agenda nhs leeds ccgs partnership: leeds …...2017/08/04 · 2007 chairman of the board of...

$: AGENDA NHS Leeds CCGs Partnership: Leeds …...2017/08/04 · 2007 Chairman of the Board of Trustees - The Prince of Wales Hospice, Pontefract X Direct The hospice could seek financial$
AGENDA NHS Leeds CCGs Partnership:

Leeds Health Commissioning & System Integration Board

Date: Wednesday 26 July 2017 Time: 14:00 – 17:00

Venue: Woodhall Room, Pudsey Civic Hall, Dawson’s Corner, LS28 5TA

Item Description Lead Paper Time LHCB 17/01

Welcome and Apologies Purpose: To record apologies for absence and confirm the meeting is quorate

Philip Lewer

N

14:00

LHCB 17/02

Declarations of Interest Purpose: To record any Declarations of Interest relating to items on the agenda: a) Financial Interest

Where an individual may get direct financial benefit from the consequences of a decision they are involved in making;

b) Non-Financial professional interest Where an individual may obtain a non-financial professional benefit from the consequences of a decision they are involved in making;

c) Non-financial personal interest Where an individual may benefit personally in ways that are not directly linked to their professional career and do not give rise to a direct financial benefit, because of the decisions they are involved in making; and

d) Indirect Interests Where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making.

Philip Lewer N

LHCB 17/03

Patient Voice – Deaf and Hard of Hearing Primary Care Survey Purpose: To receive patient experience information to inform the Board’s decision making

Jo Harding N 14:05

LHCB 17/04

Questions from Members of the Public Purpose: To receive questions from members of the public

Philip Lewer N 14:20

LHCB 17/05

Action Log Purpose: To review the outstanding actions from previous CCG Governing Body meetings

Philip Lewer Y 14:30

Item Description Lead Paper Time GOVERNANCE

LHCB 17/06

Terms of Reference: a) Leeds Health Commissioning & System Integration

Board b) Joint Quality & Performance Committee c) Joint Finance & Commissioning for Value

Committee Purpose: To receive the draft terms of reference for noting/ approval

Philip Lewer Steve Ledger Peter Myers

Y 14:35

STRATEGY LHCB 17/07

Leeds Health & Care Plan Purpose: To receive the draft plan for discussion

Phil Corrigan Y 14:50

LHCB 17/08

System Integration Update Purpose: To receive an update relation to system integration

Nigel Gray Y 15:10

BREAK FOR 5 MINUTES COMMITTEE CHAIRS’ SUMMARIES

LHCB 17/09

Audit Committee – 19 July 2017 Purpose: To receive the summary for information and assurance

Chris Schofield Y 15:35

LHCB 17/10

Remuneration & Nomination Committee – 19 July 2017 Purpose: To receive the summary for information and assurance

Graham Prestwich

Y

LHCB 17/11

Finance & Commissioning for Value Committee – 20 July 2017 Purpose: To receive the summary for information and assurance

Peter Myers Y

LHCB 17/12

Quality & Performance Committee – 12 July 2017 Purpose: To receive the summary for information and assurance

Steve Ledger Y

COMMISSIONING LHCB 17/13

Integrated Quality & Performance Report (IQPR) Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee

Sue Robins / Jo Harding

Y 15:50

LHCB 17/14

Finance Report Purpose: To receive the finance report and consider any issues escalated by the Finance & Commissioning for Value Committee

Visseh Pejhan-Sykes

Y 16:05

Item Description Lead Paper Time LHCB 17/15

Chief Executive’s Report Purpose: To receive an update on key issues from the CCGs’ Chief Executive


POLICIES LHCB 17/16

Managing Conflicts of Interest and Standards of Business Conduct Purpose: To receive the updated policies for approval


LHCB 17/17

Questions from Members of the Public Purpose: To receive questions from members of the public


LHCB 17/18

Forward Work Programme 2017 Purpose: To receive, accept and input to the programme

Philip Lewer Y

16:45

LHCB 17/19

Any Other Business


Dates of Future Meetings: 21 September 2017 21 March 2018 22 November 2017 17 May 2018 25 January 2018

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Ben Browning X X X GP NED X Lofthouse

Surgery

GP Partner in Lofthouse

surgery

X Direct Could bid to provide

healthcare services to

LSE CCG

1997

Shareholder in Leodis Care

Ltd



LSE CCG

Member of Leodis LLP (Shell

company)

X Direct Now a dormant and non-

trading company

Spouse is a GP Partner in

Lofthouse surgery

X Indirect Could bid to provide


LSE CCG

Spouse is city-wide lead for

Learning Disability services

X Indirect

Philip Lewer X X Lay Chair X X X Present at various leadership

programmes within Tees, Esk

and Wear Foundation Trust

and Northumbria NHS

Foundation Trust

approximately six times per

year.

X Direct The Trusts could bid to

provide services to the

CCG

2006 - to date

Lay Chair of NHS Leeds West

Primary Care Commissioning

Committee

X Direct 1 April 2016

to date

Gordon Tollefson X X Lay Member -

Patient &

Public

Involvement

X Advisor on Standards &

Conduct - Leeds City Council

X Direct LSE CCG engages with

Leeds City Council on

provision of services

2007

Chairman of the Board of

Trustees - The Prince of

Wales Hospice, Pontefract

X Direct The hospice could seek

financial support for

patients treated from

the LSE area

03/06/1905

Philomena Corrigan X X X Chief

Executive

X X X Trustee for the Foundation of

Nursing

X Trustee for the

Foundation of Nursing

01/12/2015

Jo Harding X X X Director of

Nursing and

Quality

X X X X

Stephen Ledger X X X X

Julianne Lyons X X X GP Partner at Leeds Student

Medical Practice

X Direct 08/07/1905

Leeds Local Medical

Committee Member

X Direct 06/07/1905

Spouse is a Director of Leeds

Haematology plc

Indirect

Spouse is a trustee of the

British Society for

Haematology

Indirect

Spouse is a trustee of UK

Myeloma Forum

Indirect

Name of

practice

(where

applicable)

Forename Surname

Current Position(s) held

Job Title

(where

applicable)

Employing/

Relevant CCG

Action Taken to

Mitigate Risk

No Interests

Declared

Declared Interest- (Name

of the organisation and

nature of business)

Type of Interest

Is the

interest

direct or

indirect?

Nature of Interest

Date of Interest

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Name of

practice

(where

applicable)

Forename Surname


Job Title

(where

applicable)

Employing/

Relevant CCG

Action Taken to

Mitigate Risk

No Interests

Declared



nature of business)

Type of Interest

Is the

interest

direct or

indirect?

Nature of Interest

Date of Interest

Julianne Lyons X X X Spouse is an employee of the

University of Leeds

Indirect

Spouse has an honorary

contract with Leeds Teaching

Hospitals NHS Trust

Indirect

Visseh Pejhan-Sykes X X X X X X Parent Governor at Oxspring

Primary School

X Direct 01/12/2014 01/12/2018

Vice Chair of Governing Body

at Oxspring Primary School

X Direct 01/09/2016 01/09/2017

Sue Robins X X X X X X Member of Leeds North

CCG’s Governing Body and

Management Team in an

executive capacity.

X Direct 01/01/2017 31/03/2017 Declare interests to both

Leeds West CCG and

Leeds North CCG and at

relevant meetings both

with CCGs and across

external organisations in

Leeds.

Gordon Sinclair X X X Partner at Burton Croft

Surgery

X Direct 15/06/1905

Director of Sinclair Healthcare

(Sole)

X Direct 02/07/1905

Partner of Viva Healthcare

LLP

X Direct 04/07/1905

Headingley Pharmacy LLP –

Viva Healthcare has a 25%

interest

Direct 04/07/1905

Simon Stockill X X X X X X Partner at Sleights and

Sandsend Medical Practice,

Whitby (Hambleton,

Richmondshire & Whitby

CCG)

X Direct 01/04/2016

GP Appraiser, NHS England

(Yorkshire & Humber)

X Direct 01/12/2013 Does not undertake

appraisals in Leeds West

practices.

Clinical Lead for Quality

Improvement Ready

Programme, Royal College of

GPs

X Direct 01/09/2016 01/08/2017

Jason Broch X X Clinical Chair X Partner Oakwood Lane

Medical Practice

X Direct 10/05/2012 current Declare conflict or

perceived conflict within

context of any relevant

meeting or project work

Director Jenjo Healthcare Ltd X Direct 10/05/2012 current Declare conflict or




Spouse business Airtight

International Ltd

Direct 10/05/2012 current Declare conflict or




Spouse business Nails 17 Ltd Indirect 10/05/2012 current Declare conflict or




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Name of

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(where

applicable)

Forename Surname


Job Title

(where

applicable)

Employing/

Relevant CCG

Action Taken to

Mitigate Risk

No Interests

Declared



nature of business)

Type of Interest

Is the

interest

direct or

indirect?

Nature of Interest

Date of Interest

Jason Broch X X Clinical Chair X Director Leeds Jewish free

school





Shareholder Alpha Dealing

Ltd





Director Brodetsky Primary

School Foundation





Foundation Trust Governor

Local Authority Brodetsky

Primary School





Nigel Gray X Chief Officer -

System

Integration

X X X Bevan Healthcare Board (Non

Exec Director)





Spouse employed by Leeds

Teaching Hospital Trust

Indirect 17/08/2015 current Declare conflict or




Sister employed by Leeds

Community Healthcare





Wetherby St James Cof E

Primary school - Federated

with Scholes





Nick Ibbotson X X GP Non-

Executive

Director

Employee One Medicare

Arthington Leeds





Peter Myers X X Non-Executive

Lay Member -

Governance

X Chief Executive Beverley

Buidling Society

X Direct 05/08/2015 11/05/2017 Declare conflict or




Director Finance Yorkshire

Ltd





Graham Prestwich X X Non-Executive

Lay Member -

PPI

X X X Astra Zeneca - Pension

provider





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Name of

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(where

applicable)

Forename Surname


Job Title

(where

applicable)

Employing/

Relevant CCG

Action Taken to

Mitigate Risk

No Interests

Declared



nature of business)

Type of Interest

Is the

interest

direct or

indirect?

Nature of Interest

Date of Interest


Lay Member -

PPI

X X X Pfizer Ltd - Pension provider X Direct 17/05/2012 current Declare conflict or




Pfizer Ltd - Shares X Direct 01/08/2013 current Declare conflict or




Graham Prestwich Ltd -

Director





Bradford school of Pharmacy -

joint chair, external advisory

board





University of Leeds - Member

of Consensus Development

panel for action to support

practices implementing

research - a 5yr £2m research

project





Change - member of the

Board of Trustees





British Standards Institute -

member, clinical service spec

Steering Group





Leeds Area Prescribing

Committee - patient

representative





National Blood Transfusion

Audit programme - member

fo PPI panel





Faculty of medical leadership

and management - associate

member of the faculty





Medicines Communications

Charter task and finish group





Leeds Teaching Hospitals

Trust - sister is employee





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ts

Name of

practice

(where

applicable)

Forename Surname


Job Title

(where

applicable)

Employing/

Relevant CCG

Action Taken to

Mitigate Risk

No Interests

Declared



nature of business)

Type of Interest

Is the

interest

direct or

indirect?

Nature of Interest

Date of Interest


Lay Member -

PPI

X X X Allied Health Professionals

Medicines Project Board





Royal College of physicians,

Joint advisory group on

gastrointestinal endoscopy -

member





Clinical standards

accreditation alliance - lay

member of project board





NHS England Medical

Directorate Quality and

Outcomes Working Group -

member





NHS England Patients and

Information Directorate PPI

lay member network

facilitator





Yorks and Humber AHSN,

Medicines Safety Expert

Reference Group m- member





Journal of Medicines

Optimisation Clinical Editorial

Group - member





NHS England - cross system

sepsis programme board -

member





Chief Professional Officers

Project Board Medicines

Prescribing non pecuniary -

lay member





Primary Care PPG Research

Group Leeds University -

group member





NHS England Independent

Investigation Governance

Committee for mental health

homicides





NHS England North Region

Independent Investigations

review group





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Inte

res

ts

Name of

practice

(where

applicable)

Forename Surname


Job Title

(where

applicable)

Employing/

Relevant CCG

Action Taken to

Mitigate Risk

No Interests

Declared



nature of business)

Type of Interest

Is the

interest

direct or

indirect?

Nature of Interest

Date of Interest

Manjit Purewal X X X X Clinical

Director

X X X North Leeds

Medical

Practice

Partner - North Leeds

Medical Practice





Tutor - Primary Care Training

Centre





Member - BMA X Direct 10/08/2015 current Declare conflict or




Member - Diabetes UK X Direct 10/08/2015 current Declare conflict or




Member - Local Care Direct X Direct 10/08/2015 current Declare conflict or




Member Circle Group X Direct 10/08/2015 current Declare conflict or




Brother partner at PWC Indirect 10/08/2015 current Declare conflict or




Owner/part owner Reborne

Healthcare Ltd





Amal Paul X X X GP Non

Executive

Director

X Roundhay

Road Surgery

GP Partner at Roundhay

Road Surgery



LSE CCG

01/07/2015

MINUTES ACTION LOG – LEEDS HEALTH COMMISSIONING AND SYSTEM INTEGRATION BOARD

1

ITEM NO:

ACTION NO:

ACTION: ACTION BY: COMPLETED/UPDATE

LEEDS WEST OUTSTANDING ACTION LIST

29 March 2017

26 1 GBAF risks relating to member practices to be separated into a capacity risk and an engagement risk.

Simon Stockill This action will be considered as part of the review of the GBAF, once the new strategic objectives have been agreed.

24 May 2017

51 1 SRAB system delivery plan to be presented to the Quality & Performance Committee.

Sue Robins Included on agenda for September 2017. Completed

54 1 Update committee collaborative agreement as agreed. Laura Parsons Completed

LEEDS SOUTH AND EAST OUTSTANDING ACTION LIST

25 May 2017

GB17/13 2 Sustainability and exit plans for non-recurrent funded projects to be considered at a future meeting.

Sue Robins/Visseh Pejhan-Sykes

To be considered at a Finance & Commissioning for Value meeting.

GB17/17 1 To place on record appreciation of the work of the Finance Team in the work which had resulted in such a highly commendable report from internal and external audit.

Philip Lewer Completed

GB17/18 1 That GP workforce challenges be considered in detail at a future Primary Care Commissioning Committee workshop.

Simon Stockill /Manjit Purewal

The Quality & Performance Committee will receive an update on workforce issues at a future meeting. The PCCC will receive regular updates on workforce through reports on the GP Forward View Delivery Plan.

GB17/20 1 A copy of the briefing provided by the Medical Director of Yorkshire Ambulance Service about ambulance response targets be circulated

Sue Robins Completed

Agenda Item: LHCB 17/05

MINUTES ACTION LOG – LEEDS HEALTH COMMISSIONING AND SYSTEM INTEGRATION BOARD

2

ITEM NO:

ACTION NO:

ACTION: ACTION BY: COMPLETED/UPDATE

GB17/20 2 That the Winter System Plan be brought to the next meeting of the Governing Body.

Sue Robins Included on Quality & Performance Committee and Leeds Health Commissioning & System Integration Board agendas for September 2017. Completed

LEEDS NORTH OUTSTANDING ACTION LIST

24 May 2017

207/ 2017

1 Questions from the public

PC / SR will liaise direct with the patient to discuss the issues raised in more detail.

Phil Corrigan / Sue Robins

Completed

207/ 2017

2 Ask the Mental Health commissioning team to liaise direct with Leeds Citizen about their involvement in the Mental Health Practitioner Pilot and to update the Board at its next meeting.

Phil Corrigan Completed

216/ 2017

1 Agree with the Director of Nursing and Quality the future reporting of quality issues.

Russell Hart-Davies

Quality reporting included in the IQPR. Completed

216/ 2017

2 Report to the Joint Quality and Performance Committee on the actions being taken in response to the Leeds Suicide Audit.

Ian Cameron Date to be confirmed.

Agenda Item: LHCB 17/05

1

Agenda Item: LHCB 17/06 FOI Exempt: No

NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting

Date of meeting: 26 July 2017

Title: Terms of Reference

Lead Board Member: Philip Lewer, Lay Chair Gordon Sinclair, Clinical Chair Jason Broch, Clinical Chair Steve Ledger, Lay Member – Assurance Peter Myers, Lay Member - Governance

Category of Paper Tick as

appropriate

()

Report Author: Laura Parsons, Head of Business & Corporate Services

Decision

Reviewed by EMT/SMT: N/A

Discussion

Reviewed by Committee: N/A

Information

Checked by Finance (Y/N/N/A): N/A

Approved by Lead Board member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to:

1. People will live longer and have healthier lives

2. People will live full, active and independent lives

3. People’s quality of life will be improved by access to quality services

4. People will be actively involved in their health and their care

5. People will live in healthy, safe and sustainable communities

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A

Statutory/Legal/Regulatory/Contractual requirements

N/A

Financial Implications N/A

Communication and Involvement Issues N/A

Workforce Issues N/A

Equality Issues including Equality Impact assessment

N/A

Environmental Issues N/A

Information Governance Issues including Privacy Impact Assessment

N/A

2

EXECUTIVE SUMMARY: The terms of reference for the Leeds Health Commissioning & System Integration Board are attached at Appendix 1 for noting. They have been approved by the CCG Governing Bodies and member practices/Council of Members. The draft terms of reference for two of the Board’s sub-committees (Quality & Performance Committee and Finance & Commissioning for Value Committee) are attached at Appendices 1-2 for approval. The draft terms of reference have been developed with input from members of the CCGs’ governing bodies and relevant staff. They have been reviewed at the first meetings of the committees, and the comments received have been incorporated into the attached versions. The terms of reference for the Patient Assurance Group (PAG) will be reviewed at the first PAG meeting, the date of which is to be confirmed, and will then be presented to the next Board meeting for approval.

NEXT STEPS: The terms of reference will be published on the CCG websites.

RECOMMENDATION: The Board is asked to:

(a) Note the terms of reference for the Leeds Health Commissioning & System

Integration Board (Appendix 1); and (b) Approve the terms of reference for the:

i. Quality & Performance Committee (Appendix 2); and ii. Finance & Commissioning for Value Committee (Appendix 3).

1

Leeds Health Commissioning and System Integration Board

Terms of Reference

Version: 15.0

Approved by: NHS Leeds North CCG, NHS Leeds South and East and NHS Leeds

West CCG Membership

Date approved: April 2017

Date issued: May 2017

Responsible Director: Philomena Corrigan

Review date: October 2017

Appendix 1

2

1. Introduction

1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing.

It has a clear vision to be a healthy, caring city for all ages, where people who

are poorest improve their health the fastest. To realise this vision, the CCGs

and Leeds City Council need to change how we commission services so that

the health and care system is sustainable, services are of high quality and we

make best use of the ‘Leeds pound’.

1.2 The three CCGs aim to ensure more integrated care, based on the needs of

local people. To do this, the Leeds CCGs and Leeds City Council will work

together to change how care is commissioned, and work with current and future

providers to develop a new, more integrated health and social care system.

1.3 The three CCGs have recognised that in a similar way to many healthcare

economies around the world, it will be necessary to adopt a Population Health

Management (PHM) approach. The key building blocks of PHM are:

Commissioning needs to be more strategic and outcomes-based rather

than activity-based.

Some current commissioning functions would be more effectively used

to develop a new provider landscape of integrated, accountable

providers working towards common goals.

This would be enabled by new payment and incentive mechanisms

supported by better use of information and technology.

1.4 To enable progress towards this vision, the CCGs have established transitional

governance arrangements that support joined-up, speedy and effective

decision-making. To oversee some functions, joint committees have been

established to enable greater co-ordination and integration of commissioning,

whilst at the same time overseeing leadership of system integration to develop

provider relationships and new commercial relationships. The governance

arrangements will be reviewed after six months of operation.

1.5 To oversee this transitional phase, the three CCGs in Leeds have set up the

Leeds Health Commissioning and System Integration Board (“the Board”). The

Board is a joint committee of NHS Leeds North Clinical Commissioning Group,

NHS Leeds South and East Clinical Commissioning Group and NHS Leeds

West Clinical Commissioning Group.

3

2. Role of the Board

2.1 The Board will be responsible for ensuring that the three Leeds CCGs work

together effectively to:

improve the health and wellbeing of the poorest, the fastest;

help people to live healthier, independent lives; and

ensure that people have access to quality health and care services.

2.2 Through transition, the Board will also oversee the development of a blueprint for

delivering PHM, which will clearly define the developmental journey for both

strategic commissioning and system integration.

2.3 This means the CCGs working with partners, the public and patients to

commission services that are high quality, sustainable, and make better use of

scarce resources. It also requires the CCGs to support a more integrated health

and care system and develop, with providers, new service models.

2.4 Bringing together strategic commissioning and innovative, integrated, provider

responses will enable delivery of the Leeds Plan, within the West Yorkshire

Sustainability and Transformation Plan.

2.5 The Board will be responsible for:

a) ensuring delivery of a single set of joint priorities;

b) driving the strategic, outcomes and needs-based commissioning of health

and care services across Leeds;

c) ensuring a focus on tackling health inequalities and improving the health

and wellbeing of the poorest, the fastest;

d) designing health and care provision around the needs of patients, with

greater emphasis on prevention and self- care;

e) shaping innovative approaches by health and care providers, which enable

them to respond to our proposed approach to commissioning for

outcomes;

f) driving new service models, which provide more integrated care for a

specific population, based on their needs and not disease pathways; and

g) driving the better use of business intelligence and technology, which will

provide the information that we need to commission effectively for

outcomes.

2.6 The Board will be responsible for exercising the following functions, to the

extent permitted, including:

a) the strategic commissioning of health and care services that meet the

reasonable needs of our population;

4

b) agreeing and monitoring the annual work programme to support the

delivery of the Leeds Plan, shared CCG objectives and operational plans;

c) reducing health inequalities, by identifying high risk, high priority

populations and targeting resources, prevention and care to meet their

needs;

d) making efficient and effective use of our collective resources by

developing new financial flows, monitoring the CCGs’ financial plans and

the delivery of financial targets set by NHS England;

e) ensuring continuous improvement in the quality of services commissioned

on behalf of the CCGs through the development of a common quality

assurance and reporting framework and quality improvement strategy;

f) ensure that arrangements are in place to secure public involvement in the

planning, development and consideration of proposals for changes and

decisions affecting the operation of commissioning arrangements;

g) supporting organisational development by establishing a single culture

where our staff adopt one set of values and behaviours;

h) promoting the integration of health and care services by driving new

provider approaches and service models;

i) monitoring provider performance and taking remedial action where

necessary;

j) driving a consistent approach to understanding the needs of our

population through the better use of business intelligence and technology;

k) establishing a single risk management and Board Assurance Framework

and thereby ensuring all principal risks are identified, managed and

mitigated with appropriate plans, controls and assurance reported; and

l) setting up and overseeing the effectiveness of sub committees deemed

necessary, agreeing terms of reference and membership of any such sub

committees.

2.7 In exercising its functions, the Board will comply with the statutory duties set out

in chapter A2 of the NHS Act and included within the CCG Constitutions.

3. Membership

3.1 The membership of the Board will be as follows:

The Chairs of each of the CCGs, one of which will be appointed as Chair

and one as deputy Chair of the Board. This will be on a rotational basis as

agreed by the Board.

CCG Accountable Officer

Chief Officer for System Integration

CCG Chief Finance Officer

CCG Director of Nursing

CCG Medical Director

5

CCG Director of Commissioning

Up to four CCG Lay Members

Up to four CCG GP Representatives

3.2 In attendance (non voting):

Director of Adults and Health, Leeds City Council

Director of Children and Families, Leeds City Council

Public Health representative

Chief Information Officer

Healthwatch Representative

3.3 Deputies may attend on behalf of executive members, with delegated voting

rights.

3.4 Other directors and senior managers will be invited to attend where

appropriate.

4. Quoracy and voting

4.1 To be quorate the following members must be present:

The Chair or deputy Chair

The Accountable Officer or deputy

The Chief Finance Officer or deputy

A minimum of 6 other members, including at least one lay member and

one GP representative

4.2 Members and attendees of the Board will participate in discussion, review

evidence and provide or seek objective expert input, to the best of their

knowledge and ability, and endeavour to support the Board in reaching a

collective view.

4.3 The Board will endeavour to make decisions by reaching a consensus, which

should also take into account the view shared by the non-voting attendees.

4.4 Exceptionally, where this is not possible, the Chair of the Board (or in their

absence a deputy Chair) may call a vote, using the following process:

i) The meeting must be confirmed as quorate, once conflicts of interest

have been accounted for, by the Chair;

ii) Each member will have one equal vote;

iii) A decision will be made by majority vote; and

iv) Where a majority vote cannot be reached the Chair will have the

casting vote.

6

5. Operation of the Committee

5.1 The Board will hold at least six meetings in public each year. Meetings of the

Board shall be conducted as if the Public Bodies (Admission to Meetings) Act

1960 applied to the Board in the same way as it applies to the Governing Bodies

of the CCGs.

5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum of

seven working days’ notice should be given when calling an extraordinary

meeting.

5.3 The agenda and supporting papers will be circulated to all members at least five

working days before the date of the meeting.

5.4 With the agreement of the Chair, items of urgent business may be added to the

agenda after circulation to members.

5.5 In the case of an emergency the Chair may take urgent action to decide any

matter within the remit of the Board, subject to consultation with at least three

other members of the Board, including a representative from each CCG. Any

such action shall be reported to the next Board meeting and to the CCG

Governing Bodies.

5.6 Minutes will be issued at latest 10 working days following each meeting and a

Chairs summary will be submitted to the CCG Governing bodies.

5.7 Secretarial support will be provided to ensure appropriate support to the Chair

and Board members in relation to the organisation and conduct of meetings

6. Conduct of the Board

6.1 Members of the Board shall at all times comply with the standards of business

conduct and managing conflicts of interest as laid down in the CCGs’

Constitutions and the Managing Conflicts of Interest Policy.

6.2 The Board shall hold and publish a register of interests. This register shall record

all relevant and material, personal or business, interests as set out in the CCGs

Managing Conflicts of Interest Policy.

6.3 All declarations of interest will be declared at the beginning of each meeting and

actions taken in mitigation will be recorded in the minutes.

7

7. Accountability and Reporting

7.1 As statutory bodies, the CCGs remain individually accountable for the delivery of

their statutory functions.

7.2 As a committee of the CCGs the Board is accountable to the CCG member

practices.

7.3 The Board will produce an annual work plan in consultation with the CCG

Governing Bodies and Membership, and will submit regular reports on progress

against delivery.

7.4 Minutes of the Board and a written summary will be submitted to the CCG

member practices and Governing Bodies.

7.5 The Board is authorised by the CCGs to commission any reports or surveys or to

create working groups as necessary to help it fulfil its obligations and will remain

accountable for any working groups. The minutes of such groups will be

presented to the Board.

8. Review of the Board

8.1 The Board will, after six months of operation, undertake a self-assessment of its

performance against the annual plan, membership and terms of reference. Any

resulting proposed changes to the terms of reference will be submitted for

approval by the CCG’s Membership.

1

Appendix 2

DRAFT

Joint Quality & Performance Committee

Terms of Reference

Version: DRAFT

Approved by: Leeds Health Commissioning and System Integration Board

Date approved:

Date issued:

Responsible Director: Director of Nursing and Quality/Director of Commissioning

Review date: [+6 months]

2

1. Introduction

1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing. It

has a clear vision to be a healthy, caring city for all ages, where people who are

poorest improve their health the fastest. To realise this vision, the CCGs and

Leeds City Council need to change how we commission services so that the

health and care system is sustainable, services are of high quality and we make

best use of the ‘Leeds pound’.

1.2 The three CCGs aim to provide more integrated care, based on the needs of






Management (PHM) approach. The key building blocks of PHM include:

strategic and outcomes-based commissioning rather than activity-based;

effective use of commissioning functions to develop a new provider

landscape of integrated accountable providers working towards common

goals;

new payment and incentive mechanisms supported by better use of

information and technology.


governance arrangements that support joined-up, speedy and effective decision-

making. To oversee some functions, joint committees have been established to

enable greater co-ordination and integration of commissioning, whilst at the same

time overseeing leadership of system integration to develop provider

relationships and new commercial relationships. The governance arrangements

will be reviewed after six months of operation.

2. Role of the Committee

2.1 The committee is responsible for the oversight and monitoring of:

the quality of commissioned services including patient experience, safety and

clinical effectiveness;

the effectiveness and performance of commissioned services;

the performance of the CCGs and their delivery of agreed outcomes.

2.2 The committee will support the Leeds Health Commissioning & System

Integration Board (“the Board”) in ensuring the continuous improvement in the

3

quality of services commissioned on behalf of the CCGs. The committee aims to

ensure that quality sits at the heart of everything the CCGs do, and that evidence

from quality assurance processes drives the quality improvement agenda across

the Leeds healthcare economy.

2.3 The Shared Commitment to Quality from the National Quality Board provides a

single shared view of quality. The NHS Five Year Forward View confirms a

national commitment to high-quality, person centred care for all and describes the

changes that are needed to deliver a sustainable health and care system. This

approach builds on the existing definition of quality:

2.4 Quality care is not achieved by focusing on one or two aspects of this definition;

high quality care encompasses all aspects with equal importance being placed on

each. This includes providers and commissioners working in partnership to

ensure organisations are well-led, resourced sustainably and equitable for all.

2.5 In fulfilling its role the Committee will seek reasonable assurance relating to the

quality and performance of commissioned services. The committee defines

reasonable assurance as evidence that performance / quality is in line with

agreed targets or trajectories, or where it is not, there is reasonable mitigation

4

and an action plan to rectify any issues (the Committee will agree on a case by

case basis what constitutes reasonable mitigation).

2.6 Where the Committee receives insufficient assurance, it will challenge, assess

risks and escalate to the Board or Primary Care Commissioning Committees if

necessary.

2.7 The Committee will be responsible for exercising the following functions:

2.8 Performance: Oversee the management of the CCGs’ performance and their

delivery of agreed outcomes by:

a) monitoring performance against national and local targets

b) monitoring performance against the standards, targets and outcomes set out

in the CCG’s operational and strategic plans

c) reviewing the CCG’s benchmarked performance against statutory frameworks

including the NHS Outcomes Framework and Improvement and Assessment

Framework

d) ensuring action plans are developed and implemented to address any areas

of unsatisfactory performance and drive improvement

e) overseeing the continuous development of the scope, format, presentation

and mechanisms of the system of performance reporting

f) reviewing those risks on the CCG risk register and Board Assurance

Framework which have been assigned to the committee and ensure that

appropriate and effective mitigating actions are in place

g) seeking assurance that the CCGs are fulfilling their statutory duties for

equality and diversity, as set out in the Equality Act 2010

h) seeking assurance of appropriate compliance by the CCG with the legal

requirements for:

emergency planning

information governance

health and safety

2.9 Quality of commissioned services: The committee will ensure the effective

delivery of quality performance across the full range of commissioned services and

seek assurances that sound systems for quality improvement and clinical

governance are in place in line with statutory requirements, by:

a) monitoring the quality performance of all providers, including detailed reports

on services that are commissioned across acute, community and primary care

b) reviewing specific action plans or recovery plans as they relate to quality

c) approving arrangements, including supporting policies, to minimise clinical

risk, maximise patient safety and secure continuous improvement in quality

and patient outcomes, including the arrangements for dealing with exceptional

funding requests

5

d) reviewing quality performance with regard to QIPP

2.10 Patient experience: The committee will seek assurance that effective systems

are in place to monitor and improve patient experience by:

a) receiving patient experience reports and information relating to commissioned

services

b) reviewing themes and trends and ensuring lessons learned are translated into

changes in way services are provided

c) approving the CCGs’ arrangements for the CCGs’ handling of patient

complaints, concerns or enquiries in accordance with relevant regulations.

2.11 Clinical Effectiveness: The committee seeks to gain assurance that there are

effective systems and processes in place to monitor and gain oversight of clinical

effectiveness. This will include:

a) receiving assurance that there is appropriate monitoring of compliance with

guidance including NICE guidelines and technical appraisals

b) monitoring the performance of trusts against the agreed Commissioning for

Quality and Innovation scheme (CQUINs)

c) receiving Quality Account updates

d) receiving assurance that providers have robust clinical audit procedures that

address trust priorities, facilitate service improvement and provide assurances

that agreed clinical standards are being met

2.12 Safety: The committee shall seek assurances regarding safety by:

a) receiving assurance that the accepted recommendations of national inquiries

and national and local reviews have been considered and actioned with

respect to the CCGs and commissioned services including primary care.

b) overseeing safeguarding arrangements to assure that the CCGs’ statutory

responsibilities for safeguarding children and vulnerable adults are met and

that robust actions are taken to address concerns via receipt of regular

reports

c) overseeing and seeking assurance that effective systems are in place in

relation to CCG services including serious incident management, continuing

healthcare and medicines management.

2.13 The work of the committee will provide the Board with assurance on the

CCGs’ delivery of the following statutory duties:

secure continuous improvement in the quality of services (including

primary medical services);

secure health services that have regard to the NHS constitution;

reduce inequalities;

promote integration of health and social care;

promote innovation; and

6

promote research, and education and training.

3. Membership

3.1 The membership of the committee will be as follows:

at least two non-executive or lay governing body members from each

CCG

CCG Director of Nursing and Quality


CCG Medical/Clinical Director

3.2 The committee will be chaired by a non-executive or lay member, to be appointed

by the committee.

3.3 The committee will appoint a deputy Chair from the remaining non-executive or

lay members.


rights.

3.5 Other directors and senior managers will be invited to attend where appropriate.


4.1 The quorum is a minimum of 4 members. This must include the Chair or Deputy

Chair, one GP non-executive, one PPI lay member and one executive.

4.2 If the committee is not quorate the meeting may be postponed at the discretion of

the Chair.

4.3 The committee will endeavour to make decisions by reaching a consensus.

Where a consensus cannot be reached, the Chair will take the committee’s views

on the issue forward for consideration by the Board.


5.1 Meetings will be held bi-monthly.

5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum of

seven working days’ notice should be given when calling an extraordinary

meeting.

7

5.3 The agenda and supporting papers will be circulated to all members at least five

working days before the date of the meeting.

