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For the attention of the Partnership Board

Title of Paper Governing Body Assurance Framework (GBAF)

Agenda Item 8 Date of meeting 27 February 2020

Exec Lead Jane Cole, Director of Finance, HIOW Partnership of CCGs

Author Normi Cadavieco, Senior Governance Manager

Purpose

For Decision X

To Ratify

To Discuss

To Note X

Executive Summary

The Assurance Framework provides the Partnership Board with an opportunity to review the risks which may prevent the organisation from achieving its strategic objectives. The Assurance Framework was last presented to the Board on 28 November 2019; comments made by the Board were noted and the Framework has been updated- this is an iterative process. The key risks identified are: Quality, Performance and Money

Providers of commissioned services are unable to meet the constitutional targets, and patients may not receive timely, effective, responsive and/or high quality care and treatment.

If CCGs are unable to deliver to their planned financial control totals for 2019/20, Then, this could impact on – (1) CCG and system reputation (2) reduced opportunity to invest in implementing models of care (3) quality of services for patients.

If CCGs do not continue to deliver improvements in primary care then the impact will be on access, practice sustainability and the development of Primary Care Networks.

Implementing Models of Care

CCGs are unable to implement urgent care service models which will mean people are unable to access the right services when they need them

People, Systems and Partnerships

If the CCGs are not able to develop confident and able leaders; and attract and retain staff then we will not be able to deliver our plans and support the development of Integrated Care Partnerships.

The CCG Partnership objectives and delivery plans are not aligned across our local systems and partners. This will result in delays in implementing models of care for patients; impact on CCG reputation; lead to duplication of work and inefficient use of resources.

There have been no changes in scoring to note since the last report to the Partnership Board.

Recommendations

The Partnership Board is asked to:

Approve the key risks as part of the Governing Body Assurance Framework

Consider whether risks are articulated correctly and the score reflects the severity and likelihood

Note the controls, mitigations and actions in plac

of 7 Assurance Framework 2019/20

February 2020

ID Partnership Priority Risk Owner Monitoring Committee

01

Care Quality & Operational Performance Objectives

Waiting times will be shorter for cancer diagnosis and treatment

Access to mental health services for children and young people will be

improved

Patient experience of urgent care services will be improved, including

shorter waiting times

Managing Directors – Cancer and Urgent Care Director of Strategy and Transformation for CAMHS Directors of Quality & Nursing

Quality Performance and Finance Committee

Risk Description Initial rating Likelihood/impact

CONTROLS

Providers of commissioned services may be unable to meet constitutional targets, and patients may not receive timely, effective, responsive and/or high quality care and treatment.

16 (4x4)

(1) Monthly review and action by Clinical Delivery Groups. (2) Assurance by Quality Performance and Finance Committee. (3) A&E Delivery Boards in each CCG system (4) Provider contractual monitoring and assurance. (5) Winter plans in place across both local and HIOW wide patches

Specific or Associated ISSUES Current rating Source of ASSURANCE

(1) Hampshire and Isle of Wight Partnership CCG providers are currently not or partially meeting key constitutional standards:

(2) There are capacity and demand issues in a number of services including Children’s and Adolescent Mental Health Services throughout Hampshire (CAMHS).

(3) There is variation in the quality of services as rated by the Care Quality Commission

16 (4x4)

Provider contractual reporting requirements

Monthly performance and quality reports to Quality, Performance & Finance Committee

Series of “deep dives” into performance at Quality, Performance and Finance Committee.

Escalation of issues to Partnership Board

NHS England/ Improvement assurance meetings

Feb 2020: Improved CQC ratings for IOW NHS Trust, PHT, and SHFT

MITIGATING ACTION (S) Target rating NEXT REPORTED ACTION (S)

1. Investment decisions taken to address capacity and demand in CAMHS service.

2. Pathway transformation and recommissioning plans in place. 3. Local CCG and integrated care partnership improvement

plans in place with clear priorities around constitutional standards.

4. Plans in place to reduce risk of harm from long waits. 5. Joint provider monitoring of outcomes, quality and safety. 6. Development and approval of Winter Plans through Quality

Finance and Performance; and Partnership Board.

12 (4x3)

(1) Integrated Care Partnerships continue to develop individual remedial plans to address non delivery of constitutional standards

(2) Await outcomes of CQC inspections for HHFT, UHS, Solent and SCAS (3) Targeted support to GP practices and independent providers with requires

improvement or inadequate ratings or whose resilience challenges are affecting quality and performance of services

Quality, Performance

& Money


February 2020

ID Partnership priority Risk Owner Monitoring Committee

02 Financial Performance

Financial control totals have been delivered Director of Finance

Quality Performance and Finance Committee


CONTROLS

If CCGs are unable to deliver to their planned financial control totals for 2019/20, Then, this could impact on – (1) CCG and system reputation (2) reduced opportunity to invest in implementing models of care (3) quality of services for patients.

16 (4x4)

Monthly review and action by Clinical Delivery Groups.

