tower hamlets clinical commissioning group governing ......tower hamlets clinical commissioning...

Tower Hamlets Clinical Commissioning Group Governing Body Meeting - Part I Agenda

Tuesday, 25 September 2018, 14.30 – 16.30 Theatre Room, Oxford House

Please look over the agenda and reflect on whether any topics or papers might present an area of interest for you. This means an item where a decision or recommendation made may advantage you, your family and/or your workplace. These advantages might be financial or in another form such as the ability to exert unseen influence.

Where anything on the agenda has the potential to put you in such a position, or raised in the meeting along the way, you should inform the meeting attendees and Chair immediately. This means we can ensure that our decision, recommendations or actions can be guarded from the impact of any possible conflict you or others could have and be seen to be so. If you are unsure, it is best to raise the possibility with the chair before the meeting, or at any point during the meeting if a possible interest strikes you. This openness is important and ensures we can discuss how to manage decision making in a complex environment and learn together how to manage these issues effectively.

Meeting attendees are agreed that we will challenge others on areas of interest or possible conflict as it is recognised that sometimes these issues can be overlooked.

1.0 General Business

Action Presenter Enc. Time Page

1.1 Welcome, Introductions and Apologies

- Sam

Everington, Chair

Verbal

14.30

(10 Mins)

1.2 Declarations of Interests &

Register of Interests

-

1.3 Chair’s Report & Managing Director’s

For Noting

Sam Everington,

Chair Simon Hall, Managing Director

A

1 1.4 Accountable Officer Report

For Noting

Jane Milligan,

Accountable Officer

Simon Hall,

Managing Director

B

1.5 Draft Minutes, Matters Arising &

Action Tracker of the Meeting held on 24th July 2018

For Approval

Sam Everington,

Chair C

14.30 (10 Mins)

7

2.0 Performance & Operations

2.1 Board Assurance Framework For

Discussion & Noting

Ellie Hobart, Acting Director of Corporate

Affairs

Tabled 14.40

(10 mins) -

2.2 Finance Report – Month 5

For Discussion & Noting

Henry Black, Chief Finance

Officer D

14.50 (10 mins)

16

2.3 Provider Update: GP Care Group For Discussion & Noting

Chris Banks, Chief Executive

Officer, GP Care Group

Verbal 15.00

(15 mins) -

2.4 Performance and Quality Report


Archna Mathur, Director of

Performance & Quality

E 15.15

(10 mins) 26

2.5 East London Health Care Partnership Winter Plan 2018


Archna Mathur, Director of

Performance & Quality

F 15.25

(10 mins) 35

2.6 Annual Letter from Audit Chair For Discussion & Noting

Mariette Davis, Audit Chair

G 15.35

(5 mins) 50

5 MINUTE BREAK

3.0 Commissioning & Strategy

3.1 Commissioning Intentions For

Approval

Warwick Tomsett, Joint

Director of Commissioning

H

15.45

(15 mins)

67

3.2 NEL Commissioning Alliance a.) Update b.) Future of Senior

Leadership Discussion (Approval for SCFO)


Jane Milligan, Accountable

Officer I

16.00 (15 mins)

78

3.3 ELHCP Update For Discussion & Noting

Jane Milligan, Accountable

Officer J

16.15 (5 mins)

84

4.0 For Information

4.1 Executive Committee

Simon Hall, Managing Director

K 16.20

(5 mins) 89

4.2 Performance, Activity and Quality

Committee Minutes

Mariette Davis, Governing Body Lead for Audit &

Governance

L

4.3 Primary Care Committee Julia Slay, Lay Member for Public and

Patient Involvement

M

4.4 Audit Committee Minutes Mariette Davis, Governing Body Lead for Audit &

Governance

N

4.5 Strategic Finance and Investment Committee Minutes Noah Curthoys,

Governing Body Lead for

Corporate Affairs

O

5.0 Questions from the Public Chair

All questions received 48 hours before the meeting in will be recorded in the minutes of the meeting. If you are asking a question at the meeting please use the sign in sheet in the public area of the meeting. You will be asked for your name and the agenda item number your question refers to. You will be expected to retain a copy of your question. Questions that are asked verbally at the meeting will only be answered if an accurate answer can be provided. Otherwise, the question will be taken on notice and will be answered at the next meeting. Please email [email protected] for more information.

6.0 Date of next Governing Body Meeting Chair

Date TBC, 14:30 – 17:00, Venue TBC

7.0 Part II- Meeting

Chair

To resolve that as publicity on items contained in Part 2 of the agenda would be prejudicial to public interest by reason of their confidential nature, representatives of the press and members of the public should be excluded from the remainder of the meeting. Section 1 (2) Public Bodies (Admission to meetings) Act 1960.

Chair’s & Managing Director’s Report

1 Purpose

The Chair & Managing Director’s report highlights items of interest to Governing Body members and the public. The Governing Body is invited to note this report and pursue any points of clarification or interest.

Quality Premium Achievement - less than 15% of all full NHS Continuing Healthcare (NHS CHC) assessments take place in an acute hospital setting

Last August, Matthew Swindells National Director, Operations and Information and Professor Jane Cummings, CNO, wrote to Tower Hamlets CCG outlining NHS England’s plans to improve the NHS CHC assessment process. These plans included actions to be taken by Clinical Commissioning Groups (CCGs) in order to achieve two key standards required for the Quality Premium for 2017/18.

We are therefore pleased to report that the action ‘for CCGs to ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting’, was achieved nationally by the end of Q4 2017/18. This was an ambitious and challenging aim and NHS England extended their thanks to everyone who has contributed in making this happen within relatively short timescales.

Tower Hamlets leads the way on personal health budgets

The number of people with a personal health budget (PHB) in Tower Hamlets has risen to 375, the highest in London and 169 more than the next highest performing borough.

PHBs are an innovative approach to giving people with long-term health conditions and disabilities more choice and control over how money is spent on meeting their health and wellbeing needs.

Each personalised budget is planned and agreed by the person receiving the care, or their representative, and local healthcare services. Health and wellbeing outcomes are then identified, giving people more involvement in decisions about their care.

Commenting on the figures, Dr Sam Everington, Chair of NHS Tower Hamlets Clinical Commissioning Group (CCG) and a local GP, said:

“This is a great result for Tower Hamlets. It means people have more of a stake in the care they receive, so instead of having services provided for them they are actively involved in their care – ensuring it is tailored to their needs.”

Tower Hamlets CCG’s success is due in part to its ‘personalised care programme’, which includes key groups such as those receiving mental health services, people with learning disabilities, those with long-term conditions such as diabetes, and children with special educational needs. The national programme is supported by NHS England.

Enclosure A

! THCCG Part 1 Papers 25th September 1

Among those in Tower Hamlets to benefit from a PHB is Jackie Kennedy, 52, from Poplar. Her PHB pays for her assistance dog Kingston. He helps her manage her physical health and emotional wellbeing.

Kingston, a black Labrador, knows nearly 200 commands. He can put Jackie’s clothes on the bed for her, open the front door, fetch her mobile phone and bring her a blanket. He can even let himself out into the garden, post a letter and take things off the shelf for her at supermarkets.

Crucially, Kingston also helps Jackie manage her physical disabilities, saving the NHS more than 60 ambulance trips this year alone.

Funded as part of her PHB for just £3,000 a year, he can alert Jackie to an epileptic seizure 45 minutes before it happens, and predict her hypo and hyperglycaemic attacks. He can also sound an alarm, take Jackie her hypo-kit and open the door for paramedics.

The impact that Kingston has had on Jackie’s life has been transformational, and she is now able to manage her health much better. She no longer requires physiotherapy, visits the GP less often and most importantly he has given her a purpose in life.

Jackie, a former nurse, said: “Between 4.30pm and 9.30am each day, when my human carer isn’t there to support me, I’m in Kingston’s paws – he’s my personal assistant and provides all the help I need.

“Since I got him just under three years ago, my health has really improved. The support Kingston provides through my PHB has had huge benefits for me personally, and the fact that he’s saved thousands of pounds for the NHS too makes is really good to know.

Jackie added: “I’m really grateful for the help Tower Hamlets CCG has given me in allowing me to use my PHB in this way and it’s great to see that more people in the borough are receiving similar support. PHBs are the way forward as they put you in the driving seat – you’re the master of your own health.”

Seven new urban gyms launched across borough

Seven new urban outdoor gyms have opened in parks across Tower Hamlets, enabling local people to use to improve their fitness and get active without the need for expensive gym memberships.

The urban gyms were suggested by residents who took part in GP patient participation groups. The council’s sports, parks and public health teams have jointly commissioned them as ‘Our Parks’ using Section 106 funding¹.

The gyms are part of a social prescribing service that GPs, nurses and other healthcare professionals can refer patients to offer them additional support to improve their health and wellbeing.

It is estimated that 20-30 per cent of the adult population in Tower Hamlets is clinically obese due to a lack of physical activity, limited access to green spaces, poverty and the widespread availability of cheap, unhealthy food.

Sam Everington, local GP and our chair, said: “We all know that keeping fit is brilliant for your health, and the launch of outdoors gyms at various parks across our borough is great news for local people who can now access free, easy-to-use and suitable for all ages equipment, without paying for an expensive gym membership.

“Physical activity can boost self-esteem, mood, sleep quality and energy, and regular exercise can reduce your risk of major illnesses, such as heart disease, stroke, type 2 diabetes and


cancer by up to 50 per cent. I encourage local people to make use of these new free-to-access facilities, and reap the many benefits exercise can provide.”

Small steps improve lives for asthma sufferers

One in 10 children and young people in London have asthma but less than half of these have an asthma management plan or know how to use their inhaler correctly.

NHS Tower Hamlets CCG is supporting the Healthy London Partnership and NHS England London campaign #AskAboutAsthma to help improve the lives of those in Tower Hamlets living with asthma.

The campaign, which is launching to coincide with children and young people returning to school and the highest peak of hospital admissions for asthma, aims to encourage all children and young people with asthma to take these three simple steps:

Have a written asthma action plan. The plan helps identify the right colour inhaler and dosage and the time to seek emergency help

Be able to use their inhaler effectively

Ensure they have an annual asthma review of their medication and care #AskAboutAsthma is also asking individuals to make small steps to improve air quality by inviting them to make a My Asthma Pledge in support of the #AskAboutAsthma campaign.

The small steps include:

Encourage more exercise by walking to work/school

Car pooling and turning off engines when idle

Using non/less toxic materials in homes and offices

Having greenery in and around homes and offices

Many of us will have a friend or relative with asthma and our actions could really help them. That’s why we are encouraging people to make a pledge in support of the #AskAboutAsthma campaign. With relatively simple approaches, we can all contribute towards making a big difference for asthmatics.

Royal London children's teams up for prestigious award

Teams caring for children at The Royal London Hospital are up for a prestigious national health award.

The play and paediatric liaison teams have been shortlisted in this year’s Health Service Journal (HSJ) awards following the success of a 'heroes' project which has boosted the confidence of children and young people with chronic illness.

The project helps them to discuss as a group how the challenges of their illness makes them feel, and share ways to cope. In doing so, they recognise personal strengths and celebrate each other's bravery as true heroes. The session ends with each awarded a certificate of achievement and a shiny cape to cement their 'hero' status.


Clinical teams have found that children and young people report feel less alone, and are more understanding and willing to accept treatment. The project has also reduced feelings of anxiety and depression in parents and carers.

Improvements at NHS Barts Health Hospitals

Patients have scored Barts Health NHS Trust top marks for cleanliness, its food services and the condition, appearance and maintenance of its hospitals.

Patients, as well as members of the public, took part across Barts Health hospital sites in the Patient-Led Assessments of the Care Environment (PLACE) - an annual, mandatory inspection led by NHS England to review the care environment.

The results not only show Barts Health as performing above the national average for cleanliness, food services and the upkeep of its hospital buildings, but show improvement has been made in every assessment category over the last year.

Congratulations to NHS Barts Health for these additional steps towards their quality improvement plans.

ELFT’s Tower Hamlets Learning Disability Service Shortlisted for Excellence

Mile End hospital based Tower Hamlets Community Learning Disability Service (CLDS) have been nominated for the Breakthrough Positive Practice in Mental Health awards 2018.

Shortlisted for excellence in Quality Improvement and Innovation in community mental health, the team is being recognised for delivering a visionary care programme as well as setting standards nationally for a service that puts patient’s needs first.

The team have pioneered an innovative approach to genetic testing. They work alongside the Clinical Genetics Service to provide a specially tailored package for people identified with genetic conditions. Then, not only are they given an explanation of their disabilities, but a more personalised method of intervention is tailored to help people lead more independent lives.

Congratulations to all those at the East London Foundation Trust for this recognition of their ground-breaking hard work.


Enc. B

Accountable Officer Update September 2018

NHSE Primary Care visit In August, the national NHS England Primary Care team visited north east London to discuss progress against the GP Five Year Forward View. As well as showcasing some of our primary care work and visiting the Sir Ludwig Guttman Health and Wellbeing Centre in Newham, the team heard about progress in BHR on GP retention. They also visited the Spring Hill practice in City and Hackney where they met the local GP Federation to talk about their work. Commissioning strategy This month the first North East London Commissioning Alliance Commissioning Strategy has been developed in partnership with the seven clinical commissioning groups, primary care, specialised commissioners, the eight London boroughs and the five NHS trust providers of the East London Health and Care Partnership. This strategy works towards breaking down the divide between providers and commissioners. It sets out:

Development of integrated care systems and assurance Priorities for transformation programme workstreams Noting the development of local system plans Proposal for changing how we contract and pay for services in future.

Following the publication of the NHS ten year long term plan, we will revise this strategy to ensure alignment to national priorities. Joint Commissioning Committee (JCC) The September JCC took place on Wednesday 13 September. It covered the following items: cancer diagnostic hub, the north east London commissioning strategy for 2018/19 – 2021/22 and an update on performance. Papers for the session and previous sessions, can be found on each CCG website and minutes will be available online one month on from the meeting. Winter planning We submitted a North East London (NEL) Wide Winter Plan to NHS England (NHSE) at the end of August. The plan aims to take some learning and reflection from last winter on which to build for our planning for this year. It identifies some of our challenges and provides a NEL wide response to the national asks for this winter around reducing extended lengths of stay, further developing ambulatory care, reducing minors breaches, improving ambulance handovers, and work to reduce the demand going into our hospital emergency departments. We are keen to ensure that we learn and share best practice from each other too this winter, and work more effectively across our partnership with community and mental health providers, local authorities, primary care and voluntary sector when we see pressure building in our emergency departments. We will be hosting a winter event on the 27th September bringing system partners together to do some further sharing


and scenario planning. We will also start work on a plain English version of the plan for patients and public. AGMs This month CCGs are holding their AGMs which will be an opportunity to share the annual reports and accounts and reflect on achievements over the last year. Details of individual CCG AGMs can be found on websites. The Tower Hamlets CCG will conduct our AGM on October 3rd, with more information available on our website: www.towerhamletsccg.nhs.uk. NHS England Long-term plan As work continues to develop the NHS England long-term plan, a consultation document has been published seeking feedback from a wide range of stakeholders. As part of the process it is vital that all those who rely on and work in or alongside the NHS have the opportunity to contribute their ideas, experiences and insights. If you would like to have your say, you can read the discussion guide and consultation document online here. The closing date is 26 September.


Minutes of the NHS Tower Hamlets Clinical Commissioning Group

Governing Body Meeting (Part 1)

Tuesday, 24 July 2018, 14.30 – 17.15 Southern Grove Community Centre, Mile End

1.1.1 Present

Name Role Organisation

Sam Everington Chair & Network 6 Representative NHS THCCG Simon Hall Managing Director NHS THCCG Jane Milligan Accountable Officer & Executive Lead for North

East London Sustainability & Transformation Plan NHS THCCG (& NELCA)

Henry Black Chief Finance Officer for THCCG NHS THCCG Mariette Davis Lay Member for Governance NHS THCCG Isabel Hodkinson Network 5 Representative NHS THCCG Judith Littlejohns Network 1 Representative NHS THCCG Victoria Tzortziou-Brown

Network 3 Representative NHS THCCG

Noah Curthoys Lay Member for Corporate Affairs NHS THCCG Linda Aldous Practice Nurse Representative NHS THCCG Maggie Buckell Secondary Care Representative - Registered

Nurse NHS THCCG

Julia Slay Lay Member for Public & Patient Involvement NHS THCCG Warwick Tomsett Joint Director of Commissioning NHS THCCG Somen Banerjee Director of Public Health LBTH Osman Bhatti Network 7 Representative NHS THCCG Virginia Patania Practice Manager Representative NHS THCCG Archna Mathur Director of Performance and Quality NHS THCCG

1.1.2 In attendance


Ellie Hobart Acting Director of Corporate Affairs NHS THCCG Sophia Beckingham Corporate Governance Manager NHS THCCG Steve Collins Finance Advisor NHS THCCG Nicola Weaver Organisational Development Manager (part) NHS THCCG Lynne Torpey Designated Nurse for Safeguarding (part) NHS THCCG Dr Julia Hale Designated Doctor for Safeguarding (part) NHS THCCG

1.1.3 Apologies

Name Role OrganisationJim Dodds Director of Acute Contract Management NEL CSU Denise Radley Corporate Director Health Adults & Community,

London Borough of Tower Hamlets LBTH

Shah Ali Network 8 Representative NHS THCCG Imrul Kayes Network 2 Representative NHS THCCG

Enclosure C


1.1 Welcomes

Sam Everington (SE, Chair) welcomed members and attendees to the meeting and members of the public seated in the public gallery.

1.2 Declarations

SE asked Members for any declarations of interest relating to matters on the agenda. No additional declarations were declared.

1.2 Chair & Managing Director’s Report

SE presented the Chair’s and Managing Director’s Report, noting that the NHS 70 event at the Mile End Hospital with the CCG’s Tower Hamlets Together (THT) partners was fantastic, and thanked all CCG and local Tower Hamlets Staff who organised the event.

SE noted that WEL chairs sent a letter regarding the implementation of an electronic referral system to the CEO and Chair of NHS Barts Health in order to agree a way forward.

Virginia Patania (VP, Governing Body Member) informed the Governing Body that Steve Field has visited Jubilee Street GP Practice as part of a tour of outstanding practices. VP explained that Steve Field had written to the practice to say that it was the best practice he had visited in many years and he was very impressed by what he saw at the practice in terms of evidence based change.

Simon Hall (SH, Managing Director) thanked all CCG staff for their contribution to the outstanding rating that Tower Hamlets CCG had received from NHS England as part of the Individual Assessment Framework.

1.5 Accountable Officer’s Report

Jane Milligan (JM, Accountable Officer) noted that the paper switch off programme was advancing and should be on track for 3rd September. JM also noted that the CCG had received a Green Star for engagement and was one of the few CCGs to do so.

The Governing Body Members NOTED the report.

1.4 Patient Story – Stroke Rehabilitation

SE welcomed Patient A to the Governing Body, noting that Patient A had been invited to speak to them regarding their experiences as a carer in Tower Hamlets with a parent currently going through a stroke rehabilitation plan and discuss better care for stroke survivors in the future. Patient A explained that their parent is a local Tower Hamlets patient, who lives in social housing and is registered with a Tower Hamlets GP. As a result of the stroke, Patient A’s parent has become disabled which has further affected her ability to recover and be independent in the home.

Patient A explained that the services that her mother had received from the stroke teams locally and her mother’s GP were disappointing, and had created many issues which meant that Patient A had to conduct additional care for her mother in order to ensure that her mother was well. Patient A explained that she had been working with the GP Care Group to assess


how to better the support offered to stroke survivors and had conducted some research in to Stroke services which had worked well nationally. Patient A gave examples of where the CCG may wish to improve the integrated nature of the service, including an elderly patient’s team which can visit elderly patients in the borough to ensure that avoidable hospital admissions do not take place.

The Governing Body welcomed the discussion, and noted that it was disappointing that a number of services for stroke survivors had been commissioned for many years but had not reached the patients it needed to. Archna Mathur (AM, Director of Performance and Quality) noted that the data the CCG receives indicates that the services are successful for most patients but that the patient testimony clearly outlined that issues remain and more must be done using patient testimony and to improve services.

Virginia Patania (VP, Governing Body Member) asked Patient A to work with her to work on transformation projects regarding patient engagement and involvement with GP practices and how to better primary care support for stroke survivors.

The Governing Body thanked the patient for their story.

1.6 Minutes and Matters Arising SE asked the Governing Body members to check and confirm the accuracy of the previous draft minutes of the meeting held on 22nd May 2018. The minutes were APPROVED as an accurate record of the meeting after taking in to account minor changes.

2.0 Performance & Quality

2.1 Safeguarding Children & LAC Annual Reports

A) LAC Annual Report

Dr Julia Hale (Designated Doctor for Safeguarding) presented the Looked After Children (LAC) annual report, noting that the previous reports presented to the Governing Body. JH noted that the CCG are required to author a Looked After Children report each year, and this report summarises activities undertaken during 2017-18, significant cages in Safeguarding and LAC legislation, work conducted in conjunction with the CCGs partners and key risks of which the Governing Body much be aware. JH explained that the CCG are working with its statutory partners, the London Borough of Tower Hamlets and the Metropolitan Police to ensure that the new arrangements are robust, promote agency joint working and take into account that ‘health’ is much wider partner than just the CCG and includes the providers.

JH noted that following reviews and the recent Children and Social Work Act 2017, a number of changes have taken place in respect of our statutory responsibilities and the way the CCG works in partnership to ensure that children are adequately safeguarded and looked after. These include replacement of Local Safeguarding Children Boards (LSCBs) with local safeguarding partnerships, improved monitoring and support offered to children in, and those, leaving care and the extension of support to care leavers by the Local Authority (LA) until the age of 25 years. The CCG is working with LA to understand the impact of legislative changes and health commissioning implications due to extension of support to care leavers up to 25 years old. The CCG, with input from the designated professionals, will be the voice of ‘health’ in these new arrangements to ensure that the CCG and providers are meeting statutory requirements.


JH explained that NHSE had sent out guidance to standardise how to commission children’s services which gives the CCG a clearer framework to work from and informs on how to measure outcomes in a formal way. JH assured the Governing Body that this has gone to providers and discussions for changes are taking place.

JH asked the Governing Body to note that the LAC report shows that challenges continue to be experienced and that local performance is poor. JH explained that this is for a number of reasons, the main of which is the joint responsibility for the Local Authority and Provider (NHS Barts Health) to complete an initial assessment within 28 days, which is currently only taking place on 28% of cases, with a target of 95%. The reasoning behind this performance is complex and relies on the LA to report to the provider within the 28 day timeframe and if this does not occur, the provider will also fail to work within the timeframe. Additionally, JH noted that the provider is also experiencing their own difficulties in assessing patients and explained that if the LA were to improve their processes, there would be no guarantee that Barts Health could ensure the 28 target is met. JH noted that meetings had taken place to improve the pathways with both the LA and Barts Health and work is taking place to create a health profile of the LAC population. This will assist the CCG in ensuring there is sufficient capacity within commissioned services to meet identified health needs for all LAC resident within Tower Hamlets boundaries.

IH (Isabel Hodkinson, Governing Body Member) asked if there were plans to recruit to the LAC designated Doctor Post which had been vacant for some time. LT explained that JH had been providing support to this area, and that Barts were currently recruiting to the post.

JH noted that there was further issues with non-locally placed children, which has limited the access of data on children outside of the borough, including basic information like immunisation data. The safeguarding groups are exploring ways to overcome this but it means Tower Hamlets are reliant on other organisations to follow the children’s action plan.

The Governing Body APPROVED:

1. The Annual Safeguarding Children Report.

2. Noted the assurance and challenges.

3. Approved the priorities for 2018/19.

B) Safeguarding Children Annual Report

Lynn Torpey (LT, Designated Nurse for Children and Safeguarding) presented the Safeguarding Children and Annual Report, noting that the changes brought about by new legislation in 2017 were now in force and the CCG continues to review and ensure that it means the new standardised approach with its partners. LT explained that the report outlines the priorities for the year, and LT asked the Governing Body to approve the plan as it stands.

LT explained that the report outlines the key changes and the plans in place with fellow statutory partners and takes in to account wider responsibilities needed in health, such as those in providers. LT noted that now statutory partners are equally responsible, we are additionally equally financially responsible too, the costs of which have not fully been worked up. LT noted that the report touched on STP wide risks, such as ensuring children’s rights and ensuring that transition arrangements are robust for safeguarding and the CCG continues to maintain statutory guidance compliance.


LT explained that locally, the Safeguarding Act has meant the borough has seen increase in terms of safeguarding activity, that despite the rise in population there had been a but drop of Children in need, children subject to child protection plans and LAC. LT noted that this goes against national trends and although this could be due to the Ofsted Improvement Board, it did raise a number of questions of the quality of the data provided in previous years.

Overall, safeguarding themes included an increase in serious youth violence, missing children, children at risk of child sexual exploitation and domestic abuse. LT noted that many children who are subject to Children Protection Plan are there due to emotional abuse linked to domestic abuse.