5.4 With the agreement of the Chair, items of urgent business may be added to the

agenda after circulation to members.


matter within the remit of the committee, subject to consultation with at least two

other members of the committee, one of which must be a non-executive or lay

member. Any such action should be reported at the next committee meeting.


Chair’s Summary will be submitted to the subsequent Board meeting. A summary

regarding issues relating to primary medical care services will be submitted to the

subsequent meeting of the Primary Care Commissioning Committees in

Common.


and committee members in relation to the organisation and conduct of meetings.

6.0 Conduct of the Committee

6.1 Members of the committee shall at all times comply with the standards of

business conduct and managing conflicts of interest as laid down in the CCGs’

Constitutions and the Managing Conflicts of Interest Policy.

6.2 All declarations of interest will be declared at the beginning of each meeting and

actions taken in mitigation will be recorded in the minutes

7.0 Accountability and Reporting

7.1 The committee is accountable to the Board.

7.2 The committee will produce an annual work plan in consultation with the Board

7.3 A Chair’s summary will be presented to the Board.

7.4 The committee is authorised by the Board to commission any reports or surveys

or to create working groups as necessary to help it fulfil its obligations and will

remain accountable for any working groups. The minutes of such groups will be

presented to the committee.

8

8.0 Review of the Committee

8.1 The committee will produce an annual work plan in consultation with the Board.

8.2 The committee will undertake an annual self-assessment of its performance

against the annual plan, membership and terms of reference. This self-

assessment will form the basis of the annual report. Any resulting proposed

changes to the terms of reference will be submitted for approval by the Board.

8.3 These terms of reference and membership will be reviewed at least annually

following their approval.

1

DRAFT

Joint Finance & Commissioning for Value Committee

Terms of Reference

Version: 7

Approved by: Leeds Health Commissioning and System Integration Board

Date approved:

Date issued:

Responsible Director: Chief Finance Officer/Director of Commissioning

Review date: [+6 months from approval]

Appendix 3

2

1. Introduction

1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing.

It has a clear vision to be a healthy, caring city for all ages, where people who

are poorest improve their health the fastest. To realise this vision, the CCGs

and Leeds City Council need to change how we commission services so that

the health and care system is sustainable, services are of high quality and we

make best use of the ‘Leeds pound’.

1.2 The three CCGs aim to provide more integrated care, based on the needs of






Management (PHM) approach. The key building blocks of PHM include:

strategic and outcomes-based commissioning rather than activity-based;

effective use of commissioning functions to develop a new provider

landscape of integrated accountable providers working towards common

goals;

new payment and incentive mechanisms supported by better use of

information and technology.


governance arrangements that support joined-up, speedy and effective

decision-making. To oversee some functions, joint committees have been

established to enable greater co-ordination and integration of commissioning,

whilst at the same time overseeing leadership of system integration to develop

provider relationships and new commercial relationships. The governance

arrangements will be reviewed after six months of operation.

2. Role of the Committee

2.1 The role of the committee is to ensure the efficient and effective use of our

collective resources by developing new financial flows, monitoring the CCGs’

financial plans and the delivery of financial targets set by NHS England.

2.2 The committee will advise and support the Leeds Health Commissioning and

System Integration Board (“the Board”) in scrutinising and tracking delivery of

key financial and service priorities, outcomes and targets as specified in each

3

CCG’s strategic and operational plans.

2.3 The committee will be responsible for the following functions:

a) ensuring the overall financial management and performance of each of

the CCGs including the delivery of investment plans, monitoring of

reserves, financial recovery plans and cost improvement plans;

b) reviewing the overall financial position of the CCG to ensure that the

CCGs each meet their statutory financial duties;

c) ensuring that financial and performance plans are consistent with the

CCGs’ annual budgets, commissioning plans and strategies;

d) approving any variations to planned investment within the limits set out in

the detailed financial policies of the CCGs, ensuring that any amended

plans remain within the overall CCG’s budget and do not adversely affect

the strategic performance of the CCGs;

e) monitoring financial performance across all commissioned services on an

exception basis, assessing potential shortfalls and risk and agreeing

actions to address them;

f) approving and monitoring delivery of the Quality, Innovation, Prevention

and Productivity (QIPP) programme(s), and agreeing corrective action if

required;

g) ensuring that QIPP programmes embed the principle of ‘value’ to include

improved health outcomes and quality improvement;

h) approving the Leeds CCG Commissioning for Value Efficiency Framework

and ensuring that all service change and decommissioning proposals are

reviewed and evaluated in line with the Framework;

i) reviewing and approving individual business cases for investment and

disinvestment within the limits of the relevant Scheme of Delegation;

j) providing assurance to the Board on the management of financial risks as

allocated to the Committee.

2.4 The work of the committee will provide the Board with assurance on the CCGs’

delivery of the following statutory duties:

act effectively, efficiently and economically;

promote innovation;

ensure the CCGs’ expenditure does not exceed the aggregate of its

allotments for the financial year;

ensure the CCGs’ use of resources (both its capital resource use and

revenue resource use) does not exceed the amount specified by NHS

England for the financial year;

take account of any directions issued by NHS England, in respect of

specified types of resource use in a financial year, to ensure the CCGs do

not exceed an amount specified by NHS England; and

4

publish an explanation of how the CCGs’ spent any payment in respect of

quality made to it by NHS England.

3. Membership

3.1 The membership of the committee will be as follows:

at least two non-executive or lay Governing Body members from each

CCG

CCG Chief Finance Officer


CCG Director of Nursing & Quality

CCG Medical Director

3.2 The committee will be chaired by a non-executive or lay member, to be

appointed by the committee.

3.3 The committee will appoint a Deputy Chair from the remaining non-executive

or lay members.


rights. The Executive member shall remain accountable for decisions made

on their behalf.

3.5 Other directors and senior managers will be invited to attend where

appropriate.


4.1 The quorum is a minimum of four members. This must include the Chair or

deputy Chair, Chief Finance Officer or their deputy and one non-executive or

lay member.

4.2 If the committee is not quorate the meeting may be postponed at the

discretion of the Chair.

4.2 The aim of the committee will be to achieve consensus decision-making. Should a vote need to be taken, only the members of the committee shall be allowed to vote. In the event of a tied vote, the Chair shall have a casting vote.


5.1 Meetings will be held bi-monthly.

5

5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum

of seven working days’ notice should be given when calling an extraordinary

meeting.

5.3 The agenda and supporting papers will be circulated to all members of a

meeting at least five working days before the date the meeting.

5.4 With the agreement of the Chair, items of urgent business may be added to

the agenda after circulation to members.


matter within the remit of the committee, subject to consultation with at least

two other members of the committee, one of which must be a non-executive

or lay member. Any such action will be reported to the next committee

meeting.


Chair’s summary will be submitted to the subsequent meeting of the Board.


and committee members in relation to the organisation and conduct of

meetings.

6. Conduct of the Committee

6.1 Members of the committee shall at all times comply with the standards of

business conduct and managing conflicts of interest as laid down in each of the

CCG’s Constitutions and the Managing Conflicts of Interest Policy.

6.2 All declarations of interest will be declared at the beginning of each meeting

and actions taken in mitigation will be recorded in the minutes.

7. Accountability and Reporting

7.1 The committee is accountable to the Board.

7.2 The committee will produce an annual work plan in consultation with the Board.

7.3 A Chair’s summary will be presented to the Board.

7.4 The committee is authorised by the Board to commission any reports or

surveys or to create working groups as necessary to help it fulfil its obligations

and will remain accountable for any working groups. The minutes of such

6

groups will be presented to the committee.

8. Review of the Committee

8.1 The committee will undertake an annual self-assessment of its performance

against the annual plan, membership and terms of reference. Any resulting

proposed changes to the terms of reference will be submitted for approval by

the Board.

8.2 These terms of reference and membership will be reviewed at least annually

following their approval.

1


NHS Leeds CCGs Partnership: Leeds Health Commissioning and System Integration Board


Title: Leeds Health and Care Plan: A Conversation with Citizens

Lead Board Member: Phil Corrigan (Chief Executive) & Nigel Gray (Chief Officer for System Integration)


appropriate

()

Report Author: Tony Cooke (Chief Officer, Health Partnerships) and Paul Bollom (Interim Executive Lead, Leeds Plan)

Decision

Reviewed by EMT/SMT/Date: N/A

Discussion

Reviewed by Committee/Date: N/A

Information

Checked by Finance (Y/N/N/A - Date): N/A


Joint Health & Wellbeing Strategy Outcomes – that this report relates to






Corporate Impact Assessment: Does the Report have any of the following key implications?


N/A

Financial Implications Refer to body of report

Communication and Involvement Issues Refer to body of report

Workforce Issues Refer to body of report


Refer to body of report



N/A

2

EXECUTIVE SUMMARY: The Leeds Health and Care Plan is the Leeds description of what it envisages health and care will look like in the future and how it will contribute to the delivery of the vision and outcomes of the Leeds Health and Wellbeing Strategy 2016-2021. It is a Leeds vision for health and care and moves beyond what is outlined in national Sustainability and Transformation Plans (STPs). The Leeds Health and Care Plan is the city’s approach to closing the three gaps that have been identified by health, care and civic leaders. These are gaps in health inequalities, quality of services and financial sustainability. It provides an opportunity for the city to shape the future direction of health and to transition towards a community focused approach, which understands that good health is a function of wider factors such as housing, employment, environment, family and community. Perhaps most importantly, the Leeds Health and Care Plan provides the content for a conversation with citizens to help develop a person-centred approach to delivering the desired health improvements for Leeds to be the best city for health and wellbeing.

NEXT STEPS: In order to progress the Leeds Health and Care Plan, the next stage is to begin a broader conversation with citizens in a way that is accessible and understandable. The conversation we would like to have with citizens will be focussed on the ideas and general direction of travel outlined in the Leeds Health and Care Plan. It will ask citizens what they think about the plan and will invite them to comment and provide their thoughts. Our preparation for delivering a conversation with citizens about plans for the future of health and care in Leeds will be reflective of the rich diversity of the city, and mindful of the need to engage with all communities.

RECOMMENDATION: The Leeds Health Commissioning and System Integration Board is asked to: (a) Consider the contents of the draft narrative for the Leeds Health and Care Plan and

provide feedback which can be incorporated into future iterations and in our conversation with citizens about the future of health and care in Leeds.

(b) Support and champion the Leeds Health and Care Plan and plans to progress a conversation with the public and wider workforce in a way that citizens and staff from across the partnership can relate to and which is accessible and understandable.

(c) Continue to support and champion the commitment ‘Better conversations: A whole city approach to working with people’.

(d) Ensure that Leeds Health and Wellbeing Strategy 2016-2021 and Leeds Health and Care Plan continue to be used to frame and drive forward the system integration work.

(e) Note the continued work that has taken place to date by NHS Leeds CCGs officers to support the development of and implementation of the Leeds Health and Care Plan.

(f) Note that the Leeds Health and Wellbeing Board will continue to provide strategic leadership for the Leeds Health and Care Plan.

3

1. SUMMARY

1.1 The purpose of this report is to provide the Leeds Health Commissioning and System Integration Board with an overview of:

The draft A3 version of the ‘Leeds Health and Care Plan on a Page’ (Appendix A) and accompanying narrative (Appendix B) as the approach taken to engage citizens in the future development and delivery of our plans. The plan has been continuously been improved through conversations with a wide range of stakeholders, and we envisage this process will continue.

Proposals to begin the next phase of our conversation with citizens, in partnership with the ‘Changing Leeds’ programme.

1.2 Seek support from the Leeds Health Commissioning and System Integration Board that it supports:

Consultation to be undertaken on the draft narrative by officers within the Health Partnerships Team (including NHS Leeds CCGs officers and wider partners) and to undertake a conversation with citizens, delivered through the ‘Changing Leeds’ platform.

2. BACKGROUND

2.1 Leeds asserted and progressed towards a locally partnership owned, locally developed and

user centred approach to planning that is right for Leeds. Leeds is a third of the West Yorkshire and Harrogate STP footprint, and if considered alone has three times the population of the smallest STP footprint. West Yorkshire and Harrogate STP footprint is the third largest STP footprint in the UK. There has been considerable progress in how the Leeds Health and Care Plan is being created through discussion with local citizens, third sector organisations, service user groups, elected members and front line clinicians.

2.2 Nationally, the NHS funding position has deteriorated with a significant deficit reported in

2016/17. In response, the NHS has moved away from an offer of significant financial support for system transformation to smaller more targeted initiatives. Nationally, NHS organisations and Clinical Commissioning Groups (CCGs) considered significantly out of balance in 2017/18 are increasingly subject to significant direct intervention to enact measures which cut costs in year. Leeds City Council has also faced significant funding reduction since 2010. Where possible organisations have aimed to protect front line services and protect the vulnerable. The approach has been led through an ongoing conversation with communities including third sector and community services about how neighbourhoods meet citizens’ needs.

Local picture

2.3 Leeds has an ambition to be the Best City for Health and Wellbeing and Leeds has the

people, partnerships and placed-based values to succeed. The vision of the Leeds Health and Wellbeing Strategy 2016-2021 is: ‘Leeds will be a healthy and caring city for all ages, where people who are the poorest will improve their health the fastest’. A strong economy and realising the potential of the ‘Leeds £’ is also key: Leeds will be the place of choice in the UK to live, for people to study, for businesses to invest in, for people to come and work

4

in and the regional hub for specialist health care. Services will provide a universal offer, but will tailor specific offers to the areas that need it the most. These are bold statements, in one of the most challenging environments for health and care in living memory.

2.4 Since the first Leeds Health and Wellbeing Strategy in 2013, there have been many

positive changes in Leeds and the health and wellbeing of local people continues to improve. Health and care partners have been working collectively towards an integrated system that seeks to wrap care and support around the needs of the individual, their family and carers, and helps to deliver the Leeds vision for health and wellbeing. Leeds has seen a reduction in infant mortality as a result of a more preventative approach; it has been recognised for improvements in services for children; it became the first major city to successfully roll out an integrated, electronic patient care record, and early deaths from avoidable causes have decreased at the fastest rate in the most deprived localities.

2.5 We have made significant progress on health coaching, adopting the house of care model

and pioneered the use of restorative approaches with vulnerable families, with Leeds City Council now recognised as a Department for Education Partner in Practice.

2.6 These are achievements of which to be proud, but they are only the start. The health and

care system in Leeds continues to face significant challenges; namely the ongoing impact of the global recession and national austerity measures, Brexit, together with significant increases in demand for services brought about by both an ageing population and the increased longevity of people living with one or more long term condition(s). Leeds also has a key strategic role to play in West Yorkshire with the sustainability of the local system intrinsically linked to the sustainability of other areas in the region.

2.7 Leeds needs to do more to change conversations across the city and to develop the

necessary infrastructure and workforce to respond to the challenges ahead. As a city, we will only meet the needs of individuals and communities if health and care workers and their organisations work together in partnership. The needs of patients and citizens are changing; the way in which people want to receive care is changing, and people expect more flexible approaches which fit in with their lives and families.

2.8 Leeds will continue to change the way it works, becoming more enterprising, bringing in

new service delivery models and working more closely with partners, public and the workforce locally and across the region to deliver shared priorities. However, this will not be enough to address the sustainability challenge. Future years are likely to see a reduction in provision with regard to services which provide fewer outcomes for local people and offer less value to the ‘Leeds £’.

2.9 Much will depend on changing the relationship between the public, workforce and services.

There is a need to encourage greater resilience in communities so that more people are able to do more themselves. This will reduce the demands on public services and help to prioritise resources to support those most at need. The views of people in Leeds are continuously sought through public consultation and engagement and prioritisation of essential services will continue, especially those that support vulnerable adults, children and young people.

5

National picture 2.10 In October 2014, the NHS published the Five Year Forward View, a wide-ranging strategy

providing direction to health and partner care services to improve outcomes and become financially sustainable. On 22nd December 2015, NHS England (NHSE) published the ‘Delivering the Forward View: NHS planning guidance 2016/17-2020/21’, which is accessible at the following link: https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

2.11 The planning guidance asked every health and care system to come together to create

their own ambitious local blueprint – Sustainability and Transformation Plan (STP) – for accelerating implementation of the Five Year Forward View and for addressing the challenges within their areas. STPs are place-based, multi-year plans built around the needs of local populations (‘footprints’) and should set out a genuine and sustainable transformation in service user experience and health outcomes over the longer term.

2.12 NHS England has provided further subsequent guidance as to expectations of greater involvement and consultation with local populations as to the content of plans and has recognised that to develop truly partnership place based plans requires time to properly engage and co-produce with citizens and their original timelines of agreed finalised plans by the end of 2016 have been relaxed.

3. PROPOSAL

3.1 The Leeds Health and Care Plan narrative sets out ideas about how we will improve health outcomes, care quality and financial sustainability of the health and care system in the city. The plan recognises the Leeds Health and Wellbeing Strategy 2016-2021, its vision and its outcomes, and begins to set out a plan to achieve its aims.

3.2 The Leeds Health and Wellbeing Board throughout 2016 has provided a strong steer to the shaping of the Leeds Health and Care Plan at formal board meetings on 12th January and 21st April 2016 and two workshops held on 21st June and 28th July 2016. The Board has held a further workshop on 20th April 2017 and more recently at a formal board meeting on 20th June 2017 where it reviewed and provided comment on the draft narrative to support the plan.

3.3 The plan recognises and references the collaborative work done by partners across the

region to develop the West Yorkshire and Harrogate STP, but is primarily a Leeds based approach to transformation, building on the existing strategies that promote health and inclusive growth in the city. Whilst the financial challenge is a genuine one, the Leeds approach remains one based on long term planning including demand management, behaviour change and transition from expensive acute services towards community based approaches that are both popular with residents and financially sustainable.

3.4 A transition towards a community focused model of health is intrinsic to the plan through

the system integration work. This is the major change locally and will touch the lives of all people in Leeds. This ‘new model of care’ will bring services together in the community. GP practices, social care, third sector and public health services will be informally integrated in

https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

6

a ‘primary care home’. Our hospitals will work closely with this model and care will be provided closer to home where possible, and as early as possible. New tools, known as ‘Population Health Management’ will be used to ensure the right people get the right services and that these are offered in a timely fashion. This is designed to prevent illness where possible and manage it in the community.

3.5 The development of the Leeds Health and Care Plan has been supported by partners and stakeholders from across various health and care providers and commissioners, as well as Healthwatch Leeds, third sector and local area Community Committees (local public meetings led by councillors across the city). Conversations have also taken place over the last year about how best to align the citizen conversation about health and care in Leeds with ‘Changing Leeds’ (see para 7.3 for further information).

3.6 A significant amount of engagement activity has taken place when the Leeds Health and

Wellbeing Strategy was being refreshed. This is alongside ongoing engagement activity on strategic decision making which occurs across the activity of the Leeds Health and Wellbeing Board and its constituent members. All of this has helped shape the Leeds Health and Care Plan.

3.7 The Leeds Health and Care Plan narrative presents information for a public and wider staff

audience about the plan in a way that that citizens and staff can relate to and which is accessible and understandable.

3.8 The Leeds Health and Care Plan narrative (when published) will be designed so that the visual style and branding is consistent with that of the Leeds Health and Wellbeing Strategy 2016-2021 and will be part of a suite of material used to engage citizens and staff.

The narrative contains information about:

The strengths of our city, including health and care

The reasons we must change

How the health and care system in Leeds works now

How we are working with partners across West Yorkshire

The role of citizens in Leeds

What changes we are likely to see

Next steps and how you can stay informed and involved

3.9 As statutory organisations across the city working with our thriving third sector and academic partners, we have come together to develop, for the first time, a system-wide plan for a sustainable, high-quality health and social care system. The plan has been improved through engagement with a wide range of stakeholders and will continue to develop through further conversations with citizens. We want to ensure that services in Leeds can continue to provide high-quality support that meets, or exceeds, the expectations of adults, children and young people across the city: the patients and carers of today and tomorrow.

3.8 Our Leeds Health and Care Plan is built on taking our asset-based approach to the next level to help deliver the health and care aspects of the Leeds Health and Wellbeing Strategy 2016-2021. It is a plan that will strive to improve health and wellbeing for all ages

7

and for all of Leeds, but where people who are poorest improve their health the fastest. This is enshrined in a set of values and principles and a way of thinking about our city, which:

Identifies and makes visible the health and care-enhancing assets in a community and sees citizens, families and communities as the co-producers of health and wellbeing rather than the passive recipients of services.

Promotes community networks, relationships and friendships that can provide caring, mutual help and empowerment.

Identifies what has the potential to improve health and wellbeing the fastest including what already works well in an area and the opportunities provided by digitalisation to improve connections and promote integration.

Further develops prevention and early intervention and uses neighbourhoods as a starting point to help integrate social care, hospital, third sector and community services to provide care closer to home and a rapid response in time of crisis.

Supports individuals’ mental health and wellbeing through self-esteem, coping strategies, resilience skills, relationships, friendships and services working to tackle physical and mental health together.

Values, empowers and helps grow our own workforce from our diverse communities and involves them in the co-production of any changes.

Understands the importance of the economy, housing, employment and environment in generating health.

4. NEXT STEPS

4.1 In order to progress the thinking and partnership working that has been done to help inform the Leeds Health and Care Plan to date, the next stage is to begin a broader conversation with citizens. The conversation we would like to have with citizens will be focused on the ideas and general direction of travel outlined in the Leeds Health and Care Plan. It will ask citizens what they think about the plan and will invite them to comment and provide their thoughts. Our preparation for delivering a conversation with citizens about plans for the future of health and care in Leeds will be reflective of the rich diversity of the city, and mindful of the need to engage with all communities. A detailed communication and engagement plan is currently being developed and will be shared with the Leeds Health and Wellbeing Board for comment.

4.2 The final version of the Leeds Health and Care Plan will contain case studies which will be co-produced with citizen and staff groups that will describe their experience now and how this should look in the future. It will enable us to engage people in a way that will encourage them to think more holistically about themselves, others and places rather than thinking about NHS or Leeds City Council services. Citizen and stakeholder engagement on the Leeds Health and Care Plan has already begun in the form of discussions with all 10 Community Committees across Leeds in February and March 2017.

4.3 The final Leeds Health and Care Plan will have to describe the financial and sustainability

gap in Leeds and demonstrate that the proposed changes will ensure that we are operating within our likely resources. In order to make these changes, we will require national support in terms of local flexibility around the setting of targets, financial flows and non-recurrent investment.

8

4.4 As part of the development of the West Yorkshire and Harrogate STP, the financial and

sustainability impact of any changes at a West Yorkshire level and the impact on Leeds will need to be carefully considered. It is envisaged that Leeds may be able to capitalise on the regional role of our hospitals and attract new specialist services to the city.

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1 At this stage there are no statutory/legal/regulatory or contractual issues arising from this

report. 6. FINANCIAL IMPLICATIONS AND RISK 6.1 The final Leeds Health and Care Plan will have to describe the financial and sustainability

gap in Leeds, the plan Leeds will be undertaking to address this and demonstrate that the proposed changes will ensure that we are operating within our likely resources. With the current resources available this will be challenging and in order to make these changes, we will require national support in terms of local flexibility around the setting of targets, financial flows and non-recurrent investment.

6.2 As part of the development of the West Yorkshire and Harrogate STP, the financial and

sustainability impact of any changes at a West Yorkshire level and the impact on Leeds will need to be carefully considered and analysis is currently underway to delineate this.

6.3 It is envisaged that Leeds may be able to capitalise on the regional role of our hospitals

using capacity released by delivering our solutions to support the sustainability of services of other hospitals in West Yorkshire and to grow our offer for specialist care for the region.

6.4 Failure to have robust plans in place to address the gaps identified as part of the Leeds

Health and Care Plan development will impact the sustainability of the health and care in the city.

6.5 Two key overarching risks present themselves given the scale and proximity of the

challenge and the size and complexity of both the West Yorkshire and Harrogate STP footprint and Leeds itself.

6.6 Potential unintended and negative consequences of any proposals as a result of the

complex nature of the local and regional health and social care systems and their interdependencies. Each of the partners has their own internal pressures and governance processes they need to follow.

6.7 Ability to release expenditure from existing commitments without de-stabilising the system

in the short-term will be extremely challenging as well as the risk that any proposals to address the gaps do not deliver the sustainability required over the longer-term.

6.8 The effective management of these risks can only be achieved through the full commitment

of all system leaders within the city to focus their full energies on developing and delivering a robust Leeds Health and Care Plan within an effective governance framework.

9

7. COMMUNICATIONS AND INVOLVEMENT

7.1 As referenced earlier in this report, the Leeds Health and Care Plan builds on the significant engagement activity which has taken place to refresh the Leeds Health and Wellbeing Strategy. It has also taken advantage of the significant engagement activity across the activity of the constituent partners of the Leeds Health and Wellbeing Board.

7.2 In addition to the Leeds Health and Wellbeing Board, recently, the emerging Leeds Health

and Care Plan has been discussed this year at:

All 10 Community Committees (February-March)

Team Leeds (MPs) (17th March)

Scrutiny Board (Adult Social Services, Public Health, NHS) (28th March)

Forum Central Health and Care Leaders Network (29th March)

Healthwatch Leeds (29th March & 29th June)

Scrutiny Board Working Group (Adult Social Services, Public Health, NHS) (9th May)

Youthwatch (13th June)

Leeds Older People’s Forum (21st June)

7.3 Leeds City Council is shortly to launch “Changing Leeds”. Changing Leeds is an engagement with the whole city on issues arising from the changing ‘social contract’, civic enterprise, and the future role of the council and other public services. Conversations have also taken place over the last year about how best to align the citizen conversation about health and care in Leeds with ‘Changing Leeds’.

7.4 The overall purpose of ‘Changing Leeds’ is to help people who live, work and study in the city think differently about their relationship with local public services, and ultimately do things differently as well.

7.5 It is proposed that through joint working and using the ‘Changing Leeds’ platform a consultation on the Leeds Health and Care Plan will form part of the wider discussions.

7.6 In order to progress the thinking and partnership working that has been done to help inform the Leeds Health and Care Plan to date, the next stage is to begin a broader conversation with citizens.

7.7 Case studies will be co-produced with citizens and staff groups which will describe their experience now and how this should look in the future. The conversation with citizens will then be focused on the ideas and general direction of travel outlined in the Leeds Health and Care Plan and whether these are in line with the case studies. We will also invite them to comment and provide their views and opinions on what the specific changes need to occur that will deliver the desired outcomes. Where the work of the Leeds Health and Care Plan develops firm proposals for service changes, then, specific plans would be developed for formal engagement and/or consultation in line with the relevant partner(s) organisational governance and best practice.

7.8 A detailed communication and engagement plan is currently being developed and will be shared with the Leeds Health and Wellbeing Board for comment.

10

8. WORKFORCE 8.1 In order to deliver on the vision of the Leeds Health and Care Plan, Leeds needs to work

as if we are one organisation, growing our own workforce from our diverse communities, supported by leading and innovative workforce education, training and technology.

8.2 The Leeds Health and Care Plan champions the ‘Better conversations: A whole city

approach to working with people’ with citizens at the centre of all decisions. In Leeds we believe wellbeing starts with people; the connections, conversations and relationships between services and citizens and between people in their families and communities have a huge impact on us all. Quality conversations make a difference, especially when used positively by services to work ‘with’ people to find solutions rather than things being done ‘to’ people or ‘for’ them. Our commitment to working with people is about bringing these beliefs to life, by developing the skills and mind-set across Leeds’ health and care workforce to use solutions that work with people wherever it is safe, appropriate and the right thing to do.

8.3 The above work is being supported by Workforce Workstream Board, which includes

representation from across the health and care system.

9. EQUALITY IMPACT ASSESSMENT 9.1 Any future changes in service provision arising from this work will be subject to an equality

impact assessment. 10. ENVIRONMENTAL 10.1 The Leeds Health and Care Plan recognises the connections between our environment

and our health and the need to ensure that the physical environment, our employment and the community support around us are set up in a way that makes staying healthy the easiest thing to do and will influence this where possible.

11. RECOMMENDATION

The Leeds Health Commissioning and System Integration Board is asked to: (a) Consider the contents of the draft narrative for the Leeds Health and Care Plan and

provide feedback which can be incorporated into future iterations and in our conversation with citizens about the future of health and care in Leeds.

(b) Support and champion the Leeds Health and Care Plan and plans to progress a conversation with the public and wider workforce in a way that citizens and staff from across the partnership can relate to and which is accessible and understandable.

(c) Continue to support and champion the commitment ‘Better conversations: A whole city approach to working with people’.

(d) Ensure that Leeds Health and Wellbeing Strategy 2016-2021 and Leeds Health and Care Plan continue to be used to frame and drive forward the system integration work.

(e) Note the continued work that has taken place to date by NHS Leeds CCG officers to support the development of and implementation of the Leeds Health and Care Plan.

(f) Note that the Leeds Health and Wellbeing Board will continue to provide strategic leadership for the Leeds Health and Care Plan.

Leeds Health and Care Plan

By 2021, Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest

A plan that will improve health and wellbeing for all ages and for all of Leeds which will…

Protect the vulnerable and reduce inequalities Improve quality and reduce inconsistency Build a sustainable system within the reduced resources available

Our community health and care service providers, GPs, local authority, hospitals and commissioning organisations will work with citizens, elected members, volunteer, community and faith sector and our workforce to design solutions bottom up that…

Have citizens at the centre of all decisions and change the conversation around health and care

Build on the strengths in ourselves, our families and our community; working with people, actively listening to what matters most to people, with a focus on what’s strong rather than what’s wrong

Invest more in prevention and early intervention, targeting those areas that will make the greatest impact for citizens

Use neighbourhoods as a starting point to further integrate our social care, hospital and volunteer, community and faith sector around GP practices providing care closer to home and a rapid response in times of crisis

Takes a holistic approach working with people to improve their physical, mental and social outcomes in everything we do

Use the strength of our hospital in specialist care to support the sustainability of services for citizens of Leeds and wider across West Yorkshire

What this

means for me…

“Living a healthy life to keep myself well” “Health and care services working with me in my

community”

“Hospital care only when I need it” “I get rapid help when needed to allow me to return to

managing my own health in a planned way”

Key actions

that will be

undertaken…

1. We will promote awareness and develop services to ensure the Best Start (conception to age 2) for every baby, with early identification and targeted support early in the life of the child.

2. We will promote the benefits of physical activity and improve the environments that encourage physical activity to become part of everyday life.

3. We will maximise every opportunity to reduce the harm from tobacco and alcohol, including enhancing the contribution by health and care staff.

4. We will have new accessible, integrated services that support people to live healthier lifestyles and promote emotional health and wellbeing for all ages, with a specific focus on those at high risk of developing respiratory, cardio-vascular conditions.

5. We will have a new, locally-based community service, ‘Better Together’, that can better build everyday resilience and skills in our most vulnerable populations.

1. People living with severe breathing difficulties will know how to manage anxiety issues due to their illness and have a supportive plan about what’s important to them by December 2017.

2. People living with severe frailty will be supported to live independently at home whenever possible, instead of having to go in and out of hospital.

3. People at high risk of developing diabetes and those living with diabetes will have access to support programmes to give them the confidence and skills to manage their condition by December 2017.

4. We will take the best examples where health and care services are working together outside of hospital and make them available across Leeds, for example muscle and joint services.

1. Patients will stay the right time in hospital.

2. Patients with a mental health need will have their needs met in Leeds more often rather than being sent elsewhere to receive help.

3. We will meet more of patients’ needs locally by ensuring their GPs can easily get advice from the right hospital specialist.

4. We will ensure that patients get the right tests for their conditions.

5. We will reduce the visits patients need to take to hospital before and after treatment.

6. We will ensure that patients get the best value medicines.

1. We will review the ways that people currently access urgent health and social care services including the range of single points of access. The aim will be to make the system less confusing allowing a more timely and consistent response and when necessary appropriate referral into other services.

2. We will look at where and how people’s needs are assessed and how emergency care planning is delivered (including end of life) with the aim to join up services, focus on the needs of people and where possible maintain their independence.

3. We will make sure that when people require urgent care, their journey through urgent care services is smooth and that services can respond to increases in demand as seen in winter.

4. We will change the way we organise services by connecting all urgent health and care services together to meet the mental, physical and social needs of people to help ensure people are using the right services at the right time.

Together these actions will deliver a new vision for community services and primary care in every neighbourhood. These will be supported by…

Working as if we are one organisation, growing our own workforce from our

diverse communities, supported by leading and innovative workforce education,

training and technology

Having the best connected city using digital technology to improve health

and wellbeing in innovative ways

Using existing buildings more effectively, ensuring that they are right for the job Using our collective buying power to get the best value for our ‘Leeds £’ Making Leeds a centre for good growth becoming the place of choice in the

UK to live, to study, for businesses to invest in, for people to come and work

Draft version 2.2 | Date 03/07/17 Appendix A

1DRAFT Version 1.3 Jun 2017

LeedsThe best city for

health and wellbeing

DRAFT Version 1.3 Jun 2017

parsonsl01

Typewritten Text

parsonsl01

Typewritten Text

Appendix B

parsonsl01

Typewritten Text

In Leeds, as we grow up and as we grow old,

the people around us, the p

laces w

e liv

e in

, the

wo

rk w

e d

o, th

ew

ay w

e m

ove a

nd th

e

type of support we receive, will keepus healthier for longer. We will build

resilie

nce, live

hap

pier

, hea

lthie

r liv

es,

do the b

est

for

on

e a

no

ther

an

d p

rovi

de the b

est

car

e po

ssib

le.

Promote mental

and physical

health equally

=

10

Leeds Health and Wellbeing

Strategy 2016-2021

We have a bold ambition:

‘Leeds will be the best city for health and wellbeing’.

And a clear vision:

‘Leeds will be a healthy and

caring city for all ages,

where people who are the

poorest improve their

health the fastest’.

IndicatorsA Child Friendly

City and

the best

start

in life

11

A valued, well

trained and

supported

workforce

1

The best care,

in the right place,

at the right time12

People’s quality of life will

be improved by access to

quality services

People will live

longer and have

healthier lives

People will live

full, active and

independent lives

People will be actively

involved in their health

and their care

People will live in healthy,

safe and sustainable

communities

5 Outcomes

1.

2.

3.

4.

5.

