforming (by 51%) due to a lower than forecast spend of budget, saving an additional £870k;

• The Complex Funding programme overperforming (by £810k, equal to 21% of plan) due to additional Learning Disabilities savings;

• Planned Care 16/17 projects performed largely to plan however an unexpected saving in pathology contributed to an overperformance of 22% (£650k);

• Additional projects proposed under the Stand Alone programme which led to overperformance (by over 600%) due to unexpected contract penalty gains (£1.4m) and overseas visitors reclaims (£1.1m).

Annex 1 provides a list of all projects by programme, their original plan and their final outturn.

4 18/19 PLANNING

Progress

The target of £26.4m has been set for Croydon, of which to date £24.6m has been identified, leaving a further £1.7m to find. Further scoping is currently a priority with a numer of pipeline projects under investigation.

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A full breakdown of the proposed projects identified to date can be found in Annex 2.

5 PROGRAMME UPDATES

Below is a short overview of each programme’s progress in the last month.

Formal closure reports incorporating lessons learnt for every project are underway. A summary of these will be shared with next month’s report.

Programme Update

Planned Care -Transformation

The Planned Care Transformation delivered a PPI Forum with Healthwatch on 13th Feb to allow residents and patients to engage with clinical and commissioning leads on Diabetes, MSK, Dermatology, ENT and Gynaecology. The colorectal and gastroenterological triage and assessment pathway is due to start in April 2018. This will ensure that patients are directed to the appropriate settings of care. Reducing the need for unnecessary invasive procedures such as colonoscopies and endoscopies. The neurology service at CHS has, after a focused advertising campaign, been successful in recruiting an epilepsy community nurse (this can often be a challenging post to fill). There will be therefore no gap in the epilepsy service.

Planned Care – 16/17 FYE Projects

There has been a significant reduction in knee replacement procedures in m11 however this could be due annual leave. There has been a significant reduction in knee arthroscopy activity aligned to Briggs review. There has been an in month improvement on heart failure QIPP which has meant that the QIPP has almost been met this month. The heart failure day centre has not been developed by CHS this year hence activity changes have not reduced. There has been the consistent reduction in non-elective angiograms by 20% as a result of the Chest Pain of Recent Onset pathway implementation. There has been a marked reduction of 30 day emergency admissions as a result of the QIPP.

Out Of Hospital Transformation

The Out of Hospital Programme is expected to deliver the financial and quality benefits outlined in the Out of Hospital business case.

Contracts have been signed with CHS to continue OOH QIPP in 2018/19, with ambitious plans to expand the success of year 1 in 17/18. The return on investment (ROI) has been completed with 12 key recommendations developed for optimising out of hospital phase 1 initiatives in 2018/18. An action plan is being developed to implement all recommendations, which will be finalised in early May. All practices have now commenced their weekly/fortnightly huddles to provide enhanced MDT support to patients at high risk of an admissions. The OOH team is doing a network by network review of huddles to agree improvement processes with GPs. To date nearly 2,500 cases have been reviewed across the 420 huddles that have taken place.

In the 28 week period from Sept 23rd 2017 to 5th April 2018 there were 646 referrals to LIFE D2A. Although there was reduced numbers in February the overall average remains 30 weekly referrals. 64% of patients seen from Sept 23 - 5 April were aged 80 or over, while 5% were under 60. Patient experience of the LIFE team continues to be generally positive. Re-admissions in the six

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weeks post discharge continue to be low, however this is being reviewed. Work is now being done as part of the recommendations to steer the LIFE team back towards admission avoidance work and not solely focusing on D2A.

Business cases are being drafted to make the case for further out of hospital transformation in 2018/19 and beyond, with falls, end of life and care homes transformation being the next programmes to move into implementation.

Urgent Care Croydon CCG’s integrated Urgent care programme is designed to reduce the number of inappropriate ED presentations through streaming and redirecting patients away from A&E to alternative pathways.

Croydon Urgent Care Alliance is now embedded in the healthcare system and electronic bookings went live from 111 to GP hubs at the beginning of April. The AEDB priorities continue to focus on meeting with 90% A&E performance target, performance against the type 1 target, the sickest patients is a particular challenge as well as maintaining patient flow within the hospital.

Around 35 people across the health and social care system attended a workshop on the 12th April – the findings of which will inform the 18/19 AEDB plan. Key findings include the need to maintain flow within the acute assessment units within the hospital; the need to strengthen whole system working and end to end pathways across primary and secondary care and continue to re-direct appropriate patients from the ED front away to alternative settings.

Other challenges include improving the performance of the out of hour’s service which is under-performing against response times.

Mental Health Transformation

The Mental Health programme is focused on reducing secondary care activity for service users through improved prevention, rehabilitation, self-care and self-management in the Community. In Q4 17/18, additional funding has been secured from NHS England to enhance the Croydon IAPT service to enable more people to access the service, improve recovery rates and to reduce waiting times. The service has achieved the 1.4% access target in March 2018 and consistently achieve the 6 week and 18 week waiting time targets. The Inpatient task & finish group for the Adult Mental Health & Older Adult Occupied Bed Day projects continues to meet toward reducing the length of stay for inpatients in secondary care, which is done by addressing any potential barriers to discharge and through improved discharge planning, which is achieved through the multiagency membership of the group. The CCG agreed a revised contract position where inefficiencies were identified, which resulted in improved quality of service for reduced funds. This was achieved by adjusting the block contract value and introducing improved quality and safeguarding reporting. This has been followed by the re-procurement of the step-down forensic service of 12 male beds, currently provided at Evergreen which will continue into 2018/19.

Medicines Optimisation

The team continue to monitor and track practices performance against workplan targets and where necessary offer advice and support to practices in mopping up where they may be falling short of year end requirements.

In the last month the team have been involved with developing the 2018/19 workplan priorities and Prescribing Incentive Scheme (PIS). Examples of priorities that focus of evidenced based clinical effectiveness and patient safety are:

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• Promoting the prescribing of branded opioid patches, in line with MHRA alerts to avoid dispensing errors.

• Promoting the prescribing of branded insulin preparations to minimise the risks of patients receiving the wrong preparations

• Including an audit of patients on DOACs within the 18/19 PIS, as a drive to reducing the % of reported medicines related incidences that are attributed to this category of drugs.

The workplan priorities for 18/19 and PIS was approved at the primary Care Prescribing Group Meeting on the 29 March 2018.

Complex Funding Learning Disabilities

The project remains on track to reach a resolution. There were 5 disputed cases identified by Croydon CCG to pursue which have been escalated to Director of Commissioning and Chief Finance Officer.

• x2 cases have reached an impasse between the disputing CCGs

• x 1 clarity reached with West Kent CCG

• x1 Canterbury & Coastal CCG have provided their written response in Arbitration format on 6 April 2018. The aim is for both CCGs to review their final response before submission to NHSE for week ending 15 April 2018.

No treatment should be refused or delayed due to uncurtaining or ambiguity as to which CCG is responsible for funding an individual’s healthcare provision. As such, Croydon CCG is continuing to pay for the health costs (unless patient is no longer eligible for CHC) until the dispute is resolved.

CHC, Mental Health and LD will ensure further checks are completed before agreeing to fund care i.e., check if it was a local authority placement, if placed out of borough ensure Croydon CCG has a copy of assessments completed by previous CCG prior to transferring to Croydon. Work continues in 18/19 to resolve the remaining cases.

Continuing Healthcare

Progress on CHC processes are slow to develop due to the need to continue running business as usual whilst developing long lasting and quality strategies that will deliver the quality improvement expected, and the amount of change and redesign that is required.

Work is on-going to identify where savings will be expected in 18/19 and PMO support has been secured to help quantify this. There is a small cohort of backlog reviews still required to be undertaken.

The team are challenging decisions made previously and to date 19 clients have had decisions overturned with an approximate saving of £750,000 whole year saving. This work will continue into 2018-19 and a review of high costs packages is still to be considered.

Personal Health Budgets

In the last two weeks the project team have engaged with several alternative providers and a provider has now been recommended. Impact assessments are due to be completed and signed off by 19 April and work continues to achieve the new QIPP for 18/19.

PHB enables services that aren’t traditionally available from the NHS to be considered and in some cases have proven to significantly improve patient’s

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health and wellbeing. The project team will consider increased promotion of PHB through patient case studies throughout Croydon once a suitable provider has been appointed. It is important to note that although we are not fully established with our PHBs, it has been received with positive feedback from a number of clients has already been submitted.

6 QUALITY

Historically the monthly QIPP report has included an additional appendix that provides a highlight for one scheme each month on the quality benefits and how it will impact patients.

In 2017/18 this has focused on programme areas, all of which have reported once in this cycle. The 2018/19 cycle will align with Governing Body and Quality Committee meetings.

Annex 1 – Full list of QIPP programme 17/18 – plan versus outturn Annex 2 – List of 18/19 QIPP projects as at 15.04.2018 Annex 1 - Full list of QIPP programme 17/18 – plan versus outturn

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Annex 2 – List of 18/19 QIPP projects as at 15.04.2018

Project Programme SRO

Planned cumulative

M12 savings (£m)

Actual cumulative M12

savings (£m)

Variance

from plan

Elective STP Planned Care transformation Stephen Warren 2.58 0.00 r

Outpatients STP Planned Care transformation Stephen Warren 1.87 0.00

Outpatients STP - Run Rate (e-referral) Planned Care transformation Stephen Warren 0.00 0.71

STP Reinvestment Planned Care transformation Stephen Warren 1.50 0.00

Elective STP Run Rate from prior yr demand mngt Planned Care transformation n/a -1.65 0.00

Cardiology Planned Care 16/17 FYE Stephen Warren 0.51 0.29

Cardiology - investment Planned Care 16/17 FYE Stephen Warren -0.15 -0.02

Choosing Wisely Planned Care 16/17 FYE Stephen Warren 1.14 1.05

Choosing Wisely - Investment Planned Care 16/17 FYE Stephen Warren -0.25 -0.15

CReSS Planned Care 16/17 FYE Stephen Warren 0.50 0.50

Diabetes - Bromley CIC Planned Care 16/17 FYE Stephen Warren 0.50 0.50

Diagnostics Planned Care 16/17 FYE Stephen Warren 0.09 0.88

IVF Planned Care 16/17 FYE Stephen Warren 0.35 0.34

NETA (planned care) Planned Care 16/17 FYE n/a -0.30 -0.17

Neurology Planned Care 16/17 FYE Stephen Warren 0.13 0.08

Neurology - investment Planned Care 16/17 FYE Stephen Warren -0.13 -0.13

Respiratory Planned Care 16/17 FYE Stephen Warren 0.35 0.21

Respiratory - COPD contract Planned Care 16/17 FYE Stephen Warren 0.15 0.00

Respiratory - investment Planned Care 16/17 FYE Stephen Warren -0.07 0.00

Urology Planned Care 16/17 FYE Stephen Warren 0.07 0.16

Emergency STP (OOH) Out of Hospital Martin Ellis 2.35 1.10

TACS Run Rate Benefit from Prior Year Out of Hospital n/a 0.00 0.80

Urgent Care Out of Hospital Stephen Warren 0.95 0.84

Urgent Care Reprocurement Out of Hospital Stephen Warren 0.59 0.59

Evergreen Mental Health Stephen Warren 0.25 0.25

IAPT Mental Health Stephen Warren 0.30 0.30

SLaM AMH OBDs Mental Health Marlon Brown 1.40 1.60

SLaM MH Bridge Mental Health Stephen Warren 0.75 0.75

SLaM MHOA OBDs Mental Health Stephen Warren 0.25 0.25

SLaM Responsible Commissioner Mental Health Stephen Warren 0.60 0.27

SLaM Specialist Mental Health Marlon Brown 0.44 0.24

Voluntary Sector (Existing) Mental Health Stephen Warren 0.08 0.08

Voluntary Sector (New) Mental Health Stephen Warren 0.15 0.17

Prescribing - BAU Medicines Optimisation Martin Ellis 1.20 2.07

Prescribing - Decommissioning Medicines Optimisation Martin Ellis 0.49 0.49

Continuing Care services Complex Funding Elaine Clancy 2.51 2.51

LD - Responsible Commissioner (existing) Complex Funding Stephen Warren 0.83 0.83

LD - Responsible Commissioner (new) Complex Funding Stephen Warren 0.47 1.25

LD - Responsible Commissioner (new) Complex Funding Stephen Warren -0.06 0.00

Personal Health Budgets Complex Funding Elaine Clancy 0.09 0.07

Oversees visitors Stand alone Mike Sexton 0.00 1.10

Paediatric Pathway Redesign Stand alone Stephen Warren 0.16 0.00

Paediatric Pathway Redesign - Staff Investment Stand alone Stephen Warren -0.06 -0.06

SALT Stand alone Stephen Warren 0.04 0.04

Wheelchairs Stand alone Martin Ellis 0.20 0.00

Contract penalties Stand alone Mike Sexton 0.00 1.38

Total: 21.16 21.16

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Programme Area Project Gross saving Investment Net saving

Planned Care Advice and Guidance £60,060 -£6,574 £53,486

Planned Care Cardiology £2,235,890 -£1,634,000 £601,890

Planned Care Dermatology £431,653 -£188,365 £243,288

Planned Care Digestive diseases £578,454 -£275,753 £302,701

Planned Care ECIs £934,572 -£189,000 £745,572

Planned Care ENT £475,669 -£322,338 £153,331

Planned Care Gynaecology £652,628 -£248,271 £404,357

Planned Care Introduction to Avastin £208,397 £0 £208,397

Planned Care IVF £429,000 £0 £429,000

Planned Care Moorfield Packages £100,000 £0 £100,000

Planned Care MSK £1,324,583 -£897,000 £427,583

Planned Care Neurology £229,677 -£88,000 £141,677

Planned Care Opthamology £300,000 £0 £300,000

Planned Care Respiratory £1,066,180 -£755,000 £311,180

Planned Care Virtual Fracture Clinic £215,000 £0 £215,000

Planned Care Programme Delivery (Change Mngt) £0 -£187,072 -£187,072

Out Of Hospital- Phase1 OOH -End of Life £118,612 £0 £118,612

Out Of Hospital- Phase1 OOH -ICNs £3,699,138 -£1,985,227 £1,713,911

Out Of Hospital- Phase1 OOH -Intermediate Care £31,970 -£104,000 -£72,030

Out Of Hospital- Phase1 OOH -LIFE £3,047,146 -£360,117 £2,687,029

Out Of Hospital- Phase1 OOH -Mental Health £110,154 £0 £110,154

Out Of Hospital- Phase1 OOH - Drugs & Alcocol £799,000 £0 £799,000

Out Of Hospital- Phase 2 OOH - Care Homes £300,000 £0 £300,000

Out Of Hospital- Phase 2 OOH - Care Homes Airedale £200,000 £0 £200,000

Out Of Hospital- Phase 2 OOH - End of Life coordination centre £300,000 £0 £300,000

Out Of Hospital- Phase 2 OOH - End of Life phase 2 £200,250 £0 £200,250

Out Of Hospital- Phase 2 OOH - Falls phase 2 £200,000 £0 £200,000

Out Of Hospital- Phase 2 OOH - ICS continence £100,000 £0 £100,000

Out Of Hospital- Phase 2 OOH - ICS wheelchairs/contracts £100,000 £0 £100,000

Out Of Hospital- Phase 2 OOH - LIFE expansion into Kings/St Georges £300,000 £0 £300,000

Urgent Care CUCA £1,000,000 -£600,000 £400,000

Medicines Optimisation 17/18 Focused Projects FYE £240,000 £0 £240,000

Medicines Optimisation 18/19 BAU Workplan Activities £1,102,614 £0 £1,102,614

Medicines Optimisation Biologics £78,946 £0 £78,946

Medicines Optimisation Category M Drugs £660,000 £0 £660,000

Medicines Optimisation Focused Prescribing Projects -ONS £56,000 £0 £56,000

Medicines Optimisation Medicine Rebate Scheme £100,000 £0 £100,000

Medicines Optimisation Medicine Waste in Care Homes £225,129 £0 £225,129

Medicines Optimisation Pharmoutcomes £100,000 £0 £100,000

Medicines Optimisation SWL MO Plan £639,527 £0 £639,527

Mental Health Community Forensic Beds £1,100,000 £0 £1,100,000

Mental Health Mental Health OBDs £2,333,000 £0 £2,333,000

Mental Health Mental Health Placements £500,000 £0 £500,000

Mental Health NCAs £500,000 £0 £500,000

Mental Health Voluntary Sector £114,000 £0 £114,000

Mental Health Core 24 - Acute MH Admissions £515,471 £0 £515,471

Named Patients Continuing Health Care £3,000,000 £0 £3,000,000

Named Patients Learning Disabilities £984,000 £0 £984,000

Named Patients Personal Health Budgets £230,000 -£75,000 £155,000

Corporate Local level CSU fee reduction £100,000 £0 £100,000

Corporate SWL level CSU management fee reduction £300,000 £0 £300,000

Indentified £32,626,720 -£7,915,717 £24,711,002

Unidentified £1,727,998 £1,727,998

Grand Total £34,354,717 -£7,915,717 £26,439,000

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1ST May 2018

Title of Paper: CONTRACTING PORTFOLIO REPORT

Lead Director Stephen Warren Director of Commissioning

Report Author Aarti Joshi/Michael Sutton (Commissioning) Josie Wright (Contracting)


SMT Finance Committee


Governing Body

Purpose of Report For discussion and noting

Recommendation:

The Governing Body is asked to: • Note the Contract Portfolio Report and action plans.

Background:

The report provides an overview of the CCGs performance against all the contracts it holds and also gives explanations where actuals are not in line with the plan. The report allows the Governing Body to see the trends and patterns of patient activity across the contracts and gives an understanding for future commissioning decisions. Data is taken from the Acute Trusts monthly reporting through SLAM and their PAS systems. The report updates Governing Body on the actions taken by the CCG to address where performance is not in line with expectations, prioritising the biggest variances.

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Key Issues:

The key issues include: ▪ M11 reporting a CCG forecast outturn position of £3.5m above plan across its acute

portfolio (1.2%).

▪ In-month deterioration of £210k FOT for the CCG, driven largely by CHS.

▪ 2017-18 CHS Year-end Agreement has been finalised

▪ 2018-19 CHS and SLaM Contract Variation has been signed in line with national

timetable; a further contract variation is to follow at the end April with amended

schedules.

Governance:

Corporate Objective To commission integrated, safe, high quality service in the right place at the right time. To have collaborative relationships to ensure an integrated approach

Risks

Risks are detailed in the report.


As described in the report.


N/A

Clinical Leadership Comments N/A


Implications as per associate arrangements

Equality Analysis N/A

Patient and Public Involvement N/A

Communication Plan N/A

Information Governance Issues N/A

Reputational Issues

Over performance at the Trusts may impact upon the CCG’s reputation.

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CONTRACTING PORTFOLIO REPORT 1. Introduction

This report provides an overview of the contract performance for Month 11 2017-18 and details the agreed actions to address issues. Please note that the information in this report is based on finance and contracting analysis undertaken on the data submitted by providers at Month 11. For the Finance Committee this paper is accompanied by the detailed Contracting Finance and Activity Report available to GB members on request. The report provides detail of all the provider’s contract performance, including actions to be undertaken.

2. Overall Position Statement 2017/18

Croydon CCG’s acute portfolio is seeing a total year to date over-performance of £830k in Month 11 and a Forecast Outturn over performance of £3.5m (1.2% overall variance); a £210k deterioration from M10 FOT. The detail by Programme

The Year to date performance and forecast outturn by provider is shown below:

YTD Budget YTD ActualYTD

Variance% Variance FOT Budget FOT Actual

FOT

Variance% Variance

Previous

Month FOT

Variance

Improved/

(Deterior-

ated)

% Variance

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

A&E £20,995 £21,338 (£342) (1.6%) £22,905 £23,386 (£481) (2.1%) (£688) £207 30.0%

CQUIN £5,428 £10,004 (£4,576) (84.3%) £5,922 £10,913 (£4,992) (84.3%) (£655) (£4,337) (662.6%)

Cri tica l Care £9,540 £10,434 (£893) (9.4%) £10,408 £11,377 (£969) (9.3%) (£1,324) £355 26.8%

Direct Access £9,524 £8,539 £985 10.3% £10,390 £9,392 £998 9.6% £972 £26 2.7%

Drugs & Devices £9,681 £9,390 £292 3.0% £10,562 £10,357 £205 1.9% (£156) £360 231.7%

Elective £42,275 £40,699 £1,576 3.7% £46,121 £44,584 £1,537 3.3% £1,191 £346 29.0%

Emergency £68,641 £70,947 (£2,307) (3.4%) £74,882 £77,726 (£2,844) (3.8%) (£2,293) (£551) (24.0%)

Maternity Pathway £27,539 £26,140 £1,399 5.1% £30,044 £28,504 £1,540 5.1% £1,225 £315 25.7%

Non-Elective £6,470 £6,396 £74 1.1% £7,058 £7,002 £57 0.8% £118 (£61) (51.7%)

Other £16,273 £11,621 £4,652 28.6% £17,741 £14,191 £3,550 20.0% £690 £2,860 414.4%

Out Patient 1st £16,975 £16,847 £129 0.8% £18,520 £18,503 £17 0.1% (£42) £59 141.5%

Out Patient Fol low Up £17,542 £18,948 (£1,406) (8.0%) £19,139 £20,730 (£1,592) (8.3%) (£1,691) £99 5.9%

Out Patient Procedure £9,776 £10,566 (£790) (8.1%) £10,665 £11,594 (£929) (8.7%) (£1,033) £104 10.1%

PTS £2,064 £2,126 (£63) (3.0%) £2,251 £2,320 (£68) (3.0%) (£68) (£0) (0.5%)

Unbundled Diagnostics £5,130 £4,690 £441 8.6% £5,597 £5,144 £453 8.1% £444 £9 2.0%

Total £267,854 £268,685 (£830) (0.3%) £292,205 £295,723 (£3,518) (1.2%) (£3,308) (£210) (6.3%)

Mitigated SLAM Month Mitigated Forecast Previous Month Mitigated FOT

YTD

BudgetYTD Actual

YTD

Variance

%

Variance

FOT

BudgetFOT Actual

FOT

Variance

%

Variance

Previous

Month FOT

Variance

Improved/

(Deterior-

ated)

%

Variance

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

STP Trust

Croydon Health Services £157,685 £154,482 £3,204 2.0% £172,020 £170,546 £1,474 0.9% £2,012 (£538) (26.7%)

Epsom and St Hel ier Univers i ty Hospita ls £8,886 £8,349 £537 6.0% £9,694 £9,268 £425 4.4% £387 £38 9.8%

South West London Elective Orthopaedic Centre £4,818 £4,165 £653 13.5% £5,256 £4,583 £673 12.8% £663 £10 1.5%

Kingston Hospita l £307 £372 (£64) (20.9%) £335 £427 (£91) (27.2%) (£91) £0 0.0%

The Royal Marsden £3,755 £4,276 (£522) (13.9%) £4,096 £4,677 (£581) (14.2%) (£610) £29 4.8%

St George's Healthcare £22,987 £24,012 (£1,025) (4.5%) £25,077 £26,200 (£1,122) (4.5%) (£873) (£249) (28.5%)

St. George's Community Services At Queen Mary's Hospita l£669 £305 £364 54.4% £730 £340 £391 53.5% £385 £6 1.4%

Total STP £199,108 £195,961 £3,147 1.6% £217,209 £216,041 £1,168 0.5% £1,873 (£704) (37.6%)

Non-STP Trusts

Over 5m

King's Col lege Hospita l £17,327 £19,109 (£1,783) (10.3%) £18,902 £20,929 (£2,027) (10.7%) (£2,017) (£9) (0.5%)

Moorfields Eye Hospita l £9,667 £10,121 (£454) (4.7%) £10,546 £11,106 (£560) (5.3%) (£574) £14 2.5%

Guy's and St Thomas ' £7,160 £7,558 (£398) (5.6%) £7,811 £8,262 (£451) (5.8%) (£645) £194 30.1%

Surrey and Sussex Healthcare £4,877 £5,287 (£410) (8.4%) £5,320 £5,918 (£598) (11.2%) (£521) (£77) (14.8%)

London Ambulance £13,368 £13,368 £0 0.0% £14,583 £14,583 £0 0.0% £0 £0 0.0%

Under 5m

One l ine - a l l consol idated £6,679 £7,063 (£384) (5.8%) £7,286 £7,729 (£443) (6.1%) (£659) £216 32.8%

non-NHS

One l ine - a l l consol idated £9,670 £10,218 (£548) (5.7%) £10,549 £11,157 (£608) (5.8%) (£765) £157 20.5%

Total Croydon CCG acute £267,854 £268,685 (£830) (0.3%) £292,205 £295,723 (£3,518) (1.2%) (£3,308) (£210) (6.3%)

Mitigated SLAM Month Mitigated Forecast Previous Month Mitigated FOT

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2.1 In month areas of note: Key areas of variance include: • YTD under-performance of £3.2m at CHS • YTD over-performance of £1.02m at St Georges • YTD over-performance of £1.78m at Kings • YTD over-performance of £454k at Moorfields • A combined YTD over-performance of £1.15m at BMI & Ramsey Independent Providers • YTD over-performance of £522k at Royal Marsden

• CHS forecast is reporting an under-performance of £1.474m for Croydon CCG, a deteriorated

position from M10 of £538k for CHS.

• St. Georges has deteriorated in their forecast position by £249k to give a forecast outturn

variance of £1.12m. An IR (Identification Rules) position has now been agreed with NHSE and

commissioners will expect to see an income benefit of £345k.

2.2 Forecast Outturn areas of note: • Despite a favourable in month position, Kings forecast remains £2.027m above plan. The over-

performance continues to be driven by Emergency (specifically Stroke and Sepsis), Electives and Critical Care. Following the NHSE decision regarding the Identification Rules (IR), Croydon CCG have been asked to accrue for £200k income.

• Moorfields FOT position has improved to £560k in Month 11 from £574k for Croydon CCG, driven by underperformance in AETC.

3. Key Issues

3.1 17/18 Year End Agreement The CCG has agreed a year position with CHS of £199m. CQUIN’s were agreed at 90% and will be paid in quarter 4 in order to maintain and monitor the quality of provision. ESH and Kingston have also agreed a year-end position. 3.2 18/19 Contract Refresh

CHS - The 18-19 contract variation was signed on the 29th March 2018. The agreed contract value is £204m. This includes both the acute and community services. Associate offers are currently being worked up by the Trust with the aim of finalising by 30th April 2018. The QIPP value agreed with CHS includes:

• Planned Care - £1.8m gross with an investment of £700k. A range of schemes including

advice and guidance, virtual follow ups, telephone assessments are being introduced which will

impact specialties such as ENT, Dermatology, Gynaecology and Neurology.

• Phase 1 Out of Hospital - £6.2m gross with a £2.2m investment.

• A&E - £1m has been included for A&E transfer to UCC.

£3.5m of repatriation was agreed in the contact (excluding SWLEOC) this is to be applied at PbR

for the first £2m with a 10% discount applied thereafter.

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An additional contract variation is to be signed by the 30th of April for outstanding schedules including: Indicative Activity Plan; Local CQUIN's; Audit Schedule; Local Prices and Community Schedule. SWL and Out of Sector Acute Contracts - Contracts have been agreed at CHS, Kingston, Royal Marsden, St. Georges, Queen Mary’s, Chelsea and Westminster, Great Ormond Street, Moorfields, UCL, Royal Brompton, Royal Free, RNOH and Bart’s and the London. Contract values are predominately without QIPP currently as this element continues to be negotiated. BMI and other independent sector proposals are being reviewed, by the CCG. SLaM – The 18-19 contract value has been agreed at £44.5m. Additional funding has been built into CCG 2018/19 allocations to support the expansion of services and the specific trajectories set for 2018/19 to deliver the Five Year Forward View for Mental Health (5YFV). Imperial and SASH are waiting to agree contracts with their host commissioner and will not review CCG offers until finalised.

3.3 Outcome of Planned and Urgent Care Commissioning Croup (PUCCG) The PUCCG meeting was held on the 23rd March 2018 to discuss key issues identified year to date. The following issues have been identified and action plan (appendix 1) taken forward: • 17/18 Prescribed Specialised Services (PSS) rules: It has been agreed that there will be no

adjustments made to Croydon CCG’s original IR allocation. Outcomes from NHSE discussions with Georges and Kings are yet to be finalised.

• Outpatient Activity: There has been a reduction in first outpatient attendances and follow-ups.

However, there was a £700k increase in outpatient procedures in 2017/18. PUCCG have agreed that an audit of outpatient procedures will be included in the CHS audit schedule for 2018/19.

• Outpatient Referral Activity: There has been a reduction in referrals in 2017/18 due to the

practice variation visits, peer review roll out and decommissioning of CRESS undertaken during 2016/17 and 2017/18. However, from Month 9 there has been a slight increase in referral activity.

Benchmarking of Croydon Outpatient activity against Rightcare peer group shows that Croydon is one of the best performing CCGs. However, there is variation across specialities. It was agreed that the report will be discussed Clinical Leaders Group in May 2018.

4. Other Key Contracts

4.1 Mental Health – South London & Maudsley Main Contract The key issues are highlighted below.

• OBDs and Crisis Care: Focus will be maintained on reducing OBDs in 18/19 through improved

discharge arrangements. Work has also started to review the community pathways and a

business case is being developed to improve the crisis pathway.

• ASD / ADHD – An additional £150k is being invested into this service in 18/19 to support improved access.

• IAPT – The CCG are investing additional funds to IAPT to enable the service to meet the national target. The service achieved the national run rate 4.2% access at the end of Quarter 4.

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• Memory service – Additional funding of £260k has been agreed for 18/19 to improve the

service to achieve care targets.

• A&E Psych Liaison & Core24 – Recruitment to Core24 posts have been a challenge, with two nursing posts remaining vacant after three recruitment drives. Locums currently fill these posts. Croydon breaches have reduced and are a standing agenda item at the monthly A&E Delivery Board and the A&E Mental Health Steering Group to maintain the focus on this area.

CAMHS - The waiting time continues to improve with no patients waiting over 12 weeks for routine appointments. The CAMHS service will receive additional funding in 18/19 to help further reduce waiting times. This funding has been longed-stopped into the contract, with agreement on value pending finalisation of delivery plans and expected outcomes.

4.2 Integrated Urgent Care Service/ CUCA

A 17/18 year-end financial position has been agreed at £5.8m (£879k below budget), with commitment to retain the total contract value at £6.7m for 18/19 in order to support urgent care QIPP initiatives. However, further negotiation is required to address long-standing differences between the provider and commissioner regarding baseline figures used to develop CUCA’s contracted activity thresholds and the KPI payment process. The table below gives a breakdown of the current CUCA performance at M11:

The table below gives a breakdown of activity YTD M11:

0

10

20

30

40

50

60

Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sept 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb18

Number of breaches in A&E Psych Liaison - due to MH Services

4 - 6 hrs wait 6+ hrs wait

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11

Core Payment 385,598 385,598 385,598 385,598 385,598 385,598 385,598 385,598 385,598 385,598 385,598

Volume Payment 116,529 116,529 116,529 116,529 116,529 116,529 116,529 116,529 116,529 116,529 116,529

Actual Outturn based on actual activity x applicable marginal rates 77,468 83,806 87,510 88,736 85,947 89,958 96,001 95,317 99,177 100,145 96,198

Variance to plan (39,061) (32,723) (29,020) (27,793) (30,582) (26,571) (20,529) (21,212) (17,352) (16,384) (20,331)

Outcomes Payment Plan 55,792 55,792 55,792 55,792 55,792 55,792 55,792 55,792 55,792 55,792 55,792

Actual Outcomes achievement 31,846 31,846 31,846 23,012 24,872 21,154 27,429 27,429 21,852 21,154 21,154

Variance to plan (23,946) (23,946) (23,946) (32,780) (30,920) (34,637) (28,363) (28,363) (33,940) (34,638) (34,638)

Total Plan 557,919 557,919 557,919 557,919 557,919 557,919 557,919 557,919 557,919 557,919 557,919

Total Actual 494,912 501,250 504,954 497,347 496,417 496,711 509,028 508,345 506,627 506,897 502,950

Variance (63,007) (56,669) (52,966) (60,573) (61,502) (61,209) (48,892) (49,575) (51,292) (51,022) (54,969)

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All service areas have seen a decrease in activity for M11 compared to M10. However, the UCC has over performed in advice and basic activity and underperformed for investigations and X-rays. The following issues were discussed and agreed at the CUCA steering group:

• Streaming: KPIs used to support the ability to stream patients away from A&E remain unmet.

It was noted in the recently published CQC report that the CUCA streaming policy was not as

clear as it could be and staff were not aware of how the system worked. The commissioning

lead has agreed to help CUCA to redevelop their streaming policy. A draft policy will be

presented and signed off at CUCAs internal governance board meeting on 24th May 2018 with

the aim to implement the revised CUCA streaming policy in June 2018.