Maggie Buckell (MB, Registered Nurse) thanked LT for the presentation and recognised the increasing complexity of which safeguarding professionals are working, both at local level and with STP level pressures which have created a complex environment. In addition, the CCG are supporting the borough on their improvement journey and MB thanked LT for her work on this work stream. MB highlighted that there are serious case reviews due to be published, and that there will be learning from these reviews to be taken in to account. MB also noted that the increase of serious youth crime is a London wide problem and is a major problem for our A&E services.

Osman Bhatti (OB, Governing Body Member) noted the increasingly complex patients and the complexity of coding these patients currently, noting that when they come off a Child Protection Plan, they are not decoded. LT agreed to link OB in with Emma Tumachi, the Clinical Lead for children and safeguarding to share guidance on data evaluation and appropriate coding for safeguarding children.

LH explained that the coding for children suffering from neglect is not the same as nationally, and may create anomalies in the data. LH noted that more work needs to be conducted locally through the partnerships to tackle neglect and agree the standardisation of tools to assess and identify children of neglect. LT supported this and noted that it is likely the data for this year is correct, and possible that the previous year’s data contains from public health contains errors.

LH noted there has been a lack of named GP on children protection plans by the Local Authority, and noted that GPs are often not invited or aware of initial case conference and the case worker may not copy GP in to communications. LH explained that the CCG and the LA are working to ensure that GPs are included, as it is fundamental that they input on plans and can liaise with other organisations regarding a child’s wellbeing.

SH agreed and noted that this has been raised on behalf of the CCG and is a matter of concern which would need to be addressed.

The Governing Body APPROVED:

1. The Annual Safeguarding Children Report

2. The assurance and challenges

3. The priorities for 2018/19

The Governing Body thanked Lynn Torpey and Dr Julia Hale for their work on safeguarding children in Tower Hamlets.


C) Briefing Paper Following Release of Statutory Guidance – Working Together To Safeguard Children 2018

The Governing Body NOTED the Briefing Paper Following Release of Statutory Guidance – Working Together To Safeguard Children 2018.

2.2 Board Assurance Framework

Ellie Hobart (EH, Acting Director of Corporate Affairs) outlined the key updates for the Board Assurance Framework 2018/19v1, noting that discussions with committees and risk leads would inform future iterations of the BAF for 2018/19. EH asked the Governing Body to note that the BAF had been to all relevant committees and outlined the key changes in this iteration.

EH noted that this BAF was the first to address the quality issues of the Continuing Healthcare Services, explaining that the risk 2.4 outlined the risk that issues with the systems and processes for managing discharge and assessing and reviewing eligibility for Continuing Healthcare (CHC) in a timely manner may lead to patients receiving a package of care which is insufficiently tailored to their needs, compromising achievement of the patient’s optimal outcome. EH explained that the risk includes the key mitigations of the recruitment of a new CHC CCG manager (a new role), with additional oversight provided through quality meetings and trajectory settings. EH noted that the CCG were working closely with the CSU and providers to improve the quality of service to patients.

EH noted that a new risk within Primary Care had been added regarding the new online GP registration forum. EH explained that the Primary Care Committee had discussed the implication of significantly easier way for Tower Hamlets residents to register with a GP practice, noting that whilst the platform will provide for a single and consistent approach to GP registrations, with one website for patients to use, local work has shown that there are many people living in Tower Hamlets that are not registered and it is impossible to quantify the number due to the nature of the data sets available. If the new platform is a success and the number of registrations increases substantially, this may create an additional financial burden for the CCG’s budget where the allocation does not reflect the potentially rapid population growth from supporting people to register quicker, and actively advertising the process.

EH also highlighted the change increase in risk rating for a number of financial risks relating to the operating plan and provider overspend, and asked the Governing Body to be cognisant of this development, with further information provided in the financial reports.

The Governing Body NOTED the BAF.

2.3 Month 12 Finance Report

Steve Collins (SC, Finance Advisor) presented the month 3 finance report explaining that the CCG was reporting a break-even year to date and full year forecast in line with the financial plan.

SC noted that despite this, the acute position continues to be challenging, with main acute provider NHS Barts Health continuing to overspend and month 2 Flex data indicating an over-performance of £1.8m YTD and £5.5m forecast, if the trend continued to be unmitigated. SC explained that these have been offset by underspends, releasing local acute reserves and unutilised prior year provisions. SC explained that the delivery of the CCGs QIPP programme had been affected by NHS Barts Health non-elective activity, with the CCG now forecasting £13.6m delivery against the QIPP target of £14.0m. SC explained that work is on-going for to


ascertain the material forecasts for non-electives in order to inform the appropriate QIPP levels.

SC noted that the primary care co-commissioning forecast a shortfall in NHSE funding had created a gap of 0.3 million and asked the Governing Body to note that prescribing costs data for April shows a forecast of £2m overspend. SC stated that work had been conducted with the NELCSU Medicine Management team to review this and overall it has not been considered sufficient for a reliable year-end forecast.

SC noted that whilst the CCG is forecasting an achievement in its financial requirements to meet its control total, the Governing Body should be cognisant of the significant pressure and risk from activity from Barts Health NHS Trust.

The Governing Body NOTED the month 3 Finance Report.

2.5 Performance and Quality Report

Archna Mathur (AM, Director of Performance and Quality) presented the Performance and Quality report, highlighting the key issues within the system in Tower Hamlets, current performance against National Constitution standards and actions taken by providers and Tower Hamlets CCG to manage the provider performance and quality portfolio for acute, community and mental healthcare in Tower Hamlets.

AM informed the Governing Body that during months one and two, Barts Health had met the cancer standards but that there was always likely to be fluctuation due to a small number of breaches, and the CCG may see a rise in over 52 week waiters. AM explained that A&E continues to be challenged and noted that Barts Health did not meet the 90% STF (Sustainability Transformation Funding), and the Royal London site did not meet the 95% standard for any week in April and May. AM noted that the delayed transfer of care (DTOCs) was challenged but had started to show improvement, with system wide plans to support DTOCs in place at the RLH including get me home meetings, daily senior operational hub call and the opening of six hostel beds To address the homeless challenges. AM noted that the main reasons for delays are choice, homelessness, awaiting nursing home beds and equipment.

AM noted that Royal London had 16 overdue SIs, down from 1 in the March position. AM explained that this was satisfactory but needed to be improved to match the national average of 7. AM reported that there had been 3 Never Events at the Royal London, with one event regarding a dental extraction, a common theme on which Barts Health and the CCG have worked to improve. AM noted the CCG are currently awaiting investigation as to how this occurred.

AM noted that Continuing Healthcare position was positive, especially in light of its placing on the BAF and explained that there had been improvement in many key areas but would continue to be a focus of the CCG going forward.

The Governing Body NOTED the Performance and Quality Report.

2.5 NHS England Improvement and Assessment Framework (IAF) Tower Hamlets CCG

AM presented the NHS England Improvement and Assessment Framework (IAF) for Tower Hamlets CCG, explaining the IAF is a tool to assess CCGs and helps inform the work the CCG needs to do to improve the outcomes for patients who live in and use NHS services in Tower


Hamlets. AM noted that the IAF reviews for areas of the CCG’s performance; Better Health, Better Care, Sustainability and Leadership

AM informed the Governing Body that Tower Hamlets CCG performed well in a number of areas this year and was rated ‘outstanding’ overall. There were notable improvements in cancer care, with improved performance in terms of cancers diagnosed at an early stage and one‐year survival rates from all cancers and significant improvement in the number of people with a first episode of psychosis receiving a NICE recommended package of care within two weeks of referral, as well as the quality of adult social care overall.

The Governing Body NOTED the update.

3.0 Commissioning & Strategy

3.1 NEL Commissioning Alliance Update

JM presented the NEL Commissioning Alliance Update, noting that review of NELCA and WEL leadership was currently under review and the CCG would explore proposals such as a single CFO across NELCA through a future OD session. JM noted that a new colleague Hilary Russ would be reviewing the strategy of TST to support areas of work.

The Governing Body NOTED the NEL Commissioning Alliance Update.

3.2 East London Health Care Partnership Update

The Governing Body NOTED the East London Health Care Partnership Update.

3.3 Tower Hamlets Plan 2018-23

SH presented the plan, noting it had been developed by the overall Tower Hamlets Strategic Partnership (led by the Mayor), which brings together key stakeholders to improve services and outcomes for local residents. Recently it has been focused on strengthening relationships and developing a vision and priorities for the next five years.

SH explained that this plan was going to the Local Authority Cabinet, replacing the old community plan but still maintaining a similar function with 4 key areas (the final of which is Health and Wellbeing). SH noted that he would be working with Somen Banerjee (SB, Director of Public Health) to ensure these strategies align with the Health and Wellbeing Strategy and the Tower Hamlets Together plan. SH noted that the plan is work in progress but is moving Tower Hamlets in the right direction.

IH hoped that recent meetings, together with the plan, would provide a vehicle to begin some of the cross cutting conversations across organisations that needed to take place and limit duplication in the system. She noted that she had met with Zena Cook to review system spending collectively within the borough to support ongoing conversations regarding areas of duplicate spend.

The Governing Body APPROVED the plan.


END


1 | P a g e

Governing Body Meeting Enclosure

Date of meeting 25th September 2018 Paper D

Agenda item 2.2

Title of report: Month 5 Finance report – 2018/19

Author(s): Andrea Antoine – Deputy Chief Finance Officer

Nitesh Parekh – Head of Financial Management

Steve Collins – Finance Adviser

Leon Karim – Head of Financial Planning

Presented by:

Sponsor (if different):

For further information

Henry Black – Chief Finance Officer, Tower Hamlets CCG

Andrea Antoine – Deputy Chief Finance Officer

[email protected] - 020 3688 2510

Executive summary

At Month 5 (August 2018) the CCG is reporting a break-even year to date (YTD) and full year forecast in line with the plan. With this position, the CCG’s cumulative surplus remains at £12.2m.

In Acute, the Barts Health activity based on M4 Flex data has indicated an over-performance of £2.5m YTD and £6.0m forecast, if trends continue unmitigated. The associates, including NCA’s and GP at Hand potential costs, are reporting a forecast overspend of £0.7m. These have been offset by releasing local acute reserves (YTD £1.6m and forecast £3.8m) and unutilised prior year provisions (YTD £1.5m and forecast £2.3m), leaving a net Acute position of £0.2m YTD and £0.5m forecast overspends.

Other areas of overspend include; Primary Care Co-Commissioning projecting a full year overspend of £0.5m (YTD £0.2m), which represents a shortfall in NHSE funding and potential GP at Hand costs; Prescribing at Month 5 is projecting a full year overspend of £1.1m (YTD £0.5m) relating to the continuation increased costs of NCSO’s and Category M.

In summary, at Month 5 the CCG is forecasting an achievement in its financial requirements to meet its control total, however,


2 | P a g e

there is a significant pressure and risk from activity from our main provider Barts Health as well as GP at Hand costs and risks around increased NCSO costs in prescribing. At month 5 all these known pressures are being mitigated through the use of reserves and unutilised prior year provisions.

Recommendation

Information Approval To note Decision

To note the content of the report, and discuss any actions required

Key issues Noted in Executive Summary

Conflicts of Interest There are no identified conflicts of interests.

Report history Strategic Finance & Investment Committee (SFIC) meetings (CCG)- Information obtained at this meeting helps inform this Board report

Patient and Public involvement

N/A

Link to the Board Assurance Framework

Addresses several corporate objectives, those around finance, ensures the governance body is sighted on key finance and performance targets:

Strategic Objective 3: Creating a thriving and stable health and social care economy

Strategic objective 4: Delivering against our statutory duties.

Impact on Equality and Diversity

N/A

Resource requirements

None

Next steps Action and next steps for each area identified is covered in the report.


3 | P a g e

Month 5 Finance & QIPP Report – 2018/19Month 9 Finance & QIPP Report – 2017/18

Executive Summary

At Month 5 (August 2018) the CCG is reporting a break-even year to date (YTD) and full year forecast in line with the plan. With this position, the CCG’s cumulative surplus remains at £12.2m.

In Acute, the Barts Health activity based on M4 Flex data has indicated an over-performance of £2.5m YTD and £6.0m forecast, if trends continue unmitigated. The associates, including NCA’s and GP at Hand potential costs, are reporting a forecast overspend of £0.7m. These have been offset by releasing local acute reserves (YTD £1.6m and forecast £3.8m) and unutilised prior year provisions (YTD £1.5m and forecast £2.3m), leaving a net Acute position of £0.2m YTD and £0.5m forecast overspends.

Other areas of overspend include; Primary Care Co-Commissioning projecting a full year overspend of £0.5m (YTD £0.2m), which represents a shortfall in NHSE funding and potential GP at Hand costs; Prescribing at Month 5 is projecting a full year overspend of £1.1m (YTD £0.5m) relating to the continuation increased costs of NCSO’s and Category M.

In summary, at Month 5 the CCG is forecasting an achievement in its financial requirements to meet its control total, however, there is a significant pressure and risk from activity from our main provider Barts Health as well as GP at Hand costs and risks around increased NCSO costs in prescribing. At month 5 all these known pressures are being mitigated through the use of reserves and unutilised prior year provisions.

Detailed Report

Revenue Resource Limit (Income) - The resource limit at Month 5 is £446.0m. This comprises of baseline and other funding and recurrent and non-recurrent as shown in the table below:


4 | P a g e

QIPP position – At month 5, the CCG is reporting a year to date delivery of £2.5m against the planned year to date QIPP programme of £3.1m. The CCG is forecasting £11.5m delivery against the QIPP target of £14.0m. This QIPP under-delivery is mainly attributable to the Urgent Care Treatment Centre scheme.

Reserves & Contingencies – The pressures in Acute, Prescribing and Co-commissioning have been offset by the use of reserves kept locally within those areas. CCG has a full year total available central reserves balance of £5.4m, after utilising £0.4m to offset the remaining Acute overspend.

Running Cost Allowance –The CCG’s running costs allowance for 2018/19 is £6.4m. At month 5 the CCG is within plan to spend within its Running Cost Allocation.

Programme Projects –The CCG’s programme projects budget for 2018/19 is £7.1m. At month 5 the CCG is within plan to spend within its Programme Projects Budget.

The table below shows the breakdown of corporate position:

Allocation AreaRecurrent

£'000

Non‐recurrent

£'000

Total

£'000

Baseline Allocation 430,047 13,239 443,286

Paramedic Allocations 241 241

HSCN 102 102

UCLH Cancer‐Cardiac Transition Support (500) (500)

Mental Health 594 594

Infrastructure funding for STPs 316 316

Maternity Transformation Funding 593 593

CHP voids and subsidies 237 237

Primary Care 807 807

Other 58 253 311

Total Allocation at M3 430,105 15,882 445,987

Service FunctionAnnual Budget £’000

YTD Budget £’000

YTD Actual £’000

YTD (Under)/

Overspend £’000

Forecast Actual £’000

Forecast (Under)/

Overspend £’000

ADMINISTRATION & BUSINESS SUPPORT 50 21 35 14 57 7BUSINESS DEVELOPMENT 0 0 28 28 0 0CEO/ BOARD OFFICE 176 73 70 (3) 161 (15)CHAIR AND NON EXECS 526 219 197 (22) 466 (61)COMMISSIONING 178 74 146 72 182 4COMMUNICATIONS & PR 528 220 196 (24) 526 (3)CORPORATE COSTS & SERVICES 1,910 796 821 26 1,911 1FINANCE 1,008 420 346 (74) 996 (12)PRIMARY CARE SUPPORT 641 267 260 (7) 636 (6)QUALITY ASSURANCE 475 198 147 (51) 409 (66)GENERAL RESERVE - ADMIN 913 0 0 0 913 (0)

Total Running Costs Allowance 6,406 2,289 2,247 (41) 6,256 (150)

PROGRAMME PROJECTS 7,124 2,782 2,940 158 7,125 0

Total Programmes (Non-RCA) 7,124 2,782 2,940 158 7,125 0

Total Corporate Financial Position 13,530 5,070 5,187 117 13,380 (150)

Tower Hamlets CCG -2018/2019 Corporate Financial Position at Month 5


5 | P a g e

Key Risks & Opportunities/Mitigation to Forecast at Month 4

Risks – At M5, the CCG recognises the following risks, above the forecast position, which will be mitigated through the reserves (as listed in the Reserves and Contingencies):

- QIPP Under-delivery of £4.5m - Acute over-performance, specifically Bart Health - £.3.6m - Prescribing overspend - £0.5m - Acute provider contracts yet to be agreed/signed off

Additional risks not reflected in the M5 financial forecasts are:

- The potential for run rates on all acute contracts to outstrip the forecast assumptions and values projected.

- Unanticipated high expenditure in Continuing Care and Prescribing, which has not been factored into the M5 reported position.

- QIPP levels anticipated not realised

Summary – at present, we believe the additional risks which have not been reflected in the financial forecasts, will be covered by the mitigations, as per the above details. There is also the possibility of additional funding as recently announced by the PM for the NHS@70 celebrations, which will be used to mitigate some pressures. The allocation is not yet known, therefore these funds have not been reflected in the position.

Summary - Revenue Financial Position

Tower Hamlets CCG - Financial Position as at Month 5

Annual Budget £’000

YTD Budget £’000

YTD Actual £’000

YTD (Under)/

Overspend £’000

Forecast Actual £’000

Forecast (Under)/

Overspend £’000

Last Mth Forecast Variance

£’000

Forecast In-Month

Movement £’000

DelegatedIn Sector Acute Trusts 156,647 65,270 67,807 2,538 162,738 6,091 6,217 (125) Out of Sector Acute Trusts 23,670 9,863 9,678 (184) 23,228 (442) (1,121) 679 Other Acute 14,038 7,717 5,519 (2,197) 8,936 (5,102) (5,096) (7) Subtotal Acute 194,356 82,849 83,005 156 194,902 547 (0) 547

Mental Health 48,973 19,769 19,769 1 48,975 2 1 1 Community Health 52,806 21,672 21,672 0 52,806 0 0 0 Other Non Acute 22,970 8,563 8,577 15 22,969 0 0 0 Subtotal Non Acute 124,749 50,003 50,019 16 124,751 2 1 1

Prescribing 33,662 13,627 13,627 0 33,663 0 0 0 Primary Care Co-Commissioning 45,034 18,764 18,983 219 45,560 526 337 189 Prime Ministers Challenge Fund 0 0 0 0 0 0 0 0 Operational Resilience 1,310 546 546 (0) 1,310 0 0 0 Other Primary Care Services 14,954 5,736 5,517 (219) 14,429 (525) (337) (188) Subtotal Primary Care 94,960 38,672 38,672 0 94,961 0 0 0

Reserves 7,066 289 0 (289) 6,666 (400) 0 (400)

TOTAL Commissioing 421,130 171,813 171,696 (117) 421,280 149 (0) 150

Corporate 12,617 5,070 5,187 117 12,467 (150) 1 (151) TOTAL CORPORATE 12,617 5,070 5,187 117 12,467 (150) 1 (151)

GRAND TOTAL 433,748 176,883 176,883 0 433,747 0 0 0 IN YEAR RESOURCE LIMIT (433,748) (176,883) (176,883) 0 (433,747) 0 0 0 IN YEAR (SURPLUS)/DEFECIT 0 0 0 0 0 0 0 0 PRIOR YEAR SURPLUS (12,239) (5,100) (5,100) 0 (12,239) 0 0 0 TOTAL (SURPLUS)/DEFICIT (12,239) (5,100) (5,100) 0 (12,239) 0 0 0


6 | P a g e

Key Variances – Forecast vs Plan

Acute Pressures

The total acute budget is £194.4m. At month 5, the CCG is reporting £0.2m overspend YTD and £0.5m overspend in full year projection. The main drivers within the position are as follows:

Over-performances in Barts Health (£2.5m YTD and £6m full year forecast) Over-performances in NCA’s (£0.2m YTD and £0.5m forecast) Net under-performance in all associates (£0.1m YTD and £0.3m forecast) Provision for GP at Hand costs (£0.1m YTD and £0.5m forecast) Release of acute reserve (£1.6m YTD and £3.8m forecast) Release of unutilised prior year acute activity provisions (£1.0m YTD and £2.3m

forecast).

These forecasts are based on providers M4 Flex activity.

The table below shows the full breakdown of the Acute position.

Acute Pressures

Barts Health - At Month 5 the CCG is reporting a year to date over performance of £2.5m with a full year projected over performance of £6m (4%). The position is continuing to be driven by higher than anticipated activity and spend in non-elective, elective and A&E.

Full Year YTD YTD YTD YE Forecast

Budget Budget Actual Variance Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000Barts and The London NHS Trust 151,378 63,074 65,574 2,500 157,378 6,000

Homerton Foundation Trust 5,269 2,195 2,233 38 5,360 91

Great Ormond Street Hospital for Children NHS Foundation Trust 236 98 108 10 259 23

Guy's and StThomas's NHS Foundation Trust 4,930 2,054 2,089 34 5,012 82

King's College Hospital NHS Foundation Trust 599 250 275 25 660 61

North Middlesex University Hospital NFT 154 64 76 12 183 29

Royal National Orthopaedic Hospital NFT 395 165 165 1 397 2

Royal Brompton and Harefield NHS Foundation Trust 52 22 7 (15) 17 (36)

Royal Free Hampstead NFT 767 320 426 106 1,022 255

Moorfields Eye Hospital NHS Foundation Trust 4,757 1,982 1,994 12 4,785 28

St George's Healthcare NFT 226 94 64 (30) 155 (71)

Whittington Hospital NFT 283 118 131 13 315 32

Barking, Havering and Redbridge Hospital NFT 746 311 339 28 814 68

The Royal Marsden NHS Foundation Trust 51 21 24 3 57 7

University College London Hospitals NHS Foundation Trust 4,528 1,887 1,668 (219) 4,003 (525)

Imperial College Healthcare NFT 704 293 293 (0) 704 (0)

Chelsea and Westminster Hospital NHS Foundation Trust 559 233 250 17 600 41

North West London Hospitals NFT 154 64 110 46 264 111

Mid Essex Hospital Services NFT 87 36 44 8 106 19

Lewisham & Greenwich NHST 642 267 188 (79) 452 (190)

BMI Healthcare Ltd 3,800 1,583 1,426 (157) 3,423 (377)

London Ambulance Service 10,201 4,251 4,251 0 10,201 0 Other Acute 845 352 502 150 1,378 533 Acute QIPPs in Development (4,482) 0 0 0 (4,482) 0 Overseas Visitors Barts Health NHS Trust 682 284 284 0 682 0 NCAS/OATS 2,959 1,233 1,458 226 3,500 541 Acute Reserve 3,834 1,597 0 (1,597) 0 (3,834) Previous Year Provisions 0 0 (976) (976) (2,343) (2,343) Totals 194,356 82,849 83,005 156 194,902 547

Tower Hamlets CCG 2017/18 Acute Financial Position at Month 05

Provider


7 | P a g e

The figure below shows the upward trend in spend for non-elective. It shows that the spend in 2018/19 is higher than what was seen last year, but activity lower. This suggests a higher case mix i.e. higher acuity of activity.

The figure below shows the upward trend both in activity and spend for elective. It shows that the activity and spend in July 2018 is higher than what was seen last year, with spend in quarter 1 considerably higher than activity, suggesting a higher case mix i.e. higher acuity of activity.


8 | P a g e

The figure below shows the upward trend both in activity and spend for A&E. It shows that the activity and spend in July 2018 is much higher than last year.

UCLH - At M5, UCLH is reporting an under-performance of £0.2m YTD and £0.5m forecast. The main areas where the activity has been lower than planned are Obstetrics and other non-elective activities and maternity antenatal pathways, Urology and Gynae elective activities. BMI Healthcare - At M5, BMI contract is reporting an under-performance of £0.2m YTD and £0.4m forecast, which is primarily driven by reduced referrals for Trauma & Orthopaedics and general surgery in day cases, elective and outpatients procedures. Lewisham & Greenwich NHST - At M5, Lewisham & Greenwich is reporting an under-performance of £0.1m YTD and £0.2m forecast. This underspend is driven by activity under-performances in non-elective excess bed days, and high cost devices in Gastroenterology and Rheumatology. GP at Hand - London CCGs have been asked to make a provision to cover the cost of acute, primary care, prescribing etc for the patients who were previously registered with their local GPs but who have switched to GP at hand and are therefore charged to Hammersmith & Fulham CCG. Acute M5 position includes this provision – £0.1m YTD and £0.5m forecast. To note, there is no formal agreement yet to recharge the costs, but CCGs are asked to factor these potential costs in their M5 position.

Non-Acute Pressures


9 | P a g e

Prescribing - At month 5, the Prescribing area is reporting a full year over-spend of £1.1m (YTD £0.5m), based on actual costs at M3 and using the new 2018/19 profile released this month by the NHSBSA and provisions for additional winter pressures and GP at Hand costs.

There have been two cost pressures to the prescribing budget running throughout 2017/18 and continuing into 2018/19. These are NCSO (no cheaper stock available) and medicines introduced at a higher rate to the pre-agreed drug tariff price.