12 Priority

areas

Support self-care,

with more people

managing their

own conditions

9

Strong,

engaged and

well-connected

communities

3

A strong

economy with

quality, local jobs

5

Get more

people, more

physically

active,

more

often

6

In our city…wellbeing starts with people and everything is connected

An Age Friendly

City where

people age well

A stronger focus

on prevention

8

Maximise the

benefits from

information and

technology

7

4

Housing

and the

environment

enable all

people of Leeds

to be healthy

2

• Infant mortality

• Good educationalattainment at 16

• People earning a Living Wage

• Incidents of domestic violence

• Incidents of hate crime

• People affording to heattheir home

• Young people in employment,education or training

• Adults in employment

• Physically active adults

• Children above ahealthy weight

• Avoidable years of life lost

• Adults who smoke

• People supported to managetheir health condition

• Children’s positive viewof their wellbeing

• Early death for people witha serious mental illness

• Employment of people witha mental illness

• Unnecessary time patientsspend in hospital

• Time older people spendin care homes

• Preventable hospitaladmissions

• Repeat emergency visitsto hospital

• Carers supported

DRAFT Version 1.3 Jun 2017 1

Leeds Health and Care Plan

By 2021, Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest

A plan that will improve health and wellbeing for all ages and for all of Leeds which will…

Protect the vulnerable and reduce inequalities Improve quality and reduce inconsistency Build a sustainable system within the reduced resources available

Our community health and care service providers, GPs, local authority, hospitals and commissioning organisations will work with citizens, elected members, volunteer, community and faith sector and our workforce to design solutions bottom up that…

Have citizens at the centre of all decisions and change the conversation around health and care

Build on the strengths in ourselves, our families and our community; working with people, actively listening to what matters most to people, with a focus on what’s strong rather than what’s wrong

Invest more in prevention and early intervention, targeting those areas that will make the greatest impact for citizens

Use neighbourhoods as a starting point to further integrate our social care, hospital and volunteer, community and faith sector around GP practices providing care closer to home and a rapid response in times of crisis

Takes a holistic approach working with people to improve their physical, mental and social outcomes in everything we do

Use the strength of our hospital in specialist care to support the sustainability of services for citizens of Leeds and wider across West Yorkshire

What this means for me…

“Living a healthy life to keep myself well” “Health and care services working with me in my community”

“Hospital care only when I need it” “I get rapid help when needed to allow me to return to managing my own health in a planned way”

Key actions that will be undertaken…

1. We will promote awareness and develop servicesto ensure the Best Start (conception to age 2) forevery baby, with early identification and targetedsupport early in the life of the child.

2. We will promote the benefits of physical activityand improve the environments that encouragephysical activity to become part of everyday life.

3. We will maximise every opportunity to reduce theharm from tobacco and alcohol, includingenhancing the contribution by health and carestaff.

4. We will have new accessible, integrated servicesthat support people to live healthier lifestyles andpromote emotional health and wellbeing for allages, with a specific focus on those at high risk ofdeveloping respiratory, cardio-vascular conditions.

5. We will have a new, locally-based communityservice, ‘Better Together’, that can better buildeveryday resilience and skills in our mostvulnerable populations.

1. People living with severe breathing difficulties willknow how to manage anxiety issues due to theirillness and have a supportive plan about what’simportant to them by December 2017.

2. People living with severe frailty will be supported to live independently at home whenever possible,instead of having to go in and out of hospital.

3. People at high risk of developing diabetes andthose living with diabetes will have access tosupport programmes to give them the confidenceand skills to manage their condition by December2017.

4. We will take the best examples where health andcare services are working together outside ofhospital and make them available across Leeds, forexample muscle and joint services.

1. Patients will stay the right time in hospital.

2. Patients with a mental health need will havetheir needs met in Leeds more often ratherthan being sent elsewhere to receive help.

3. We will meet more of patients’ needs locally byensuring their GPs can easily get advice fromthe right hospital specialist.

4. We will ensure that patients get the right testsfor their conditions.

5. We will reduce the visits patients need to taketo hospital before and after treatment.

6. We will ensure that patients get the best valuemedicines.

1. We will review the ways that people currentlyaccess urgent health and social care servicesincluding the range of single points of access. Theaim will be to make the system less confusingallowing a more timely and consistent response andwhen necessary appropriate referral into otherservices.

2. We will look at where and how people’s needs areassessed and how emergency care planning isdelivered (including end of life) with the aim to joinup services, focus on the needs of people andwhere possible maintain their independence.

3. We will make sure that when people require urgentcare, their journey through urgent care services issmooth and that services can respond to increasesin demand as seen in winter.

4. We will change the way we organise services byconnecting all urgent health and care servicestogether to meet the mental, physical and socialneeds of people to help ensure people are using theright services at the right time.

Together these actions will deliver a new vision for community services and primary care in every neighbourhood. These will be supported by…

Working as if we are one organisation, growing our own workforce from our diverse communities, supported by leading and innovative workforce education,

training and technology

Having the best connected city using digital technology to improve health and wellbeing in innovative ways

Using existing buildings more effectively, ensuring that they are right for the job Using our collective buying power to get the best value for our ‘Leeds £’ Making Leeds a centre for good growth becoming the place of choice in the UK to live, to study, for businesses to invest in, for people to come and work

Draft version 2.2 | Date 03/07/17

DRAFT Version 1.3 Jun 2017 2


Contents

Chapters Page No.

Chapter 1: Introduction 04-05

Chapter 2: Working with you: the role of citizens and communities in Leeds 06-08

Chapter 3: This is us: Leeds, a compassionate city with a strong economy 09-10

Chapter 4: The Draft Leeds Health and Care Plan: what will change and how will it affect me?

11-14

Chapter 5: So why do we want change in Leeds? 15-17

Chapter 6: How do health and care services work for you in Leeds now?

Chapter 7: Working with partners across West Yorkshire

Chapter 8: Making the change happen

18-22

23

24

Chapter 9: How the future could look… 25-26

Chapter 10: What happens next?

Chapter 11: Getting involved

27-28

29

3


Chapter 1 IntroductionLeeds is a city that is growing and changing. As the city and its citizens change, so will the need of those who live here.

Leeds is an attractive place to live, over the next 25 years the number of people is predicted to grow by over 15 per cent. We also live longer in Leeds than ever before. The number of people aged over 65 is estimated to rise by almost a third to over 150,000 by 2030. This is an incredible achievement but also means the city is going to need to provide more complex care for more people.

At the same time as the shift in the age of the population, more and more people (young and old) are developing long-term conditions such as #etes and other conditions related to lifestyle factors such as smoking, eating an unhealthy diet or being physically inactive.

Last year members of the Leeds Health and Wellbeing Board (leaders from health, care, the voluntary and community sector along and elected representatives of citizens in the city) setout the wide range of things we need to do to improve health and wellbeing in our city. This was presented in the Leeds Health and Wellbeing Strategy 2016-2021.

The Leeds Health and Wellbeing strategy is required by government to set out how we will achieve the best conditions in Leeds for people to live fulfilling lives – a healthy city with high quality services. Everyone in Leeds has a stake in creating a city which does the very best for its people. It is a requirement from government that local health and care services takeaccount of our Strategy in their spending and plans for services.

Leaders from the city’s health and care services, and members of the Health and Wellbeing Board now want to begin a conversation with citizens, businesses and communities about the improvement people want to see in the health and wellbeing of Leeds citizens, and ask if individuals and communities should take greater responsibility for our health and wellbeing and the health and wellbeing of those around us.

Improving the health of the city needs to happen alongside delivering more efficient, services to ensure financial sustainability and offer better value for tax payers.

The NHS in England has also said what it thinks needs to change for our health services when it presented the “Five Year Forward View for the NHS”. As well as talking about the role of citizens in improving the health and wellbeing of Leeds, the city’s Health and Wellbeing Board must also work with citizens to plan what health and care services need to do to meet these changes:

Health and Wellbeing Board members believe that too often care is organised aroundsingle illnesses rather than all of an individual’s needs and strengths and that thisshould change.Leaders from health and care also believe many people are treated in hospitals whenbeing cared for in their own homes and communities would give better results.

“When the NHS was set up in 1948, half of us died before the

age of 65.

Now, two thirds of the patients hospitals are looking after are

over the age of 65……lifeexpectancy is going up by five

hours a day”

Simon Stevens, Chief Executive NHS England

4


Services can sometimes be hard to access and difficult to navigate. Leeds will makehealth and care services more person-centred, joined-up and focussed on prevention.

Improving the health of the city needs to happen alongside delivering better value for tax payers and more efficient services. This is a major challenge.

What is clear is that nationally and locally the cost of our health and care system is rising faster than the money we pay for health and care services. Rising costs are partly because of extra demand (such as greater numbers of older people with health needs) and partly because of the high costs of delivering modern treatments and medicines.

If the city carries on without making changes to the way it manages health and care services, it would be facing a financial gap. Adding up the difference each year between the money available and the money needed, by 2021 the total shortfall would be around £700 million across Leeds.

As residents, health care professionals, elected leaders, patients and carers, we all want to see the already high standards of care that we have achieved in our city further improved tomeet the current and future needs of the population.

What is this document for?

We are publishing a Draft Leeds Health and Care Plan at a very early stage whilst ideas are developing. Ideas so far have been brought together from conversations with patients, citizens, doctors, health leaders, voluntary groups, local politicians, research and what has worked well in other areas. This gives everyone a start in thinking what changes may be helpful.

The Draft Leeds Health and Care Plan sets out initial ideas about how we could protect the vulnerable and reduce inequalities, improve care quality and reduce inconsistency and build a sustainable system with the reduced resources available. The key ideas are included at the front of this document; we want to help explain how we could make these changes happen.

This report contains a lot more information about the work of health and care professionals, your role as a citizen and the reasons for changing and improving the health and wellbeing of our city. Once you have taken a look we want to hear from you.

By starting a conversation together as people who live and work in Leeds we can begin creating the future of health and care services we want to see in the city.

We want you to consider the challenges and the plans for improving the health and wellbeing of everyone in Leeds. We want you to tell us what you think, so that together, we can make the changes that are needed to make Leeds the best city for health and wellbeing ensuringpeople are at the centre of all decisions.

Chapters 10 & 11 are where we set out what happens next, and includes information about how you can stay informed and involved with planning for a healthier Leeds.

5


The NHS Constitution

Patients and the public: our responsibilities

The NHS belongs to all of us. There are things that we can all do for ourselves and for one another to help it work effectively, and to ensure resources are used responsibly.

Please recognise that you can make a significant contribution to your own, and your family’s, good health and wellbeing, and take personal responsibility for it.

Chapter 2 Working with you: the role of citizens and communities in Leeds

Working with people

We believe our approach must be to work ‘with’ people rather than doing things ‘for’ or ‘to’ them. This is based on the belief that this will get better results for all of us and be more productive.

This makes a lot of sense. We know that most of staying healthy is the things we do every day for ourselves or with others in our family of community. Even people with complex health needs might only see a health or care worker (such as a doctor, nurse or care worker) for a small percentage of the time, it’s important that all of us, as individuals, have a good understanding of how to stay healthy when the doctor isn’t around.

This is a common sense or natural approach that many of us take already but can we do more? We all need to understand how we can take the best care of ourselves and each other during times when we’re at home, near to our friends, neighbours and loved ones.

Figure 1 on the next page, gives an indication of the new way in which health and care services will have better conversations with people and work with people.

Work health and care leaders have done together in Leeds has helped us to understand

where we could be better.

What we need to do now is work with the people of Leeds to jointly figure out how best to make the changes needed to improve, and the roles we will

all have in improving the health of the city.

6

In Leeds we believe wellbeing starts with people: The connections,

conversations and relationships between services and citizens and

between people in their families and communities have a huge impact on

us all.

Quality conversations make a difference, especially when used

positively by services to work ‘with’ people to find solutions rather than things being done ‘to’ people or ‘for’

them.

Our commitment to working with people is about bringing these beliefs

to life, by developing the skills and mind-set across Leeds’ health and

care workforce to use solutions that work with people wherever it is safe, appropriate and the right thing to do.

Working ‘with’ means…

Better conversations: A whole city approach to working with people

Focus on‘what’s strong’

rather than‘what’s wrong’

Actively listento what

matters mostto people

Start withpeople’s lived

experience

Put people atthe centre ofall decisions

Work aspartners to

achieveindividual

goals

Be‘restorative’.

Offer highsupport and

high challenge

Build on theassets in

ourselves, ourfamilies & ourcommunities



Joining things up

We all know good health for all of us is affected by the houses we live in, the air we breathe, the transport we use and the food that we eat. We know good health starts at birth and if we set good patterns early they continue for a life time. We know that physical and mental health are often closely linked and we need to treat them as one.

We need to recognise the connections between our environment and our health. This will mean ensuring that the physical environment, our employment and the community support around us are set up in a way that makes staying healthy the easiest thing to do.

It will mean working with teams in the city who are responsible for work targeted at children and families, planning and providing housing and the built environment, transport and others. It will also involve us working with charities, faith groups, volunteer organisations and businesses to look at what we can all do differently to make Leeds a healthier place in terms of physical, mental and social wellbeing.

Taking responsibility for our health

If we’re going to achieve our ambition to be a healthier happier city, then each of us as citizens will have a role to play too.

In some cases this might mean taking simple steps to stay healthy, such as taking regular exercise, stopping smoking, reducing the amount of alcohol we drink and eating healthier food.

As well as doing more to prevent ill health, we will all be asked to do more to manage our own health better and, where it is safe and sensible to do so, for us all to provide more care for ourselves. These changes would mean that people working in health and care services would take more time to listen, to discuss things and to plan with you so that you know what steps you and your family might need to take to ensure that you are able to remain as healthy and happy as possible, even if living with an on-going condition or illness.

This wouldn’t be something that would happen overnight, and would mean that all of us would need to be given the information, skills, advice and support to be able to better manage our own health when the doctor, nurse or care worker isn’t around.By better managing our own health, it will help us all to live more independent and fulfilled lives, safe in the understanding that world class, advanced health and care services are there for us when required.

This won’t be simple, and it doesn’t mean that health and care professionals won’t be there when we need them. Instead it’s about empowering us all as people living in Leeds to live lives that are longer, healthier, more independent and happier.

Working together, as professionals and citizens we will develop an approach to health and wellbeing that is centred on individuals and helping people to live healthy and independent lives.

Cycling just 30 miles aweek could reduce your risk

of cancer by 45%

That’s the same as riding to work from Headingley to the Railway Station each day.

8


Chapter 3 This is us: Leeds, a compassionate city with a strong economy

We are a city that is thriving economically and socially. We have the fastest growing city economy outside London with fast growing digital and technology industries.

Leeds City Council has been recognised as Council of the Year as part of an annual awards ceremony in which it competed with councils from across the country.

The NHS is a big part of our city, not only the hospitals we use but because lots of national bodies within the NHS have their home in Leeds, such as NHS England. We have one of Europe’s largest teaching hospitals (Leeds Teaching Hospitals NHS Trust) which in 2016 was rated as good in a quality inspection. The NHS in the city provides strong services in the community and for those needing mental health services.

Leeds has a great history of successes in supporting communities and neighbourhoods to be more self-supporting of older adults and children, leading to better wellbeing for older citizens and children, whilst using resources wisely to ensure that help will always be there for those of us who cannot be supported by our community.

The city is developing innovative general practice (GP / family doctor) services that are among the best in the country. These innovative approaches include new partnerships and ways of organising community and hospital skills to be delivered in partnership with your local GPs and closer to your home. This is happening at the same time as patients are being given access to extended opening hours with areas of the city having GPs open 7 days per week.

Leeds is also the first major UK city where every GP, healthcare and social worker can electronically access the information they need about patients through a joined-up health and social care record for every patient registered with a Leeds GP.

We have three leading universities in Leeds, enabling us to work with academics to gain their expertise, help and support to improve the health of people in the city.

Leeds is the third largest city in the UK and home to several of the world’s leading health technology and information companies who are carrying out research, development and manufacturing right here in the city. For example, we are working with companies like Samsung to test new ‘assistive technologies’ that will support citizens to stay active and to live independently and safely in their own homes.

The city is a hub for investment and innovation in using health data so we can better improve our health in a cost effective way. We are encouraging even more of this type of work in Leeds through a city-centre based “Innovation District”.

Leeds has worked hard to achieve a thriving ‘third sector’, made up of charities, community, faith and volunteer groups offering support, advice, services and guidance to a diverse range of people and communities from all walks of life.

9


The Reginald Centre in Chapeltown is a good example of howhealth, care and other council services are able to work jointly, in one place for the

benefit of improving community health and wellbeing.

The centre hosts exercise classes, a jobshop, access to education, various medical and dental services, a café, a bike library, and many standard council services such

as housing and benefits advice.

10


Chapter 4 The Draft Leeds Health and Care Plan: what will change and how will it affect me?

Areas for change and improvement

To help the health and care leaders in Leeds to work better together on finding solutions to the city’s challenges, they have identified four main priority areas of health and care on which to focus.

Prevention (“Living a healthy life to keep myself well”) – helping people to stay well and avoid illness and poorhealth.Some illnesses can’t be prevented but many can. We want to reduce avoidable illnesses caused by unhealthy lifestyles as far as possible by supporting citizens in Leeds to live healthier lives.

By continuing to promote the benefits of healthy lifestyles and reducing the harm done by tobacco and alcohol, we will keep people healthier and reduce the health inequalities that exist between different parts of the city.

Our support will go much further than just offering advice to people. We will focus on improving things in the areas of greatest need, often our most deprived communities, by providing practical support to people. The offer of support and services available will increase, and will include new services such as support to everyday skills in communities where people find it difficult to be physically active, eat well or manage their finances for example.

We will make links between healthcare professionals, people and services to make sure that everyone has access to healthy living support such as opportunities for support with taking part in physical activity.

Self-management (“Health and care services working with me in my community”) – providing help and support to people who are ill, or those who have on-goingconditions, to do as much as they have the skills and knowledge to look after themselves and manage their condition to remain healthy and independent while living normal lives at home with their loved ones.

People will be given more information, time and support from their GP (or family doctor) so

11


that they can plan their approach to caring for themselves and managing their condition, with particular support available to those who have on-going health conditions, and people living with frailty.

Making the best use of hospital care and facilities (“Hospital care only when I need it”)– access to hospital treatment when we need it is an important and limited resource, withlimited numbers of skilled staff and beds.

More care will be provided out of hospital, with greater support available in communities where there is particular need, such as additional clinics or other types of support for managing things like muscle or joint problems that don’t really need to be looked at in hospital. Similarly there will be more testing, screening and post-surgery follow-up services made available locally to people, rather than them having to unnecessarily visit hospital for basic services as is often the case now.

Working together, we will ensure that people staying in hospital will be there only for as long as they need to be to receive help that only a hospital can provide.

Reducing the length of time people stay in hospital will mean that people can return to their homes and loved ones as soon as it is safe to do so, or that they are moved to other places of care sooner if that is what they need, rather than being stuck in hospitals unnecessarily.

Staff, beds, medicines and equipment will be used more efficiently to improve the quality of care that people receive and ensure that nothing is wasted.

Urgent and Emergency Care (“I get rapid help when needed to allow me to return to managing my own health in a planned way”) – making sure that people with an urgent health or care need are supported and seen by the right team of professionals, in the right place for them first time. It will be much easier for people to know what to do when they need help straight away. Currently there are lots of options for people and it can be confusing for patients. As a result, not all patients are seen by the right medical professional in the right place.

For example, if a young child fell off their scooter and had a swollen wrist, what would you do? You could call your GP, dial 999 ring NHS111, drive to one of the two A&E units, visit the walk-in centre, drive to one of the two minor injuries units, visit your local pharmacy or even just care for them at home and see how they feel after having some rest, a bag of frozen peas and some Calpol.

Given the huge range of options and choices available, it’s no wonder that people struggle to know what to do when they or their loved ones have an urgent care need.

We want to make this much simpler, and ensure that people know where to go and what to do so that they’re always seen by the right people first time.

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GP and Primary Care Changes

The biggest and most important idea to help with the above is to really change services tobeing more joined up around you – more integrated and more community focused.

The most important place to do this is in our communities and neighbourhoods themselves. Itstarts with recognising how communities can keep us healthy – through connecting us withactivity, work, joining in with others and things that help gives us a sense of wellbeing. GPs, (primary care) nurses and other community services such as voluntary groups working closer as one team could focus better on keeping people healthy and managing their own health.We could also use health information better to target those at risk of getting ill and interveningearlier.

This will mean our whole experience of our local health service (or other community servicessuch as a social worker) could change over time. We may find that in future we see differentpeople at the GP to help us – for instance a nurse instead of a Doctor and we would have to spend less time travelling or talking to different services to get help. We may get more joined up help for housing, benefits and community activities through one conversation. It is likelythat to do this GPs need to join some of their practices together to share resources, staff andpremises to make sure they can work in this new way. Other health, care and communityservices will need to join in with the approach. We will all still be on our own GP list and have our own named doctor though – that will not change.

This big change would mean we would need to ensure we train our existing and futureworkforces to work with you in new ways. The approach would also use new technologies tohelp you look after your own wellbeing and help professionals to be more joined up.

The approach will bring much of the expertise of hospital doctors right into communityservices which would mean less referral to specialists and ensuring we do as much as wecan in your community. This should mean fewer visits to hospital for fewer procedures.

Getting all of this right will help people be healthier and happier. It will mean we will furtherreduce duplication in the way that we spend money on care. Figure 2 shows how our use ofthe money available for heath and care in Leeds might change. Note the shift towards more investment in Public Health where money will be used to encourage and support healthierlives for people in Leeds.

13


Figure 2 – An indicative view of the way that spending on the health and care system in Leeds may change

14


Chapter 5 So why do we want change in Leeds?

Improving health and wellbeing

Most of us want the best health and care.

Most health and care services in Leeds are good. However, we want to make sure we are honest about where we can improve and like any other service or business, we have to look at how we can improve things with citizens.

Working together with the public, with professionals working in health and care and with the help of data about our health and our health and care organisations in the city, we have set out a list of things that could be done better and lead to better results for people living in Leeds.

This will mean improving the quality of services, and improving the way that existing health and care services work with each other, and the way that they work with individuals and communities.

We want to share our ideas with people in Leeds to find out whether citizens agree with the priorities in this plan. Citizens will be asked for their views and the information we receive will help us to improve the initial ideas we have and help us to focus on what is of greatest importance to the city and its people.

What we need to do now is work with people in the city to jointly figure out how best to make the changes and the roles we will all have in improving the health of the city.

Three gaps between the Leeds we have, and the Leeds we want

1. Reducing health inequalities (the difference between the health of one group ofpeople compared with another)

Reducing the number of early deaths from cancer and heart disease, both of whichare higher in Leeds than the average in EnglandClosing the life expectancy gap that exists between people in some parts of Leeds andthe national averageReducing the numbers of people taking their own lives. The number of suicides isincreasing in the city.

2. Improving the quality of health and care services in LeedsImproving the quality of mental health care, including how quickly people are able toaccess psychological therapy when they need itImproving the reported figures for patient satisfaction with health and care servicesMaking access to urgent care services easier and quicker

10 years:The difference in life

expectancy between people in Hunslet and Harewood

15


Reducing the number of people needing to go into hospitalReducing the number of people waiting in hospital after they’ve been told they’remedically fit to leave hospitalEnsuring that enough health and care staff can be recruited in Leeds, and that staffcontinue working in Leeds for longer (therefore making sure that health and careservices are delivered by more experienced staff who understand the needs of thepopulation)Improving people’s access to services outside normal office hours.

3. Ensuring health and care services are affordable in the long-termIf we want the best value health services for the city then we need to question how ourmoney can best be spent in the health and care system. Hospital care is expensive for eachperson treated compared to spending on health improvement and prevention. We need tomake sure that we get the balance right to ensure we improve people’s health in a muchmore cost effective way.

We believe the health and wellbeing of citizens in Leeds will be improved through more efficient services investing more thought, time, money and effort into preventing illness and helping people to manage on-going conditions themselves. This will help prevent more serious illnesses like those that result in expensive hospital treatment.

We think we can also save money by doing things differently. We will make better use of our buildings by sharing sites between health and care and releasing or redeveloping underused buildings. A good example of this is the Reginald Centre in Chapeltown.

Better joint working will need better, secure technology to ensure people get their health and care needs met. This might be through better advice or management of conditions remotely to ensure the time of health and care professionals is used effectively. For example having video consultations may allow a GP to consult with many elderly care home patients and their carers in a single afternoon rather than spending lots of time travelling to and from different parts of the city.

We plan to deliver better value services for tax payers in Leeds by making improvements to the way that we do things, preventing more illness, providing more early support, reducing the need for expensive hospital care and increasing efficiency.

Changing the way that we work to think more about the improvement of health, rather than just the treatment of illness, will also mean we support the city’s economic growth - making the best use of every ‘Leeds £’.

This will be important in the coming years, as failure to deliver services in a more cost effective way would mean that the difference between the money available and the money spent on health and care services in Leeds would be around £700 million.

Preventable Diabetescosts taxpayers in Leeds

£11,700 every hour

16


This means if Leeds does the right things now we will have a healthier city, better services and ensure we have sustainable services. If we ignored the problem then longer term consequences could threaten:

A shortage of money and staffshortages

Not enough hospital beds

Longer waiting times to see specialists

Longer waiting times for surgery

Higher levels of cancelled surgeriesLonger waiting times for GPappointments

Longer waiting times in A&E

Poorer outcomes for patients

None of us wants these things to happen to services in Leeds which is why we’re working now to plan and deliver the changes needed to improve the health of people in the city and ensure that we have the health and care services we need for the future.

This is why we are asking citizens of Leeds, along with people who work in health and care services and voluntary or community organisations in the city to help us redesign the way we can all plan to become a healthier city, with high quality support and services.

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Chapter 6 How do health and care services work for you in Leeds now?

Our health and care service in Leeds are delivered by lots of different people and different organisations working together as a partnership. This partnership includes not only services controlled directly by the government, such as the NHS, but also services which are controlled by the city council, commercial and voluntary sector services.

The government, the Department of Health and the NHS

The department responsible for NHS spending is the Department of Health. Between the Department of Health and the Prime Minister there is a Secretary of State for Health. GPs were chosen by Government to manage NHS budgets because they’re the people that see patients on a day-to-day basis and arguably have the greatest all-round understanding of what those patients need as many of the day to day decisions on NHS spending are made by GPs.

Who decides on health services in Leeds? The role of ‘Commissioners’

About £72 billion of the NHS £120 billion budget is going to organisations called Clinical Commissioning Groups, or CCGs. They’re made up of GPs, but there are also representatives from nursing, the public and hospital doctors.

The role of the CCGs in Leeds is to improve the health of the 800,000 people who live in the city. Part of the way they do it is by choosing and buying – or commissioning - services for people in Leeds.

They are responsible for making spending decisions for a budget of £1.2bn.

CCGs can commission services from hospitals, community health services, and the private and voluntary sectors. Leeds has a thriving third sector (voluntary, faith and community groups) and commissioners have been able to undertake huge amounts of work with communities by working with and commissioning services with the third sector.

As well as local Leeds commissioning organisations, the NHS has a nationwide body, NHS England, which commissions ‘specialist services’. This helps ensure there is the right care for health conditions which affect a small number of people such as certain cancers, major injuries or inherited diseases.

Caring for patients – where is the health and care money spent on your behalf in Leeds?

Most of the money spent by the local NHS commissioners in Leeds, and by NHS England as part of their specialist commissioning for people in Leeds is used to buy services provided by four main organisations or types of ‘providers’, these include:

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GPs (or family doctor) in LeedsGPs are organised into groups of independent organisations working across Leeds. Most people are registered with a GP and they are the route through which most of us access help from the NHS.

Mental Health Services in LeedsLeeds and York Partnership NHS Foundation Trust (LYPFT) provides mental health and learning disability services to people in Leeds, including care for people living in the community and mental health hospital care.

Hospital in LeedsOur hospitals are managed by an organisation called Leeds Teaching Hospitals NHS Trust which runs Leeds General Infirmary (the LGI), St James’s Hospital and several smaller sites such as the hospitals in Wharfedale, Seacroft and Chapel Allerton.

Providing health services in the community for residents in LeedsThere are lots of people in Leeds who need some support to keep them healthy, but who don’t need to be seen by a GP or in one of the city’s large, hospitals such as the LGI or St James. For people in this situation Leeds Community Healthcare NHS Trust provides many community services to support them.

Services include the health visitor service for babies and young children, community nurse visits to some housebound patients who need dressings changed and many others.

Who else is involved in keeping Leeds healthy and caring for citizens?As well as the money spent by local NHS commissioners, Leeds City Council also spends money on trying to prevent ill health, as well as providing care to people who aren’t necessarily ill, but who need support to help them with day to day living.

Public health – keeping people well and preventing ill healthPublic health, or how we keep the public healthy, is the responsibility of Leeds City Council working together with the NHS, Third Sector and other organisations with support and guidance from Public Health England.

Public Health and its partners ensure there are services that promote healthy eating, weight loss, immunisation, cancer screening and smoking cessation campaigns from Public Health England and national government.

Social care - supporting people who need help and supportSocial care means help and support - both personal and practical - which can help people to lead fulfilled and independent lives as far as possible. Social care covers a wide range of services, and can include anything from help getting out of bed and washing, through to providing or commissioning residential care homes, day service and other services that support and maintain people’s safety and dignity.

Mental Health affects many people over their lifetime. It is estimated that 20% of all days of work lost are through mental

health, and 1 in 6 adults is estimated to have a common

mental health condition.

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It also includes ensuring people’s rights to independence and ensuring that choice and control over their own lives is maintained, protecting (or safeguarding) adults in the community and those in care services.

Adult social care also has responsibility forensuring the provision of good quality care to meet the long-termand short-term needsof people in the community, the provision of telecare, providing technology to supportindependent living, occupational therapy and equipment services.

Lots of questions have been asked about whether the government has given enough moneyfor social care, and how it should be paid for.

During 2016/17 Leeds City Council paid for long term packages of support to around 11,000people.

Approximately 4,230 assessments of new people were undertaken during the 2016/17 with around 81.5% or 3,446 of these being found to be eligible to receive help.

Leeds City Council commissions permanent care home placements to around 3,000 people at any time, and around 8,000 people are supported by Leeds Adult Social Care to continue living in their communities with on-going help from carers.

Figure 3, shows how the local decision makers (NHS Commissioners and Leeds Citycouncil) spend health and care funding on behalf of citizens in Leeds.

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Figure 3 – Indicative spending of health and care funding in Leeds

Children and Families Trust Board The Children and Families Trust Board brings together senior representatives from the keypartner organisations across Leeds who play a part in improving outcomes for children andyoung people.

They have a shared commitment to the Leeds Children & Young People’s Plan; the vision forLeeds to be the best city in the UK for children and young people to grow up in, and to be aChild Friendly city that invests in children and young people to help build a compassionatecity with a strong economy.

In Leeds, the child and family is at the centre of everything we do. All work with children and young people starts with a simple question: what is it like to be a child or young person growing up in Leeds, and how can we make it better?

The best start in life provides important foundations for good health. Leeds understands theimportance of focussing on the earliest period in a child’s life, from pre-conception to age two,in order to maximise the potential of every child.

The best start in life for all children is a shared priority jointly owned by the Leeds Health and Wellbeing Board and the Children & Families Trust Board through the Leeds Best Start Plan;a broad collection of preventative work which aims to ensure a good start for every baby.

Under the Best Start work in Leeds, babies and parents benefit from early identification andtargeted support for vulnerable families early in the life of the child. In the longer term, this willpromote social and emotional capacity of the baby and cognitive growth (or the developmentof the child’s brain).

Amount (£m)

Hospital Care

Mental Health

Public Health

GPs

Community HealthCare

Social Care

Other

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By supporting vulnerable families early in a child’s life, the aim is to break the cycles of neglect, abuse and violence that can pass from one generation to another.

The plan has five high-level outcomes:

Healthy mothers and healthy babiesParents experiencing stress will be identified early and supportedWell prepared parentsGood attachment and bonding between parent and childDevelopment of early language and communication

Achieving these outcomes requires action by partners in the NHS, Leeds City Council and the third sector. A partnership group has been established to progress this important work.

Leeds Health and Wellbeing BoardThe Health and Wellbeing Board helps to achieve the ambition of Leeds being a healthy and caring city for all ages, where people who are the poorest, improve their health the fastest.

The Board membership comprises Elected Members and Directors at Leeds City Council,Chief Executives of our local NHS organisations, the clinical chairs of our Clinical Commissioning Groups, the Chief Executive of a third sector organisation, Healthwatch Leeds and a representative of the national NHS. It exists to improve the health and wellbeing of people in Leeds and to join up health and care services. The Board meets about 8 times every year, with a mixture of public meetings and private workshops.

The Board gets an understanding of the health and wellbeing needs and assets in Leeds by working on a Joint Strategic Needs Assessment (JSNA), which gathers lots of information together about people and communities in the city.

The Board has also developed a Health and Wellbeing Strategy which is about how to put in place the best conditions in Leeds for people to live fulfilling lives – a healthy city with high quality services. Everyone in Leeds has a stake in creating a city which does the very best for its people. This strategy is the blueprint for how Leeds will achieve that. It is led by the partners on the Leeds Health and Wellbeing Board and it belongs to everyone in the city.

Healthwatch LeedsPeople and patients are at the heart of our improvement in health. This means their views are at the heart of how staff and organisations work and that they are at the heart of our strategy.

Healthwatch Leeds is an organisation that’s there to help us get this right by supporting people’s voices and views to be heard and acted on by those who plan and deliver services in Leeds.

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Chapter 7 Working with partners across West Yorkshire

Leeds will make the most difference to improving our health by working together as a city, for the benefit of people in Leeds.

There are some services that are specialist, and where the best way to reduce inequalities, improve the quality of services and ensure their financial sustainability is to work across a larger area. In this way we are able to plan jointly for a larger population and make sure that the right services are available for when people need them but without any duplication or waste.

NHS organisations and the council in Leeds are working with their colleagues from the other councils and NHS organisations from across West Yorkshire to jointly plan for those things that can best be done by collaborating across West Yorkshire.

This joint working is captured in the West Yorkshire and Harrogate Sustainability and Transformation Plan (STP).