• The Out of Hours (OOH) service: The service will produce an action plan to ensure that

performance improves. The OOH clinical and operational leads will present the action plan at

May’s CUCA CQRG meeting.

• 111 bookable appointments: GP Hubs are now able to receive bookable appointment from

111 since 9th April 2018 for all 3 GP Hubs.

• Roving GP: The Roving GP service is under review. The lead commissioner is drafting a

proposal for how the service can be re-designed, to improve efficiency and outcomes for

patients.

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4.3 Intermediate Contracts

The table below summarises the position on intermediate contracts

• COS –the contract has been extended for 11 months to support the transformational work on

ophthalmology.

• ENT – the contract term has been extended for the remaining 6 months permitted under the

contract until 30th September 2018.

As part of the transformation of ENT services in Croydon, the intermediate providers and the

CCG have agreed the following:

o The urgent ENT service will be repatriated from St George’s to the intermediate provider

from June 2018.

o To transfer hearing patients from the intermediate provider to CHS in July 2018.

• Dermatology – The Communitas contract ended 31st March 2018. The Croydon Collaborative

will provide this service for 6 months from the 1st April 2018 whilst the CCG conducts its

procurement and mobilisation process.

• Gynaecology – The commissioning lead is undertaking a review of activity going to secondary

providers, to understand the reasons for reduced intermediate activity. A new referral form is

going to be introduced to direct GPs to refer to the intermediate service.

• Diabetes – The Diabetes contract has been extended for a further 12 months, from 1st April

2018.

Contract NameYTD Plan (£)

‘000’

YTD Actual

(£) ‘000’

Variance

(over)/under

‘000’

Annual

Plan (£)

‘000’

Forecast

Outturn (£)

‘000’

Variance

FO

(over)/under

‘000’

Communitas

–Dermatology482 418 64 526 462 64

Communitas – ENT

(including triage and

audiology)

337 419 (82) 368 460 (92)

BMI – Gynaecology 393 233 160 429 262 167

COS (including

Paediatric Screening)560 566 (6) 611 628 (17)

Bromley Healthcare -

Diabetes (including

education)

513 498 15 560 544 16

Parkside Group Practice

- Vasectomy 50 56 (6) 54 61 (7)

Boots – Anti-coagulation 336 177 159 367 190 177

CUCA 6,137 5,525 612 6,695 6,037 658

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• Anti-Coagulation – This has been extended for a further 12 months, from the 1st April 2018.

The CCG have negotiated a higher package price with the provider. However, due to the

anticipated activity reduction, the increase in package price has no effect on the overall

contract.

5. Recommendations Note the Contract Portfolio Report and action plans.

6. Conclusion

Croydon CCG’s acute portfolio is seeing a total year to date over-performance of £830k in Month 11 and a Forecast Outturn over performance of £3.5m (1.2%). This is a deteriorated position from M10 of £210k. The CHS and SLaM contracts have been agreed and signed for 2018-19. An additional contract variation is to be signed by the 30th of April for outstanding schedules. The IAPT waiting time target is expected to be achieved from April 2018 onwards and the national run rate was achieved at the end of March. In the meantime, the Planned and Urgent Care Commissioning Group (PUCCG) continues to monitor progress against actions and ensure all steps are taken to manage projected over-performance.

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Appendix 1: PUCCG Action Log from23rd March 2018 Meeting

# Date Raised Area

Issue Action Owner Due by RAG Progress

Status

72 15/01/2018 Viral Pneumonia audit

A Viral Pneumonia audit has identified potential counting and coding issues at Princess Royal University Hospital. CSU, to investigate this further.

CSU to investigate potential counting and coding issue and challenge if appropriate.

Jess Hart 26/04/2018

23.03.2018 To identify miscoded patients and share data with Jess Hart. To discuss issue with KCH associates regarding potential miscoding

79 23/03/2018 ECI Audit Terms of

Reference

ECI audit at CHS is to be conducted to establish the effectiveness of the ECI choosing wisely process and adherence to the clinical threshold.

MS to send Tony Brzezicki draft TORs for review. Tom Chan escalate this to Nnenna Osuji to discuss need for the audit from a clinical perspective.

MS/Tony Brzezicki/Tom Chan

26/04/2018

27.03.18 MS has redrafted and shared ECI TORs with TB. 28.03.18 TB has written to TC to discuss TORs with Nnenna Osuji.

80 23/03/2018 Stroke Deep Dive

It has been identified that the stroke pathway is not being followed aligned to the HASU pathway. Feedback from the Trust has identified that this is due to late diagnosis after admission and an issue with HASU bed provision at St George’s.

Shamaila Masood (Stroke Clinical Lead) to discuss the ongoing stroke issue at Stroke Steering Group. TB to support the stroke steering group to understand issues with HASU pathway and develop action plan to support the pathway.

Amit Chavda/Tony Brzezicki

26/04/2018

18.04.18 AC to organise between SM and TB to agree action plan to be discussed with the stroke steering group.

81 23.03.2018 Outpatients Activity

and Finance Performance

An audit of outpatient procedures for the top 5 specialties at CHS to be included in the audit schedule

The audit is to understand whether this activity can be undertaken by a different provider.

Jess Hart/Josie Wright

26/04/2018

28.03.18 JH to share audit to be added in the contract audit schedule. Audit schedule to be agreed.



Following contract negotiations, the CCG should setup the Demand and Repatriation group

Demand and Repatriation group to be set up Mike Sutton/Aarti

Joshi 26/04/2018

26.03.18 Repatriation meeting between Melissa Morris, AJ and MS was set up but needed to be rescheduled due to contract negotiations. Meeting to be rearranged.



Outpatient Report slides detailing GP practices trend was shared

This is to be amended and shared at CLG Ola Oluyemi/Mike

Sutton 02/05/2018

18.04.18 the report has been updated and shared with AF



Agnelo Fernandes to be informed of the Outpatient Report that would be shared at CLG

An email to be sent by TB to inform him of the current status requesting that he review the data and provide feedback and support where necessary.

Tony Brzezicki 26/04/2018

26.03.18 TB has sent through an email for review to be take forward to AF

85 23.03.2018 Future meetings: May

and June 2018

It was agreed that it will be helpful to work on: Lessons Learnt Elective and Non elective activities How are variations resolved Identify common themes

Work on: Lessons Learned Elective and Non elective activities How are variations resolved Identify common themes

Mike Sutton/Josie Wright

24/05/2018

Work is progressing to timescale

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1 May 2017

Title of Paper: FINANCE COMMITTEE ANNUAL REPORT – REVIEW OF

EFFECTIVENESS AND COMPLIANCE

Lead Director Mike Sexton Chief Finance Officer

Report Author Ben Smith Board Secretary


n/a


CCG Governing Body

Purpose of Report For Agreement

Recommendation:

The Governing Body is asked to: ▪ Note the Annual Report on the Finance Committee ▪ Note the Terms of Reference of the Committee have been reviewed and the

recommendation, subject to Committee review, is that they should be adopted for a further year, subject to consideration of the following changes:

- Subject to Governing Body agreement of a recommendation to have delegated authority from the Governing Body for the approval of procurement decisions - Clarity of section 10 to be explicit that the Finance Committee is authorised as a Governing Body Committee and so will require Governing Body agreement of Terms of Reference revisions. - Reflecting formal titles of Governing Body Members.

Executive Summary:

The Finance Committee is a Committee of the Governing Body and also provides oversight reporting to the Integrated Governance and Audit Committee (IGAC) (in its position of oversight for CCG internal control and governance). It has been established to ensure a robust financial strategy is in place and to oversee the organisation-wide system of financial management, working with IGAC to ensure viability, effectiveness and financial probity within the CCG.

The Committee is required by the Constitution to review its Terms of Reference annually and to update them as required. The Terms of Reference also state that a report of the Committee’s work and achievements should be compiled annually and presented to the Governing Body.

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The Finance Committee has met on 13 separate occasions and fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2018/19 with a minor amendment clarifying the expectation of Accountable Officer attendance.

Key Issues:

The Governing Body is asked to review the content of the Finance Committee Terms of Reference. Attached as appendix e

Governance:

Corporate Objective • To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes

• To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health

• To achieve sustainable financial balance by 2018/19 and NHS business rules of 1% surplus by 2020/21

• To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care

• To have all Croydon GP practices actively involved in commissioning services and develop a responsive and learning commissioning organisation

Risks Failing to make appropriate preparations for such a report would be sub-optimal governance arrangements in respect of the Governing Body having oversight of the activities of the Committee


Conflicts of Interest The terms of reference provide for the handling of conflicts of interest in accordance with the CCG policy. Declarations of interest have been made and managed appropriately during meetings of the Committee. No conflict of interest breaches have been identified in respect of the work of the Committee.



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Information Governance

Issues

Not applicable

Reputational Issues Failure to manage financial issues effectively would attract adverse attention from patients, the public and NHS England.

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TERMS OF REFERNCE REVIEW – REVIEW OF EFFECTIVENESS AND

COMPLIANCE

1. Introduction

The Finance Committee is a Committee of the Governing Body and has been established to ensure a robust financial strategy is in place and to oversee the organisation-wide system of financial management, working with IGAC to ensure viability, effectiveness and financial probity within the CCG. The committee also provides oversight reporting to the Integrated Governance and Audit Committee.

The Committee is chaired by a lay member and draws on members nominated by the Governing Body as well as staff with key governance roles from within the CCG and NELCSU.

2. Membership


Roger Eastwood Lay Member (Chair)

Jon Norman Secondary Care Consultant Agnelo Fernandes (optional) CCG Chair Tom Chan (from July 2017) GP Governing Body Member Yogesh Patel (from July 2016) GP Governing Body Member In attendance Andrew Eyres Accountable Officer (From July 2017) Paula Swann Chief Officer (To June 2017) Mike Sexton Chief Finance Officer Stephen Warren Director of Commissioning Martin Ellis Director of Primary Care (From June 2017)

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During 2017/18 attendance was as follows:

3. Functions

The Committee provides a number of functions which are set out in its Terms of

Reference. The functions are listed below along with an assessment on

whether the function was fulfilled, evidenced by references to the achievement

section

Responsibilities of Finance Committee Fulfilled Evidence

Keep under review strategic and operational financial plans and the current and forecast financial position of the CCG.

4.3.1 4.3.2 4.4.1 4.4.3

Oversee the arrangements in place for the allocation of resources and the scrutiny of all expenditure. This will include actual and forecast expenditure and activity on commissioning contracts.

4.4.1 4.4.3

Consider and review the financial report to be presented to the Governing Body, incorporating financial performance against budget, financial risk analysis, forecasts and robustness of underlying assumptions.

4.4.1

Provide assurance to the Governing Body and the Integrated Governance and Audit Committee of the

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completeness and accuracy of the financial information provided to the Governing Body.

Consider and review any external financial monitoring returns and commentary.

4.1.5

Ensure any financial improvement plan is monitored and reviewed and appropriate actions are taken.

4.3.4 4.3.6

Review by exception performance report summaries and consider performance issues in so far as they impact on financial resource.

4.4.3

Receive a monthly report on the progress of the QIPP plan

4.4.1

Review, scrutinise and recommend business cases to the Governing Body.

4.3.4 4.7.1

Review, scrutinise and recommend procurement decisions as appropriate in accordance with Prime Financial Policies and the Scheme of Delegation and recommend to the Governing Body.

In practice this function has been undertaken by Part 2 of Governing Body

Where appropriate refer issues to other committees of the Governing Body.

By exception

4.4.2

4. Activities

The Committee considered the following during the year 2017/18 and achieved the outcomes as detailed:

4.1 Governance 4.1.1 Agreed and recommended the Terms of Reference reflecting its assurance role. 4.1.2 Agreed schedule for 2017/18 Committee Reports in line with CCG Annual Report

to support Governance Statement 4.1.3 Discussed and reviewed handling of contractual disputes including mediation 4.1.4 Discussed and reviewed the specification and output of the Strategic Review of

the Croydon health system by McKinsey 4.1.5 Discussed and reviewed the External Review by NHS England on 2017/18

Financial Performance 4.2 Funding/Resource Allocation

4.2.1 Provided oversight to CCG activities related to population trajectories and links to

funding (refer 2017/18 Financial Plan and 2018/19 Financial Plan)

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4.2.2 Reviewed planning data regarding historical growth in demand, historical population trends, and forecast trends for the Croydon population (refer to 2017/18 Financial Plan)

4.3 Planning and Strategy

4.3.1 Reviewed and recommended the 2018/19 Financial Plan 4.3.2 Monitored and challenged development of the 2017/18 QIPP initiatives.

Reviewed summary forecast for each scheme. 4.3.3 Reviewed and recommended the Draft Expenditure Reduction Proposals. 4.3.4 Reviewed the draft Financial Recovery Plan 4.3.5 Reviewed the 2018/19 Budget Setting Framework 4.3.6 Reviewed capital requests and the NHSE 2018/19 capital budget submission

(excludes STP and ETTF funding) and the STP 5-year capital budget submission (includes STP and ETTF funding)

4.4 Monitoring

4.4.1 Monitored the CCG Financial Plan by reviewing monthly reports detailing the financial position (Finance Report and QIPP Report)

4.4.2 Referred the Quality Highlight Report to the Quality Committee for review. 4.4.3 Reviewed periodically the contract and Integrated Quality & performance reports

4.5 Review of the Financial Position of Key Providers

4.5.1 Reviewed monthly synopsis of the Finance Reports from Croydon Health Services NHS Trust and South London and the Maudsley NHS Foundation Trust.

4.6 Delegation of Primary Medical Services (PMS)

4.6.1 Reviewed the budget and monthly financial reports for Primary Medical services. 4.6.2 Reviewed the 2018/19 Financial Plan for Primary care Services.

4.7 Development of Outcomes Based Commissioning

4.7.1 Reviewed the One Croydon Alliance Out of Hospital Business Case having discussed the final funding proposal for the out of hospital business case.


5.1 The Finance Committee is obliged to review its Terms of Reference annually to

ensure that they remain fit for purpose. The Committee, through this report has done so and considers that they remain relevant and adequately reflect the functions of the Finance Committee and recommends that their current format be adopted for the year 2018/19.

Andrew Eyres, Accountable Officer replaced Paula Swan, Chief Officer in July 2017. Andrew Eyres’ works two days a week in Croydon and these do not coincide with Finance Committee meeting dates. Neither the Chief Officer nor Accountable Officer attended the Committee in 2017/18. It is acknowledged that the Chief Finance Officer is the Executive Committee lead. The Committee are

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asked to consider changing the Accountable Officer from In Attendance to by invitation.

Report Author: Ben Smith Email address: [email protected]

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Last updated March 2018 CCG Finance Committee

TERMS OF REFERENCE

CROYDON CCG FINANCE COMMITTEE

1. Introduction

The Finance Committee (the Committee) is established by the Governing Body

and provides assurance by reporting to the Governing Body ensuring a robust

financial strategy is in place and to oversee the organisation-wide system of

financial management. It will work with the Integrated Governance and Audit

Committee to ensure viability, effectiveness and financial probity in the CCG.

2. Authority

The Committee is authorised by the Governing Body to pursue any activity within

these Terms of Reference and within the Scheme of Reservation and Delegation,

including (without limiting the generality of the foregoing) to:

a) seek any information it requires from CCG employees, in line with its responsibility under these terms of references and the Scheme of Reservation and Delegation

b) require all CCG employees to co-operate with any reasonable request made by the Committee, in line with its responsibility under these terms of references and the Scheme of Reservation and Delegation

c) review and investigate any matter within its remit and grants freedom of access to the CCG’s records, documentation and employees. The Committee must have due regard for the Information Policies of the CCG,

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regarding personal health information and the CCG’s duty of care to their employees when exercising its authority.

3. Remit and responsibilities of the Committee

The remit and responsibilities of the Committee are to:

a. Keep under review strategic and operational financial plans and the current and forecast financial position of the CCG.

b. Oversee the arrangements in place for the allocation of resources and the scrutiny of all expenditure. This will include actual and forecast expenditure and activity on commissioning contracts.

c. Consider and review the financial report to be presented to the Governing Body, incorporating financial performance against budget, financial risk analysis, forecasts and robustness of underlying assumptions.

d. Provide assurance to the Governing Body and the Integrated Governance and Audit Committee of the completeness and accuracy of the financial information provided to the Governing Body.

e. Consider and review any external financial monitoring returns and commentary.

f. Ensure any financial improvement plan is monitored and reviewed and appropriate actions are taken.

g. Review by exception performance report summaries and consider performance issues in so far as they impact on financial resource.

h. Receive a monthly report on the progress of the QIPP plan

i. Review, scrutinise and recommend business cases to the Governing Body.

j. Review, scrutinise and approve procurement decisions as appropriate in accordance with Prime Financial Policies and the Scheme of Delegation and recommend to the Governing Body.

k. Where appropriate refer issues to other committees of the Governing Body.

4. Membership

The Committee shall be appointed by the Governing Body and will consist of:

Members:

• The Chair who will be a Lay Member

• Secondary Care Clinician

• 2 x GP Governing Body Member In addition to the stated committee members, the CCG Chair has an open invitation to attend the Finance Committee. For quoracy purposes, the CCG Chair shall count as a GP member if they attend.

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In attendance:

• The Accountable Officer (Open invitation)

• The Chief Finance Officer

• Director of Commissioning

• Other directors if required

If the Chair of the Finance Committee (a lay member), is unable to attend, then

the other lay member (the Secondary Care Clinician) can deputise (note para 5

Quorum).

If an officer on the “In attendance” list is unable to attend, then a suitable delegate

with appropriate authority should attend in their place.

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5. Quorum

The meeting will be quorate when 2 members are present, which would include

one lay member (incl. Secondary Care clinician) and one GP member, and with

the Chief Finance Officer (or delegate) in attendance.

6. Reporting Procedures

Formal minutes of meetings shall be recorded and will go to the Governing Body.

7. Declarations of Interest

If any member has an interest, financial or otherwise, in any matter and is present

at the meeting at which the matter is under discussion, he/she will declare that

interest as early as possible and shall not participate in the discussions. The

Chair will have the power to request that member to withdraw until the committee

consideration has been completed. All members will be expected to adhere to

and comply with any relevant policy; including but not exclusive to Conflicts of

Interest and Anti-Bribery.

8. Attendance and Administration

In addition to the standing members of the Committee, any other Governing

Body Member may attend with the agreement of the Chair of the Finance

Committee.

9. Frequency and notice of meetings

Meetings shall be held monthly (except August and December). In exceptional

circumstances additional meetings can be convened. A notice period of at least

14 days shall be given before the Committee meets.

10. Review

These Terms of Reference will be reviewed after six months and on an annual

basis thereafter. Any resulting changes to the terms of reference should be

approved by the Integrated Governance and Audit Committee.

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1 May 2018

Title of Paper: REPORT FROM THE CHAIR OF THE QUALITY COMMITTEE

Lead Director Amy Page, Governing Body Member Chair, Quality Committee

Report Author Elaine Clancy, Director of Quality & Governance Ben Smith, Board Secretary


N/A


CCG Governing Body


Recommendation:

The Governing Body is asked to note: ▪ The Integrated Quality and Performance Report Month 11. ▪ The annual review of the Committee and its Terms of Reference

The Governing Body is asked to agree the following changes to the Terms of Reference for the Quality Committee:

- Amend section 2c and 6 to be explicit that the Quality Committee reports directly to the Governing Body Committee while working with the Integrated Governance & Audit Committee.

Executive Summary:

The Quality Committee is a Committee of the Governing Body but also provides oversight reporting to the Integrated Governance and Audit Committee (in its position of oversight for CCG internal control and governance) and has been established to oversee the application of quality in services commissioned.

The Quality Committee has met on six separate occasions since January 2017 and confirmed that it has fulfilled its obligations in line with the agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2018/2019 subject to minor amendments shown by tracked changes in Appendix A. Key Papers: The papers on the agenda at the March meeting were:

• Update Primary Care CQC quality points following PCCC

• Croydon CCG Strategic And Operational Quality And Safety Risks

• Integrated Performance and Quality report M10.

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• CQC Inspection report – Croydon Healthcare Services NHS Trust

• QIPP Report Quality Annex - Planned Care (omitted from March GB)

• SEND report

• Terms of Reference review - Review of effectiveness/compliance

• SGH Clinical harm Group Update Feb 2018

• PPI report Quarter 3

• CQRG Minutes

• LAC Health Assessment update

• Continuing Healthcare Review The Committee met on 26 March 2018, and discussed these papers. It was agreed that the Committee would receive regular reports from the Joint Impact Assessment Panel (JIAP) to be assured of the quality and equality benefits to the QIPP schemes.

Governance:











Not applicable


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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY IN PUBLIC

1 May 2018

Title of Paper: INTEGRATED PERFORMANCE & QUALITY REPORT – MONTH 11

(February 2018)

Lead Director Amy Page Governing Body Member/Quality Committee Chair Elaine Clancy Director of Quality and Governance

Report Author Andrea Davis Head of Quality Simon Lee Associate Director of Quality and Governance


SMT


Governing Body Clinical Leaders Quality Committee

Purpose of Report For Discussion and Noting

Recommendation:

The Senior Management Team is asked to: ▪ Note and discuss the Integrated Performance & Quality Report, which is reporting

Month 11 – February 2018 data, where available, and the actions being taken to address key concerns at the time of reporting.

Background:

This report forms part of the CCG’s Quality Assurance activities for their main healthcare providers. Content is based largely on validated Month 11 – February 2018 data, however the latest position is included around service quality, patient safety and decisions that have arisen, where available. Integrated Performance and Quality Reports are routinely presented to and scrutinised by Croydon CCG Quality Committee. Quality Committee will highlight areas of concern to Governing Body, as required.

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Key Issues:

Performance 52ww (Incomplete) Croydon CCG had seven patients waiting over 52 weeks in February. Five at King’s; one at CHS and one at Surrey and Sussex Healthcare Trust. Confirmation that patients had been reviewed for harm was sought, with no indication of patients coming to harm as a result of a prolonged wait for treatment. Accident and Emergency In M11, CHS’ 4 hour A&E performance remained below the national standard with 87.11%. The Trust is operating against a revised trajectory, agreed with NHSI and NHSE, to meet 95.0% for March. The All Types position is composed of Type 1 performance of 69.01% and type 3 at 99.9%. Issues affecting the type 1 position remain bed availability, affecting patient flow, and availability of middle-grade emergency clinician and bed capacity. An updated AEDB improvement plan has been drafted. Cancer Waits Croydon CCG met 5 out of 8 cancer wait standards for February. The CCG did not achieve the 62 day first definitive treatment standard, with 9 breaches from 55 pathways. Breaches were largely shared pathways across a number of providers and predominantly due to late referrals. Across SWL providers, a new weekly shared care, Patient Tracking List (PTL) telephone conference has been initiated to give greater oversight to patients whose pathway spans two or more providers. In addition to this, the CCG did not achieve the 31 day subsequent treatment (drug) and 62 day (screening) standards. This was a result of 1 breach in each of the standards, as a result of an administrative error and late referral. IAPT Access IAPT Access remains non-compliant against the local recovery plan and national standard in February. Weekly monitoring continues to track progress of increasing the access rate to achieve the 4.2% target in Q4. This required the use of £300k to recruit 21 additional staff to the Croydon IAPT service and promote the service to GPs, the public and other health professionals with the aim of almost doubling the number of referrals. Following a number of actions, including a leaflet drop to all households in the borough, GP Network Meeting presentations by the CCG and SLaM, face to face engagement events in the Whitgift shopping centre and using social media, referrals for the last two weeks have been at a sufficient rate to achieve this challenging increase. Whilst the forecast for Q4 is circa 3.5% against the 4.2% target, promotion of the service will continue through March to ensure the CCG are in a better position to achieve Q1 2018/19.

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The CCG met with SLaM and the IAPT Intensive Support Team from NHSE on 15/03/18 to review actions agreed in September and identifies any other opportunities for learning. The CCG has invested additional funding in 2018/19 in order to meet the national standard. IAPT Recovery Monthly monitoring shows the CCG remained below the 50% target in February. Recovery will benefit from an investment in the service as evidence shows larger services have better recovery rates. Improvement and Assessment Framework: Clinical Priority Areas NHSE have shared the latest IAF scorecard for CCGs. Key changes of note occurred in Cancer, where Croydon’s one-year survival rates for all cancers increased from 71.1% to 73.4% between 2014 and 2015 (latest published data). Dementia, post diagnostic support – Croydon achieved 79% of people diagnosed within the last 12 months having a face to face review of their care plan. This puts the CCG in the best quartile and ranked 7th nationally, from 207 CCGs.

Quality Croydon Health Services NHS Trust ▪ Croydon CCG continue to monitor the top three categories of Serious Incidents (SIs)

reported by the Trust; Diagnostic incidents including delay (including failure to act on test results), Sub-optimal care of the deteriorating patient) and Medication SIs. The outcomes of a deep dive into medication SIs is currently awaited.

▪ CHS reported 6 SIs in M11, none of which were Never Events.

South London and the Maudsley NHS Trust (SLaM) ▪ SLaM reported 1 SI in M11, under category Apparent/actual/suspected self-inflicted

harm, which is the highest reported category by the Trust.

▪ As part of the 4-Borough CQRG meeting, the Trust have agreed to undertake a Thematic Review of self-harm and attempted suicide SIs, the outcome of which will be presented at the May 4-Borough CQRG meeting.

CQC Visit Updates

▪ Croydon Health Services NHS Trust The Trust has now responded to the factual accuracy checks of the CQQ report published in February 2018 and submitted an action plan to the CQC. Recommendations will be incorporated into the Trusts wider quality improvement plan, which will be monitored by Croydon CCG. The remaining core services are still to be inspected.

▪ SLaM Following concerns received from a group of patients regarding SLaMs Specialist eating disorder services based at The Bethlem Royal Hospital in Beckenham, an unannounced inspection was undertaken by the CQC in February 2018.

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Whilst the report published on 19 April 2018 did not give this ward a rating, inspectors found issues of concern as well as good practice, which are summarised further in this quality report. Action plans submitted by the Trust following the CQC inspection of community-based mental health services continue to be monitored at monthly 4-Borough CQRG meetings and quarterly meetings with the CQC.

▪ The Croydon Urgent Care Alliance (CUCA)

CUCA have been requested to re-submit their CQC action plan to Croydon CCG including timelines, deliverables and evidence of completion of actions taken, as the current format did not provide the required assurances.

Due to a drop in incident reporting, CUCA have been asked to undertake a deep dive of all incident reporting in CUCA services, showing trends for each area in 2017/18. Following poor performance against KPIs and concerns raised by Croydon CCG of the quality impact of the service for patients, CUCA have been asked to produce and present an action plan at the May CQRG meeting.

▪ Primary Care The second Primary Care CQRG took place on 11 April 2018 and whilst GP Practices were not represented at this meeting, NHE England and Public Health colleagues joined the group. Croydon CCG updated local Primary Care Dashboard and NHS England sustainability and efficiency dashboard were shared with the Group and report will be prepared for future meetings which will focus on areas of concern identified from the Dashboards.

Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care.

Risks Risks identified in this paper are considered and included in the Corporate Risk Register as appropriate.

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Clinical Leaders comments where appropriate

None


Any financial implications of improving quality would be reported separately. Performance breaches in A&E, RTT, Cancer Waits and Ambulance Response times will impact adversely on the CCG’s Quality Premium award for 2017/18.

Conflicts of Interest No conflicts of interest have been identified or declared as relevant to decision making processes relating to this report.

Clinical Leadership Comments Not applicable in influencing the content of this report.

Implications for other CCGs

Where the CCG is the host commissioner, it is required to ensure it manages quality and performance of these providers. There is currently no single host commissioner for South London and Maudsley NHS Foundation Trusts; where significant quality risks are identified in this Trust the information will be shared with relevant CCGs.

Equality Analysis

Any action plans developed for those areas of high risk will take into account the needs of all our communities.

Patient and Public Involvement There are no current projects or recommendations resulting from this report that require PPI.

Communication Plan Outputs of this report are communicated at the Clinical Quality Review Group for the relevant providers, and at CCG Governance meetings.

Information Governance Issues Patient confidentiality is maintained.

Reputational Issues

Failure to achieve performance standards, deliver improvements in IAF Clinical Priority Areas, manage quality issues effectively or identification of poor quality could attract adverse attention from patients, the public and NHS England.

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Longer, healthier lives for

all the people in Croydon

Integrated Performance & Quality Report

February (M11) 2017/18

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Operating Plan Exceptions Management

Page 2 of 26

Heading Page

1. Croydon CCG Scorecard – Operating Plan Indicators Page 3

2. Operating Plan Exceptions Management Page 4

3. Improvement and Assessment Framework (IAF) Dashboard Page 13

4. IAF Clinical Priority Areas Page 14

5. Quality Premium Page 17

6. Quality Assurance – Highlights Page 20

7. Serious Incidents Page 21

8. Croydon Health Services (CHS) Patient Experience Page 22

9. South London and Maudsley NHS Foundation Trust (SLaM) Patient Experience Page 23

10. CHS and SLaM Staff Experience Page 24

11. Croydon CCG Quality Alerts Page 25

12. Quality Updates Page 26

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CCG Scorecard - Operating Plan (OP) Indicators

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2017/18

Target Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarRolling 12 Month

Trend

Recent

MovementYTD 2016/17 2015/16

Healthcare Acquired Infection

E.A.S.4 MRSA (PIR Assigned) Monthly 0 0 1 0 0 1 0 0 0 0 2 0 1 ▲ 5 3 3

E.A.S.5 C Difficile Monthly 4 2 4 7 7 9 4 2 8 3 4 3 5 ▲ 56 58 61

Referral To Treatment

E.B.3 RTT 18 weeks (incomplete pathways) Monthly 92.0% 91.5% 91.2% 91.7% 91.9% 92.2% 92.1% 92..2% 92.8% 92.9% 92.7% 92.7% 92.7% ► 92.3% 91.9% 93.6%

E.B.4 Diagnostic tests waiting time Monthly 99.0% 96.2% 94.2% 94.7% 95.9% 97.1% 98.4% 99.7% 99.6% 99.2% 99.3% 99.4% 99.5% ▲ 97.9% 98.0% 94.3%

E.B.S.4 RTT 52 weeks (incomplete pathways) Monthly 0.0% 9 7 7 7 7 4 2 6 3 6 4 7 ▼ 60 68 27

Urgent Care

E.B.5 A and E waiting times (CHS) Monthly 95.0% 86.10% 88.40% 91.20% 90.60% 88.30% 90.10% 90.90% 94.80% 93.00% 89.40% 86.80% 87.11% ▲ 90.00% 89.0% 92.3%

E.B.S.5 Trolley waits over 12 hours (CHS) Monthly 0 0 0 0 0 0 0 0 0 0 0 0 0 ► 0 1 0

E.B.S.6 Urgent operations cancelled for a second time or more (CHS) Monthly 0 0 0 0 0 0 1 0 0 0 0 0 0 ► 1 0 0

E.B.S.7 Ambulance handover within 30 minutes (CHS) Monthly 0 101 80 108 102 120 86 93 53 63 125 186 165 ▼ 1056 950 458

E.B.S.7 Ambulance handover within 60 minutes (CHS) Monthly 0 4 1 2 3 7 3 0 0 0 4 15 17 ▲ 48 46 7

Mixed Sex Accommodation / Cancelled Operations

E.B.S.1 Mixed sex accommodation breaches Monthly 0 0 1 0 1 0 0 0 0 0 1 5 0 ► 9 3 0

E.B.S.2 Cancelled Ops (CHS) Quaterly 0 ► 3.0% 0.4% 1.5%

Cancer Waiting Times

E.B.6 Cancer two weeks (monthly) Monthly 93.0% 98.0% 97.2% 96.4% 95.6% 96.5% 95.0% 94.7% 97.4% 96.8% 95.5% 95.9% 97.3% ▲ 96.1% 96.7% 95.3%

E.B.7 Breast symptoms two weeks (monthly) Monthly 93.0% 97.2% 97.5% 98.1% 100.0% 99.0% 93.8% 98.2% 99.1% 98.2% 99.0% 98.5% 100.0% ▲ 98.3% 97.6% 95.3%

E.B.8 Cancer first definitive treatment 31 days (monthly) Monthly 96.0% 96.3% 96.9% 98.5% 93.9% 99.2% 98.3% 97.5% 98.0% 97.4% 99.2% 96.6% 98.0% ▲ 97.6% 97.7% 98.0%

E.B.9 Cancer subsequent treatment 31 days, surgery (monthly) Monthly 94.0% 92.3% 100.0% 83.3% 100.0% 87.0% 93.3% 100.0% 95.0% 100.0% 93.3% 88.2% 100.0% ▲ 94.4% 96.1% 96.1%

E.B.10 Cancer subsequent treatment 31 days, drug (monthly) Monthly 98.0% 98.2% 100.0% 100.0% 97.9% 100.0% 98.0% 95.9% 100.0% 100.0% 97.6% 100.0% 97.9% ▼ 98.9% 99.0% 99.8%

E.B.11 Cancer subsequent treatment 31 days, radiotherapy (monthly) Monthly 94.0% 97.0% 89.8% 90.3% 100.0% 95.0% 91.4% 97.1% 96.3% 94.4% 91.4% 100.0% 100.0% ▲ 94.3% 96.5% 98.0%

E.B.12 Cancer composite, 62 days first treament plus rare cancers (m) Monthly 85.0% 90.8% 86.8% 81.6% 89.0% 82.6% 84.6% 79.5% 78.7% 90.4% 87.8% 83.7% 83.9% ▲ 84.4% 84.4% 82.4%

E.B.13 Cancer first treatment 62 days, Screening (monthly) Monthly 90.0% 100.0% 100.0% 89.5% 85.7% 80.0% 90.0% 92.3% 77.8% 91.7% 100.0% 86.7% 66.7% ▼ 89.7% 94.9% 92.4%

E.B.14 Cancer first treatment 62 days, Consultant upgrade (monthly) Monthly 85.0% 94.4% 78.6% 86.7% 75.0% 73.3% 89.5% 76.9% 80.0% 100.0% 90.9% 88.2% 58.3% ▼ 85.3% 88.4% 87.1%

Mental Health

E.A.S.1 Dementia Diagnosis Rate Monthly 66.7% 67.4% 66.8% 65.9% 66.7% 66.9% 67.5% 67.0% 67.9% 67.6% 67.7% 67.6% ▼ 69.9% 67.4% 66.5%

E.A.3 IAPT (Access) as a proportion of prevalence Monthly 0.95% 0.6% 0.6% 0.8% 1.0% 0.9% 0.9% 0.7% 1.0% 0.8% 0.7% 1.1% 0.9% 1.5% ▼ 10.80% 11.04% 10.36%

E.A.S.2 IAPT (Recovery) Monthly 50.0% 44.7% 46.8% 39.0% 48.9% 50.0% 53.0% 43.0% 50.7% 43.3% 51.7% 47.2% 39.1% 50.0% ▼ 47.1% 46.5% 46.6%

E.H.1_B1 IAPT 6 week wait - Referral to Treatment Monthly 75.0% 98.00% 98.00% 84.80% 97.00% 92.00% 93.00% 92.00% 94.00% 91.00% 96.00% ▼ 94.00% 95.4% N/A*

E.H.2_B2 IAPT 18 week wait - Referral to Treatment Monthly 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% ► 99.9% 99.9% N/A*

E.B.S.3 Care Programme Approach (CPA) Quarterly 95.0% ▲ 95.7% 97.8% 97.8%

E.H.4 Early Intervention in Psychosis (Max 2 week wait) Monthly 50.0% 50.0% 40.0% 50.0% 53.8% 75.0% 75.0% 45.5% 55.6% 81.8% 100.0% 37.5% 88.0% ▲ 61.0% 65.9% N/A*

Trend Outturn

Indicator Reporting

9.4% 0.0% 0.0%0.0%

95.5% 95.7%97.8% 95.9%

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Indicator / Issue Cause Action Timescale / Assurance

E.A.S.4: MRSA ▪ Croydon CCG had 1 case of

MRSA assigned in Month 11 (February). The case was reported at CHS.