The Category M and NCSO cost pressures had a significant impact on our budgets in 2017/18. The DH were involved in the national mitigation plans and expectations were that as stock became available throughout 2018/19 these pressures would reduce. However, the cost pressures continued throughout the 1st quarter in this year (at a reduced rate).

A new national cost pressure for Cat M was announced 19th July 2018. Early indications suggest an additional increase in costs for this financial year of £0.5m (from August 2018). This has not been included in the position, however the CCG has included these within the risks and mitigations.

Continuing Health Care (CHC) - Continuing Health Care M5 forecast data indicates an overall increase in the costs and is now reporting a small overspend (forecast £36k). However, this has not resulted in an adverse swing from last month as a contingency was held against the previous month’s forecast of £0.2m under-spend. There are still risks in this area as the past trend in CHC suggests that the cost in this area increases as the year progresses.

Summary QIPP position

£2.3m overall shortfall against £14m QIPP plan. Key drivers of shortfall:

Full year of £2.2m underperformance relates to the Urgent Treatment Centre forecast, which has been revised to reflect current financials (transitional support) & timescales, with a view that QIPP delivery will commence in Nov-18 (QIPP plan originally Jun-18). The part year effect saving is £545k.


10 | P a g e

Key Performance Indicators (KPI’s Month 5)

Appendices - Available to Committee members, if requested.

Statement of Financial Position

Cash Position and Forecast

BPPC detail

QIPP Tracker 2018/19

Indicator Plan Actual Variance Plan Forecast Variance Narrative

£'000 £'000 £'000 £'000 £'000 £'000

Surplus/(Deficit) 5,100 5,100 0 12,239 12,239 0The CCG is forecast to break‐even in

year and keep its cumulative brought

forward surplus of £12.2m.

Programme Budget 174,595 174,636 41 427,342 427,491 150

Running Cost/Admin

Budget2,289 2,247 (41) 6,406 6,256 (150)

Total Financial

Performance176,883 176,883 (0) 433,748 433,747 (0)

QIPP Performance 3,099 2,460 (639) 13,959 11,514 (2,445)Shortfall relating to slippage in the

implementation of UTC

Indicator Narrative YTD Forecast

BPPC NHS ‐ Inv No's 95% 98.80% 3.80% 95% 96.00% 1.00% n/a

BPPC NHS ‐ Inv Value 95% 100.00% 5.00% 95% 100.00% 5.00% n/a

BPPC Non NHS ‐ Inv

No's95% 98.70% 3.70% 95% 98.10% 3.10% n/a

BPPC Non NHS ‐ Inv

Value95% 99.10% 4.10% 95% 98.90% 3.90% n/a

Month 5 Cumulative

The CCG's BPPC rating is affected by

any invoices which are not paid within

30 days. CCG has achieved the targets

in Month 5 ‐ both in month and

cumulatively on all counts.

Key Performance Indicators ‐ Month 5

Year to Date Full Year Plan

YTD

Rating

Forecast

Rating

The programme position includes

release of some contingency reserves

to offset the overspends in Acute, Co‐

commissioning and Prescribing.



Date of meeting Sept 25th 2018 G

Agenda item 3.2

Title of report: Performance and Quality Report

Author(s): Sandra Moore - Deputy Director Performance & Quality (CCG) and CSU Performance team

Presented by:


Archna Mathur – Director Performance & Quality – THCCG Archna Mathur – Director Performance & Quality - THCCG [email protected] (020 3688 2528)

Executive summary

This paper provides a high level overview of performance and quality across Tower Hamlets reported for the month of September and October where data is available.The report highlights the key issues, current performance against National Constitution standards and actions taken by providers and Tower Hamlets CCG in managing the provider performance and quality portfolio for acute, community and mental healthcare in Tower Hamlets.

Recommendation


The Governing Body is asked to note the contents of the report, particularly in relation to the Board Assurance Framework.

Key issues CANCER WAITING TIMES For June and July Barts Health met all the cancer operational standards (see Table 1). Table 1: Barts Health Cancer Waiting Times June and July 2018.

Waiting time

Description Operational

Standard June18

% July 18

%

2 week wait

All cancers 93% 95.8 95.3

Breast 93% 93.2 99.4

31 day wait

1st treatment 96% 98.9 98.6

2nd/sub surgery 94% 99.0 97.4

2nd/sub chemo 98% 99.5 100

2nd/sub RT 94% 100.0 99.3

62 day wait

Urgent referrals 85% 86.1 85.7

Screening 90% 100 93.8


mailto:[email protected]

beckinghams

Text Box

2.4

beckinghams

Text Box

E

2

In June THCCG did not meet the 2nd/subsequent surgery cancer operational standard standard – 90.5% against the operational standard of 94%. In July all of the cancer operational standards were met (see table 3 below). Table 2: NHS Tower Hamlets CCG Cancer Waiting Times June and July 2018

Waiting time

Description Operational

Standard June 18

% July 18

%

2 week wait

All cancers 93% 95.0 95.2

Breast 93% 96.8 100.0

31 day wait

1st treatment 96% 98.0 98.0

2nd/sub surgery 94% 90.5 100.0

2nd/sub chemo 98% 100.0 100.0

2nd/sub RT 94% 100.0 100.0

62 day wait

Urgent referrals 85% 88.9 90.9

Screening 90% 100.0 100.0

REFERRAL TO TREATMENT (RTT) Barts Health returned to national RTT reporting in April. For June they are reporting a PTL of 91, 892 and there were 63 >52 week incomplete pathways for the month. Barts Health did not meet the waiting time standard of 92% for June 2018. Performance was 85.1% in June (see table 3 below). For July the performance against the 92% standard was at 85.4% compared to the June position of 85.1%. Table 3: RTT waiting times June 2018

Patients waiting to start treatment Proportion of patients waiting within 18 weeks (NHS operational standard 92%)

85.%

Half of the patients were waiting less than

8 weeks

92 out of a 100 patients were waiting less than

23 weeks

No of patients waiting to start treatment

90, 758

Challenged specialties include: Trauma and Orthopaedics, Oral Surgery, ENT and Plastic Surgery.


3

DIAGNOSTICS Barts Health achieved the 6 week waiting standard in July 2018 with performance at 99.8% compared to 99.50% in June. Compliance was achieved in the majority of modalities with the exception of sigmoidoscopy and cystoscopy (mainly as a result of small numbers resulting in performance volatility). A&E: Table 4: Barts Health June and July A/E Performance All Types

A/E all types Trajectory June %

July %

95% 84.98 87.57 Barts Health did not meet the 90% STF trajectory in June and July. Scrutiny on the delivery of the A&E trajectory remains high, but a robust plan is in place. Weekly A&E Performance Table 5 shows the weekly A/E performance from 8 August up to week ending 2 Sept 2018. Barts Health and the RLH site has not met the 95% standard any week during this period. Table 5: All Types against the 95% standard for RLH site and BH.

Trust and RLH site

Wk ending 5/8/18

Wk ending 12/8/18

Wk ending 19/8/18

Wk ending 26/8/18

Wk ending 2/9/18

RLH 82.09% 83.40% 86.55% 88.68% 90.64% BH 86.49% 86.92% 87.30% 87.50% 87.36%

DELAYED TRANSFERS OF CARE Chart 1 below shows the Tower Hamlets delayed transfers of care at the RLH site and performance against the BCF target of 13.3 for July 2018. There were six days in July when performance was above 13.3. The average daily DTOC for July was 10.3. Chart 1: Tower Hamlets Delayed Transfers of Care at the Royal London Hospital for July 2018.

Chart 2 below shows the Tower Hamlets delayed transfers of care at the RLH site and performance against the BCF target of 13.3 for August 2018. Performance was below the BCF target of 13.3 every day in the month of August. The average daily DTOC for August was 9.3.


4

Chart 2: Tower Hamlets Delayed Transfers of Care at the Royal London Hospital for August 2018.

System wide plans to support DTOCs are in place at the RLH these include get me home meetings, daily senior operational hub call and six hostel beds to address the homeless issues. There is a focused piece of work with the national emergency care improvement team taking place on the 14th floor (older people) where a number of delays occur. The main reasons for delays are:-

Choice Homeless Awaiting Nursing Home bed Equipment

Barts Health are in the process of finalising their choice policy and further nursing home beds have become available for Tower Hamlets patients at a Baker Court Nursing home in Newham. THE NUMBER OF PATIENTS WITH LONG STAYS OF 21 DAYS OR MORE IN HOSPITAL NHS England and NHS Improvement have recently set out their ambition for reducing long stays in hospital by 25% to reduce patient harm and bed occupancy. NHS England and NHS Improvement have asked trusts and CCGs to work with local government partners to agree local sectoral ambitions to achieve this reduction. Figures have been shared with local systems that show the baseline (average number of beds occupied by patients in hospital for 21 days or more) and the expected reduction.by December 2018. The number of patients with stays of 21 days or more will commence being reported at governing body as of November 2018. BARTS HEALTH CQC INSPECTION The CQC undertook inpsections of RLH, Newham and Whipps Cross sites on the 11th and 12th of September. An update on how the inspection went at the RLH site was provided at the RLH CQRM on 19 September.


5

LONDON AMBULANCE SERVICE: (LAS) Table 6: Weekly position at week ending 02 September 2018

KPI 1. % within 15 minutes

KPI 2. % within 30 minutes

KPI 3. No Delays

KPI 4. Data completeness

30 mins

60 mins

42.4 89.2 54 1 88.7 A&E (Mental Health Liaison - ELFT)

ELFT A&E performance was 94% against the 95% standard as at end of July 2018.

DEMENTIA

In August 2018 (latest published data), the dementia diagnosis rate for Tower Hamlets CCG was 83.52% above the 67% standard.

In August 2018, there were 927 patients aged 65 years+ on the dementia register compared with the 1110 estimated dementia prevalence rate.

EARLY INTERVENTION IN PSYCHOSIS As at July 2018 (latest published data), the Tower Hamlets CCG level data indicated that 100% of the service users within Tower Hamlets commenced treatment within 2 weeks, above the 50% national standard. IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES (IAPT) All IAPT data provided below is based on the self reporting done by Compass Wellbeing CIC and will be subject to NHS Digital validation. IAPT Access Rate: The number of service users entering treatment during July 2018 was 433 providing a monthly access rate of 1.39% (below 1.49% NHS England monthly plan). IAPT Recovery Rate: Performance during July 2018 was 52.9%, achieving the 50% target. IAPT Six-Week Waiting Times: In July 2018, 96.9% Tower Hamlets service users with an ended referral received their first IAPT treatment appointment within 6 weeks of referral, above the 75% target. IAPT 18 Week Waiting Times: As at July 2018, 100% Tower Hamlets service users with an ended referral received their first IAPT treatment appointment within 18 weeks of referral, above the 95% target. SERIOUS INCIDENTS (SIs): Barts Health: Currently BH are reporting 48 overdue SI reports in August compared to 43 in July. RLH site are reporting 19 overdue SI reports in August compared to 18 in


6

July.The RLH overdue incidents have been raised at CQRM and remains a standing item on the agenda. ELFT Mental Health: July 2018 - Four overdue SIs. Nine SIs were reported – apparent/actual/suspected self- inflicted harm (1), disruptive, aggressive, violent behaviour (3), treatment delay (2), sub-optimal care of deteriorating patient (1), abuse/alleged abuse of adult patient by third party (1) and confidential leak/information governance breach (1). CHS (ELFT) July 2018: 1 SI reported – Grade 3 pressure ulcer. No overdue Sis. NEVER EVENTS Barts Health: Since the last governing body meeting in July when two never events were reported a futher four never events have been declared by the Trust. Further assurance on has been requested from the Trust and the Trust are in the process of providing an action plan. Table 7: Never Events Reported by Barts as of 14/09/2018

Site Type Date incident identified

RLH Wrong site surgery - superficial femoral artery (SFA) angioplasty. 27/04/2018 RLH Wrong implant/prosthesis – wrong internal pulse generator 14/06/18 SBH Retained foreign object – swap following mastectomy 22/06/2018 RLH Wrong site surgery – tooth extraction 20/07/18 Wx Retained foreign object post procedure – retained obstetric swab 07/08/2018 Wx Retained foreign object post procedure retained tampon 07/08/2018 RLH Unintentional connection of a patient requiring oxygen to an air

flowmeter 20/08/2018

ELFT (Mental Health)

Zero never events reported. ELFT (CHS)

Zero never events reported. MIXED SEX ACCOMODATION (MSA): 19 MSA breaches were reported at BH in July 2018 compared to 16 in June. 4 of the 19 breaches reported occurred at the RLH site.


7

HEALTH CARE AQUIRED INFECTIONS (HCAIs): Table 8: YTD position for BH and RLH site as of end of August 2018 HCAI Year

End Target

BH RLH

MRSA 0 1 0 C Difficile 81 24 11

There has been 1 MRSA reported which occurred at Whipps Cross Hospital against the zero target. The end of year target for BH C Diff is 81 or less which equates to 6.75 per month. BH are currently on track to meet this target. CONTINUING HEALTH CARE (CHC) Table 9: CHC Performance

Standard Jan Feb March April May June Jul Aug % DSTs completed in an acute hospital setting (target is 15% or less)

42% 44% 43% 57% 36% 31% 31% 50%

% of referrals completed within 28 days (target is 80% or more)

43% 43% 60% 77% 73% 65% 45% 50%

The position for DSTs completed in a hospital setting has deteriorated in August. Contributory factors include patients refusing to have their assessments completed in the community and to be placed in a nursing home located outside the borough. With the implementation of the choice policy in September, performance is predicted to improve going forward. The percentage of referrals completed within 28 days has improved in August compared to the previous month, but the target to ensure 80% of assessments are completed within 28 days has still not been reached. Performance is being reviewed monthly at the Joint CHC committee. LAC Review A service review into the LAC service is currently underway. Lead by the CSU, there will be an evaluation of the current governance processes against statutory best practice, review of SOPs and a LAC action plan will be produced and reviewed at the CHS Alliance CQRM. Community Pressure Ulcers Table 10: Number of Community Pressure Ulcers and Grade

Grade Jan-18

Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18

Grade 2 3 4 4 3 9 12 8 7 Grade 3 5 1 0 2 0 5 5 1 Grade 4 0 0 0 0 0 0 1 0

Total 8 5 4 5 9 17 14 8


8

The number of pressure ulcers (PU) decreased in August compared to previous months. The severity of PU reported has also decreased. To help identify learning and identify actions that need to be implemented, ELFT Community team complete 48 hour reports for PU Datix incidents. PRIMARY CARE The GP Patient Survey (GPPS) results for 2018 have been published. The questionnaire has been redeveloped in response to transformational changes introduced as part of the GP Forward View. New questions have also been introduced to help CCGs’ understand how local services are supporting patients with long term conditions. Tower Hamlets has improved performance in certain key areas i.e.

Patients getting through the practice by phone Helpfulness of receptionist staff Patients’ satisfaction with Out of Hours Services

However, the CCG is still performing below the national average on the majority of the questions in the survey. There are areas where there has been a deterioration in performance compared to 2017 results, with patients reporting a decrease in satisfaction levels with regards to:

Patient’s experience in booking appointments Availability of appointments

Theere is currently a number of quality improvement projects underaway focused on improving patient access.

Conflicts of Interest

There are no identified conflicts of interest.

Report history Information presented at the CCG Performance & Quality meetings informs this Governing Body report.


The Friends and Family Test (FFT) provides patient feedback to improve service provision as well as NHS Choices providing patient comments on services.


This paper affects all of the risks under Strategic Objective 2: Systems and processes to monitor challenge and support provider delivery of the NHS Constitution targets.


Monitoring and actively improving the performance and quality of service provision will have a benifical impact for all patients in Tower Hamlets.

Resource requirements

N/A

Next steps Action and next steps for each area identified is covered in the report.


9



Date of meeting 25th September 2018 F

Agenda item 2.5

Title of report: East London Health and Care Partnership (ELHCP) Winter Plan 2018/19

Author(s): Archna Mathur – SRO Urgent and Emergency Care for North East London

Presented by:



Archna Mathur

Executive summary

The ELHCP Winter Plan has been produced in response to a letter received in early August from Jane Cummings, Regional Director NHS England (London) and Steve Russell (Executive Regional Managing Director NHS Improvement (London). The requirement is for the plan to focus on the following 5 key areas:

Reducing extended lengths of stay

Development of ambulatory emergency care services

Minors patient breach reduction

Improving ambulance handovers

Implementing effective demand management schemes

Recommendation


This Governing Body is asked to note the contents of this report.

Conflicts of Interest N/A

Key issues The Winter Plan is a summary document that reflects on winter 2017/18 identifying key challenges experienced and addresses the key asks in the executive summary above.

The plan has been produced with partner Trusts across the North East London STP and will lead to an event on the 27th September to undertake some scenario planning work.

The STP has been further awarded £410k transformation funding, so the report provides a high level view of how this could be allocated,


which is yet to be formally agreed.

Report history The Winter Plan has been presented to the NELCA (North East London Commissioning Alliance) Senior Management Team and Tower Hamlets CCG senior management team.


Work is underway to develop a plain English version of the plan.


The Plan is a mitigation to delivery of the A&E standard across the North East London STP


N/A

Resource requirements N/A

Next steps Development of a plain English version

Winter event on the 27th September


ELHCP Winter PlanArchna Mathur – NEL STP Urgent and Emergency Care Senior Responsible Officer Jane Milligan – NEL STP Senior Responsible Officer

Contents• Background and Context• Reflections from winter 201718• Challenges• Reducing Extended Lengths of Stay• Development of Ambulatory Emergency Care• Minors Patients breach reduction• Improving ambulance handovers • Implementing effective demand management schemes• Flu management• Governance and oversight• NEL Winter Event 2018

2


Background and context • ELCHP is committed to effective winter planning for 2018/19 building on learning from 2017/18.• ELHCP has two systems currently challenged in delivering the required 90% trajectory with BHRUT

(Category 4) and Barts Health NHS Trust (Category 3).• These two systems have A&E recovery plans in place for which detailed action plans addressing

the priority focus areas are embedded.• The Homerton consistently performs against the standard, and is focused on locally identified

priority areas through winter.• This presentation provides an overview of plans for winter to address the priority areas of focus

reflecting on previous learning, but also governance and oversight, operational grip and flu.• The system has a winter event planned on the 27th September to further share learning and

explore opportunities for cross organisational support. The event will also support thoughts onaward of the £410k transformation funding.

• Across the system, external support for driving delivery of the A&E standard is utilised through20:20, PWC, ECIST and the HLP Improvement Collaborative.

3

Reflections from Winter 2017/18 (1/2)• Performance in winter (Q4) of 2017/18 compared to 2016/17 was for Barts Health 85.55% vs 83.24%

(2.3% increase), for Homerton 93.38% vs 93.64% (0.27% decrease), for BHRUT 74.48% v 84.53%(10.05% decrease)

• Winter plans for each system were based on initiatives across the patient pathway, Pre-hospital flow,ED flow, ward through flow, and outflow.

• Plans for BHR focussed on managing demand, UCC capacity, workforce and acute leadership.• Plans for Barts Health focussed on streaming, ambulatory care, early discharge, flow (PWC Perform),

repatriations and tightening operational grip and escalation through the “winter room”.• Plans for the Homerton focussed on DTOC management, flu management & strengthening of front

door senior capacity.• Winter monies were made available adding acute escalation capacity, and initiatives to manage

demand through strengthening streaming to UTC and ambulatory care.• Winter Directors were in place for each system to drive improvement and system leadership across

health and social care.• Focus was also on management of the elective profile.• Work in train last winter on NHS 111 and Clinical Assessment Service has now been delivered in

preparation for winter 2018 with a live service as of August 18.

4


ChallengesBased on learning from 17/18, the following are our largest challenges. They are common to allsystems within the STP, although their impact on performance does vary• Workforce sustainability remains a challenge – this is a cross STP issue for middle grade ED

doctors in ED and GPs who work within urgent care services (which includes telephone triagewithin the NEL IUC). ED nurses and therapists are also challenged. We are working with our GPFederations and workforce enabler work-streams on short and longer term strategic solutions(collectively commissioning home visits for example).

• Out of area discharges remain a challenge in achieving LOS reductions particularly where patientsare from outside London, mainly from Essex and Hertfordshire. Winter event should support crosssystem working on DTOCs and stranded patients from within NEL

• Ensuring there is capacity in Neuro rehab services to support repatriations• Ensuring there is capacity within our mental health services so that people presenting in ED

requiring psychiatric liaison services and inpatient care can access it quickly – this is for bothadults and CAMHS

• Use of system wide data e.g. care home capacity. We are working to collectively explore usage ofthe CarePulse Capacity Management System (CPMS)

5

Reducing Extended Lengths of Stay - 1• The NEL system is focussed on achieving the required long stayer reductions by Trust and CCG:

Trust Baseline (beds occupied by long stay patients 201718)

Ambition (maximum number of beds to be occupied by long stay patients)

Reduction to be delivered by the system

Homerton 160 117 43

Barts Health 408 298 110

BHRUT 155 118 37

CCG Baseline (bedsoccupied by long stay patients 201718)

Ambition (maximumnumber of beds to be occupied by long stay patients)

Reduction to be delivered by the system

% Reduction

Tower Hamlets 127 93 34 -27

Waltham Forest 111 81 30 -27

City and Hackney 159 116 43 -26.9

Newham 86 63 23 -26.9

Redbridge 93 69 24 -25.7

Barking and Dagenham

49 37 12 -24.9

Havering 71 54 17 -24.3

6

NB; theses figures were taken from the letter which gave the trust and system level targets. The figures for Homerton and C+H do not look right as there is a discrepancy with the sitrep - the sitrep showed c.70 beds occupied with long stay patients each day in August.


Reducing Extended Lengths of Stay - 2Overarching commitment across the NEL system is in place to manage longstayers by:

Whole system senior leadership as point of escalationPlans jointly owned by health and social careSystem wide MADE eventsContinued focus on DTOC reductions7 day working across social care, community and mental health servicesDaily tracking through Long Stayers Dashboard & NELCSU SMART systemFurther work on application of excess bed day local incentive schemesWorking with voluntary sector partners to support discharge and reduceLOS e.g. Age Uk, Red Cross

7

Reducing Extended Lengths of Stay - 3• The below provides a high level overview of NEL position on key areas of focus, and associated actions:Focus area BHRUT/BHR system Barts Health /WEL system Homerton /C&H system

Use of real time PAS x x x

Treating Los > best practice as safety issue

xPlans to include patients to clinical harm

review process (Barts)

x

Admissions avoidance services

Functional screening for > 75sFOPAL in A&E but we need consistent

assessment across systemAt WX with highest volume

attendances/admissions for > 75s

Community rehab

Community EOL care

Simple & criteria led discharge Principles agreed and implementation in progress

x

Red2Green and SAFER

Trust Board Accountability –reporting stranded/super stranded

XHUH Reporting includes length of

stay but does not highlight stranded

8


Reducing Extended Lengths of Stay - 4• The below provides a high level overview of NEL position on key areas of focus, and associated actions:

Focus area BHRUT/BHR system Barts Health /WEL system Homerton /C&H system

100% to extended GP services

Hear & treat/See and Treat for care home residents

Home & bed based intermediate care, crisis response & reablement No in-borough bed-based provision –

spot purchase beds at St Pancras

7 day access to social care

Choice Policy Implementation in progress Further work on comms/training

neededFurther work on comms/training

needed

Trusted assessor for care homes In development X

Care home acceptance 7 days/week XArrangements not universally in place

XArrangements not universally in place

XArrangements not universally in place

Discharge to Assess Being piloted

9

System level plans to reduce long stays: priority aactions

10

System

Current long stays against plan (taken from sitrep)

Priority Actions

BHR / BHRUT

140 on 28/8 against a baseline of 155 and an ambition of 118

• MADE events on a 3 week cycle alternating between Queens and KGH• All patients with LOS over 14 days to be reviewed at Queens site every Tuesday and Thursday and patients with LOS over 7 days

on KGH site to be reviewed at the same regularity – MDT approach• Implement trusted assessor model• Full implementation of Choice policy• Full implementation of Red to Green by 30/11/18

WEL / Barts

176 (RLH); 129 (NUH); 86 (WX). Total = 391 against a baseline of 408 and ambition of 298

• Monthly MADE events• Weekly CEO-led hospital review of plans to improve LoS, including sustaining ‘Perform’ programme• Embed the high impact change model• Further development of discharge to assess arrangements with care sector and community health providers• Full implementation of choice policy• Implement trusted assessor model• Embedding culture and process for treating LOS above threshold as a serous incident / safety issue• Implementation of Red2Green and SAFER on all wards• Commissioning of additional community capacity for homeless patients

C+H/ Homerton

70, against a plan of 117, which is 19% of bed-base– although the plan maybe incorrect

• Embed the high impact change model• Realise benefit from the new discharge to assess model which is being piloted• Implement trusted assessor model• Multi-disciplinary review of long stay patients with primary care input• Expansion of Age UK’s Take Home and Settle service which supports discharge from the Homerton• Detailed multi-disciplinary audit of 50 DToCs was undertaken, resultant action plan being delivered, key actions include improved

management of patient choice and closer working with housing services


Community incentive schemes to support rreduced long stays

• A CCG transformation board paper has been written to outline the principles for any local incentiveschemes across the STP footprint.