The West Yorkshire and Harrogate STP has identified nine priorities for which it will work across West Yorkshire to develop ideas and plan for change, these are:

PreventionPrimary and community servicesMental healthStrokeCancerUrgent and emergency careSpecialised servicesHospitals working togetherStandardisation of commissioning policies

The West Yorkshire and Harrogate STP is built from six local area plans: Bradford District & Craven; Calderdale; Harrogate & Rural District; Kirklees; Leeds and

Wakefield. This is based around the established relationships of the six Health and Wellbeing Boards and builds on their local health and wellbeing strategies. These six

local plans are where the majority of the work happens.

We have then supplemented the plan with work done that can only take place at a West Yorkshire and Harrogate level. This keeps us focused on an important principle

of our STP - that we deal with issues as locally as possible

23


Chapter 8Making the change happen

The work to make some changes has already started. However, we don’t yet have all of the answers and solutions for exactly how we will deliver the large changes that will improve the health and wellbeing of people in Leeds.

This will require lots of joint working with professionals from health and care, and importantlylots of joint working with you, the public as the people who will be pivotal to the way we do things in future.

We will work with partners from across West Yorkshire to jointly change things as part of the West Yorkshire and Harrogate STP (where it makes sense to work together across thatlarger area). Figure 4 (below) shows the priorities for both plans.

Figure 4: Draft Leeds Health and Care Plan & West Yorkshire & HarrogateSTP priorities

Draft Leeds Health and Care Plan

1. Prevention

2. Self-Management

3. Making the best useof hospital care andfacilities

4. Urgent andEmergency Care

West Yorkshire & Harrogate STP

1. Prevention2. Primary and community

services3. Mental health4. Stroke5. Cancer6. Urgent and emergency care7. Specialised services8. Hospitals working together9. Standardisation of

commissioning policies

24


Chapter 9 How the future could look…

We haven’t got all the answers yet, but we do know what we would like the experiences and outcomes of people in Leeds to look like in the future.

We have worked with patient groups and young people to tell the stories of 8 Leeds citizens, and find out how life is for them in Leeds in 2026, and what their experience is of living in the best city in the country for health and wellbeing.

*NOTE - This work is on-going 1 story is presented here for information.Upon completion, we will have graphic illustrations in videos produced for each of the

cohorts:

1. Healthy children

2. Children with long term conditions (LTC)

3. Healthy adults –occasional single episodes of planned and unplanned care

4. Adults at risk of developing a LTC

5. Adults with a single LTC

6. Adults with multiple LTCs

7. Frail adults - Lots of intervention

8. End of Life – Support advice and services in place to help individuals and theirfamilies through death

9. We will also be developing health and care staff stories

25


Present Day 2016 Fast Forward to 2026“It’s a rare genetic condition that affects the collagen build-up in your body and it results in dislocating bones and other related conditions like Fibromyalgia (another long-term condition that causes pain all over the body, heightened sensitivity to pain and extreme tiredness), pots, irritable bowel syndrome, and several other conditions. I suffer with all of them.”

“I have access to up to date information about my conditions and I have wearable technology that helps me keep track of my health and better manage my own condition.”

“I spend all of my life in and out of hospitals for appointments and surgery all across the country.”

“I have video conferences with the health professionals involved in my care together, so that all my conditions are discussed at the same time.”

“I wish there would be a better all-round approach to these types of conditions, for example I’ve got ten different consultants all across the country.

I’ve got one in York for my wrist, I’ve got one in Bristol for my Knee, I’ve got one in Leeds for my foot, it’s mad.”

“My appointments are fitted around my life and when I need an operation, I can pick where it happens.”

“I believe that having better communication between departments and maybe a better filing system about patient information would make things like this a lot easier so that people don’t have to go in and explain the case to every single person that they see.”

“All my health and care information is kept in one central place. I can access it whenever I like, and choose who to share it with. This way, those involved in my care will have all the information they need to treat me.”

“The doctor I was speaking with during my last visit said that things have been much better since everyone in Leeds began sharing access to all records. They used to have to phone up each time they wanted information, and even sent faxes. Now they can get what they need straight away. This doctor was saying it saves the hospitals more than £1m a year because they don’t have to waste time phoning round and chasing people for information.”

Patient Story – Claire, 24, MiddletonClaire has multiple long-term conditions and needs on-going support to manage these“Hi, my name’s Claire. I’m 24 years old and I’ve suffered with quite a rare condition called Ehlers Danlos syndrome all my life.”

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Chapter 10 What happens next?The Leeds Health and Care Plan is really a place to pull together lots of pieces of work that are being done by lots of health and care organisations in Leeds.

Pulling the work together, all into one place is important to help health care professionals, citizens, politicians and other interested stakeholders understand the ‘bigger picture’ in terms of the work being done to improve the health of people in the city.

Change is happening alreadyMuch of this work is already happening as public services such as the NHS and the Council are always changing and trying to improve the way things are done.

Because much of the work is on-going, there isn’t a start or an end date to the Leeds plan in the way that you might expect from other types of plan. Work will continue as partners come together to try and improve the health of people in the city, focussing on some of the priority areas we looked at in Chapter 4.

Involving you in the plans for changeWe all know that plans are better when they are developed with people and communities; our commitment is to do that so that we can embed the changes and make them a reality.

We will continue to actively engage with you around any change proposals, listening to what you say to develop our proposals further.

We are starting to develop our plans around how we will involve, engage and consult with all stakeholders, including you, and how it will work across the future planning process and the role of the Health and Wellbeing Boards.

Working with HealthwatchPlanning our involvement work will include further work with Healthwatch and our voluntary sector partners such as Leeds Involving People, Voluntary Action Leeds, Volition and many others to make sure we connect with all groups and communities.

When will changes happen?While work to improve things in Leeds is already happening, it is important that improvements happen more quickly to improve the health of residents and the quality and efficiency of services for us all.

Joint workingWorking together, partners of the Health and Wellbeing Board in Leeds will continue to engage with citizens in Leeds to help decide on the priorities for the city, and areas that we should focus on in order to improve the health of people living in Leeds.

Alongside the Health and Wellbeing Board, the heads of the various health and care organisations in the city will work much more closely through regular, joint meetings of the Partnership Executive Group (a meeting of the leaders of each organisation) to ensure that there is a place for the more detailed planning and delivery of improvements to health and care in the city.

27


Who will make decisions? Ultimately, there will be lots of changes made to the way that health and care services work in Leeds. Some of these will be minor changes behind the scenes to try and improve efficiency.

Other changes will be more significant such as new buildings or big changes to the way that people access certain services.

The planning of changes will be done in a much more joined up way through greater joint working between all partners involved with health and care services in the city (including citizens). Significant decisions will be discussed and planned through the Health and Wellbeing Board. Decision making however will remain in the formal bodies that have legal responsibilities for services in each of the individual health and care organisations.

Legal duties to involve people in changesLeeds City Council and all of the NHS organisations in Leeds have separate, but similar, obligations to consult or otherwise involve the public in our plans for change.

For example, CCGs are bound by rules set out in law, (section 14Z2 of the NHS Act 2006, as amended by the Health and Social Care Act 2012).

This is all fairly technical, but there is a helpful document that sets out the advice from NHS England about how local NHS organisations and Councils should go about engaging local people in plans for change.

The advice can be viewed here:

https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf

NHS organisations in Leeds must also consult the local authority on ‘substantial developments or variation in health services’. This is a clear legal duty that is set out inS244 of the NHS Act 2006.

ScrutinyAny significant changes to services will involve detailed discussions with patients and the public, and will be considered by the Scrutiny Board (Adult Social Services, Public Health and the NHS). This is a board made up of democratically elected councillors in Leeds, whose job it is to look at the planning and delivery of health and care services in the city, and consider whether this is being done in a way that ensures the interests and rights of patients are being met, and that health and care organisations are doing things according to the rules and in the interests of the public.

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Chapter 11 Getting involved

Sign up for updates about the Draft Leeds Health and Care Plan

*NOTE –Final version will include details of how to be part of the Big Conversation

Other ways to get involvedYou can get involved with the NHS and Leeds City Council in many ways locally.

1. By becoming a member of any of the local NHS trusts in Leeds:Main Hospitals: Leeds Teaching Hospitals Trust -http://www.leedsth.nhs.uk/members/becoming-a-member/

Mental Health: Leeds & York Partnership Foundation Trust -http://www.leedsandyorkpft.nhs.uk/membership/foundationtrust/Becomeame

mberLeeds Community Healthcare Trust –http://www.leedscommunityhealthcare.nhs.uk/working-together/active-and-

involved/

2. Working with the Commissioning groups in Leeds by joining our PatientLeaderprogramme:https://www.leedswestccg.nhs.uk/content/uploads/2015/11/Patient-leader-leaflet-MAIN.pdf

3. Primary Care –Each GP practice in Leeds is required to have a PatientParticipation GroupContact your GP to find out details of yours. You can also attend your local PrimaryCare Commissioning Committee, a public meeting where decisions are made aboutthe way that local NHS leaders plan services and make spending decisions about GPservices in your area.

4. Becoming a member of Healthwatch Leeds or Youthwatch Leeds:http://www.healthwatchleeds.co.uk/content/help-us-outhttp://www.healthwatchleeds.co.uk/youthwatch

29

1


NHS Leeds CCGs Partnership - Leeds Health Commissioning & System Integration

Board Meeting


Title: System Integration Update paper

Lead Board Member: Nigel Gray, Chief Officer System Integration


appropriate

()

Report Author: Gina Davy, Becky Barwick and Martin Wright

Decision

Reviewed by EMT/SMT/Date: N/A

Discussion

Reviewed by Committee/Date: N/A

Information

Checked by Finance (Y/N/N/A - Date): N/A










Y – 2.3

Financial Implications Y – 2.3

Communication and Involvement Issues Y – 2.1 & 8

Workforce Issues Y – 2.4


NA

Environmental Issues NA


NA

2

EXECUTIVE SUMMARY: The paper provides an update on the positive progress made by the System Integration (SI) function since it was established in April 2017. The purpose of the System Integration function is to lead and facilitate the establishment of a Population Health Management (PHM) approach across the Leeds Health and Care system by developing system relationships; facilitating joint accountability; enabling a shift to a population approach to commissioning and provision; developing a risk and gain share approach across the system and supporting leaders to drive system change. In the first three months, the initial focus of SI has been in four key areas: 1) Establishing understanding and building relationships 2) Creating a Blueprint and Roadmap to establish PHM 3) Supporting the development of new financial and commercial arrangements 4) Supporting development of new workforce model Through the CCG’s existing contract with eMBED, the SI function has been working with a consultancy firm, BDO, to develop a ‘Blueprint’ and Roadmap for establishing PHM in Leeds. The draft Blueprint identifies four key challenges and associated solutions to accelerating a PHM approach to commissioning and provision across Leeds. The draft Blueprint has been shared and further developed through discussions with system leaders and in key strategic meetings including SMT, ICE and most recently at PEG where support for the emerging recommendations was confirmed.

NEXT STEPS:

• Draft blueprint to be circulated to members of Partnership Executive Group for comment (end July)

• SI function with BDO to support individual organisations to position and frame the Blueprint internally (July – August)

• Amendments made as needed (August) • Blueprint to return for sign off at next PEG (September) • Blueprint presented at Board to Board (September) • Blueprint presented to Health and Wellbeing Board to provide final sign off

(September)

RECOMMENDATION: The Leeds Health Commissioning and System Integration Board is asked to:

• Receive and note the update contained within this paper. • Note and support the content and emerging recommendations of the Blueprint. • Ensure that decisions made by the Strategic commissioning and System Integration

Board support and reflect the move towards a Population Health Management approach across Leeds.

3

Leeds Health Commissioning and System Integration Board – 26th July 2017

System Integration Update Paper

1. Context & Background

The Leeds Health and Wellbeing Strategy 2016-2021 sets out a clear objective to improve health

and care services for Leeds. It highlights a priority that care will be transformed so that people

receive the best care, in the right place at the right time. Care will be personalised and more care

will be provided in peoples own homes whilst making the best use of collective resources to

ensure sustainability.

Achieving the ambition set out in the Leeds Health and Wellbeing Strategy will require the Leeds

Health and care system to close the recognised gaps in health and wellbeing, care and quality and

funding and efficiency.

Nationally and internationally, there is increasing recognition that traditional approaches to

commissioning and provision can, in themselves, be a barrier to reducing the gaps in health and

care. Multiple commissioners contracting units of activity or segments of care pathways from

different providers often results in duplication of activities, gaps in care and a lower likelihood of

people experiencing improved health and care outcomes.

There is awareness across the Leeds Health and Care Systems that we need to change the way

we work to achieve better outcomes for local populations. Commissioners need to contract for

improved outcomes for populations of people with similar needs, as opposed to ‘widgets’ of activity

or sections of care pathways. At the same time,

providers need to work more closely to be jointly

accountable for delivering these outcomes within an

agreed budget and timeframe. This different approach to

commissioning and provision is referred to as a

Population Health Management approach (see figure 1).

A key objective of the One Voice programme,

undertaken across the Leeds CCGs from Autumn 2017,

was to support the move towards a Population Health

Management (PHM) approach across Leeds. The

formation of the Leeds Clinical Commissioning

Partnership across the Leeds CCGs will enable the

establishment of a PHM approach through:

Establishing a Strategic Commissioning function, integrating previously separate

commissioning teams and functions.

Establishing a System Integration function to proactively establish a PHM approach by

facilitating a move to commissioning for population level outcomes alongside the

development of providers to deliver population level outcomes through accountable care

arrangements.

Figure 1 – Population Health Management Approach

4

At the same time, providers across the city are working together more closely than ever before

through the Leeds Provider Network which includes representation from all providers including the

Third Sector and General Practice.

2) The System Integration Function – Focus and Progress since April 2017.

The System Integration (SI) function was established from April 2017 and is led by Nigel Gray,

Chief Officer for System Integration with a small team and support from Clinical Leadership, Public

Health, Business Intelligence and other key functions from within Strategic commissioning and the

Local Authority (see Figure 2).

The role of SI is to lead and facilitate the establishment of a PHM approach across the Leeds

Health and Care system by:

Developing system relationships: Between providers, between commissioners and between

commissioners and providers.

Facilitating joint accountability: To enable providers to be jointly accountable for the delivery of population outcomes set by the strategic commissioners. This requires a range of new ways of working including new approaches to the management of financial and clinical risk between providers.

Enabling a shift to a population approach to commissioning and provision: Working with commissioners and providers to agree a phased approach to commissioning for population level outcomes whilst simultaneously ensuring current (non-population based) approaches to commissioning develop in line with wider PHM principles.

Developing a risk and gain share approach across the system: Establishing a PHM approach requires detailed analysis and modelling of impact on existing and future commissioner, provider and system financial flows as well as agreed principles on the sharing of risks and gain.

Supporting leaders to drive system change: Establishing a PHM approach requires strong and clear leadership at both organisational level and at system level.

Figure 2 – System Integration Function

5

A significant amount of work has been undertaken by SI in the first three months since its

establishment. The initial focus of SI has been in four key areas:

1) Establishing understanding and building relationships

2) Creating a Blueprint and Roadmap to establish PHM

3) Supporting the development of new financial and commercial arrangements

4) Supporting development of new workforce models

The following sections will describe progress made within these areas in greater detail.

2.1 Developing understanding and building relationships

The concept of moving towards a Population Health Management approach has been discussed,

in theoretical terms, within multiple commissioner, provider and system forums over the last 18

months. However, the establishment of the SI function, and its mandate to facilitate the system to

move from theory into practice has required an intensive period of stakeholder engagement,

relationship building and specific development activities with commissioning, provider and partner

organisations across Leeds. A non-exhaustive summary of key engagement activities undertaken

is provided below.

Commissioning Provider Partner System Leaders

Presentation and discussion of emerging Blueprint at Integrated Commissioning Executive – appetite and energy to progress.

SI provides summary and update as standing item on Leeds Clinical Commissioning Partnership Senior Management Team Meeting.

Two of three workshops on outcomes based commissioning delivered for CCG commissioning teams.

Facilitated ‘Provider Away Day’ for >30 representatives of Leeds provider organisations. Huge energy and appetite to progress towards accountable care working and PHM approach.

SI Presentations to all three CCG GP members forums.

SI Presentation on PHM, segmentation and commissioning for outcomes as part of LCH Board workshop.

SI presentation and initial feedback of 1:1 discussions to citywide DoFs.

Presentation and discussion at Healthwatch Board workshop.

Site visits undertaken by members of SI team to learn from approach undertaken in Nottingham, Salford and Stockport.

Informal Scrutiny Briefing.

Presentation and discussion at Health and Wellbeing Board – support for direction of travel.

Presentation and discussion with Partnership Executive Group – support for recommendations in emerging Blueprint.

Establishment of citywide Population Health Management Group to bring commissioners and providers together to progress PHM

6

Key themes emerging through the discussions within the forums above include:

Strong overall understanding and support to progress a Population Health Management

approach across Leeds.

Commence work to commission for population outcomes for an initial population segment.

The importance of working alongside citizens to ensure local understanding of the way in which

services will need to change in future e.g. the development of extended primary care teams

may mean that people will see the most appropriate professional for their needs and that this

may not always be a GP.

The need to develop new workforce models and employment frameworks that enable

professionals to work seamlessly across different organisations

The huge opportunity, afforded through longer term outcomes based contracts, to realign

resources into prevention and sell management approaches.

2.2 Creating a Blueprint and Roadmap to establish PHM.

A key priority for SI has been to develop a ‘blueprint’ to identify and describe:

How a PHM approach could be practically established across the Leeds.

The extent to which the system is currently aligned and ready to progress this approach.

The challenges and opportunities to the delivery of the approach and how these could be

addressed.

A clear roadmap with timeframes for implementation of PHM.

Through the CCG’s existing contract with eMBED, BDO were commissioned to deliver an 8 week

project, (on track to complete at the end of July) to work with SI to develop the Blueprint. BDO,

who have recently worked with New York and Stockport health and care systems to establish

PHM, have worked closely with SI to drive the development and socialisation of the draft PHM

Blueprint for Leeds which is outlined in the following section 3.

2.3 Supporting the development of new financial and commercial arrangements

System alignment – Finance Leaders

Finance can sometimes be seen as a blocker to transformational change, therefore it is crucial to

have early involvement of the Finance Leaders from across Leeds system to gain support around

the principles and direction of travel for PHM in an accountable care system.

As part of the BDO work to develop the blueprint, discussions with individual Finance Directors

over the last few weeks have been very positive in this regard. Discussions have highlighted:

Finance leads are conversant with PHM and, more importantly, all are keen to support a

move towards PHM contracting principles, with some shadow testing during 2018/19.

There were no immediate barriers (red lines) identified for implementing a PHM-style

contract approach, however there were a number of individual organisational concerns that

would need to be worked through as this work progresses.

7

There is the willingness to work in partnership across the system. It would help if there was

an agreed single vision to drive all partners in the same direction towards a common

objective.

Initial feedback was presented at the citywide Finance Leaders meeting on 4 July 2017 and further

discussions are planned to take this forward. The blueprint will be a key document to support this.

Alliance contracts and revised payment mechanism

If we are moving towards a system where healthcare is co-ordinated around the person rather

than the organisation, then money flows will need to be adapted accordingly. The old mind-set in

which each organisation tries to maximise activity and income will need to change to one where

the whole financial model drives population health and cost containment. A revised payment

model to support PHM should:

Remove the direct relationship between activity and payment;

Improve alignment of payment for all providers within the care model;

Better incentivise prevention and wellbeing; and

Focus on the management of outcomes.

The transition to any new payment arrangement will need to be managed carefully to ensure that

financial risks (or gains) are shared whilst keeping the overall system in a sustainable position.

An early test of partnership working and the development of new alliance contracting and payment

arrangements will be the development of the GP streaming service in A&E, which needs to be in

place by 1 October 2017. SI is contributing to the process by:

Supporting strategic commissioners to develop an alliance contract that is more focused on outcomes, including a payment methodology that incentivises providers to work together to deliver the best outcomes for patients.

Supporting providers, including primary care, to work in a more collaborative way. Progress is being made at pace for providers to work together under alliance arrangements so that they are in a position to deliver a seamless service across organisational boundaries.

This will be an early example of trying to move to alternative contractual arrangements and any

lessons learned will be used to inform future plans as part of a continual improvement process.

2.4 Supporting development of new workforce models

The Five Year Forward View, The Leeds Health and Care Plan, and the journey towards establishing a Population Health Management approach set the context in which the workforce in the city will need to work in the future.

Increasingly care currently delivered in an acute hospital setting will be delivered closer to patients own homes. Provider accountability for the delivery of improved outcomes over a longer time period will incentivise a greater focus on prevention and self-care as well as the integration of workforce across organisational boundaries.

8

Work to date has been focussed on nursing however in due course this needs to widen to include all elements of the workforce, as well as new types of workforce models, as the implications of the ‘Primary Care Home’ delivery model are understood.

The citywide nursing workforce group, led by the Lead Nursing Officer, System Integration, is in the process of finalising the nursing workforce programme plan and deliverables. The delivery of this programme plan is integral to the establishment of a Population Health Management approach across the city. The overall aim here is to support integrated nursing.

The clinical and non-clinical workforce needs to change to support this changing future – the size, shape and composition of the workforce, how and where staff (health and social care staff) work and the content of their roles will all need to change as will our approach to recruiting and retaining staff – particularly doctors and nurses.

How and where our clinical and non-clinical staff will work in the future

Some clinicians who currently deliver care in acute hospital settings will move to delivering

care in community settings (hubs) and peoples own homes, supporting our neighbourhoods

and Primary Care Home Model.

There will be a move towards closer integration of primary and community care nursing.

Clinicians will increasingly support people and families to self-care.

Care will increasingly be delivered (remotely or virtually) with increasing use of telephone

conversations and assessments via skype and telehealth.

Discussions have commenced with YAS regarding a new approach to employing paramedics

and nurses in primary care and in the 111 Service – rotation and shared posts.

Planning is underway to test the use of telehealth into care homes in the city.

Providers in the city are working together to identify a city wide approach to utilising the

apprenticeship levy for graduate nurse training.

The city is reengaging the city wide clinical senate to embrace the bigger picture of workforce

integration; setting out strategic aims and sharing these with the Leeds Academic Health

Partnership (LAHP) and the potential Leeds Academy.

3. The draft Blueprint for PHM in Leeds

System Integration has been working closely with public sector consultants BDO to develop a

System Blueprint for Population Health Management.

There has been broad agreement over the past eighteen months within the system around moving

towards commissioning for outcomes and further integration of provision, as the key solution to

delivering the triple aim in Leeds. However progress was being hampered by the three Leeds

CCGs’ more ‘siloed’ approaches, a lack of consistent language and different levels of

understanding as to the implications of this transformation.

BDO have experience of working in other health and care systems further ahead in their journey

towards commissioning for outcomes and accountable care provision and have been able to bring

that experience, along with a level of independence, to support the system to design a Blueprint

which describes the system view and an approach that is right for Leeds.

9

Process to develop the Blueprint

BDO working with SI from May to July 2017 focussed the development of the Blueprint on four key

workstreams:

1. System Alignment: 1:1 meeting with key leaders to understand aspirations, organisational

red lines, concerns etc

2. Segmentation and Outcomes: developing a process for agreeing population

segmentations and outcomes

3. Finance and data: reviewing progress and identifying next steps with finance leads

4. Blueprint and Roadmap: writing up the outcomes from the other workstreams and

developing a roadmap (programme plan)

Blueprint system challenges

From the work undertaken in workstreams 1-3 the draft Blueprint outlines four challenges and

recommendations for system solutions to these challenges:

Challenge Blueprint Response

Challenge 1: System Level Changes

There is a shared vision and each organisation has its own priorities – but there is a gap between the two.

A framework is required to join and translate the work being undertaken into the context of the overarching vision and articulate the System Level Changes that are required.

This will “bunch the thousand flowers that are blooming” and test whether these initiatives are delivering what is required and intended in the strategy and vision.

This will build on provider appetite and pro-activity, clarify the role and direction of the commissioner and set the plan for going forward in the same direction – working as an aligned system.

System Level Changes are proposed which

provide the bridge between the vision and the

initiatives that are being developed, providing

sight of the real impact that delivering the vision

for Leeds will have. The impact on organisations’

roles is also described.

Challenge 2: Leadership and Governance

System level leadership could be developed further to drive the above activities forward.

The Strategic Commissioner, System Integrator and Providers need to rapidly clarify leadership arrangements and drive this work forward, supported by an effective, transformational and integrated governance structure.

This document proposes an approach for how

Leadership and Governance across the system

can be developed, based upon engagement with

leaders and forums across the city to deliver real,

system leadership.

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Challenge 3: Evolution of the Leeds Plan

Leaders articulated that neither the vision nor the three gaps/‘triple aim’ in the Leeds Plan are deliverable without system integration.

The Plan is also not aspirational enough to deliver against these gaps.

Therefore, there is a risk that work becomes pathway based, can be delivered by structures as they currently exist and only incremental improvement is achieved.

A way of grouping the activities of the Leeds Plan so that services can be transformed at a system level and greater change can result.

The Leeds Plan requires evolution to drive work

at a greater scale, across the system, building

upon the good work that is currently happening

and utilising a PHM approach to make more

significant change – commissioning for outcomes

and creating accountable provision.

Challenge 4: Rapid implementation of PHM

The system will not deliver significant change without system change (through innovation and integration of services).

Population Health Management has been signed up to by the system as the route to achieve this, but it is currently only peripheral to the work underway through the existing 4 programmes of the Leeds Plan.

Rapid progress is needed, identifying and developing the first, accelerator segment and implementing commissioning for outcomes.

Once this happens, the system can start to change. Providers have articulated their readiness for this to take place.

A clear approach is provided to driving PHM

forward. Workstreams have developed an

approach to population segmentation, outcome

based commissioning and started to explore

enablers such as linked data and finance and

contracting. There is appetite from providers to

make progress, support from PEG and a roadmap

is provided to enable PHM to be taken forward at

scale and pace.

Next steps

To date the emerging findings of the Blueprint and challenges have been well received by the

various stakeholder forums (e.g. Health and Wellbeing Board, Partnership Executive Group and

Provider Network). There is support for the strategy and approach across commissioning and

provider partners in the health and care system.

A process has been agreed to share and sign off the Blueprint across the health and care system

over the summer, culminating in final sign off by the Health and Wellbeing Board in September:

Draft blueprint to be circulated to PEG for comment (end July)

‘Socialise’ the Blueprint in respective organisations (July – August)

Amendments made as needed (August)

Blueprint presented at Board to Board (September)

Blueprint to return for sign off at next PEG (September)

HWB to provide final sign off (September)

Key tasks thereafter will be to develop the programme plan in detail, including a set of core metrics

to measure progress and to progress the piece of work with stakeholders to confirm the

segmentation and outcomes approach.

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4. Issues and Risks

The System Integration function has developed a risk register which is reviewed fortnightly by the

SI team. SI risks will be reported through the Leeds Clinical Commissioning Partnership corporate

risk register following the update of the corporate risk reporting arrangements to reflect the new

organisational structure.

There are currently three risks SI1, SI2 and SI5) with a post mitigation score of 12 on the SI risk

register. A brief summary of these risks and mitigating actions is provided in Table 1 below.

Table 1 – Summary of System Integration Risks with post mitigation score of 12>

Description of Risk Mitigating Actions

SI1 – Alignment between the System Integration and Commissioning Strategy Functions to deliver Blueprint There is a risk that Strategic commissioning Functions and System Integration Functions do not align to enable a population health management approach; inability to move to an outcomes based contract for the first population segment and the challenge of staff being enabled to support SI in the delivery of key BI, finance, contracting and commissioning tasks. This would result in the inability to deliver the Blueprint and establish a PHM approach within the initial population segment by April 2019.

- The Blueprint is being co-produced taking into account all key leaders' views to gain consensus and support.

- Commissioning for outcomes workshops will provide greater understanding and awareness of SC and SI functional requirements and for the need to work differently. Two of three undertaken to date.

- The Roadmap will clearly identify tasks, timescales and proposed leads for delivering different components of the Blueprint - to be discussed at future SMT.

SI2 - Provider Buy-in and Support - There is a risk that all key providers are not fully engaged to working as an Accountable Care entity to deliver outcomes for an agreed population due to lack of understanding and/or perceived negative impact on organisational objectives and viability . This would result in the inability of providers to work together to fully deliver outcomes through accountable working arrangements through new risk and finance arrangements.

- Ongoing attendance of Chief Officer for SI

at Provider Network. - Provider network to develop into System

Integration Board from July 2017. - Positive feedback and confirmation of

appetite to move towards accountable care delivery at Provider Away Day ( July 3rd)

- Plans in place to work with all providers, on an individual basis, to ensure full understanding of the implications of the Blueprint in advance of Blueprint being presented to PEG for final sign-off in September 17.

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Description of Risk Mitigating Actions

SI3 - Capacity to Deliver the Recommendations of the Roadmap - There is a risk that the System Integration is unable to co-ordinate the delivery of the Blueprint due to key staff and functional delivery – new way of working within Strategic Commissioning and within provider organisations not being enabled to deliver key components of the roadmap. This would result in the Blueprint and roadmap not being delivered to agreed timescales.

- Final PEG sign off of Blueprint will make

clear the requirement that delivery is dependent on resources being in place across all organisations.

- Roadmap will clearly identify functions within Strategic Commissioning and within Provider organisations required to deliver recommendations of the Blueprint.

- Proposal to present this to SMT in late Summer to agree arrangements for aligning staff to deliver key components of Blueprint within System Integration Blueprint delivery programme.

5. Conclusions and Next Steps

In just over three months, the SI function has made significant progress in gaining system-level

buy-in, understanding and support to establish a PHM approach across Leeds. Working with BDO,

the SI function has directed the production of a Blueprint for PHM which identifies four key

challenges and associated solutions to progress to establish PHM. The Blueprint and associated

roadmap will provide the clarity regarding direction of travel and required steps along the way that

was previously missing. System leaders have confirmed support for the direction of travel

described in the Blueprint however the critical next step is for organisations to endorse support for

the Blueprint having understood the implications of the Blueprint on their own organisations.

At the 6th of July Partnership Executive Group, leaders of the Leeds health and care system

confirmed support for the emerging direction of travel and recommendations made within the

Blueprint. Recognising the significant implications of the Blueprint for individual organisations,

members of PEG agreed the following next steps and timescales:

Draft blueprint to be circulated to members of PEG for comment (end July)

SI function with BDO to support individual organisations to position and frame the Blueprint

internally (July – August)

Amendments made as needed (August)

Blueprint presented at Board to Board (September)

Blueprint to return for sign off at next PEG (September)

Blueprint presented to Health and Wellbeing Board to provide final sign off (September)

This ambitious proposed process for gaining understanding, support and sign-off of the Blueprint

will enable formal implementation of the Blueprint from September 17 as described in the

underpinning Roadmap.

Through the development of the Roadmap, considerable work has already been undertaken within

the areas of population segmentation, potential governance structures to support PHM and

progress towards a framework for outcomes based commissioning. To maintain momentum, this

work will continue and associated milestones will be incorporated into the roadmap for delivery.

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The strong support for the draft principles and recommendations within the Blueprint can be

attributed to the extensive engagement undertaken by both the SI team and BDO in advance of

and through the development of the Blueprint. To maintain these good levels of understanding and

buy-in, an engagement plan will form part of the underpinning roadmap for the Blueprint. Within

this, the SI function will proactively engage with Healthwatch and the Scrutiny Board for Adults and

Health to transparently describe progress and processes in the delivery of the Blueprint. The SI

function will also support providers to strengthen citizen involvement in the design of the extended

primary care teams and services and approaches they deliver across the 13 neighbourhoods /

localities.

6. Recommendations

The Leeds Health Commissioning and System Integration Board is asked to:

Receive and note the update contained within this paper.

Note and support the content and emerging recommendations of the Blueprint.

Ensure that decisions made by the Strategic commissioning and System Integration Board

support and reflect the move towards a Population Health Management approach across

Leeds.

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1




Title: Chair’s Summary of the Audit Committees Meeting in Common held on 19 July 2017

Lead Governing Body Member: Chris Schofield, Lay Member - Governance


appropriate

()

Report Author: Stephen Gregg, Head of Governance and Corporate Services

Decision

Discussion

Information

Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY:

This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Audit Committees in common meeting held on 19th July 2017. Where possible, the Chair of the Audit Committees will attend meetings of the Leeds Health Commissioning & System Integration Board to present the summary.

RECOMMENDATION: The Board is asked to: RECEIVE the report.

Description of key items of business discussed and key outcomes

Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Audit Committees in Common on 19th July 2017. Further information can be obtained by reference to the minutes of that meeting.

Strategies/Policies approved

Managing conflicts of interest and Standards of Business Conduct policies The Committees noted that revised guidance from NHSE had been reflected in the CCGs’ policies on managing conflicts of interest and standards of business conduct. Each CCG previously had separate policies which had now been amalgamated. The Committees reviewed the policies and recommended that they be approved by the Leeds Health Commissioning and System Integration Board. Operational scheme of delegation The Committees noted that the Leeds CCGs were now working more closely, with joined up

2

governance arrangements and that it was necessary to align the operational schemes of delegation to ensure that the same approval limits applied across the CCGs. The Committees reviewed the draft amalgamated operational scheme of delegation and recommended that it be approved by the CCGs’ Governing Bodies.

Items of positive assurance or issues to be raised

Terms of reference The Committees noted their terms of reference. They highlighted that although each CCG had its own Audit Committee and would take individual decisions for that CCG, by meeting in common the Committees would aim to work jointly wherever possible. The Committee will review the terms of reference again prior to presenting to the governing bodies for approval. Risk management The Committees noted the proposed city wide format for the Board Assurance Framework and the proposals for managing risk across the 3 CCGs. They noted that all risks would be allocated to the appropriate Committee, which would be responsible for overseeing and challenging their management. Exception reports would be submitted to the LHCSIB, which would be the main point of co-ordination for all strategic risks. Finance The Committees received an update on IR35 off-payroll legislation. This had significant implications for public bodies who hire off payroll workers (particularly where the workers are employed through their own company). The Committees noted the risks associated with IR35, and the actions that the CCGs were taking to mitigate them, including external specialist employment tax advice. The Committees requested that following the review, a report be brought to a future meeting of the LHCSIB setting out the risks, the mitigating actions and a recommended policy position. Internal audit The Committees approved the audit plan for 2017/18, which had been aligned across the 3 CCGs. The Committees noted the risks associated with cyber-security, the actions that were being taken to mitigate them and the need for the Committee to follow this up as part of its work programme. They requested that the audit of Conflicts of Interest be brought forward to provide assurance that the CCGs’ arrangements were robust. External audit The Committees noted the annual audit letters for each CCG, and that they would be published on the CCGs’ websites. Counter fraud The Committees of Leeds South and East and Leeds West noted the Annual Counter Fraud Report for their respective CCGs, and the overall assessments of ‘green’ (note: Leeds North Audit Committee had received the Leeds North report at a previous meeting) The Committees of all 3 CCGs noted the progress report on work to date and approved the aligned Counter Fraud Plan for 2017/2018.