▪ Diagnosed on blood cultures collected at the time of admission to Croydon Healthcare Services

• Post infection review was carried out and the case was allocated to Croydon CCG

▪ Clinical Infection Prevention and Control Lead at the Commissioning Support Unit o Investigates MRSA

bacteraemia requiring a post infection review (PIR);

o Alerts Croydon CCG to any HCAI issues that the CCG should be aware of that come to attention;

• Provides a quarterly HCAI report to Croydon CCG.

E.A.S.5: Clostridium-Difficile ▪ Croydon CCG had 5 cases

of Clostridium-Difficile (C-Diff) infections reported in Month 11 (February).

▪ Three instances were community assigned, with the remaining 2 assigned to the RMH and SGH.

▪ Root cause analysis is undertaken for all hospital acquired cases to see if there are any lapses in care / lessons to be learnt.

▪ Clinical Infection Prevention and Control Lead at the Commissioning Support Unit o Signs off lapses in care for

Clostridium Difficile at Croydon Health Services;

o Alerts Croydon CCG to any HCAI issues that the

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CCG should be aware of that come to attention;

o Provides a quarterly HCAI report to Croydon CCG.

E.B.S.4 RTT 52 Weeks (Incomplete) ▪ Croydon CCG had 7 patients

waiting over 52 weeks in February 2018.

▪ Croydon Health Services and Surrey and Sussex

Healthcare Trust reported 1 breach each, whilst King’s College Hospital reported 5 breaches

Croydon Health Services – Ear Nose & Throat Clock

stop incorrectly applied earlier in pathway. Resulted in patient not being tracked appropriately. The patient was assessed for clinical harm with none found. Patient treated in March.

▪ Surrey and Sussex Healthcare Trust – Neurology. The long wait is due to internal capacity and the patient is currently

▪ Croydon Health Services plans to ensure weekly tracking is conducted of all patients referred to another clinician to ensure they are followed up and monitored.

▪ Croydon Healthcare Services provides RCA reports on all 52 week waiters. These are reviewed at the monthly performance meeting between Croydon CCG and CHS.

▪ Long waiters are also discussed at the CHS CQRG meeting.

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awaiting diagnostic at Tertiary centre.

▪ King’s College Hospital –

Trauma & Orthopaedics x3

2 x capacity issues. Pathways are currently being reviewed. All long waiters offered earlier treatment at Orpington.

1 x patient cancellations/ patient choice. TCI in May at request of patient.

General Surgery Date(s)

x 1 The long wait is due to

capacity issues in Bariatric service which are currently being reviewed by the Trust. TCI in March cancelled for clinical reasons.

Other x 1

Long wait is due to clinician absence and prioritisation of cancer pathways.

▪ King’s College Hospital report 198 patients waiting over 52 weeks in February, up from146 in January 2018. The majority of these occur in admitted pathways across General Surgery and Trauma & Orthopaedics which account for 138 of these. o In light of this the

trajectory and action plans are currently under review.

▪ Full complement of staff, with an additional clinician to clear current backlog

▪ NHS England and NHS Improvement have oversight of King’s College Hospital RTT action plans and recovery trajectories.

▪ NEL CSU will monitor the progress against the trajectory on a monthly basis, on behalf of Croydon CCG

▪ King’s College Hospital has been requested to provide breach reports / root cause analysis reports for review.

E.B.5 A&E 4 hour wait (Croydon Health Services)

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Croydon Healthcare Services did not achieve the 95.0% national standard for February with 87.11%. The local target was 93.5%.

Underperformance against the target was due to Type 1 performance of 69.01% o Type 1 performance was

affected by the following themes: Lack of bed availability

which stifled patient flow and resulted in delays to admission from the ED

Internal Emergency Department delays, some of which was due to the lack of patient flow. Impact on waits for initial assessment, and subsequent late referrals and delayed treatment decisions.

Medical staffing – availability of middle-grade Emergency Medicine clinicians continues to present a challenge.

Croydon Healthcare Services is focused on improving flow, with improved and early discharges the main element of this.

▪ Croydon Health Services are reviewing their internal escalation, ensuring that Out of Hours escalation remains robust and compliments the Operational Pressures Escalation Levels Framework (OPEL framework).

▪ A new ED improvement plan has been developed, through the AEDB, to support improved patients experience and performance.

▪ Increased multi-disciplinary input is being bedded-in for the daily Croydon Health Services conference calls in order to get earlier escalation of pending discharge issues.

▪ Croydon CCG monitors and

performance manages A&E performance as an active member of the Croydon Accident & Emergency Delivery Board

▪ Daily assurance is received via the morning surge call, hosted by NEL CSU.

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St. George's Hospital A&E All Types performance was 83.52% in February.

▪ St. George's Hospital performance was affected by the following themes: o Availability of acute and

general medical beds. o Beds continue to be

occupied by patients awaiting repatriation

o Surges of attendances and ambulance conveyances, leading to long waits and Emergency Department’s capacity issues especially early evening.

▪ St. George's Hospital is

undertaking joint investigation work into Emergency Department processes as part of the Trust‘s ‘Flow Programme’.

▪ Plans are being developed to increase medical ambulatory provision (from 6 trolleys & 1 chair to 12 trolleys 15 chairs).

▪ Plans in place to increase Emergency Department streaming rates (through increase in Rapid Assessment & Treatment (RAT) area and scope).

▪ Recruitment work is in progress to fill vacancies and there is an upcoming nurse recruitment drive.

▪ Management of sickness is in line with NHS T&Cs.

▪ Work is on-going around their demand and capacity, and a 28 bedded Surgical ward has been flipped to General Medicine to accommodate flows.

▪ A proposal for managing repatriations across South

▪ A&E performance is monitored

and performance managed at the St. George's Hospital Performance Meeting held monthly between Provider and commissioners, supported by the Commissioning Support Unit and the Merton & Wandsworth Urgent Care Delivery Board

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West London is being rolled out subject to approvals.

▪ Make A Difference Events (MADE) is planned at St. George's Hospital to identify flow issues with discharges, alongside increased CCG presence on-site.

E.B.S.7 Ambulance Handover (CHS) ▪ CHS finished February with

165 x 30 minute breaches and 17 x 60 minute breaches

▪ Delays due to patient flow through the emergency department not being sufficient at busy times.

▪ This is compounding delays attributed to the current location of the Emergency Department which should be resolved by completion of the ED improvement work.

▪ Improvement in handovers forms part the Croydon A&E Delivery Board plan, with a compliance date listed as March 2018 for ensuring all handovers occur within 15 minutes.

▪ Other actions that should have longer term impacts on the number of ambulances presenting to A&E are: Direct conveyance of

patients to RAMU. Maximising the use of ‘See

and Treat’. Green calls being referred

for clinical triage to avoid A&E disposition being made.

▪ Completion of the new ED at CHS has slipped from February 2018 to June 2018.

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E.B.10 Cancer Subsequent

Treatment, 31 Days (Drugs)

Croydon CCG did not meet the standard with an outcome of 97.9% due to 1 breach out of 47 pathways

▪ Royal Marsden Hospital – 1

breach due to an administrative error where the patient was booked outside of target date.

▪ Reviewed with administration

service and breach report completed

▪ Actions to avoid administrative errors identified within the breach review and implemented

▪ To be monitored by Croydon

CCG and Commissioning Support Cancer Performance Managers.

▪ Oversight by South West London Cancer System Leadership Forum

E.B.12 Cancer 62 Days (GP)

Croydon CCG did not meet the standard with an outcome of 83.9%, against the 85% threshold.

Due to 9 breaches out of 55 pathways. ▪ 2 breaches between King’s

College Hospital and Guy’s & St Thomas’s Both Lung breaches due

to a delay in clinical work up.

▪ 3 breaches between Croydon Health Services and Royal Marsden Hospital 1 Upper GI referred after

day 38 1 Urology referred after

day 38 1 Other referred after day

38

▪ South West London now holds regular weekly shared care PTL meetings to discuss pathways between providers.

▪ Breach reports for patients outside of South West London are being requested for Croydon CCG as agreed to support the breach review process at Croydon CCG level.

▪ As agreed through South West London Cancer System Leadership Forum, all 62 day breach reports from within South West London are now received where previously it was only patients who were passed 104 days. This is to

▪ Patient Tracking Lists (PTLs) started in March 2018 and are being reviewed through the South West London Cancer System Leadership Forum (SLF).

▪ Key themes for delays in transfer of care are being discussed weekly through the South West London PTL Meetings and will be fed into respective performance meetings and South West London Cancer System Leadership Forum.

▪ Croydon CCG engages with the South West London Cancer Leadership Forum

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▪ 3 Breaches between Croydon Health Services and St. George's Hospital All 3 breaches were

Urology cases. 2 were referred after day 38 and 1 was an administrative error at St. George's Hospital.

▪ 1 – Croydon Health Services o Patient required cardiac

work-up prior to commencing treatment.

support transformation and sustainability plans. South West London is planning to re-assess the breach reporting process across South West London.

▪ South West London is planning to re-assess the breach reporting process across South West London so as understand the current process and to make recommendations for improvement if required.

▪ Monthly performance meetings are held with CHS

E.B.13 Cancer 62 Days

(Screening)

Croydon CCG did not meet the standard with 66.7% against the 90% threshold.

Due to 1 breach out of 3 pathways ▪ 1 breach shared between St.

George's Hospital and Royal Marsden Hospital which was a late referral.

▪ The breach has been reviewed to fully understand the pathway.

▪ St. George's Hospital and

Royal Marsden Hospital will share the learning from this breach with clinical and administrative teams.

▪ Shared screening pathways are included in the weekly shared care PTL discussions.

E.A.3 IAPT Access

▪ Croydon saw a monthly rate of 0.94% in February against a monthly target of 1.40%.

▪ Prioritisation of investment had been given to other mental health services in 2017/18.

▪ This lead to a reduction in the IAPT service capacity,

▪ With the additional funding, SLaM have near doubled the number of therapists within the service with 21 wte recruited since November.

▪ The CCG is working to increase referrals to deliver the national 4.2% run rate in Q4.

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▪ The rolling 3 month position was 2.69% against a 3.75% national, quarterly target.

adversely impacting on the IAPT Access Rate.

▪ Additional funding to improve the Q4 position to meet the national standard of 4.2% was confirmed in November.

▪ The CCG has been working with SLaM to help raise the profile of the service with GPs, the public and other health professionals to increase referrals.

▪ Weekly monitoring of performance is taking place in Q4 to ensure all is being done to meet the national target. The service has sufficient capacity, meaning focus is now upon increasing referrals.

▪ The CCG engaged with the IAPT Intensive Support Team to review actions taken to ensure maximum uptake of IAPT services

▪ Additional investment has been made to IAPT to sustain compliance in to 2018/19.

E.A.S.2 IAPT Recovery Rate ▪ The CCG’s recovery rate in

February was 39.11%, below the 50.0% standard.

▪ Performance in M11 fell below the quarterly standard of 50%

▪ The YTD position is 47.21%

▪ The Croydon IAPT service has recruited to increase capacity due to additional investment for Q4 this year.

▪ Waiting times remains low for first and second appointments.

▪ A new process of texting patients to remind them of booked appointments has been amended to improve drop-out rates.

▪ As the service expands and the new run rate stabilises, this will have a positive impact on recovery rate also.

▪ The CCG expects to see improvement in the recovery rate by the end of Q4.

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Improvement and Assessment Framework (IAF)

Page 13 of 26

Better Health Period CCG Peers England Trend

R 102a % 10-11 classified overweight /obese2013/14 to

2015/16 38.8% 6/11 190/207

R 103a Diabetes patients who achieved NICE targets 2016-17 38.6% 10/11 142/207

R 103b Attendance of structured education course 2016-17* 2.7% 8/11 151/207

R 104a Injuries from falls in people 65yrs + 17-18 Q1 2,391 10/11 169/207

R 105b Personal health budgets 17-18 Q2 4 7/11 184/207

R 106a Inequality Chronic - ACS & UCSCs 17-18 Q1 2,360 11/11 133/207

R 107a AMR: appropriate prescribing 2017 09 0.901 7/11 32/207

R 107b AMR: Broad spectrum prescribing 2017 09 7.3% 3/11 47/207

108a Quality of l ife of carers (not available)

Sustainability Period CCG Peers England Trend

R 141b In-year financial performance 17-18 Q2 Red ↔ #N/A #N/A

R 144a Utilisation of the NHS e-referral service 2017 10 41.9% 8/11 152/207

Leadership Period CCG Peers England Trend

R 162a Probity and corporate governance 17-18 Q2 Fully Compliant ↔ #N/A #N/A

163a Staff engagement index 2016 3.79 9/11 106/207

163b Progress against WRES 2016 0.16 3/11 170/207

164a Working relationship effectiveness 16-17 61.90 10/11 171/207

R 165a Quality of CCG leadership 17-18 Q2 Red ↔ #N/A #N/A

Key

Worst quartile in England

Best quartile in England

Interquartile range

Better Care Period CCG Peers England Trend

R 121a High quality care - acute 17-18 Q2 58 4/11 126/207

R 121b High quality care - primary care 17-18 Q2 64 2/11 154/207

R 121c High quality care - adult social care 17-18 Q2 64 1/11 20/207

122a Cancers diagnosed at early stage 2015 54.7% 2/11 50/207

R 122b Cancer 62 days of referral to treatment 17-18 Q2 81.7% 7/11 115/207

R 122c One-year survival from all cancers 2015 73.4% 3/11 42/207

122d Cancer patient experience 2016 8.9 2/11 38/207

R 123a IAPT recovery rate 2017 09 50.0% 9/11 123/207

R 123b IAPT Access 2017 09 2.4% 10/11 206/207

R 123c EIP 2 week referral 2017 11 63.3% 9/11 180/207

R 124a LD - reliance on specialist IP care 17-18 Q2 35 2/11 17/207

R 124b LD - annual health check 2016-17 49.5% 2/11 96/207

R 124c Completeness of the GP learning disability register2016-17 0.47% 3/11 96/207

R 125d Maternal smoking at delivery 17-18 Q2 5.9% 4/11 33/207

125a Neonatal mortality and stil lbirths 2015 4.1 2/11 75/207

125b Experience of maternity services 2015 75.3 8/11 183/207

125c Choices in maternity services 2015 64.8 6/11 123/207

R 126a Dementia diagnosis rate 2017 11 67.6% 9/11 114/207

R 126b Dementia post diagnostic support 2016-17 83.4% 1/11 7/207

R 127b Emergency admissions for UCS conditions 17-18 Q1 2,699 10/11 151/207

R 127c A&E admission, transfer, discharge within 4 hours2017 12 88.6% 1/11 34/207

R 127e Delayed transfers of care per 100,000 population2017 11 6.1 4/11 33/207

R 127f Hospital bed use following emerg admission 17-18 Q1 530.8 8/11 143/207

128b Patient experience of GP services 2017 82.8% 1/11 154/207

R 128c Primary care access 2017 10 100.0% ↔ 1/11 1/207

128d Primary care workforce 2017 03 0.94 1/11 127/207

R 129a 18 week RTT 2017 11 92.9% 2/11 47/207

R 131a % NHS CHC full assessments taking place in acute hospital setting17-18 Q2 37.5% 7/11 156/207

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IAF Clinical Priority Areas

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2016/17 Rating

Improvement & Assessment Framework Indicator

Latest Data

CCG Rank / Quartile range

(unless later data available)

Comments C

an

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Go

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122a Cancers diagnosed at early stage

2015 54.7% 50/207 – Best Quartile

122b Cancer 62 days of referral to treatment

Q3 2017/18 85.0% SWL Cancer Strategic Leadership Forum coordinating improvements across SWL Trusts

122c One-year survival from all cancers

2015 73.4% 42/207 - Best Quartile

More Croydon patients diagnosed with cancer are surviving after a year. The CCG’s one-year survival rate has increased between 2014 and 2015, with 71.1% to 73.4%, respectively.

122d Cancer patient experience 2016 8.9 38/207 - Best Quartile

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126a Dementia Diagnosis Rate Jan (M10) 2017/18

67.6%

Croydon CCG has maintained compliance for 9 out of the 10 months, YTD, in 2017/18

126b Dementia Post Diagnostic Support

2016/17 79.0% 7/207 - Best Quartile

The latest scorecard from NHSE shows that Croydon are ranked 7th in the country. Increasing from 79% to 83.4% in 2016/17, meaning more people diagnosed with dementia in the past 12 months had a face to face review of their care plan.

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123a IAPT Recovery Rate Feb (M11) 2017/18

39.11%

Whilst EIP was below the target waiting time in M11, the CCG remains compliant for 2017/198 YTD. The YTD position is 47.21%. This is expected to improve one the service is operating at capacity and stabilised.

123b IAPT Access Dec – Feb 2017/18

2.69%

Provisional data shows a 0.19% increase in the rolling 3 month performance. £300k investment made to deliver compliance in Q4, 2017/18. Whilst this is unlikely to be achieved based on provisional weekly data, the CCG continues to work with SLaM to publicise the service and increase referrals.

123c Early Intervention for Psychosis

Feb (M11) 2017/18

88% With achievement of the target in M11, the CCG remains compliant for 2017/198 YTD.

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2016/17 Rating


Latest Data



Comments

123d Children & Young People MH Access

- - No data available Provisional data shows that the CCG are on track to deliver the 35% access rate for CYPMHs by the end of 2017/18.

123e MH Crisis Care and Liaison - - No data available

123f MH Out of Area Placements - - No data available The CCG is working to reduce out of area placements to zero in 2017/18. In January there were 17 occupied OAP bed days.

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124a Reliance on specialist Inpatient beds

Q2 2017/18 35 17/207 – Best Quartile There have been improvements in 124a and 124b since the last publication. 124c is a new count. An action plan is being developed to raise awareness of the benefits to individuals with LD from maintaining the LD register and offering health checks in Primary Care. Work is being planned with Public Health, Primary Care Commissioning, Variation team, the LD team within the council and the GP Lead.

124b Annual Health checks 2016/17 49.5% 96/207 - Interquartile

124c Completeness of GP LD register

2016/17 0.47% 96/207 - Interquartile

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103a Diabetes patients who achieve NICE treatment targets

2016/17 38.6% 142/207 - Interquartile

CCGs received 2016/17 annual ratings diabetes in January. The CCG received a ‘Requires Improvement’ based on these two indicators from the most recent results from the National Diabetes Audit. Local data shows that far greater numbers of people accessed structured education. Nationally, this is under reported and is being addressed by the introduction of a new data collection. The CCG is developing a comprehensive action plan to improve performance against these metrics.

103b Attendance of structured education

2016/17 2.7% 151/207 - Interquartile

Ma

tern

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TB

C 125a Neonatal mortality 2015 4.1 75/207 – Interquartile

125b Experience of maternity services

2015 75.3 183/207 – Worst Quartile The age of this data should be noted.

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2016/17 Rating


Latest Data



Comments

More recently, FFT scores for CHS are good, 90% of women would recommend the service to friends and family.

125c Choice in maternity services 2015 64.8 123/207 – Interquartile

125d Maternal smoking at delivery Q1 2017/18 8.2% 68/207 - Interquartile

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Quality Premium

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QP1. Early Cancer Diagnosis

QP2. GP Access & Experience

Commissioner 2012 2013 2014 2015

07V NHS Croydon CCG 34.4% 46.5% 52.7% 54.7%

08J NHS Kingston CCG 24.7% 34.1% 55.2% 54.5%

08R NHS Merton CCG 39.3% 47.7% 48.1% 52.8%

08P NHS Richmond CCG 31.7% 39.3% 53.3% 53.6%

08T NHS Sutton CCG 31.5% 43.9% 49.7% 52.0%

08X NHS Wandsworth CCG 39.1% 46.6% 49.5% 51.8%

QP1. This Quality Premium (QP) existed in 2016/17 and

continues in to 2017/18.

▪ To achieve QP1 the CCG must demonstrate either an increase of 4 percentage points in the proportion of all staged cancers staged at 1 or 2, from the 2016 baseline or achieve >60% in 2017.

▪ Data is published with a significant lag, in calendar years. The most recent available nationally published data is from 2015, meaning that the 2016 baseline is not yet known.

QP2. This QP also applied in 2016/17.

▪ The measure of success in QP2 is to achieve 85% of respondents, to the July 2018 GP Patient Survey results, reporting a good experience of making an appointment to see their GP or a 3 percentage point increase in the same question, compared to July 2017.

▪ The CCG did not achieve the improvement target in 2016/17.

▪ Data is published annually, which will limit the ability of the CCG to quantify progress in-year.

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Quality Premium

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0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q1 Q2 Q3 Q4

QP3. CHC Quality Premium Indicators

Acute Setting Decision in 28 days

Acute Setting Target (Max) Decision Target (Min)

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

2016/17 Estimate* 2017/18 National Standard 2017/18 QP Stretch Target

QP4. CYPMHs Access Rate.

QP3. This QP is made up of two parts, each worth half of the

available award.

Part a) >80% of CHC eligibility decisions to be made within 28 days

from receipt of notification of potential eligibility.

Part b) <15% of all full CHC assessments tack place in an acute

hospital setting.

The CCG has not met the CHC QP targets Q1-Q3. Year to date:

▪ 30.6% of CHC eligibility decisions were made within 28 days from receipt of the eligibility checklist.

▪ 23.2% CHC assessments occurred in an acute setting.

Action plans have been developed to deliver the targets by March

2018 against monthly trajectories.

QP4. The options available for the MH QP were:

1. Reduction in out of area placements 2. Equity of IAPT access and outcomes 3. Improved access to Children’s and Young people’s MH

services.

▪ Option 3 was selected as the most pertinent to Croydon and the decision ratified by SMT. This also aligns with the new CYPMHs national priority to increase access, as mandated through ‘Next Steps’.

▪ To achieve this QP the CCG needs to either deliver a 14% point increase on the 2016/17 baseline or achieve a 32% proportion of diagnosable 0 – 18 year-olds a diagnosable condition, starting treatment in 2017/18.

▪ Croydon CCG is forecast to achieve 35% based on Q3 YTD data

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Quality Premium

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QP5. Bloodstream Infections (BSI)

2,050

2,100

2,150

2,200

2,250

2,300

2,350

64.5%

65.0%

65.5%

66.0%

66.5%

67.0%

67.5%

68.0%

68.5%

QP6. Dementia Diagnosis Rate

Register Rate National Target

QP6. This QP is aligned to the national standard and

the IAF clinical priority area.

▪ Building upon the improvement seen in 2016/17, when Croydon CCG became compliant against the 66.7% standard for the proportion of people listed on the local dementia register as a proportion of the estimated prevalence of dementia among the over 65s.

▪ 2017/18 saw an increase in the estimated prevalence and a change in the data source used nationally to determine CCGs’ performance.

Reducing gram negative blood stream infections (BSI) across the health economy.

1a) 10% reduction in all E.coli BSI reported at CCG level. – Still awaiting national data

1b) Collect and report a core primary care data set for all E.coli BSI Q2-Q4 2017/18. – Still awaiting national data

(See page 28 for local actions)

Reduction of inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care.

2a) 10% reduction in trimethoprim:Nitrofurantoin prescribing against June 2015 – May 2016 – Being met at M10 with 0.388

2b) 10% reduction in the number of trimethoprim items prescribed to patients >70 years of age. – Being met at M10

Sustained reduction of inappropriate prescribing in primary care.

3) Items per STAR-PU must be equal to or below 1.161 – Being met at M10, with 0.881

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Quality Assurance – Highlight Report

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High number of SIs reported by CHS under STEIS category ‘Diagnostic incident including delay (including failure to act on test results)’.

▪ Problems with Metastatic Spinal Cord Compression (MSCC) pathway.

▪ Trust undertook a deep dive of SIs relating to MSCC and developed an action plan, focussed largely on training and education.

▪ The CCG continues to monitor the implementation of this action plan at monthly SI Review meetings.

High number of SIs reported by CHS under STEIS category ‘Sub-optimal care of the deteriorating patient’

▪ Issues around incorrect classification of SIs.

▪ Issues around failure to follow policy and escalate to senior clinical staff.

▪ Trust undertook a deep dive of SIs relating to Sub Optimal care of a deteriorating patient.

▪ An action plan was developed to address the causes of high numbers being reported and presented to SIRM.

▪ The CCG continues to monitor the implementation of this action plan at monthly SI Review meetings.

High number of SIs reported by CHS under STEIS category “Medication Incidents”, including 1 Never Event and increase in low harm incidents.

▪ Issues around in-patient and discharge medicine management.

▪ Issues around safe storage of medications.

▪ The Trust is undertaking a deep dive into Medication SIs and Incidents.

▪ Outcome to be shared at CQRG following internal ratification.

An unannounced visit of Specialist eating disorder services undertaken by CQC February 2018.

▪ Concerns received from a group of patients regarding Tyson West 2 Ward at The Bethlem Royal Hospital in Beckenham (part of SLAM services)

▪ An action plan will be prepared by the Trust taking into account the findings and recommendations made by the CQC. CQRG to monitor work undertaken and planned by the Trust. The next review meeting is due to take place at the end of April 2018.

▪

▪ Monitor work undertaken by the Trust and action plan at monthly 4-borough CQRG meetings.

▪ Quarterly monitoring meeting with 4-Borough Quality Leads and the CQC (next meeting end of April 2018).

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Quality Assurance – Serious Incidents

Page 21 of 26

0

2

4

6

8

10

12

14

September October November December January February

Serious Incidents Reported by Providers

CHS NHS Trust - Count of SIs Reported

NHS Croydon CCG - Count of SIs Reported

SLaM NHS FT - Count of SIs Reported

SLaM NHS FT - Count of No of days toreport

NHS Croydon CCG - Count of No of days toreport

CHS NHS Trust - Count of No of days toreport

▪ Croydon Health Services (CHS) NHS Trust reported 6 SIs in M11, none of which were Never Events. The 3 highest categories under which SIs have been reported by CHS NHS Trust over the last 6 months are Sub-optimal Care of the deteriorating patients (9), Medication incidents (6) and Diagnostic incidents (6). The increase in medication incidents including the Never Event reported in M09 has been discussed at CHS NHS Trust monthly Clinical Quality Review Groups (CQRG) and an update on work being undertaken by the Trust has been shared. This includes a deep dive into medication SIs, the outcome of which is currently going through internal governance prior to be presented at CQRG.

▪ SLAM reported 1 SI in M11 under category Apparent/actual/suspected self-inflicted harm, which is the highest reported category by the Trust over the last 6 months. As part of the 4-Borough CQRG meeting, the Trust have agreed to undertake a Thematic Review of self-harm and attempted suicide SIs and will be presenting the outcome of this to the May 4-Borough CQRG meeting.

▪ No SIs were reported by Croydon CCG in M11.

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Quality Assurance – CHS Patient Experience

Page 22 of 26

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18

Patient Experience - FFT Score and Response Rate (In-patient services and A&E )

Inpatients A&E Inpatients response rate A&E response rate

95%

96%

97%

98%

99%

100%

101%

0

10

20

30

40

50

60


Patients Experience - Complaints Received

No. of complaintsreceived

% acknowledgedwithin 3 day target

• CHS NHS Trust received 55 complaints in Month 11, 100% of which were acknowledged within the 3-day target.

The top 3 areas in which complaints were received were Integrated Adult Care (28), Integrated Surgery, Cancer and Clinical Support (14) and Integrated Women’s, Children’s and Sexual Health (8). A review of nursing staffing levels, measured against incidents and complaints received during the period Dec 16 - Dec 17 was undertaken by the Trust in March 2018 to identify if harm events or adverse incidents have any correlation to staffing levels. The data presented to the CQRG meeting suggests no significant correlation. • CHS NHS Trust’s internal target for Patient

Experience FFT is currently set at 90%. The Trust met this target for both A&E and Inpatients in M11 achieving 93% and 91% respectively.

• However, patient response rates in both areas continue to remain low, particularly when compared against the national average in M11; A&E 8.9% against 13.4% and Inpatients 12.6% against 23.9%.

• Initial action plans to address areas of concern identified following the publication of the Patient Surveys of Children and Young People, Maternity and In-patients services have been presented to the CQRG. Further work on these were requested by the CCG.

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Quality Assurance – SLaM Patient Experience

Page 23 of 26

Sept Oct Nov Dec Jan Feb

Adults Mental Health 5 10 14 5 5 13

Child and Adolescent Mental Health 1 0 0 0 0 0

Mental Health Older Adults 0 0 0 0 0 0

Learning Disabilities 0 0 0 0 0 0

0

2

4

6

8

10

12

14

16

No

of

Co

mp

lain

ts r

ece

ive

d

Patient Experience - Complaints Received

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%


Patient Experience - FFT Score and Response Rate (SLAM/England )

FFT - Recommend SLAM FFT - Recommend England

▪ In M11, 2.7% of SlaM patients completed the FFT test and of these, 82% would recommend the service to their friends and family if they needed similar care or treatment.

▪ When benchmarked nationally, SLAM continues to remain below the average recommendation rate of 89%.

▪ SLaM received 13 complaints in M11 involving Croydon CCG residents, spread out over 12 wards/services within the Adult Mental Health Services All complaints were acknowledged within the 3-day target.

• Monitoring of Trust wide complaints and presentation of lessons learnt are shared at the monthly 4 Borough CQRG meetings. 3 Blue Light Bulletins were disseminated throughout the Trust in Q3 highlighting patient safety learning from complaints and incidents including guidance on self-harm ingestion, management of sharps in inpatient settings and supporting safe use of e-cigarettes.

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Quality Update

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CQC Visit Updates

• Croydon Health Services NHS Trust The CQC published their Inspection Report on Croydon Health Services NHS Trust on 21 February 2018 and whilst some areas of improvement were noted since the last inspection in 2015, the overall rating remains “Requires Improvement”. The Trust are preparing a concise action plan to address all recommendations made by the CQC and proposals for collaborative monitoring of these with Croydon CCG is being prepared by the Trust. As part of their factual accuracy check, the CQC recommended that an SI previously declared by Croydon Health Services NHS Trust should have been reported as a Never Event. This SI has been reviewed by both the Trust and Croydon CCG and robust challenge has been noted. Following discussions at February CQRG, NHS Improvements (NHSI) have been asked to follow this recommendation up with the CQC.