- The incentive schemes should build on current local plans and support the delivery of the STP winterplan;

- Overall the schemes should be cost neutral at STP level, and payments should incentivise delivery;

- Schemes should have clear local governance and ownership at system level, e.g. throughTransformation Boards, including all stakeholders;

- Schemes should have clear and measurable KPIs;

- Systems must agree how released acute capacity is managed, either to address ED pressures orsupport QIPP/CIP plans;

• A review of existing schemes and services to support timely discharge is also being undertaken acrossthe STP to ensure local incentive schemes are used for initiatives to support reduction over and abovethis.

11

Development of Ambulatory Emergency CareBHRUT Barts Health Homerton

Hours of operation

Queens: 12 hours M-FWeekends: 8 hoursKGH: No service – patients are directed to Queens

RLH: 14 hours (7 days) Whipps Cross: 10 hours (M-F), 8 hours (weekends)Newham: 10 hours (M-F)

Homerton (HAMU)M-F: 0800-2000W/end: 0800-1400, nurse ledBeen open since April 2017.

Local tariffs in place to replace non-elective tariff

Work being undertaken across the ELHCP footprint to agree

Current daily activity

22 average daily but this is variable between M-F and weekends

RLH: 44 (optimum condition> 20)Whipps Cross: 50 (optimum condition >50)Newham: 9 (optimum condition >11)

HUH: 22 average per day

12


System level plans to improve ambulatory care: ppriority actions

13

System Priority Actions

BHR / BHRUT • Current review of pathways to ensure that we are maximising capacity and opportunity• Development of service specification• Review of demand at weekends to assess need, but there are no current plans for extension of operating hours at the weekend

WEL / Barts • Cost benefit analysis to be completed to inform 12 hour 7 day working• Agreement of single consistent service specification across all three sites• Clinically led site level reviews to understand opportunity for growth and optimisation of ambulatory care as additional admitted capacity• Agreement of performance management framework to support monitoring against agreed against KPIs

C+H/ Homerton • HAMU had a positive impact on flow in 17/18, and we expect to see that again this winter• Review of HAMU underway. This will model the review underway in Barts and will ask the following:

How can we improve data capture of HAMU patientsAre we getting full benefit from the unit, could volumes and range of cohorts be expanded

• This will be completed in November, although actions to improve activity and flows into the unit will be taken forward as they arise

Minors patient breach reduction BHRUT Barts Health Homerton (N/A)

Compliance with SITREP/ECDS

Protected function during times of stress

ACP/ENP led (as opposed to medical model)

Nurse/ GP streaming; GP led; ENPs for minor

injuries are seconded to PELC

XProvided by GPs and ANPs

together

Streaming capacity matched to demand – zero tolerance to breaching 4 hour standard

Where possible – challenge with GP staffing and competing

pay rates for temp staff –minors breach tracked daily

Speciality reviews within 30 mins/Professional standards in place PWC work in ED (RLH) & ECIST

all sites

XPolicy is 45 minutes

14NB: HUH do not have type 3 and 4 activity, the above relates to their PUCC which is the primary care stream within ED


System level plans to improve minors pperformance

15

System Current performance

Priority Actions

BHR / BHRUT

UCCs at Queens and KGH both consistently hit 99%

• Individual streamer review by PELC to address any variation in performance• New clinical pathways developed with A&E and being implemented to increase numbers seen in UCC to 45% of all A&E activity (excluding

eyes) from November 2018• Enhanced paediatric capacity in the UCC at Queens to address increase number of patients <16 attending A&E

WEL / Barts Type 3 performance: WX 97.24%; RLH 99.86%; NUH 99.67%

• Increasing over night resilience within EDs • Site level UTC redesign and development, including use of consistent front door streaming protocols and access to same day diagnostics• Implementation of outputs of PWC review at RLH site

C+H/ Homerton

HUH do not report category 3 and 4 activity. Primary care stream in ED (PUCC) is consistently hits 99%

• Sustain current PUCC performance• Work with system partners to try to address the GP workforce challenge

Improving Ambulance Handovers

16

Site/Provider 2017-18 (15 mins Handover)

2017-18 (30 mins handover)

NEL STP 35.6% 89.6%HUHT 73.0% 100.0%Newham 17.1% 94.7%Royal London 44.5% 98.8%Whipps Cross 31.4% 90.1%BH (Aggregate) 34.6% 95.1%Queens Hospital 24.9% 80.4%King George Hospital 17.4% 77.7%BHRUT (Aggregate) 22.9% 79.7%

2018-19 *(15 mins Handover)

2018-19 *(30 mins Handover)

32.9% 89.0%73.0% 100.0%24.8% 98.5%42.2% 97.0%30.9% 92.3%33.9% 96.0%21.6% 80.4%12.3% 69.9%19.0% 77.5%

* Denotes 2018-19 performance based on validated data (April 2018 to July 2018).


System level plans to improve ambulance hhand-overs

17

System 17/18 Performance

Priority Actions

BHR / BHRUT

22.9% (15 ins)79.7% (30 mins)

• System wide ambulance handover group established• Utilisation of regular ‘pit stops’ in ED to manage flow through department including RAFTing• Increase senior presence in RAFTing with additional ED consultants on late shifts and senior nurse and senior ED registrar dedicated to

RAFTing 24/7• RAFTing SOP has been reviewed, updated and signed off and is now included in all educational and induction session• Introduction of RAFT workshop as part of ED registrar teaching and as part of KIT days for ED nurses

WEL / Barts

34.6% (15 mins)95.1% (30 mins)

• Monthly ECIST Front door challenge• Agreement of internal professional standards across all three sites• Implementation of actions driven from ambulance handover management group established at NUH (most challenged site)• Implementation of internal escalation processes and executive oversight to release admitted pathway waits from ED

C+H/ Homerton

73% (15 mins)100% (30 mins)

• Sustain current performance• Work with LAS to improve uptake of alternative care pathways to avoid conveyance to hospital

Implementing Effective Demand Management Schemes Across NEL:

100% coverage of the NHS 111 Clinical Assessment Service (CAS) ascommenced August 2018100% coverage of NHS Online as of August 2018100% coverage of NHS 111 * lines (* 5*6*7) for care homes and rapid

response100% bookable appointments from 111 CAS to primary care hubs/face to

face/Home visitingFocused work on frequent attendersFocused work on paediatric streamingUtilisation of community pharmacists in care homes to ensure effective

medicines optimisation reducing likelihood of medication relatedadmissions

18

h


System level plans to improve demand mmanagement and ensure full benefit from NEL IUC

19

System Priority Actions

BHR / BHRUT

• GP Chairs meeting with practices who have highest urgent care demand to understand reasons for variation and opportunity to address these

• Communication and engagement with local GPs around our range of admission avoidance services• Public consultation on community urgent care to raise awareness of urgent care options• Work with LAS to improve uptake of ACPs• Review of paediatric demand and development of plan to address

WEL / Barts

• Embedding of new IUC service following August go-live to increase utilisation of CAS• Work with LAS to improve uptake of ACPs, including commissioning of the Physicians Response Unit to manage

patients at high risk of admission in their home• Sharing of consistent practice level demand data to target high demand / referring practices, including to agree direct

referral / access to assessment locations for GP referrals (for an agreed cohort of accepted patients) rather than streaming through ED

C+H/ Homerton

• Cross system work to try to address GP workforce challenge in order to ensure that out of hours GP services are fully operational and utilised

• Communication and engagement with local GPs around our range of admission avoidance services• We expanded our Paradoc service by 4 hours (now 0800-0000) in April, this should support winter• Work with LAS to improve uptake of ACPs• Proactive care service started in 17/18 to better manage frail patients at risk of admission

Name of Trust No. HCWs with Direct patient

Care 17/18

Seasonal Flu doses given since 1st September 2017

No of vaccinations given %

Barts Health Trust 11,712 7,491 64

Barking, Havering and Redbridge University Hospital

NHS Trust4,678 3,291 70.4

North East London Foundation Trust 38.7 1,964 51.6

Moorfield Eye Hospital NHS Foundation Trust 1,206 873 72.4

Homerton University Hospital NHS Foundation Trust 4,140 2,928 70.7

East London Foundation Trust 3,998 2,361 59.120

Flu – 17/18 vaccination rates


Actions to improve flu resilienceWe are taking a common approach across the systems to ensure maximum fluresilience:

Within trusts there will be senior level focus on achieving high vaccination uptakeratesEnsuring all community and primary care sites have easy access to vaccinationsfor all staffContinued focus of primary care on vulnerable groupsRobust emergency response plans in place and tested in case of outbreakSTP and system level communication to the public, including dissemination ofnational messagesWork with local authorities and EPPR leads on escalation protocols from carehomes and schools on community norovirus and herd immunity for fluEnsure data capture of flu vaccinations in care homes and care agencies

21

Governance and oversight (1/2) • The NEL STP system governance on performance is in development aligned

to the broader framework for ICS development but is making goodprogress.

• NEL level oversight for A&E performance is a function of sub systemgovernance lead by “place level” borough Urgent Care Working Groups,A&E Delivery Boards (BHR/WEL/C&H) and Transformation Boards and“system” level escalation to STP Executive and NEL Clinical Senate.

• CCG Director on Call arrangements supporting by CSU surge function inplace.

• Provider Trust level oversight is within this framework but additionallyrequires operational site level escalation triggers, Executive leadership, andinternal escalation e.g. Barts Health Operational Hub (2017/18 winterroom).

• Regular touch point between winter directors and STP AO, and CCG MDsand AOs.

22


Governance and oversight (2/2) Each local system has additional local structures in place to support performance challenges and winter:BHR:• Daily system calls with extra calls on Monday and Friday• Fortnightly AEDB meetings attended by NHSE/NHSI• Fortnightly escalation meetings with NHSE/ NHSI• Monthly CEO level system assurance meeting with NHSE/ NHSI

Barts/WEL• Weekly calls between the CEO and each site MD and CCG Performance Director• Monthly site and borough specific urgent care working groups• Quarterly Trust and system wide A&E DBS• Daily escalations from winter room based on escalation triggers to sites, Trust silver and gold on call generating calls as needed

HUH• Daily system calls to support DToCs, with weekly escalation meeting• Weekly COO led review of ED performance

23

NEL Winter Event 2018 Purpose:• To reflect on previous winter, identify what worked well and not well and use scenarios to test

and challenge the system response Contributors:• NELCA CCGs• Local Authorities• NHS Acute Trusts• Community and Mental Health Trusts (including UTC providers)• GP federations• LAS (including 111 and CAS)• NHSE/I

24


Draft Session Content – 27th September Session Title Timing Lead

1 Welcome and Introductions STP SRO or deputy

2 Background Context NHS England or NHS Improvement representative

3 Update on action progress from last winters review

STP SRO or deputy

5 Winter Exercise Scenarios1 – Poor ED performance2 – Bad weekend forecast* Break *3 – Major HCAI Outbreak

All

6 Learning Review STP SRO or deputy

7 Close STP SRO or deputy

NB: This agenda is draft and will be updated. The agenda is based on the suggested event format by Richard Mckewan, Senior EPRR Manager – Surge Capacity & Winter, NHSE



Date of meeting 25th September 2018 G

Agenda item 2.6

Title of report: Report (1st April 2017 to 30 June 2018) from the Audit Committee to the Governing Body

Author(s): Mariette Davis – Governing Body – Lay Member for Governance

Presented by:



Mariette Davis – Governing Body Lay Member for Governance Sophia Beckingham – [email protected] Corporate Governance Manager

Executive summary

This paper provides a summary of the work carried out by the Audit Committee during 1st April 2017 to 30 June 2018 each of the key duties of the Committee, as set out in the terms of reference.

The Audit Committee’s role is to seek assurance that financial reporting and internal control principles are applied and to maintain an appropriate relationship with the organisation’s auditors, both internal and external. The Audit Committee offers scrutiny and advice to the Governing Body, about the reliability and robustness of the CCG’s processes of internal control.

Recommendation


The Governing Body is asked to note the contents of the report.

Conflicts of Interest There are no identified conflicts of interests.

Report history This is the first time this report has been presented to the Tower Hamlets CCG Governing Body.


N/A


The Audit Committe reviews the Board Assurance Framework (BAF) at all Audit Committee meetings to ensure the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the CCG’s


activities.


N/A

Resource requirements None

Next steps As outlined in the report.


Report from the Audit Committee to the Governing Body 1st April 2017 to 30 June 2018

Introduction

The requirement for Clinical Commissioning Groups (CCGs) to establish an Audit Committee (The Committee) is included in the Health and Social Care Act 2012. The Governing Body established this Committee of the Governing Body in its Constitution. The Committee is a non - Executive Committee of the Governing Body and has no executive powers, other than those specifically delegated in its Terms of Reference, which are included at APPENDIX B.

In November 2017, a single Accountable Officer (and CEO for the North-East London and the City (NELC) Sustainability and Transformation Plan footprint) across the seven CCGs of NEL was appointed by the seven CCG Governing Bodies. The Governance arrangements have been, and still are, under development as Tower Hamlets CCG works collaboratively with other CCGs, Tower Hamlets Local Authority and Healthcare Providers across NELC. Governance arrangements, including the CCG Constitution and the Terms of Reference of Committees continue to be reviewed and appraised as new working structures develop. The Audit Committee plays a lead role in providing Assurance to the Governing Body on governance arrangements and the management of conflicts of interest, which are taking on a new dimension across the new collaborative operating environments.

During the period under review, National Health Service England (NHSE) asked Audit Chairs of CCGs to take on specific additional responsibility, including:

Counter – signing, with the CCG Accountable Officer, the quarterly Conflict of Interest Indicator under NHSE’s New Improvement and Assessment Framework for CCGs- which assesses the CCG’s compliance with the revised Statutory Guidance on Managing Conflicts of Interest for CCGs published in June 2017 (“The Statutory Guidance”)

Counter-signing, with the Accountable Officer, the Annual self -certification of the Conflict of Interest Indicator. Inter alia, this requires confirmation of Lay Members’ capacity and compliance with Conflict of Interest training for all those involved in Commissioning

Becoming the CCG’s Conflict of Interest Guardian, the responsibilities of which are summarised in the Statutory Guidance.

Membership The Committee membership during the period covered in this report was as follows.

Name Role

Mariette Davis Lay Member for Governance and Chair Noah Curthoys Lay Member for Corporate Affairs Mr Tan Vandal Secondary Care Specialist (resigned on 31 May 2018)

Since Tan Vandal resigned from the Governing Body, the Audit Committee has only two members. This matter needs to be resolved quickly so that the Committee can function as intended. It may be the


case that audit committees across the North East London Commissioning Alliance can share audit committee members and this is currently being considered.

In Attendance


Simon Hall Acting Chief Officer/ Managing Director Tower Hamlets CCG

NHS Tower Hamlets CCG

Ellie Hobart Acting Director of Corporate Affairs

NHS Tower Hamlets CCG

Andrea Antoine Deputy Chief Finance Officer NHS Tower Hamlets CCG (in CFO’s absence) Richard Quinton Finance Advisor NHS Tower Hamlets CCG (Apr to Dec 2017) Steve Collins Finance Advisor NHS Tower Hamlets CCG (1 Jan to 30 Jun 2018Justin Phillips Corporate Governance Manager NHS Tower Hamlets CCG (to Oct 17) Sophia Beckingham Corporate Governance Officer

/Manager NHS Tower Hamlets CCG (Manager from Nov 2017)

Neil Thomas Partner – External Audit KPMG Jack Stapleton Auditor – External Audit KPMG John Elbake Manager – Internal Audit RSM LLP Nick Atkinson Partner – Internal Audit RSM LLP Gemma Higginson Counter Fraud Manager RSM LLP

Others have been invited to attend meetings as required, for example the Accountable Officer and the Chair were invited to attend May meetings when the Annual Report was reviewed by the Audit Committee to provide assurance over Governance and the Annual Governance Statement.

Meeting schedule

The Committee met 8 times during the period on the following dates, and was quorate at each meeting:

9th May 2017 23rd May 2017 11th July 2017 10th October 2017 9th January 2018 8th March 2018 8th May 2018 24th May 2018

Executive Summary of work done by the Audit Committee during the period

The Committee has carried out its duty to provide the Governing Body with assurance (or not) that effective control arrangements are in place. Appendix A sets out the detailed work carried out in accordance with the Committee’s Terms of Reference.

In summary, specifically, the Committee:

1. Reviewed the Annual Financial Statements, the Annual Reports (including the Annual Governance Statements) and recommended that the Governing Body should approve the Financial Statements for each of the years ended 31 March 2017 and 2018

2. Reviewed and monitored the external auditors’ independence and objectivity and the effectiveness of the external audit process.


3. Met with the external and internal auditors on our own, without CCG officers or employees present,

before Audit Committee meetings, to provide the auditors with the opportunity to raise matters concerning conflicts, whistleblowing, internal controls, risks or any other issues which they wished to draw to our attention

4. Oversaw the procurement of Internal Auditors from 1 April 2018 following the end of the previous contract expiring on 31 March 2018 and approved the new appointment.

5. Discussed Conflicts of Interest breaches and agreed appropriate action to be taken. Carried out a review of the Statutory Guidance on managing conflicts of interest for CCGs issued by NHSE in June 2017. The Corporate Governance Manager is specifically responsible (reporting to the Audit Chair as Conflict of Interest Guardian) to ensure that the CCG Conflicts of Interest Policy is updated and all staff have read and evidenced that they have read and understood and agree to comply with the Policy, that all breaches and potential breaches are brought to the attention of the Conflicts of Interest Guardian and that the Policy is followed at all times by the CCG. The main areas updated in the June 2017 Statutory Guidance were changes relating to conflict of interest management in providers and the levels of gifts and hospitality that employees can receive.

6. Reviewed the CCG’s register of interests and ensured that there was a process for it, and the register of procurements, to be updated regularly by a named and responsible individual and displayed on the CCG website, as was required in the NHSE’s CCG guidance on conflict of interest management.

7. Reviewed and provided comments on the quarterly Primary Care Commissioning self-certification prior to it being signed by the Accountable Officer and the Audit Chair and then submitted to NHSE. The Audit Chair signed the certification as follows “Nothing in this certification is inconsistent with my knowledge of the CCG”; reflecting the limited detail the Audit Chair has of the day to day detailed operations at the CCG.

8. Counter – signed, with the CCG Accountable Officer, the quarterly Conflict of Interest Indicator under NHSE’s Improvement and Assessment Framework for CCGs- which assesses the CCG’s compliance with the revised Statutory Guidance on Managing Conflicts of Interest for CCGs published in June 2017.

9. Counter-signed, with the Accountable Officer, the Annual self -certification of the Conflict of Interest Indicator. Inter alia, this requires confirmation of Lay Members’ capacity and compliance with Conflict of Interest training for all those involved in Commissioning

10. As part of a general review of governance and review of conflicts of interest management, reviewed minutes of a number of sub-committees’ meetings

11. With increasing collaborative work between the CCG and the GP Care Group, the Committee has requested on going assurance that training, awareness and active management of Conflicts of Interest are all in place.

12. Approved and oversaw a programme of internal audit work on systems and processes of integrated governance and risk management to provide assurance that internal controls and risk systems both at the CCG and at the CSU were in place and working in practice and where they were not working, to propose recommendations to deal with the issues arising and to get them back on track. The Audit Committee followed very closely the internal audit reports and recommendations and ensured that the recommendations were being implemented on a timely basis.

13. Reviewed the Board Assurance Framework and influenced the ongoing development of this as the organisation underwent and continues to undergo change. Successfully encouraged the Governing Body to engage with the Board Assurance Framework process and to discuss the BAF, presented by the Director of Corporate Affairs at every meeting of the Governing Body, high up on the agenda.

14. Requested and considered governance and other updates on the North- East London Commissioning Alliance, the Transforming Services Together Group, Tower Hamlets Together Board, and the Sustainability and Transformation Plans (STP) Board across North East London and the City, with particular focus on the financial and governance implications. Recommended that BAFs need to be worked up for each of these tiers of governance to provide clarity on the risks within the systems and assurance as to how they are being managed.


15. Reviewed the CCG’s and Provider’s approaches to cyber security and management actions after the

Wannacry Attack in May 2017.

16. Reviewed the CCG’s compliance with the newly introduced General Data Protection Regulation, and the CCG’s preparedness for its implementation.

17. Supported the Governing Body by continuously reviewing governance and assurance processes.

18. Reported during the year to the Governing Body, in writing (until it was decided that full minutes instead should go to the Governing Body) all matters considered significant by the Committee. A written summary will again be provided to the GB summary going forward, and I recommend that all committees report to the GB in this way.

Additional proactive work undertaken by the Audit Chair

19. The Audit Chair was a founder member of, and meets on a quarterly basis with, a CCG Audit Chairs’ Forum (now comprising around 15 CCG Audit Chairs) to highlight, discuss and propose solutions to national and local healthcare initiatives and challenges. This Group invites guests, e.g. NHSE Audit Chair, Audit Chairs of Hospital Trusts and Foundation Trusts, NHSE London Finance Director.

20. The Audit Chair attended and contributed to regular NHSE organised National Forums for CCG Audit Chairs to discuss and share ideas and to propose solutions to National NHS issues

21. The Audit Chair and Lay Member for Corporate Affairs were members of the small group of Lay members who developed terms of reference and membership for the North East London Commissioning Alliance

22. The Audit Chair is a member of the STP Financial Strategy Group

23. The Audit Chair sits on the proposed STP Assurance Committee along with other Audit Chairs across NELC CCGs and the Providers within the STP footprint.

Assurance statement

The Committee confirms that it fulfilled its duties under the Terms of Reference during the period. I would like to draw attention of the GB to two issues, mentioned in the Annual Governance Statement, and which the audit committee is following up closely:

1. Continuing health care management; and

2. Procurement policies and practices

There are no matters of which the Committee is aware that have not been disclosed appropriately to the Governing Body.

Recommendation

The Governing Body is asked to:

1. Receive assurance from the Audit Committee about the delivery of the work of the Audit Committee and the work of the Audit Chair during the period under review.

2. To provide the Chair of the Audit Committee with any feedback on this report or the work of the Committee.

Mariette Davis Audit Committee Chair 30 June 2018


APPENDIX A

Work carried out by the Audit Committee during the period 1 April 2017 to 30 June 2018

This Annual Report from the Audit Committee is divided into sections and describes work done by the Committee following the order of responsibilities as set out in the Committee’s Terms of Reference (Appendix B).

Integrated Governance, risk management and internal control

24. The Committee reviewed the CCG’s 2017 and 2018 Annual Report and Accounts including the Independent Auditors Reports to the members of the CCG Governing Body at the end of May 2017 and 2018 meetings. Prior to this meeting, the Committee had reviewed relevant disclosure statements, including: The Head of Internal Audit Opinions, External Auditors opinions, Letters of Representation required by the External Auditors and other documents. The Committee reviewed the Annual Governance s included within the CCG’s Annual Reports and concluded that they were consistent with their knowledge of the CCG’s systems of internal control. The Committee recommended that the Governing Body approve the Financial Statements for each year.

25. The Committee met with the external and internal auditors on our own, without CCG officers or employees present, before Audit Committee meetings, to provide the auditors with the opportunity to raise matters concerning conflicts, whistleblowing, internal controls, risks or any other issues which they wished to draw to our attention.

26. The Committee reviewed the Board Assurance Framework (BAF) at each Audit Committee meeting, providing feedback and discussing the level of assurance provided to the Governing Body. The Committee requested and ensured that Committee Leads regularly review and update the BAF risks that they own (as highlighted on the BAF) and document the outcome of that review on the BAF. The internal audit function utilises the BAF to ensure that audit work is driven towards providing key assurance over the principal risks. The Committee worked with the Governance manager to develop a BAF tracker to be used for the year 2018/19 to support Governing Body reviews.

27. The Committee has sought assurance from the Financial Adviser and Interim CFO the Acting Accountable Officer (now Managing Director), regarding the implications for governance, risk management and internal control and for the CCG’s statutory duties in the emerging new models of working, including the NEL Sustainability and Transformation Plan (NEL STP) footprint ( now the East London Health Care Partnership ( “ELHCP”), the North -East London and the City Commissioning Alliance the Transforming Services Together and the Tower Hamlets Together arrangements. The Committee recommended that BAFs need to be worked up for each of these tiers of governance to provide clarity on the risks within the systems and assurance as to how they are being managed.

The Audit Committee recognised the substantial adjustments in governance taking place in the health and social care system in London, as well as locally within the borough, at WEL footprint level and further across North East London. Due to the changing landscape, the Audit Committee noted that governance procedures that directly affect the CCG’s statutory duties and that of its partner organisations would need review and assurance, with a view to ensure that decision making and management of risk was appropriately placed. The Committee in year:

Asked for and reviewed updates regarding the Tower Hamlets Together governance developments, THT board composition, the delegated authority and chain of decision making and its future sustainability.