1




Title: Chair’s Summary of the Remuneration & Nomination Committee meeting held on 19 July 2017

Lead Governing Body Member: Graham Prestwich, PPI Lay Member


appropriate

()

Report Author: Stephen Gregg, Head of Governance and Corporate Services

Decision

Discussion

Information


EXECUTIVE SUMMARY:

1. This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Remuneration and Nomination Committees in common meeting held on 19th July 2017.

RECOMMENDATION: The Board is asked to: (a) RECEIVE the report.

Description of key items of business discussed and key outcomes

Please note that this is a brief summary of the items considered and decisions taken at the meeting of Remuneration and Nomination Committees in Common on 19th July 2017. Further information can be obtained by reference to the minutes of that meeting. Please note: the Leeds West CCG Remuneration and Nomination Committee was not quorate and was not able to take decisions.


HR policies The Committees of Leeds North and Leeds South and East CCGs received 2 updated policies covering Employment breaks and Grievance. They noted that there had been no substantive change to either policy. For employees who had contracts with 2 different employers, the Committees noted the need to establish which polices would take precedence.

2

The Committees of Leeds North and Leeds South and East CCGs approved the policies, subject to some minor changes and the Equality Impact Assessments being signed off.

The Committees requested that all existing HR policies be reviewed to ensure alignment between the 3 CCGs, and be brought back to the Committee for approval. If any material differences are noted as part of the review process this will be highlighted to the Committee at the earliest opportunity.

Items of positive assurance or issues to be raised

Governing body Non-Executive Directors The Committees noted a summary of terms of office of current Governing Body members and noted that a review of the One Voice project will take place in 2017/18, during which succession planning and vacant offices will be considered. Agenda for Change Pay Award 2017/18 - Leeds North CCG The Committee of Leeds North considered a report on the national 1% Agenda for Change pay award in 2017/18. The report proposed that to ensure consistency with the national pay award, Leeds North CCG Board members and the previously substantive members of the CCG Board who had moved into system integration roles under One Voice, should receive the 1% award. The Committee noted that the other two Leeds CCGs had already approved a consolidated pay award of 1% for 2017/18 for their CCG Governing Body members. The Committee approved the 1% pay award for Leeds North Board members, consistent with the other members of the Leeds Clinical Commissioning Groups Partnership. Note: No member of the Committee was involved in agreeing their own remuneration. Members left the meeting when their own remuneration was considered.

Any additional comments

Terms of Reference The Terms of Reference were noted, particularly that the Committee will make remuneration decisions in relation to Governing Body members and Clinical Leads, and will recommend decisions to the Governing Body in relation to employees. The nomination responsibilities were also noted, which are new responsibilities for the Leeds North and Leeds West committees.

1




Title: Chair’s Summary of Finance & Commissioning for Value Committee Meeting held on 20th July 2017

Lead Board Member: Peter Myers Chair – Finance & Commissioning for Value Committee


appropriate

()

Report Author: Peter Myers

Decision

Discussion

Information


EXECUTIVE SUMMARY:

1. This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Finance & Commissioning for Value Committee meeting held on 20th July 2017.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is asked to: (a) RECEIVE the report.

Description of key items of business discussed

The first meeting of the Finance and Commissioning for Value Committee was held on the 20th July. Peter Myers was confirmed as the Chair and Dr Ben Browning was appointed as Deputy Chair. The draft Terms of Reference were reviewed and comments provided. The Committee received:

o Finance report at M2 17/18 o Budget setting principles and high level details across the three CCGs o QIPP overview paper detailing local, Leeds-wide and STP level QIPP initiatives

The Committee highlighted the following key areas: - the c£34m QIPP challenge. - the potential need for a workshop to establish the universe of options to achieve the strategic

2

aims and financial plan. - concerns from GPs that things had to be done differently, to avoid for example issues just being displaced to another area, rather than cost being saved or the quality of care improved. - the view that positive options should be presented, including the displacement cost and effects to ensure a comprehensive approach to improvement and efficiency. - the criticality of engagement.

Strategies/Policies approved N/A

Any other Comments:

N/A

1




Title: Chair’s Summary of Quality & Performance Committee Meeting held on 12 July 2017

Lead Board Member: Dr Steve Ledger, Lay Member, Assurance and Chair – Quality & Performance Committee


appropriate

()

Report Author: Dr Steve Ledger

Decision

Discussion

Information


EXECUTIVE SUMMARY:

1. This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Quality & Performance Committee meeting held on 12 July 2017.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is asked to: (a) RECEIVE the report.

Description of key items of business discussed

1. Please note that this is a brief summary of the items considered and decisions taken at the

meeting of the Quality & Performance Committee on 12 July 2017. Further information can be obtained by reference to the minutes of that meeting.

Appointment of Chair and Deputy Chair 2. The Committee approved the appointment of Dr Steve Ledger, Lay Member – Assurance

as the Chair and Diane Hampshire, Non Executive Board Nurse as Deputy Chair.

Actions from Previous Meetings 3. Concerns had been raised at previous meetings regarding the District Nursing service and

the process for accepting new referrals. It was confirmed that new referrals should be made via the Single Point of Urgent Referral (SPUR). There was some soft intelligence that there were some delays in accepting new referrals, and staff from Leeds Community Healthcare (LCH) had described the prioritisation criteria used to manage the workload of District Nursing teams. It was agreed that LCH would be asked to present a ‘deep dive’ on this issue at the LCH Quality Meeting. The assurances required from the ‘deep dive’ would

2

be clarified by the Committee Chair and Director of Nursing & Quality.

Quality & Performance Committee Draft Terms of Reference 4. The Committee reviewed its draft Terms of Reference. Some amendments were

suggested, particularly in relation to clinical effectiveness, which have been reflected in the version presented for approval elsewhere on today’s agenda (see item LHCB 17/06).

Integrated Quality & Performance Report (IQPR) 5. The proposed new IQPR format was presented for discussion. It was proposed to present

the following data:

CCG Improvement and Assessment Framework indicators – on a six-monthly basis

NHS Constitution and Operational Plan targets

Primary Care dashboard

Quality dashboard

Commissioning portfolio dashboard e.g. planned care

6. Members were supportive of the proposed format and made some suggestions for improvement, such as clarifying the denominator where a figure is presented and highlighting key issues in the cover paper. Members agreed to provide any further feedback to the Associate Director of Planning.

7. In relation to quality, LTHT had reported a further Never Event since the report was produced. Due to the overall number of Never Events reported, NHS Improvement will be reviewing this and the CCGs have been asked to provide an overview of the processes in place to seek assurance from LTHT. This includes an annual reflective learning event with the Trust.

8. System flow was an ongoing issue which impacted on performance, including the

Emergency Care Standard. This was being addressed through the development of the Leeds Local Delivery Plan (see paragraph 10 below).

9. It was agreed that it would be helpful for the Committee to understand the work being

undertaken to address workforce issues such as staff retention. This will be included on the Committee’s work plan.

Corporate Risk Register 10. The Head of Governance informed members that the risk register was being reviewed and

updated as appropriate. The updated version of the risk register will be presented to the Senior Management Team and the Leeds Health Commissioning & System Integration Board. Quality and performance related risks will be presented at future Quality & Performance Committee meetings.

Leeds Local Delivery Plan 11. The Committee was provided with an update on progress of the development of the Leeds

Local Delivery plan and the approval route. The plan is due to be signed off at the System Resilience Assurance Board on 2 August, and will then be presented to the Quality & Performance Committee and Leeds Health Commissioning & System Integration Board in September. It was agreed that the proposed engagement in relation to each element of the

3

Plan should be presented to the Patient Assurance Group

Safeguarding Update 12. The Head of Safeguarding provided an update on safeguarding issues within Leeds

including the PREVENT agenda (part of the Government’s counter terrorism strategy) and the development of training in this area, and the draft Bill relating to Deprivation of Liberty Safeguards (DoLs). One of the main implications of the Bill would be the proposed transfer of responsibility for the authorisation of a DoLs for patients in receipt of Continuing Healthcare funding to CCGs. This will continue to be monitored as the Bill progresses and more information becomes available.

Continuing Healthcare Assurance 13. The Committee received an update on the continuing healthcare (CHC) service including

the status of Previously Unassessed Periods of Care (PUPoC) assessments which were now fully completed, and appeals against CHC decisions of which there were 42 to be completed. Information was also provided on national benchmarking which showed that the Leeds CCGs were within the average range for the number of CHC or Funded Nursing Care patients per 50,000 of the population. The CCGs are meeting the Quality Premium target to have less than 15% of CHC assessments taking place in a hospital setting. Currently this is 8.4% of assessments in Leeds. The target to ensure that decisions are made within 28 days of receiving a positive CHC checklist is not currently being achieved and the Committee was informed of the actions being taken to address this.

14. A copy of the internal audit report relating to CHC was provided including the recommendations raised and the action being taken as a result. The overall rating for the audit was ‘significant assurance’ that there are effective controls within the processes adopted by the CCGs to discharge the CHC duties.

15. The Committee supported a recommendation that the CHC service make returns to NHS

England on behalf of Leeds as a whole rather than individual CCGs. This will be discussed with NHS England.

Care Homes Quality Assurance 16. The Head of Quality presented an update on key issues relating to care homes in Leeds

and the mechanisms in place to monitor and address them. An update was provided on the three care homes where suspension of continuing care and/or community intermediate care placements had been implemented due to concerns in relation to quality and/or unfavourable CQC ratings.

17. The CCGs have started to work more closely with the local authority and providers to develop a ‘One City’ approach to improving the quality of care in care homes. A working group has been set up to drive this forward.

18. Members were assured that support would be put in place for a care home if an issue

arose such as a concerning CQC inspection and this would be improved with the ‘One ‘City’ approach. It was noted that there are some common themes that arise including leadership and care planning documentation so support can be provided for these areas.

19. In future the Committee will receive a bi-monthly report relating to providers under

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enhanced surveillance, including care homes.

Care Homes Suspension Procedure 20. The Committee reviewed and supported the Care Homes Suspension Procedure.

Suspensions will now require approval from the Director of Nursing & Quality, or the Director of Commissioning or Chief Executive in her absence.

Information Governance Update 21. An update was presented to provide assurance that the CCGs are meeting their statutory

responsibilities in relation to information governance (IG). The CCGs now have one Senior Information Risk Owner (SIRO) (Visseh Pejhan-Sykes) and a Deputy SIRO (Jenny Davies). The Caldicott Guardian role is shared between the Medical Directors.

22. The CCGs achieved Level 2 IG Toolkit and the CCGs’ self assessments were reviewed and supported by Internal Audit. In relation to IG incidents, a number of staff have reported the receipt of ‘phishing’ emails and guidance has been circulated on how to deal with these. The General Data Protection Regulations come into force in May 2018. An action plan has been developed and is being monitored by the IG Committee.

Patient Experience Update 23. The Committee received details of issues identified at recent Patient Insight Workgroup

meetings. There had been a number of negative patient opinion posts in relation to a service provided by LTHT. No similar issues had been identified from other sources, but consideration is being given to what action would be expected from the provider in response to such posts. Concerns were also noted in relation to Pain Management Solutions which were due to a lack of clarity on the pathway. This has been raised with the lead commissioner. The Workgroup had also reviewed a national report on neurology services, however information was not provided on a CCG or regional basis. This has been fed back to the report authors (the Neurological Alliance) who have confirmed that broken down data can be provided at a local level if there are sufficient numbers of patients to ensure data confidentiality.

24. The CCGs’ patient experience processes will be reviewed as a result of the One Voice review. A workshop will be arranged to develop a citywide process for the three CCGs.

Commissioning for Quality & Innovation (CQUIN) Assurance 25. The Committee received an overview of performance against the three main Leeds

providers’ CQUIN schemes for Quarter 4 2017/18. LTHT and LCH achieved all of their indicators and it was noted that the joint CQUIN between these two providers had proved successful.

26. LYPFT achieved the majority of indicators however one was partially achieved (sharing of care plans / discharge summaries with GPs) and one was not achieved (75% of staff to have a flu vaccination). The Committee agreed to make a recommendation to the LYPFT Quality Meeting that these areas should continue to be monitored.

27. An overview of the 2017-2019 CQUIN scheme was provided. This is nationally prescribed

therefore no local indicators have been agreed.

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Committee Work Plan 28. It was agreed that items on the Leeds Suicide Audit, Leeds Local Delivery Plan, Providers

under Enhanced Surveillance, Yorkshire Ambulance Service Response Pilot and workforce assurance would be added to the work plan. It was also agreed that a workshop on system integration and potential quality impacts would be helpful for the Committee. This will be developed for later in 2017/18.


The Committee approved the following policies: Individual Funding Request Policies (updates to existing policies):

General Cosmetic Exceptions and Exclusions Policy

Complementary and Alternative Therapy Framework 2015-18

Spine, Pain and Neurological Treatments Commissioning Policy (change of title from ‘Spine and Pain Commissioning Policy 2016-2019’)

Aesthetic Abdominal Procedures Policy

Access to Infertility Treatment Policy

Botulinum Toxin Policy

Insulin Pumps and Glucose Monitors in Adults, Children and Young People Policy

Information Governance Policies (updates to existing policies):

Records Management and Information Lifecycle Policy

Information Security Policy – approved subject to further clarification being provided on the requirement for work related information / information assets not to be held on personal devices.

Email Policy

Internet and Social Media Policy

Any other Comments:

N/A


NHS Leeds CCGs Partnership – Leeds Health Commissioning and System Integration Board

Date of meeting: 26th July 2017

Title: Integrated Quality and Performance Report

Lead Governing Body Member: Sue Robins, Director of Commissioning and Jo Harding, Director of Nursing and Quality


appropriate

()

Report Author: Multiple

Decision

Reviewed by EMT/SMT/Date: n/a

Discussion

Reviewed by Committee/Date: Quality & Performance Committee, 12th July 2017

Information

Checked by Finance (Y/N/N/A - Date): n/a








Corporate Impact Assessment: Does the Report have any of the following key implications?


Report includes performance against the constitutional targets





N/A



N/A

EXECUTIVE SUMMARY: This report provides assurance to the organisation that we are delivering against the requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described.

The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:

NHS Constitution and Operational Planning

Quality and Safety

In addition, the Board will receive an update every 6 months on the CCG Improvement & Assessment Framework (IAF) indicators.

The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.

It should be noted that the Quality & Performance Committee will also receive more detailed information in the form of dashboards and a report in the following areas:

Commissioning portfolios

Primary Care (also presented to the Primary Care Commissioning Committee)

Quality

This will enable the Committee to provide assurance to the Board across a broader agenda.

As an interim, the format of this report largely replicates that of the IQPR previously produced by Leeds West CCG although the content represents that of all three Leeds CCGs. Following the One Voice review of the CCG governance structures, a need to update the Integrated Quality and Performance Report has been identified and will be introduced at the next Board meeting.

NEXT STEPS: The key actions which will be undertaken in relation to performance are as follows:

To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.

The key actions which will be undertaken in relation to the development of the IQPR are as follows:

To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics, Quality and Primary Care in the development of the report and identification of local measures;

To introduce a new, shared city-wide performance report which will replace the existing three CCG IQPRs. The content of the report will be influenced by the new committee structures across the city.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is asked to:

a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information and note the current areas of underperformance; and

b) NOTE the feedback from the Quality & Performance Committee included in the Chair’s Summary (agenda item LHCB 17/12).

Performance Area

Actions Responsible Body

Lead Manager

Projected Timescale to Delivery

CCG IAF NHS England has a statutory duty (under the Health and Social Care Act (2012)) to conduct an annual assessment of every CCG. In 2016/17 NHS England introduced the CCG Improvement and Assessment Framework (CCG IAF) which replaced both the existing CCG assurance framework and CCG performance dashboard. There are a number of possible ratings as follows:

Outstanding is applied where at least one component is outstanding and the others are all good

Good is applied if all components are good; or at least four components are rated as good (or good and outstanding) and one component is requires improvement, unless requires improvement is in the finance, planning or well led component

Requires improvement if four components are rated as good (or good and outstanding) and the finance, planning or well led components are assessed as requires improvement or inadequate or there is more than one requires improvement component rating

Inadequate overall if more than one component is rated as inadequate The Leeds CCGs received notification of their assurance ratings on Friday 14th July. All three Leeds CCGs have achieved a rating of ‘Good’. The CCG IAF is underpinned by an indicator set. CCG performance against the indicator set forms a significant element of the CCGs annual assurance rating. Every quarter NHS England publishes the CCG IAF indicators are on myNHS as a mechanism for providing the public with an assessment of how well CCGs are performing. As the CCG was not informed of the rating until after the Quality and Performance Committee meeting and the data was not received until late June there has not as yet been an opportunity for a full review of the dashboard. It is therefore proposed that a review of the indicators and trends be reviewed at the next Quality and Performance Committee meeting and that the dashboard and a report on any issues for performance improvement be provided from the Committee to the next Joint Board meeting.

N/A John Tatton N/A

Emergency Care Standard (ECS)

The CCG continues to fail the A&E 4 Hour Access standard although there appears to be some signs of improvement in recent months and weeks.

Delivery of the A&E target is dependent on a combination of demand and systems flow. The increased pressure on A&E and acuity of patients attending along with delay in discharge has led to challenges in delivering not only the A&E target but also other targets such as RTT and cancer 62 day waits key issue. Reasons for delays in discharge are multifactorial however key issues this winter have included:

a) The loss of community beds (nursing, EMI, residential) across the Leeds economy b) Nurse staffing pressures within Leeds Community Healthcare continue to impact on

LTHT’s ability to discharge patients from the acute bed base. c) Delays in sourcing home care packages d) Delays in assessment by care homes e) Time taken by patients and families in choosing care homes.

The continued pressure in outflow from the emergency department has led to a number of patients waiting admission on trollies. A number of initiatives have been put in place in recent months which appear to be having some impact. These include:

GP in A&E: The GP pilot has delivered significant benefit with 99% of patients managed through this stream being seen, treated and discharged within the 4-hour standard. 86% of all patients seen by the primary care stream were discharge requiring no follow up or follow up by their own GP. Overall 11% of activity during the hours of operation was seen through the primary care stream; and

Additional capacity at Wharfedale: the additional capacity has supported flow out of A&E to wards and reduced the need for patients to wait on trollies in A&E.

Consequently, the position for March 2017 was 9.07% better than in January and 3.76% better than March 2016. April 2017 shows a further improvement of 0.8% from March to over 90% enabling the Trust to achieve the performance levels required to ensure access to the Sustainability and Transformation Fund (STF).

In addition to the above a number of new initiatives have started or are due to come on stream shortly which the system expects will to alleviate pressures on A&E and beds. These include:

a) A new social care reablement service model which enable same day discharge of

System Resilience Assurance Board

Sue Robins/ Debra Taylor-Tate

End March 2017

patients and should offset some of the delays in home care packages. This came on stream on 19th June and we await an assessment of impact on admissions, length of stay and on delayed transfers of care.

b) Additional community/neighbourhood team staffing capacity which also came on stream on 19th of June and we await assessment of impact.

Referral to Treatment (RTT)

Leeds CCGs are all failing to deliver the required standard with respect to proportion of incomplete waits over 18 weeks from referral. This is primarily due to challenges at LTHT in delivery of the 2016/17 activity plans i.e. LTHT under delivered on 2016/17 elective activity plans by around 10% against plan as a result of lack of beds due to increased non- elective demand and poor systems flow (delayed discharges). In addition referrals in some specialties grew faster than expected compounding the pressures and there have been gaps in outpatient capacity. These two factors have created a backlog that will need to be addressed as part of 2017/18 plans i.e. in order to deliver an improvement our providers and notably LTHT will need to ensure the delivery of the contracted elective activity plan for 2017/18. Specialties that are non-compliant with RTT in the main continue to reflect the areas where demand is significantly outweighing available capacity or non-elective bed pressures are a major factor i.e. those specialties where a high proportion of caseload is routine (not urgent). All CSUs and specialties with significant backlogs of patients over 18 Weeks have agreed recovery plans. The primary risks to the delivery of recovery plans remain non-elective demand and flow and ability to recruit and maintain workforce.

At LTHT the number of reporting specialties failing the 92% improved in January and February and was maintained in March. Despite this improvement recovery of Leeds CCG position may take months to achieve. There are also RTT pressures at Mid Yorkshire impacting on the position particularly in Leeds West and Leeds South and East.

Acute PMG Helen Lewis March 2018

Cancer Whilst LTHT continued to perform well against the majority of the Cancer Waiting Time targets, including the 14 day urgent referral (2ww) standard, there are pressures on both the 31 day subsequent surgery and the 62 days referral to treatment target. Breaches of the 31 day target primarily relate to patients requiring plastic surgery after initial treatments. Factors impacting on the 62 day performance include

a) the significant number of patients who chose to decline appointments over the Christmas period (leading to delays in diagnosis and late addition to waiting lists)

Acute PMG Helen Lewis Aim to deliver from Sept 2017

b) Increase in 2ww demand (636 additional patients in Q4 compared with the same

period in the previous year) continues to place additional pressure on the diagnostic, outpatient and surgical investigation services. Increased diagnostic demand makes it more challenging to ensure that patients who do have cancer receive a diagnosis as early in the pathway as possible, allowing adequate time to arrange appropriate treatment within the 62-day standard.

c) Challenges in key surgical specialties due to the impact of cancellation of operations due to lack of beds (knock on impact of non-elective pressures) which impact on both diagnostic and treatment admissions

Given the need to clear significant surgical backlogs, delivery against these standards is not expected to recover until September 2017 at the earliest. The final factor is the high number of onward referrals from other providers which arrive late in their pathways. Since patients are treated in chronological order, this can impact on timeliness for Leeds patients. LTHT Cancer Pathway Review Programme: The following pathways have been reviewed by the Lead Cancer team in conjunction with key CSUs:

Lung

Urology

Head and Neck; and

Gynaecology. This work focused on reducing waste in the pathways and removing steps which did not add value in the following key pathways: Further pathway reviews are to be undertaken in early 17/18 in the following areas:

Skin

Breast; and

Lower gastrointestinal (GI).

Mental Health Access: 11.95% of the prevalent citywide population entered treatment during 2016/17.

This is 3.05% below the mandated target - a 0.15% increase on 2015/16.

Considerable work continues to take place to increase the access figure, through supporting

staff to make swift and efficient clinical decisions on the hub, allocating resources to the

waiting list for telephone screenings, piloting a triage system for telephone screenings, and

Mental Health PMG

Post currently vacant. IAPT (Jess Evans) EIP (Rachel McCluskey)

N/A

close monitoring of daily activity. This has shown impact in May 2017 - the number of people

entering treatment to date in 2017/18 is 247 greater than the same timeframe in 16/17 year

and closer to target.

A Yorkshire Building Society pilot (offering workshops/seminars to 200 of their employees as

a pilot, which can then be rolled out across other employers) is in development with a

proposal to start in Autumn 2017.

Recovery: 46.0% of people achieved recovery during 2016/17. This is 4% below the

mandated target – a 4.4% increase on 2015/16.

A range of initiatives have been taking place over the past number of months to increase

recovery rate and a working group has been established to oversee this. A recovery working

group is taking steps to embed the recent recovery work around people discharged as

unrecovered from Step 2 groups, and to expand it to include people who didn’t engage well

with the groups. At the same time, monthly reports on individual therapist recovery rates

continue to support a focus on recovery in line-management supervision and team meetings.

As a result, recovery rates have consistently been above the mandated target of 50% from

February 2017 onwards.

Waiting times: The IAPT waiting time standards were exceeded within each of the three

CCGs during 2016/17.

However, entering treatment is defined as attending a first treatment appointment, although it

is worth noting that the waiting time data does not identify those people who are waiting to

access subsequent therapy, such as Step 3 1:1 interventions. The service continues to have

high volumes of patients waiting for 1:1 therapy at Step 3, particularly CBT & CFD. A range of

work continues to take place to address such waits. This includes the following:

- NHS England awarded Leeds CCGs a total of £150,000 (£50,000 per Leeds CCG

- based upon a £150,000 CCG match allocation) to address Step 3 waits.

Following on from this, which ended on 31st March 2017, Leeds CCGs have

provided £80,000 of non-recurrent funding to extend this initiative.

- Considerable work is taking place to increase the access figure and address the

high volume of online referrals. The service is continuing to allocate 500 cases to

the 7 teams each month (in addition to ongoing screening that occurs within the

screening hub) in order to reduce waiting list volume and to ensure that all

assessments are screened within 4 weeks of receipt. This is an interim measure

until a longer term solution is in place, and an options appraisal for the longer term

plan will go before the IAPT Board later this month.

- A CBT Waiting List Working Group has been established to co-ordinate actions to

reduce the CBT list, including a focus on staff productivity, throughput and

ensuring streamlined waiting list systems.

- Work continues to address the waits for clients through robust methods with

administrators; this has a positive effect in ensuring those waiting the longest are

addressed with efficiency. The monthly review of cases continues and clients are

highlighted for short notice appointments to maximise any gaps in bookings.

Early Intervention in Psychosis Access and Waiting Time Standard (AWT)

The EIP access standard is measured in two parts:

(a)Allocation to a specialist EIP team with 2 weeks of referral – 50%

In 2016-17 Leeds achieved 73.23%

(b)Access to NICE concordant package of care

Monitoring of this part of the standard is under development by NHSE and is linked to the use of SNOMED clinical intervention codes. Leeds providers are slowly implementing use of the codes across teams. The national requirement in 16/17 was to complete the CQCI Early Intervention in Psychosis self-assessment. Leeds met this requirement. Leeds was graded “Outstanding” for “access” and “Requires Improvement” for “effective treatment” and “well managed service”. The overall score for Leeds was “Requires Improvement” which is level 2*.

*The 5YFV target for 2017-18 is for all services to be graded level 2

Quality and Safety

Narrative has been included within the quality section of the IQPR. The Board is asked to note that LTHT has reported four never events since the 1st April 2017. We are working with the Trust to understand any emerging themes and immediate actions.

Leeds CCGs and provider Quality Group

Russell Hart-Davies/ Joanna Howard

N/A

Other issues of note

A programme of enhanced surveillance continues to be led by the CCG Head of Quality in relation to Donisthorpe Hall care home, which has previously been rated as ‘inadequate’ by the Care Quality Commission. An unannounced inspection was undertaken by the CQC on 19th and 24th April, and the associated report was published on 3rd June, which rated the home as ‘requires improvement’ overall and reflects the improvements made. The domain of ‘well led’ was rated as inadequate and the CCG continues to work with the local authority in support and monitoring of progress within the home. A comprehensive assurance visit has been arranged for early August to inform the CCG and local authority going forward. Admissions to the home remain suspended but this may be reviewed following the assurance visit.

Quality team Russell Hart-Davies

OTHER NHS PRIORITIES

Leeds North Leeds S&E Leeds WestRTT Incomplete Pathway ‐ % incomplete < 18 weeks Apr‐17 92% 90.89% 90.20% 90.49% 90.49% 90.49%No. of > 52 week wait (incompletes) Apr‐17 0 0 0 0 0 0Diagnostic Test Waiting Times ‐ seen within 6 weeks * Apr‐17 99% 99.28% 99.28% 99.28% 99.28% 99.28%Cancelled Ops (Urgent Operations Cancelled twice) * May‐17 0 0 0 0 0 0 LTHT Monthly SITREPCancelled Ops % readmitted within 28 Days (LTHT) * Mar Q4 100% 77.45% 77.45% 77.45% 77.45% 86.10% Unify2 data collection ‐ QMCOCancer Waiting Times ‐ 2 Week Wait Apr‐17 93% 92.99% 93.95% 93.58% 93.54% 93.54%Cancer Waiting Times ‐ 2 Week Wait (Breast Symptoms) Apr‐17 93% 91.67% 96.05% 90.72% 92.76% 92.76%Cancer Waiting Times ‐ 31 Day First Treatment Apr‐17 96% 98.31% 91.76% 96.00% 95.08% 95.08%Cancer Waiting Times ‐ 62 Day GP Referral Apr‐17 85% 82.76% 76.92% 74.42% 77.48% 77.48%Cancer Waiting Times ‐ 62 Day Screening Apr‐17 90% ‐ 83.33% 80.00% 81.25% 81.25%Cancer Waiting Times ‐ 62 Day Upgrade Apr‐17 90% ‐ 100.00% 100.00% 100.00% 100.00%Category 1 Calls (Response within 8 Minutes) (Leeds Average of CCGs)# May‐17 75% 81.36% 81.90% 71.11% 78.12% 76.30% YAS A&E Contracting Report

Emergency Care Standard ‐ seen in 4 hours (LTHT type 1) * May‐17 95% 86.54% 89.19%

Patients Waiting > 12 Hours in A&E for Admission * May‐17 0 0 0 0 0 0

Dementia ‐ Estimated Diagnosis Rate for people aged 65+ May‐17 66.7% 69.80% 80.30% 72.50% 74.30% 74.30%

IAPT Roll‐out ‐ % entering service against the level of estimated need May‐17 100.0% 84.6% 82.6% 97.5% 89.9% 85.9%

IAPT ‐ Number people receiving psychological therapy May‐17 292 337 546 1,076 2,257

IAPT Recovery Rate May‐17 50% 61.9% 49.6% 54.5% 54.6% 55.0%

IAPT Waiting Times ‐ 6 Weeks May‐17 75% 96.4% 96.4% 94.9% 95.7% 96.2%

IAPT Waiting Times ‐ 18 Weeks May‐17 95% 100.0% 100.0% 100.0% 100.0% 99.8%

EIP ‐ Psychosis treated with a NICE approved care package within 2 weeks of referral May‐17 50% 100.0% 61.5% 60.0% 63.2% 57.1% EIS Monthly Return

Improve Access Rates to CYPMH 30%

Eating Disorder Service ‐ Waiting Times for Routine Referrals within 4 weeks 95%

Eating Disorder Service ‐ Waiting Times for Urgent Referrals within 1 week 95%% of discharged in‐patients who are on Care Programme Approach (CPA) followed up within 7 days of discharge

Feb‐17 95% 95.5% 92.3% 96.8% 94.8% NHS Statistics

Learning Disabilities Bed Occupancy

E‐Referrals Coverage# Apr‐17 80% 66.7% 54.7% 56.1% 59.2% 59.2% eRS Weekly Utilisation Report

Personal Health Budgets Jun Q1 N/A

Children Waiting no more than 18 Weeks for a Wheelchair Mar Q4 92% 69.6% 97.6% 82.6% 86.2% 80.0%Wheelchairs Operational Data

Collection ‐ Quarterly

Extended Access (Evening & Weekends) at GP services Apr‐17 50.0% 0.0% 73.2% 100.0% 63.2% 63.2%

Reliance on Inpatient Care for People with LD or Autism

Notes* Reported at LTHT for all 3 CCGs # Leeds Total Latest based on CCG Average

Leeds Total YTD

Leeds Trend Source

Monthly RTT returns via Unify

Cancer Waiting Times Database (CWT‐Db)

LTHT Emergency Care Monthly SITREP

NHS CONSTITUTION & OPERATIONAL PLAN Latest Data

PlanActual Latest Month Leeds Total

Latest

Awaiting data

Awaiting data

IAPT Performance Report

Awaiting data

Awaiting data

Awaiting data

Awaiting data

Quality and Safety

Month YTD2016-2017

totalTrend (2016-17 and 2017-18)

9 9 68

14 14 88

6 6 54

5 5 26

Data

PeriodMonth YTD

2016-2017

totalTrend (2016-17 and 2017-18)

April -

May 2017 4 4 7

Data

PeriodTrust Expected Actual Trend

LTHT Band 2 Band 2

BTHT Band 2 Band 2

MYHT Band 2 Band 2

HDFT Band 2 Band 2

Oct 2015 -

Sept 2016

Narrative

Serious Incidents Data Source: CCG/STEIS

2 treatment delays – Yorkshire Ambulance Service

1 medication incident – Primary Care (Leeds West area)

1 treatment delay – Mid Yorkshire Hospital Trust

1 never event – Spire Leeds

Never Events Data Source: CCG/STEIS

Narrative

LTHT:

2 retained foreign objects post procedure. One incident involved a retained guide wire from

one of the PICC line procedures and the other included a retained oral throat pack following

surgery for a fractured mandibular.

1 wrong implant: non removable oesophageal stent was inserted instead of a temporary

stent

The 3 never events that have been reported in 2017/18 have been raised at the LTHT quality

meeting. Whilst investigations are underway the Trust has confirmed that the incidents did

not occur within the same theatre or team.

Spire Leeds:

1 wrong site nerve block

Mortality Rate (Standardised Hospital Mortality Index) Data source: NHS Digital Leeds Teaching Hospitalshttp://www.content.digital.nhs.uk/media/22827/SHMI-interpretation-guidance/pdf/SHMI_interpretation_guidance.pdf

Narrative

Other Provider (Leeds Patient)

SHMI compares the number of patients who die following hospitalisation at a trust with the

number that would be expected to die based on average England figures, given the

characteristics of the patients treated there. A Trust report ing higher or lower than the

baseline may still be within the expected range if these fluctuations are not statistically

significant. To enable analysis of the SHMI over time a trend line is provided.

Band 1 = higher than expected

Band 2 = as expected

Band 3 = lower than expected (when compared to the national baseline)

Patient Safety

4 slips, trips and falls

1 unexpected death

1 medical equipment

3 never events (detailed below)

Data

period

April -

May 2017

11 pressure ulcer category 3


1 child serious Injury

The CCG is currently reviewing the pressure ulcer reporting process and is working in

conjunction with our providers to implement a standardised approach to reporting within

Leeds. The proposals and update report will be presented to the CCG committee in

September.