• SLaM The CQC published their report on SLAM Community-based mental health services for working age adults on 31 October 2017, with an overall rating as “Requires Improvement”. The Trust presented their action plan to address the “must do” and “should do” recommendations made by the CQC to the 4-borough CQRG meeting in February 2018, together with a plan to address statutory and mandatory training requirements. As part of the work currently undertaken, SLaM have reviewed their pathway for mental health act assessments across the 4 commissioning Boroughs and are hosting a multi-agency event to present the findings and put in place mitigating actions against reasons for delay and cancellation across the pathway. Whilst assurance was provided of work being undertaken against the action plans, it was agreed by the 4 boroughs that further work is required such as the inclusion of evidence where actions had been taken and clear timescales, trajectories and named leads on those which remain outstanding. The CQC action plans remain a standing item on the 4 borough CQRG meeting monthly agenda.

• Primary Care The CQC has undertaken a schedule of planned visits to the following Croydon borough practices over the last three months:

• Parkway Health Centre (AT Medics) - Good

• South Norwood Hill Medical Centre – Not published

• Coulsdon Medical Centre – Not published

• Edridge Road Community Health Centre - Inadequate

• Shirley Medical Centre, Coulsdon Medical Centre – Not published

• Stovell House Surgery – Good

• Queenhill Medical Practice - Not published

• Dr Jamil Khan – Not published

• Birdhurst Medical Practice - Good

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Quality Update

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Edridge Road Croydon CCG has provided extensive support to the Practice in the lead up to and following the CQC visit and continue to do so to assure the safe provision of patient care. The Practice are developing an action plan to address the recommendations made by the CQC and a CCG task and finish group has been set up to develop a plan of support for the Practice. A further visit by the CQC is expected within the next 6 months.

• The Croydon Urgent Care Alliance (CUCA) The CQC published their report on the Croydon Urgent Care Centre in early December 2017, with an overall rating of “Requires Improvement”. Croydon CCG are supporting CUCA to address one of the issues identified by the CQC regarding their Streaming Policy, including a clinically lead meeting to review the existing policy to consider how this could be improved. Whilst CUCA have submitted their response to the CQC and commenced work to meet the recommendations contained within the report, a detailed action plan is still awaiting internal sign off. This issue will continue to be monitored at monthly CQRG meetings with the Provider.

Croydon Care Homes Quality Assurance Croydon CCG Quality Nurse Advisor presented at the “Improving Pressure Ulcer Prevention in Croydon Event” in March 2018, alongside colleagues from Croydon Health Services NHS Trust and Croydon Local Authority. The event was held due to a noted increase of community acquired pressure ulcers and aimed to support Care Homes in their management of these. The event was well attended by staff from Croydon Nursing Homes and positive feedback was received, examples of which are detailed below: “I will ensure that all residents at risk are assessed in a timely manner”

“This training will help me with local training at the care home”

“Make all staff aware of the safeguarding adult and pressure ulcer protocol and display the decision making flowchart”

“This session has allowed me to discuss and hear how other healthcare professionals deal with their experiences and that some issues are universal”

Development of the Care Home Dashboard continues and metrics being considered for inclusion are, staff training, CQC rating, bed capacity, hospital admissions, infection control outbreaks and compliance, purple guide compliance and service user feedback. Croydon CCG Quality Nurse Advisor has taken part in quality visits to Croydon Care Homes alongside the Safeguarding Service Manager and the Quality Monitoring Team within the Local Authority. The aim of these visits are to gain assurance of quality within Care Homes by reviewing areas such as the physical environment, staff supervision and training and service users care plans and folders, as well as strengthening relationships and partnership working.

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Quality Update

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Intermediate Services CQRG Meeting The quarterly Intermediate Services CQRG meeting is due to take place at the end of March 2018 and details of the outcomes of this meeting will be shared in the next Quality Report.

Two additional providers have been added to the agenda for quality review:

• Marie Stopes

• St Christopher’s Hospice (end of life care)

Primary Care Quality

The second GP CQRG is due to take place at the end of March 2018. Further details of the outcomes of this meeting will be shared in the next Quality Report. In preparation, the Primary Care Dashboard is being updated and will include compliance to Safeguarding Training and Infection Control Audits. In order to review the alignment of responsibilities and share quality data, a meeting/workshop is being arranged with Croydon CCG Primary Care and Quality Teams and NHS England Primary Care Team in April 2018. E-coli Infection As agreed at Croydon Health Services NHS Trust February CQRG meeting, Croydon CCG hosted a meeting with the Trust to consider the barriers in achieving the Quality Premium to reduce Blood Stream Infections (BSI) across the whole health economy.

It was recognised that further information would be required from Primary and Acute care to gain an understanding of the numbers of patients on catheters as well as clarity around the pathways currently in place. A further meeting will be organised and the invite extended to all relevant people.

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1 May 2018

Title of Paper: QUALITY COMMITTEE ANNUAL REPORT




CCG Quality Committee CCG Integrated Governance & Assurance Committee


CCG Governing Body


Recommendation:

The Governing Body is asked to : ▪ Note the annual report on the Quality Committee. ▪ Approve the Terms of Reference of the Committee that, following Committee review,

are recommended to be adopted with the following amendments for a further year: - Clarity of section 2c and 6 to be explicit that the Quality Committee reports directly to

the Governing Body Committee while working with the Integrated Governance & Audit Committee.

- Clarity of the expectation of the Governing Body Clinical Chair and Accountable Officer attendance (open invitation)

- Reflecting formal titles of Governing Body Members.

Executive Summary:

The Quality Committee is a Committee of the Governing Body but also provides oversight reporting to the Integrated Governance and Audit Committee (in its position of oversight for CCG internal control and governance) and has been established to oversee the application of quality in services commissioned. The Committee is required by the constitution to review its Terms of Reference annually and to update them as required. The Terms of Reference also state that a report of the Committee’s work and achievements should be compiled annually and presented to the Governing Body.

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The Quality Committee has met on six separate occasions and fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2018/2019.

Governance:











Not applicable

Reputational Issues Failure to manage quality issues effectively would attract adverse attention from patients, the public and NHS England.

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TERMS OF REFERENCE REVIEW – REVIEW OF EFFECTIVENESS AND COMPLIANCE

1. Introduction

The Quality Committee is a Committee of the Governing Body and provides oversight reporting to the Integrated Governance and Audit Committee and has been established to oversee the application of quality in commissioning activity. The Committee reviews and discusses the identification and management of quality, patient safety; safeguarding and performance risk (where relevant to quality).

The Committee is chaired by the Lay Member, Registered Nurse and draws on members nominated by the Governing Body as well as staff with key governance roles from within the CCG and NEL CSU.

2. Membership


Committee members:

• Amy Page, Governing Body Member - Registered Nurse

• Jon Norman, Governing Body Member - Secondary Care Consultant,

• Tom Chan, Governing Body GP & Medical Director (From June 2017)

• Tony Brzezicki, Clinical Chair (To June 2017)

• Agnelo Fernandes, Clinical Chair (From July 2017)

• Emily Symington, Governing Body GP and Clinical Lead

Those in attendance:

• Elaine Clancy, Director of Quality & Governance

• Andrew Eyres, Accountable Officer (From July 2017)

• Paula Swann, Chief Officer (To June 2017)

• Stephen Warren, Director of Commissioning

• Martin Ellis, Director of Primary & Out of Hospital Care

• Quality Lead (Head of Quality)

• Head of Safeguarding

Quoracy rules

• Quorate when 3 members are present.

• The Committee was not quorate at its meeting on 23 October 2017.

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Attended : Apologies Received: Non-Attendance:

Name

23

Jan

24

Apr

26

Jun

25

Sep

23

Oct

22

Jan

Amy Page Registered Nurse, Chair

100.00%

Jon Norman Secondary Care Consultant

50.00%

Helen Pernelet Lay Member, Governance & PPI

100.00%

Philip Hogan Lay Member, Governance

25.00%

Paula Lloyd-Knight Lay Member, PPI

0.00%

Tony Brzezicki Clinical Chair

0.00%

Agnelo Fernandes Clinical Chair

0.00%

Emily Symington Governing Body GP

16.67%

Tom Chan Governing Body GP, Medical Director

75.00%


0.00%

Paula Swann Chief Officer

0.00%

Stephen Warren Director of Commissioning

16.67%


83.33%

Martin Ellis Director of Primary & Out of Hospital Care

33.33%

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3. Functions

The Committee provides a number of functions which are set out in its Terms of Reference. The functions are listed below along with an assessment on whether the function was fulfilled, evidenced by references to the achievement section.

Responsibilities of Quality Committee Fulfilled Evidence

To provide assurance to the Governing Body that commissioned services are safe and of high quality and that there are adequate plans in place to respond to any issues of poor quality that may arise

1,2,3

To establish and oversee an approach to quality by Croydon CCG to include patient safety, clinical effectiveness and patient experience

3,4

To advise the Integrated Governance and Audit Committee and the Governing Body on the management of clinical risk

3,4

To oversee the procedures for identifying, investigating and learning for serious incidents and for safeguarding children and vulnerable adults

2

To support a culture of learning and continuous improvement in healthcare services within those services that Croydon CCG is responsible for

5

To draw upon and receive assurance, on behalf of the governing body, that issues related to the quality of care within Croydon and commissioned elsewhere, such as by the NHSE, are taking place effectively and being appropriately coordinated.

5

4. Activities


1. Agreed the Terms of Reference reflecting its assurance role. 2. Regularly received and reviewed Quality and Safeguarding Reports to be assured of

the quality of services. 3. Discussed areas of concern to agree whether there was a need for the CCG to take

remedial action and to understand whether there were any implications for patients. 4. Regularly reviewed the CCG’s strategic, operational quality and safety risks, agreed

the level of risk, and identified any risks that should be included on the Risk Register. 5. Regularly receives QIPP Quality Highlight Reports and Integrated Performance

Reports.

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The Quality Committee is obliged to review its Terms of Reference annually to ensure that they remain fit for purpose. The Committee, through this report has done so and considers that they remain relevant and adequately reflect the functions of the Quality Committee and recommends that their current format be adopted for the year 2018/2019.

Minor amendments are recommended as follows:

• Andrew Eyres, Accountable Officer replaced Paula Swan, Chief Officer in July 2017. Andrew Eyres’ works two days a week in Croydon and these do not coincide with Quality Committee meeting dates. The Accountable Officer has not attended the Committee in 2017/18.

• The Clinical Chair of the Governing Body has not attended in 2017/18. There has been a change of CCG Clinical Chair in July 2017 at the end of the original post holder’s term. Intended attendance should be confirmed.

• The routine review of these terms of reference has been set to annual now that the committee is established (initial review period had been set to 6 monthly when established in 2013.

• As the CCG has appointed to the Lay Member (Patient and Public Engagement) post, and assigned to them more sessions than their predecessor, the Committee may wish to consider whether the Lay Member to attend is specified. Only the Lay Member (Governance) has attended in 2017/18.

• The Committee has not provided a quarterly written report to the Integrated Governance Committee. Minutes have been provided together with a verbal update of matters discussed and risks to be escalated. The formality of escalation should be considered.

• Following a resignation in October 2017, the CCG has 3 GP members of the Governing Body (including the Clinical Chair) and two further GP member vacancies. One of the GP Members has been assigned the role of Medical Director with a particular focus on service quality.

• The Governing Body roles are distinct to those of Clinical Network leads but could have been open to misunderstanding. The Terms of Reference line indicating Clinical Leads has been clarified to include the Governing Body GP Members expectation to attend.



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TERMS OF REFERENCE

CROYDON CCG QUALITY COMMITTEE

1. Introduction The Quality Committee is a Committee of the Governing Body and provides oversight reporting to the Integrated Governance and Audit Committee and has been established to oversee the application of quality in commissioning activity. This Committee will be chaired by the Governing Body Member, Registered Nurse and will draw on members nominated by the Governing Body as well as staff with key governance roles from within the CCG and contracted Commissioning Support. 2. Duties

a. To provide assurance to the Governing Body that commissioned services are safe

and of high quality and that there are adequate plans in place to respond to any issues of poor quality that may arise

b. To establish and oversee an approach to quality by Croydon CCG to include patient

safety, clinical effectiveness and patient experience c. To advise the Integrated Governance and Audit Committee and the Governing Body

on the management of clinical risk d. To oversee the procedures for identifying, investigating and learning for serious

incidents and for safeguarding children and vulnerable adults e. To support a culture of learning and continuous improvement in healthcare services

within those eservices that Croydon CCG is responsible for f. To draw upon and receive assurance, on behalf of the Governing Body, that issues

related to the quality of care within Croydon and commissioned elsewhere, such as by NHS England, are taking place effectively and being appropriately coordinated.

3. Roles and Responsibilities a. Governance

i. Agree an annual work plan and identify areas for focused thematic review

ii. Present an annual quality report to the Governing Body

iii. Recommend the performance management and monitoring mechanisms for the SLA Quality Schedules to be developed by local contracting teams for commissioned services

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Last Updated 19 March 2018 CCG Quality Committee

iv. Maintain an oversight of the management of clinical risk within Croydon and apprise the Integrated Governance and Audit Committee of any significant issues

v. To provide quality surveillance across the CCG’s commissioning portfolio

vi. Maintain oversight of implementation of NICE Technical Appraisals and

consideration of NICE Guidelines.

vii. Receive regular updates from all service providers on progress towards meeting CQC registration requirements, continuing compliance and the outcomes of special reviews.

viii. To ensure that the CCG fulfils national requirements in respect of the use,

transfer and storage of patient identifiable information (Caldicott) and to receive an annual report from Caldicott Guardians

ix. To monitor and review the CCGs research governance arrangements

x. To have regard for, and receive assurance on safeguarding children and

vulnerable adults issues ensuring appropriate action when required; Safeguarding adults information will include ensuring compliance with the Mental Capacity Act (MCA) and Deprivation of Liberties (DOLs), the ‘prevent’ agenda and also issues relating to restraint.

b. Patient Safety

i. To assure the Governing Body that there are robust procedures in place: ▪ for the effective management of clinical incidents within commissioned

services and which allow CCG level reporting on incident management:

▪ that promote understanding, learning from serious incidents, mistakes and “near misses” through the use of learning, development and dissemination tools that result in improved patient safety

▪ for managing infection control within all commissioned services

▪ for safeguarding children, young people and vulnerable adults within all

commissioned services and to promote shared learning and good practice across Croydon.

▪ for the safe and effective prescribing and management of medicines ▪ for learning from other incidents or adverse events which may impact upon

patient care of safety, for example, related to health and safety in commissioned services

▪ for the distribution of safety notices and alerts (Central Alerting System)

and promotion of compliance

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c. Clinical Effectiveness i. To recommend and have oversight of programmes of CQUINS for all major

contracts.

ii. To assure ourselves in respect of appropriate payments for CQUIN achievement.

iii. To receive the annual audit reports of the major providers

iv. To review and recommend Croydon policies relating to Patient Safety, Clinical

Effectiveness and Patient experience. d. Patient Experience

i. Where requested by the Governing Body, to provide assurance that it is compliant with its Duty to Consult

ii. To monitor and promote compliance with the NHS Constitution

iii. To ensure that mechanisms are in place to seek feedback on patient experience

of health services and that promote their involvement in the planning and delivery of health services. To provide assurance to the governing body of CCG compliance with section 242A of the Health and Social Care Act 2006

iv. To ensure that patient feedback received, including patient surveys, influences

the design and review of services

v. To ensure that patient reported outcomes are used to monitor the quality of care

vi. To ensure that feedback gained from patient experience monitoring mechanisms including complaints is used in the commissioning monitoring and review of health care services

4. Accountability

The Quality Committee is a Committee to the Governing Body and provides assurance to the Integrated Governance and Audit Committee and may where invited report to the Governing Body (it will report at least annual on its activities). It will set out its plan of work in an annual plan and will produce an annual report.

5. Committee Membership 1 Lay Member Chair of the Governing Body (open invitation) 2 Governing Body GP Members or Clinical Leads CCG Governing Body Registered Nurse – Chair CCG Secondary Care Consultant In attendance (as required):

• Accountable Officer

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• Director of Quality and Governance

• Director of Commissioning

• Director of Primary and Out of Hospital Care

• Head of Safeguarding

• Head of Quality

6. Reporting Arrangements. Minutes and risk escalation reports will be presented to the Governing Body and Integrated Governance & Audit Committee

7. Quorum rules The quorum of the Committee will be three members.

8. Frequency of Meetings The Committee will meet a minimum of quarterly but usually bi monthly.

9. Monitoring adherence to the Terms of Reference As part of the annual reporting process.

10. Review Terms of Reference will be reviewed annually.

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1 May 2018

Title of Paper: REPORT FROM THE CHAIR OF THE PRIMARY CARE

COMMISSIONING COMMITTEE

Lead Director Philip Hogan, Lay Chair

Report Author Martin Ellis, Director of Primary & Out of Hospital Care Ben Smith, Board Secretary


N/A


CCG Governing Body


Recommendation:

The Governing Body is asked to note: ▪ The annual review of the Committee and its Terms of Reference The Governing Body is asked to agree the following changes to the Terms of Reference for the Primary Care Commissioning Committee: ▪ Insertion of a note indicating that national guidance (issued since approval of these

Terms of Reference June 2017) advises that the Conflict of Interest Guardian should not hold the role of Primary Care Commissioning Committee Chair such that the Chair should be elected from an alternative Lay Member present

Executive Summary:

The Croydon CCG Primary Care Commissioning Committee is a Committee of the Governing Body. The Primary Care Commissioning Committee has been established and will function as a corporate decision-making body for the management of the functions delegated to the CCG (from NHS England) and the exercise of the delegated powers.

The Committee is required by the constitution to review its Terms of Reference and to update them as required. Other Committees of the Governing Body present reports of the Committee’s work and achievements, compiled annually and presented to the Governing Body.

The Primary Care Committee has met in public in each quarter since being established and holding its inaugural meeting in July 2017 and has held additional meetings where urgency and commercial sensitivity required the meetings to be held in private. These meetings in private have been reported to the next meeting in public through Chair’s reports. The Annual Review confirms the Committee has fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed

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and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2018/2019. Key Papers: The papers on the agenda for the May 2018 Primary Care Commissioning Committee are provided below and the Chair will give verbal feedback on specific areas of interest from the meeting.

• Review of Committee (Annual) and Terms of Reference (attached)

• Primary Care Finance Report

• Commissioning Update

• Update from CQC Visits

Governance:











Not applicable


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GOVERNING BODY

1 May 2018

Title of Paper: TERMS OF REFERENCE REVIEW – REVIEW OF EFFECTIVENESS

AND COMPLIANCE




CCG Integrated Governance & Assurance Committee Primary Care Commissioning Committee


CCG Governing Body


Recommendation:

The Governing Body is asked to : ▪ Note the annual report on the Committee. ▪ Note the Terms of Reference of the Committee have been reviewed and the

recommendation, subject to Committee review, is that they should be adopted with the minor amendments for a further year: -Clarify Lay Member Chairing – Referencing National Guidance suggests avoiding this being the Conflict of Interest Guardian.

Executive Summary:

The Croydon CCG Primary Care Commissioning Committee is a Committee of the Governing Body. The Primary Care Commissioning Committee has been established and will function as a corporate decision-making body for the management of the functions delegated to the CCG (from NHS England) and the exercise of the delegated powers. The Committee is required by the constitution to review its Terms of Reference and to update them as required. Other Committees of the Governing Body present reports of the Committee’s work and achievements, compiled annually and presented to the Governing Body. The Primary Care Committee has met in public in each quarter since being established and holding its inaugural meeting in July 2017. The Committee has fulfilled its obligations in line with its agreed Terms of Reference. The Terms of Reference themselves have been reviewed and found to adequately represent the functions and duties of the Committee and it is recommended that they be renewed for the year 2018/2019.

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Governance:











Not applicable

Reputational Issues Failure to manage quality issues effectively would attract adverse attention from patients, the public and NHS England.

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TERMS OF REFERENCE REVIEW – REVIEW OF EFFECTIVENESS AND COMPLIANCE

1. Introduction

The Primary Care Commissioning Committee (PCCC) is a Committee of the Governing Body and has been established to

The Committee is chaired by a Lay Member and draws on members nominated by the Governing Body as well as staff with roles from within NHS England and other bodies that hold the CCG to account. The committee receives governance support from NEL CSU.

2. Membership


Committee members:

Voting members:

• Croydon CCG Primary Care Committee Chair (Lay Member)

• Croydon CCG Primary Care Committee Vice Chair (Lay Member)

• Croydon CCG Chief Officer

• Croydon CCG Chief Finance Officer

• Croydon CCG Chair

• Independent GP (to attend for decision making to avoid conflict of interest)

• Croydon CCG Registered Nurse Lay Member



Non-voting members:

a. Representative from the Croydon Health and Wellbeing Board

b. Representative from Croydon Healthwatch

c. Representative from the Surrey and Sussex Local Medical Committee

d. NHS England Representative

e. Croydon CCG Governing Body Members other than those listed as voting

members.

Quoracy rules

One third of committee members are required for the meeting to be quorate (currently

6 members), including:

• The committee chair or the vice chair

• Two of the following: Chief Officer; Chief Finance Officer, Director of

Commissioning

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Attended : Apologies Received:

Non-Attendance:

Not in post

Not invited / recused conflict:

Name

4 Jul 3 Oct

(private)

7 Nov 09 Jan 6 Feb

(private)

6 Mar

Members:

Philip Hogan Lay Member, Governance & CoI Guardian

Roger Eastwood Lay Member, Finance

Paulette Lewis, Lay Member, Patient & Public Involvement

Amy Page Registered Nurse, Governing Body Member


Mike Sexton Chief Finance Officer

Dr Agnelo Fernandes Clinical Chair, Croydon CCG Governing Body


Martin Ellis Director of Primary & Out of Hospital Care

Independent GP

Rachel Flowers Health and Wellbeing Board Representative Deputy

Jai Jayaraman Healthwatch (Croydon) Representative

Richard Brown LMC (Surrey Sussex) Representative

Deputy attended

William Cunningham-Davis NHS England Representative

Tom Chan, Governing Body GP & Medical Director

Corrected minute

Emily Symington, Governing Body GP

Yogesh Patel, Governing Body GP (to Oct

2017)

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Name

4 Jul 3 Oct

(private)

7 Nov 09 Jan 6 Feb

(private)

6 Mar

Stephen Warren Director of Commissioning

%

Jon Norman Secondary Care Consultant, Governing Body Member

3. Functions

The Committee provides a number of functions which are set out in its Terms of Reference. The functions are listed below along with an assessment on whether the function was fulfilled, evidenced by references to the achievement section.

Responsibilities of the Primary Care Commissioning Committee

Fulfilled Evidence

The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

2.

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

3

• Decision making on whether to establish new GP practices in an area;

Not within review period

Considered in 6

• Approving practice mergers; and Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

6

The CCG will also carry out the following activities:

a) To plan, including needs assessment, primary medical care services in Croydon

b) To undertake reviews of primary medical care services in Croydon;

c) To co-ordinate a common approach to the commissioning of primary care services generally;

d) To manage the budget for commissioning of primary medical care services in Croydon.

3, 5 2 3,4,5 4. 7

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e) To develop providers to deliver the CCG’s plans for transforming primary care, alongside the STP, as part of it’s out of hospital strategy.

f) To develop providers to support the CCG to reduce areas of variation to improve health outcomes for patients

g) To support the plans for transforming Estates and Technology in primary care in line with the CCG’s estates and IT strategy.

3. 3. 8.

4. Activities


1. Agreed the Terms of Reference reflecting its assurance role. 2. Agreed and recommended the Contract offer to Practices of PMS and APMS

Contracts. 3. Reviewed the Practice Development and Delivery Scheme (PDDS) designed to

support delivery of the CCG priorities in particular Out of Hospital Business Case and Outcome Based Commissioning by providing funding for more time with complex patients, electronic joint shared care plans and support for regular MDT meetings to support delivery.

4. Reviewing and agreeing the design of Quality Monitoring arrangements including a dashboard and the terms of reference of the Contract Quality Review meeting arrangements. The General Practice CQR includes Urgent Care hubs that were not part of the Croydon Urgent Care Alliance (CUCA). CUCA has an aligned but separate CQR arrangement.

5. Received reports on matters of concern around practices and reviewed Quality and Safeguarding Reports to be assured of the quality of services.

6. Discussed areas of concern to agree the action for the CCG to take as remedial action and to understand whether there were any implications for patients in response to a practice’s stated intention to hand back a contract to the CCG, indicating support, and granting eventual approval, to an associated practice merger.

7. Received and reviewed Primary Care Finance Reports at each meeting. In January 2018 the Committee noted that due delay in the mobilisation of some of the projects which has resulted in a forecast underspend of £427K on 2017/18 GPFV funds but that the total sum was fully committed and the funding would roll over into 2018/19.

8. Recommended a significant capital bid for the enhancement of Primary Care Estate and IT (Successful).

9. Agreeing a comfort letter, subject to conditions, associated with a long-terms lease to enable and support succession planning with a practice

Terms of Reference

The Quality Committee is obliged to review its Terms of Reference annually to ensure that they remain fit for purpose. The Committee, through this report has done so and considers that they remain relevant and adequately reflect the functions of the Quality Committee and recommends that their current format be adopted for the year 2018/2019.

Minor amendments are recommended as follows:

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• National Guidance issued in June 2017 around the handling of conflicts of interest in CCGs indicates that the CCG Conflict of Interest Guardian should not be Chair of the Primary Care Commissioning Committee. Now that the CCG has the recommended minimum number of Lay Members in post, it is an opportunity to reference the guidance to ensure that the Chair and Vice Chair Lay Member roles are selected accordingly.



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Approved at Croydon CCG Governing Body on 14 March 2017

Terms of Reference

Croydon CCG Primary Care Commissioning Committee

Introduction

1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014

that NHS England was inviting CCGs to expand their role in primary care

commissioning and to submit expressions of interest setting out the CCG’s

preference for how it would like to exercise expanded primary medical care

commissioning functions. One option available was that NHS England would

delegate the exercise of certain specified primary care commissioning functions

to a CCG.

2. In accordance with its statutory powers under section 13Z of the National Health

Service Act 2006 (as amended), NHS England has delegated the exercise of the

functions specified in Schedule 2 to these Terms of Reference to NHS Croydon

Clinical Commissioning Group. The delegation is set out in Schedule 1.

3. The Croydon CCG Primary Care Commissioning Committee (“Committee”) has

been established and will function as a corporate decision-making body for the

management of the delegated functions and the exercise of the delegated

powers.

4. It is a committee comprising representatives of the following organisations:

• Croydon CCG

• NHS England

• Surrey and Sussex LMC

• Croydon Healthwatch

• Croydon Health and Wellbeing Board

Statutory Framework

5. NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 in accordance with section 13Z of

the NHS Act.

6. Arrangements made under section 13Z may be on such terms and conditions

(including terms as to payment) as may be agreed between the Board and

the CCG.

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7. Arrangements made under section 13Z do not affect the liability of NHS

England for the exercise of any of its functions. However, the CCG

acknowledges that in exercising its functions (including those delegated to it), it

must comply with the statutory duties set out in Chapter A2 of the NHS Act and

including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and

economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

8. The CCG shall, with respect to functions delegated from NHS England,

exercise those in accordance with the relevant provisions of section 13 of the

NHS Act:

• Duty to have regard to impact on services in certain areas (Section 130)

• Duty as respects variation in provision of health services (Section 13P)

9. The Committee is established as a committee of the Governing Body of

Croydon CCG in accordance with Schedule 1A of the “NHS Act”.

10. The members acknowledge that the Committee is subject to any directions made

by NHS England or by the Secretary of State.

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Role of the Committee

11. The Committee has been established in accordance with the above statutory

provisions to enable the members to make collective decisions on the review,

planning and procurement of primary care services in Croydon CCG, under

delegated authority from NHS England.

12. The functions of the Committee are undertaken in the context of a desire to

promote increased primary care commissioning to increase quality, efficiency,

productivity and value for money and to remove administrative barriers.

13. The role of the Committee shall be to carry out the functions relating to the

commissioning of primary medical services under section 83 of the NHS

Act.

14. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

• Decision making on whether to establish new GP practices in an area;

• Approving practice mergers; and

• Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

15. The CCG will also carry out the following activities:

a) To plan, including needs assessment, primary medical care services in

Croydon

b) To undertake reviews of primary medical care services in Croydon;

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c) To co-ordinate a common approach to the commissioning of primary

care services generally;

d) To manage the budget for commissioning of primary medical care

services in Croydon.

e) To develop providers to deliver the CCG’s plans for transforming

primary care, alongside the STP, as part of it’s out of hospital strategy.

f) To develop providers to support the CCG to reduce areas of variation

to improve health outcomes for patients

g) To support the plans for transforming Estates and Technology in

primary care in line with the CCG’s estates and IT strategy.

Geographical Coverage

17. The Committee will cover the area of Croydon CCG

Membership

18. The Committee shall consist of the following voting members:

• Croydon CCG Primary Care Committee Chair (Lay Member)

• Croydon CCG Primary Care Committee Vice Chair (Lay Member)

• Croydon CCG Chief Officer

• Croydon CCG Chief Finance Officer

• Croydon CCG Chair

• Independent GP (to attend for decision making to avoid conflict of interest)

• Croydon CCG Registered Nurse Lay Member



19. The Chair of the Committee shall be elected from the

CCG Lay Members.

20. The Vice Chair of the Committee shall be the Lay member

not elected as the Chair

21. The following members will be non-voting members:

a. Representative from the Croydon Health and Wellbeing Board

b. Representative from Croydon Healthwatch

c. Representative from the Surrey and Sussex Local Medical Committee

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d. NHS England Representative

e. Croydon CCG Governing Body Members other than those listed as voting

members.

Meetings and Voting

22. The Committee will operate in accordance with the CCG’s Standing Orders.

The Board Secretary for Croydon CCG will act as Secretary to the Committee,

and will be responsible for giving notice of meetings. This will be accompanied

by an agenda and supporting papers and sent to each member representative

no later than 5 days before the date of the meeting. When the Chair of the

Committee deems it necessary in light of the urgent circumstances to call a

meeting at short notice, the notice period shall be such as s/he shall specify.

23. Each member of the Committee shall have one vote. The Committee shall

reach decisions by a simple majority of members present, but with the Chair

having a second and deciding vote, if necessary. However, the aim of the

Committee will be to achieve consensus decision-making wherever possible.

Quorum

24. One third of committee members are required for the meeting to be quorate,

including:

• The committee chair or the vice chair

• Two of the following: Accountable Officer; Chief Finance Officer, Director of Primary and Out of Hospital Care

Frequency of meetings

23. The Committee will meet at least once a quarter in public, except as

otherwise agreed by the members. This will normally be scheduled before a

Croydon CCG Governing Body Meeting.

24. Meetings of the Committee shall:

a. be held in public, subject to the application of 26(b);

b. the Committee may resolve to exclude the public from a meeting that is

open to the public (whether during the whole or part of the proceedings)

whenever publicity would be prejudicial to the public interest by reason of

the confidential nature of the business to be transacted or for other

special reasons stated in the resolution and arising from the nature of that

business or of the proceedings or for any other reason permitted by the

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Public Bodies (Admission to Meetings) Act 1960 as amended or

succeeded from time to time.

25. Examples of where it may be appropriate to exclude the public include:

o Information about individual patients or other individuals

which includes sensitive personal data is to be discussed ;

o Commercially confidential information is to be discussed, for

example the detailed contents of a provider’s tender submission;

o Information in respect of which a claim to legal professional

privilege could be maintained in legal proceedings is to be discussed;

o To allow the meeting to proceed without interruption and

disruption.

26. Members of the Committee have a collective responsibility for the operation of

the Committee. They will participate in discussion, review evidence and

provide objective expert input to the best of their knowledge and ability, and

endeavour to reach a collective view.

27. The Committee may delegate tasks to such individuals, sub-committees or

individual members as it shall see fit, provided that any such delegations are

consistent with the parties’ relevant governance arrangements, are recorded in

a scheme of delegation, are governed by terms of reference as appropriate and

reflect appropriate arrangements for the management of conflicts of interest..

28. The Committee may call additional experts to attend meetings on an ad

hoc basis to inform discussions.

29. Members of the Committee shall respect confidentiality requirements as set

out in the CCG’s Standing Orders and Standards of Business Conduct Policy.

30. The Committee will present its minutes to NHSE England and the Governing

Body of Croydon CCG on each occasion for information, including the minutes

of any sub-committees to which responsibilities are delegated under

paragraph 28 above.

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31. The CCG will also comply with any reporting requirements set out in

its constitution.

32. It is envisaged that these Terms of Reference will be reviewed from time to

time, reflecting experience of the Committee in fulfilling its functions. NHS

England may also issue revised model terms of reference from time to time, in

which case the CCG will review these Terms of Reference and revise as

appropriate.