Ensured that the developments within the North-East London Commissioning Alliance (such as the appointment of the Single Accountable Officer and the establishment of the Joint Commissioning


Committee) were reviewed and updated on in each Audit Committee. The TOR, Scheme of Delegations and Memoranda of Understanding of newly established committees or governance structures were reviewed and scrutinised.

Oversaw and gained assurance of the processes for the considerable Constitution changes as a result of the developing governance system in North East London.

Reviewed the governance of the Community Health Services Alliance Model and its interoperability with current governance workstreams.

Requested and considered updates on the Sustainability and Transformation Plans (STP) across North East London and the City, with particular focus on the financial and governance implications.

28. The Committee noted waivers to the CCG’s standing orders as well as financial write-offs which were presented to the Committee and had been authorised by the Chief Finance Officer or Acting Accountable Officer/ Managing Director.

29. As part of the ongoing scrutiny of the CCG’s governance, the Committee reviewed the terms of reference of several committees of the Governing Body, policies covering conflicts of interest, gifts and hospitality and we also reviewed the register of interests.

The Audit Chair prepared a written summary report for the Governing Body following each Committee meeting during the period covered by this report. It has been agreed that this practice will be adopted by all committees going forward.

Internal Audit and Counter Fraud

30. Throughout the period, the Committee oversaw the internal audit function to review and strengthen the CCG’s internal control processes. The Committee:

31. Reviewed and approved the Internal Audit Plan for each of the years 2017-18 and 2018-19, detailing the programme of internal audit work covering systems and functions within the CCG.

32. Reviewed and approved the CSU Assurance Work plan for 2017-18 to be carried out by the internal auditors to provide assurance on those CCG functions outsourced to the CSU.

33. Reviewed internal audit reports and CSU assurance reports and CFO CSU Assurance Group reports and minutes throughout the period covering reviews on the CCG systems and the CSU systems. The Committee discussed and considered their findings and recommendations. The Committee ensured that management had responded appropriately to the reports’ recommendations and monitored the follow up of the implementation of those recommendations.

34. Using the reviews and feedback from the Internal Auditors, requested further assurances regarding number of NEL CSU services delegated from the CCG, including Procurement, Continuing Healthcare, IT and Cyber Security.

35. Reviewed and approved the local counter fraud services plan for the year and considered reports from Local Counter Fraud Service.

36. Raised local issues with the Local Counter Fraud Service Lead, and monitored the progress and outcome of live investigations. The Committee asked for a number of specific reviews to take place and Received and considered reports on specific investigative fraud cases.

External Audit


37. The Committee reviewed and approved the external auditor’s annual audit plan for the 2017-18 year.

38. The Committee reviewed and discussed with the external auditors their work in respect of the 2017-18 audit and reports prepared by them.

39. The Committee reviewed all audit reports prepared by the external auditors, including their report to those charged with governance and agreed the Annual Audit letter before submission to the Governing Body.

Management

40. The Committee has continually challenged the assurance process when appropriate and has requested and received assurance from CCG management and other sources, both internally and externally, throughout the year.

41. This process has included calling managers to account when considered necessary to obtain relevant assurance. The Committee works closely with the Interim Accountable officer (now Managing Director), the Financial Adviser/ Interim CFO, and the Governance and Risk Manager to ensure that the assurance mechanism within the CCG is effective. The Committee has in year:

42. Reviewed the CCG’s Conflict of Interest and Gifts and Hospitality Policy, updated to reflect the new NHS England CCG Conflict of Interest Statutory Guidance, before being approved by the Governing Body on 6 December 2017.

43. Carried out an ongoing review of the revised statutory guidance on managing conflicts of interest for CCGs) issued by NHSE in June 2017. The CCG received a substantial opinion from the Internal Auditors for their 2017/18 Conflict of Interest Audit, demonstrating the CCG’s and Audit Committee’s committed approach to managing conflicts of interest.

44. Reviewed the CCG’s register of interests and ensured that there was a process for it, and the register of procurements, to be updated regularly by a named and responsible individual and displayed on the CCG website, as was required in the NHSE’s CCG guidance on conflict of interest management.

45. As part of a general review of governance and review of conflicts of interest management, reviewed minutes of a number of sub-committees’ meetings, agendas and conflicts management.

46. Under the standing agenda item of Whistleblowing, discussed current whistleblowing cases, procedures, outcomes and lessons learnt.

47. Reviewed the Terms of Reference for the newly formed Strategic Finance and Investment Committee.

48. Reviewed the CCG’s and Provider’s approaches to cyber security and management actions after the Wannacry Attack in May 2017.

49. Reviewed the CCG’s compliance with the newly introduced General Data Protection Regulation, and the CCG’s preparedness for its implementation.

50. Supported the Governing Body by continuously reviewing governance and assurance processes.

51. Reported during the period to the Governing Body, all matters considered significant by the Committee.

Whistleblowing


There is a whistleblowing policy in place which was reviewed by the Committee before its approval by the Governing Body. Apart from meeting with the internal and external auditors without executives present, and from members meeting and talking to staff outside formal Committee meetings, the Committee did not carry out specific review work on Whistleblowing,

Financial reporting

52. The Committee, through internal audit, ensured that the systems for financial reporting to the Governing Body, including those of budgetary control, were subject to review as to the completeness and accuracy of the information provided to the Governing Body.

53. The Committee reviewed the CCG’s Annual Financial Statements for each of the years ended 31 March 2017 and 31 March 2018 before they were recommended to the Governing Body for approval. The Audit Committee had no significant matters to draw to the attention of the Governing Body on either set of Financial Statements.

54. The Audit Committee reviewed and discussed, with the CCG Executives, the Governing Body’s response to the external auditor’s Letter of Representation relating to the Annual Financial Statements for each of the years 2016-2017 and 2017-2018.

55. The Audit Committee Introduced a standing agenda item for Strategic Finance to account for and discuss the risk share with Barking Havering and Redbridge CCGs, the financial implications of the system changes in North East London, and the financial position of the CCG considering the strategic changes.

56. Reviewed the IR35 / PAYE HMRC guidance and sought assurance from the CCG that suitable mitigations are in place.

Conflicts of Interest

57. The Committee continuously considered the CCG’s processes for managing conflicts of interest throughout the CCG and specifically and reviewed the Primary Care Committee’s Terms of Reference and a sample of the Minutes of meetings during the period.

58. The Committee recommended a form of words for inclusion on the agendas of every CCG meeting to prompt individuals attending the meeting to consider carefully whether they have a conflict of interest and to declare it at the meeting. The note also highlights that other individuals at the meeting should raise, at the meeting, any conflicts they consider others may have.

59. The Committee reviewed the CCG’s register of interests and ensured that there was a process for it to be updated regularly and displayed on the CCG website, together with the procurement register, as required in the NHSE’s CCG guidance on conflict of interest management dated 18 December 2014.

60. Having been reviewed by the Committee, the Audit Chair counter – signed, with the Accountable Officer, the quarterly Conflict of Interest Indicator under NHSE’s Improvement and Assessment Framework for CCGs- which assesses the CCG’s compliance with the revised Statutory Guidance on Managing Conflicts of Interest for CCGs published in June 2017.

61. Having been reviewed by the Committee, the Audit Chair counter-signed, with the Managing Director, the Annual self -certification of the Conflict of Interest Indicator. Inter alia, this requires confirmation of Lay Members’ capacity and compliance with Conflict of Interest training for all those involved in Commissioning.


APPENDIX B

Audit Committee Terms of Reference covering the period under review – 1 April 2017 to 30 June 2018

Introduction

The requirement for Clinical Commissioning Groups (CCGs) to establish an Audit Committee is included in the Health and Social Care Act 2012. The Governing Body established this Committee of the Governing Body in its Constitution. The Committee is a non-Executive Committee of the Governing Body and has no executive powers, other than those specifically delegated in this Terms of Reference. Its role is to seek assurance that financial reporting and internal control principles are applied and to maintain an appropriate relationship with the organisation’s auditors, both internal and external. The Audit Committee offers scrutiny and advice to the Governing Body, about the reliability and robustness of the CCG’s processes of internal control.

Membership

The members shall be appointed by the Governing Body, and to maintain its independent assurance and scrutiny role, the Committee will be made up of Lay Members of the CCG Governing Body. A quorum shall be two of the three independent members. One of the members shall be appointed Chair of the Committee by the Governing Body. The Chair of the organisation shall not be a member of the Committee. Current members are:

• Lay Member – lead for Governance – Chair

• Lay Member - lead for Patient and Public Engagement

• Registered Nurse or Secondary Care Consultant

The Chair shall have recognised professional accountancy qualification

Attendance at meetings

The Chief Finance Officer and appropriate internal and external audit representatives shall normally attend meetings.

The Counter Fraud Specialist shall attend at least two committee meetings a year.

The Accountable Officer should be invited to attend meetings and should discuss at least annually with the Audit Committee the process for assurance that supports the Annual Governance Statement. He or she should also attend when the Committee considers the Annual Governance statement and the Annual Report and Accounts.

Other executive directors/managers should be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director/manager.

Representatives from other organisations (for example NHS Protect) and other individuals may be invited to attend on occasion.


The organisation’s secretary (or governance lead) shall be secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the chair and the Committee members.

At least once a year the Committee shall meet privately with the internal and external auditors.

Meetings are not open to the public.

Access

The Head of Internal Audit, representative of external audit and counter fraud specialist have a right of direct access to the Chair of the Committee.

Frequency of meetings

The Committee will consider the frequency and timing of meetings needed to allow it to discharge all its responsibilities. The Committee will meet at least quarterly at appropriate intervals in the financial reporting and audit cycle and otherwise as required. The Chair can call a meeting of the Committee as and when required with at least three weeks’ notice.

The Governing Body, Accountable Officer, external auditors or Head of Internal Audit may request an additional meeting of they consider one is necessary.

Outside of the meeting the Chair will maintain a dialogue with the Chief Finance Officer

Authority

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 employee and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.

Responsibilities

The duties/responsibilities of the Committee fall into the following main categories:

Governance, risk management and internal control

The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the CCG’s activities, that supports the achievement of the organisation’s objectives;

The Committee will review the adequacy and effectiveness of:

• All risk and control related disclosure statements (in particular the Annual Governance Statement) together with any accompanying Head of Internal Audit Opinion, external audit opinion or other appropriate independent assurances, prior to submission to the Governing Body.


• The underlying assurance processes that indicate the degree of achievement of strategic objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

• The policies and procedures for all work related to fraud and corruption as required by NHS Protect.

The Committee will review any incident of fraud, corruption or possible breach of ethical standards, conflicts of interest or legal or statutory requirements that has been brought to its attention and could have a significant impact on the CCG’s financial accounts or reputation.

The Committee will note waivers or breaches to the Prime Financial Policies or standing orders which have been approved by the Chief Finance Officer or Chief Officer.

In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from executives and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

This will be evidenced through the Committee’s use of an effective assurance framework to guide its work and that of the audit and assurance functions that report to it.

As part of its integrated approach, the Committee will have effective relationships with other key committees (for example the Finance, Performance and Quality committee) so that it understands processes and linkages.

Internal audit

The Committee shall ensure that there is an effective internal audit function established by management that meets Public Sector Internal Audit Standards 2013 and provides appropriate independent assurance to the Audit Committee, Chief Officer and the Governing Body. This will be achieved by:

• Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.

• Review and approval of the internal audit plan and the more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the Assurance Framework.

• Considering the major findings of internal audit work (and management’s response), and ensuring co-ordination between the internal and external auditors to optimise audit resources.

• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the organisation

External audit

The Committee shall review and monitor the external auditors’ independence and objectivity and the effectiveness of the audit process. In particular, the Committee will review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:


• Considering of the appointment and performance of the external auditors, as far as the rules governing the appointment permit.

• Discussing and agreeing with the external auditors, before the audit commences, the nature and scope of the audit as set out in the annual plan.

• Discussing with the external auditors their evaluation of audit risks and assessment of the CCG and associated impact on the audit fee.

• Reviewing all external audit reports, including the report to those charged with governance (before submission to the Governing Body) and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

Other Assurance Functions

The Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications for the governance of the CCG.

These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission, NHS Litigation Authority, etc.) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges, accreditation bodies, etc.)

In addition, the Committee will review the work of other committees within the organisation whose work can provide relevant assurance to the Audit Committee’s own scope of work. In particular, this will include the Finance Performance and Quality Committee

Counter fraud

The Committee shall satisfy itself that the organisation has adequate arrangements in place for counter fraud and security that meets NHS Protect standards and shall review the outcomes of counter fraud work in these areas.

Management

The Committee shall request and review reports and positive assurances from directors and managers on the overall arrangements for governance, risk management and internal control.

The Committee may also request specific reports from individual functions within the organisation as they may be appropriate to the overall arrangements

In particular, a separate record of matters discussed during suspension of standing orders shall be kept. These records shall be made available to the Governing Body’s Audit Committee for review of the reasonableness of the decision to suspend standing orders.

Financial Reporting

The Audit Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance.


The Committee should ensure that the systems for financial reporting to the Governing Body including those of budgetary control are subject to review as to completeness and accuracy of the information provided to the Governing Body.

The Audit Committee shall review the annual report and financial statements before submission to the Governing Body, focusing particularly on:

• The wording in the Annual Governance Statement and other disclosures relevant to the terms of reference of the Committee • Changes in, and compliance with, accounting policies, practices and estimation techniques • Unadjusted mis-statements in the financial statements • Significant judgements in preparation of the financial statements • Significant adjustments resulting from the audit • Letter of representation • Qualitative aspects of financial reporting. • Explanation of significant variances Whistle blowing

The Committee shall review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.

Reporting / Accountability

The Committee shall report to the Governing Body on how it discharges its responsibilities.

The minutes of the Committee’s meetings shall be formally recorded by the secretary and made available for the Governing Body to review. The Chair of the Committee shall deliver a summary written report of the key issues discussed to the Governing Body on its proceedings after each meeting on all matters within its duties and responsibilities.

The committee shall make whatever recommendations to the Governing Body as it deems appropriate on any area within its remit

The Committee shall produce an Annual Report to the Governing Body of its work.

Administrative support

The Committee shall be supported administratively by the Governance and Risk Manager, whose duties in this respect will include:

• Agreement of agendas and forward planner with Chair and attendees and collation and circulation of papers in good time • Taking the minutes and helping the Chair prepare reports to the Governing Body • Keeping a record of matters arising and issues to be carried forward • Ensuring that action points are taken forward between meetings • Arranging meetings for the Chair, for example, with the internal or external auditors or local counter fraud specialists • Advising the Committee on pertinent issues/areas of interest/policy developments • Ensuring that Committee members receive the development and training they need • Maintaining a record of all Audit Committee documentation. All Committee papers and minutes will be stored on the CCG I drive under a separate file called Audit Committee.


• Maintaining records of members’ appointments and renewal dates etc.

Management of conflicts of interest

If any member has an interest, pecuniary 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 consideration of the conflicted item has been completed

If the Chair has a conflict, then an alternative Chairperson will be nominated from the membership of the committee by the other members

Review of Terms of Reference

The Committee terms of reference will be reviewed every 2 years unless required sooner.

Last reviewed 14 March 2017

End


THCCG Governing Body Enclosure

Date of meeting 25th September 2018 H

Agenda item 3.1

Title of report: Commissioning intentions and contract variation process for 2019/20

Author(s): Warwick Tomsett, Joint Director of Commissioning Damian Panesar-Gipson, Head of PMO

Presented by:



Warwick Tomsett, Joint Director of Commissioning Simon Hall, Managing Director

Executive summary

This report provides an update on the process the CCG is following to develop commissioning intentions and agree contract variations to the various service contracts it holds with local provider organisations.

It sets out the key strategic changes and system developments the CCG intends to pursue with its Tower Hamlets Together partners as well as high-level local service developments.

Recommendation

Information Approval To note X Decision

Key issues Financially, the CCG has an ambitious QIPP programme for 19/20 and joined up working with Tower Hamlets Together partners will be necessary to align respective QIPP and CIP programmes.

Conflicts of Interest Any potential conflicts of interest are being managed via the appropriate CCG and NELCSU CoI policies

Report history This report has been written solely for the Governing Body.


The CCG is engaging with its Community Commissioning Panel to develop its commissioning intentions for 2019/20 and is drawing on various other sources of patient and public engagement intelligence that has been gathered during the past year.


The development of commissioning intentions and the introduction of contract variations during 2019/20 directly support the delivery of the following corporate objectives:


CO (1) - To work in partnership to commission high quality hospital services that are accessible, provide the appropriate treatment in the right place, and achieve good patient outcomes for people of all ages living in the borough CO (2) - To commission person-centred, integrated health and care services that are sustainable and that equally meet the mental and physical needs of our residents CO (3) - To contribute towards a financially sustainable and responsive health and care economy which delivers value for money and innovation and supports the appropriate use of services CO (4) - To support local people and stakeholders to have a greater influence on services we commission In particular, the process the CCG is following to develop commissioning intentions and contract variations directly supports the management of the following risks identified on the CCG’s Governing Body Board Assurance Framework:

- Risk 1.1 - Risk 3.1 - Risk 3.2 - Risk 3.5 - Risk 4.1


As part of the business case process to refine commissioning intentions and contract variations, impact assessments on equality and diversity are being undertaken.

Resource requirements This programme of work is being undertaken by members of the commissioning directorate, finance directorate, programme management office and NELCSU contracting team and forms part of their core work plan for 2018/19.

Next steps A further update on the development of commissioning intentions and contract variations will be brought to the Governing Body in January 2019.


20/09/2018

1

2019/20

High Level Planning and Commissioning Intentions

Governing Body Update September

Warwick Tomsett, Joint Director of Integrated CommissioningDamian Panesar-Gipson, Head of CCG PMOSeptember 2018

www.towerhamletstogether.com #TH2GETHER

N.B These are a high level DRAFT at this stage

2

• Tower Hamlets Together (THT) is a partnership of commissioners and providers working towards the shared aimof improving the health and wellbeing of people in Tower Hamlets

• THT has developed three life course workstreams which have been delegated the task of developing collective,system wide commissioning intentions for 2019/20 and beyond

• Additionally, enabler and cross-cutting programmes are also being developed for those areas that have asignificant impact across life courses or are enablers to transformation. For example, mental healthtransformation is aligned and embedded across all workstreams.

• The CCG and the local authority are forging ahead with integrated commissioning, as the best means ofmeeting the financial challenges ahead and this is supported by the appointment of a Joint Integrated Directorof Commissioning to lead this process

• THT are beginning to move to the alignment of system wide planning and commissioning processes as anenabler to developing integrated system intentions

• The priority for THT in developing 2019/20 commissioning intentions is to take a collaborative, co-developmentapproach to removing costs out of the system, joining up service delivery, improving quality and moving awayfrom the commissioner-provider split

• It is acknowledged that this is a developmental year for the THT workstreams in moving towards a system widejoint process to planning and commissioning

Planning and Commissioning Intentions Considerations - 2019/20


20/09/2018

2

3

• In addition to the local THT system commissioning priorities development, the North East LondonCommissioning Alliance (NELCA) are developing a commissioning strategy across NEL

• The strategy will be outlining the overarching vision, strategic priorities and scope of the 2019/20process to cover NEL, WELC and dovetailing with local commissioning priorities

• In addition, the strategy will outline the 13 main workstreams across NELCA that will need to havesynergy with local plans

• The strategy is expected to outline a ‘collaborative framework’ approach to commissioning with themajor providers across North East London – something which THT has already started with themultiagency workstreams tasked with developing commissioning plans

• Individual Boroughs should ensure that local commissioning development is in alignment with theoverarching NEL commissioning strategy and its 13 work streams, whilst allowing for localinterpretation, collaboration and innovation

• It is anticipated that the commissioning strategy will be coming to the THT Board in October forengagement

North East London Commissioning Strategy* (NELCA)

* The thirteen NELCA workstreams are summarised on slide 14

4

The following criteria was agreed by THT in June to support the workstreams to develop commissioning ideas

1. All money is public money and that all staff work for the benefit of our local population

2. Every penny counts, that there is no duplication of services between different agencies

3. Services meet the identified needs of our local population

4. We will review and reconfigure services and budgets where necessary to ensure that we achieve the maximum health and care improvements from our collective resources.

5. Start with ensuring that money in the system is being efficiently utilised as there is no new investment and we are expect to see reductions in budgets.

Scene Setting: High Level Principles for THT System Wide Commissioning


20/09/2018

3

5

Jan – March

Contractual alignment to

facilitate system change

Nov – Dec

System-wide Negotiations

Oct – Nov

Provider and Commissioner Collaborative Business Case Development

Sept

Finalise 19/20

Intentions Letters

July – Aug

Develop System-wide Joint

Commissioning Intentions

Commissioning Intentions Basic timelinePlanning for 19/20 and beyond will be developed through system partnership and collaborative working. The Tower Hamlets Together partnership, made up of the 1) Born well, Growing well; 2) Living Well and 3) Promoting Independence life course work streams (plus Cross –cutting and Enabler programmes) brings together commissioners and providers to drive the system-wide commissioning intentions process.

Demonstrable Commissioner and Provider Collaboration + Extensive Public Engagement

Demonstrable Commissioner and Provider Collaboration + Extensive Public Engagement

• The following slides outline the high level draft of emerging commissioning intention outputs from the 3 life course work streams and the cross cutting, enabler themes that were presented to the August THT Board

• These have been developed during July and August and continue to be worked up

• It is clearly acknowledged that this is a snap shot of progress so far and that more work refining and development is needed during September and October to ensure that they are aligned with the system wide principles outlined on slide 4

High Level Commissioning Ideas - THT


20/09/2018

4

Born Well and Growing Well – high level plans 2019/20

Title High level description

Mental Health and Wellbeing - CAMHS Place holder for local CAMHS transformation programme

Allergy/Asthma/EczemaCoordinate the care of children with allergy/asthma/eczema, with a focus on reducing admissions to hospital for children with eczema.

Maternity and Neonatal system transformation

In addition to supporting sector level works of the Local Maternity System on the Maternity Transformation Programme and the key lines of enquiry, WEL commissioning of the Maternity Voices Partnership will focus attention on patient experience and involvement in transformation.Specifically in Tower Hamlets the collaborative antenatal project will continue to work at pace to ensure a seamless handover of community antenatal care to Barts Health which will include the timely actioning of investigations and associated prescribing.

Continuing Healthcare (CHC) pathway – Children's Alignment with adults pathway

Adolescent Health

Development of an adolescent health hub - with a prototype in one of the four localities.Inspired by the Well Centre this would initially consist of embedding a GP in a current youth service, running drop in clinics in collaboration with youth workers, sexual health and mental health support and other key partners.

Early Years language acquisition projectDevelop the early years language acquisition offer for children in an integrated early years language service offer. Locate Barts Speech and Language Therapists in children’s centres for an agreed period each month

Hospital at Home Development of a Hospital at Home offer to integrate care between CCNT/Inpatient and Outpatient care

Audiology Tier 3 service.To augment the existing T1/2 CHS (Community Health Services) audiology service we will be looking to market test for an audiologist led –- T3 service with consultant input as required.

Living Well – high level plans 2019/20


Dermatology Review secondary care dermatology pathway, increase capacity at Barts Health and explore triage options through ERS and RAS

Community ENT Increase the use of RAS, Advice & Guidance and other virtual models. Explore community ENT options

Direct Access MRI Reduce the number of direct access MRIs

Virtual Biologics Clinic Implement a virtual MDT model in the biologics clinic

OutpatientsReduce the number of outpatient appointments through increased use of RAS and Advice & Guidance, and reduce follow up appointments through improved use of technology

MSKReview the pathway locally in partnership with Public Health and LBTH obesity pathways as well as linking with the opportunitiesacross WEL.

Physical activity and nutrition in adults Coproduction of new targeted programme to support physical activity and healthy nutrition in adults

An integrated information offer to support health and wellbeing

Work in partnership across the council, NHS and non statutory sector to align resources to provide people in Tower Hamlets with easy access to information around health and wellbeing and connection to local assets and services (including integrating SPAs and alignment to Mental health information and access processes)

A strategic approach to social prescribingProposal is to take a strategic view of social prescribing and align approaches across sectors (council, NHS and non statutory) – link across to Promoting Independence workstream

A whole system approach to reproductive health Identifying opportunities to streamline the pathway and potential cost savings. This is the QI project for this workstream.