2 actual/apparent/suspected self-inflicted harm

1 actual/apparent/suspected suicide

1 information governance breach


1 unauthorised absence

LTHT

LCH

LYPFT

0.96

0.98

1

1.02

0.92

0.94

0.96

0.98

1

0.9

0.92

0.94

0.96

0.98

0.92

0.94

0.96

0.98

1

Trend

month YTD

Jun-17 0 1 1

Trend

month YTD

May-17 12 9 18

Trend

(national and Trust)

Trend

April 2016 - April

2017

Harrogate and District

Foundation Trust

Bradford Teaching

Hospitals Trust

Mid Yorkshire Hospital

Trsut

Classic Safety Thermometer Data Source: NHS Improvement

Data Period Trust

Clostridium difficile infection – number and rate per 100,000 bed days LTHT Data source: PHE/CCG

Data

Period

Expected

(month)

Actual Narrative

Clostridium difficile infection occurring within the Trust remains within the threshold set by

NHS Improvement.

The trend data included in this report represents incidence of Clostridium difficile infection

per 100,000 bed days on a quarterly basis over time. The key to this graph is shown below.

Narrative

The Classic Safety Thermometer is a measurement tool for improvement that focuses on the

four most commonly occurring harms in healthcare: pressure ulcers, falls, UTI (in patients

with a catheter) and VTEs.

*Safety thermometer data and website is currently under review and therfore additinal data

may be available wihtin the next report*

Leeds Teaching

Hospitals Trust

Leeds Community

Healthcare Trust

Leeds and York

Partnerhsip Foundation

Trust

Mental Health Safety Thermometer Data Source: NHS Improvement

Data Period Trust Narrative

April 2016 - March

2017

Leeds and York

Partnerhsip Foundation

Trust

The mental health sagfety thermometer enables teams to measure harm and the proportion

of patients that are 'harm free' from: self-harm, psychological safety, violence and aggression,

omissions of medication and restraint (inpatients only).

*There is currently no national data available*

*Restraint data not currently avialable*

NarrativeActualData

PeriodExpected

The Trust has reported 3 cases of MRSA bacteraemia to date. In April, 1 case was identified as

a likely contaminant and was assigned to the Trust as shown in the ytd column. A further 2

cases have occurred in May and June. Post infection review identified these cases as not

having occurred as a result of any lapse in care; both will therefore be referred to the NHS

England arbitration panel requesting third party assignment. The data represented under the

month heading is therefore provisional.

The trend data included in this report represents incidence of MRSA per 100,000 bed days on

a quarterly basis over time

MRSA blood stream infection – number and rate per 100,000 bed days as assigned by Post Infection Review LTHT Data source: PHE/CCG

90

100

90

100

90

95

100

80

100

80

100

90

100

0

100

Data

PeriodTrust

Trend

(national average and Trust)

Av.

Response

rate

Narrative

23%

31%

4%

not

available

39%

not

available

not

available

7%

20%

LYPFT 0.30%

0%

0%

Data

PeriodTrust Trend Apr-17 Narrative

LTHT *awaiting data* 42

Awaiting annual report to be published for lates figures to see YTD trend.

During 2016/17 97% complaints were acknowldeged within the statutory

timeframe of 3 working days

LCH 12


timeframe of 3 working days and 100% were responded to within 180 days

LYPFT 18


timeframe of 3 working days and 30% of complaints were responded to within

30 days

Friends and Family Test (% recommended) Data Source: NHS England

Due to the flexibility organisations have over the degree and frequency of

promotion of the FFT there is no response rate.

Response rates should not be used to compare the number of responses

received across organisations and consideration should also be given to the

nature of the service and the regularity with which it may be used.

Work continues within the Business Units to increase response rates with action

plans being driven by Quality Leads

Options paper is being developed regarding the use of technology for gathering

FFT data

Patients are now able to complete survey on Fujitsu laptops

Steering group in place to review further action to produce the desired

increased response rate Services are being offered the opportunity to input their

own FFT, providing an opportunity for ownership and increased awareness of

the FFT data

In April 2017, inpatient and maternity performance remained strong and above

internal 30% response rate targets. A&E have maintained good performance

with figures remaining above

internal target of 20%. In addition, recommended rates in A&E have increased

for a second month, demonstrating patients are reporting more positively about

their experience

Text messaging and IVM facility became operational in all day case areas and

outpatient areas and was available to patients within 48 hours of discharge.

Additionally, in December 2016 / January 2017, six inpatient areas successfully

went live using a FFT link on electronic tablets rolled out alongside the Trust e-

Obs initiative. A live link on the Trust internet page to collect feedback was also

made available to patients.

The introduction of electronic methods of capturing feedback will be increased

in Q1 and Q2 2017/18, as more inpatient areas receive tablet devices, and will

continue as part of the e-Obs rollout until the end of 2017. This will support

growth in the numbers of Trust areas with the opportunity to respond to

feedback more speedily and close to the time when issues are reported. Access

to the associated data has been made available through the delivery of a new

‘Envoy’ database for which staff training is provided.

Community

Mental Health

Mental Health

Maternity Antenatal

Complaints Data Source: LCH, LTHT, LYPFT

Indicator

Total complaints

received

April 2016

- March

2017

Maternity Birth

Post natal ward

Post natal community

A&E

May 2016 -

April 2017

LCH

YAS

LTHT

Ambulance (SAT)

Ambulance (PTS)

Area

Inpatient

Outpatient

Patient Experience

60

80

100

90

100

80

90

100

80

100

90

100

50

100

80

100

60

80

100

0

100

0

100

0

100

80

100

0

50

0

50

Data

PeriodTrust Trend

LCH

LTHT

LYPFT

LCH

LTHT

LYPFT*

LCH

LTHT

LYPFT*

Narrative

Staff Turnover

Sickness - Short term

Sickness - Long Term

April 2016

- March

2017

The trend diagrams detail staff turnover and sickness/absence over the period

2016/17.

The sharp reduction seen in staff turnover and sickness rates in the LYPFT graphs

represents the transfer of staff to Tees Esk and Wear Valley Trust.

The slight increase in turnover rate at LTHT is consistent with growing competition

amongst the healthcare workforce. The position is not

consistent across staff groups and for registered nurses the LTHT turnover rate is

actually decreasing. Further work on reasons for leaving, length of service and why

staff stay at the Trust is planned for 2017.

*LYPFT have not reported on long term and short term sickness seperately.

Indicator

Staffing Data Source: LCH, LTHT, LYPFTEffectiveness

11121314

12

14

16

18

0123

0123

0123

3

4

5

0

20

40

4.754.9

5.055.2

4.75

4.9

5.05

5.2

1




Title: Finance Report for the three months ended 30th June 2017

Lead Board Member: Visseh Pejhan-Sykes, Chief Finance Officer


appropriate

()

Report Author: Judith Williams, Senior Finance Manager

Decision


Discussion


Information









Corporate Impact Assessment: Does the Report have any of the following key implications? Statutory/Legal/Regulatory/Contractual requirements

Financial Implications




N/A



N/A

2

EXECUTIVE SUMMARY: This report for provides an update on the combined financial positions of the Leeds CCGs for the three months to 30th June 2017,and the expected outturn position for the 2017-18 financial year. Details of the performance of the individual CCGs is provided in Appendix 1. The CCGs are on track to achieve the key financial targets. The biggest risk is around non achievement of QIPP.

NEXT STEPS: Updates on the 2017-18 financial position will continue to be presented to the Board and/or Senior Management Team (SMT) on alternate months to ensure that the CCGs’ financial position is formally reported and reviewed each month under the CCGs’ governance arrangements.

RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is requested to:

Note the Month 3 financial position; and

Discuss, comment and highlight actions required to progress and report to the next meeting of the SMT.

Leeds Clinical Commissioning Groups Partnership

Finance Report for the three months ended 30th June 2017

Page 1

Financial Performance Report 30th June 2017


Revenue Expenditure 2017-18

Target Performance RAG Target Performance RAG

£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 293,145 293,145 1,185,310 1,185,310

Programme spend less than allocation 260,762 260,762 1,058,571 1,058,571

Running costs spend less than allocation 4,361 4,361 17,451 17,451

Delegated Co-commissioning less than allocation 28,021 28,021 109,288 109,288

Planned Surplus in year 0 0 0 0

QIPP 8,725 5,950 34,900 23,800

Cash

Cash amount

requested for

month

Balance at month

end

Balance at month

end as % of

requested RAG Annual Cash LimitCash at bank balance within 1.25% of the monthly amount reqested or

£250k, whichever is greater £'000 £'000 % £'000Leeds North CCG 20,616 212 1.03% 297,000

Leeds South and East CCG 28,355 182 0.64% 433,000

Leeds West CCG 34,165 182 0.53% 485,000

Better Payment Practice Code (BPPC)The BPPC requires the CCG to aim to pay 95% of valid invoices by the

due date or within 30 days of receipt of a valid invoice, whichever is

later. By Value By Number By Value By Number RAGLeeds North CCG 99.88% 99.21% 99.58% 98.08%

Leeds South and East CCG 100.00% 99.68% 99.82% 99.34%

Leeds West CCG 100.00% 99.51% 99.94% 98.58%

Year to Date Forecast

NHS Non NHS

Page 2

Overview 30th June 2017

Cumulative Surplus Position:

Accumulated

surplus at the

end of 2016-17

Surplus

drawdown/draw-

up

Accumulated

surplus

remaining 2017-

18

% of allocation

(excl. Pcco

allocation

Value of

remaining

surplus over 1%

business rules

1% Sustainability

& Transformation

Fund (STF) also

held as surplus

in 2016-17

£m £m £m £m £mLeeds North CCG 5.8 - 5.8 2.20% 3.2 2.7Leeds South and East CCG 9.4 0.6 8.8 2.30% 5.1 4.1Leeds West CCG 7.7 - 7.8 1.80% 3.4 4.5

TOTAL 22.9 0.6 22.4 11.7 11.3

This report provides an update on the financial performance of the Leeds Clinical Commissioning Groups Partnership for the three months to 30th June 2017 and the expected

outturn position for the 2017-18 financial year. Details of the performance of the individual CCGs are provided in Appendix 1.

For 2017-18 onwards NHS England has changed the requirements for financial performance reporting for CCGs to be on an in year basis. The in year surplus or deficit is to be

calculated as the difference between the in year allocation (plus any pre-approved surplus drawdown) and total expenditure. CCGs have previously reported against a required

surplus control total.

The cumulative surplus or deficit are reported as a separate memorandum item in monthly reporting and the Leeds CCG's positions (excluding the 1% Sustainability and

Transformation Fund also required to be held as a surplus at end of 2016-17) are as follows:

The Leeds CCG's have submitted balanced plans to NHSE for 2017-18, with a citywide QIPP target of 3% (£34.9m) to achieve this position. At this early stage in the year with

limited data available the forecast is for a breakeven position. Relevant risks are highlighted in the commentary for each specific area below. But a key risk is that the QIPP targets

remain unmitigated. For 2017-18 a risk reserve is held to mitigate this however the CCG's financial position moving forward is untenable without the realisation of this QIPP

requirement.

Page 3

Financial Position Summary 30th June 2017

Budget Actual Variance Budget Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000Programme Services

Acute Services 140,982 140,872 -110 565,623 565,062 -561

Mental Health Services 32,387 32,365 -22 130,385 130,382 -3

Community Health Services 34,299 34,311 12 132,154 132,177 23

Continuing Care Services 12,517 12,418 -99 50,069 49,831 -238

Prescribing and Primary Care Services 37,375 37,245 -129 149,499 149,377 -122

Other 664 656 -8 2,655 2,656 1

Primary Care Co-Commissioning 28,021 28,021 0 109,288 109,288 0

Total Programme Services 286,246 285,889 -357 1,139,674 1,138,774 -900

RUNNING COSTS 4,361 4,361 0 17,451 17,451 0

RESERVES 2,538 2,894 357 28,185 29,085 900

CCG Net Expenditure 293,145 293,145 0 1,185,310 1,185,310 0


Revenue Expenditure 2017-18Year To Date Annual

Page 4

Allocations 30th June 2017

£'000 £'000 £'000 £'000

Opening Baseline Allocation 1,056,938 17,416 109,288 1,183,642

Neonatal hearing 359 0 0 359

GP Reception & Clerical Training 111 0 0 111

NHS WiFi (GP) 265 0 0 265

N3 connection (GP) 230 5 0 235

Market rents adjustment -433 7 0 -426

Paramedic rebanding 291 0 0 291

Diabetes Transformation Fund (LSE) 157 0 0 157

Other -6 59 53 106

Subtotal Month 3 Adjustments 974 71 53 1,098

Closing Allocation 1,057,912 17,487 109,341 1,184,740

Running CostsCo-

commissioning

IN YEAR

ALLOCATIONLeeds Clinical Commissioning Groups Partnership

Allocations 2017-18

Programme

Page 5

Risks and mitigations 30th June 2017

Key Risks £m £m £m £mAcute Services 2.0 3.3 2.5 7.8 Activity/system resilience pressure

Mental Health Services 0.2 0.2 0.2 0.6 Service pressures/demand

Community Health Services 0.0 0.0 0.3 0.3 Integration pilots/system resilience

Continuing Care Services 0.2 0.5 0.4 1.1 Service pressures/demand

Prescribing 0.1 0.5 0.0 0.6 High cost drugs & demand

QIPP under delivery 1.0 0.0 2.1 3.1

Other 0.0 0.0 0.3 0.3

3.5 4.5 5.8 13.8

Mitigations/Reserves £m £m £m £mContingency 1.5 2.1 2.4 6.0

Reserves 2.0 2.4 3.4 7.8

3.5 4.5 5.8 13.8

Leeds West CCG

TOTAL

for city


Revenue Expenditure 2017-18 Leeds North CCG

Leeds South &

East CCG Leeds West CCG

TOTAL

for city


Revenue Expenditure 2017-18 Leeds North CCG

Leeds South &

East CCG

Page 6

Acute Services 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000Leeds Teaching Hospitals NHS Trust 101,596 101,660 64 406,383 406,383 0

Mid Yorkshire NHS Trust 6,415 6,379 -36 25,662 25,662 0

Harrogate Foundations Trust 6,284 6,248 -36 25,134 25,134 0

Bradford Foundation Trust 1,187 1,196 9 4,747 4,747 0

York Foundation Trust 579 590 11 2,318 2,318 0

Other NHS Trusts 1,219 1,270 51 6,576 6,738 162

Non contract Activity 2,213 2,210 -3 8,848 8,848 0

Non NHS Acute 10,480 10,313 -167 41,919 41,196 -723

Urgent Care 11,009 11,006 -3 44,036 44,036 0

Total Acute Services 140,982 140,872 -110 565,623 565,062 -561

Leeds Teaching Hospital Trust (LTHT) – Data has been received for May activity and the CCGs are currently continuing to forecast a balanced position. Non-elective costs and activity are

potentially showing an overtrade but we are still discussing a counting and coding issue with LTHT which we need to determine before being able to see the real impact.

We have now received the allocation for specialist rehab from NHSE, this will have no net financial impact. CCGs are also expecting to become commissioners of morbid obesity activity

but have not yet agreed or received the allocation which would be transferred from NHSE. We recently met with the trust and NHSE around the identification rules review (the algorithm

used to determine what activity is commissioned by CCGs and NHSE respectively) for 17.18, this is due to be finalised by the end of July when CFOs will be asked to agree to the principles,

currently this would transfer of over a £1M to Leeds West CCG.

Mid Yorkshire Hospital Trust (MYHT) – The 16.17 financial positions were all agreed at year end, the 17.18 data is flowing as expected with no issues to report at this early stage of the

year.

Harrogate District Hospital Foundation Trust (HDFT) - The 16.17 final positions have been agreed for Leeds S+E and North, Leeds West is due to be closed off imminently, with a final

credit to the CCG of around £100K due to decreased activity in AP12. The Month 2 17.18 flex data has been received and there is nothing significant to report at this stage.

Other Acute Contracts – All the 16.17 contract outturn positions have been finalised. The CCGs have received all the month 2 reports for 17.18. The overspend within the Leeds North

CCG ledger is an accounting issue and not a real overspend; this will be corrected at Month 4.

Non NHS Acute – Month 2 activity data has been received for independent sector and AQP contracts and all data is flowing as expected at this early stage. The under spend is due to

Neuro rehabilitation patients. The neuro-rehab cases are individually managed and forecasts are based on individual case packages of care, four cases have been discharged over recent

months which has meant significant savings have been made and can be incorporated into the forecast position. The annual forecast however is still subject to activity level fluctuations

over the remainder of the year.



Page 7

Mental Health Services 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000Leeds and York Partnership Foundation Trust 23,482 23,481 0 93,927 93,927 0

Bradford District Care NHS Foundation Trust 19 18 -1 77 75 -3

Independent/Voluntary Sector/LCC 1,548 1,509 -40 7,028 7,028 0

Learning Disabilities 6,315 6,314 0 25,258 25,258 0

IAPT 270 270 0 1,082 1,082 0

Mental Health Specialist Services 439 457 18 1,754 1,754 0

Mental Health NCAs 134 134 0 534 534 0

Mental Health Other 181 182 1 724 724 0

Total Mental Health Services 32,387 32,365 -22 130,385 130,382 -3

At month 3 Mental Health and Learning Disabilities (LD) services are currently forecast to spend to budget. The main risks continue to be the Transforming Care Programme and

specialist patients with complex needs, requiring high cost and different services to those currently provided by the LD pooled budget and Leeds and York Partnerships

Foundation Trust, meaning that additional bespoke services have to be commissioned, often out of area, and for which the CCG has no budget.



Page 8

Community Health Services 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000Leeds Community Healthcare NHS Trust 24,992 24,993 1 99,968 99,968 0

Voluntary Sector/Local Authority 4,011 4,011 1 16,042 16,048 6

Community Intermediate Care (CIC) Beds 1,398 1,398 0 5,592 5,582 -10

Hospices 2,421 2,421 0 4,894 4,896 2

Reablement 702 702 0 2,807 2,807 0

Children's Services excluding Continuing Care 776 786 10 2,851 2,876 25

Total Community Health Services 34,299 34,311 12 132,154 132,177 23

Year To Date AnnualLeeds Clinical Commissioning Groups Partnership

Revenue Expenditure 2017-18

Community Services budgets are currently reporting a small overspend, mainly in children's services. This is due to Looked After Children's charges. This is an activity based

service and if the activity charged by LCH continues at the current rate there would be an overspend at year end, however this is not material to the CCGs. The main risk in

children's services is the Local Transformation Plan. This is £1.7m citywide, with £425k and £360k within the LCH contract for the Eating Disorders Service and Single Point of

Access Service respectively. This leaves £933k for children's mental health services, which is currently forecast to be spent in full. Plans are to be submitted to NHSE for approval

by the end of July. The other main risk area in children's services are potential future long term ventilation packages. There have been no new packages in 17-18 yet but as the

average cost of a package is £100k even one new case would significantly increase the forecast.

The CIC bed service is in the middle of a procurement exercise. Until this is completed and a contract awarded to the new provider(s) the financial position is unknown, so to be

prudent it has been forecast as fully spent at year end. There is a contingency built into the budget for any double running costs during the transition period between the new

and old suppliers, however this cannot be accurately estimated until the procurement process is complete.

Page 9

Continuing Care Services 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000Continuing Healthcare 8,422 8,368 -55 33,688 33,508 -180

Continuing Healthcare PHBs 1,138 1,162 23 4,553 4,646 94

Funded Nursing Care 2,203 2,189 -14 8,812 8,754 -58

Children Continuing Care including PHBs 209 210 1 835 835 0

Continuing Healthcare - operational 545 490 -56 2,182 2,087 -95

Total Continuing Care Services 12,517 12,418 -99 50,069 49,831 -238

This is a demand led service and can vary significantly month on month. For the three largest areas of continuing care services (continuing healthcare, personal health budgets

and funded nursing care), current activity data would give a relatively small forecast underspend of £144k on a budget of £47m, equating to 0.03%. The risk is that due to the

volatility of this service that this will not continue throughout the year.

AnnualLeeds Clinical Commissioning Groups Partnership

Revenue Expenditure 2017-18Year To Date

Page 10

Prescribing and Primary Care Services 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000Prescribing 31,630 31,637 7 126,519 126,519 0

Ex centrally funded drugs 853 825 -28 3,414 3,414 1

Oxygen contract 292 282 -10 1,168 1,126 -43

Prescribing staff 420 384 -35 1,680 1,617 -63

Primary Care Schemes 3,593 3,530 -63 14,372 14,355 -17

Primary Care - GP IT 587 587 0 2,347 2,347 0

Total Prescribing & Primary Care Services 37,375 37,245 -129 149,499 149,377 -122

Prescribing information is received 2 months in arrears, so there is currently only April data available for 2017-18, and therefore budget is taken as the best guide at this early

point in the year. Home oxygen underspend relates to Leeds South and East CCG based on 2 months of costs received. Prescribing staff shows a slight underspend due to

vacancies at Leeds South and East CCG. Primary Care schemes includes some schemes still in development and some costs that are backloaded towards later in the year.



Page 11

Other Services 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000Non Recurrent Projects 664 656 -8 2,656 2,656 0

Total Other Services 664 656 -8 2,656 2,656 0

Non Recurrent Projects includes a variety of small schemes. The largest schemes are the care homes schemes run non recurrently by Leeds West CCG and Leeds North CCG (the

scheme is recurrent at Leeds South & East) which is to going out to procurement on a citywide basis in 17-18, and the social prescribing service commissioned from BARCA which

runs up to August 2019. These schemes are forecast to spend in full in this financial year.



Page 12

Primary Care Co-Commissioning 30th June 2017


£'000 £'000 £'000 £'000 £'000 £'000GMS 6,038 6,039 1 24,154 24,154 0

PMS 11,680 11,672 -8 46,720 46,720 0

APMS 1,054 1,126 72 4,217 4,217 0

QOF 2,357 2,342 -15 9,428 9,428 0

Enhanced Services 699 897 198 2,796 2,796 0

Premises - Reimbursed Costs 4,404 4,231 -173 14,814 14,814 0

Premises - Other 41 25 -16 161 161 0

Prof Fees Prescribing & Dispensing 339 337 -2 1,357 1,357 0

Collaborative Payments 4 4 0 18 18 0

Other GP Services (inc. PCO) 653 693 40 2,612 2,612 0

Other Non GP Services 285 655 370 1,137 1,137 0

Reserves (91811030) 467 0 -467 1,875 1,875 0

Total Primary Care Co-Commissioning 28,021 28,021 0 109,289 109,289 0



The forecast is at budget levels for Primary Care co-commissioning at month 3, the PMS contracts were uplifted in Month 2 as expected. The majority of the practices QOF

achievement was paid in Month 3 with the remainder expected in Month 4.

There are a number of ETTF bids in the system from across the CCG, it is expected there will be Capital investment available in 17/18. We now need to prioritise our schemes

and work through the revenue implications, an estates workshop is planned for August 2017 to work through the developments.

Page 13

Running Costs 30th June 2017

Budget Actual Variance Budget Forecast Variance£'000 £'000 £'000 £'000 £'000 £'000

Pay 2,568 2,254 -314 10,273 9,299 -974

Non Pay/Income 1,793 2,107 314 7,178 8,152 974

Total Running Costs 4,361 4,361 0 17,451 17,451 0

Annual

Running costs are currently forecast to be spent in full. The budgets for pay will be re-costed once the city wide structures are agreed. The non pay costs will also be re-costed on

a common set of principles. A paper will be presented to SMT for discussion and agreement once this has been completed.


Revenue Expenditure 2017-18Year To Date

Page 14

Consolidated Statement of Financial Position 30th June 2017

30-Jun-17 30-Jun-16

£'000 £'000

Current AssetsTrade & Other Receivables 8,918 13,297

Cash & Cash Equivalents 118 117

Total Current Assets 9,035 13,414

Total Assets 9,035 13,414

Current LiabilitiesTrade & Other Payables: (64,471) (53,118)

Provisions (766) (382)

Total Current Liabilities (65,237) (53,500)

Total Assets less Current Liabilities (56,202) (40,086)

Non-current LiabilitiesProvisions (1,414) (656)

Total Non-current Liabilities (1,414) (656)

Total Assets Employed (57,616) (40,742)

Financed by Taxpayers’ EquityGeneral Fund (57,616) (40,742)

Total Taxpayers’ Equity (57,616) (40,742)

Page 15

Appendix 1


Finance Report by CCG for the three months ended 30th June 2017

Financial Performance Report by CCG 30th June 2017

Leeds North Clinical Commissioning Group Revenue Expenditure

2017-18


£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 71,222 71,222 289,546 289,546

Programme spend less than allocation 63,497 63,497 258,641 258,641




QIPP 2,150 1,466 8,600 5,865

Leeds South & East Clinical Commissioning Group Revenue

Expenditure 2017-18







QIPP 3,125 2,131 12,500 8,524

Leeds West Clinical Commissioning Group Revenue Expenditure

2017-18







QIPP 3,450 2,353 13,800 9,411




Financial Position Summary by CCG 30th June 2017



Acute Services 34,639 34,661 22 138,554 138,554 0

Mental Health Services 7,960 7,960 0 31,841 31,841 0


Continuing Care Services 3,504 3,481 -22 14,015 14,015 0

Prescribing and Primary Care Services 8,924 8,924 0 35,696 35,696 0

Other 0 0 0 0 0 0


Total Programme Services 69,019 69,019 0 276,078 276,078 0

RUNNING COSTS 1,096 1,096 0 4,383 4,383 0

RESERVES 1,107 1,107 0 9,085 9,085 0

CCG Net Expenditure 71,222 71,222 0 289,546 289,546 0

Leeds North Clinical Commissioning Group Revenue Expenditure

2017-18Year To Date Annual




Acute Services 49,709 49,712 2 200,535 200,267 -268

Mental Health Services 11,685 11,666 -19 47,577 47,574 -3




Other 280 304 24 1,121 1,121 0


Total Programme Services 102,367 102,212 -155 406,961 406,505 -456

RUNNING COSTS 1,370 1,370 0 5,485 5,485 0

RESERVES 37 192 155 8,834 9,290 456


Leeds South and East Clinical Commissioning Group Revenue

Expenditure 2017-18Year To Date Annual




Acute Services 56,634 56,499 -134 226,534 226,241 -293

Mental Health Services 12,742 12,739 -3 50,967 50,967 0




Other 384 352 -32 1,535 1,535 1


Total Programme Services 114,859 114,658 -202 456,634 456,191 -443

RUNNING COSTS 1,896 1,896 0 7,583 7,583 0

RESERVES 1,393 1,595 202 10,267 10,710 443


Leeds West Clinical Commissioning Group Revenue Expenditure

2017-18Year To Date Annual

1

Agenda Item: LHCB 17/15 FOI Exempt: N



Title: Chief Executive’s Report

Lead Board Member: Phil Corrigan, Chief Executive


appropriate

()

Report Author: Phil Corrigan, Chief Executive Decision


Discussion


Information











N/A





N/A



N/A

2

EXECUTIVE SUMMARY: The Chief Executive’s report informs the Board of: CCG Improvement and Assessment Framework

1. On 19 July NHS England published the outcome of their assessment of CCGs’ delivery

of their statutory responsibilities as measured using the new CCG Improvement and Assessment Framework published in 2016/17. The Framework was developed with input from NHS Clinical Commissioners, CCGs, patient groups and charities with assessment based on how CCG as doing in delivering across a range of areas including NHS Constitution, NHS Mandate and finance metrics along with meeting the transformational challenges facing the NHS. There are four possible ratings i.e. Outstanding, Good, Requires Improvement and Inadequate. The three Leeds CCGS all achieved a rating of ‘Good’ for 2016/17. A full review of the CCGs’ performance against the framework will be undertaken over the coming month and a report on areas of good performance and areas for improvement provided to the next Board meeting.

Forced marriage and Honour Based Abuse Pledge of Intention

2. Forced marriage and Honour Based Abuse is a serious violation of human rights and a

form of domestic violence and abuse. Where it affects children and young people it is child abuse. Religion, tradition and culture cannot be used to justify depriving citizens of their rights. Forced Marriage is a criminal offence.

3. Karma Nirvana is an award-winning British Human Rights Charity based in Leeds which supports victims of Honour Based Abuse and Forced Marriage.

4. Karma Nirvana run a national helpline offering direct support and guidance to victims and professionals, provide training to the Police, NHS and Local Authorities. They act as expert witnesses in court, speak out in schools and attend awareness raising events internationally. After ten years of campaigning and lobbying Government, in 2014 Karma Nirvana were instrumental in ensuring that forced marriage became a criminal offence. Annual Day of Memory July 14th 2017

5. Karma Nirvana hosted their annual ‘Day of Memory Conference’ each year on July 14th to remember those lost to honour killings. Where some families feel dishonoured, shamed and choose to forget, Karma Nirvana remembers and celebrate victim’s lives. This year the event is to be held in Leeds.

6. The Day of Memory was inspired by Bradford-born Shafilea Ahmed who was murdered by her parents in 2003 after suffering years of abuse for becoming ‘too westernised’.

7. The 2017 Day of Memory was held in conjunction with the West Yorkshire Police Crime Commissioner and Leeds City Council. 200 guests heard from experts and survivors

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and learn how local and national partners are tackling honour-based abuse and what they are doing to prevent further honour killings in Britain.

8. Leeds City Council, West Yorkshire Police, NHS England (Yorkshire and Humber), Leeds Teaching Hospitals NHS Trust, Leeds Community Healthcare NHS Trust, Leeds and York Partnership NHS Foundation Trust, and NHS Leeds Clinical Commissioning Groups Partnership have all been asked by Karma Nirvana to sign a pledge to become a beacon of best practice on this issue in the UK and it is hoped other councils will follow suit.

9. Signatories pledge to:

• Promote ways of safeguarding our children and adults at risk • Increase public awareness • Influence social change • Develop effective support and responses for victims and survivors of FM • Develop the capacity and capability of our workforce • Develop a co-ordinated city-wide response

10. In order for this pledge to be implemented a city wide steering group will be established and Gill Marchant, Designated Nurse for Safeguarding Children and Adults has agreed to represent the Leeds CCGs Partnership on this group.

11. The agencies listed above have all committed to the pledge.

Health and Social Care Academy for Leeds

12. I'm pleased to update the Board on the good progress we have made with the development of a Health and Social Care Academy for Leeds, bringing together all those involved in the coordination and delivery of the training, education and development of health and social care staff in Leeds under one management. At its meeting in June, the Leeds Academic Health Partnership (LAHP) Board agreed the following recommendations which derived from an independently commissioned report: a. That the project should proceed to the next stage (planning and implementation). b. When it becomes operational, the Academy will, at least initially, be “hosted” by a

Partner organisation rather than created as a standalone legal entity. c. The transition team, which will be responsible for the planning and implementation

phase, will be funded from a combination of investment by partners according to a fair shares model with some use of the LAHP seed fund to cover non-staff transition costs.

d. The planning and implementation stage and the operational stage of the Academy should be governed according to the recommendations of the main report

13. The LAHP Board also agreed the following: a. That, for reasons of continuity, Dean Royles (Director of Human Resources and OD,

LTHT) should remain the Senior Responsible Owner for the planning and

4

implementation stage. b. Which organisation should host the Academy. It was agreed this would be LTHT. c. The transition team should be appointed by the host organisation as an immediate

action and the planning and implementation stage should proceed at pace according to the roadmap which accompanies the main report.

d. That each individual LAHP Partner organisations affected directly will now begin the process of securing formal agreement to the creation of the Academy from their individual partner boards or governing bodies. This process will be supported by the transition team as a priority activity.

14. The above recommendations were agreed. The Board will continue to provide regular updates on the establishment of the Academy.

New CCGs on call rota

15. The CCG has a requirement to provide access to an on call manager during the out of hours period, evening and weekends. The CCG on call system has been reviewed and consultation with all staff grade 8C and above has been done regarding a new on call system.

16. Instead of one executive on call for each week we propose that two senior posts buddy up together and cover one week in 12 between them (or 1:24 each). This will ensure continuity and immediate support in the event of an incident plus allow increased flexibility between buddies as to which days are covered.

17. For all on call staff on Agenda for Change contracts a 2% on call supplement becomes applicable and arrangements will be made to pay this to staff from 1st September 2017 when the new on call rota commences. To support on call staff a refreshed on call handbook has been developed and on call training will commence in August.

Communications and engagement update Leeds Health and Wellbeing Board

18. At its meeting on 20 June 2017, the Leeds Health and Wellbeing Board received an

update on the Leeds Plan and was asked for support from the Board for the draft narrative the of the Plan to be published in order to develop a citywide conversation with citizens.

19. The draft narrative set the Leeds Plan in context with the West Yorkshire Sustainability and Transformation Plan. To achieve the maximum chance of engaging the public and delivering change; the Plan was user friendly and accessible reflecting the core value of working with the population.

20. During discussions the following matters were raised:

Acknowledged and welcomed the opportunity for the Community Committees to have had early discussions on the Leeds Plan during the Spring 2017. A request for an update to the community committees was noted

5

The need to realise the value of the collective Leeds Pound and emphasise this within the health economy and beyond; acknowledging that service users may be buyers as well as consumers who could form co-operatives or social enterprises. This was also an opportunity to engage businesses in the ambitions of the Leeds Health and Care Plan; to interact with inclusive growth alongside Leeds Growth Strategy and with the Leeds Academic Health Partnership

A request for the draft Plan to include a foreword emphasising the role of feedback in shaping a live document that will evolve. Associated to this, a review of the language and phrasing to ensure a plain English approach and to avoid inadvertently suggesting that areas of change have already been decided. The narrative to also clarify who will make decisions in the future

The Plan to include case studies

Acknowledged the need to broaden the scope of the Plan in order to “if we do this, then this how good our health and care services could be” and to provide more detail on what provision may look like in the future

Noted the request for the Plan to provide more focus on some of the options from the Joint Health and Wellbeing Strategy

References to taking self-responsibility for health should also include urgent care/out of hospital health

References to the role of the Leeds Health and Wellbeing Board and the Joint Health and Wellbeing Strategy to be strengthened and appear earlier in the Plan

Assurance was sought that the Plan would be co-produced as part of the ongoing conversation

A focus on Leeds figures rather than national

Requested that a follow up paper with more detail, including the extended primary care model, be brought back in September.

21. In conclusion, the Chair noted that the Board was supportive of the draft Plan being released for consultation, subject to the amendments suggested being made.