Accountability of the Committee

33. The budget and resource accountability arrangements and the decision-making

scope of the Committee will be agreed pursuant to the delegation and

delegation agreement with NHS England.

34. For the avoidance of doubt, in the event of any conflict between the terms of the

Delegation and Terms of Reference and the Standing Orders of Standing

Financial Instructions of any of the members, the Delegation will prevail.

35. The Committee will make allowance for consultation with members of the public

and other CCGs, where this is appropriate.

Procurement of Agreed Services

36. Particular care is needed where the CCG commissions healthcare services,

including GP services, in which a member of the CCG has a financial or other

interest. This may most often arise in the context of co-commissioning of

primary care, particularly with regard to delegated commissioning, where GPs

are current or possible providers. Details of managing conflicts of interest can

be found in the CCG’s conflict of interest policy.

37. The CCG may work with the CSU to support procurement or contract

monitoring for primary care commissioned services, however the CCG is still

responsible for decision making and assurance.

38. The detailed arrangements regarding procurement will be set out in the

delegation agreement entered into between Croydon CCG and NHS England.

Decisions

39. The Committee will make decisions within the bounds of its remit.

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40. The decisions of the Committee shall be binding on NHS England and Croydon

CCG.

41. The Committee will produce an executive summary report which will be

presented to NHS England London Region and the governing body of Croydon

CCG on each occasion for information.

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1 May 2018

Title of Paper: CHAIRS ACTION: Direct Award of language and British Sign Language

interpretation contract to Language Line for 36 months from 1st April 2018

Lead Director Martin Ellis, Director of Primary and Out of Hospital Care

Report Author Ruth Frost / Ishfaq Hussain

Groups/Committees which have previously discussed/agreed the report.

Procurement Advisory Group Senior Management Team


Governing Body

Purpose of Report For Ratification

Recommendation:

The Governing Body is asked to Ratify the Chair’s action to ▪ Approve the direct award of the language and British Sign Language

interpretation contract with Language Line for 36 months from 1st April 2018 with an option to extend by 24 months.

Background:

The Standing Orders, which form part of the CCG’s Constitution, provide for “Emergency powers and urgent decisions” by way of Chair’s Action, in order to be able to transact necessary business in a timely way when a formal Governing Body meeting is not scheduled to take place. “Chairs action” is a formal governance process, requiring the Chair and Accountable Officer (or Chief Finance Officer if the Accountable Officer is unavailable) to approve a decision presented, having consulted with a Lay Member of the Governing Body prior to taking the decision. The decision must then be reported to the next Governing Body meeting, for ratification by the full meeting.

The CCG currently commissions language and British Sign Language interpreting from Language Line. The contract commenced 1st June 2013 and was due to end 31st March 2016. The lawful option within the contract to extend its duration was exercised and the contract was extended for 24 months.

• The current contract is now due to expire 31st March 2018.

• The estimated annual value of the service is currently £400,000 (combined spend by both CCG and Croydon Health Services).

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• The estimated whole life financial value of a replacement contract exceeds the threshold (£615k), above which there is application of the Public Contracts Regulations 2015. As such, the CCG has certain obligations in regard to ensuring transparency of the contract opportunity and where there is more than one capable and interested provider, to competitively tender the contract after advertising through both the Official Journal of the European Union (OJEU) and Contracts Finder.

• Alternatively, it is possible to lawfully award a call-off contract from a framework agreement which has been established through a procurement process which complied with the Public Contracts Regulations 2015. NHS Shared Business Services (SBS) has established such a framework in order to enable NHS Trusts and CCGs to commission services quickly and efficiently.

• The SBS framework allows the CCG to select a framework supplier either following a mini-competition process, or by directly selecting a provider of choice and entering into a contract without any further competition, as long as the CCG is satisfied that the supplier is able to deliver the CCG’s requirements and value for money.

• SBS has advised that the framework prices secured from the framework suppliers are very competitive and that undertaking a mini-competition process is unlikely to improve on the framework prices.

• Whilst the SBS framework runs until 31st October 2020, it is lawful to award a contract before this deadline and for the contract awarded to have a duration which exceeds this deadline.

There are two suppliers for the London region which have been successfully appointed to the SBS framework - these are Language Line Services and Capita. With the framework offering a choice in scope of services through different “lots”, it is possible for the CCG to award either one contract to a single provider, or split the CCG’s requirement to have a different supplier for different elements of service, e.g. telephone interpreting, face to face, British Sign Language, etc. The SBS framework includes a “lot” ( “One stop Shop”) which includes within its scope the following activities:

• Telephone interpreting

• Face to Face interpreting (in hours and out of hours)

• BSL (in hours and out of hours)

Key Issues:

• The CCG currently commissions language and British Sign Language interpreting from Language Line. The contract commenced 1st June 2013 and was due to end 31st March 2016. The lawful option within the contract to extend its duration was exercised and the contract was extended for 24 months.

• The current contract is now due to expire 31st March 2018.

• The CCG has the option to lawfully award a call-off contract from a framework agreement which has been established through a procurement process which complied with the Public Contracts Regulations 2015. NHS Shared Business Services (SBS) has established such a framework in order to enable NHS Trusts and CCGs to commission services quickly and efficiently.

• This opportunity may be taken to review the commissioning strategy and not follow a business as usual approach. The CCG may wish to either act as the lead commissioner for the service or request that CHS commission the service separately. The key issue is that CHS should be invoiced directly for activity generated. Finance is supportive of this approach.

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Governance:

Corporate Objective To commission integrated, safe, high quality service in the right place at the right time.

Risks

If the service continued beyond the contract end date without an extension the CCG would be in breach of EU procurement regulations. A direct award to a provider for the service using the NHS SBS framework this approach is lawful and fully compliant with the procurement regulations.


None identified


No conflicts of interest have been declared.

Clinical Leadership Comments Not requested


None identified

Equality Analysis

The service actively promotes equality of access to health services


There is no provision in the current contract to survey patients’ experience of the service. However, complaints from the health professionals and administrative staff who use the service are collated and reported by the provider.

Communication Plan


The contract is a call-off from an NHS SBS framework, assurances will be obtained to ensure appropriate IG policies are in place.

Reputational Issues

Equal access to health services would be affected if continuity of the service was not maintained.

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EXECUTIVE SUMMARY Background/Purpose Title: Language and British Sign Language interpreting for primary and secondary

care currently provided by Language Line

1. Background and Purpose The CCG currently commissions the supplier “Language Line” to provide Language interpreting and British Sign language interpreting services on a cost and volume basis, the service being accessible for use by Croydon Dental practices, GP practices, Pharmacies, Bromley Community Diabetes Service, Croydon University Hospital, Marie Stopes, St Christopher’s Hospice, and Urgent Care Centre. Activity carried out at CUH is recharged to

CHS. Marie Stopes pays Language Line directly and recharges the CCG. The purpose of this paper is to seek approval from the SMT to directly award a contract as a call-off from a lawfully established framework agreement. 2. Current service provision The service currently provided by Language Line contract comprises two components:

i. By appointment - Face-to-face language and British Sign Language interpretation ii. No pre-booking required - telephone language interpreting service

Clinicians and practice managers can book face-to-face interpreters over the phone or via the internet using a unique customer ID. The interpreters’ timesheets are validated by the service which booked the interpreter and a copy is kept by Language Line. There are approximately 800 face-to-face bookings per month with around half being in secondary care. The numbers of telephone bookings are much lower at around 100 in total. Activity which takes place at Croydon University Hospital (CUH) is recharged to CHS. On the advice of Finance it is suggested that the new contract should be structured to ensure that CUH are invoiced directly for activity. This will reduce the administrative burden in the recharge process and highlight to the Contract Lead for CUH activity occurring at CUH. 3. Performance of the current service GP Network meetings Prior to the contract extension in March 2016 all GP Networks via network meetings were asked for feedback about the service. The overall feedback was positive to very positive. It is recommended that a similar exercise is undertaken to provide reassurance to the CCG that GP experience has not changed detrimentally. Complaints No other complaints regarding the service have been received directly. Complaints sent to the provider are recorded and detailed in the monthly monitoring and are very low (<1%). 4. Financial Implications The contractual pricing and payment arrangements involve a “cost and volume” approach with an indicative CCG budget for 2016/17 of £400k. Whilst VAT is added to the service fees, this is lawfully reclaimed by the CCG under arrangements agreed between HMRC and the public sector in regard to this type of outsourced service. The values below are shown net of VAT.

Year Sum of Total invoice

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amount (£)

2017/18 (Year to date) 338,376.08

2016/17 482,156.13

2015/16 437,848.85

2014/15 424,515.17

2013/14 200,796.31

To be appointed to the NHS SBS Framework for the provision of Interpreting and Translation Services, applicant suppliers were checked to ensure good standing and financial stability – including failure scores, risk indicators, 3 years auditors accounts and financial strength. As an additional due diligence measure, the CCG may wish reassure itself that the successful supplier exceeds the company viability score set by the CCG by analysing the Dun & Bradstreet report. An analysis of this report has been requested from the Finance 5. Options to procure a new service Option 1: Direct Award of a Contract from the SBS Framework Agreement The NHS SBS Framework for the provision of Interpretation and Translation Services went live on 1st November 2016 and runs until 31st October 2020. The Service Level Agreement covers five “lots”: Lot 1: Face to Face (spoken language) Lot 2: British Sign Language Lot 3: Telephone Interpreting Lot 4: Document Translation Lot 5: One Stop Shop The CCG has the ability to contract directly with framework providers for Interpretation & Translation services via direct award on expiry of the contract to the current provider. Direct award can be made where: (a) only one supplier is able to meet the requirement of the organisation, OR (b) the most appropriate supplier can be identified based on the terms of the framework, OR (c) the award is made based on lowest price. As long as the CCG adheres to the SBS procurement process and Service Level Agreement relevant to the Framework, the awarding of a contract in this way is lawful and compliant with the Public Contracts Regulations 2015. The two framework suppliers for the London region are Language Line Services and Capita. The services can be broken down to specific “lots” eg telephone interpreting, face to face, British Sign Language etc. The CCG has the option to either award for separate “lots” or award a “Lot 5 One Stop Shop”. Through discussion with SBS, it has been assessed that the framework prices offered by Language Line Services are lower than those being offered by Capita (A copy of the rate cards are available) and in the case of BSL, the price difference is significant. Change in rate of unit costs

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The following table demonstrates the changes in unit cost by service for Language Line.

Current unit price (£) Framework price (£)

Telephone Interpreting £0.63 per minute £0.50

Face to Face £26 per hour £23 per hour

British Sign Language £135 minimum for 3 hours

£80 for 2 hour minimum

Using the activity for 206/17 financial modelling was undertaken to quantify the impact of these price changes (see Appendix 1). Overall the service cost would decrease by approximately £70k (an overall 17% cost reduction). Merits of this approach

a. NHS SBS have undertaken requisite supplier audits requirements to ensure compliance with specification and pre-employment checks.

b. Cash releasing savings opportunities through competitive pricing.

c. Ability to call-off services without having to complete a full OJEU procurement.

d. Disruption to the service is minimised with no mobilisation period, TUPE undertakings and disruption to the service as professionals familiarise themselves with the new arrangements.

e. Flexibility to allow organisations to specify the type of service they require

f. Additional discounts may be available through volume-based commitment

g. The latest Technology enabled products and services

h. The scope to specify bespoke requirements (fill rates, travel costs, etc.) at a local level.

i. Ability to call-off services without having to complete a full OJEU procurement

j. A wide variety of free of charge training SBS recommend that a further competition process (also known as a ‘mini-comp’) is completed to identify the most suitable supplier for the CCG and provide best value. The trend amongst awarding bodies is to award a contract duration of three years. Demerits No risks have been identified. The NHS SBS framework was established through a formal procurement process in compliance with the Public Contracts Regulations 2015. The specification had been developed through thorough consultation with the market and a wide range of public sector stakeholders. As NHS SBS have provided a fully EU compliant route for Public Sector Organisations to access Interpretation & Translation Services the risk of legal challenge cannot be quantified. However, this is not a new framework and many public bodies have already awarded contracts through it successfully.

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Option 2: Undertake a formal procurement process This option was explored with the CCG’s procurement specialists (NHS SBS). As service providers have provided their most competitive prices to gain acceptance on the national framework there will be marginal cost saving. Demerits

a. Procurement costs may outweigh any cost savings which may not be realised.

b. The procurement process will overrun the time available before the current service provider contract expires.

c. Service disruption and uncertainty whilst this procurement process is run. 6. Conclusion Croydon has a large immigrant population, therefore, a higher than average proportion of the population requires English to be interpreted into their first language. It is essential to afford equal access to health services for this group of patients. ‘Clinicians need to be able to communicate with patients to enable effective diagnosis of the

patient’s medical condition, failing to match a patient’s first or preferred language can impact on patient experience and health outcomes, the frequency of missed appointments and the effectiveness of consultations. The error rate of untrained interpreters (including family and friends) may make their use more high risk, than having no interpreter at all. It may have serious implications such as misdiagnosis and treatment, ineffective interventions and, in extreme circumstances, preventable deaths1. BSL interpretation is required to avoid indirect discrimination against ‘someone with a disability’ and is, therefore, required within the provisions of the Equalities Act 2010. In light of the above it is recommended that Croydon CCG continue to commission interpreting services for non-English speaking individuals and individuals who require British Sign Language interpreting. Feedback regarding the current service from local GPs is good and no contract management issues currently exist. The Commissioning Lead is not in receipt of any information which would indicate that there would be a cost saving creating an overall financial benefit by undertaking a procurement process and it is possible that future rates will rise. It is therefore recommended that the contract be awarded for 36 months. 7. Recommendation

1 Principles for high quality interpreting and translation services [version 1.19] Policy statement, NHS England

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SMT is asked to:

1. Separate the contract into the two elements, namely primary care and acute setting. CHS would be advised that the CCG will not be commissioning the interpreting and translation service on their behalf. CHS would then have the option to commission the service for themselves, possibly via the national framework.

2. Approve the direct award of the language and British Sign Language interpreting contract with Language Line for 36 months from 1st April 2018, reserving the option to extend this for up to a further 24 months.

8. Next Steps The next steps will be as follows: Engage the procurement support of NHS SBS to ensure that the process of awarding a contract remains compliant with the requirements of the Framework. Prepare a Contract Award Notice for publication through both OJEU and Contracts Finder. Engage with Language Line to progress toward contract signature, ensuring all necessary due diligence.

Appendix 1

20180215 Finance modelling ver 0.2.xlsx

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Croydon Clinical Commissioning Group

Governing Body Chair’s Action

Subject: LANGUAGE LINE – Interpreter & Sign Language Service Contract Award 1. Introduction and background: The CCG currently commissions language and British Sign Language interpreting from Language Line. The contract commenced 1st June 2013 and was due to end 31st March 2016. The lawful option within the contract to extend its duration was exercised and the contract was extended for 24 months. The current contract is now due to expire 31st March 2018.

The estimated annual value of the service is currently £400,000 (combined spend by both CCG and Croydon Health Services). The estimated whole life financial value of a replacement contract exceeds the threshold (£615k), above which there is application of the Public Contracts Regulations 2015. As such, the CCG has certain obligations in regard to ensuring transparency of the contract opportunity and where there is more than one capable and interested provider, to competitively tender the contract after advertising through both the Official Journal of the European Union (OJEU) and Contracts Finder. Alternatively, it is possible to lawfully award a call-off contract from a framework agreement which has been established through a procurement process which complied with the Public Contracts Regulations 2015. NHS Shared Business Services (SBS) has established such a framework in order to enable NHS Trusts and CCGs to commission services quickly and efficiently.

The SBS framework allows the CCG to select a framework supplier either following a mini-competition process, or by directly selecting a provider of choice and entering into a contract without any further competition, as long as the CCG is satisfied that the supplier is able to deliver the CCG’s requirements and value for money.

SBS has advised that the framework prices secured from the framework suppliers are very competitive and that undertaking a mini-competition process is unlikely to improve on the framework prices.

Whilst the SBS framework runs until 31st October 2020, it is lawful to award a contract before this deadline and for the contract awarded to have a duration which exceeds this deadline. There are two suppliers for the London region which have been successfully appointed to the SBS framework - these are Language Line Services and Capita.

It is proposed that the CCG proceeds to ensure that primary care patients can access the services. If CHS decide to revert to contracting with the CCG, CHS can be added to the contract for their respective activity at a later date.

At £321,311.95 per annum (with CHS share of the charge extracted), over the proposed life of the contract (3 years with an option for a further 2 year extension), this requires Governing Body approval.

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2. Reason for Emergency Action:

• The aim and expectation had been to contract jointly with CHS. However, in late February 2018, it was reported to SMT that CHS are contemplating a separate procurement with other SWL Acute Trusts.

• This contract award proposal was not therefore taken to the March 2018 Governing Body.

• The Governing Body does not meet until 1 May 2018. The CCG will be outside of a contract for interpreter and sign language services for primary care services until this time.

3. Recommendation: It is recommended that the Chair, on behalf of the Governing Body and in accordance with the CCG’s Standing Orders: Approve the direct award of the language and British Sign Language interpretation contract with Language Line for 36 months from 1st April 2018 with an option to extend by 24 months. This Action will be reported to the Croydon Clinical Commissioning Group Governing Body meeting in public, on 1 May 2018 for formal ratification. Signed:

Responsible Director/ Lead Date:

Chief Finance Officer Date:

Accountable Officer Date: CCG Chair Date Signed with the support of 1 Lay Member who has been consulted beforehand (to be attached by email).

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP Governing Body

6 March 2018

Title of Paper: Chair’s Action: Award of Interim Contract to current Community Ophthalmology Provider, Complete Ophthalmic Services (COS)

Lead Director Stephen Warren Director of Commissioning

Report Author Ben Smith CCG Board Secretary


SMT – 27 February 2018


Governing Body

Purpose of Report For Ratification

Recommendation:

The Governing Body is asked to Ratify the Chair’s Actions as detailed for: ▪ Award an “interim” contract to the current community ophthalmology provider, for an 11

month period, whilst the transformation of Ophthalmology services in Croydon is being undertaken.

Background:

The Standing Orders, which form part of the CCG’s Constitution, provide for “Emergency powers and urgent decisions” by way of Chair’s Action, in order to be able to transact necessary business in a timely way when a formal Governing Body meeting is not scheduled to take place. “Chairs action” is a formal governance process, requiring the Chair and Accountable Officer (or Chief Finance Officer if the Accountable Officer is unavailable) to approve a decision presented, having consulted with a Lay Member of the Governing Body prior to taking the decision. The decision must then be reported to the next Governing Body meeting, for ratification by the full meeting. Croydon has had a community ophthalmology service since 2009. In 2014, the CCG re-procured the community service to provide treatment for a specific list of minor eye conditions as detailed in Appendix 1. Complete Ophthalmology Service (COS) was awarded a three year contract April 2014. This contract was extended for a further 12 months and this is now coming to an end on the 30th April 2018. There are no further contract extensions available on this contract – revisit this subject to my earlier question. Chair’s action was taken on 3 April 2018 with support from Mike Sexton, Chief Finance Officer and Roger Eastwood, Lay Member - Finance

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Key Issues:

The key issues are as follows: 1) The Ophthalmology transformation programme is still progressing and therefore there

currently is no agreed model of care.

2) The Governing Body has not met in public since 6 March 2018.

3) The current community service contract will end 30th April 2018, with no further extensions available. Therefore to support the transformation programme progress and a new model developed and agreed jointly with key stakeholders, the CCG needs to extend the current contract with COS to maintain service provision in the community.

4) This also enable us mitigate risks around patient care and increases in potential financial impact due to increased activity in secondary care.

Governance:

Corporate Objective To commission integrated, safe, high quality service in the right place at the right time..

Risks

There are significant risks to the service not being extended i.e. there will be no service provision for patients requiring urgent and non-urgent community eye care that poses quality (increased pressure on secondary care) and associated financial risks. Additionally: ▪ There will be no service provision in place to support

the paediatric eye screening service. ▪ There will be no provision for triage resulting in

increased referrals to secondary care provider. ▪ GPs will have to book patients via errs to MEH as this

is currently done via COS. . ▪ The will be no community provision for walk in

services.


The potential contract value if extended for 11 months would be £586,000. Should the contract not be extended and on the assumption that it will result in activity going to secondary care, the likely financial impact on the acute contract will be an increase of £1.26m


None

Clinical Leadership Comments Clinical Lead is involved in transforming planned care programme. CLG To input into service review.


None Identified

Equality Analysis

N/A


To be included in the Planned Care Transformation Programme.

Communication Plan Letter to be sent to provider


None

Reputational Issues

Lack of an informed commissioning /procurement plan will have a negative impact on the CCG.

Without a community provider, minor eye conditions

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and glaucoma/cataract refinement would be treated in secondary care, time to treatment and cost of care.

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1 May 2018

Title of Paper: MINUTES OF THE INTEGRATED GOVERNANCE AND AUDIT COMMITTEE

Lead Director Philip Hogan, Lay Member

Report Author Elaine Clancy, Director of Quality and Governance


None


Croydon Clinical Commissioning Group (CCG) Governing Body

Purpose of Report For Information

Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the Integrated Governance and Audit Committee meeting held on

29 January 2018.

Background:

The Integrated Governance and Audit Committee (IGAC) provides the Governing Body with a means of independent and objective review of financial, quality, corporate governance, assurance processes and risk management across the whole of the CCG’s activities (clinical and non-clinical). The approved minutes of the meeting held on 29 January 2018 are attached. The Integrated Governance and Audit Committee met on 19 April 2018 and the minutes of the meeting will be brought to the next Governing Body.

Key Issues:

The Key issues discussed at the Integrated Governance and Audit Committee on the 29 January 2018 were :

▪ Review of the Board Assurance Framework and Risk Register Report ▪ The Counter Fraud Update Report was presented and discussed ▪ Annual Accounts arrangements were discussed ▪ The Internal audit report was presented and discussed.

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▪ The External audit report was presented and discussed. ▪ NEL CSU attended to present the Mid-Year Service Auditor report ▪ An update was provided on the Governance Review and proposed improvement

actions by Governing body members following discussions at Governing Body seminars

Governance:

Corporate Objective To commission high quality health care services that re accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve financial balance. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care.

Risks

No new risks were identified as a result of this paper.


None


None

Clinical Leadership Comments None

Implications for Other CCGs None

Equality Analysis

EIA are considered in the development of all quality and governance processes.

Patient and Public Involvement None

Communication Plan None

Information Governance Issues None

Reputational Issues

None

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Croydon Clinical Commissioning Group Integrated Governance and Audit Committee

Minutes

Date: Monday 29 January 2018 Time: 09.00 – 11.00 Location: Room 1.16, Sanderstead, Bernard Weatherill House


Members: ▪ Philip Hogan (PH), Lay Member for

Governance - Chair ▪ Roger Eastwood (RE), Lay Member for

Finance ▪ Amy Page (AP) Registered Nurse, Lay

Member

▪ Elaine Clancy (EC) Director of Quality and Governance

▪ Mike Sexton, (MS) – Chief Finance Officer

▪ David May (DM) Internal Audit, RSM UK ▪ Matthew Dean (MD) External Audit,

(Grant Thornton), for Sarah Ironmonger ▪ Mike Harling (MH), Counter Fraud, (RSM

UK) ▪ Ben Smith (BS) Board Secretary-minutes

▪ Martin Campbell-Smith (NELCSU) for

Service Auditor Review item

Apologies Apologies

▪ Andrew Eyres (AE) interim Chief Officer ▪ Tom Chan (TC), GP Governing Body

Member and Medical Director

▪ Nick Atkinson (NA) - Internal Audit, RSMUK

▪ Sarah Ironmonger (SI) Grant Thornton

Action

1 Introduction and Welcome Apologies were noted.

2 Declarations of Interest There were no declarations of interest relevant to the Agenda

3 3.1

Minutes of Last Meeting The minutes of the meeting held on 24 November were agreed as an accurate record subject to correction of three typographical errors: 5.3 – remove duplicate ‘that’ 6.1 – should read ‘deep dive’ 8.6 – remove remnant lines from July 2017 meeting concerning CQRG

4 4.1 4.2

Matters Arising and Action Log The action log was presented: All actions were noted to be complete as follows:

▪ Going Concern clarification was completed and on the agenda ▪ The contract log action has been addressed and is received by

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4.3

the Finance Committee quarterly. ▪ Meeting dates have been scheduled for the year.

The matter arising from the November meeting concerning the governance review was described by the Chair. The timeline for the governance improvement work-plan was tabled and noted. A workshop had taken place with governing body members and improvement actions allocated. A review of committee functions had taken place and considered fundamentally sufficient. Reviewed committee terms of reference were scheduled for the 19 April 2018 IGAC meeting.

5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.9

Governing Body Assurance Framework and Risk Report Elaine Clancy presented the report, explaining that the report seeks to provide an update on the status of risks to the strategic objectives of the CCG Governing Body and also receives escalated risks (those rated 15 and above on the risk register). New risks relating to primary care were noted and had been reported to the January 2018 Governing Body. There were no changes to other risk scores Roger Eastwood commented that the risks seemed relatively static. Elaine Clancy suggested that some more intensive work may be needed with Directorates since, while there is Director ownership and reviews taking place, a workshop programme reinforcing basics and concentrated reviews with teams should bring deeper embedding and enable greater assurance of risks being considered and updated as part of day to day operations. Members discussed the risk profile noting that financial risks dominate and the Chair added that the critical risks should have discussion at each meeting. Elaine Clancy asked if there were particular areas that the Committee sought to deep dive, noting the review of safety risks that takes place at the Quality Committee and risks duplication. Amy Page questioned whether the issues previously discussed around Continuing Healthcare were described in sufficient detail in the existing entries. Roger Eastwood said that the strategic objectives addressing health inequalities and transforming GP groups into hubs of excellence may have risks to examine in more detail. David May offered that an alternative approach to the scheduled board assurance and risk register audit may be to utilise the audit universe approach to complete and assurance map to prompt priority considerations. Members considered this would be a positive and beneficial use of internal audit support. The Integrated Governance and Audit Committee noted the Board Assurance Framework and Risk Register

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6 6.1 6.2 6.3 6.4 6.5 6.6

Counter Fraud Update Mike Harling presented the counter fraud update. It was noted that the Fraud Risk Assessment had taken place and the report would be considered by the Chief Finance Officer. Mike Harling provided an update on ongoing investigations. Members discussed the available responses to the now completed investigation into a Personal Health Budget that had not been used appropriately. Elaine Clancy noted that such cases can be revealed by quality assessments taking place that determine whether the right level and right quality of care is being received. It was noted previously that the audits assured the arrangements for other clients using personal health budgets. Roger Eastwood noted the earlier concern in relation to some provider activity at CHS and Mike Sexton was seeking a position statement from the Trust. The Integrated Governance and Audit Committee noted the Counter Fraud Update

7 7.1 7.2 7.3

Information Governance Quarterly Report Elaine Clancy provided a verbal update confirming that the IG steering group continues to monitor progress with IG toolkit and other actions. Good progress has been made and the focus is on the perennial action to ensure the necessary staff training completion by 31 March 2018. Elaine Clancy reported good progress on implementing the General Data Protection Regulations (GDPR) and that the CCG is on track to be compliant by May 2018. Elaine Clancy advised that no Subject Access requests had been received in Quarter 3. There had been no IG related Serious Incidents but some reports of minor IG breaches arising in continuing healthcare. Freedom of Information (FOI) requests were acknowledged to be broadly the same as those received across South West London. It was noted that there has been an ongoing FOI particular to Croydon that concerns a personnel matter where the CCG has sought to apply an exemption in seeking to protect a former officer’s personal information. The Integrated Governance and Audit Committee noted the Information Governance update.

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8 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9

Annual Accounts Mike Sexton provided a report that reflects the inter-company consolidation process under the DH and highlighted the relevant April and May 2018 timetable for reviewing and approving the accounts. The Accounting Policies were presented for approval and these were noted to be broadly unchanged. Mike Sexton reported that the going concern assumptions had been refreshed and were clearer that that Trusts and CCGs could remain a going concern irrespective of special measures. Mike Sexton drew the committee’s attention to the relevant Governing Body and Committee dates and described the management team’s proposal that the Governing Body delegates review of the final draft Annual Report and Annual Accounts (ahead of Council of Members approval) to the Integrated Governance Committee that meets on 21 May 2018. Matthew Dean confirmed that that External Audit would have no issues with the proposed arrangement. There was a discussion of the pre-CCG history in Croydon that had led to the Council of Members reserving the authority for Accounts approval. Mike Sexton presented the key sources of information and certainty. It was noted that the sections highlighted refer to estimates to be updated as the position on arbitrations etc become clearer. The committee noted that draft Annual Accounts would be received by their meeting on Thursday 19 April 2018. The Integrated Governance and Audit Committee

▪ Noted the timetable for completing the annual accounts ▪ Noted the draft accounting policies ▪ Noted the CCG management’s assumptions around Going

Concern for 2017/18

9 9.1 9.2 9.3

Internal Audit Update David May presented the report informing the Committee of completed audit assignments and the impact of those findings since the last meeting. David May confirmed the Information Governance Toolkit Audit was undertaken as advisory and confirmed that the CCG was on track to achieve at least level 2 compliance. The audit indicated two toolkit areas for which minutes will be required for upload to substantiate compliance. David May explained the Continuing Healthcare review was provided as a position statement. The report lists the previous issues and confirms progress is being made and substantiated with evidence. Three high

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9.5 9.6 9.7 9.8 9.9 9.10 9.11

recommendations and one medium recommendation remain partially outstanding. Data cleansing of the broadcare system had taken place but it was noted that this had not been commonplace prior to the audit. David May advised that there remains some discussion of joint funding and Elaine Clancy responded that there had been further discussion of the practicalities relating to the hosting of a joint post. David May said there was an action plan in place for delivering the ‘28 day’ standard. Progress had not been advanced as far as had been hoped and the impact of changes should be clearer by March 2018. Mike Sexton added that the CSU leadership responsible for the Continuing Healthcare team had attended the CCG’s senior management team and were scheduled to return. Mike Sexton said he had challenged their view that business as usual had been achieved and had advised the CCG’s requirements before this is accepted. Members looked forward to the official commencement of the joint post. David May agreed for the report to be shared with the Governing Body Members were advised of other internal audit work planned and David May said that RSM had been asked to look at the IT service provided by NELCSU; to include performance management and inventory/asset management. This had been a management request from the responsible CCG Director, Martin Ellis. Philip Hogan mentioned that the standard of IT in areas of Primary Care is a concern. Members discussed aspects of the update provided with the papers, arising from experiences in RSM’s wider customer base. Amy Page referred to the gender pay gap reporting requirement. Elaine Clancy said there had been work with NHS England on the issue and said Agenda for Change provides a protective framework while equality analysis takes place around the WRES data for the Annual Equality Report. Elaine Clancy advised members that applicants had been interviewed for the Lay Member, PPI role and that an offer has been made. Philip Hogan asked that an induction pack is prepared for the new appointee. In respect of the item drawing attention to the safety of staff when carrying valuable equipment. Elaine Clancy described the work taking place to review lone worker safety, including a policy for the independence coordinators that was approved alongside safety devices. David May described the approach taken to the early draft of the Head of Internal Audit Opinion. The Integrated Governance and Audit Committee noted the Internal Audit Update

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10 10.1 10.2 10.3 10.4

External Audit Update Matthew Dean provided an update on External Audit progress on behalf of Sarah Ironmonger. The work to date around the control environment was described and there was nothing to be brought to the committee’s attention. Members discussed the sector update and making use of the apprentice levy. Philip Hogan asked for assurance that any apprenticeship offered by the CCG could not be viewed as exploitative. Elaine Clancy described the apprentice currently working in the CCG corporate team attending college weekly and undertaking further on the job training on an agenda for change scale (employed via NEL CSU). Roger Eastwood prompted a discussion of CCGs control and information in the context of the STPs. Mike Sexton described the range of programmes from NHS-wide (e.g. Rightcare), to various regional and local to Croydon arrangements. Examples were given from the local workforce working to redesign services; noting that areas are targeted and locked within the £22 per head management cost. In response to a question from Amy Page around data accessibility across the region, Mike Sexton described the interoperability through ETTF funding. The Integrated Governance and Audit Committee noted the External Audit Progress Report and Emerging Issues Update

11 11.1 11.2 11.3

NEL CSU Service Auditor Reporting Martin Campbell-Smith attended to present the SAR report and covering letter. Martin Campbell-Smith highlighted that the report covers control design, not only sampled content during the reporting period. Three qualifications were described in relation to matters that had not been qualified in previous years including one where the design of a control was such that it could not be shown to be operating for the full 6 months. Members attention was drawn to a control exception in respect of Bank reconciliations. Martin Campbell-Smith added that the next report is due around 27 April 2018. Amy Page asked what day to day significance the stated control exceptions have. Martin Campbell-Smith said that the NELCSU produce a pack including aged debt information and the exception had arisen through no meeting having taken place (in April/May), despite constant engagement with the CCG. Mike Sexton said that he did not consider this to give rise to risk as June Month 3 data will catch up and this related to the CCG’s normal prioritisation of work, noting that the SAR process is very rigid. Members acknowledged the technicality of the breach.