Outpatient and inpatient episodes coded ‘digestive’ Explore opportunities to redesign the pathway to prevent inappropriate referrals and identify potential savings

Health Checks Review/evaluate/potentially re-scope Health Checks to see how these could be used more effectively for prevention and with a wider focus

Blood Borne Virus (BBV) case finding in A&E Mainstreaming of inclusion of HIV, Hepatitis B and C testing in A&E . Continuation of BBV nurses in community settings and toexplore opportunities to redesign the pathway to prevent inappropriate referral and identify potential savings


20/09/2018

5

Promoting Independence – high level plans 2019/20 – part 1


Personalisation

Developing a refreshed personalisation strategy across Tower Hamlet moving towards mainstreaming personal budgets within learning disabilities and mental health.Improve the personalisation offer for adults and children and young people with long term conditions and complex needs, including continuing healthcare and continuing care Revisiting our approach to the commissioning of community based support, Identifying options for sustaining personalisation across the system in 2020/21 and beyond

Developing Care CoordinationStrengthen integrated care MDT working across the primary, community, secondary and social care interface (QI Project)

Continuing healthcare (CHC)Block contracting of nursing care home beds (with LBTH) in borough to secure an adequate supply of CHC bed provision (including for discharge to assess D2A)Looking at opportunities for pooled budgets where appropriate

Heart Failure Pathway review looking at medicine optimisation and/or proactive patient finding and intervention

Pooled Budgets Domiciliary Care Explore bed based and domiciliary care pooled budgets

Community services reviewReview of existing day services, and information and advice community services including recovery college, well-being and recovery and mental health user led grants; review to inform future model and pattern of services. Procurement required for new services to be in place by July 1st 2019

Review of employment pathways and outcomesReview of existing employment services to inform future pattern or services in the context of work path and IAPT Employment advisors pilot; review to inform future model and pattern of services. Procurement required for new services to be in place by Apr- Jul 2019

Older adults pathways

Initial scoping of the opportunities for developing community provision as an alternative to the current CHC inpatient provision at Thames ward for those with more complex needs associated with dementia.This will primarily explore community support models and an enhanced nursing care offer for this small group of patients.

Promoting Independence– high level plans 2019/20 – part 2


Social Prescribing Co-design integrated model of information, advice and social prescribing (linked with Living Well)

Respiratory

There is a significant opportunity for Tower Hamlets to improve our spend and outcomes in the area of respiratory. Respiratory non-elective admissions are particularly high, with the two main drivers of this appearing to be obstructive airways disease and influenza and pneumonia. We will be working with system partners to understand why this may be and work collectively to develop plans to begin to address the opportunities that have been identified.

CHC and Learning Disability Accommodation pathway and spend review

Deliver Mental Health (MH) 5 Year Forward View (5YFV) requirements

Review of mental health crisis pathways in Tower Hamlets to deliver key requirements of 5YFV

Care at home Increasing skills in home care workforce to provide a range of health interventions

Improved physical health for those with SMI Review current delivery against 5YFV, develop workforce, develop monitoring dashboard

Accommodation pathways Review of current resettlement capacity and recommendations for future model

Strategic development, learning disabilities (LD)

LD Partnership Board (LDPB) to meet every 2 months to oversee implementation of Strategy and monitor implementation of delivery plan and outcomes frameworkSustain promotion of annual health checks and health action plans and distribution of accessible information about health improvement

Transforming Care: Building the Right Support Programme

Review needs of people in registered care out of borough back into borough and plan to bring them back with increased development and use of supported local accommodationDevelop a service model to support people with challenging behaviour to participate in local activitiesDeliver training to staff in all services about positive management of people with challenging behaviour


20/09/2018

6

Cross Cutting Themes – high level plans 2019/20


URGENT CARE

Urgent Care and 111 Consolidation of UTC and 111 to increase streaming, assessment and triage into UTC and redirection as appropriate to primary andcommunity care

Physician Response UnitExtension of operating hours to provide out of hospital response, with improved co-ordination with rapid response and admissionsavoidance services

Frequent Attenders Implement model for early identification, management and intervention to support medium risk cohort

Ambulatory Emergency CareEmbed model to investigate and treat patients attending A&E without the need for a hospital admission and reduce potential ofbecoming complex frequent attenders

PRIMARY CARE

Primary Care model for the ‘mostly healthy’To implement a new model of primary care for the ‘mostly healthy’ cohort that utilises digital technology to provide accessible and convenient primary care services

APMS Review Review of General Practice APMS contracts

PMS Review/Reinvestment Agree investment against released PMS funds

NIS Review To review the NIS outcomes to ensure they align with the THT outcomes framework Stretch NIS targets to include metrics with broader system impact

Homeless Services Implementation of the new service model for homeless services

Cross Cutting Themes – high level plans 2019/20


PRIMARY CARE ESTATES

Reduction of NHS void space to reduce direct cost to THCCG and the wider NHS

THCCG commissioners to consider estates costs (direct to the particular and indirect to the wider NHS)

Work with practices to reduce the remaining historic debt and other complications

Resolve historic debt owed to NHS Property Services by working to resolve the outstanding service charge issues at practices

Strategic and operational delivery of renewal/expansion of THCCG primary care estate

Improvement and increased cost effectiveness of primary care in TH. APMS contract renewal to consider estates issues

PRIMARY CARE ICT AND INFRASTRUCTURE

Update the CV CoIN (N3) to HSCNBetter interoperability within services on the HSCN, greater bandwidth, upgrade the infrastructure from ADSL lines to Ethernet for future proofing of the network

S106 IT funding for GP PracticesTelephony solutions at better value which are fit for purposeAccess to Ipad’s, patient online, local practice services, PODs for patient registration services, apps that support video communication

EMIS Video ConsultEnable GP’s to adopt remote working practices leading to time saved, patients with barriers accessing GP services to remotely access services equality of access

MENTL HEALTH MH commissioning intentions have been aligned to each work stream and will feature heavily across the system. Additional cross cutting schemes are also being developed

Cross cutting MH CiS are currently being developed that may include:• S136 location transition• Review and develop community services (10 year plan)• Review MH primary care service provision• Individual placements support (psychosis)• Perinatal MH pathway funding review


20/09/2018

7

After using Tower Hamlets Together services we want residents to be able to say…

Around me

I feel safe from harm in my communityI play an active part in my communityI am able to breathe cleaner air in the place where I liveI am able to support myself and my family financiallyI am supported to make healthy choicesI am satisfied with my home and where I liveMy children get the best possible start in life

My doctors, nurses, social

workers and other staff

I am confident that those providing my care are competent, happy and kind

I am able to access the services I need, to a safe and high quality

I want to see money is being spent in the best way to deliver local services

I feel like services work together to provide me with good care

Me

It is likely I will live a long, healthy lifeI have a good level of happiness and wellbeingRegardless of who I am, I am able to access care services for my physical and mental health

I have a positive experience of the services I use, overallI am supported to live the life I want

Cross Cutting Themes – Integrate THT Outcomes Framework into a streamlined contractual process

NELCA 13 Work Stream – high level summary plans


1. Urgent and Emergency Care • Urgent treatment centres; reducing extended lengths of stay; ambulatory Emergency Care; reducing minors breaches; Home Visiting Services; Winter Planning

2. Cancer • Alliance diagnostic hub for NEL; Rapid assessment and diagnostic pathways for lung, prostate and colorectal cancers;

Stratified follow up and recovery package-breast cancer; Pathway change for the management of major colorectal cancer

surgery

3. Medicines Optimisation • NEL Joint Formulary; Care Home Pharmacists; Discharge to Pharmacy; Primary Care and Secondary Care/High cost drugs

4. End of Life (EOL) • Single Hospice at Home model; Implementation of Coordinate My Care (CMC); Improve access and uptake of EoLC education and training

5. Transforming Care • Redesign (and potential new model of care) for the Assessment and Treatment Unit

6. Continuing Healthcare (CHC) and Personal Health

Budgets (PHB)

• Alignment to national commitments and standards

7. Mental Health • Improve Crisis & Psychosis Pathways; Improve Community Mental Health; Improve Suicide Prevention; Improve services for

children and young people

8. Maternity • PPI engagement and Maternity Voice Partnerships; Neighbourhood Midwives; Shared Maternity Specification for all

maternity Providers; Shared KPIs for all providers

9. Prevention • Childhood Obesity; Smoking Cessation; Diabetes Prevention; TB pathway review; Workplace Health

10. Workforce • Physician Associate Training Programme; Apprentice Provider scheme; Development of integrated roles across providers;Development of workforce to meet Stepping forward (MH)

11. Digital • Data sharing; Facilitate use of e-Referral Service; Improve clinical safety ; Improving the flow of medicines data around the system; Implementation of new systems or modules to support STP/ICS initiatives; Improve uptake and use of tools and

services

12. Provider Productivity • Bank staffing and agency caps; Improve quality and reduce cost of pathology services; Explore opportunities to consolidate mental health inpatient beds and free up estate at the Homerton for alternative use; Reduce the number of referrals and

support patients to be managed in primary care

13. Primary Care • Primary Care Data Improvements; GP Retention & New Employment Models For Newly Qualified GPs; GPN Leadership Development; Implement a sustainable NEL system wide plan for quality and efficiency; Reduce variation in quality and

secure universally high performance


20/09/2018

8

15

THT Commissioning Intentions – sign off and engagement timeline

Month CI Stage THT Board JCE SFIC Born Well Growing Well

Living Well Promoting Independence

August2018 CI

Development +

Commissioning Intentions

Sign off

3.08.18THT FINANCE SUMMIT

17.08.18CI PROCESS SHARE

22.08.18CI PROCESS SHARE

14.08.18CI SHORTLISTING

29.08.18CI SHORTLISTING

21.08.18CI SHORT LISTING

September2018

6.09.18RECOMMEND CI

SHORTLIST TO SFIC + JCE

21.09.18CI PROGRESS

19.09.18CI PROGRESS

25.09.18REFINE CIs

28.09.18REFINE CIs

No meeting

Commissioning Intentions Letters Sign off & Send by end of Sept

October2018

Develop &

Sign off Business

Cases

11.10.18SHORTLIST DISCUSSIN

UPDATE ON BC DEV

19.10.18SHORTLIST UPDATEUPDATE ON BC DEV

17.10.18UPDATE ON BCDEVELOPMENT

30.10.18SUPPORT BC DEV



Initial business case proposals for savings schemes (QIPP and LA) to be progressed as appropriate

1.11.18RECOMMEND BUSINESS CASE APPROVALTO SFIC

16.11.18REPORT ON BUSINESS

CASE PROGRESS

21.11.18SIGN OFF BUSINESS

CASES

No meeting 29.11.18REFINE 19/20 WORK

PRIORITIESSUPPORT BC SIGN OFF

06.11.18REFINE 19/20 WORK

PRIORITIESSUPPORT BC SIGN OFFNovember

2018

Collaborative System Negotiation - Agree QIPP and LA Savings programmes and contract negotiation/changes

December2018

6.12.18ALL BUSINESS CASES

APPROVED

21.12.18REPORT ON BUSINESS

CASE PROGRESS

19.12.18SIGN OFF BUSINESS

CASES

4.12.18REFINE 19/20

PRIORITIES

20.12.18REFINE 19/20

PRIORITIES

04.12.18REFINE 19/20

PRIORITIES

Jan2019

Contract Negotiations

+Submit Operating

plan

3.01.19FINALISED QIPP + LA

SAVINGS

18.01.19REPORT ON QIPP + LA

SAVINGS

TBAFINALISED QIPP + LA

SAVINGS

4.01.19TEST PRIORITIES



Feb2019

7.02.189 TBA TBA 19.02.1919/20 WORK PLAN

27.02.1919/20 WORK PLAN

05.02.1819/20 WORK PLAN

NE Health & Wellbeing Committee

Joint Commissioning Executive

Tower Hamlets Together Partnership Board

CCG (SFIC)

LBTH

Involvement Centre of Excellence

User & Stakeholder Engagement

Promoting Independence

(complex adults)

Living Well(healthy adults)

Born Well & Growing Well

(Children & young people)

System Management Committee

Oversee 2018/19 delivery

NW Health & Wellbeing Committee

SW Health & Wellbeing Committee

SE Health & Wellbeing Committee

Receives recommendation

from THTB for final sign off

Receives recommendations

from Workstreams -final sign off for

THT

Development of commissioning

intentions & workstream

endorsement

Workstreams to check off and/or

develop ideas with LHWC

Test ideas with the people of

TH

Health and Well Being Board

Planning Governance 2019/20 - Sign off process reminder


20/09/2018

9

Commissioning Intentions - next steps

• Life course work streams to continue work to refine commissioning intentions (Commissioning Leads)

• Commissioning leads to review the NELCA commissioning strategy against local plans to look for synergies, scale and to avoid duplication

• A central master spreadsheet capturing progress of all commissioning intentions to be circulated to commissioning leads and will be used to monitor progress (CCG PMO)

• A refined CI ‘shortlist’ to be presented back to the October THT board, that separates out identified savings schemes vs longer term exploratory/strategic review work

• All ‘saving scheme’ proposals will need to take business case proposals through the most appropriate governances process for sign off and mobilisation and will need to satisfy the system commissioning principles outlined on slide 4*

*Business cases for all savings schemes will need to have final sign off at future THT Boards and CCG SFIC meetings (Dec being the very latest - if a 19/20 mobilisation is required). Any direct Local Authority schemes can follow the LA savings governance process. The CCG have adapted their PID template (Initial business case proposal) for all schemes to complete, as well as a Full Business Case template (All high value/high risk schemes need to complete a second, more detailed business case for sign off). It is up to the life course work streams to decide how they will support scheme development over the next few months (i.e act as a ‘gate keeper’ for which schemes and define how much the workstream should be involved in the scheme development



Date of meeting 25th September I

Agenda item 3.2 (b)

Title of report: Proposed Single Chief Finance Officer

Author(s): Jane Milligan, Accountable Officer, NELCA CCGs

Presented by: Jane Milligan, Accountable Officer, NELCA CCGs

Executive summary

Since the appointment of the Single Accountable Officer in December 2017 roles have been put in place to strengthen borough based commissioning arrangements, with the appointment of Managing Directors, and the establishment of the North East London Commissioning Alliance to underpin the continued delivery of our Sustainability and Transformation Partnerships and development of local Integrated Care Systems. In addition, we have begun to put in place some shared resources to support better collaboration and planning at scale where this makes sense, for example the Director of Strategic Commissioning across NEL. In order to further support our focus on collaborative commissioning and partnership work, it is critical that we now appoint a Single Chief Finance Officer to support the significant financial challenges we face, not only as individual commissioners but as a whole system. Given the highly complex financial challenges associated with our NHS reform agenda a single CFO across NELCA is pivotal to the achievement of our overall aims and objectives.

The report builds on a number of discussions held over the past few months at Governing Body / Committee meetings regarding the development of new senior roles that enable our CCGs to move at pace. This is a critical step change that supports the achievement of both national and local objectives. This is achieved from within existing budgets and running cost allowances’ (RCAs)

Recommendation


The Governing Body is asked to:

1. Approve the appointment of a Single Chief Finance Officer

2. Note steps taken regarding the implementation of a structure to underpin the NELCA arrangements

3. Approve Next Steps.

Conflicts of Interest In the event of the CCG considering an action or decision, does the


paper conflict with any of the declared interests of members or attendees of the CCG? E.g:

The CCG is asked to Commission services in Primary Care

The CCG is considering business cases related to Barts Health NHS Trust

Key issues The purpose of this report is to describe the requirements of a Single Chief Finance Officer across North East London Commissioning Alliance, which is required to support the complex financial challenges across the system as a whole. The critical components of this post will include:

• Supporting the SAO to undertake their role

• Ensuring strategic alignment across North East London with the NHS Five Year Forward View and anticipated 10 year plan

• Ensuring Financial achievement and delivery of our Sustainability Transformation Plan

• Managing financial challenges and sustainability across NEL CCGs and East London Health and Care Partnership.

• Ensuring improvements in outcomes, quality and performance and reducing variation across North East London

Report history Report is visiting all NELCA CCG Governing Bodies


N/A


List the risks the paper affects or is related to and explain how it affects the risk.


N/A


Next steps As outlined in paper


1

North East London Commissioning Alliance

Proposed Single Chief Finance Officer

EXECUTIVE SUMMARY Since the appointment of the Single Accountable Officer in December 2017 roles have been put in place to strengthen borough based commissioning arrangements, with the appointment of Managing Directors, and the establishment of the North East London Commissioning Alliance to underpin the continued delivery of our Sustainability and Transformation Partnerships and development of local Integrated Care Systems. In addition, we have begun to put in place some shared resources to support better collaboration and planning at scale where this makes sense, for example the Director of Strategic Commissioning across NEL. In order to further support our focus on collaborative commissioning and partnership work, it is critical that we now appoint a Single Chief Finance Officer to support the significant financial challenges we face, not only as individual commissioners but as a whole system. Given the highly complex financial challenges associated with our NHS reform agenda a single CFO across NELCA is pivotal to the achievement of our overall aims and objectives. The report builds on a number of discussions held over the past few months at Governing Body / Committee meetings regarding the development of new senior roles that enable our CCGs to move at pace. This is a critical step change that supports the achievement of both national and local objectives. This is achieved from within existing budgets and running cost allowances’ (RCAs)

RECOMMENDATIONS: The committee is asked to:

1. Approve the appointment of a Single Chief Finance Officer 2. Note steps taken regarding the implementation of a structure to underpin the NELCA

arrangements 3. Approve Next Steps.

1. Purpose The purpose of this report is to describe the requirements of a Single Chief Finance Officer across North East London Commissioning Alliance, which is required to support the complex financial challenges across the system as a whole. The critical components of this post will include:

Supporting the SAO to undertake their role

Ensuring strategic alignment across North East London with the NHS Five Year Forward View and anticipated 10 year plan

Ensuring Financial achievement and delivery of our Sustainability Transformation Plan

Managing financial challenges and sustainability across NEL CCGs and East London Health and Care Partnership.

Ensuring improvements in outcomes, quality and performance and reducing variation across North East London


2

Coordinating the approach to supporting the financial challenges in delivering the STP Integrated care systems (ICS)

Supporting the delivery of the priorities for 2018/19 and beyond to the establishment of IC systems

2. NELCA Chief Finance Officer

The majority of the long‐standing and complex financial challenges require a system solution. It would

be the responsibility of the CFO to manage system control totals that combine commissioning

expenditure and oversee delivery of cost improvement programmes across local systems to ensure

strategic alignment with the system wide financial strategy. Having a single consistent financial voice

that has sufficient weight and formal authority to act on behalf of all NEL CCGs is crucial in addressing

and reducing significant financial challenge and risk for CCGs. In addition, a coordinated approach to

supporting the financial challenges in delivering Integrated Care Systems is a critical component of our

evolving landscape and reform agenda. A Single CFO with responsibility for developing a NEL financial

framework will focus on achieving:

Payment reform and a new contracting model to enable the move away from Payment by Results and delivery of Integrated Care Systems (ICS)

A Single overarching financial strategy which consolidates a shared approach to system wide issues around acute commissioning, reducing duplication and ensuring that appropriate energy and attention of each individual CCG can be focused on local ICS delivery.

Management of the process for Acute Trusts to return to financial balance requires a clear and robust commissioner plan. Without this there is a significant risk that Acute Trusts’ financial plans will be based on income growth which has a high risk of placing the commissioning system in an economic failure position.

Devolution of relevant elements of specialised commissioning supported by a financial governance framework across NEL CCGs.

Access to transformation monies – these may be devolved to the SAO at a North East London level, but this will be subject to the establishment of a single coherent financial strategy and a single integrated assurance framework. Successful delivery will require clear leadership at executive level.

The Single CFO will be supported by local Executive Directors of Finance within individual or

clustered CCGs with clear strategic versus operational roles and responsibilities. Local Executive

Directors of Finance will report to the Single CFO and have a dotted line to the Managing Directors.

To illustrate the respective roles some examples are outlined below:


3

NEL Single CFO CCG Executive DoF (C&H, WEL,BHR)

Voting member of GB and JCC

Voting member of GB and CCG committees

Strategic Overview NEL Control Totals setting

Local CCG / sub‐system Control Total delivery

NEL financial performance CCG financial plans

NEL financial plans and sign off of Annual Accounts

CCG / local financial performance

NEL system triangulation management

CCG Quarterly Returns

NEL QIPP CCG QIPP

NEL risk share governance CCG Risk Share business case

PbR / contract reform Local Contract Strategy/management for acute and community contracts

Overarching acute contracting strategy

Integrated Commissioning arrangements with local boroughs (contract sign off up to £xm)

NEL Estates Strategy/Major Sites

Local Primary Care Estates CCG Estates Implementation

NEL Digital Strategy Information Governance NEL wide

Local Digital Roadmap implementation

Primary Care at Scale Primary Care Reform – financial strategy

CCG Primary Care Co Commissioning

NEL Internal Audit Approach/Review

CCG internal Audit

NEL External Audit sign‐off CCG External Audit liaison

NELCSU in housing Local RCA monitoring/control

3. Summary As described above, the background to this reform agenda is the need to transform the way in which

we deliver services to patients. Given the extremely challenging financial pressures facing our system,

the recommendation is to recruit to and appoint a NELCA Single CFO to enable a decrease in

fragmentation across the system and enable greater coherence and ability to ensure system wide

financial planning in a structured and consistent way.

4. Next Steps Regarding the CFO post:

A Should approval to proceed with the appointment be granted a Remuneration Committee in

Common to be convened to seek approval of remuneration package.

B Proceed with a robust recruitment plan in line with the process for recruiting the Single

Accountable Officer and in accordance with equal opportunities.

C To align the appointment of this post with the key milestones and timescales that support

NELCA’s Target Operating Model


4

D Discuss implications for the appointment of a Single CFO with existing individual CCG CFOs in

accordance with HR Policies and Procedures.

Jane Milligan NELCA Accountable Officer August 2018



Date of meeting 25th September 2018 J

Agenda item 3.3

Title of report: East London Health Care Partnership Update

Author(s): Laura Anstey - Head of Office for Accountable Officer

Presented by: Jane Milligan, Accountable Officer, THCCG

Executive summary

The East London Health and Care Partnership (ELHCP) brings together the 12 local NHS organisations (commissioners and providers) and eight local councils to improve health and care services and outcomes. It takes the lead around the NEL Sustainability and Transformation Plan (STP). This report sets out:

the latest summary of progress on the main transformation programmes delivered through the ELHCP

the work of our clinical senate

the main communication and engagement developments in the last quarter

An update on the work of ELHCP will be provided at alternate meetings of the CCG Governing Body.

Recommendation


For Information.

Conflicts of Interest N/A

Key issues N/A

Report history N/A


N/A


N/A


N/A



Next steps N/A


1

East London Health and Care Partnership Update – September 2018

1. The East London Health and Care Partnership (ELHCP) brings together the 12 local

NHS organisations (commissioners and providers) and eight local councils to improve health and care services and outcomes. It takes the lead around the NEL Sustainability and Transformation Plan (STP). This report sets out: the latest summary of progress on the main transformation programmes delivered

through the ELHCP the work of our clinical senate the main communication and engagement developments in the last quarter

2. An update on the work of ELHCP will be provided at alternate meetings of the CCG

Governing Body. Delivery of the NEL Sustainability and Transformation Plan (STP) 3. The ELHCP drives the transformation programmes within the NEL Sustainability and

Transformation Plan.

4. Key progress areas to note are: UEC: Integrated Urgent Care 111 and Clinical Assessment Service was

successfully launched on 1 August 2018 which means patients are now able to make contact to a fully trained adviser and we have implemented NHS 111 Online across NEL.

Mental Health: The Health Based Place of Safety (HBPoS) model for NEL has been developed for implementation by April 2019. We are also developing plans to transform services for Child and Adolescent Mental Health Service (CAMHS), initial plans will be in place by October 2018. Other key areas of mental health transformation are in access (Improvising Access to Psychological Therapies service model), prevention, (mainly suicide prevention) and MH service integration.

Maternity: Plans are in place locally to ensure we meet the national requirement of 20% of women receiving full continuity of carer by women booking in March 2019 across all NEL provider sites. Progress made to stage two of recruitment and retention of midwives with an offer made to one applicant.

Primary Care: Focused on improving the quality of local primary care using the local health and care model for neighbourhood/network development as the vision for local system development. Exploring local models for convenient access to general practice (for younger adults and others), this will build on work already being undertaken within NEL and forms part of wider work on new models of primary care.

Cancer: Project established to secure equitable direct access to key cancer diagnostic tests across the STP supported by the Healthy London Partnership (HLP) cancer programme and the establishment of a single diagnostics hub. This proposal was supported at the NELCA Joint Commissioning Committee on 12 September 2018.

Digital: All Trusts, all GPs and 2 out of 5 councils using Local Electronic Patient Record, allowing sharing of records with health, social and community care on track for full roll in 18/19 and completed a project to roll out e-tertiary referral functionality across the three local provider cancer systems.


2

Infrastructure: The strategic estates plan (SEP) has been produced for north east London covering planned and existing estates/infrastructure programmes. It is a ‘living’ document which we expect to develop further over time as we work with our partners and stakeholders to ensure we have a sustainable and flexible, ‘fit for purpose’ care and health estate. Whilst estates and infrastructure projects and programmes are led locally, the SEP for ELHCP takes an over-arching, strategic view of what needs to happen to support integrated services. The estates programme team are publishing an accessible version of the SEP this month, to be followed by an engagement programme later in the year

Provider Productivity: Agency cap arrangements are now in place to reduce the cost of bank and agency staff used in NEL. For pathology there are continued discussions with acute providers and NHS Improvement (NHSI) on how to network services to be in place by autumn 2018.