GP practices – engagement

22. In our role as co-commissioners of primary care services we have been advising three

practices around their need to engage with their registered patients following their decisions to either close their practice entirely or apply to close a branch surgery. The practices currently undertaking patient engagement are:

York Road practice – closure of practice

Whinmoor Road Surgery – closure of practice

The Avenue Surgery (Alwoodley) – proposed closure of Green Road (Meanwoood) branch surgery

Changes to prescribing consultation

23. Our consultation on proposed changes to prescribing of certain medications has come to a close. Our proposal is:

To not routinely fund gluten-free foods on a prescription basis.

6

We will routinely commission the prescribing of non-branded (generic) products unless there is a medical reason.

To not routinely fund a range of “over the counter” medicines on prescription.

24. We’ve received over 3,000 responses and are in the process of writing an engagement report. This will help inform our decision on future guidance as well as any future communications with patients. Since we launched the consultation in spring (with a pause for the pre-election period) a national consultation was also launched by the Department of Health on the prescribing of gluten-free foods. The outcome of this and any possible national changes will have an impact on guidance issued locally.


(a) Receive the Chief Executive’s report.

1

Agenda Item: LHCB 17/16 FOI Exempt: N



Title: Managing Conflicts of Interest and Standards of Business Conduct Policies

Lead Board Member: Phil Corrigan, Chief Executive


appropriate

()

Report Author: Governance Leads

Decision


Discussion

Reviewed by Committee: Audit Committees, 19 July 2017

Information











The updated policies will ensure that the CCGs comply with NHS England Statutory Guidance on conflicts of interest





N/A



N/A

2

EXECUTIVE SUMMARY: NHS England released new cross-system guidance for NHS organisations in April 2017 relating to managing conflicts of interest (‘Managing Conflicts of Interest in the NHS: Guidance for staff and organisations’). This came into force on 1 June 2017 and applies to CCGs, provider trusts, and NHS England. NHS England has updated the statutory guidance for CCGs to align with the cross-system guidance (‘Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017’). CCGs are therefore required to update their policies in accordance with the new guidance. The key changes are as follows:

Registers of interest: CCGs to satisfy themselves as a minimum on an annual basis that their registers of interest are accurate and up to date. Only decision making staff are required to be included on the publicised register.

Gifts from suppliers or contracts: gifts of low value (up to £6) can now be accepted (see below).

Gifts from other sources: Gifts of under £50 can be accepted from non suppliers and contractors. These do not need to be declared. Gifts of over £50 can only be accepted on behalf of the organisation.

Hospitality - meals and refreshment: hospitality under £25 does not need to be declared. Anything between £25 and £75 can be accepted but must be declared. Anything over £75 should be refused until senior approval is given.

New care models: a new annex has been included to provide further advice in this developing area.

The changes to the guidance have been reflected in the CCGs’ policies on managing conflicts of interest and standards of business conduct. Each CCG previously had separate policies which have now been amalgamated into joint policies for the CCGs Partnership. The policies have been reviewed by the Audit Committees which have agreed to recommend that the policies are approved by the Board. The full policies, including tracked changes, are attached at appendices 1-2. The main amendments are also outlined below: Managing Conflicts of Interest Policy

Section 1 – Introduction / Section 2 – Definition of an interest - Revised definition of a conflict of interest as per the guidance.

Section 6 – Declaring Interests – updates will be sought on an annual basis rather than six monthly.

Section 8 – Publication of registers – only the declarations for decision making staff will be published. The definition of ‘decision making staff’ has been adopted from the guidance.

Section 11.1 – Register of procurement decisions – updated to reflect that procurements over £100,000 will be included in the register to align with the proposed new scheme of

https://www.england.nhs.uk/wp-content/uploads/2017/02/guidance-managing-conflicts-of-interest-nhs.pdf


https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf

3

delegation.

General updates to reflect that the policy applies to the CCGs Partnership, clarification that the policy applies in the development of new care models and to include the new post of Head of Corporate Governance which will have responsibility for conflicts of interest in the new CCG structure.

The appendices have been updated as appropriate.

Standards of Business Conduct Policy

Section 5 – Hospitality / Gifts – updated limits for accepting hospitality in line with the guidance.

Section 5 – Sponsored events – additional principles added in line with the guidance, and reference to sponsored posts.

Section 5 – Gifts, Hospitality and Sponsorship register - only the declarations for decision making staff will be published. The definition of ‘decision making staff’ has been adopted from the guidance.

Section 6 – Outside Employment – updates in line with the guidance.

General updates to reflect that the policy applies to the CCGs Partnership and to include the new post of Head of Corporate Governance which will have responsibility for conflicts of interest in the new CCG structure.

The appendices have been updated as appropriate.

NEXT STEPS: The policies will be disseminated to governing body and committee members, staff and member practices.


(a) Approve the Managing Conflicts of Interest and Standards of Business Conduct

policies.

1

Managing conflicts of interest policy

Version DRAFT

Ratified by Leeds Health Commissioning & System Integration Board

Date ratified TBC

Name and title of originator/Authors Head of Corporate Governance

Name of responsible Committee/Individual

Audit Committee

Date issued TBC

Review date [1 year from date of approval]

Target audience See section 1.6

2

CONTENTS

Page

1. Introduction

3

2. Definition of an interest

4

3. Equality statement

76

4. Principles

76

5. Roles and responsibilities

87

6. Declaring interests

98

7. Register of interests

1110

8. Publication of registers

1210

9. Appointing Governing Body or committee members and senior staff

1311

10. Conflicts of interest at meetings

1411

11. Managing conflicts of interest throughout the commissioning cycle

1614

12. Raising concerns and breaches

2118

13. Conflicts of interest training

2421

APPENDIX 1- Declaration of interests form

2522

APPENDIX 2 – Register of interests template

2925

APPENDIX 3 – Declarations of interest checklist for chairs

3026

APPENDIX 4 – Minutes template for recording declarations of interest

3328

APPENDIX 5 - Procurement checklist

3429

APPENDIX 6 – Register of procurement decisions template

3631

APPENDIX 7 - Declaration of interests for bidders/contractors template

3732

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1. Introduction

1.1 Managing conflicts of interest appropriately is essential for protecting the integrity of the NHS commissioning system and to protect Leeds West CCGs Partnership and GP practices from any perceptions of wrongdoing. Commissioners need the highest level of transparency so they can demonstrate that conflicts of interest are managed in a way that cannot undermine the probity and accountability of the organisation.

1.2 It will not be possible to avoid conflicts of interest. They are inevitable in many

aspects of public life, including the NHS. Healthcare professionals have always had to manage competing interests. However, by recognising where and how they arise and dealing with them appropriately, commissioners will be able to ensure proper governance, robust decision-making and appropriate decisions about the use of public money.

1.3 A conflict of interest is defined asoccurs:

“a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold” Where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her involvement in another role or relationship. In some circumstances, it could be reasonably considered that a conflict exists even when there is no actual conflict. In these cases it is important to still manage these perceived conflicts in order to maintain public trust.

1.4 This policy seeks to ensure that conflicts are identified, declared and recorded,

and that clear mechanisms exist to manage or diffuse conflicts of interest when they arise. It is also important to acknowledge that conflicts may not always be obvious to, or recognised by, the individuals concerned. Therefore, a policy based on full disclosure regarding competing interests will best safeguard healthcare professionals as they exercise their new commissioning responsibilities. NHS Leeds West CCG’s Partnership’s Managing Conflicts of Interest Policy is based on the principle of: “If in doubt, disclose”.

1.5 The Health and Social Care Act 2012 places a duty on the NHS Commissioning Board to publish guidance for CCGs on managing conflicts and a duty on CCGs to have regard to such guidance. It also requires that CCGs set out in their constitution their proposed arrangements for managing conflicts of interest (see section 8.2 of the Leeds West CCG constitution). This policy provides more specific, additional safeguards that the CCG has put in place. It reflects the revised statutory guidance for CCGs on Managing Conflicts of Interest, issued by NHS England in June 20162017.

1.6 This policy applies to:

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All CCG employees, including all full and part-time staff, staff on sessional or short term contracts, students and trainees (including apprentices), agency staff, seconded staff.

Members of the CCG’s Governing Body, Committees, Sub Committees and Sub Groups, including co-opted members, appointed deputies and members of committees/groups from other organisations (where the CCG is participating in a joint committee alongside other CCGs, any interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG).

Members of the CCG – defined as GP partners (or where the practice is a company, each director) and any individual directly involved with the business or decision making of the CCG.

Who are referred to collectively in this policy as ‘individuals within the CCG’.

2. Definition of an interest 2.1 Conflicts of interest can arise in many situations, with an increased risk in

primary care commissioning, out-of-hours commissioning and involvement with integrated care organisations, as clinical commissioners may find themselves in a position of being at once commissioner and provider of services. Conflicts of interest can arise throughout the whole commissioning cycle, from needs assessment, to procurement exercises, to contract monitoring The following types of conflict are likely to affect CCGs:

For the purposes of this policy a conflict of interest is defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold” 1.

2.2 A conflict of interest may be:

Actual Potential

There is a material conflict between one or more interests.

There is the possibility of a material conflict between one or more interests in the future.

2.3 Individuals within the CCG may hold interests for which they cannot see

potential conflict. However, caution is always advisable because others may see it differently. It will be important to exercise judgement and to declare such interests where there is otherwise a risk of imputation of improper conduct. The perception of an interest can be as damaging as an actual conflict of interest.

1 Managing conflicts of interests in the NHS: Guidance for staff and organisations.2017.

https://www.england.nhs.uk/wp-content/uploads/2017/02/guidance-managing-conflicts-of-interestnhs.pdf



5

2.4 Conflicts of interest can arise in many situations, environments and forms of commissioning, with an increased risk in primary care commissioning, out-of- hours commissioning and involvement with integrated care organisations and new care models, as individuals within the CCG may here find themselves in a position of being both commissioner and provider of services. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring. References in this policy to ‘new care models’ refer to Multi-speciality Community Providers (MCP), Primary and Acute Care Systems (PACS) or other arrangements of a similar scale or scope.

2.5 Interests fall into the four categories outlined below. A benefit may arise from

the making of a gain or the avoidance of a loss: 2.62 Financial interests

This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include an individual being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. This includes involvement with a potential provider of a new care model;

A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;

A management consultant for a provider;

A provider of clinical private practice;

In secondary employment outside of the CCG;

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one-off payments, day allowances or travel or subsistence) from a provider;

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; or

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider); or.

Substantively employed by another organisation, i.e. when on secondment.

2.73 Non-financial professional interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

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An advocate for a particular group of patients;

A GP with special interests e.g. in dermatology, acupuncture, etc.;

An active member of a particular specialist professional body (although routine GP membership of the Royal College of General Practitioners (RCGP), British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE);

A medical researcherEngaged in a research role;.

Involved in the development and holding of patents and other intellectual property rights which allow staff to protect something that they create, preventing unauthorised use of products or the copying of protected ideas;

GPs and practice managers, who are members of the Governing Body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

2.84 Non-financial personal interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment;

A member of a lobby or pressure group with an interest in health. 2.95 Indirect interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as described above) for example, a:

Spouse / partner

Close relative e.g., parent, grandparent, child, grandchild or sibling;

Close friend or associate;

Business partner.

A declaration of interest for a “business partner” in a GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim).

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Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG.

2.106 NHS England has published conflicts of interests case studies which are available on its website here.

2.11 The above categories and examples are not exhaustive and a common sense approach should be adopted. Individuals within the CCG should exercise discretion on a case by case basis, including in relation to new care model arrangements, having regard to the principles set out in section 4 of this policy, in deciding whether any other role, relationship or interest may impair or otherwise influence the individual’s judgement or actions in their role within the CCG. If so, this should be declared and appropriately managed.

3. Equality statement 3.1 This policy applies to all employees, Governing Body and Committee

members and members of the NHS Leeds West CCGs Partnership irrespective of age, race, colour, religion, disability, nationality, ethnic origin, gender, sexual orientation or marital status, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or trade union membership.

3.2 A full Equality Impact Assessment is not considered to be necessary as this

policy will not have a detrimental impact on a particular group.

4. Principles 4.1 The CCG observes the following principles of good governance:

The Nolan Principles of selflessness, integrity, objectivity, accountability, openness, honesty and leadership2

The Good Governance Standards for Public Services (2004), Office for Public Management (OPM) and Chartered Institute of Public Finance and Accountancy (CIPFA)3

The seven key principles of the NHS Constitution4

The Equality Act 20105

The UK Corporate Governance Code6

Standards for members of NHS boards and CCG governing bodies in England7

2 The 7 principles of public life https://www.gov.uk/government/publications/the-7-principles-of-public-

life 3 The Good Governance Standards for Public Services, 2004, OPM and CIPFA

http://www.opm.co.uk/wp-content/uploads/2014/01/Good-Governance-Standard-for-Public-Services.pdf 4 The seven key principles of the NHS Constitution

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx 5 The Equality Act 2010 http://www.legislation.gov.uk/ukpga/2010/15/contents

6 UK Corporate Governance Code https://www.frc.org.uk/Our-Work/Codes-Standards/Corporate-

governance/UK-Corporate-Governance-Code.aspx

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/06/coi-case-studies-jun16.pdf

https://www.gov.uk/government/publications/the-7-principles-of-public-life

https://www.gov.uk/government/publications/the-7-principles-of-public-life

http://www.opm.co.uk/wp-content/uploads/2014/01/Good-Governance-Standard-for-Public-Services.pdf

http://www.opm.co.uk/wp-content/uploads/2014/01/Good-Governance-Standard-for-Public-Services.pdf

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx

http://www.legislation.gov.uk/ukpga/2010/15/contents

https://www.frc.org.uk/Our-Work/Codes-Standards/Corporate-governance/UK-Corporate-Governance-Code.aspx

https://www.frc.org.uk/Our-Work/Codes-Standards/Corporate-governance/UK-Corporate-Governance-Code.aspx

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4.2 The CCG endorses other principles that can safeguard against conflicts of

interest:

Doing business appropriately;

Being proactive about identifying and minimising the risks of conflicts;

Being balanced and proportionate in managing conflicts;

Being transparent and documenting every stage in the commissioning cycle; and

Creating an environment and culture where individuals feel supported and confident in declaring relevant information and raising any concerns.

4.3 The CCG also recognises that:

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

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

For a conflict of interest to exist, financial gain is not necessary. 4.4 This policy reflects ‘Managing Conflicts of Interests: Revised Statutory

Guidance for CCGs 2017’ (Issued by NHS England, June 20176). It should be read alongside the following Leeds West CCGs Partnership documents:

Anti-Fraud, Bribery and Corruption Policy;

Code of Conduct for NHS Managers, also contained within individual contracts of employment;

Whistleblowing Policy;

Working Time Regulations Policy (including Secondary Employment);

Disciplinary Policy;

Procurement Policy; and

Standards of Business Conduct Policy.

5. Roles and responsibilities 5.1 The Accountable Officer has overall accountability for the CCG’s

management of conflicts of interest. 5.2 The Conflicts of Interest Guardian, who will be the Chair of the Audit

Committee, will:

Act as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest;

7 Standards for members of NHS boards and CCG governing bodies in England

http://www.professionalstandards.org.uk/publications/detail/standards-for-members-of-nhs-boards-andclinical-commissioning-group-governing-bodies-in-england



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Be a safe point of contact for employees or workers of the CCG to raise any concerns in relation to this policy;

Support the rigorous application of conflict of interest principles and policies;

Provide independent advice and judgment where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation;

Provide advice on minimising the risks of conflicts of interest; and

If an individual requests that information is not included in the public register(s), decide whether the information should be published or not.

5.3 The Head of Business and Corporate Services Governance has day to day

responsibility for managing conflict of interests, including:

Maintaining the CCG’s register(s) of interest and the other registers referred to in this policy;

Supporting the Conflicts of Interest Guardian to enable them to carry out the role effectively;

Providing advice, support, and guidance on how conflicts of interest should be managed; and

Ensuring that appropriate administrative processes are put in place. 5.4 All members of the Governing Body must act in accordance with this policy

and lead by example in acting with the utmost integrity and ensuring adherence to all relevant regulations, policies and procedures.

5.5 Line Managers are responsible for assisting employees in complying with this

policy by ensuring that this policy and its requirements are brought to the attention of employees for whom they are responsible, and that those employees are aware of its implications for their work.

5.5 All individuals within the CCG are required to be aware of and comply with

the policy.

5.6 If any individual within the CCG has any doubt about the relevance of an interest, this should be discussed with the Conflicts of Interest Guardian or the Head of Business & Corporate ServicesGovernance.

6. Declaring interests 6.1 All individuals within the CCG must declare any interests that might have any

bearing on the work of the CCG:

a) on appointment - applicants for any appointment to the CCG or its Board Governing Body or any committees should be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests should again be made and recorded.

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b) six-monthlyannually - declarations will be sought from all relevant individuals every six monthson an annual basis and where there are no interests or changes to declare, a “nil return” will be recorded.

c) at meetings - all attendees are required to declare their interests as a standing agenda item for every BoardGoverning Body, committee, sub-committee or working group meeting, before the item is discussed. Even if an interest has been recorded in the register of interests, it should still be declared in meetings where matters relating to that interest are discussed. Declarations of interest must be recorded in minutes of meetings.

d) on changing role, or responsibilityies or circumstances - whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests (e.g. where an individual takes on a new role outside the CCG, or enters into a new business or relationship, starts a new project/piece of work or may be affected by a procurement decision e.g. if their role may transfer to a proposed new provider), a further declaration should be made to reflect the change in circumstances as soon as possible, and in any event within 2814 days. This could involve a conflict of interest ceasing to exist or a new one materialising. It is the individual’s responsibility to make a further declaration as soon as possible, rather than waiting to be asked.

e) if they come to know that the CCG has entered into (or proposes to enter into) a financial arrangement in which they or any person connected with them has any interest, direct or indirect.

6.2 CCG staff should declare any interests by completing the declaration of

interests form at Appendix 1 and submitting this to their Line Manager, within 2814 days. Line Managers will record the interests and make a decision on whether the declaration is deemed to require any action to ensure transparency and avoid a conflict of interest. If required, Line Managers should seek advice on appropriate action from the Head of Business and Corporate Services Governance and/or Conflicts of Interest Guardian.

6.3 Line Managers should hold any interests declared on the individual’s personal

file. All interests should be declared as and when they arise. Individuals are responsible for ensuring that their registered interests are kept up to date at all times.

6.4 Once any arrangements for mitigating the risk have been agreed by the

individual’s Line Manager, these should be documented on the approved form and submitted to the Head of Business and Corporate ServicesGovernance. Such arrangements will specify:

• whether and when an individual should withdraw from a specified activity, on a temporary or permanent basis; and

• monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

6.5 Where an individual is unclear about the arrangements for managing the

interest, they should seek advice from their Line Manager.

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6.6 All other individuals should submit declarations directly to the Head of

Business and Corporate Services Governance using the form at Appendix 1, who will decide, in conjunction with the Conflicts of Interest Guardian, whether any specific arrangements are required to manage the conflicts or potential conflicts declared.

6.7 Although the interest may be declared, this does not remove the individual’s

personal responsibilities of removing themselves from a position or situation which may result in a potential breach of this policy.

7. Register of Interests 7.1 Registers will be maintained of the interests of individuals within the CCG,

specified in paragraph 1.6. 7.2 The registers for all the above will be published on the CCG’s website and

maintained by the Head of Business and Corporate ServicesGovernance. The register(s) will be reviewed six-monthlyannually, and updated as necessary. For a new declaration, the relevant register will be updated inside 28 days. All individuals within the CCG must submit a nil declaration where they have no interests or changes to declare. All interests will remain on the register for a minimum of 6 months after the interest has expired. The CCG will retain a private record of historic interests for a minimum of 6 years after the date on which it expired.

7.3 Where an individual is unable to provide a declaration in writing, e.g. if a

conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.

7.4 Registers will include:

Name of the person declaring the interest;

Position within, or relationship with, the CCG (or NHS England in the event of joint committees);

Type of interest e.g., financial interests, non-financial professional interests;

Description of interest, including for indirect interests details of the relationship with the person who has the interest;

The dates from which the interest relates; and

The actions to be taken to mitigate risk - these should be agreed with the individual’s line manager or a senior manager within the CCG.

7.5 A template is attached at Appendix 2. 7.6 The register of interests will be reviewed at every Audit Committee meeting.

The Governing Body will review the register of interests on an annual basis.

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8. Publication of registers 8.1 The CCG will publish the register of interests and gifts and hospitality and the

register of procurement decisions described below, in a prominent place on the CCG’s website.

8.2 Although all individuals must declare interests, the CCG will only publish the interests of decision makers. Decision makers are defined as follows:

All governing body members;

Members of advisory groups which contribute to direct or delegated decision making on the commissioning or provision of taxpayer funded services such as working groups involved in service redesign or stakeholder engagement that will affect future provision of services;

Members of the Primary Care Commissioning Committee (PCCC);

Members of other committees of the CCG e.g., audit committee, remuneration committee etc.;

Members of new care models joint provider / commissioner groups / committees;

Members of procurement (sub-)committees;

Individuals on Agenda for Change band 8d and above;

Management, administrative and clinical staff who have the power to enter into contracts on behalf of the CCG;

Management, administrative and clinical staff involved in decision making concerning the commissioning of services, purchasing of goods, medicines, medical devices or equipment, and formulary decisions; and

Management, administrative and clinical staff responsible for processing payments on behalf of the CCG.

8.2 In exceptional circumstances, where the public disclosure of information could give rise to a real risk of harm or is prohibited by law, an individual’s name and/or other information may be redacted from the publicly available register(s). Where an individual believes that substantial damage or distress may be caused, to him/herself or somebody else by the publication of information about them, they are entitled to request that the information is not published. Such requests must be made in writing. Decisions not to publish information will be made by the Conflicts of Interest Guardian for the CCG, who will seek appropriate legal advice where required, and a confidential un-redacted version of the register(s) will be retained.

8.3 All persons who are required to make a declaration of interests will be made aware that the register will be published in advance of publication. This will be done by providing a fair processing notice that details the identity of the data controller, the purposes for which the registers are held and published, and contact details for the data protection officer. This information will also be provided to individuals identified in the registers due to their relationship with the person making the declaration. All decision making staff will be made aware, in advance of publication, that the register(s) will be kept, how the

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information on the register(s) may be used or shared and that the register(s) will be published. This will be done by the provision of a fair processing notice that details the identity of the data controller, the purposes for which the registers are held and published, how the information on the register(s) may be used or shared and contact details for the data protection officer. This information will also be provided to individuals identified in the register(s) because they are in a relationship with the person making the declaration.

8.4 All individuals who are not decision makers but who are still required to make a declaration of interest(s) will be made aware that the register(s) will be kept and how the information on the register(s) may be used or shared. This will be done by the provision of a separate fair processing notice that details the identity of the data controller, the purposes for which the register(s) are held, how the information on the register(s) may be used or shared and contact details for the data protection officer. This information will also be provided to individuals identified in the register(s) because they are in a relationship with the person making the declaration.

9. Appointing Governing Body or committee members and senior staff

9.1 On appointing Governing Body, committee or sub-committee members and

senior staff, the CCG will consider whether conflicts of interest should exclude individuals from being appointed to the relevant role. The CCG will assess the materiality of the interest, in particular whether the individual (or any person with whom they have a close association could benefit (whether financially or otherwise) from any decision the CCG might make. This will be particularly relevant for Governing Body, committee and sub-committee appointments, but should also be considered for all employees and especially those operating at senior level.

9.2 The CCG will also determine the extent of the interest and the nature of the

appointee’s proposed role within the CCG. If the interest is related to an area of business significant enough that the individual would be unable to operate effectively and make a full and proper contribution in the proposed role, then that individual should not be appointed to the role.

9.3 Any individual who has a material interest in an organisation which provides,

or is likely to provide, substantial services to the CCG (whether as a provider of healthcare or commissioning support services, or otherwise) should recognise the inherent conflict of interest risk that may arise and should not be a member of the Governing Body or a committee or sub-committee of the CCG, in particular if the nature and extent of their interest and the nature of their proposed role is such that they are likely to need to exclude themselves from decision-making on so regular a basis that it significantly limits their ability to effectively perform that role.

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10. Managing Cconflicts of interest at meetings 10.1 Declarations of interests will be a standing item on all meeting agendas. The

chair of a meeting of the CCG’s Governing Body or any of its committees, sub-committees or groups has ultimate responsibility for deciding whether there is a conflict of interest and for taking the appropriate course of action in order to manage the conflict of interest. In reaching this decision the chair will seek advice from the Head of Corporate Governance or their representative, or where there is not one, another senior manager.

10.2 In the event that the chair of a meeting has a conflict of interest, the vice chair

is responsible for deciding the appropriate course of action in order to manage the conflict of interest. If the vice chair is also conflicted then the remaining non-conflicted voting members of the meeting should agree between themselves how to manage the conflict(s).

10.3 In making such decisions, the chair (or vice chair or remaining non-conflicted

members as above) may wish to consult with the Conflicts of Interest Guardian or another member of the Governing Body.

10.4 It is good practice for the chair, with support of the CCG’s Head of Business

and Corporate Services Governance and, if required, the Conflicts of Interest Guardian, to proactively consider ahead of meetings what conflicts are likely to arise and how they should be managed, including taking steps to ensure that supporting papers for particular agenda items of private sessions/meetings are not sent to conflicted individuals in advance of the meeting where relevant.

10.5 Chairs will be provided with a declaration of interests checklist (attached at

Appendix 3) with the meeting papers, which will include details of any declarations of interest which have already been made by members of the Governing Body / committee / sub-group.

10.6 The chair should ask at the beginning of each meeting if anyone has any

conflicts of interest to declare in relation to the business to be transacted at the meeting. Each member of the group should declare any interests which are relevant to the business of the meeting whether or not those interests have previously been declared. Any new interests which are declared at a meeting must be included on the CCG’s relevant register of interests to ensure it is up-to-date. Similarly, any new offers of gifts or hospitality which are declared at a meeting must be added to the register of gifts and hospitality.

10.7 It is the responsibility of each individual member of the meeting to declare any

relevant interests which they may have. However, should the chair or any other member of the meeting be aware of facts or circumstances which may give rise to a conflict of interests but which have not been declared then they should bring this to the attention of the chair who will decide whether there is a conflict of interest and the appropriate course of action to take in order to manage the conflict of interest.

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10.8 If, after a meeting, the chair or any other member becomes aware that a conflict of interest has not been declared, they should raise this with the Head of Business and Corporate Services Governance or Conflicts of Interest Guardian who will consider the appropriate course of action.

10.9 When a member of the meeting (including the chair or vice chair) has a

conflict of interest in relation to one or more items of business, the chair (or vice chair or remaining non-conflicted members where relevant as described above) must decide how to manage the conflict. The appropriate course of action will depend on the particular circumstances, but could include one or more of the following:

Where the chair has a conflict of interest, deciding that the vice chair (or another non-conflicted member of the meeting if the vice chair is also conflicted) should chair all or part of the meeting;

Requiring the individual who has a conflict of interest (including the chair or vice chair if necessary) not to attend the meeting;

Ensuring that the individual does not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict;

Requiring the individual to leave the discussion when the relevant matter(s) are being discussed and when any decisions are being taken in relation to those matter(s). In private meetings, this could include requiring the individual to leave the room and in public meetings to either leave the room or join the audience in the public gallery;

Allowing the individual to participate in some or all of the discussion when the relevant matter(s) are being discussed but requiring them to leave the meeting when any decisions are being taken in relation to those matter(s). This may be appropriate where, for example, the conflicted individual has important relevant knowledge and experience of the matter(s) under discussion, which it would be of benefit for the meeting to hear, but this will depend on the nature and extent of the interest which has been declared;

Noting the interest and ensuring that all attendees are aware of the nature and extent of the interest, but allowing the individual to remain and participate in both the discussion and in any decisions. This is only likely to be the appropriate course of action where it is decided that the interest which has been declared is either immaterial or not relevant to the matter(s) under discussion.

10.10 Where the conflict of interest relates to outside employment and an individual

continues to participate in meetings pursuant to the preceding two bullet points, he or she should ensure that the capacity in which they continue to participate in the discussions is made clear and correctly recorded in the meeting minutes. Where it is appropriate for them to participate in decisions they must only do so if they are acting in their CCG role.

10.11 Where over half of members withdraw from a part of a meeting -– due to the

arrangements agreed for the management of conflicts of interests - the chair (or deputy) will determine whether or not the discussion can proceed. In

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making this decision the chair will consider whether the meeting is quorate in accordance with the required number /balance of membership.

10.121 Where the meeting is not quorate the discussion will be deferred until

such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall consult with the Conflicts of Interest Guardian on the action to be taken. This may include:

requiring another committee or sub-committee which can be quorate to progress the item of business; or if this is not possible,

inviting on a temporary basis one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that the group can progress the item of business:

a member of the CCG who is interest free; an individual nominated by a member to act on their behalf in the

dealings between it and the CCG; a member of a relevant Health and Wellbeing Board; a member of a board/Governing Body for another CCG.

10.132 The minutes will record all declarations of interest and actions taken in

mitigation. A minutes template for recording declarations is attached at Appendix 4.

11. Managing conflicts of interest throughout the commissioning cycle

11.1 Conflicts of interest need to be managed appropriately throughout the whole

commissioning cycle. At the outset of a commissioning process, the relevant interests of all individuals involved should be identified and clear arrangements put in place to manage any conflicts of interest. This includes consideration as to which stages of the process an individual should not participate in, and, in some circumstances, whether they should be involved in the process at all. The CCG will identify and appropriately manage any conflicts of interest that may arise where staff are involved in both the management of existing contracts and the procurement of related / replacement contracts. The CCG will also identify as soon as possible where staff might transfer to a provider (or their role may materially change) following the award of a contract. This will be treated as a relevant interest, and the CCG will manage the potential conflict.

Designing service requirements

11.2 The way in which services are designed can either increase or decrease perceived or actual conflicts of interest. Public involvement supports transparent and credible commissioning decisions. It should happen at every stage of the commissioning cycle from needs assessment, planning and

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prioritisation to service design, procurement and monitoring. The CCG has a legal duty under the Act to involve patients and the public in their respective commissioning processes and decisions.

Provider engagement

11.3 It is good practice to engage relevant providers, especially clinicians, in confirming that the design of service specifications will meet patient needs. This may include providers from the acute, primary, community, and mental health sectors, and may include NHS, third sector and private sector providers. Such engagement, done transparently and fairly, is entirely legal. However, conflicts of interest, as well as challenges to the fairness of the procurement process, can arise if a commissioner engages selectively with only certain providers (be they incumbent or potential new providers) in developing a service specification for a contract for which they may later bid. Individuals should be particularly mindful of these issues when engaging with existing / potential providers in relation to the development of new care models.

11.4 Provider engagement should follow the three main principles of procurement law, namely equal treatment, non-discrimination and transparency. This includes ensuring that the same information is given to all at the same time and procedures are transparent. This mitigates the risk of potential legal challenge.

11.5 As the service design develops, it is good practice to engage with a range of providers on an on-going basis to seek comments on the proposed design e.g., via the commissioners website and/or via workshops with interested parties (ensuring a record is kept of all interaction). NHS Improvement has issued guidance on the use of provider boards in service design.8

11.6 Engagement should help to shape the requirement to meet patient need, but it is important not to gear the requirement in favour of any particular provider(s). If appropriate, the advice of an independent clinical adviser on the design of the service should be secured.

11.7 Individuals should ensure that decisions are documented to ensure that the CCG meets its obligations under, but not limited to, the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and the Public Contracts Regulations 2015.

Specifications

11.87 The CCG will seek, as far as possible, to specify the outcomes that it wishes to see delivered through a new service, rather than the process by which these outcomes are to be achieved. As well as supporting innovation, this helps prevent bias towards particular providers in the specification of services.

8 Monitor, Case closure decision on Greater Manchester and Cheshire cancer surgery services,

January 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284832/ManchesterCaseClosure.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284832/ManchesterCaseClosure.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284832/ManchesterCaseClosure.pdf

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The CCG will also ensure that careful consideration is given to the appropriate degree of financial risk transfer in any new contractual model.

11.9 Specifications should be clear and transparent, reflecting the depth of engagement, and set out the basis on which any contract will be awarded.

Procurement and awarding grants

11.108 The CCG will seek to recognise and manage any conflicts or potential conflicts of interest that may arise in relation to the procurement of any services or the administration of grants. “Procurement” relates to any purchase of goods, services or works and the term “procurement decision” should be understood in a wide sense to ensure transparency of decision making on spending public funds. The decision to use a single tender action, for instance, is a procurement decision and if it results in the commissioner CCG entering into a new contract, extending an existing contract, or materially altering the terms of an existing contract, then it is a decision that should be recorded.

11.119 NHS England and CCGs must comply with two different regimes of procurement law and regulation when commissioning healthcare services: the NHS procurement regime, and the European procurement regime:

The NHS procurement regime – the NHS (Procurement, Patient Choice and Competition (No.2)) Regulations 2013: made under S75 of the 2012 Act; apply only to NHS England and CCGs; enforced by NHS Improvement; and

The European procurement regime – Public Contracts Regulations 2015 (PCR 2015): incorporate the European Public Contracts Directive into national law; apply to all public contracts over the threshold value; enforced through the Courts. The general principles arising under the Treaty on the Functioning of the European Union of equal treatment, transparency, mutual recognition, non-discrimination and proportionality may apply even to public contracts for healthcare services falling below the threshold value if there is likely to be interest from providers in other member states.

11.120 Whilst the two regimes overlap in terms of some of their requirements, they are not the same – so compliance with one regime does not automatically mean compliance with the other. The National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 state:

CCGs must not award a contract for the provision of NHS health care services where conflicts, or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract; and

CCGs must keep a record of how it managed any such conflict in relation to NHS commissioning contracts it has entered into.

11.131 Paragraph 24 of PCR 2015 states: “Contracting authorities shall take appropriate measures to effectively prevent, identify and remedy conflicts of

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interest arising in the conduct of procurement procedures so as to avoid any distortion of competition and to ensure equal treatment of all economic operators”. Conflicts of interest are described as “any situation where relevant staff members have, directly or indirectly, a financial, economic or other personal interest which might be perceived to compromise their impartiality and independence in the context of the procurement procedure”.