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11.4 11.5

Martin Campbell Smith said that 3 of the 5 Commissioning Support Units nationally had the same qualification but there was limited appetite to change the control design. Members considered the areas to which SAR is or might be applied. Mike Sexton said that there is a standard suite, generally around financial process and, while there had been efforts to add other areas, inclusion requires agreement with the CSU and across the CSU’s customer base and the current scope of SAR was now adopted. Mike Sexton advised members that while NEL CSU SAR includes SBS system use, SBS has their own SAR scheduled from April 2018 while NHS England also lead on SAR for Capita’s processing of payments to primary care due in early February. Mike Sexton agreed to share these other SAR reports when available. It was noted that last years’ Capital SAR had several control exceptions that had required the CCG’s External Auditors to undertake additional work. The Integrated Governance and Audit Committee received and noted the report on Service Auditor Reporting.

MS

12 12.1 12.2

Report on Losses and Special Payments Mike Sexton presented the report. Mike Sexton advised that the Personal Health Budget Matter had been assessed together with the External Auditor and while approaches to recovery are considered, in the meantime these represent a CCG loss of £14,900. This sum was noted to be within Mike Sexton’s delegated limit for write-off. The Integrated Governance and Audit Committee noted the update on losses and special payments.

13 13.1 13.2 13.3

Report on Waiver of Standing Orders and Prime Financial Policies Mike Sexton presented the report Mike Sexton advised of one waiver for KPMG work supporting work of the Alliance and explained that the CCG is bearing around 50% of the cost. Agreement had been reached to extend to mid-December in respect of work around Alliance Agreement papers that were reported to the January Governing Body. Amy Page asked Mike Sexton if he is confident that there will be no further call on the CCG for Alliance Resource. Mike Sexton said that re-evaluating what extra resource is needed will go to the Alliance Board and that any additional contract support will be re-let through a new procurement. The Integrated Governance and Audit Committee noted the report on Waiver of Standing Orders and Prime Financial Policies

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14 14.1 14.2 14.3 14.4 14.5

Register of Interests and Declarations of Hospitality The register of interests was presented and members noted that this is provided and shared on the website for transparency. Amy Page noted that a request for a removal of one of her recorded interests had not yet been recorded. Elaine Clancy agreed to ensure this is examined with the Board Secretary to determine if there had been a lapse. Post-meeting note. The request to remove work with Brent CCG had been pending as this notification was in advance of the contract end date to take effect. The written message around the removal of Four Eyes Insight consulting has not been found (clarified on 26 March 2018 when 18/19 return received). Ben Smith drew attention to the Christmas Lunch offered by Ramsey Healthcare to Croydon GPs which had been declined by the CCG Chair but accepted by others noting the complexity when the offer is made to all practice staff not in their commission capacity. Ben Smith had talked at the Clinical Leadership Group in December to advise caution and subsequently pointed network chairs and other clinical leads to national guidance specific to clinicians in commissioning roles. Elaine Clancy advised that the national e-learning training was being provided and the CCG was determining how best to ensure accessibility. This e-learning will required completion by all governing body members by 31st May 2018. Philip Hogan noted that the national policy increased the threshold for acceptable gifts and hospitality from the CCG’s policy that remains in place and while attention had been drawn to the new limits, felt that the policy should be aligned before staff and officers are directed to training. Elaine Clancy explained the background to the policy statements and the decision to maintain existing limits while the consultation had been ongoing. The Integrated Governance and Audit Committee noted the Register of interests and declared Gifts and Hospitality

15 15.1 15.2

Minutes of Quality Committee The approved minutes of the Quality Committee on 23 October 2017 were presented for information Amy Page described matters considered at the more recent meeting on 22nd January 2018, staring that the Quality Committee have received updates on Continuing Healthcare and previous points discussed in the internal audit update were ongoing not deteriorating. The Integrated Governance and Audit Committee noted the minutes of the Finance Committee.

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16 16.1 16.2 16.3 16.4

Minutes of Finance Committee The approved minutes of the meeting of 24 November 2017 and were shared for information and noting. A more recent meeting had taken place on 8 January 2018 and Mike Roger Eastwood provided a verbal update. Mike Sexton said that the committee was going through the Recovery Log at each monthly meeting and advised that the Edgecombe dispute with CHS will require arbitration during February 2018. Mike Sexton drew members’ attention to the prescribing cost pressure projected up to £2m relating to shortages and associated price increases. Members were advised that NHS England had provided support confirming that the CCG would be allowed to run a larger deficit for 2017/18 and that NHS England will cover the costs in 2018/19 making clear that this is an exceptional issue that CCGs are not expected to resource. Mike Sexton said the risk narrows as year end approaches. The Chair asked if there had been news around the Virgin dispute and Mike Sexton provided an update noting that the CCG accounts contain provision associated with the legally assessed risk. The Integrated Governance and Audit Committee noted the minutes of the Finance Committee.

Risk Review There were no additional matters to be escalated for the Governing Body’s attention

18 18.1

Any Other Business Members discussed where short updates from external partners could be handled differently to enable best use of their time. Mike Sexton provided the context to NEL CSU’s approach to SAR updates and the circumstances in which they request to attend the CCG Audit Committees in person. It was confirmed that the CSU had not been called to attend for the purpose of being held to account.

17 Date of Next Meeting Date of Next Meeting Thursday 19 April 2018

The Chair brought the part 1 meeting to a close while those members in attendance left the room. A Part 2 Meeting followed to be minuted separately.

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1 May 2018

Title of Paper: MINUTES OF THE QUALITY COMMITTEE

Lead Director Amy Page, Registered Nurse, GB Member

Report Author Elaine Clancy, Director of Quality and Governance


None




Recommendation:

The CCG Governing Body is asked to: ▪ Note the approved minutes of the Quality Committee meetings held on 22 January

2018.

Background:

The Croydon CCG Quality Committee provides the Governing Body and Integrated Governance and Audit Committee with a means of independent and objective review of quality, corporate governance, assurance processes and risk management across the CCG’s clinical activities.

The minutes of the meeting of 22 January 2018 are attached. Quality Committee met on 26 March 2018. The minutes for this meeting will be brought to the next Governing Body meeting.

Key Issues:

The main issues discussed at the Quality Committee Meeting on the 22 January 2018 were:

▪ Integrated Performance and Quality report M7. ▪ Croydon CCG Strategic And Operational Quality And Safety Risks ▪ Safeguarding Update ▪ Looked After Children Health Assessment Update ▪ Quality Assurance visit update

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▪ Equality and Diversity Annual Report ▪ Terms of Reference for the Primary Care Contract Quality Review Group ▪ QIPP Highlight report ▪ Continuing Healthcare Review

Governance:


Risks

No new risks were identified as part of this report


None


None



None

Equality Analysis



None



None

Reputational Issues

None

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QUALITY COMMITTEE

MINUTES Date: Monday 22 January 2018 Time: 2.00 – 3.30 Location: Room 1.09


Members: ▪ Amy Page (AP) – Chair - Lay

Member, (Registered Nurse (AP) ▪ Tom Chan (TC) – Medical Director ▪ Elaine Clancy (EC) Director of

Quality and Governance ▪ Jon Norman (JN) GP, Governing

Body Member, Secondary Care Consultant – arrived during Item 5.2

▪ Michelle Perry (MP) Minutes ▪ Simon Lee (SL) Associate Director of Quality

and Governance

Apologies: ▪ Emily Symington (ES) Governing

Body Member ▪ Martin Ellis (ME) Director of

Primary Care and Out of Hospital ▪ Philip Hogan (PH) Lay Member

1. Introductions and Declarations of Interest Action

1.1 There were no declarations of interest declared.

2. Minutes of the last meeting

2.1 The minutes of the 4 September 2017 were agreed as a true record. The minutes of the 23 October 2017 were provided in line with Amy Page’s request to provide a line of sight around a Continuing Health Care update.

3. Action Log and Matters Arising

3.1 The action log was reviewed and members agreed that the following items are closed: QS-130 QS-131 QS-132 QS-133 QS-134

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4. Integrated Performance and Quality report Month 7 (October 2017)

4.1 4.2 4.3 4.4 4.5 4.6 4.8

Elaine Clancy outlined the following points around each of the areas listed below: Diagnostic Waits Diagnostics continues to be compliant following the workforce issues in echos at CHS. Month 7 saw the CCG achieve 99.6% against the 99.0% standard. Jon Norman joined the committee. Accident and Emergency performance remains below the national standard with 93% which is in line with where Croydon Clinical Commissioning Group wanted them to be at that point. However they are currently just above 90% YTD and issues affecting the type 1performance position include the bed availability. Cancer Waits Croydon CCG met 6 out of 8 cancer wait standards for October. 62 day first treatment and 62 day first treatment (screening referral) underperformed against 85.0% and 90.0% targets, respectively. CHS met 7 of the 8 standards for October, also missing the 62 day first treatment target with 83.0%. Cancer performance across Croydon and SWL continues to perform well compared to the national picture – some of CHS breaches are due to the cancer pathways in SWL and the current challenges at STG. IAPT Access recovery and intervention IAPT continues to improve and on trajectory. Quality Quality CQC visits took place at both Croydon Health Services and South London and Maudsley Community Mental Health Services (SLaM). The CQC report stated that SLaM Community mental health services require improvement. The Clinical Quality Review Group (CQRG) had a dedicated Care Quality Commission (CQC) action plan meeting to discuss timelines and actions. The report recognised the Trust are working hard and are aware of the issues. EC informed the members that she has requested a detailed quality report from the CQRG which includes an in-depth analysis of staffing, incidents and the quality impacts of performance.

5. Croydon CCG Strategic and Operational Quality and Safety risks

5.1 5.2

EC reported that the strategic and operational quality and safety risks have been updated and monitored and there are no significant changes. The members discussed steadily increasing emerging risks around black breaches. Tom Chan enquired about Croydon Urgent Care Alliance (CUCA) Safeguarding arrangements to which EC responded that there were concerns about safeguarding processes initially, however explained that

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the concern was not around patient’s safety and treatment rather concern around the contract-holder did not have sufficient governance processes in place to be assured and therefore how were they pulling everything together for shared learning. EC assured members that the Safeguarding team have been supporting the CUCA team to assist progression and are now assured that governance structures are now in place.

6. Safeguarding Update

6.1

EC pointed out that the 6 monthly safeguarding update should have come to today’s Quality Committee and reported that safeguarding continue to do an excellent job in the current challenges. There are small changes planned around a new model for the team for efficient delivery and succession planning and a draft structure is being worked on for further discussion. Action: MP to circulate the month 6 safeguarding report to members.

MP

7. Looked After Children (LAC) Health Assessment Update

7.1

EC explained to members that LAC health assessments (both initial and reviews) continue to increase and remain challenging in terms of DNA rates. The service for initial assessments is undertaken by North Croydon Medical Practice is currently meeting targets Since the Ofsted report Social Services have worked on systems and processes to ensure that the referrals are received and respond in a timely manner. EC pointed out that review health assessments are possibly more challenging for many reasons and expressed concern around managing capacity going forward. Senior Management Team (SMT) approved addition funding to the Trust. Members debated possible solutions in detail and EC resolved that lots more demand and capacity planning is required with more robust performance management processes in place. Simon Lee concluded that Sandra Richards had informed that the model for delivery from Croydon Health Services is due by 30 January to review.

8. Quality Assurance Visit Update

8.1 EC informed members about her visit with Andrea Davis to Jeanette Wallis House (community mental health teams). During the visit all the teams demonstrated the hard work and commitment in progress to improve quality and respond to the recent CQC report and subsequent actions. EC spoke to various clinical staff in general the feel is very positive.

9. Equality and Diversity Annual Report

9.1 Members discussed the Equality and Diversity annual report and agreed approval for the report to be uploaded to the website by 31 January 2018 and go to Governing Body in March 2018. The group discussed the WRES action plan and added that EC has asked the staff forum to look at the action plan and work with the E and D team. Action: SL to give update from staff forum around action plan.

SL

10. Primary Care CQRG Terms of Reference

10.1

TC confirmed that the first General Practice CQRG is taking place on Thursday 26 January 2018. EC informed that Martin Ellis (ME), Ben Smith

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(BS), TC and EC agreed that the diagrams around governance are not correct and need revising. EC explained that Primary Care Committee CQRG feeds into Quality Committee (QC) and then into PCC with a dotted line to Governing Body (GB). TC concluded that he expects lots of debate and sensitivity is key.

11. QIPP Highlight Report – QIPP report in full – Month 8

11.1 11.2 11.3 11.4 11.5 11.6

AP confirmed that members have already seen the QIPP report (M8) in full at Governing Body. EC enquired as to whether the report is at the level members requested. SL explained that the JIAP is aiming to scrutinise all impact assessments that have been completed for all QIPP projects to ensure that a full assessment has been done, to highlight and risks and mitigations are put in place where necessary. SL reassured members that robust processes and scrutiny is appropriate and advised that a decisions log is in place which he proposed to bring to the next quality committee to highlight evidence of assurance. Action: SL bring decisions log to quality committee to offer assurance. AP and Jon Norman (JN) discussed the ownership of QIPP and expressed concern around finance owning quality assessments. JN stated that better communication with GP’s would ensure better working relationships which would positively impact on patients.

SL

12. Continuing Healthcare Review

12.1 12.2

EC pointed out that the Associate Director of Continuing Health Care post has been appointed and is officially in post from 1st February 2018. This is a new joint post new post accountable to Director of Quality and Governance (CCG) and Director of Clinical services (CSU). EC informed members that there are still significant challenges within the service but that there was an understanding of the issues and a robust action plan being developed alongside the transformation plan to improve the governance systems processes and culture of the team.

13. Quality Risks

13.1

JN expressed anxiety over the fact that there are no new risks emerging. AP requested further updates on Looked after Children health assessments and Continuing Health Care.

14. Any Other Business

14.1

EC announced that the CUCA CQC report results are overall requires improvements which was expected because it is a new service. There will be an update of the findings and the action plan at the next committee

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14.2

following the next CUCA CQRG where EC has requested an action plan. Flu has been on the increase in Croydon, and identified by PHE as an outlier. The flu group continues to meet regularly and EC was pleased that vaccinations of staff at CHS have been over 70%, as well as 40 out of 78 staff vaccinated in the CCG.

15. Date of next meeting: Monday 26 March 2018 2–4 pm Room: 1.09 - BWH

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1 May 2018

Title of Paper: MINUTES OF THE CLINICAL LEADERSHIP GROUP

Lead Director Agnelo Fernandes, Chair

Report Author Martin Ellis, Director of Primary and Out of Hospital Care


Clinical Leadership Group




Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the Clinical Leadership Group meetings held on:

7 February 2018

Background:

The purpose of the Clinical Leadership Group is to provide clinical and corporate support to the Croydon Clinical Commissioning Group (CCG) Governing Body. The group supports the Governing Body to realise and deliver the strategic aims and objectives of the CCG, addressing local and national targets and health care needs. The minutes of the meetings held on 7 February 2018 are attached.

Key Issues:

The following were the key issues discussed on the 7 February 2018:

▪ Governing Body and Finance Highlights ▪ Feedback from Primary Care CQRG held on 24 January 2018 ▪ Feedback from GP Open Meeting held on 25 January 2018 ▪ Update on Clinical Leads recruitment ▪ Feedback from Network Meetings ▪ QIPP Workshop

A special Meeting was held on 4 April 2018 so March CLG Minutes are not yet approved.

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Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve sustainable financial balance by 2020/21. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care. To have all Croydon GP practices actively involved in commissioning services and develop a responsible and learning commissioning organisation.

Risks

No new risks were identified as part of this report.


None


None



None

Equality Analysis



None



None

Reputational Issues

None

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Croydon Clinical Commissioning Group Clinical Leadership Group Meeting

MINUTES

Date: Wednesday 7 February 2018 Time: 13:30 – 15:30 Location: Braithwaite Hall, Croydon Town Hall, Katherine Street, Croydon


▪ Dr Agnelo Fernandes (AF), Chair ▪ Dr Amit Abbot (AA), Deputy Clinical Lead ▪ Dr Yinka Ajayi-Obe (YAO), Clinical Network

Lead ▪ Dr Tony Brzezicki (TB), Clinical Lead

Planned Care ▪ Dr Tom Chan (TC), Medical Director ▪ Dr Karthiga Gengatharan (KG), Clinical

Network Lead ▪ Dr Dev Malhotra (DM), Clinical Lead –

Mental Health (rotating Co-Chair Part A) ▪ Dr Shamaila Masood Hussain (ShM)

Deputy Clinical Lead ▪ Dr Ameesh Patel (AP), Deputy Clinical Lead ▪ Dr Sam Randle (SR), Clinical Lead – IT ▪ Dr Farhhan Sami (FS), Clinical Network

Lead ▪ Dr Josephine Sheyin (JS), Clinical Lead –

IUC & NHS 111 (rotating Co-Chair Part B) ▪ Dr Mike Simmonds (MSi), Clinical Network

Lead ▪ Dr Emily Symington (ES), Croydon CCG

Governing Body Member ▪ Dr Nishal Velani (NV), GP Lead – End of

Life Care

▪ Claudette Allerdyce (CA), Associate Chief Pharmacist, Croydon CCG

▪ Kate Archer (KA), Head of Programme Management Office, Croydon CCG

▪ Marlon Brown (MB), Head of Integrated Commissioning – Mental Health, Croydon CCG

▪ Paul Cooper (PC), Commissioning Programme Lead, Planned Care Commissioning, Croydon CCG

▪ Martin Ellis, (ME), Director of Primary and Out of Hospital Care, Croydon CCG

▪ Ruth Frost (RF), Head of Primary Care, Croydon CCG

▪ Fouzia Harrington (FH) Aarti Joshi (AJ), Associate Director of Planned Care Transformation, Croydon CCG

▪ Jon Norman (JN), Secondary Care Consultant, Croydon CCG GB

▪ Tumsilla Sethi (TS), Primary Care Project Manager, Croydon CCG

▪ Mike Sexton (MiS), Chief Finance Officer, Croydon CCG

▪ Stephen Warren (SW), Director of Commissioning, Croydon CCG

▪ Cynthia Renders (CR), Business Manager, NELCSU

Apologies:

▪ Dr Bobby Abbot (BA), Clinical Network Lead ▪ Dipti Gandhi (DG), Clinical Lead – Diabetes ▪ Dr Kamran Khan (KK), Clinical Lead –

Education

1 Welcome, Introductions and Clinical Lead work headlines Action

1.1

AF welcomed everyone to the meeting. Members introduced themselves and provided a brief update on their achievements since the last meeting.

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2 Apologies for absences

2.1

Apologies noted above.


3.1

There were no declarations of interest reported.


4.1

The minutes of the meeting held on 3rd January 2018 were agreed as an accurate record.

5 Matters Arising

5.1

The action log was reviewed and updated.

6 Governing Body and Finance Highlights

6.1 6.2

Mike Sexton updated the group on the GB and Finance highlights. The group requested that the GB summary be shared with Network Leads as soon as possible. ACTION: Martin Ellis assured the group that the updated version of the GB summary will be sent out to Network Leads.

ME

7 Feedback from Primary Care CQRG held on 24 January 2018

7.1 7.2 7.3

Tom Chan reported that the first GP CQRG meeting took place and attendance was good. This meeting will meet bi-monthly. He advised that the Dashboard was sent out and asked the group to look through it. However, he stated that this meeting is still in its early days and encouraged Network Leads to attend; it was suggested by Karthiga Gengatharan that workforce issued should be included. ACTION: Vasudha Rai to invite Network Leads to future Primary Care CQRG meetings. Tom Chan also reported that a couple of CCGs across the UK have a mature group that he would like to learn from.

VR

8 Feedback from GP Open Meeting

8.1

The second GP Open Meeting met on 25th January 2018 and the key focus was on the following:

• IT systems are old and need updating.

• There is a need to demonstrate that what’s being said is being heard.

• Next meeting is on 21st March 2018 and plans are being made to ensure the momentum is picked up.

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9 Update on Clinical Leads Recruitment

9.1 9.2

Agnelo Fernandes reported the following:

• Independent Chair of Alliance appointed.

• Adverts going out for GP on the Governing Body shortly. ACTION: Tom Chan and Martin Ellis to review Clinical Leads portfolio.

TC / ME

10 Feedback from Networks

10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12

Purley Network Meeting Sickness Claims NHSE advised that these would be decided by local CCGs. ACTION: Martin Ellis will chase up where sickness claims should go and will share the response with the group. Thornton Heath Network Meeting ERS The Network felt that not all specialities were on ERS for CUH. However, Sam Randle confirmed 92% of clinics were on ERS. ACTION: Shamaila Masood will ask for any specific examples if there are any further issues. GP Hubs (CUCA) Not enough info on discharges is being received. And Network members reported that the reason for this is only one line is received in CUCA by GPs on EMIS as a function needs to be switched on and the GPs don’t know what that function is which is causing an Information Governance breach, however, Sam Randle reported that this is being looked at by Alison O’Grady, Interim Head of Urgent Care. ACTION: Stephen Warren to liaise with Dr Josephine Sheyin on resolving the EMIS and 111 glitches, as well as the dressing’s issue. The Network had asked where they could access data on how much each practice is using the GP Hubs. This is available on Power BI. East Croydon Network Meeting CMC Tom Chan advised that the 2% target message needs to be communicated clearly; however, members believe this system is outdated, but Agnelo Fernandes reported that there are still a number of organisations that use it. The CMC have has been advising service users to only use the online

ME

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10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25

method rather than the paper format as using both tends to cause discrepancies between the two. The highest practice usage in Croydon is Woodcote Medical. ACTION: Nishal Velani to draft a letter to practices advising them on how to achieve the 2% target on CMC. GP Networks to encourage Practices to complete the CMC tool all the time. GP Forward View Money was discussed and practices were asked to bring further ideas for next meeting. ACTION: Group members to bring ideas for the GP Forward View Money discussion. Training on ERS referrals, to be conducted by Practice Managers/Nurses instead of GPs, is being held. Clinical Leads are also welcome to complete the training. Mayday Network Yinka Ajayi-Obe reported that the latent TB pathway has been through the LMC and CCG, however, it will be revisited because uptake was low. Woodside/ Shirley Network Amit Abbot advised that there were no issues to report. Selsdon/New Addington Network Mike Smmonds advised that there were no issues to report, except to raise the issue on GP Forward View money. In a separate comment Martin Ellis reported that there is an opportunity to improve GP by bolstering the good practices and learning from the bad. This will be the focus for the next few months.

NV

ALL

11 QIPP Workshop

11.1

Tom Chan led the group in an interactive session with focus to ensure each pound spent has maximum benefit, and requested that members share their suggestions and recommendations as soon as possible.


12.1 12.2

Long Term Conditions never had integration with Public Health, which needs improvement Mike Simmonds reported that GP’s at South Norwood Hill Medical

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12.3 12.4 12.4

Centre are not referring patients to the CUH Breast Cancer service; there is a need for comms to be fed back to Network Leads to begin to do so and Mr Sarakbi is happy to visit practices to offer support. ACTION: Mike Simmonds to share referral benchmark list with members. ACTION: Vasudha Rai to add STP update to the next agenda. Agnelo Fernandes reminded members to complete 360 survey responses.

MSi

VR

13 Date of Next Meeting

7 March 2018, 13:30 – 15:30, Braithwaite Hall, Croydon Council

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Croydon Clinical Commissioning Group

Finance Committee

Minutes Date: 26 February 2018 Time: 16.00-17.30 Location: Room 1.07

Members In Attendance

Present: ▪ Roger Eastwood, (RE) Lay Member – Chair ▪ Tom Chan (TC) GP Member ▪ Jon Norman (JN) Secondary Care

Consultant member

Present: ▪ Mike Sexton (MS), Chief Finance

Officer ▪ Marion Joynson (MJ), Deputy Finance

Officer ▪ Jessica D’Cruz (JD), Business Manager

to MS – for minutes

Apologies: ▪ Agnelo Fernandes (AF) Clinical Chair

Apologies: ▪ Andrew Eyres, Chief Officer ▪ Stephen Warren (SW), Director of

Commissioning

1 Apologies for Absence Action

1.1 The apologies were noted

Introductions and Declaration of Interest

2.1

No interests were declared.

3. Minutes From Last Meeting

3.1 3.2 3.3 3.3

The minutes of the last meeting were agreed, subject to the following amendments. Minute 4.1 - amend outside the meeting Minute 4.3 - remove the last sentence. Minute 8.4 - remove the last sentence.

JD JD JD

4. Action Log / Matters Arising

No items.

5. Finance Report (M10)

5.1

MS highlighted the key financial risks to the Finance Committee: Acute contracts performance (incl LAS), delivery of £21.2m QIPP programme (£4m) and the Edgecombe unit dispute with CHS.

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5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9

MS drew the committee’s attention to the Croydon Health Services contract position - the reported position is £3.0m year-to-date underspend and £3.6m forecast underspend. Performance is down across most points of delivery including elective and emergency admissions. MS explained it should be noted that A&E attendances are above plan reflecting sub-optimal impact of the new Urgent Care services. The CCG is exploring a year-end agreement with the Trust which will need to address the on-going funding dispute for the Edgecombe Unit (£2.6m 16/17 and £1.2m 17/18). MS provided an update on Mental health (including learning disabilities) and explained the CCG and SLaM continue to work through the recommendation from the independent audit that the CCG was not the responsible commissioner for £473k of occupied bed day activity (mental health inpatient stays).

In respect of Continuing Health Care (CHC) budget and the CHC QIPP target, significant risk was highlighted due to the longer than expected timetable in the transformation of the underlying service provision. However with only 2 months remaining the in-year financial risk was now limited.

The responsible commissioner disputes continue to be challenged through the NHSE CHC leads. The Dorset CCG dispute is in the NHSE formal process, and the Kingston CCG dispute is in a SWL dispute resolution process.

Mike Sexton highlighted additional risks on the specialised commissioning allocation adjustment (net £400k), Q4 impact of out of hospital business case, and receipt of £400k dowry funding for LD clients.

Tom Chan asked for clarity that the specialised commissioning and dowry funding would be resolved by March. MS confirmed this was the CCGs expectation and that the indications from NHSE were that the allocations would be made in 2017/18.

Jon Norman asked why the value of the “Sepsis” coding risk is so high. The understanding is that CHS has pushed harder than other local Trusts to improve coding of Sepsis, as they are required to do. The issue is subject to further guidance from NHSE/I. MS explained the CSU have contracted an independent audit of sepsis coding at CHS and other SWL providers.

In respect of aged debt, MS highlighted that the oldest items related to the responsible commissioner disputes which were on-going. In respect of resolving historic transactions with the council, it was likely the disputed 2014/15 Amberley Lodge invoice (£140k) would be withdrawn as part of an overall settlement on responsible commissioner items with the council.

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6 QIPP Report (M10)

6.1

Mike Sexton highlighted the current position the Finance committee noted the QIPP report as read. The risks had been highlighted in the previous agenda item.

7 Contracting Portfolio Report (M9)

7.1 7.2 7.3 7.4 7.5 7.6 7.7

The committee noted the Contract Portfolio Report and action plans. The committee reviewed the recommendations and concluded the following:

• Dermatology - agreed no action to be taken by the Committee.

• Locally Commissioned Services (LCS, also known as LIS) – agreed no action to be taken by the Committee

Jon Norman asked had there been any reduction in the numbers of patients going to the private sector. MS explained the Director of Commissioning has sought legal advice about reducing activity flows to the independent sector. The CCG is refining actions plans in light of the advice. Mike assured Jon Norman the number of referrals have not increased but have stabilised. Tom Chan confirmed to the Finance Committee that at all network meeting he has raised awareness regarding continuity benefits of the NHS rather than referrals to the private sector. Mike Sexton explained volume of patients seen at the GP Hubs and Urgent Care Centre (delivered by Croydon Urgent Care Alliance) is increasing, but the CUCA alliance continue to not meet the quality targets in the contract.

Jon Norman requested an explanation of the term “paediatric village”. CHS has developed a business case to develop paediatric short stay services and paediatric/ critical care services. Mike Sexton explained the management team had considered a first draft business case, but had further questions on affordability, and the involvement of NHSE Specialised Commissioning. Roger Eastwood asked what is happening with the wheelchair services. Mike explained the CCG and CHS are working with London Borough of Croydon to see if this can be managed by as part of the wider equipment services provision, at the current cost levels. There is a risk the business case to transfer to the council is not ready in time for March 2018.

8 Primary Care Finance Report

8.1

Mike Sexton explained to the committee the full range of extended access services were now in place. The Finance committee noted this report.

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9 Key Provider Report

9.1 The committee noted the reports. The strong performance of the Croydon borough in the SLAM report was noted.

10 Financial Planning 2018/19

10.1 10.2 10.3 10.4 10.5

Mike Sexton presented to the Committee the 2018/19 Financial Plan - delivering statutory breakeven underpinned by £26.4m QIPP, growth and inflation assumptions and latest planning guidance. MS highlighted that the additional flexibility has been deployed to create 0.25% transition fund, MH investment (to 0.59%) and £4m contingency against delivery risk. Mike Sexton explained that the increase in Mental Health expenditure is the same as the overall CCG year-on-year increase in expenditure (0.59%). It should be noted that this is short of the national requirement to increase Mental Health expenditure by the rate of the allocation growth (3.59%). The further required would is £1.2m and would be a priority against the 0.25% transformation fund. Mike Sexton asked the committee to note the requirement for SWL CCGs to deliver £7.4m surplus and the meet the Mental Health Investment Standard. These are significant risks to the CCG. The SWL CCGs are considering how they can provide short term support in Richmond and Croydon.

Mike Sexton explained the final plans to NHSE will be submitted on the 30th April. Jon Norman was assured with the level of 2018/19 QIPP development.

11 Update on IT and Estates

11.1 11.2 11.3

To manage the emerging capital programmes, Martin Ellis will be establishing an Estates and IT Steering Group. The terms of reference are to be circulated for comment and will include a Lay Chair for the group. It was recommended this is the Chair of the Finance Committee.

The CCG Corporate IT Team is working with SWL Alliance to roll out the use of Surface Pro’s.

In respect of GP IT, the CCG is continuing to work with SWL to roll out ETTF funded schemes such as interoperability and remote working technology for GP’s for home visits.


None reported.

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1 May 2018

Title of Paper: MINUTES OF THE FINANCE COMMITTEE

Lead Director Roger Eastwood, Lay Member

Report Author Mike Sexton, Chief Finance Officer


None




Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the Finance Committee meeting held on 26 February 2018

Background:

The Croydon CCG Finance Committee provides the Governing Body and Integrated Governance and Audit Committee with a means to exercise its role of independent and objective review of financial assurance processes and risk management across the whole of the CCG’s financial activities. The minutes of the meetings held on 26 February 2018 are attached.

Key Issues:

The following were the key issues discussed on the 26 February 2018:

▪ Turnaround Action Log ▪ Finance Report (M10) ▪ QIPP Report (M10) ▪ Contracting Portfolio Report (M9) ▪ Primary Care Finance Report ▪ Key Provider Report ▪ Financial Planning 2018/19 ▪ Update on IT and Estates

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Governance:

Corporate Objective To achieve sustainable financial balance by 2020/21.

Risks

Significant risks in delivering Detailed Financial Plan as outlined in the paper. The current risk rating of QIPP/Transformation is £14m of the £21m QIPP plan.


None


None



None

Equality Analysis



None



None

Reputational Issues

None

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1 May 2018

Title of Paper: MINUTES OF THE PRIMARY CARE COMMISSIONING COMMITTEE

Lead Director Philip Hogan, Lay Member (Governance) and Conflict of Interest Guardian



None




Recommendation:

The CCG Governing Body is asked to: ▪ Note the approved minutes of the Primary Care Commissioning Committee held on 9

January 2018

Background:

The Croydon CCG Primary Care Commissioning Committee is a decision-making committee of the Governing Body responsible for the approval of arrangements for discharging the CCG’s responsibilities and duties associated with its primary care commissioning functions, including those delegated by NHS England in accordance with section 13Z of the NHS Act.

The minutes of the meeting of 9 January 2018 are attached. The Primary Care Commissioning Committee met in public on 6 March 2018. The minutes for this meeting will be brought to the next meeting. In the meantime, a summary of matters discussed is provided on the CCG website.