Medicines Optimisation: Defining an overall strategy in relation to demand and capacity to provide a baseline from which changes can be formulated. Established engagement between CCGs and community pharmacy about maximising the utilisation of resources to provide efficient services to patients.

Provider Alliance: NEL Provider CEOs oversee opportunities for provider collaboration on a monthly basis. Provider Alliance across BHR has been established focusing on a small number of key themes and an Alliance Director has been appointed.

Workforce: ELHCP bid successfully for £500k from Health Education England (HEE) to improve local recruitment and retention. Providers to continue and expand remit of bank and agency and careers and marketing work. An apprentice programme across ELHCP will be established.

Clinical Senate 5. During July and August the co-chairs of the clinical senate led on work to review the

terms of reference (TOR) for the senate. This included reviewing responsibilities, principles and membership whilst acknowledging the Clinical Senate’s role in providing strategic clinical input for ELHCP and its workstreams. The ToR have been updated to focus more tightly on the plans and priorities of ELHCP and to make sure that there is representation from health and social care clinicians and practitioners including nurses, social workers and other practitioners.

6. The Senate has agreed to focus on primary care in October given the wider primary care reforms and the importance of primary care within local care delivery models.

Electronic Referral Service 7. As referred to above, part of the national programme of switching off paper referrals to

hospitals, all hospitals have been completing the rollout of the electronic referral system across NEL. The deadline for the switch-off is October 2018.

8. On 3 September the last Barts Health site, Whipps Cross Hospital ‘switched-off’ paper

referrals, completing the rollout of the electronic referral system across NEL.

9. There has been extensive and ongoing engagement, training and awareness raising with GP practices as part of this work which could not have been possible without the commitment and hard work of the clinical leads and the commissioner and provider project teams. During the next few weeks colleagues will be working closely with those who may be experiencing difficulties using the system providing support and advice. One of the NEL videos was adopted for use by NHS England to explain the service.


3

Citizens’ Panel 10. The NEL Citizens’ Panel was launched on 17 August. There has been media coverage

in the Newham Recorder, Barking & Dagenham Council magazine, Hackney Today, Guardian Series (Redbridge and Waltham Forest) and the East London Advertiser. A series of tweets have been promoted by the Partnership and CCG communication teams.

11. At the end of August about 170 people have signed up. There has been representation

from every borough although the split is varied and currently corresponds with the areas where there has been more coverage. All age groups are also represented, however under 25s are underrepresented. The majority of those signed up so far are white, but there is representation from all ethnic groups. Current sign up (recognising that the boroughs vary in size) is as follows: Newham – 36% Barking and Dagenham – 20% City and Hackney – 11% Redbridge – 9% Waltham Forest – 9% Havering – 8%

12. To ensure the Panel is representative of the demography of all boroughs, the next stage

is for the commissioned specialist market research company to target and recruit further members. It is anticipated that the Panel will be established fully by the end of October.

NHS Long Term Plan 13. NHS England is developing its Long Term Plan (LTP) following the announcement of

significant investment in the NHS. This will be published in November.

14. During September NHS England is inviting input to shape the LTP through an online questionnaire and feedback is invited from all health and care staff, patient groups and local organisations. The deadline for responses is 30 September. Details of this have been cascaded across NEL through ELHCP and CCGs


Executive Committee Minutes

Date: 19th June 2018

Time: 9.30-11am

Venue: Simons Office, Alderney Building, Mile End Hospital, E1 4DG

Chair: Simon Hall

Present: Simon Hall- Managing Director THCCG

Archna Mathur –Director of Performance and Quality THCCG

Sam Everington – Chair THCCG

Jenny Cooke – Deputy Director of Primary and Urgent Care THCCG

Steve Collins – Financial Adviser THCCG

Ellie Hobart – Acting Director of Corporate Affairs THCCG

Isabel Hodkinson – THT Chair and Principal Clinical Lead

Apologies: Somen Banerjee-Director of Public Health LBTH

Victoria Tzortziou-Principal Clinical Lead THCCG


ACTION LOG SUMMARY

Agenda item no.

Action Due date

RAG rating Lead

2.6 Feb 18 Principles to be agreed regarding TOIL with staff and SMT

Update April: Policy currently being worked on.

May 18 EH

2.1 April 18 Possible meeting with Alwen Williams to be arranged. Sam to speak to Jane regarding this.

Update: Meeting has now been arranged for 3rd September. It was also agreed that a letter should be written to Alwen from all the CCG Chairs defining what needs to be done and the financial risks.

July 18 SE

2.3 April 18 Update to be given regarding the possibility of a review of NHS Charging Regulations & Migrant Health in Tower Hamlets Update: Emailed Jon Owen but have not heard back regarding the current status Update July: A bid for funding has now been submitted the outcome will be received August/September

July 18 JO

1.5 June 18 Progress on the updated Individual Funding Policy to be sought

July 18 EH

1.6 June 18 Changes to be made to the BAF as noted in section 1.6 Offer Risk training across the CCG

July 18 EH/SB/IH SB

1.8 June 18 Recruitment of an Independent Clinical Lead to be investigated

July 18 JC/EH

1.11 June 18 Jenny Cooke to contact Councilor Jones to communicate the changes to the Walk in Centre’s

July 18 JC

Item no.

Item name Lead

1. General Business

1.1 Apologies for Absence SH

The Chair welcomed everyone to the meeting and apologies were noted and are detailed in the apologies section on page one.

1.2 Declarations of Interest SH


None noted.

1.3 Action Log Update and Minutes of the Previous Meeting SH

The minutes of the last meeting dated 24th April 2018 were agreed as accurate. There was an action noted on page three of the minutes for Isabel Hodkinson to lead on a work stream for quality and performance for Barts, which will now not be actioned.

1.4 NHS Benchmarking: CCG Functions Report EH

Ellie Hobart explained that this is the second year that we had received this report, which is a useful tool but does only contain data that is found in the public domain. The report does compare us to other CCG’s across the country and in our footprint. The question was raised whether we need the report as we are paying £4000 per year to receive it.

It was agreed by the Committee that the NHS Benchmarking report would no longer be purchased.

1.5 IFR Quarter 4 Report EH

The report contains an end of year overview of Tower Hamlets cases for 2017-18. There were 26 cases from Primary Care and 248 from providers. A question was raised regarding the gender transition information which is set out in the Individual Funding Policy, the information is vague and it was confirmed that the policy is currently being updated. Ellie Hobart will seek progress on the updated policy. The committee discussed the potential of sharing the clinical lead input into the panel across the WEL or NELCA footprint in the future.

1.6 BAF EH/SB

Sophia Beckingham explained that she was keen to encourage use of local risk registers and is currently reviewing the risk management as part of the audit committee workplan.

The Committee reviewed the BAF and the following changes were agreed:-

It was noted that there is an ambition to establish a WEL wide risk register. There is currently a risk register for the JCE and STP

The score for the risk relating to local commissioning and governance arrangements should be reviewed to reflect the Barts and WEL risks. There is a possibility of also splitting the risk. EH/SB will work on this risk and IH will assist from a THT perspective.

It was agreed by the Committee that risk training at team level is useful and will help to embed risk management. SB will take this forward.

The Equalities risk needs work to make it more impactful in terms of commissioning. EH/WT will work on this, take it to the Equalities Working Group for discussion and then feed back to the Committee.

SB to review and up –date the conflict of interest risk

1.7 GB Elections EH

An email and job description is being sent out tomorrow, which will request any expressions of interest by the 8th July. The interviews will be on the 20th July. The new Board will be in place by October 2018. With regard to any members of the Board who will not be continuing, this will be handled with sensitivity. The recruitment will need to include a Caldicott Guardian.

It was confirmed that the constitutional changes have all been approved by NHS England with exception of the NELCA changes required by the appointment of the single accountable officer, which is currently waiting on clarification.


1.8 Independent Clinical Lead/Medical Director JC

Jenny Cooke explained that in a recent review of clinical leadership a gap was identified in the way they are supported, developed and managed. In addition the need for independent non conflicted clinical leads for procurements is an ongoing issue.

Jenny’s proposed the idea of appointing an independent Clinical Lead at Tower Hamlets citing the examples of City and Hackney CCG and Islington. Jenny explained that as we are reducing the Board overall at Tower Hamlets, we could invest the money saved and look into this idea as a possible opportunity.

It was agreed by the Committee that Jenny’s proposal should be taken forward and that a retired person could be approached for recruitment rather than to deplete the current pool of GP’s. The person specification for the role would need scoping with regard to linking it in with what the CCG are doing with broader clinical leadership.

EH and JC will take this forward and then feedback to the Committee.

1.9 Tower Hamlets Plan SH

There has been a very high-level discussion at the Tower Hamlets Together Board regarding this plan. The plan includes community safety, housing and businesses and needs to be linked into the Health and Wellbeing Strategy. The plan is being presented to the Cabinet and Governing Body in July.

1.10 Continuing Health Care SH

Simon Hall explained that the paper being presented to the Committee has been put together by a combination of teams across the CCG. The issue is very complex with both NHS E and NELCA taking an interest in finding a solution to how CHC is managed across the system.

It was agreed by the Committee that savings should be made around the front and back office functions. The Continuing Health Care role within the CCG needs to be recruited to and Warwick Tomsett will take this forward and get someone in post.

1.11 Walk in Centre Changes JC

Jenny Cooke explained that from the 1st August the walk in centre’s would change the way they operate. The service will still be available but will be a service for registered patients; Tower Hamlets non-registered will be registered.

The aim will be to provide a service that is similar to the service the hubs provide. The patients that are not Tower Hamlets residents, will be asked to call the 111 number and the new 111 service will be available to help and redirect them.

The public communications plan is in the process of being finalised and the message is that the walk in centre’s are changing, not closing. It was agreed that the changes should be communicated to Councilor Debbie Jones who Jenny will contact.

1.12 Non-Elective Admissions Analysis of Data SC

Steve Collins explained that in April the non-elective analysis data showed a 20% increase. This may present a threat to financial stability so the CCG need to know why this is happening. There has been movement in respiratory and infectious diseases so it is necessary to know and understand what this relates to. It was confirmed that the change to the data was not linked to the recent stabbings that have taken place in Tower Hamlets.

Steve explained that in order to investigate the increases further, he had looked at the data in more detail by splitting the coding and looking at the areas that are ‘spiking’. There is an increase of high complexity cases, which are £340,000 of the costs.


There was some discussion by the Committee in connection with respiratory problems and how this may relate to the environment.

It was agreed by the Committee that more work is needed regarding the uptake for flu vaccinations next year and that once the CCG have more information regarding the data, lessons learnt can be put into action.

1.13 Access to CT Chest for Benign Changes on Chest X Ray Lesley Perkins

Lesley Perkins explained that the paper she is presenting to the Committee is a proposal for a pilot for GP’s to have access to CT chest for benign changes on chest X ray.

It is proposed that a new pathway is introduced for Chest X Rays which show benign disease, but which would benefit from further clarification by a CT. Doing so may prevent a respiratory referral, and if it does not (i.e. the patient still requires a referral) the CT result would be available for the initial appointment. This may speed up treatment and prevent unnecessary appointments down the line. An initial pilot is proposed for 3/4 months to evaluate the benefits of the new pathway

It was agreed by the Committee that something should be added onto Edenbridge in relation to the patient journey and Lesley will speak to Tom Margham regarding coding. A video could also be made and shown across WEL, which messages how the new pathway will work.

A pilot across WEL for GP’s to have access to CT chest for benign changes on chest X ray was agreed by the Committee.

2. AOB ALL

None noted.


NHS Tower Hamlets Clinical Commissioning Group

Performance Activity Quality Committee Meeting 25thJuly 2018

Date: 25 July 2018

Time: 13:30-15:30

Venue: TH CCG, Room 2F, 2nd Floor, Alderney Building, Mile End Hospital, London E1 4DG

Chair: Simon Hall (SH), Managing Director, TH CCG

Attendees: Sandra Moore (SM), Deputy Director of Performance & Quality, TH CCG Mariette Davis (MD), Lay Member for Governance, TH CCG Helen Pace (HP), Head of Contract Provider Performance Improvement NEL CSU Yasmin Korimbux (YK), Senior Prescribing Advisor, NEL CSU Hina Shahid (HS), Prescribing Advisor, NEL CSU Pacifique Kimonyo (PK), Performance and Quality, TH CCG Farhan Ismail (FI), Senior Prescribing Advisor, NEL CSU Frank Cothorpe (FC), Performance Manager, NEL CSU Pacifique Kimonyo (PK), Performance and Quality Manager, TH CCG Sulaimon Quadri (SQ), Performance & Quality Manager for Mental Health, TH CCG Yasmin Korimbux (YK), Senior Prescribing Advisor, NEL CSU Andrea Antoine (AA), DCFO, TH CCG Jig Tailor (JT), Contract Manager, NEL CSU Tamantha Hearne (TH), Business Manager, Performance & Quality Team, TH CCG (Minutes)

Apologies: Archna Mathur (AM), Director of Performance & Quality, TH CCG Natasha Adams-Collman (NAD) Assistant director of Contracts NEL CSU Cathryn Maybin (CM), Transformation Manager for Cancer and End of Life Care, TH CCG Warwick Tomsett (WT) Joint Director for Integrated Commissioning Maggie Jeffery (MJ), Assistant Director of CHS and Urgent Care Contract Management. Jim Dodds (JD), Acute Finance Lead (WELC POD), NEL CSU Carrie Kilpatrick (CK), Deputy Director Mental Health and Joint Sam Buckland (SB), Prescribing Advisor, NEL CSU Kaylee Gibson (KG), CHC Manager, NEL CSU Jumoke Ogunmokun (JO) Senior Contracts Manager, NEL CSU Ellie Hobart (EB), Acting Director of Transformation, TH CCG Judith Fairweather (JF), Assistant Director of Contracts, NEL CSU Isabel Hodgkinson (IH), Principal Clinical Lead, TH CCG


ACTION LOG SUMMARY

Agenda item no.

Action Lead Issued Outcome Status

1. Barts Health Performance & Quality Report

TH to add page numbers to the agenda/papers.

TH 27.06.2018 25.07.2018

Completed

2. Acute Activity Report including LAS and 111

SM to bring slide pack put together by LAS re journey of improvement.

SM 27.06.2018 25.07.2018

SM to circulate this document.

3. CHS Quality Report – Barts

PK to add arrow direction to quality premium charts for future reports.

PK 27.06.2018 27.06.2018

PK confirmed that this has been done.

Completed

4. CHS Quality Report – Barts

Wider interactive discussion to take place re children’s services and how they are commissioned-jointly alongside the local authority.

SH/SM/CK/WT 27.06.2018 27.06.2018

This will be discussed at Joint Commissioning Executive.

Completed

5. PAQ General

SH, SM and WT to discuss agenda flow.

SH/SM/WT 27.06.2018 27.06.2018

This has taken place.

Completed

6.

PAQ General

TH to speak to LS re page numbering combined document.

TH 27.06.2018

27.06.2018

This has taken place.

Completed


7. MH Performance and Quality Report (ELFT and Compass)

SH to raise the data capturing issue for all CYP services, this includes the voluntary sector and shared services with the local authority at the next JCE. SM will raise CYP data collection for access rate and marketing with Carrie Kilpatrick.

SH/SM 25.07.2018


ELFT indicative performance figures will be reviewed/highlighted for discussion next quarter dependant on whether target has been met.

FC 25.07.2018


SQ to report back on key lines of enquiry from August SPR re Psychological Therapies Service.

SQ 25.07.2018

10. CHS Contract Performance

JT to request a full action plan for improvement of SLT service. Capacity issue to be taken to the main Alliance Board.

JT 25.07.2018


JT to pick up the Broad Care issue discrepancies around data.

JT 25.07.2018


JT to link with SM to discuss requirements/what should

JT 25.07.2018


be included in the IPR report.

13. CHS Quality Report

PK to report on vacancy rates for ELFT at future PAQ meetings going forward.

PK 25.07.2018


PK/SM to report GP’s not reporting pressure ulcers to the Alliance Board.

PK/SM 25.07.2018


PK to report LAC numbers to PAQ and to the Alliance meetings.

PK 25.07.2018


PK to meet with Warwick Tomsett and Rahima Miah to discuss adopting a similar process as Newham MSK Physiotherapy Service.

PK 25.07.2018

17. Primary Care Medicine’s Management

YK to report spend per population figure for next PAQ meeting.

YK 25.07.2018

18. The State of Care in Urgent Primary Care Services.

PK to feedback this CQC information to the hubs.

PK 25.07.2018


Item no. Item name Lead

1. Welcome and Introductions SH

TV welcomed all to the meeting and noted the apologies.

2. Conflicts of Interest

Please look over the agenda and reflect on whether any topics or papers might present an area of interest for you. This means an item where a decision or recommendation made may advantage you, your family and/or your workplace. These advantages might be financial or in another form such as the ability to exert unseen influence.

If anything on the agenda has the potential to put you in such a position, or raised in the meeting along the way, you should inform the meeting attendees and Chair immediately. This means we can ensure that our decision, recommendations or actions can be guarded from the impact of any possible conflict you or others could have or be seen to have. If you are unsure, it is best to raise the possibility with the chair before the meeting or at any point during the meeting if a possible interest strikes you. This openness is important and ensures we can discuss how to manage decision making in a complex environment and learn together how to manage these issues effectively.

Meeting attendees are agreed that we will challenge others on areas of interest or possible conflict as it is recognised that sometimes these issues can be overlooked.

SH

None declared

3. Review of June 2018 minutes and action log SH

Minutes and Actions reviewed and agreed.

4. Acute Report (see enc) Performance – LAS, A/E, Diagnostics, RTT, Over 52 week

waits. Activity – Planned and Unplanned Contract Performance – Tower Hamlets – BH, Associates

and BMI, LAS.

HP/JD

HP presented highlights to the committee focussing on A&E and RTT A&E

Performance is poor, Barts has under-performed against 90.5% trajectory with 87.57%. Latest position for RLH specifically w/end 15.07.2018 was 80.15% against trajectory of 90.7%.

AA asked why Homerton figures appeared to be better than other sites, and the group discussed factors at length such as population, size, location and services offered. Discussion continued with 111 and community services as well as their impact. RTT

Although April and May figures were positive, June is disappointing. A huge growth in the PTL has been seen (3,000 patients from May into June 2018). These appear to be referrals.

52+ week wait growth has been identified – increased to 63 52+ week waiters, which was at

37 in May 2018. These are believed to be pop on’s and tip in’s. This is a training issue that will be taken to the Barts CCC meeting on Monday, awaiting the outcome of a deep dive


analysis from Barts to understand what is driving the growth. The issue will also be taken to the RTT Recovery Board.

No concern with Cancer and Diagnostics.

Contract Performance

Total GP referrals are up 4.9% for Tower Hamlets. Although an improvement on last month, this is above plan. The NEL Demand and Capacity Committee chaired by Archna Mathur looks at capacity within the system and working on strategies to manage this.

NHSE to provide a breakdown of GP referrals by practice, this will be passed to all CCGS for further investigation in order to understand the drivers.

SH added that although not ideal, a piece of work is being carried out to tackle the referral issue.

For information, SM alerted the committee to the Tower Hamlets financial overview (page 21) showing rag rated spend along with other providers.

Regarding the non-elective increase that has been seen in Tower Hamlets, an analysis has been carried out at Barts CCC as well as various other pieces of work on-site (Katie Brennen’s team), which will be brought together to establish the cause. Victoria Brown, clinical lead is also involved for input.

SM identified an increase in referrals at BMI. AA added that in terms of finances these have decreased. Specialities such as trauma and orthopaedics have increased at Barts but decreased at BMI. It appears that the message to GP’s to go to Barts, is working.

5. Barts Health Quality Report

FFT

Training

HCAIs

Sepsis

Complaints

SM

SM reported key highlights to the committee

Significant improvement in the administration of antibiotics for sepsis within 1 hour. This has been a key focus for Barts Health. The RLH has chosen this as a key priority area.

3 never events have now been reported. The third being a wrong tooth extraction reported this week. 72 hour report has been received. It has been established that this is an individual performance issue, where the process was not followed.

Still seeing a large number of overdue serious incidents. A meeting has taken place involving SM to close some of these. The issue is monitored at monthly CQRMs and monthly Barts Health KPI meetings. Action plan is in place.

6. Acute Medicines Management Report FI

FI reported highlights to the committee


YTD savings achieved for Tower Hamlets – 1 biosimilar drug going through SLAM. Big hitter for QUIPP for the acute contract is adalimumab – not released before October.

Problems experienced with SLAM data flow – issues with the landing platform for NHSE

only Barts data. This has been escalated and submissions should be received today.

In terms of year to date spend – not far off from last year, slightly lower.

High Adalimumab usage in Tower Hamlets (used for chromes, rheumatoid arthritis).

Adalimumab is being used off label at Barts, this will be picked up on 01.08.2018.

A proposal has been put through to de-categorise some drugs at Barts. Assurance should be confirmed by next year.

NELMMN audit completed now under review.

New drugs Guselkumab and Dupilumab.

Regarding work plans – no rheumatoid arthritis work plan in place, this is currently being managed. Robust psoriasis pathway underway.

Regarding clinical trials, data captured from Barts does not capture everyone. To be brought back today.

Provider training day scheduled for 31.07.2018.

All providers using Blueteq, Barts to be included.

7. MH Performance and Quality Report (ELFT and Compass) SQ/FC

FC reported an overview to the committee

IAPT Access rate

FC reported that performance at Q4 is 4.1% which is just below the NHSE 4.2 plan. Recovery rate is at 50.9% which is above target. Because of the transition from Compass Wellbeing to ELFT, a dip in performance may be likely. The rolling position for next month suggests Tower Hamlets is on target for access rates and recovery rates.

CYP Access rate

FC reported that the access rate across the STP footprint is challenged regarding targets. A one off opportunity has been offered for providers to re-submit their data in June, where an uplift has been seen, particularly for Tower Hamlets.

Expecting revised data on prevalence rate figures in 2 months.

AA asked about demographics e.g. Havering – where the population is predominantly older people. FC mentioned that part of the issue around this indicator, is about capturing all CYP data within services including eating disorders as well as shared services with the local authority, and voluntary sectors data. SH suggested that this issue is raised at the next Joint Commissioning Executive.

A brief discussion took place between SH and SQ regarding CYP data collection and marketing and whether this was included in the spec for the new service due to be covered by ELFT. SQ


added that Compass had recruited a marketing professional to focus on marketing of the service. As a part of the mobilisation of the new service SH suggested that the marketing aspect is investigated and covered. SM will raise CYP data collection for access rate and marketing with Carrie Kilpatrick.

FC continued with ELFT’s latest indicative performance for Tower Hamlets 94.4% against a 95% target, where a quarter by quarter improvement has been seen. Systems now in place to ensure that all patients admitted for psychiatric care and then discharged, are followed up. Performance had decreased due to out of borough patients. FC expects this target to be met by Q3 but if not, would require constant follow-up. SH mentioned that the indicative performance figures should be reviewed/highlighted for discussion next quarter dependant on whether targets have been met.

SQ reported highlights around Performance and Quality

Psychological Therapies Service remains an area of concern where the 18week waiters target has not been met for the last 5 quarters. The latest data from ELFT shows that the 11week waiters target was not met - 75.7% in Q1, (first time that this has happened in the last 2 years). This had been addressed previously via CQRM and SPR (Service Performance Review).

Two meetings have since taken place with ELFT to address 18week waiters and 11week waiters’ issue. Key lines of enquiry across the 3 CCGS have been collated and documented. ELFT have been asked to attend the next SPR in August to present/address all issues raised within the key lines of enquiry. This will be reported back at next PAQ.

FC added that going forward, all data regarding Psychological Therapies Service will be presented at SPR as well as CQRM.

The clinical outcomes group (mental health leads/senior clinicians) have been asked to suggest clinical outcomes/activity measures as well as overall KPI’s for the Psychological Therapies Service – this will also be reported back to next PAQ meeting.

Acute bed occupancy rate target has been reduced to 91.6% in May, compared to 98.4% in April. ELFT have worked alongside community health services to avoid admissions. CCG will continue to monitor this.

Regarding the perinatal mental health service there are 2 concerns here –

Accurate data capture – ELFT had only been reporting GP referrals and are now currently working alongside CSU to ensure all data is captured e.g. midwifery and health visitors.

Staffing gaps - there has been application for transformation funding at STP level for the specialist community perinatal service. It has not been confirmed whether this has been approved.

Regarding Mandatory training, the whole training process is being revamped to improve by September 2018. Workforce application has been suggested by CCG to address this.

CAHMS % of clients offered an appointment who dna’d (follow up appointments) – this is the first time that this target has been achieved in 15 months. CCG will continue to monitor this.

Action: SH to raise the data capturing issue for all CYP services, this includes the voluntary sector and shared services with the local authority at the next JCE. SM will raise CYP data collection for access rate and marketing with Carrie Kilpatrick.


Action: ELFT indicative performance figures will be reviewed/highlighted for discussion next quarter dependant on whether target has been met.

Action: SQ to report back on key lines of enquiry from August SPR re Psychological Therapies Service.