Assurance and scrutiny of plans and delivery by Quality Performance and Finance Committee.


(1) Confidence and deliverability of CCG financial plans. (2) Mitigation of financial risks that have emerged during 2019/20,

including Cat M National Prescribing cost pressure together with local system activity and performance issues impacting on system finances

(3) Confidence of pace of delivery of system financial recovery plans (NH, IOW and PSEH)

(4) North and Mid Hampshire system financial recovery plan – development of short and medium term plan with support from Financial Improvement Director.

12 (3x4)

Quality, Performance & Finance Committee – monthly review of financial performance against plans.

Regular finance report presented to Partnership Board.

NHS England/ Improvement assurance meetings

All major contracts (Portsmouth, Isle of Wight, Frimley, Southern Health and Hampshire Hospitals) have been signed.

All major contracts are no longer operate on a pure Payment by Results basis (activity x tariff).

Financial Improvement Director at North Hampshire Hospitals Trust

MITIGATING ACTION (S) Target rating NEXT ACTIONS

(1) Quality Performance and Finance Committee continue to review financial performance against plans for 2019/20 together with any potential risks and mitigations

(2) Quality Performance and Finance Committee to continue to review delivery of CCG savings plans for 2019/20

(3) Partnership Board continue to review overall financial performance against plans and control totals for 2019/20 together with any potential risks and mitigations

8 (2x4)

(1) Non-recurrent financial support for in-year 2019/20 risks secured from NHSE/I

(2) Operating Plan Guidance 2020/21 now published, draft Financial and Operating Plans submission on 5th March in line with financial trajectories and wider ICS financial plans. These will be subject to scrutiny by Quality Performance and Finance Committee, including savings required and planned investments.


February 2020


03

Service Redesign and Improvement

Access to primary care has improved

Primary care resilience has improved, with fewer clinical vacancies in

General Practice

Primary Care Networks established in line with the national timetable and

are leading the delivery of integrated primary, community & social care

Managing Director (s)

Clinical Chairs

Director of Strategy and

Transformation

Primary Care Commissioning

Committee

Risk Description Initial rating

Likelihood/impact CONTROLS

If CCGs do not continue to deliver improvements in primary

care then the impact will be on access, practice sustainability

and the development of Primary Care Networks.

16 (4x4)

Primary Operational Groups actively monitor and work with primary care

Primary Care Commissioning Committee receive areas of escalation.

NHS England in attendance to provide guidance and receive assurance at both Primary Care Operational Groups and Primary Care Commissioning Committee meetings


(1) Practice closure on Isle of Wight

(2) Practice list/hours closures in Gosport and Havant

(3) Limited branch surgery closure in Gosport 12 (3x4)

CCG Primary Care Operational Groups

Contract Review meetings

Regular meetings with NHSE and with LMC

Monthly reports and escalation to Partnership Primary Care Commissioning Committee.

NHS England assurance meetings

Primary Care Networks established

Primary Care Strategy

MITIGATING ACTION (S) Target rating NEXT REPORTED ACTION (s)

(1) Agreed patient transfer undertaken by April 2020 (2) Limited time agreed and action plan in place (3) Continuity of care assured at the other three sites

6 (2x3) Each PCN has submitted a plan for their leadership/PCN development. A

support package is being developed across all 42 PCNS across the STP. Supported by £1.3m development monies.

Plan to implement Integrated Care teams by March 2020.


February 2020


04

Service Redesign and Improvement

The whole population know how to access the right emergency care

when they need it e.g. NHS 111

Director of Delivery Clinical Directors

Partnership Clinical Delivery Group


CONTROLS

CCGs are unable to implement urgent care service models which will mean people are unable to access the right urgent care services when they need them

16 (4x4)

Integrated Urgent Care Transformation Board (includes all CCGs and main provider) managing the Integrated Urgent Care/111 design programme

Escalation to Partnership Board on risks and mitigation.


(1) Awaiting outcome of PIN and market response to the direct award.

(2) Uniformity of Integrated Urgent Care delivery across Hampshire & Isle of Wight. 2/3 procurements yet to be completed.

(3) Separate procurement arrangements planned for (1) Southampton, and (2) Portsmouth, South Eastern Hampshire and Fareham &Gosport.

(4) Overarching procurement governance is a gap.

8 (2x4)

(1) Partnership Board have received assurance on next steps on programme actions, highlighting risks and mitigation.

(2) Committee in Common has been convened and will meet again in mid-March 2020.

(3) Completion of NHS England checkpoint one with checkpoint two pending.

MITIGATING ACTION (S) Target rating NEXT REPORTED ACTIONS

(1) One specification agreed for the IUC pathway (2) Committees in common agreement to direct award the IUC

contract to a single provider for NHS 111; quality governance; and data co-ordination.

(3) Market engagement event. (4) NHS England Assurance process underway.

4 (1x4)

(1) Committees in common agreement to direct award the IUC contract to a single provider for NHS 111.