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Governance:


Risks

No new risks were identified as part of this report


None


None



None

Equality Analysis



None



None

Reputational Issues

None

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MINUTES

Date: Tuesday 09 January 2018 Time: 2:00pm – 4.00 p.m. Location: Ranyard Room, Croydon Conference Centre, Croydon


Governing Body Members ▪ Agnelo Fernandes (AF), Chair ▪ Emily Symington (ES) GP Governing Body

Member ▪ Amy Page (AP) Registered Nurse, Lay

Member ▪ Roger Eastwood (RE) Lay Member -

Finance ▪ Andrew Eyres (AE), Accountable Officer ▪ Mike Sexton (MS) Chief Finance Officer ▪ Stephen Warren (SW) Director of

Commissioning ▪ Elaine Clancy (EC) Director of Quality and

Governance ▪ Martin Ellis (MC) Director of Primary and

Out of Hospital Care

▪ Jai Jayaraman (JJ) Healthwatch Chief Executive

▪ Ellen Schwartz (RF) Director of Public Health, Local Authority (Deputising for Rachel Flowers

▪ Ben Smith (BS), Board Secretary

Apologies ▪ Philip Hogan (PH) Lay Member

Governance and Conflict of Interest Guardian

▪ Jon Norman (JN) Secondary Care Consultant

▪ Tom Chan, Medical Director and GP Governing Body Member

Apologies ▪ Barbara Peacock (BP) Director of

People, Local Authority ▪ Rachel Flowers (RF) Director of Public

Health, Local Authority

Ref: 2018/01/01

1 Introduction and Apologies Action

1.1 1.2

Apologies were noted. Dr Agnelo Fernandes opened the meeting.

Ref: 2018/01/02


2.1 There were no specific declarations of interest other than the generic interest of practicing GPs.

Ref: 2018/01/03


3.1 The minutes of the meeting held on 07 November 2017 were agreed

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Ref: 2018/01/04

4 Matters Arising

4.1 4.2

CCG-192 Mike Sexton described that the QIPP report format that was the subject of this action had continued to develop. The Quality spotlight section had been restored and was included in the QIPP paper attached to the Governing Body meeting agenda. The action was closed CCG-193 Martin Ellis advised that the Quality Arrangements for Primary Care providers including General Practice had been presented and discussed at the preceding meeting of the Primary Care Commissioning Committee. These arrangements including terms of reference for the General Practice Contract Quality Review Group had been accepted subject to agreement by the Quality Committee on 22 January 2018.

Ref: 2017/09/05

5 Joint Chair/Chief Officer Report

5.1 5.2 5.3 5.4

Andrew Eyres and Dr Agnelo Fernandes presented the report. Andrew Eyres highlighted three areas of positive assurance since

the last meeting starting with a peer-led visit to the Croydon Care

System by the National ‘Hospital to Home’ Executive Team,

endorsing the work taking place in conjunction with the Croydon

Alliance. Croydon had been rated ‘green’ against NHS England’s

Patient and Community Engagement Indicator that forms part of the

CCG improvement and assessment framework (IAF). Andrew Eyres

thanked the communications and engagement team for their hard

work ensuring the improvement this represented. The CCG’s

emergency preparedness, resilience and response (EPRR)

arrangements, needed in case of big infrequent events, had been

assessed in November 2017 and rated fully compliant with national

emergency planning standards.

Agnelo Fernandes congratulated Lucy Ndomo on news of her receiving recognition in the New Year’s Honours list for her inspirational work engaging with local people on the dangers of female genital mutilation (FGM). Angelo Fernandes also welcomed the announcement of Mike Bell’s reappointment as Chair of Croydon Healthcare Services NHS Trust (CHS) saying he offers important stability and leadership.

Ref: 2018/01/06

6 Medicines Optimisation Presentation

6.1 6.2

Martin Ellis introduced Louise Coughlan, Joint Chief Pharmacist of both the CCG and CHS since September 2017 who gave the presentation on the work of the CCG’s pharmacy teams. Louise Coughlan illustrated the work of the team interpreting and implementing national guidance and working closely with prescribers

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6.3 6.4 6.5 6.6 6.7

on the introduction of new medicines and described work across London on new drugs. A graph was used to show Croydon’s as one of the most cost-effective pharmacy teams (by average cost per prescribing unit) Medicines optimisation was explained in lay terms as ensuring medicines are appropriate to the individual patient (rather than ‘take as directed’ when it is estimated that only a small percentage of patients do so correctly). Louise Coughlan described the patient interface system helping to make referrals into hospital or flagging to community pharmacists to undertake a review. Recruitment to the Integrated Community Network (ICN) Pharmacist posts was described as nearing completion and Louise Coughlan explained their work with GP practices and with out of hospital ‘huddles’ making interventions and reducing waste; illustrated by ceasing the inadvertent stockpiling of medicines by patients in the community. The work of the Variation team, alongside practice support pharmacists, to tackle issues across GP practices was described, noting their success at extracting data; especially improving coding around diabetes and COPD and using prompts to GPs via the EMIS system to enable measurable data showing the impact of changes. Future developments were described, noting the NHS England interest in self-care and use of local pharmacies. There are also plans for increasing medicines optimisation work into care homes, further joint working with Croydon University Hospital including improved IT connectivity to enable review of referrals where re-admissions may be avoidable. Other areas of development were described around working with the Alliance, expanding the local formulary across SW London, reducing geographic anomalies around respiratory medicines. Louise Coughlan was thanked for the presentation and the work of her team, acknowledging the legacy of her predecessor. GP members described the productive relationships developed with the pharmacy team in their practice. In response to a question about news of medicines shortages, Louise Coughlan explained shortages tend to come and go quickly but that the team are signed up to early warning bulletins with which they work with GPs to change their prescribing practice appropriately.

Ref: 2018/01/07

7 Developing our Strategic and Operational Plans

7.1

Croydon’s Health and Care Transformation Plan and 2018/19 Financial Plan Stephen Warren introduced Croydon’s Health and Care Transformation Strategy and Planning Summary.

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7.2 7.3 7.4 7.5 7.6 7.7

Agnelo Fernandes explained that the combination of plans presented are key to the CCG’s sight and influence over the Croydon Health and care system. Andrew Eyres added these follow engagement with Governing Body members in seminar time in November and had been fully endorsed as the right approach, informed by the learning from the strategic review commissioned with CHS from McKinseys. Some plans represent work in progress and will be brought back to future Governing Body meetings for approval. Andrew Eyres added that the financial position of the Croydon system remains paramount with an aim to get back to a sustainable position while ensuring patient outcomes are assured. The attached plans were described as communicating the CCG’s intention to extend both the partnerships and the scope of work of the Alliance; there was also an illustration of the Sustainability and Transformation Programme (STP) and timeframes of collaborative work. Mike Sexton introduced the draft finance position explaining that the paper was not a full set of plans but is a draft detailed paper. The main content is expected to remain stable but require a firming of the QIPP efficiency component. The draft strategic and operational plan for 2018/19 was presented. The CCG’s allocation for 2018/19 had been set at £500m, which includes modest 2.57% (£13m) growth in funding from last year. This includes funding for acute, community, mental health, prescribing, and corporate running costs. Mike Sexton described there is a Primary Care allocation showing 3.72% growth (£1.9m) – in line with the “GP Forward View”. All the primary care allocation and growth will be spent on GP primary care in line with GMS/PMS review, national pay award to primary care, list growth, premises improvements and out of hospital business case investment. Mike Sexton drew attention to the expenditure plan was listed and highlighted that these plans are not zero based but are instead based on forecast outturn including a set of assumptions including a £26m (£30m stretch) efficiency challenge. The CCG was described as planning to breakeven in 2018/19, dependent on a £26.4m QIPP programme. An update on the QIPP planning was presented. There was a discussion of the status of expected QIPP delivery shown on page 54 of the agenda pack. Mike Sexton acknowledged the scale of work ahead and noted that risk and contingency is weighted towards the beginning of 2018/19 with cumulative deficit mapped to into the plan. Mike Sexton said the plan will be presented again building on Primary Care and comparators for 2019/20. The Chair reminded Governing Body members of their responsibility for managing the budget and managing the risks in the wider health system, noting the scale of these. Agnelo Fernandes noted the number of ‘red’ risks on the QIPP list. Mike Sexton added that this is a reflection of the early state of plans and that these are being de-risked and that extended review by Deloittes had given good

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7.8 7.9 7.10 7.11 7.12

assurance on the approach. Andrew Eyres said he expected plans to begin cautiously but the CCG expects more projects to have a more amber/green coloured risk rating when it is presented for final sign off at March’s Governing Body meeting. Mike Sexton said the RAG rating was based on the methodology applied when the CCG has been externally reviewed. Mike Sexton said that project readiness is continuously improving and the CCG is in a better position than at the same stage in previous years. Andrew Eyres acknowledged that there is less ‘low handing fruit’ for efficiency savings, the task is large and harder so the solutions need to be more transformative, preventative and more integrated. Amy Page prompted a discussion of the specific diabetes plans and clarified the series of quality initiatives behind these. Martin Ellis noted that diabetes arrangements requires improvement despite little savings being achievable. Emily Symington asked what was meant by budgets coming out at a SW London level. Mike Sexton said the actual allocation directly for Croydon was the same, not shared, but the financial performance control totals set by NHS England on the STP and that the message has been one of ‘no further draw/deficit expectation’ with an ask for CCGs to break even in 18/19. Andrew Eyres said that these encourage thinking at a SW London scale to share benefits. Tom Chan asked whether management can continue to motivate staff with the unrelenting challenge. Andrew Eyres said that solutions are not exhausted and that public demand and implementing the Big Ideas identified in the Summer of 2017 provide fresh impetus and continued motivation. The Chair opened a discussion about the role of Governing Body members in supporting delivery of the plan. Amy Page said the CCG must continue to support bold plans and agreed with Andrew Eyres statement that the answers are to be found in the experiences of the people of Croydon. Stephen Warrant said the recent QIPP development session had been powerful while Roger Eastwood noted the importance of helping to break down barriers in support of the local hospital and said that the plans feel realistic and reasonable. Jai Jayaraman supported the view that the ideas need to come from the public and welcomed more activities like the upcoming diabetes workshop. The Governing Body: ▪ NOTED the approach to developing our Croydon health and care transformation plan, ▪ NOTED the 2018/19 financial plan and associated assumptions

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7.13 7.14 7.15 7.16 7.17 7.18 7.19

One Croydon Alliance: Extension of the Alliance Agreement Outcomes Based Commissioning Andrew Eyres asked Martin Ellis to present the paper on the One Croydon Alliance explaining that this is a summary of the first year of the work of the Alliance and contains a proposal to extend the agreement for a further 9 years. Martin Ellis explained that the Alliance, formed of the Croydon GP Collaborative, South London & Maudsley NHS Foundation Trust and Croydon Health Services NHS Trust, Age UK, Croydon Council (as both provider and commissioner) and NHS Croydon CCG represents Outcomes Based Commissioning for over 65s through an integrated health and care system. Martin Ellis said that the Alliance vision has always been to extend the model of care and approach adopted for over 65s if successful to other areas of the social care and health economy. Martin Ellis listed the achievements of the first year of the Alliance though the Living Independently for Everyone (LIFE) rehabilitation and re-ablement programme, that has an agreed single eligibility assessment and review process; the Integrated Care Networks (ICN) with an emphasis on Huddles proactively managing the care of people with complex health and care needs; and an Impact on activity and outcomes of the Alliance Out of Hospital Programme. Martin Ellis said that the case for extending the agreement for the further 9 years following the transition year had been at the Alliance Board in early December and was agreed. The governance arrangement was described as requiring each partner’s Board to approve the extension. Emily Symington asked what review points could or should be included and Andrew Eyres said breakpoints can be designed into the agreement. Members asked what alternatives are considered. Andrew Eyres advised that organisations are not compelled to integrate more deeply but that his opinion is this offers the opportunity to place management of risk closest to the appropriate partner and represents the best approach. Andrew Eyres said that any extension of scope of the Alliance programme would come back to Governing Body for ‘by item’ agreement. Tom Chan asked what the original rationale for a 10 year agreement had been. Martin Ellis replied that wholesale transformation takes time and that there was historically an 18 year turn on contracts and the timescales take account of this. There was a discussion prompted by a question from Jai Jayaraman of what changes a patient would experience from expansion of the Alliance scope to under 65. Andrew Eyres explained that it primarily enables the partnerships to work creatively without organisational barriers.

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7.20 7.21 7.22 7.23 7.24 7.25

The Chair asked voting members for a show of hands to indicate support for the recommendations proposed, first for the extension of the term of the Alliance agreement and then for the expended remit of the Alliance Agreement to over 65s. The vote was unanimous in support of the recommendations: The Governing Body AGREED the extension of the Alliance Agreement for a further 9 years from 1 April 2018; The Governing Body: AGREED to expand the remit of the Alliance Agreement to ensure the potential for whole population transformation for health and social care. Decisions to increase programme scope will be taken as part of the CCG’s decision making process. AGREED to Delegate to the Accountable Officer the signing of the final 9 year Alliance agreement on or around 1/04/2018. Any new or revised service contracts will be transacted in line with our Standing Financial Instructions and Scheme of Delegation. Strategic and Operational Planning - South West London Health and Care Partnership Andrew Eyres introduced the final paper in the strategy pack. The South West London strategy for health and care supports the NHS and wider partners across South West London where appropriate supported by individual, locally focused health and care plans. South West London Sustainability and Transformation Plan (STP) was published in November 2016, following significant engagement across South West London commissioners, providers and local authorities. Whilst implementation of local plans continues, a refresh is being undertaken in order to support even greater local planning and delivery. Andrew Eyres said that the local partnerships in SW London are represented by Croydon plus 3 other partnerships being Wandsworth & Merton; Kingston & Richmond; and Sutton. Andrew Eyres added that the need for coordination across acute services makes these plans especially relevant and said that a two-step approach to refreshing the South West London strategy for health and care had been undertaken: the first stage of which (ending in November 2017 set out the progress and next steps of the STP. Stage Two from December 2017 to June 2018 is concerned with developing “Local Health and Care Plans” for each of the four Local Transformation Boards (LTBs): For Croydon this will set the Croydon Transformation Board’s vision; model for health and care; local context and challenges; actions to address local financial and clinical

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7.26

sustainability issues and meet the health and care needs of the local population. We will co-produce these plans with local authorities and wider partners. Croydon’s health and care transformation plan will inform the South West London Sustainability and Transformation Partnerships refresh. Andrew Eyres explained that the strategy builds plans bottom up, establishing how collaboration will offer benefits. Andrew Eyres noted that there is an addition put forward as a proposal on the basis that Child and Adolescent Mental Health Services (CAMHS) needs collective tackling for improvements. The Governing Body: NOTED and endorsed the “South West London Health and Care Partnership: one year on” paper and the two-step approach to refreshing the South West London strategy for health and care that it describes

Ref: 2018/01/08

8 Governing Body Assurance Framework and Risk Register

8.1 8.2 8.3

Elaine Clancy presented the report. The Chair noted that the report was brought for assurance and asked whether there were particular aspects that the Integrated Governance & Audit Committee (IGAC) wished to bring to the Governing Body’s attention. Elaine Clancy confirmed that IGAC had reviewed the Strategic Risks on the Governing Body Assurance Framework as well as the Risk Register containing some operational risks at their July and November meetings. Two new Primary Care risks were highlighted as being worked through. IGAC would be requesting Executive Directors as senior risk owners to attend IGAC meetings on a scheduled basis to provide a spotlight on their respective risks. The Governing Body NOTED the Assurance Framework and Risk Register summary

Ref: 2018/01/09

9 2017/18 Finance Report: Period 8 (November 2017)

9.1 9.2 9.3

Mike Sexton presented the Report and in connection with the GBAF item above, explained that the finance report provides assurance through demonstrating focus and close monitoring of highest priority areas. NHS England has recognised the significant challenge to deliver £21m QIPP, and in the absence of other mitigation, has agreed that the CCG can report a £15m deficit (£6.9m planned deficit plus £8.1m unidentified QIPP). Members asked whether further action was contemplated that could bring further mitigation. Mike Sexton said that £21.2m QIPP had

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9.4 9.5

been de-risked with work alongside Deloittes but this did not extend to the £29.3m. There was a discussion about the time taken to gain this recognition. Mike Sexton explained that the CCG is under special measures and Directions and so there was a process that had to be followed whereby NHS England completed a review that endorsed his reporting to committees and agreed that the deficit will not be further mitigated this financial year. Mike Sexton noted financial recovery plan forming part of risk mitigation and noted that while CHC and QIPP are long recognised financial risks new prescribing risks associated with fluctuating drug prices have the potential for an updward trend to a further £2m pressure. Mike Sexton added that the Secretary of State authorises price concessions and while the CCG has little influence it can mitigate the risk through early warning and work in conjunction with the medicines optimisation team. Mike Sexton added that the exposure to these risks appears to be reducing following internal review of the Month 9 position. As Chair of Finance Committee, Roger Eastwood said he was content with the reporting and Amy Page observed that the latest reports appear to bear out the confidence of earlier estimates. The Governing Body:

• NOTED the CCG is reporting a year -to -date deficit of £7.2m (£2.7m adverse variance) and a forecast in -year deficit of £15.0m (£8.1m adverse variance). The year -to -date variance reflects two month s of the £8.1m not being delivered.

• NOTED the CCG continues to identify opportunities to mitigate risks against the original ambitious £21.2m QIPP programme.

• NOTED the consistent performance against the Public Sector Payment Policy (95% within 30 days) and cash management.

Ref: 2018/01/10

10 2017/18 QIPP Programme Report Month 9 (December 2017)

10.1 10.2 10.3 10.4

Mike Sexton presented the Report. Overall, the majority of the programme is on track to perform by the end of the year however the revised Forecast outturn of £20.5m is £0.7m short of the QIPP plan of £21.2m. Mike Sexton said he does not want this to slip further. At month 8, some projects had declared that they will be unable to meet their planned target within year. Some of this shortfall is being off-set by newly identified projects as well as minor over-performances in a few others Mike Sexton noted the Quality Highlight report coincides with the

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earlier presentation. The delivery of the Out of Hospital Business Case in reducing length of stay was identified to be essential. Mike Sexton was thanked for the Month 9 report and for the continued diligence of his team. The Governing body:

• NOTED that the CCG had delivered £10.9m of QIPP to date (based on actual data for M1 -7 plus a forecast for M8), against a plan of £12.3m,

• NOTED the CCG’s full year forecast outturn of £20.5 m against a target of £21.2m

• NOTED NHS England has recognised that the maximum QIPP that will be delivered is £21.2m and therefore the unidentified QIPP of £8.1m will not be resolved in 2017/18

• NOTED The overall risk status of the QIPP programme is currently rated Amber

• NOTED The Quality Spotlight Report on Medicines Optimisation.

Ref: 2018/01/11

11 Contracting Portfolio Report (Month 7)

11.1 11.2 11.3 11.4 11.5 11.6

Stephen Warren presented the Report Based on Month 7 data, the CCG has total forecast overspend on Acute contacts of £1.3m. Stephen Warren described the impact of the PSS (Prescribed Specialist Services) movement of NHSE activity to CCG and vice-versa on plans and actuals and of HRG4+ highlighted in section 2.1 of the report) Stephen Warren said the CCG has continued to see Over performance at Kings and St Georges in addition to that caused by the PSS movement while there is apparent underperformance at CHS. Stephen Warren described a work programme is underway on private-sector referrals. The variation team was described to be working to support practices and locums on awareness of the agreed pathways. Emily Symington observed Kingston starting to show a variance and asked if an explanation for the variance was known. Stephen Warren said that at a lower order of magnitude variation could be attributed to specific patients presenting but offered to investigate. Stephen Warren described the Quarter 1 Reconciliation and Year End Settlement as well as the Sepsis Counting and Coding Challenge. Feedback was given on a viral pneumonia admission audit undertaken in Selsdon and New Addington Practices. Amy Page asked whether there are projections of the impact of reducing non-urgent elective activity on year-end performance. Stephen Warren acknowledged that the work of the variation team had been important. While some technical issues were known, Stephen Warren indicated that hospitals do tend to plan to reduce

Action: SW

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elective work around winter time. The Governing Body:

NOTED the Contract Portfolio Report

Ref: 2018/01/12

12 Month 6 (September 2017) Integrated Performance and Quality Report

12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11

Elaine Clancy presented the Report. Elaine Clancy noted that in September data was showing good improvement in reducing referral to treatment (RTT) and there had been a decrease in infection control reports. Elaine Clancy reported that the CCG returned to compliance on diagnostic testing in September, after missing the standard since February, due to issues in echos at CHS. The non-compliance with 52 week waits had occurred in hospitals not in Croydon. A&E 4 Hour Wait – Elaine Clancy described that CHS had been very close to the A&E target but was challenged more recently by pressures experienced both locally and nationally Cancer Waiting Times – While cancer targets continue to be delivered well, occasional breaches tend to be complex. IAPT Access and Recovery – Elaine Clancy said that while the IAPT delivery was not at the desired level, the trajectory in September had improved Serious Incidents (SI) – CHS had reported 8 SIs in the period and SLAM reported 2 SIs. Neither Trusts reported any Never Events in the period. Elaine Clancy reminded members that the Quality team are now informed by Contract Quality Review Meetings for smaller providers and CUCA and added that the team are now sighted on any London Ambulance Services SIs affecting Croydon residents. Members asked about the impact of more recent winter pressures on RTT and elective activity. Elaine Clancy said that CHS reportedly cancelled no operations, only some diagnostic tests – according to plans While some long ambulance waits at CHS had come to the attention of the CCG, these were not at the level of trusts in the national press. Elaine Clancy said that it appeared that robust planning and social care support had somewhat mitigated CHS’s exposure to considerable winter pressures and that a walk-round in the week beginning 1/1/2018 gave the CCG Director of Quality and Governance confidence that the Trust was coping.

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12.12

Members were encouraged to recognise the contribution that having a flu-jab can make in reducing a common seasonal pressure on admissions. All but one member declared having had a flu-jab this winter. Andrew Eyres noted that a very good staff uptake was submitted in a for a return to the STP. The Governing Body: NOTED the Month 6 performance and quality report and actions taken within the period.

Ref: 2018/01/13

13 Patient and Public Engagement Report Quarter 2

13.1 13.2 13.3

Elaine Clancy presented the report. The PPI key activities during this period were: • Planned Care Transformation consisting of fieldwork, workshop and working groups, Equalities Impact Assessments and evaluation of patient lead involvement • Mental Health Voluntary Sector Review - Equalities Impact Assessment, fieldwork – meetings with providers and council • PPI Forum: Big Ideas workshop (presented previously to the Governing Body) to support development of future commissioning intentions • PPI Forum: Redesigning PPI structures - To co-design the CCG’s overall engagement structure to identify when and how we engage with Croydon residents. Elaine Clancy updated members that the advert for the Lay Member (PPI) had just closed and the CCG is due to shortlist and hoped a new appointment would be in post for the next Governing Body meeting. The Governing Body NOTED the report.

Ref: 2018/01/14

14 Minutes of the Integrated Governance and Audit Committee

14.1


Ref: 2018/01/15

15 Minutes of the Committee in Common

15.1


Ref: 2018/01/16

16 Minutes of the Clinical Leaders Group

16.1 The minutes were presented for information and there was no discussion.

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The CCG Governing Body noted the Minutes.

Ref: 2018/01/17

17 Minutes of the Finance Committee

17.1


Ref: 2018/01/17

17 Register of Interests and Hospitality

17.1

The register of interests and hospitality were presented and there was no discussion

The CCG Governing Body noted the Registers of Interest and Hospitality.

Ref: 2018/01/18

18 Open Space for Public Questions

No questions were submitted in advance of the meeting.

There was a question about whether the strategic plans being discussed represented a change to the planned care strategy and if the ‘rainbow approach’ previously illustrated would still apply.

Stephen Warren replied that sign-off is being arranged with CHS and the Croydon Transformation Board together with the associated pathways. Stephen Warren added that the same areas will be covered including diabetes and dermatology and that further updates will be provided through the planned care steering group.

Ref: 2018/01/19


Agnelo Fernandes announced details of the Diabetes engagement event booked for Wednesday 17th January 2018; reservations on Event Brite.

Date of Next Meeting

Tuesday 6 March 2018 14:00 until 17:00, Croydon Conference Centre, Croydon for Meeting on Tuesday 6 December

Signed…………………………………………………….. Dated………………………………………………………

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1 May 2018

Title of Paper: MINUTES OF THE COMMITTEE IN COMMON

- South West London Committee for Collaborative Decision Making

Lead Director Agnelo Fernandes, Chair

Report Author Carol Varlaam, Lay Member and Independent Convenor for the SWL CCDM





Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the South West London Committee for Collaborative Decision

Making held on 27 March 2017

Background:

The role of the SWL CCDM is to make decisions on behalf of the six SWL CCG Governing Bodies, in areas where they wish to collaborate with their neighbouring CCGs, in order to make collaborative organisational or commissioning decisions. Such decisions will be taken by individual Committees of each CCG Governing Body that have been instructed to meet in common. The SWL CCDM Terms of Reference state that: “Each Committee [in Common] will present the agreed minutes to its Governing Body… The CIC Convenor will, in addition, provide a written summary report to each Governing Body following each meeting of the [SWL CCDM] business. This should highlight: •Issues •Decisions •Risks and Assurance”. The second meeting was held on 27 March 2018. This report is a summary of the meeting for the participating CCG Governing Bodies to accompany the meeting minutes. There were two items on the agenda for the 27 March 2018 Committee: Primary care at scale funding and the development and implementation of a SWL IFR Triage Process and Panel.

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Key Issues:

The meeting had two agenda items: 1. Delivering Primary Care at Scale funding across SWL CCGs

The Committee unanimously approved the recommended approach in the presented paper for apportioning the Delivering Primary Care at Scale funding across SWL CCGs

2. SWL IFR Triage Process and Panel The Committee unanimously approved the development and implementation of a SWL IFR Triage Process and Panel.

Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve sustainable financial balance by 2020/21. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care. To have all Croydon GP practices actively involved in commissioning services and develop a responsible and learning commissioning organisation.

Risks

Risks and assurances were set out in the presentations given at the meeting.


The approval of the approach for Primary Care funding at Scale for all SWL CCGs. The approval of the development and implementation of a SWL IFR Triage Process and Panel will create savings across SWL as there will be a reduction in Panel meetings (from the current 24 meetings a month to 6 meetings a month).


None – Managed through recusing conflicted GP Members and inviting deputy representatives


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None

Equality Analysis

EIAs will be undertaken where relevant for the SWL IFR policy and procedure changes.


Patient and Public engagement will be undertaken where relevant for the IFR policy and procedure changes.



None

Reputational Issues

None

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SOUTH WEST LONDON

COMMITTEE FOR COLLABORATIVE DECISION MAKING 27 March 2018, 17:30 – 19:30

Rooms 6.2/6.3 120 the Broadway, SW19 1RH

MINUTES Members in attendance Name Designation Organisation Carol Varlaam Convener Wandsworth CCG Roger Eastwood Lay Member

CCG Committee Chair Croydon CCG

Elaine Clancy Clinical Member Croydon CCG Andrew Eyres Managerial Member Croydon CCG Dr. Agnelo Fernandes Non-Voting Clinical Member Croydon CCG Clare Gummett Lay Member

CCG Committee Chair Merton CCG

Julie Hall Clinical Member Merton CCG Sarah Blow Managerial Member Merton CCG Susan Gibbin Lay Member

CCG Committee Chair Sutton CCG

Dr. Chris Elliott Managerial Member Sutton CCG Dr. Les Ross Clinical Member Sutton CCG David Knowles Lay Member

CCG Committee Chair Kingston CCG

James Murray Managerial Member Kingston CCG Dr. Naz Jivani Non-Voting Clinical Member Kingston CCG Susan Smith Lay Member

CCG Committee Chair Richmond CCG

Fergus Keegan Clinical Member Richmond CCG Stephen Hickey Lay Member

CCG Committee Chair Wandsworth CCG

Sam Page Clinical Member Wandsworth CCG James Blythe Managerial Member Wandsworth CCG Dr. Nicola Jones Non-Voting Clinical Member Wandsworth CCG

Attendees Name Designation Organisation Adrian Attard Director Healthwatch Sutton Jamie Gillespie Vice Chair Healthwatch Wandsworth Josephine Baxter Public Representative Zoli Zambo Project Manager SWL STP PMO Louise Fleming Director of Quality and Governance SWL Alliance Jonathan Bates Director of Commissioning Operations SWL Alliance Lucie Waters Managing Director Sutton CCG Paul Linehan Interim Head of Governance SWL CCG Alliance Emma Haran Governance Support SWL CCG Alliance

Apologies Name Designation Organisation Deputy attending None received.

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Item Title Action 1. Welcome, Introduction and Apologies – Carol Varlaam 1.1. The convenor welcomed all to the meeting. No apologies were received for this

meeting. The meeting was quorate. The convenor explained that the meeting was being filmed for uploading onto CCG websites. The convenor informed the Committee that, following the Committee’s decision, questions will be invited on today’s agenda. Priority is usually given to written questions received in advance of the meeting; however, no written questions were received for this meeting. Members of the public are usually invited to ask questions on the agenda; however, no members of the public were in attendance for this meeting.

2. Declarations of Interest – Carol Varlaam 2.1. All members and attendees may have interests relating to their roles. These interests

are declared on the register of interests. While these general interests do not need to be individually declared at meetings, interests over and above these, where they are relevant to the topic under discussion, should be declared. No other declarations of interest were received from the Committee.

3. Funding to Deliver Extended Access and Primary Care at Scale in 18/19 – Lucie Waters

3.1. The Funding to Deliver Extended Access and Primary Care at Scale in 18/19 paper was presented by Lucie Waters. The main points from the discussion were as below: • There will be £8m of funding available for SWL which will be going to the STP rather

than directly to CCGs. SWL have flexibility in using the money as a system, as long as assurance is regularly given on the system's compliance with the specification

• This funding is to be used to deliver the Extended Access specification for 18/19, and make tangible progress towards delivering Primary Care at Scale

• SWL are delivering the GP Forward View (GPFV) Primary Care extended access requirements of 8am – 8pm

• The Healthy London Partnership have done some good work to explain what is meant by delivering Primary Care at Scale; this includes a focus on quality, patient outcomes and improvements, shared corporate functions and effective governance and stewardship

• SWL have a Transforming Primary Care Delivery Group (TPCDG), which meets monthly, with membership from across SWL: a CCG Chair as clinical lead; the SWL Primary Care Transformation Senior Responsible Officer (SRO); CCG Primary Care leads and the SWL Transformation team

• The TPCDG are working through the granularity of the requirements of delivering Primary Care at Scale and what it means to SWL; as well as how the system will start to make progress against the maturity framework

• This is a build on, not a substitution of, funding – regulators will want regular assurance it is being used as per the framework.

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3.2. Questions and comments The Committee from Wandsworth asked if this is a one-off piece of work or an ongoing commitment. They added that they felt very comfortable with the proposals and recommendations in their CCG discussions; and asked for confirmation that, as well as the monitoring and assurance taking place in the SWL TPCDG group, Governing Bodies will also be able to review and discuss the monitoring and assurance. LW responded that this will be a positive opportunity to transform Primary Care in SWL and SWL want to use this opportunity to make real inroads in Transforming Primary Care over the next 12 months. It is recognised that it is a big ask and significant change for Primary Care. The SWL Primary Care team have assurance from the London team that this will be recurrent funding and it is up to CCGs to decide how it is used. It can be used for non-recurrent spend to do with the delivery; e.g. interim Project Managers. There was an expectation for a modest increase next year set out in the original GPFV framework. The TPCDG will discuss how plans should develop over several years. The TPCDG will expect local ownership and for every CCG to monitor this work through their Primary Care Commissioning Committees and Governing Bodies. Healthwatch stated that they felt that the biggest barrier to extended access is robust information sharing, and asked how much extra money will be going into I.T. In terms of extended access; each service organises a process to ensure appropriate data sharing is in place. For Primary Care at Scale going forward, the principles of operating clinical and contracting models at scale may have Information Governance / data sharing challenges depending on what models CCGs choose. One of the workstreams in Transforming Primary Care is the development of digital platforms to access primary care. This work has additional funding associated with it. It is recognised that it is important that the digital platforms are integrated with the Primary Care at Scale plans. Healthwatch asked if SWL are confident there is the man power to deliver the Transforming Primary Care workstream; e.g. are there enough GPs. There is a separate workforce workstream in the Transforming Primary Care programme that looks at recruitment and retention, as well as the retirement of GPs and the Primary Care workforce as a whole. The principle of Primary Care at Scale is that the clinical and commissioning models are flexible, thus you get improvements in GP work-life balance and staff satisfaction. There is some evidence that where Primary Care at Scale operates already, GPs opt to remain in practice longer. This work will help to make sure that SWL are building a system that attracts and keeps GPs of the future and ensures a resilient General Practice, as well as attracting and keeping other Primary Care staff (e.g. nurses, Heath Care Assistants, pharmacists).

3.3. The Committee in Common were asked to consider approving the following approach for apportioning Delivering Primary Care at Scale funding across the SWL CCGs:

• CCGs will all receive £5.41 per head funding in 18/19 • CCGs will follow local governance arrangements to oversee the development of

local plans • The SWL STP will have a QA process aligned to the London process; money

will be released upon evidence of investment and assurance that plans meet the London specifications and will deliver the required benefits

• Spend and delivery will be monitored on an ongoing basis by the Alliance SMT. The STP will, in turn, be monitored at London level; 50% funding will be released upon demonstration of robust plans, and 50% will be released at Month 6, upon assurance that delivery is to plan

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• The SWL TPCDG should review progress and options for accelerating primary care transformation over the next six months to get maximum advantage from 19/20 funding.