8. Quality Assurance Visit Reports: (see enc)

Diagnostic Memory Clinic

Thames House Ward

SQ

SQ reported highlights to the committee

Diagnostic Memory Clinic

The service is not consistently achieving 6 and 18 week standards.

Two concerns are staffing and IT systems – currently being investigated.

No allocated OT time for the memory clinic, which has created a backlog of waiters. Number of waiters has been requested by CCG which will be picked up at next CQRM.

Lack of space on site for emergency slots (only 4 consultant rooms). Concerns have been highlighted by CCG and will be picked up at next CQRM.

Thames House Ward

CCG commended work taking place here.

Key concern around physical health resource – which has been escalated/highlighted. CCG will continue to monitor this.

No falls.

Good staff retention.

9. Primary Care Medicine’s Management (see enc) YK

YK reported highlights to the committee

Quality and Savings Programme Update

Regarding the allocated prescribing budget, still too early to forecast a financial position.

Additional savings have been reported for specials £7,850. Specials Pharmacists are still engaging with individual practices looking at where specials are being prescribed.

Over delivery of £39,337 for Script switch. Practices are reviewing missed savings.

Regarding ONS, there is a new SLA this year – more accurate figures to be reported next month. The team will be reviewing up to 30 patients to reduce cost. The team have also met with dieticians as part of quarterly contract meetings to review this as well as reviewing guidelines.

Key Performance Indicators


Currently organising practice visits to commence in quarter 2. Three quarters of the total of 36 practices have already been booked.

Good representation for all major medicines committees.

MMT Workstreams

Still working on the implementation of the all of national consultations.

Developing NIS resource tools which has changed significantly from last year.

Still working on MOU for the CHS Substance Misuse Service.

Reviewing several guidelines e.g. Pain, Antimicrobial, ADHD pathway.

Key Messages

Regarding WEL MOCC, looking at standardised pathways across the 3 boroughs – Implementation of Freestyle Libre to commence in August. Communication has gone out to practices for awareness of the processes here.

Asthma guideline position has now been approved – now out and available for practices to use.

PC Membership Engagement

26 clinical queries and 18 non-clinical queries. 100% responded to within timeline.

Regarding the Quality Premium 18/19 – meeting all 3 components.

MD asked about spend per population and how we fare on this. YK confirmed that this would be low but could provide this figure for the next PAQ.

Action: YK to report spend per population figure for next PAQ meeting.

10. CHS Contract Performance (see enc) JT

JT reported highlights to the committee

Children’s SLT (speech and language) – still an issue due to capacity issues. Action plan to improve this includes training of staff to carry out assessments.

SH requested a full action plan for SLT. SH has requested that this issue also goes to the main Alliance Board.

SM expressed concern around performance which is taken from Broad Care, which isn’t up to date/not accurate. JT to pick up this issue.

SH asked about other activity reports that are received. JT gave examples of this which include discharges, DNA rates, waiting times. JT continued that KPI’s are included and are being reviewed.

SM highlighted that activity for CHS was not included in the IPR report. JT to link with SM to discuss what requirements/what should be included within the IPR report e.g. key waiting times and referral to treatment.

AA asked about actual reports available to reflect activity. JT explained that this data can now be provided, with comparisons.

SH expressed concern around a large vacancy rate for ELFT. PK explained that vacancy rates are reported monthly. PK added that a restructuring of staff is taking place which could affect


vacancy rates, and going forward will report on this at PAQ meetings.

Action: JT to request a full action plan for improvement of SLT service. Capacity issue to be taken to the main Alliance Board.

Action: JT to pick up the Broad Care issue discrepancies around data.

Action: JT to link with SM to discuss requirements/what should be included in the IPR report.

Action: PK to report on vacancy rates for ELFT going forward.

11. CHS Quality Report (see enc) PK

PK reported highlights to the committee

Training remains an issue, although some progression has been seen.

Safeguarding Children L2 is sitting at 49%. The outstanding number overdue has been identified and training has been scheduled for these with the expectation of meeting target by the end of August 2018. Safeguarding and medicines management training are the main priorities.

Regarding pressure ulcers, although an increase in June has been seen, x12 of these are grade 2 and x5 grade 3. PK currently analysing where these are being reported i.e. locality.

SM suggested linking these with vacancy rate locality. SH stated that GPs are no longer reporting pressure ulcers related concerns to district nursing team as they are assuming that nothing will be done. SM requested that this issue is taken to the Alliance Board.

CHC NHSE Reporting

Quality Premium 1 - 31% of assessments were completed in acute setting against the 15% target. Meeting the target is challenging as there are only two care homes in tower hamlets. Discussions have taken place around a specific QI project in this area.

Quality Premium 2 – Target to ensure 80% of DST assessments were completed within 28 days was not met. Only 45% of assessments completed were done in this time frame. Performance has deteriorated for June. Pathway issues are currently being investigated.

Barts Health – Paeds Serious Incident

365 patients have been identified. Actions include additional capacity 2 vacancies (x1 interview taken place and x1 currently being advertised).

EMIS has now been implemented and staff have been trained.

Clinical Harm Review process has started.

Countdown of the 365 will be reported (once each appointment is received) going forward in future CQRM meetings. PK will also be able to identify if this affects waiting times.

SM mentioned that a meeting has taken place with the CSU delivery team. A supportive service review has been agreed. Meeting will also take place with Helen Byrne to agree scoping and what that will include, with a view to commence imminently.

SH asked about LAC numbers (referring to and from local authority), and would like to see these figures reported into PAQ and the Alliance meetings.

Regarding MSK Physiotherapy telephony access issues – patients can now book appointments via email. Communication going out to GPs to confirm that the issue is being


prioritised. Work being carried out with the Alliance patient experience lead to receive patient feedback.

SH requested that PK meet with Warwick Tomsett and Rahima Miah to discuss adopting a similar process as Newham.

GPCG highlights

GPCG receiving a lot compliments (33) which is commendable.

Issue around Safeguarding L1 training could be due to all staff outstanding at the same time. This will be monitored.

Action: PK/SM to report GP’s not reporting pressure ulcers concerns to the Alliance Board.

Action: PK to report LAC numbers to PAQ and to the Alliance meetings.

Action: PK to meet with Warwick Tomsett and Rahima Miah to discuss adopting a similar process as Newham MSK Physiotherapy Service.

12. The State of Care in Urgent Primary Care Services (see enc) MJ

PK presented an overview of findings

63 GP OOH services where 75% are rated as good.

Key challenges that CQC have identified in other areas include increasing demand for the service, capacity issues, recruitment and retention issues, integration and access issues (to GP notes).

Key lines of enquiry has already been sent out to GPCG for updates around national areas identified by CQC.

Action: PK to also feedback this CQC information to the hubs.

13. Safeguarding Adults CCG Committee Exception Report (see enc) SM

For information.

14. RLH CQRM July 2018 Agenda CRG Report June 2018 (see enc) (information only)

SM

For information.

AOB

MD asked about a Secondary Care Consultant. SH confirmed an advert has gone out jointly with Newham for a Secondary Care Consultant.

SM requested that the narrative around the declarations of interest is added to future templates.


Primary Care Committee Minutes Part I

Date: 11th July 2018

Time: 3.30-4.30pm

Venue: 2nd Floor Meeting Room, Alderney Building, Mile End Hospital E1 4DG

Chair: Julia Slay

Voting Members:

Julia Slay Governing Body Lead for Patient and Public Involvement

NHS THCCG

Maggie Buckell Governing Body Registered Nurse Member NHS THCCG

Mariette Davis Governing Body Member for Governance NHS THCCG

Simon Hall Managing Director NHS THCCG

Rebecca Rosen Independent Clinical Advisor NHS THCCG

Steve Collins Financial Advisor NHS THCCG

Non-Voting Members:

Angela Ezimora-West

Assistant Head of Primary Care (North East London)

NHSE

Alison Goodlad Director of Primary Care (North East London) NHSE Karen Bollan Healthwatch Representative HealthwatchJackie Applebee LMC Representative LMC Virginia Patania Governing Body Member for Primary and

Urgent Care NHS THCCG

In attendance: Lynne Smith Business Manager (Minute Taker) NHS TH CCG

Jenny Cooke Deputy Director of Primary and Urgent Care NHS TH CCG

Apologies: Nicola Hagdrup GP Representative NHS THCCG

Denise Radley Corporate Director, Health, Adults & Community

LBTH

Jo-Ann Sheldon Primary Care Commissioning Manager NHS THCCG

Chima Olugh Primary Care Commissioning Manager NHS THCCG


ACTION LOG SUMMARY

Agenda item no.

Action Due date RAG rating Lead

3.1 Half Day closing Arrangements Informal letter to be sent GP practices setting out the expectations. Update to be given at October Committee

October 2018

AEW

3.2 Special Allocations Service – London Framework Discussions to continue at STP level. An update will be given at the September Committee.

September 2018

AEW

AOB PCDC to be operational for the Lifecourse Workstreams. Jenny will flag this to the Commissioning Leads for the September PCDC meeting.

September 2018

JC

Item no.

Item name Lead

1. General Business JS

1.1 Welcome, introduction and Apologies

The Chair welcomed everyone to the Committee. Apologies are noted and listed on page one of the minutes.

1.2 Declarations of Interest

None noted.

1.3 Minutes of the Previous Meeting

It was agreed that the minutes of Part I of the meeting held on the 13th June 2018 were accurate.

The actions were updated and noted in the Action Log Summary.

2. Finance

2.1 Primary Care Finance: Month 2 SC

Steve Collins confirmed that There is currently some debt outstanding for properties managed by NHS Property Services. The CCG is working closely both with practices and NHS Property Services to facilitate the resolution of the issues that are behind the non-payment of these costs.


There was some discussion regarding the on-line registration process that the CCG are putting in place. This may cause a lag in funding due to the possibility of an increase in registrations.

The Committee agreed that the finance report is clear and helpful and shows how the CCG are controlling their costs.

3. Commissioning and Contracting

3.1 Half Day Closing Arrangements AEW

Angela Ezimora-West explained that half day closing by GP Practices has come under scrutiny at a national level. One in seven practices are still closing half day with London and the Midlands being rated the highest.

NHS England have gathered information together for the practices in Tower Hamlets relating to eDEC, triangulation, accident and emergency and patient experience and put together a dashboard, which shows that whilst most practices in Tower Hamlets are rated green there are still a few showing red in relation to their practice opening hours.

It was noted that from the information the practices provided regarding opening hours, a majority of the practices did not consult their PPG’s so there was no back up information provided regarding patient satisfaction for opening hours. NHS England have been in communication with practices, checking eDEC and asking them to update their websites where discrepancies in opening hours were noted.

There was some discussion regarding Tower Hamlets practices not being benchmarked against the borough average for opening hours. It was agreed a consistent approach is needed but noted that no correlation has been found between patient satisfaction and opening hours if the practice provides a good service this is enough to achieve patient satisfaction.

It was agreed by the Committee to action option 2 as set out in the paper presented. This option is to issue a notice of objection on the grounds that the sub-contractor would be unable to meet the Contractor’s obligations under the Contract. The approach to the practices will be from a patient perspective. NHS England and Tower Hamlets CCG will commence discussion with the practices and an informal letter will be sent to the practices by NHS England outlining the expectations. An update will be given to the Committee in October.

3.2 Special Allocations Service – London Framework AEW

This service is run for patients that have been physically violent when attending a GP practice. There are referrals directly into the service and the patient can appeal against the decision. The idea is to rehabilitate the patient so they can then go back to their regular GP practice for an appointment.

Discussions have started at STP level, as the service needs a specification. It is necessary to get an idea of what is being referred to the service with a plan to have several sites across the STP footprint that will be able to offer the service.

It was agreed by the Committee that it would be favorable to have a better quality service that is further away rather than one that is local but lacks quality even if this means that the patient has to travel further.

Actions going forward are to continue discussions at STP level. An update will be provided at the September Committee.

4. Governance

4.1 Board Assurance Framework (BAF) JC


Jenny Cooke explained that she has now updated the changes and added in the risks as discussed at the last Committee meeting. There are concerns about the finance risk with contractual payments but the CCG are keeping a close track on this.

It was agreed by the Committee that any comments made would be tracked on the BAF register going forward.

4.2 PCDC Update

Jenny Cooke explained that the Primary Care Development Committee have been meeting regularly to work out how the meeting would run, the first official meeting took place yesterday and consisted of attendees from the GP Care Group, LMC and CCG. The idea of this Committee is to aim to achieve the same goals and bring resources together.

The overall priorities of this Committee are:-

GP on line platform

Patient communication

Informatics (Edenbridge)

In practice suppliers (EQUIP, GP Care Group)

Workforce Development

Work at scale (Back office offer to practices)

Funding has been allocated from NHS England to support these workstreams and a plan is being put in place. PDDC will agree and delegate funding to smaller teams so they can drive the worksteams forward and recruit to posts. Healthwatch will continue to be involved with the workstreams from a patient perspective.

5. AOB

The Committee had a discussion regarding how the CCG will maintain things while we integrate. It was identified that having the Primary Care Development Committee where all the different parts of Tower Hamlets Together are coming together is helpful to the CCG as Commissioners and enables us to talk about the commissioning intentions. The CCG now have a Project Management Office log, which keeps track of business cases so we have early sight of potentials savings and allows us to look at doing things differently.

Jo-Ann Sheldon will be attending the Lifecourse Workstreams in order to respond to any changes that will be developed there and incorporate this into the NIS. The suggestion was made that PCDC could be used for operational purposes for the Lifecourse Workstreams and Jenny Cooke suggested that she would flag this to the Commissioning Leads who will be attending the September meeting for PCDC.

Jo-Ann Sheldon will be setting up a task and finish group to look at how we invest the NIS funding back into general practice.


TOWER HAMLETS CCG STRATEGIC FINANCE & INVESTMENT COMMITTEE (SFIC) Date: Wednesday 18th July 2018 Time: 14:00 – 15:30 Venue: Room F24 1st Floor Beaumont House, Mile End Hospital, Bancroft Road E1 4DG Members Noah Curthoys (NC) – Chair Sam Everington (SE) – Deputy Chair Archna Mathur (AM) Mariette Davis (MD) Isabel Hodkinson (IH) Victoria Tzortziou Brown (VTB) Simon Hall (SH) Henry Black (HB) Attendees Damian Panesar-Gipson (DPG) Andrea Antoine (AA) Katie Brennan (KB) Hawa Sesay (HS) Steve Collins (SC) Luke Orwell (LO) Nitesh Parekh (NP) Leon Karim (LK) Margo Solomon (MS) Cathryn Maybin (CM) Dennise Friday (DF) Daniel Devitte (DD) Maureen Fitzgerald (MF)

Agenda Item Agenda Update Lead

1. Chair Welcome and Introductions

NC welcomed members and attendees to the meeting. Steve Collins (SC) deputised for HB for decision making purposes.

NC

2. Apologies Sam Everington (SE), Sophia Beckingham (SB), Mariette Davis (MD), Warwick Tomsett (WT), Henry Black (HB)

3. Conflicts of

Interest

SH declared his interests as trustee in: Metro: A charity promoting health and wellbeing and celebrating

difference in South London University Schools Trusts: Running schools in Greenwich and

Tower Hamlets

IH declared her role as Clinical Director in Primary Care Development Committee

This is a joint post between the CCG and GP Care Group. The implication is that IH is exposed to working across Primary Care Development space and she is party to some of Primary Care provider elements

NC

Minutes of the last meeting were approved subject to: NC


4. Approval of Minutes & Review Action Log

Clarification of the meaning of “precedent” noted in July’s minutes re: Item 11: Health Education England (HEE) Access to Psychological Therapies (IAPT) training The CCG must not be expected to fund training costs of providers’ staff. IH believes this is not a good precedent to set.

5. Procurement

Working Group (PWG) Update

The Procurement Working Group update was noted. Points raised included: AA commented on the following items from the Procurement Working Group (PWG) Narrative document: Tier 1, 2 & 3 Audiology Procurement: Due to the complex nature of this procurement, the PWG agreed to hold a separate meeting in order to discuss, in detail, the best way forward. It is a work-in-progress SH queried the reason behind attempts to procure St Joseph’s St Joseph’s will no longer be procured separately. Newham CCG has confirmed that the current joint commissioning arrangements will continue Social Value Act Document: Sets out how the CCG will embed Social Value Act considerations into the procurement process. This committee was informed previously that the CCG has the internal capacity to develop and embed these without the help of outside organisations. Consideration had been given to the use of the Social Value Exchange (SVE), an organisation used by the local authority, but this was rejected on cost grounds.

AA

6. Long Term

Financial Plan Refresh

LK presented the refreshed five-year Long-Term Financial Plan. Key points highlighted:

No drawdown for future years No provision was made in this plan to accommodate the recent

government announcement of additional £20Bn to the NHS Allocation for 2019/2021 remains unchanged as given by NHSE

in the five year forward view 2018/19 – NHSE dropped the full 1% contingency requirement,

but there is no guidance for future years. The 1% contingency has therefore been included. SH and SC agreed.

Risks centred around activity growth and QIPP Mental Health Investment Standard to be met in the coming five

years Running Cost Allowance spend within allocation £17.8m reserves – to manage risk in Acute, CHS, and Prescribing

NC sought assurance that the reduction in contracted CHS Alliance spend would not result in negative reaction from partners. LK provided this, reaffirming there were the agreed contract values SH expressed concern regarding the management of CHS contract especially by GP Care Group. He suggested

LK


beckinghams

Text Box

REDACTED

Action – SFIC requests a review of the workings of the contract to ensure these are in conformity with the prescribed mandate VTB suggested the committee gets a report on how investment is spent, placing emphasis on vacancy rates for staff. VTB noted vacancy rate is a recurring problem for Barts impacting its ability to deliver and wondered if this is the case for CHS Action – SH and WT to look into CHS, and specifically the GPCG fulfilling its mandate in managing the Alliance contract IH queried the population projection data, observing that in the short term, the expected planned growth in GP registered patients could skew the cost of services charged to the CCG. SC highlighted the high level of QIPP in the model. These may need to be revised as potentially not sustainable, but long terms savings would need to be embedded to allow this. IH suggested standardising the reporting format when reviewing the Alliance Contract

7. Programme

Budgeting

LK outlined the 17/18 Programme budgeting process to the committee. Programme Budgeting is a cost compilation exercise produced by NHSE. CCGs are expected to divide expenditures into twenty three care categories in accordance with World Health Organisation’s recommendations. The paper evaluated the merits and demerits of the 2016/17 Programme Budgeting methodologies IH stressed that the underlying concept upon which programme budgeting is built is outdated and not fit for purpose, and fails to cover the escalating levels of multimorbidity. She added that the framework is in danger of driving a ‘silo’ approach around disease packages, secondary and tertiary deliverables. The framework does not put any emphasis on personalisation, which IH believes is where the organisation should be heading. AA clarified that the paper was prepared in conformity with the guidelines and format prescribed by NHSE Action – IH proposed commenting on the usefulness of this framework to NHSE. Through Tower Hamlets Together (THT) Board, IH will work on comment to be submitted NHSE via Finance DPG sought clarification on the continued inclusion of Right Care into the Programme Management Office’s processes The committee confirmed DPG maintain current approach to Right Care

LK

8. M3 Finance &

QIPP Update

NP reported the following:

The CCG broke-even on Year-To-Date and forecasting with significant pressures from Acute over-performance chiefly with Barts Health

NP


Over-performance of £1.8M is offset by under-spend in associates, releasing local acute reserves and unutilised prior year provisions (contingency reserves to be utilised)

Activity pressures gone up, Non-Electives highlighted last month. Over-performance in Electives and A & E activities

Risks – Acute activities as some contracts are yet to be agreed SC thanked the team for doing a great job. He cautioned the committee on the need for attention around risks because the organisation is running an underlying deficit due to increasing demand and inefficient current Operating Procedures. Presently, the organisation only manages due to high-level reserves from last year, which is not sustainable SH asked what needs to be done to address this as he is concerned that QIPP alone may not be able to resolve the situation SC proposed closing outstanding transactional items, make efficiency, lean thinking and addressing the root causes of problems as opposed to treating symptoms the modus operandi SH will look into the possibility of getting reports for the CCG from Electronic Referral System (ERS)

9. Board Assurance

Framework Deferred AA

10. Tower Hamlets CCG Governance Self-Assessment

The committee noted this paper

AA

11. Special School

Nursing Remodelling

Maureen Fitzgerald provided an update on the plans to remodel delivery of services to special schools This was in response to significant growth in demand, as population growth is projected to put further pressure on an already stretched situation. The borough hosts one of the highest proportion of pupils with statements or Education Health and Care (EHC) Plans. A review of the current delivery model was prompted by additional pressure on nursing capacity as one of the schools moves to a second site. The review proposed to continue supporting schools in providing core services, which, if adhered to would not require additional financial investment from the CCG. MF assured the committee that there is no clinical risk to children. The nursing staff were involved in the decision-making process and Barts have conveyed concerns raised by two head teachers. MF and team were in talks with the head teachers whose concern is centred on losing extra services they are used to but which do not form part of the CCG’s core service specification. The Committee recommends this proposal on the basis that it brings no additional financial cost to the CCG and poses no clinical risk to children

MF


12. QIPP and

Business Case Status

DPG outlined progress on the CCG’s QIPP plans, explaining that the £14M target now included £4.2M of risk, up from £3.5M last month. DPG reported expected delay in some QIPP schemes led or developed across the STP. This means that some promised benefits would now be realised in 2019 instead of 2018. DPG stated that these schemes would undergo the same vetting process as all Tower Hamlets schemes. He expected some category F (‘in development’) schemes to move into delivery stage providing £800K QIPP which would mitigate some of the risk The PMO is working towards aligning work-streams and processes that can be tracked through commissioning intentions with THT, WEL, NELCA and WELC. SH inquired about the best way of getting THT to understand and accept that funds are short IH recommended ensuring QIPP schemes are designed in a collaborative manner.

DPG

13. CEG Referral

template roll our variation

It was stated that Transforming Services Together (TST) intended to commission the Clinical Effectiveness Group (CEG) to design referral templates for Barts. The cost of £25K is to be borne by TST and STP. TST were seeking to commission this via TH’s contract in the form of a contract variation. She sought permission to move this to the next stage. The committee advised KB to add this item to the upcoming WELC TST Agenda SC questioned the need for designing new forms and VTB wanted to know if the design would seek input from specialists. The committee approved this variation subject to TST Board approval and clarity on ownership of costs

KB

14. Internal

Approach to Social Value Act Consideration in Procurement (Final Draft)

Verbal update provided. It was agreed that this paper be sent to be group via e-mail following the end of the meeting SC wanted clarity around the methodology to be employed in ranking the importance of the Social Value Act (SVA). Action – AA to seek clarity and detail on how scaling will be administered in terms of weighting SVA considerations versus cost and efficiency in procurements IH commented that SVA consideration ought to be embedded in Standard Operating Procedures across the organisation and not limited to procurement.

AA

15. AOB

Take Home and Settle – CM said that HB rejected an extension waiver for this service in August 2017 on the basis that said extension could lead to a challenge for there were other providers in the market.

CM


beckinghams

Text Box

REDACTED

The service was the formally procured and an award is imminent. CM sought the committee’s approval in a bid to proceed with the award. SH sought assurance that due process has been followed should there be a challenge CM assured the committee that this had been the case NC suggested CM asks the Governing Body for second governance oversight The committee recommends this paper and asks CM to get second opinion from the Governing Body

Close

Next Meeting: Wednesday 22nd August 2018. Room F24 1st Floor Beaumont House Mile End Bancroft Road E1 4DG


beckinghams

Text Box

REDACTED

No. Action Lead Last Update Due Date RAG

1. SC to raise the use of waivers at next NELCA CFOs meeting

SC NELCA CFO meeting

postponed, expected to take place in September

SFIC September

2.

AA & LK to present a revised draft of the Procurement Strategy Document at the next SFIC meeting

AA

Almost completed policy, strategy completed –

sending to SC and SH for review. Then SMT and

SFIC

22nd August

3. MD to review the final draft of the PSD for the committee’s recommendation

MD 22nd August

4.

AA to give SFIC continual update of Conflict of Interest (COI) throughout the procurement process

AA On-going

5.

SH to have meeting outside of the SFIC with clinical oversight for further investigation into the complex cases possibly responsible for the overspend in M2 Finance report

SH On-going 20th August

6.

SFIC requests a review of the workings of the CHS Alliance contract to ensure these are in conformity with the prescribed mandate

SH 20th August

7.

SH and WT to look into CHS fulfilling its mandate in managing the Alliance contract

SH & WT 20th August

8.

Action – IH – Proposed commenting on the usefulness of this framework to NHSE. Through Tower Hamlets Together Board, IH will work on comment to be submitted NHSE via Finance

IH 20th August

9.

SH – Will look into the possibility of getting reports for the CCG from Electronic Referral System (ERS)

SH 20th August

10.

AA to seek clarity and detail on how scaling will be administered in terms of weighting SVA considerations versus cost and efficiency in procurements going forward

AA 20th August


tower hamlets clinical commissioning group governing ......tower hamlets clinical commissioning...

Documents