(2) Market engagement event on the 2nd March 2020 (3) Await outcome of the publication of the PIN (4) Convene the Transition and Development Board (5) Convene the arrangements for quality governance oversight (6) Implement arrangements for data-co-ordination (7) Overarching procurement governance required

Implementingmodels of care


February 2020


05

Delivering our People Plan

The skills and confidence of leaders to effectively improve performance

and develop staff has been improved.

Local teams have effectively supported the development of Integrated

Care Partnerships.

Director of People and Development Clinical Chairs

Remuneration Committee


CONTROLS

If the CCGs are not able to develop confident and able leaders; and attract & retain staff then we will not be able to deliver our plans and support the development of Integrated Care Partnerships.

16 (4x4)

Escalation to Remuneration Committee, Corporate Governance Group and Partnership Board

All staff appointments and re-appointments and requests for recruitment and staffing changes are approved through an Establishment Control process through the Corporate Governance Group.


1. Resources to support the transformation across Hampshire and Isle of Wight

2. Running cost reduction. 3. Sustainable clinical workforce

12 (4x3)

The Remuneration Committees in Common are monitoring progress against plan for the People Plan 2019/20

Partnership objectives and priorities for 2019/20 were agreed at May 2019 Board, which includes a strand on people as a priority.

People Plan and implementation plan agreed and reviewed regularly.

Remuneration Committee receive workforce reports which identify establishment statistics and KPI’s for workforce and overall wage bill for the Partnership.

Remuneration Committee and Corporate Governance Group are monitoring improvements in staff survey results and progress against actions.

Remuneration Committee overseeing the delivery of the Clinical Leadership strategy development and action plan

Corporate Governance Group have oversight of all Establishment Control Business Cases, ensuring robust management of recruitment

The Leadership Development Programme is ongoing, with the second cohort of senior leaders currently attending sessions focussing on appreciative performance development and coaching skills.

People, Systems and Partnership


February 2020


(1) Partnership Values agreed at Partnership Board on 24th October 2019.

(2) Developing skills within the team to create a framework for internal talent management and succession planning for senior posts and working with other partners on a systematised approach to talent management and succession planning. This work will link to performance management and pay progression.

(3) Using the results of the staff survey to create an action plan to address employees concerns and improve culture and to be a base line for improving leadership capability.

(4) Clinical leadership action plan developed and shared with the Remuneration Committee.

6 (2x3)

(1) Human Resources policies continue to be reviewed and streamlined across the partnership and updated to align with people plan.

(2) Managing Directors are addressing staff survey results locally with Human Resources support and independently facilitated focus groups will take place in November to work with staff to assess what is driving results.

(3) The development of a statutory people management programme of skills building is underway to support improvement in survey results and support building leadership capability.

(4) Development of business case in progress to increase resources further to manage increased demand.


February 2020

ID Partnership Priorities Risk Owner Monitoring Committee

06

System Reform

There are clear system delivery plans in place, with fully aligned CCG staff,

for the Portsmouth South East Hampshire, North & Mid Hampshire and Isle

of Wight Integrated Care Partnerships

We will have changed the way CCGs work together and with other partners

within the Hampshire Isle of Wight and Frimley systems.

Chief Executive and Clinical Chairs

Partnership Board


CONTROLS

The CCG Partnership objectives and delivery plans are not aligned across our local systems and partners. This will result in delays in implementing models of care for patients; impact on CCG reputation; lead to duplication of work and inefficient use of resources.

16 (4x4)

Clear and agreed objectives & priorities for the CCG Partnership; cascaded to teams and individuals.

Each system has clear governance structures to enable partnership working across CCGs, local government and providers.

Clear system delivery plans in place.


(1) Working more closely with Hampshire County Council, Southampton City Council, Isle of Wight Council and local government to align delivery plans and implement models of care.

(2) Chief Executive appointed as the Accountable Officer for Southampton and West Hampshire CCGs.

(3) Ensuring that CCGs across Hampshire and Isle of Wight improve their commissioning abilities in preparation of being designated an Integrated Care System by 1st September 2020

9 (3x3)

Implement models of care with Local Authorities via the Primary Care Transformation Board for the Hampshire and IoW Wight

Executive Delivery Group signed up to delivery of Integrated Care Teams by March 2020

North East Hampshire and Farnham CCG has successfully transitioned into the Frimley Collaborative of CCGs from Dec 2019.

Continue to ensure that connections are maintained and strengthened between North East Hampshire and Farnham CCG and rest of Hampshire.

Isle of Wight Health and Care Sustainability Plan

Executive Directors working closely with Portsmouth CCG.

Executive Directors and Clinical Chairs linked to each Local Care Partnership.


(1) Development of a clear strategy to work with local government.

(2) A work programme in place between all Hampshire and Isle of Wight CCGs and establishment of a steering board.

6 (2x3)

(1) Steering Board to develop 6-month work programme on CCG reform. (2) Begin engagement with stakeholders across the system including

Providers and GP member practices.

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