The convenor asked the Committee members if they approve the recommended approach for apportioning the funding. Each Committee was asked to vote in turn: Croydon – support Kingston – support Merton – support Richmond – support Sutton – support Wandsworth – support. The Committee unanimously approved the recommended approach for apportioning the Delivering Primary Care at Scale funding across SWL CCGs.

4. Developing a South West London (SWL) Individual Funding Requests (IFR) Triage Process and Panel – Jonathan Bates and Zoli Zambo

4.1. Jonathan Bates and Zoli Zambo presented a paper on developing a SWL IFR Triage Process and Panel. The main points from the discussion were as below: • A SWL IFR triage process and panel would be streamlining what is currently done

across SWL and would be a system-wide QIPP saving; it will also improve quality and consistency for patients

• The proposal is to move to one triage panel process across SWL – there are currently three panels – and to move to one formal IFR panel; the frequency will be based on the current workload (there are currently weekly triage panels and fortnightly formal panels)

• Having one panel with the same set of clinicians will raise expertise and consistency in decision making

• One panel will reduce costs – 24 meetings a month will be reduced to six meetings a month

• There will be greater service resilience by drawing on skills and personnel across SWL

• Fertility cases will not be included • In November 2017 the SWL Committee in Common agreed a SWL-wide ECI policy;

one of the consequences of implementing this policy is that a smaller group of patients will go through the SWL IFR panel process as they will instead go through prior approval

• Next steps are set out as in appendix one of the paper. There will be workshops with current panel members to finalise the process. The plan is to have implementation by July 2018. This includes appointing panel members, governance and documentation.

4.2. Questions and comments The Committee from Sutton asked if the proposed IFR panel will have an independent chair structure as it is an independent funding review panel; and whether there will be a rotation of clinical leads or someone from outside of the CCGs chairing. It was clarified that the SWL IFR panel is not an independent panel. The panel membership proposed is set out in the paper. The team have checked with the current IFR panels and they feel that the membership proposed is right and they support it. Going forward, should the proposal be agreed today, it will be considered how other CCGs run their panels. For example, NWL and Kent rotate the chairs of their panel and NEL CSU provides the admin for the panel.

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The Committee from Sutton asked if there had been any communication with member practice GPs about these proposals; there has not been any specific communications to the GP population or discussion through Medicines Management Committees. Yes – Jonathan Bates wrote out to all members of IFR panels, including GPs, asking for their views. These views have been collated and are in the paper with responses. The GPs will also be invited to the workshops with IFR panels; this is a second opportunity for panel members to be involved in the design of the process. For the wider GP population, this will be part of the mobilisation and communications plan if the paper is agreed here today. The team will adopt a similar approach to the ECI paper to ensure that the general GP membership is aware of what is proposed. Dr. Nicola Jones added that the new process has been discussed at Governing Body level. What tends to happen with the wider GP membership is that they do not get involved in the panel, as they are not the referring clinician, this is usually the hospital consultants / secondary care clinicians; but GPs will get feedback on decisions from the panels. As they do not get involved in the IFR process this should have no effect on the SWL GP population and there should be no changes to how the service is accessed by the patient. She added that GPs have complained about the current IFR process for many years and it has been bought by GP members to Governing Body meetings. She feels therefore that the SWL GP membership would support this new process. If a decision is made to implement the new process there needs to be communications to GPs and their feedback sought on the new system to ensure it is doing what they need it to do. The Committee from Sutton asked what the role of the lay member on the IFR panel would be; is there a view as to who would be a preferred lay member and could they be the chair? Zoli Zambo clarified that the lay member on the panel does not have to be a governing body lay member. He was not sure what input the lay member would provide as he is not a member of the panel; he said he presumed they would represent the patient view. The Committee from Kingston asked about the implementation of the new IFR process and panel being monitored and managed by the Directors of Commissioning (DOCs) group; they asked would that group monitor the impact after the change? Can SWL evidence things such as improved timeliness and consistency of decision making? Can this be included in the group's remit? It was confirmed that there is an agreement and plan to evaluate implementation at three and six months, including the above criteria and any enhancements SWL want to add e.g. CCG Governing Body reports. DOCs have said they will find this helpful. The Committee from Wandsworth are hugely supportive of the new process but had two comments: in the pool of members, it is important to have the balance of a big enough group of people versus getting the right experts and a consistent approach – therefore training and policy must be tight; also there are concerns around the transition period. Historically it has been quite difficult for patients to go through this system; and the Committee would want to ensure patients are seen quickly. The team completely agree; that is why there will be a workshop with all of the current panel members before anything new is implemented. In respect of the transition period, SWL have senior leadership and overview and senior resource involved in this; the STP PMO will be hiring a permanent manager to oversee the panels and process. The DOCs are a senior group monitoring the transition to manage it safely. There is also the option to default to the current process if needed but that is not the plan. Around 100 patients a year in SWL go through the IFR panel process, so the system should be able to manage these patients well and safely through the process in the paper.

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The Committee from Merton added that the panel lay members provide a unique role and are selected from members of the public; they will have developed some unique skills and she is concerned that these skills could be lost. She asked how lay members will be integrated into one panel; e.g. rotations. There is no intention to lose the lay members' unique skills; this is why SWL are holding the workshops, to see how to draw on and retain that expertise, at the same time as making the process as efficient as possible. There would be a process after the workshops to agree the final set of arrangements to ensure the panel is drawing on those skills. However, moving from 24 to six meetings a month may mean that it is not possible to include all current members. It will make the panels more resilient as there will be a pool of lay members to choose from and will mean peer support is available. Healthwatch asked if there is a central budget for IFR cases or would each CCG continue to meet the cost of any treatment agreed by the panel. Clinician funding comes from individual CCGs; the administration element is provided by NELCSU and funding for this is pooled across SWL. Treatment payment remains with the CCG. CCGs may want to consider a pooled budget and risk share in the future; however, at this point that is not the proposal.

4.3. The convenor asked the Committee members if they approve the development and implementation of a SWL IFR Triage Process and Panel. Each Committee was asked to vote in turn: Croydon – support Kingston – support Merton – support Richmond – support Sutton – support Wandsworth – support. The Committee unanimously approved the development and implementation of a SWL IFR Triage Process and Panel.

5. Public Questions 5.1. Usually at this point in the meeting, any members of the public present are invited to

ask questions of the Committee relating to the business being conducted, with priority given to written questions that were received in advance of the meeting. However, at this meeting, there were no members of the public present and no questions were received in advance of the meeting.

6. Any Other Business 6.1. No other business was raised at this meeting.

7. Close of meeting 7.1. The convenor thanked the members of the Committee for their attendance.

The meeting closed at 18:16.

Minutes agreed by: Carol Varlaam Role: Convenor Date: 12/04/18

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1 MAY 2018

Title of Paper: REGISTER OF INTERESTS AND DECLARATIONS OF GIFTS & HOSPITALITY

Lead Director Elaine Clancy, Director of Quality and Governance



None



Purpose of Report For information

Recommendation:

The CCG Governing Body is asked to ▪ Note the Register of Interests

Background:

Members of the CCG Governing Body and Clinical Leadership Group are required, on appointment to subscribe to a Code of Conduct. As part of that Code of Conduct members must declare any conflict of interest that arises in the course of conducting NHS Business. Members are required to declare any business interest, position of authority in a charity or voluntary body in the field of health and social care and any connection with a voluntary or other body contracting for NHS services. Declarations of interest are a core part of the corporate governance requirements of a CCG Governing Body and the CCG is required to ensure that steps are taken to ensure conflicts of interests are handled correctly. Croydon CCG Governing Body members are required to update their declaration on an annual basis and report any in year changes to the Board Secretary. The CCG’s Accountable Officer should be informed within 28 days of a member taking office of any interests requiring registrations, or within 28 days of any change to a member’s registered interests. The Register of Interests will be presented at each Governing Body meeting and published on Croydon CCG’s website.

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In line with NHSE guidance the CCG Governing Body approved the new Conflicts of Interest Policy in June 2017. This maintains the requirement to include staff Band 8C and above on the Register of Interests. The Policy is being reviewed in the light of NHS England statutory guidance issued in June 2017. A Register of Interests for all members of its practice (applicable to senior clinicians and managers who influence decision making) is now maintained. The CCG has an expectation that any such conflicts of interest are reported through minutes and reports, when made, to decision making committees of the CCG detailing where an interest has been declared in any discussion leading up to the request for a decision from such a committee.

Key Issues:

The Register of Interests is attached. There are recent additions to the register since the last review including additions for:

- The CCG Lay Member, Governance (new interests advised to the committee at the January meeting); and the

- CCG Lay Member, Finance. - GP Governing Body Member - Emily Symington - New CCG Lay Member, PPI - Paulette Lewis MBE

Removal of past interests have been recorded for the Governing Body Registered Nurse member Some staff departures and nil returns are included. Updated Register of Interest forms for Governing Body Members and Clinical Leads were issued on 22 March 2018 for update and returns are being compiled. Gifts & Hospitality There have been no declarations of gifts and hospitality since the version submitted in January 2018 and received by the Governing Body Procurement Decisions A recent audit of conflict of interest had indicated that an out of date version of the Decisions Log was shown on the CCG website and advised that this represents a risk that conflicts of interest have not be considered in procurement decisions. The website has been updated to show the current version of the document maintained on an ongoing basis and is attached for information.

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Governance:

Corporate Objective Meets all objectives. EIA are considered in the development of all

Risks

No new risks were identified as a result of this paper.

Financial Implications The Governing Body declaration of interest forms part of good governance and financial management and is a requirement for public sector organisations

Conflicts of Interest None



None

Equality Analysis

EIA are considered in the development of all


None

Communication Plan This register will continue to be published on the CCG website


None. Relevant guidance from the Information Commissioner is considered in the publication of this register and FoI

Reputational Issues

None

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Croydon CCG Register of Interests

From To

Fin

an

cia

l

Inte

res

ts

No

n-F

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts

Parchmore Partnership

Partner

X Direct Roles and Responsibilities held within

member practices

To date Declare.

Discuss where relevant with Conflict

of Interest Guardian

Haling Park Medical Practice

Partner


member practices

To date Declare.



South Norwood Medical Practice

Partner


member practices

To date Declare.



Croydon GP Collaborative

Parchmore Partnership, Haling Park Medical

Practice and South Norwood Medical Practice are

shareholders

Declared March 2016

X Direct Shareholding 2016 To date Declare.



London School of General Practice

GP Trainer

Direct Position of Authority in an organisation

in the field of health and social care

To date Declare.



Croydon Local Medical Committee

Member

X Direct Position of Authority in an organisation


2002 12.5.17 Declare.



National NHS Pathways Governance Group

(Royal College General Practitioners)

Chairman



2009 To date Declare.



National Urgent and Emergency Care Steering

Group - NHS England

Member



01-Jul-16 Declare.



South London Faculty Board, Royal College of

General Practioners

Member

X Indirect Position of Authority in an organisation





NHS England (London) - Pan London

Integrated Urgent Care Governance Group

Chairman



To date Declare.



London Ambulance Service Clinical Quality

Group

GP Representative for NHS SW London



To date Declare.



London Urgent and Emergency Care Clinical

Leadership Group

Member

x Indirect Position of Authority in an organisation


To date Declare.



National NHS Pathways Programme Board

(NHS England/Health & Social Care Information

Centre)

Member

Declared May 2016

x Direct Position of Authority in an organisation


To date Declare.



Health Education England South London

GP Trainer






Action taken to mitigate risk

Nature of InterestDeclared Interest- (Name of the organisation, nature

of business and role)

Name,

Current position (s) held, and dates (i.e. Governing Body, Member, practice, Employee

or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair

Parchmore Medical Centre

Start Date: 01 July 2017

Agnelo Fernandes (continued)

Croydon CCG Chair



Ref

02

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From To

Fin

an

cia

l

Inte

res

ts

No

n-F

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Russell School Trust (Royal Russell School)

Governor

X Indirect Other 2006 To date Declare.



Community Phlebotomy Service

Parchmore Partnership provides premises for this

service

X Direct Other To date Declare.



Community Anti-Coagulation Service


service to Boots PLC




Community Minor Surgery Service


service




Community Diabetes Service - Bromley

Healthcare

Parchmore Partnership provide the premises for

this service




Guy's, King's and St Thomas's Medical School

Parchmore Partnership Medical Learner Centre




Dr ABC First Aid Training Company

Wife-owner. Provides training for

schools/nurseries and some GP practices (there is

no link to the CCG or contracting)

Indirect Other 2010 To date Declare.



Quintos Works Limited - Physiotherapy (non

NHS)

Parchmore partnership provides the premises for

this service

X Direct Other 2010 To date Declare.



Circumcision Centre

Parchmore Partnership provide the premises for

this service

Declared October 2015




Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



02

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From To

Fin

an

cia

l

Inte

res

ts

No

n-F

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Greenside Group Practice

GP Partner


member practices




Enmore Practice

Partner


member practices

To date Declare.



Greenwood Group which includes Country

Park Practice

Partner


member practices

01-Oct-16 To date Declare.



London and Surrey Healthcare Services

Limited (facilitates Out of Hours GP work and

CReSS work)

Director

X Direct Directorship/Ownership 2012 Aug-17

Communitas Limited

Greenside Group Practice has a share in

Communitas Limited

X Direct Shareholding To date Declare.




Greenside Group Practice is a shareholder




Croydon Referrals Support Service (CReSS)

Clinical Lead

X Position of Authority in an

organisation in the field of health and

social care

2011 31.1.17

Local Out of Hours Provider (Virgin)

GP work

Other Jan-16

CReSS

Triager

Other 31.1.17


GP Trainer and Out of Hours Educational

Supervisor for GP trainees

X X Direct Other 2014 To date Declare.



Richmond GP Alliance Ltd

Clinical Reviewer for prior approval service

(SW London)

X Direct Position of Authority in an


social care

01-Jul-17 To date Declared Interest

Greenside Group Practice provides a local

office hub for CReSS triage work.

Other 31.1.17

Tom Chan

GP Governing Body Member (Medical

Director)

Network Deputy GP Clinical Leader

East Croydon Network

Start Date: 1 May 2015

On Governing Body from June 2017

27

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ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Upper Norwood Group Practice

GP Partner


member practices

2011 To date Highlighted in meeting if direct

conflict


Upper Norwood Group Practice is a shareholder

X Direct Shareholding 2011 To date Highlighted in meeting if direct

conflict

Communitas (previously Croydon PBC Limited)

Upper Norwood Group Practice is a share holder


conflict

Croydon LMC

Member




conflict

Primary Care Research Network

Provide support costs ot the Upper Norwood

Group Practice

X Direct Other 2011 To date Highlighted in meeting if direct

conflict

St Georges Medical School and Kings College

Medical School

GP Tutor


conflict

NHS England

GP Appraiser


conflict

London GP School

Trainer


conflict

Wife is Dr Yanushka patel - a GP in Croydon X Indirect Other To date Highlighted in meeting if direct

conflict

Brother is Dr Ameesh Patel who is a Deputy

Clinical Lead

X Indirect Other To date Highlighted in meeting if direct

conflict

Brother Dr Ameesh Patel's spouse is a CCG

Pharmacist.

X Indirect Other 01-Jul-16 To date Highlighted in meeting if direct

conflict

Yogesh Patel

GP Governing Body Member


05

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n-F

ina

nc

ial

Pe

rso

na

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Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Parchmore Medical Centre

Salaried GP


member practices

01-Sep-15 To date Highlighted in meeting if direct

conflict

Amersham Vale Training Practice (Lewisham

CCG)

GP


member practices

01-Sep-16 To date Highlighted in meeting if direct

conflict


Parchmore Medical Centre is a shareholder

X Direct Shareholding 01-Sep-15 To date Highlighted in meeting if direct

conflict

Royal College of GPs Pan London AiT/First 5

Committee

Committee Member



05-Jul-05 To date Highlighted in meeting if direct

conflict

UCL Medical School

Amersham Vale Training Practice is a teaching

practice for the medical school

X Direct Other 01-Sep-16 To date Highlighted in meeting if direct

conflict

Georgina Craig Associates Limited - GP clinical

expert supporting group consultation training on an

ad-hoc basis (no Croydon based training). This

company has close links to Experience Lead

Care which is contracted by Croydon CCG to

support role out of group consultations in Croydon.



13-Mar-18 To date Highlighted in meeting if direct

conflict.

Health Education England

Grant provided to Croydon CCG for group

consultation training

X Indirect Other 01-Oct-15 Jun-16 Highlighted in meeting if direct

conflict

Emily Symington

GP Governing Body Member

Start Date: 1 September 2016

06

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n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02

Eastbourne Homes Limited (Private company

set up to provide housing services to council

tenants and lease holders)

Non Exec Director

X Indirect Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct

conflict

South East Independent Living Limited

(Management of real estate)

Non Exec Director

X Indirect Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct

conflict

South Essex Homes Limited (management of

council housing for Southend-on-Sea Borough

Council)

Non Executive Director

Declared 25 July 2016

X Indirect Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct

conflict

Eastwood Consultants Limited (Management

consultancy activities)

Director and Co Owner

X X Indirect Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct

conflict

Eastbourne Housing Investment Company

Limited (letting and operating of real estate)

Non Exec Director

X Indirect Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct

conflict

ALMOS

Social Housing Trade Association

Non-Exec Director

X Indirect Non Exective Director 01-Apr-18 To date Highlighted in meeting if direct

conflict

South East Independent Living Limited

(provides supporting people services to over 65

year olds in East Sussex for Eastbourne, Lewes

and Wealden districts and "Navigator" services for

younger people with complex needs in East

Sussex)

Non Exec Director



To date Highlighted in meeting if direct

conflict

08 The Collegiate Trust, Purley

Non Executive Director

(Multi Academy Trust - no conflict)

X Indirect Non Exective Director 01-Dec-15 To date Highlighted in meeting if direct

conflict

Woodcote Park Golf Club,

Committee Member

X Indirect Other Oct 2017 To date Highlighted in meeting if direct

conflict

ICMD2 Limited

Service company providing services to Financial

Services clients

X Direct Director and shareholder Nov 2017 To date Highlighted in meeting if direct

conflict

The Haven + London

Charity providing pastoral and mental health

services to the London Creatives community

X Indirect Honorary Treasurer Oct 2017 To date Highlighted in meeting if direct

conflict

Roger Eastwood

Lay Member

Start Date: September 2014

GOVERNING BODY - LAY MEMBERS

Philip Hogan

Lay Member Governance and Conflicts of

Interest Guardian


07

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No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Black Country Partnership NHS Foundation Trust

Associate NED

X indirect Directorship/Ownership

PLK and Company Consultancy Limited

Shareholder

X Direct Shareholding

BME Cancer Voice (MHI Charity)

Chair



National Prostate Cancer Advisory Group

Chinese TV and ITV

Media appearances in relation to cancer news

stories

X Indirect Other

Christie Hospital NHS Foundation Trust

Macmillan Patient Engagement Programme Lead

Greater Manchester Cancer

x Indirect Other - Fixed term to 31 March 2018 22-May-17 31-Mar-18

PBL Associates

Management Consultancy

X Direct Directorship/Ownership 01-Mar-18 To date Highlighted in meeting if direct

conflict

Womens Health

Vice Chair - Health Sector




conflict

Nurses Association Jamaica (UK)

BME Forum




conflict

Paula Lloyd-Knight

Lay Member PPI

Start Date: February 2017

End Date: July 2017

Paulette Lewis MBE

Lay Member, PPI

Start Date 1 March 2018

09

44

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n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

0210 Jonathan Norman

Secondary Care Consultant

Start date: December 2012

None

Amy Page Consultancy Services (company used

to deliver healthcare improvement and leadership

coaching

Managing Director

X Direct Directorship/Ownership 2008 To date Highlighted in meeting if direct

conflict

Leadership Insight

Associate Consultancy


conflict

Mobius Partners Limited

Consultant

(ceased)

X Indirect Other Jan-16

London NW Healthcare NHS Trust and NHS

Brent CCG for Brent Harrow and Hillingdon

CCG Federation

Working under contract through Amy Page

Consultancy Ltd as the Emergency Access



12/09/2017 12/01/2018 Highlighted in meeting if direct

conflict

Four Eyes Insight

Consultant

(ceased Feb 2016 then restarted)

X Indirect Other 01-Aug-16 To date Highlighted in meeting if direct

conflict

12 Helen Pernelet

Lay Member

Start Date: January 2013

End Date: May 2017

None

Amy Page

Registered Nurse

Start Date: December 2012

11

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res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02

Lambeth, Southwark and Lewisham LIFTco.

Director.

Representing class B shares on behalf of

Community Health Partnerships Ltd with the aim of

inputting local knowledge to the LSL LIFTco, for

the following LIFT companies: Building Better

Health –Lambeth Southwark Lewisham Limited

Building Better Health –Lambeth Southwark

Lewisham (Holdco 2) Limited Building Better

Health –Lambeth Southwark Lewisham (Holdco 3)

Limited Building Better Health –Lambeth Southwark

Lewisham (Fundco 2) Limited Building Better

Health –Lambeth Southwark Lewisham (Fundco 3)

Limited Building Better Health –LSL (Fundco

Tranche 1) Limited

Building Better Health –LSL (Fundco Holdco

Tranche 1) Limited Building Better Health –LSL Bid

Cost Holdco Limited Building Better Health –LSL

Bid Cost Limited

Building Better Health - LSL (Holdco 4) Limited




Lambeth Clinical Commissioning Group.

Chief Officer.

X Direct 01/04/2013 To date Declare.



Married to Director of Performance and Delivery -

Kings Health Partners

X Indirect Personal 29/10/2012 To date Declare.



13 Elaine Clancy

Director of Quality and Governance

Start Date: June 2015

Parent Governor- Langley Park School for Girls x indirect 01/09/2017 To date Highlight in Meeting if direct conflict

14 Mike Sexton

Chief Finance Officer

Start Date: June 2012

None

15 Paula Swann

Chief Officer

Start Date: May 2012

End Date: May 2017

South London and Maudsley Mental Health

Trust (SLaM)

CCG Commissioner Council of Governors

Representative

X Position in Authority in an organisation


2013 To date

16 Stephen Warren

Director of Commissioning

Start Date: September 2012

None

GOVERNING BODY - DIRECTORS

Andrew Eyres

Chief Officer

Start Date: July 2017

40

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res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

0239 Martin Ellis

Director of Urgent and Primary Care

Start Date: July 2017

None

GOVERNING BODY - IN ATTENDANCE

Council of the Association of Directors of

Public Health (ADPH)

London Representative



2016 To date Declared Interest

NICE Resource Impact Assessment Team

Consultee



Declared Interest

Occasional Media appearances in relation to role

as Director of Public Health for Croydon

X Indirect Other 2016 To date Declared Interest

Octavo (Croydon Schools Mutual) - delivers

school improvement services across the Borough

of Croydon

Director

Directorship/Ownership Declared Interest

Journal of Emotional and Behavioural

Difficulties

Member of Editorial Board

Position of Authority in an organisation


Declared Interest

Director for Association of Director of Children's

Services (ADCS) - Honorary Secretary.

X Position of Authority in an organisation


2016 2019 Declared Interest

RIP/RIPFA

Board Member

X Position of Authority in an organisation


2016 2019 Declared Interest

Paul Greenhalgh

Executive Director People, Croydon Council

Start Date: January 2015

End Date: 31 July 2016

Rachel Flowers

Director of Public Health

Start Date: 23 February 2016

Barbara Peacock

Executive Director - People Croydon Council


19

18

17

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nc

ial

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fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 CLINICAL LEADERSHIP GROUP

Eversley Medical Practice

Partner


member practices

01-Jan-00 To date Declare.


of Interest GuardianHealth Safeguarding Limited (provides

healthcare conferences, workshops and seminars

aimed at Safeguarding children and protecting

adults) - Director

X Direct Directorship/Ownership 01-Jul-10 To date Declare.



Communitas (previously Croydon PBC Limited)

Shareholder





Eversley Medical Centre is a shareholder




Croydon Health Services

Wife is Deputy Director for Safeguarding at CHS



To date Declare.




GP Trainer




NHS England

GP Appraiser




Kings College Hospital

GP Tutor

Start August 2016




Croydon Urgent Care Alliance

Educational Supervisor of GP Trainees Out of

Hours




Virgin/London School of General Practitioners

Educational Supervisor of GP Trainees Out of

Hours

X Direct Other

Olayinka Ajayi-Obe

GP Clinical Leader

Mayday Network

Start Date: 1 November 2013

20

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res

ts

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n-F

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Shirley Medical Practice

GP Partner


member practices



of Interest GuardianAbbot Medical Practice

Director

(for locum work and private fees)

X Direct Directorship/Ownership 2002 To date Declare.



Communitas (previously Croydon PBC

Limited)

Shirley Medical Centre is a shareholder





Shirley Medical Practice is a shareholder



of Interest GuardianCroydon LMC

Member






Croydon Prescribing Care Group

Member






Shirley Oaks Hospital

GP Sessions under GP extra service






Pharmaceutical Sponsored Educational Events

Chairing and talking at occasional educational

meetings






(SW London)



social care


Dr Amit Abbot is my brother and has recently been

elected and is a Deputy Network Lead




Bobby Abbot

GP Clinical Leader

Woodside Shirley Network

Start Date: April 2012

21

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res

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ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Locum GP X Direct Roles and Responsibilities held within

member practices

To date Declare.


of Interest GuardianAjamay Limited (specialist practice medical

activities)

Shareholder

x Direct Shareholding To date Declare.



Croydon CCG IFR Triage Panel

Member

Commenced March 2015

x Position of Authority in an


social care

01-Mar-15 To date Declare.



ESL2 (GP Learning Set)

Member

Mar-17 Declare.



Surrey and Sussex LMC

Medical Director

x Position of Authority in an


social care

01-Feb-17 To date Declare.



GP Collaborative Data Sharing Governance

Group

Member

Position of Authority in an


social care

Mar-17 Declare.



GP Collaborative Urgent Care Reference

Group

Member

Position of Authority in an


social care

Mar-17 Declare.



ASA (company providing private dental

sedations

Husband is staff)

x Indirect Other To date Declare.



Guys and St Thomas NHS Trust

Husband is staff




Ajamay Limited (specialist medical

practices activities)

Husband is Director and Shareholder




Karthiga Gengatharan

GP Clinical Leader

East Croydon Network


22

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cia

l

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res

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n-F

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Country Park Practice

GP Partner


member practices

01-Apr-16 To date Declare.



Greenwood Group Partnership

Partner - started 1 October 2016


member practices




Greenside Group Practice

Named Partner


member practices




The Enmore Practice

Partner


member practices

01-Apr-17 To date Declare.




Limited)

Shareholder





Country Park Practice is a shareholder

X Direct Shareholding 08-Jul-05 To date Declare.



The Moorings Practice

Partner


member practices



Limited)

Shareholder

X Indirect Shareholding 2011 To date Declared Interest


The Moorings Practice is a shareholder

X Indirect Shareholding 2016 To date Declared Interest

Local Medical Committee

Member

X Indirect Position of Authority in an


social care


NHS England (South London)

GP Appraiser



social care


Shirley Oaks Hospital

Private work as part of GP extra

X Direct Other 2011 To date Declared Interest

Queenhill Medical Practice

GP Partner


member practices

To date Declared Interest


Queenhill Medical Practice is a shareholder

X Direct Shareholding To date Declared Interest

Croydon LMC

Member



social care

To date Declared Interest

Minor Surgery and Joint InjectionsContract

Queenhill Medical Practice povides premises

for this service

X Direct Other 2004 To date Declared Interest

Rajeev Sagar

GP Clinical Leader

Thornton Heath Network


Farhhan Sami

GP Clinical Leader

Purley Network


Mike Simmonds

GP Clinical Leader

Selsdon/New Addington Network

Start Date: December 2015

23

24

25

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Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02

Shirley Medical Centre

Partner


member practices


conflict

Locum GP at other practices X Direct Roles and Responsibilities held within

member practices


conflict

A&M Abbot Medical (Private Company for

locum work and Medical)

Director

X Direct Directorship/Ownership 2014 To date Highlighted in meeting if direct

conflict


Limited)

Shareholder


conflict


Shirley Medical Centre is a shareholder


conflict



(SW London)



social care


Dr Bobby Abbot is my brother and is a Clinical

Network Lead.

x Indirect Other 2014 To date Highlighted in meeting if direct

conflict

DEPUTY CLINICAL LEADERSHIP GROUP

Amit Abbot


Shirley/Woodside Network


26

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ial

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fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Bramley Avenue Surgery

GP Partner

x Direct Roles and Responsibilities held within

member practices


conflict


Bramley Avenue Surgery is a shareholder

x Direct Shareholding To date Highlighted in meeting if direct

conflict

Croydon Referrals Support Service (CReSS)

GP Triager

x Direct Position of Authority in an


social care


conflict

SEQOL (a social enterprise running GP Out of

Hours and Urgent Care Centre in Swindon

GP Out of Hours work)

x Direct Other To date Highlighted in meeting if direct

conflict

AT Medics Parkway Health Centre

Locum GP


member practices

01-Aug-14 To date Highlighted in meeting if direct

conflict

S Karim Limited (company used for locum

work mostly in Croydon and Crawley area)

Director

X Direct Directorship/Ownership 01-Aug-14 To date Highlighted in meeting if direct

conflict


Haling Park Centre

Lead GP

x Direct Roles and Responsibilities held within

member practices

08-Aug-10 To date Highlighted in meeting if direct

conflict

Spouse is an A&E Consultant at St Georges

Hospital

x Indirect Other 01-Jan-15 To date Highlighted in meeting if direct

conflict

Thusitha Gooneratne


Purley Network


Shahab Karim


Selsdon/New Addington Network


Shamaila Masood-Husain


Thornton Heath Network


28

29

30

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Pro

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na

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Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

02 Violet Lane Medical Practice

Salaried GP


member practices


conflict


Violet Lane Medical Practice is a shareholder

X Direct Shareholding 01-Mar-16 To date Highlighted in meeting if direct

conflict

AP Medics Limited (company providing

Locum Medical work)

Director

X Direct Directorship/Ownership 1.1.15 To date Highlighted in meeting if direct

conflict

AP Medics Limited

Shareholder

X Direct Shareholding 10.1.15 To date Highlighted in meeting if direct

conflict

South East London Doctors Co-Operative

(SELDOC) (out of hours provider)

Associate Clinical Governance Lead

X Direct Other 01-Sep-13 To date Highlighted in meeting if direct

conflict

Spouse is a Pharmacy Advisor at the CCG x Indirect Other 24-Feb-14 To date Highlighted in meeting if direct

conflictBrother is Dr Yogesh Patel who is a GP

Governing Body Member

x Indirect Other 01-Jul-16 To date Highlighted in meeting if direct

conflict

32 Sally Innis

Head Safeguarding/Designated Nurse

None

33 Aarti Joshi

Associate Director Planned Care

None

34 Simon Lee

Associate Director Quality and

Governance

A family member is employed by Marie Stopes

International which is currently commissioned

by the CCG to provide services.

X Indirect 12-Dec-16 To date Declared Interest

35 Janice Steele

Chief Pharmacist and Variation Lead

None

36 Michael Sutton

Head of Planned Care

None

37 Ronak Unija

Head of Transformation and Urgent Care

None Feb-17

STAFF GRADE 8C AND ABOVE

Ameesh Patel


Mayday Network


31

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Enc

16

Reg

iste

r of

Inte

rest

s

Page 293 of 294


From To

Fin

an

cia

l

Inte

res

ts

No

n-F

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-F

ina

nc

ial

Pe

rso

na

l

Inte

res

ts




Name,


or other )

Date of Interest

Type of Interest

Is the interest

direct or

indirect?

(I / D)

Agnelo Fernandes

Croydon CCG Chair




Croydon CCG Chair



Ref

0238 Paul Young

Associate Director Out of Hospital and

Urgent Care Development and Delivery

None

39 Louise Coughlan

Chief Pharmacist

Shared post with Croydon Health Services

NHS Trust

Croydon Health Services NHS Trust

Chief Pharmacist (shared post)



12/09/2017 To date Highlighted in meeting if direct

conflict

40 Rachael Colley

Head of Urgent Care / Seconded to CHC

service

None

41 Kieran Houser

Head of Out of Hospital Care

Vodafone

Motif Bio Pharmaceutical

Amryt Pharma

X Direct Small shareholding 06/11/2017 To date Highlighted in meeting if direct

conflict

42 Fouzia Harrington

AD of Strategy & Planning

Palace for Life Foundation X Indirect Interests of family member.close

friend (employment)


conflict

43 Ruth Frost

Head of Primary Care

None

Page 18 of 18

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16

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s

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nhs croydon clinical commissioning group governing … body/governing … · audit committee for...

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