11.142 The Procurement, Patient Choice and Competition Regulations (PPCCR) place requirements on commissioners to ensure that they adhere to good practice in relation to procurement, run a fair, transparent process that does not discriminate against any provider, do not engage in anti-competitive behaviour that is against the interest of patients, and protect the right of patients to make choices about their healthcare. Furthermore the PPCCR places requirements on commissioners to secure high quality, efficient NHS healthcare services that meet the needs of the people who use those services. The PCR 2015 are focussed on ensuring a fair and open selection process for providers.

11.153 The CCG will use a procurement checklist (see Appendix 5) to record the factors that should be addressed when drawing up its plans to commission services. This will help to evidence the CCG’s deliberations on conflicts of interest. The CCG will make the evidence of its management of conflicts publicly available, and the relevant information from the procurement template will be used to complete the register of procurement decisions. Complete transparency around procurement will provide:

Evidence that the CCG is seeking and encouraging scrutiny of its decision-making process;

A record of the public involvement throughout the commissioning of the service;

A record of how the proposed service meets local needs and priorities for partners such as the Health and Wellbeing Boards, local Healthwatch and local communities;

Evidence to the audit committee and internal and external auditors that a robust process has been followed in deciding to commission the service, in selecting the appropriate procurement route, and in addressing potential conflicts.

11.164 External services such as commissioning support services (CSSs) can play an important role in helping CCGs decide the most appropriate procurement route, undertake procurements and manage contracts in ways that manage conflicts of interest and preserve the integrity of decision-making. The CCG will assure itself that a CSS’ business processes are robust and enable the CCG to meet its duties in relation to procurement (including those relating to the management of conflicts of interest). This will require the CSS to declare any conflicts of interest it may have in relation to the work commissioned by the CCG.

11.175 A CCG cannot, however, lawfully delegate commissioning decisions to an external provider of commissioning support. Although CSSs are likely to play a

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key role in helping to develop specifications, preparing tender documentation, inviting expressions of interest and inviting tenders, the CCG itself will need to:

Determine and sign off the specification and evaluation criteria;

Decide and sign off decisions on which providers to invite to tender; and

Make final decisions on the selection of the provider.

Register of procurement decisions

11.186 The CCG will maintain a register of procurement decisions taken with a value in excess of £30,000100,000, either for the procurement of a new service or any extension or material variation of a current contract. This will include:

The details of the decision;

Who was involved in making the decision (including the name of the CCG clinical lead, the CCG contract manager, the name of the decision making committee and the name of any other individuals with decision-making responsibility);

A summary of any conflicts of interest in relation to the decision and how this was managed by the CCG; and

The award decision taken.

11.197 The register of procurement decisions will be updated whenever a procurement decision is taken, using the register at Appendix 6. The Procurement, Patient Choice and Competition Regulations 9(1) place a requirement on commissioners to maintain and publish on their website a record of each contract it awards. The register of procurement decisions will be made publicly available and easily accessible to patients and the public by:

Ensuring that the register is available in a prominent place on the CCG’s website; and

Making the register available upon request for inspection at the CCG’s headquarters.

Declarations of interests for bidders / contractors

11.2018 As part of the CCG’s procurement processes, bidders will be asked to declare any conflicts of interest. This allows the CCG to ensure that it complies with the principles of equal treatment and transparency. When a bidder declares a conflict, the CCG will decide how best to deal with it to ensure that no bidder is treated differently to any other. A declaration of interests for bidders/ contractors template is attached at Appendix 7.

11.2119 It will not usually be appropriate to declare such a conflict on the register of procurement decisions, as it may compromise the anonymity of bidders during the procurement process. However, the CCG will retain an internal audit trail of how the conflict or perceived conflict was dealt with to allow it to provide information at a later date if required. The CCG is required under regulation 84 of the Public Contract Regulations 2015 to make and retain records of contract award decisions and key decisions that are made during the procurement process (there is no obligation to publish them). Such records must include

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“communications with economic operators and internal deliberations” which should include decisions made in relation to actual or perceived conflicts of interest declared by bidders. These records must be retained for a period of at least three years from the date of award of the contract.

Contract Monitoring

11.2220 The management of conflicts of interest applies to all aspects of the commissioning cycle, including contract management. Any contract monitoring will consider conflicts of interest as part of the process i.e., the chair of a contract management meeting will invite declarations of interests; record any declared interests in the minutes of the meeting; and manage any conflicts appropriately and in line with this guidance. This equally applies where a contract is held jointly with another organisation such as the Local Authority or with other CCGs under lead commissioner arrangements.

11.2321 The individuals involved in the monitoring of a contract should not have any direct or indirect financial, professional or personal interest in the incumbent provider or in any other provider that could prevent them, or be perceived to prevent them, from carrying out their role in an impartial, fair and transparent manner. The CCG will be mindful of any potential conflicts of interest when it disseminates any contract or performance information/reports on providers, and manage the risks appropriately.

12. Raising concerns and breaches

12.1 There will be situations when interests will not be identified, declared or managed appropriately and effectively. This may happen innocently, accidentally, or because of the deliberate actions of staff or organisations. For the purposes of this policy these situations are referred to as ‘breaches’.

12.2 It is the duty of every individual within the CCG to speak up about genuine

concerns in relation to the management of conflicts of interests, and to report any concerns in accordance with the terms of this policy and the CCG’s Whistleblowing Policy or with the whistleblowing policy of the relevant employer organisation (where the breach is being reported by an employee or worker of another organisation). Individuals should not ignore their suspicions or seek to investigate them, but speak to the CCG’s Conflict of Interest Guardian or the Head of Business and Corporate ServicesGovernance.

12.32 Where a breach is suspected or has occurred, this will be investigated by the

Head of Business and Corporate Services Governance who will draw on other expertise available to the organisation such as internal audit. The findings will be shared with the Conflicts of Interest Guardian and the breach formally reported to the Audit Committee.

12.43 A review of lessons learned will be conducted by the Head of Business and

Corporate Services Governance following any incident of non-compliance with this policy and the report reviewed by the CCG’s Audit Committee. Anonymised details of breaches will be published on the CCG’s website for the purpose of learning and development.

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12.54 Anyone who wishes to report a suspected or known breach of the policy, who

is not an employee or worker of the CCG, should ensure that they comply with their own organisation’s whistleblowing policy, since most such policies should provide protection against detriment or dismissal.

12.65 All notifications will be treated with appropriate confidentiality at all times, in

accordance with the CCG’s policies and applicable laws, and the person making such disclosures can expect an appropriate explanation of any decisions taken as a result of any investigation.

12.76 Providers, patients and other third parties can make a complaint to NHS

Improvement in relation to a commissioner’s conduct under the Procurement Patient Choice and Competition Regulations. The regulations are designed as an accessible and effective alternative to challenging decisions in the courts.

Fraud or Bribery

12.87 Any suspicions or concerns of acts of fraud or bribery can be reported online via https://www.reportnhsfraud.nhs.uk/ or via the NHS Fraud and Corruption Reporting Line on 0800 0284060. This provides an easily accessible and confidential route for the reporting of genuine suspicions of fraud within or affecting the NHS. All calls are dealt with by experienced trained staff and any caller who wishes to remain anonymous may do so. Please refer to the CCG’s Anti-Fraud, Bribery and Corruption Policy for further details.

Impact of non-compliance

12.98 Failure to comply with the CCG’s policy on conflicts of interest management can have serious implications for the CCG and any individuals concerned.

Civil implications

12.109 If conflicts of interest are not effectively managed, CCGs could face civil challenges to decisions they make. For instance, if breaches occur during a service re-design or procurement exercise, the CCG risks a legal challenge from providers that could potentially overturn the award of a contract, lead to damages claims against the CCG, and necessitate a repeat of the procurement process. This could delay the development of better services and care for patients, waste public money and damage the CCG’s reputation. In extreme cases, staff and other individuals could face personal civil liability, for example a claim for misfeasance in public office.

Criminal implications

12.10 Failure to manage conflicts of interest could lead to criminal proceedings including for offences such as fraud, bribery and corruption. This could have implications for CCGs and linked organisations, and the individuals who are engaged by them. The Fraud Act 2006 created a criminal offence of fraud and defines three ways of committing it:

https://www.reportnhsfraud.nhs.uk/

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Fraud by false representation;

Fraud by failing to disclose information; and,

Fraud by abuse of position.

12.11 An essential ingredient of the offences is thatIn these cases, the offender’s conduct must be dishonest and their intention must be to make a gain, or cause a loss (or the risk of a loss) to another. Fraud carries a maximum sentence of 10 years imprisonment and /or a fine if convicted in the Crown Court or 6 months imprisonment and/or a fine in the Magistrates’ Court. The offences can be committed by a body corporate.

12.12 Bribery is generally defined as giving or offering someone a financial or other

advantage to encourage that person to perform their certain functions or activities. The Bribery Act 2010 reformed the criminal law of bribery, making it easier to tackle this offence proactively in both the public and private sectors. It introduced a corporate offence which means that commercial organisations, including NHS bodies, will be exposed to criminal liability, punishable by an unlimited fine, for failing to prevent bribery.

12.13 The offences of bribing another person, being bribed and bribery of foreign

public officials can also be committed by a body corporate. The Act repealed the UK’s previous anti-corruption legislation (the Public Bodies Corrupt Practices Act 1889, the Prevention of Corruption Acts of 1906 and 1916 and the common law offence of bribery) and provides an updated and extended framework of offences to cover bribery both in the UK and abroad.

12.134 The offences of bribing another person, being bribed or bribery of

foreign public officials in relation to an individual carries a maximum sentence of 10 years imprisonment and/or a fine if convicted in the Crown Court and 6 months imprisonment and/or a fine in the Magistrates’ Court. In relation to a body corporate the penalty for these offences is a fine.

Disciplinary implications

12.143 Individuals who fail to disclose any relevant interests or who otherwise breach this policy will be subject to investigation and, where appropriate, to disciplinary action in accordance with the CCG’s Disciplinary Policy. Individuals should be aware that the outcomes of such action may, if appropriate, result in the termination of their employment or position with the CCG.

Professional regulatory implications

12.154 Statutorily regulated healthcare professionals who work for, or are engaged by, CCGs are under professional duties imposed by their relevant regulator to act appropriately with regard to conflicts of interest. The CCG will report statutorily regulated healthcare professionals to their regulator if they believe that they have acted improperly, so that these concerns can be investigated. Statutorily regulated healthcare professionals should be made aware that the consequences for inappropriate action could include fitness to practise

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proceedings being brought against them, and that they could, if appropriate, be struck off by their professional regulator as a result.

13. Conflicts of interest training

13.1 The CCG will ensure that training is offered to all individuals within the CCG

on the management of conflicts of interest. This is to ensure staff and others within the CCG understand what conflicts are and how to manage them effectively. All individuals within the CCG are required to complete this mandatory training on an annual basis.

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Appendix 1: Declaration of interests form

Name:

Position within, or relationship with, the CCG (or NHS England in the event of joint committees)

Details of interest held (complete all that are applicable)

Type of interest (see reverse of form)

Description of interest (including for indirect interests, details of the relationship with the person who has the interest)

Date of interest From & To

Actions to be taken to mitigate risk (if required) To be agreed with line manager (CCG employees only)

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that the CCG holds.

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I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 2814 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary action may result. I am / am not a decision maker [delete as applicable]. If you are band 8d or higher, or undertake any of the activities listed overleaf then you are a decision maker. I do / do not [delete as applicable] give my consent for this information to published on registers that the CCG holds. If consent is NOT given

please give reasons:

Declarer’s signature: …………………………………………. Date: ………………..

For CCG employees only:

Signature of line manager: …………………………………. Name: ……………………………

Position: ………………………………………. Date: ………………..

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Types of interest

Type of interest

Description

Financial Interests

This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. This includes involvement with a potential provider of a new care model;

A shareholder (or similar owner interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A management consultant for a provider;

A provider of clinical private practice;

In secondary employment outside of the CCG (see paragraph 56 to 57);

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider.

Non-Financial Professional Interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

An advocate for a particular group of patients;

A GP with special interests e.g., in dermatology, acupuncture etc.

An active member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE);

A medical researcherEngaged in a research role;

The development and holding of patents and other intellectual property rights which allow staff to protect something that they create, preventing unauthorised use of products or the copying of protected ideas; or

GPs and practice managers, who are members of the governing body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

Non-Financial Personal Interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment;

A member of a lobby or pressure group with an interest in health and care.

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Indirect Interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include:

Spouse / partner;

Close relative e.g., parent, grandparent, child, grandchild or sibling;

Close friend or associate; or

Business partner Decision Maker Decision makers are defined as follows:









Management, administrative and clinical staff involved in decision making concerning the commissioning of services, purchasing of goods, medicines, medical devices or equipment, and formulary decisions; and

Management, administrative and clinical staff responsible for processing payments on behalf of the CCG,

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Appendix 2: Register of Interests template

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Appendix 3: Declarations of interest checklist for chairs

Under the Health and Social Care Act 2012, there is a legal obligation to manage conflicts of

interest appropriately. It is essential that declarations of interest and actions arising from the

declarations are recorded formally and consistently across all CCG governing body,

committee and sub-committee meetings. This checklist has been developed with the

intention of providing support in conflicts of interest management to the Chair of the meeting-

prior to, during and following the meeting. It does not cover the requirements for declaring

interests outside of the committee process

Timing

Checklist for Chairs

Responsibility

In advance of the meeting

1. The agenda to include a standing item on declaration of interests to enable individuals to raise any issues and/or make a declaration at the meeting. 2. A definition of conflicts of interest should also be accompanied with each agenda to provide clarity for all recipients. 3. Agenda to be circulated to enable attendees (including visitors) to identify any interests relating specifically to the agenda items being considered. A form (see below) will also be circulated on which attendees can record any interests relating to the agenda items. 4. Members should contact return the form to the Chair or Head of Corporate Governance as soon as an actual or potential conflict is identified. 5. Chair to review a summary report from preceding meetings i.e. sub-committee, working group, etc., detailing any conflicts of interest declared and how this was managed. 6. A copy of the members’ declared interests is checked to establish any actual or potential conflicts of interest that may occur during the meeting.

Meeting Chair and secretariat Meeting Chair and secretariat Meeting Chair and secretariat Meeting members Meeting Chair Meeting Chair

During the meeting 7. Chair requests members to Meeting Chair

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declare any interests in agenda items, including the nature of the conflict. 8. Chair makes a decision as to how to manage each interest which has been declared, including whether / to what extent the individual member should continue to participate in the meeting, on a case by case basis, and this decision is recorded. 9. As minimum requirement, the following should be recorded in the minutes of the meeting:

Individual declaring the interest;

At what point the interest was declared;

The nature of the interest;

The Chair’s decision and resulting action taken;

The point during the meeting at which any individuals retired from and returned to the meeting - even if an interest has not been declared

Visitors in attendance who participate in the meeting must also follow the meeting protocol and declare any interests in a timely manner

Meeting Chair Secretariat

Following the meeting

10. All new interests declared at the meeting should be promptly updated onto the declaration of interest form. 11. All new completed declarations of interest should be transferred onto the register of interests. 12. If, following the meeting, the chair or any other member becomes aware that a conflict of interest has not been declared, they should raise this with the Head of Business and Corporate Services Governance or Conflicts of Interest Guardian who will consider the appropriate course of action.

Individual(s) declaring interest(s) Designated person responsible for registers of interest Person who becomes aware of the conflict

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DECLARATION OF INTERESTS FORM – MEETINGS

Please complete and return this form to the Head of Corporate Governance prior to the start of the meeting, or at any point at which you

become aware of an interest during the meeting.

Name:

Meeting:

Date:

Agenda item in which you have an interest

Type of Interest:

Financial

Non Financial Professional

Non Financial Personal

Indirect

Brief Description of your interest

Arrangement for managing the conflict of interest (to be agreed with the Chair of the meeting)

Signed:

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Appendix 4: Template for recording minutes

Item no Agenda item

Actions

Declarations of interest SK reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of the CCG. Declarations are listed in the CCG’s Register of Interests. The Register is available via the CCG website at the following link: [link to be inserted] Declarations of interest from sub committees None declared Declarations of interest from today’s meeting The following update was received at the meeting: With reference to business to be discussed at this meeting, MS declared that he is a shareholder in XXX Care Ltd. SK declared that the meeting is quorate and that MS would not be included in any discussions on agenda item X due to a direct conflict of interest which could potentially lead to financial gain for MS. SK and MS discussed the conflict of interest, which is recorded on the register of interest, before the meeting and MS agreed to remove himself from the table and not be involved in the discussion around agenda item X.

Agenda Item <Note the agenda item> MS left the meeting, excluding himself from the discussion regarding xx. <conclude decision has been made> MS was brought back into the meeting.

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Appendix 5: Procurement checklist

Service:

Question

Comment/Evidence

1. How does the proposal deliver good or improved outcomes and value for money-what are the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations?

2. How have you involved the public in the decision to commission this service?

3. What range of health professionals have been involved in considering the proposals?

4. What range of potential providers have been involved in considering the proposals?

5. How have you involved the Health and Wellbeing Board? How does the proposal support the priorities in the joint health and wellbeing strategy?

6. What are the proposals for monitoring the quality of the service?

7. What systems will there be to monitor and publish data on referral patterns?

8. Have all conflicts and potential conflicts of interests been appropriately declared and entered on registers?

9. In respect of every conflict or potential conflict, you must record how you have managed that conflict or potential conflict. Has the management of all conflicts been recorded with a brief explanation of how they have been managed?

10. Why have you chosen this procurement route e.g. single action tender*?

11. What additional external involvement will there be in scrutinising the proposed decisions?

12. How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision making process and award of any contract?

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Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply)

13. How have you determined a fair price for the service?

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers

14. How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for proposed direct awards to GP providers

15. What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider?

16. In what ways does the proposed service go beyond what GP practices should expect to provide under the GP contract?

17. What assurances will there be that a GP practice is providing high quality services under the GP contract before it has the opportunity to provide any new services?

*Taking into account all relevant regulations (e.g. the NHS (Procurement, patient choice and

competition) (No.2 Regulations 2013 and guidance (e.g. that of Monitor))

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Appendix 6: Register of Procurement Decisions Template

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Appendix 7 - Template of conflict of interests for bidders /contractors This page requires completion of details of organisations Page 2 overleaf requires completion of details of individuals

Name of organisation:

Details of interest held

Type of interest

Details

Provision of services or other work for the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG or NHS England or professional, which the public could perceive may impair or otherwise influence the CCG’s or nay of its members or employees’ judgments, decisions or actions

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Name of relevant person

(complete for all relevant persons)

Details of interest held:

Type of interest

Details

Personal interest or that of a family member, close friend or other acquaintance?

Provision of services or other work for the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG or NHS England or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members or employees’ judgments, decisions or actions

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update the information as necessary. Signed: On behalf of: Date:

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Standards of Business Conduct Policy

Version: DRAFT

Ratified by: Leeds Health Commissioning & System Integration Board

Date ratified: TBC

Name & Title of originator/author: Head of Corporate Governance

Name of responsible committee/individual: Audit Committee

Date issued: TBC

Review date: [1 year from date of approval]

Target audience: See section 3

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Contents Paragraph Page 1 Introduction 3 2 Purpose 3 3 Scope 3 4 Duties 4 5 Receipt of Hospitality, Gifts and Commercial Sponsorship 5 6 Outside Employment 139 7 Contracts for Goods and Services 1310 8 Intellectual Property 1410 9 Confidentiality 1411 10 The Bribery Act 2010 1511 11 Equality Impact Assessment 1512 12 Monitoring Compliance and Effectiveness 1512 13 Associated Documentation 1612 14 References 1612

Appendices

Appendix 1 The Seven Principles of Public Life 1713 Appendix 2 Standards of Business Conduct - Quick Guide 1814 Appendix 3 Declaration of Gift/Hospitality/Sponsorship Form 1915 Appendix 4 Non Disclosure Agreement 2218 Appendix 5 Policy Consultation Process 2319

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1 Introduction

1.1 The Code of Conduct and Code of Accountability in the NHS (second revision

July 2004) sets out the following three public service values which are central to the work of the NHS:

Accountability - everything done by those who work in the NHS must be able to stand the test of parliamentary scrutiny, public judgements on propriety and professional codes of conduct.

Probity - there should be an absolute standard of honesty in dealing with the assets of the NHS: integrity should be the hallmark of all personal conduct in decisions affecting patients, officers and members and suppliers, and in the use of information acquired in the course of NHS duties.

Openness - there should be sufficient transparency about NHS activities to promote confidence between the NHS and its staff, patients and the public.

1.2 In addition to the public service values described above, all individuals within

the CCG should follow the Seven Principles of Public Life (the Nolan Principles) - see Appendix 1.

1.3 All individuals within the CCG are responsible for ensuring that they are not

placed in a position which risks conflict between their private interests and their NHS duties. Every individual is responsible for ensuring that they comply with this policy. Some individuals may additionally be required to adhere to a code of conduct of their own professional body.

2 Purpose 2.1 This policy provides guidance on what is deemed to be acceptable in terms of

receipt of gifts, hospitality and sponsorship and provides a code of conduct that individuals within the CCG are expected to follow.

2.2 This policy reflects and builds on the following national guidance:

HSG(93)5 Standards of Business Conduct for NHS Staff

Seven Principles of Public Life

The Codes of Conduct and Accountability in the NHS 2004

The Code of Conduct for NHS Managers 2002

Professional Standards Authority ‘Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England’ 2012

2.3 This policy should be read in partnership with the CCG’s Conflicts of Interest

Policy, the Anti‐Fraud and Bribery Policy, the Working Time Regulations Policy (in relation to secondary employment) and the Procurement Policy.

3 Scope 3.1 This policy applies to:

All CCG employees, including: o All full and part time staff; o Any staff on sessional or short term contracts;

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o Any students and trainees; o Agency staff; and o Seconded staff.

In addition, any self-employed consultants or other individuals working for the CCG under a contract for services should make a declaration of interestdeclare gifts, hospitality and sponsorship in accordance with this guidancepolicy, as if they were CCG employees.

Members of the governing body: All members of the CCG’s committees, sub-committees/sub-groups, including:

o Co-opted members; o Appointed deputies; and o Any members of committees/groups from other organisations.

All members of the CCG (i.e. each practice) This includes each provider of primary medical services which is a member of the CCG under Section 14O (1) of the 2006 Act. Declarations should be made by the following groups:

o GP partners o Any individual directly involved with the business or decision-

making of the CCG. Who are referred to collectively in this policy as ‘individuals within the CCG’.

4 Duties

4.1 The Chief Executive is the organisation’s designated ‘Accountable Officer’

and has overall responsibility for ensuring that the CCG operates efficiently, economically and with probity. The Chief Executive (alongside other members of the Governing Body) has a duty to ensure that the CCG provides a secure environment in which to work, and one in which people are confident to raise concerns which will be listened to and addressed.

4.2 The Chief Finance Officer is responsible for ensuring this policy is in place.

The Chief Finance Officer, in conjunction with the Chief Executive, monitors and ensures compliance with NHS Protect Standards for Commissioners regarding fraud, bribery and corruption. In addition and in consultation with the Local Counter Fraud Specialist (LCFS), the Chief Finance Officer will decide whether there is sufficient cause to conduct an investigation in relation to bribery, and whether the Police and external audit need to be informed.

4.3 The Head of Corporate Governance is responsible for administering this

policy and ensuring reporting to the Audit Committee. 4.4 All members of the Governing Body must act in accordance with this policy

and lead by example in acting with the utmost integrity and ensuring adherence to all relevant regulations, policies and procedures. Governing Body members must abide by the Professional Standards Authority Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England.

http://www.professionalstandards.org.uk/docs/psa-library/november-2012---standards-for-board-members.pdf?sfvrsn=0



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4.5 Line Managers are responsible for assisting employees in complying with this policy by ensuring that this policy and its requirements are brought to the attention of employees for whom they are responsible, and that those employees are aware of its implications for their work.

4.6 All individuals within the CCG are required to:

Act honestly and with integrity at all times and to safeguard the organisation’s resources for which they are responsible.

Ensure that they read, understand and comply with this policy.

Adhere to all relevant regulations, policies and procedures.

Raise concerns as soon as possible if they believe or suspect that a conflict with this policy has occurred, or may occur in the future.

Ensure that the interests of patients remain paramount at all times.

Be impartial and honest in the conduct of their official business.

Use the public funds entrusted to them to the best advantage of the service, always ensuring value for money.

Not abuse their official position for personal gain or to benefit their family or friends.

Not seek to gain advantage or further private business or other interests, in the course of their official duties.

Be aware that it is both a serious criminal offence (under the Bribery Act 2010, the Theft Act 1968 and the Fraud Act 2006) and disciplinary matter to corruptly receive or give any fee, loan, gift, reward or other advantage in return for doing (or not doing) anything or showing favour (or disfavour) to any person or organisation.

Understand that failure to follow this policy may damage the CCG and its work and so may be viewed as a disciplinary matter. The organisation’s Disciplinary Policy makes it clear that bringing the organisation into disrepute is potentially gross misconduct. As well as the possibility of civil and criminal prosecution, individuals that breach this policy will face disciplinary action, which could result in dismissal for gross misconduct.

5 Receipt of Hospitality, Gifts and Commercial Sponsorship

Hospitality

5.1 Delivery of services across the NHS relies on working with a wide range of partners (including industry and academia) in different places and, sometimes, outside of ‘traditional’ working hours. As a result, individuals within the CCG will sometimes appropriately receive hospitality. Individuals receiving hospitality should always be prepared to justify why it has been accepted, and be mindful that even hospitality of a small value may give rise to perceptions of impropriety and might influence behaviour.

5.2 For the purpose of this policy, hospitality is defined as the receipt of entertainment, e.g. meals, lunches, functions, events, etc. or equivalent, for personal use or benefit to the individual, their family, relatives or friends, from either commercial or non-commercial (i.e. patients, carers or relatives), charitable or non-profit making bodies sources.offers of meals, refreshments, travel, accommodation, and other expenses in relation to attendance at meetings, conferences, education and training events, etc.

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5.3 Overarching principles:

Individuals within the CCG should not ask for or accept hospitality that may affect, or be seen to affect, their professional judgement;

Hospitality must only be accepted when there is a legitimate business reason and it is proportionate to the nature and purpose of the event;

Particular caution should be exercised when hospitality is offered by actual or potential suppliers or contractors, these can be accepted if modest and reasonable, but individuals should always obtain senior approval and declare these.

5.1 Hospitality should always be secondary to the purpose of the meeting, event,

function or contact and the level of hospitality offered must be appropriate and in proportion to the occasion.

5.2 Modest hospitality, provided it is usual, responsible and proportionate in the circumstances (e.g. lunch in the course of working visits), may be acceptable, though it should be similar to the scale of hospitality which the NHS as an employer would be likely to offer. A common sense approach should be adopted as to whether hospitality offered is modest or not. Hospitality of this nature does not need to be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality, nor recorded on the register, unless it is offered by suppliers or contractors linked (currently or prospectively) to the the CCGs business in which case all such offers (whether or not accepted) should be declared and recorded.

5.3 Offers of hospitality which go beyond modest or of a type that the CCG itself might offer, should be politely refused. Examples might include:

Hospitality of a value above £25.00; and

In particular, offers of foreign travel and accommodation.

5.4 Meals and refreshments:

Under a value of £25.00 – may be accepted and need not be declared;

Of a value between £25.00 - £75.00 – may be accepted and must be

declared;

Over a value of £75.00 – should be refused unless (in exceptional

circumstances) senior approval is given. A clear reason must be recorded

in the register of gifts and hospitality as to why it was permissible to

accept.

A common sense approach should be applied to the valuing of meals and

refreshments (using an actual amount, if known, or an estimate that a

reasonable person would make as to its value).

5.5 Travel and accommodation:

Modest offers to pay some or all of the travel and accommodation costs

related to attendance at events may be accepted and must be declared.

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Offers which go beyond modest or are of a type that the CCG itself might

not usually offer, need senior approval, should only be accepted in

exceptional circumstances, and must be declared. A clear reason must be

recorded in the register of gifts and hospitality as to why it was permissible

to accept travel and accommodation of this type.

A non-exhaustive list of examples includes:

o Offers of business class or first class travel and accommodation

(including domestic travel); and

o Offers of foreign travel and accommodation.

5.4 In addition, particular caution should be exercised where hospitality is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business. Offers of this nature can be accepted if they are modest and reasonable but advice should always be sought from a senior member of the CCG (e.g. the CCG governance lead or equivalent) as there may be particular sensitivities; for example, if a contract re-tender is imminent. All offers of hospitality from actual or prospective suppliers or contractors (whether or not accepted) should be declared and recorded.

5.5 In cases of doubt, advice should be sought from the Line ManagerHead of

Corporate Governance or the gift hospitality should be politely declined.

5.6 The Code of Conduct: Code of Accountability In the NHS advises that the use of NHS monies for hospitality and entertainment, including hospitality at conferences or seminars, should be carefully considered. It advises that all expenditure on these items should be capable of justification as reasonable in the light of general practice in the public sector. It reminds NHS organisations that hospitality or entertainment is open to challenge by auditors and that ill-considered actions can damage respect for the NHS in the eyes of the community.

5.7 In cases of doubt, advice should be sought from either the Chief Finance

Officer or the Head of Governance.

Gifts 5.6 Staff in the NHS offer support during significant events in people’s lives. For

this work they may sometimes receive gifts as a legitimate expression of gratitude. We should be proud that our services are so valued. But situations where the acceptance of gifts could give rise to conflicts of interest should be avoided. Individuals within the CCG should be mindful that even gifts of a small value may give rise to perceptions of impropriety and might influence behaviour if not handled in an appropriate way.

5.85.7 A ‘gift’ is defined as any item of cash or goods, or any service, which is provided for personal benefit, free of change or at less than its commercial value.

5.95.8 Overarching principles:

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Individuals within the CCG must not accept gifts that may affect, or be seen to affect, their professional judgement. This overarching principle should apply in all circumstances;

Any personal gift of cash or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or representing the CCG) must always be declined, whatever their value and whatever their source, and the offer which has been declined must be declared and recorded in the register of gifts and hospitality.

5.9 Gifts from suppliers or contractors:

Gifts from suppliers or contractors doing business (or likely to do business) with the CCG must be declined, whatever their value (subject to this, low cost branded promotional aids may be accepted and not declared where they are under the value of a common industry standard of £6.00). The person to whom the gifts were offered must also declare the offer so that it can be recorded on the register of gifts and hospitality.

All gifts of any nature offered to CCG staff, governing body and committee members and individuals within GP member practices by suppliers or contractors linked (currently or prospectively) to the CCG’s business should be declined, whatever their value; The person to whom the gifts were offered should also declare the offer to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality so the offer which has been declined can be recorded on the register;

5.10 Gifts from other sources (e.g. patients, families, service users):

Individuals must not ask for any gifts;

Modest gifts of less than £50.00 can be accepted and do not need to be declared;

Gifts valued at over £50.00 should be treated with caution and only be accepted, with senior approval, on behalf of an organisation (i.e. to an organisation’s charitable funds), not in a personal capacity. These must be declared;

Multiple gifts from the same source over a 12 month period must be treated in the same way as a single gift in respect of the £50.00 threshold.

5.11 Gifts offered from other sources should also be declined if accepting them

might give rise to perceptions of bias or favouritism, and a common sense approach should be adopted as to whether or not this is the case. The only exceptions to the presumption to decline gifts relates to items of little financial value (i.e. less than £10.00)such as diaries, calendars, stationery and other gifts acquired from meetings, events or conferences, and items such as flowers and small tokens of appreciation from members of the public to staff for work well done. Gifts of this nature do not need to be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality, nor recorded on the register.

5.12 Any personal gift or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or

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representing the CCG) must always be declined, whatever their value and whatever their source, and the offer which has been declined must be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality and recorded on the register.

5.135.11 In cases of doubt, advice should be sought from the Line ManagerHead of Corporate Governance or the gift should be politely declined.

5.145.12 If a member or staff an individual becomes aware that they are a named beneficiary in the will of a patient they have provided care to, they must contact the Chief Executive or Chief Finance Officer to discuss the ethics of remaining a beneficiary.

Commercial SponsorshipSponsored events

5.13 Sponsorship of NHS events by external providers is valued. Offers to meet some or part of the costs of running an event secures their ability to take place, benefiting NHS staff and patients. Without this funding there may be fewer opportunities for learning, development and partnership working. However, there is potential for conflicts of interest between the organiser and the sponsor, particularly regarding the ability to market commercial products or services. As a result there should be proper safeguards in place to prevent conflicts occurring.

5.155.14 For the purpose of this policy, commercial sponsorship is defined as including:

NHS funding from an external source, including funding of all or part of

the costs of a member of staff; and

NHS research, staff training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, hotel and transport costs (including trips abroad), provision of free services (speakers), buildings or premises.

5.165.15 Prior to entering into any sponsorship agreement, individuals must consider the followingWhen sponsorships are offered, the following principles must be adhered to:

Sponsorship of CCG events by appropriate external bodies should only be approved if a reasonable person would conclude that the event will result in clear benefit for the CCG and the NHS.

Acceptance of commercial sponsorship must not in any way compromise the commissioning decisions of the CCG or be dependent on the purchase or supply of goods or services.

At the CCG’s discretion, sponsors or their representatives may attend of take part in the event but they Sponsors should not have any dominant influence over the content or main purpose of an event, meeting, seminar, publication or training event.

The involvement of a sponsor in an event should always be clearly identified in the interests of transparency.

The sponsorship agreement must be in writing and must include the following statement: ‘The fact of sponsorship does not mean that the

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CCG endorses [company name]’s products or services.’ This should also be made visibly clear on any promotional or other materials relating to the event.

No information should be supplied to a company for their commercial gainthe sponsor from which they could gain a commercial advantage, and information which is not in the public domain should not normally be supplied.

Ensure there are no potential irregularities that may affect a company’s ability to satisfy the conditions of the agreement or impact upon it in any way. This would include checking the company’s financial standing and referring to the company’s accounts.

Consider the costs and benefits in relation to alternative options where appropriate. The decision making process must be transparent and defensible.

During dealings with sponsors there must be no breach of patient or individual confidentiality or data protection rules and legislation. Any Ddisclosure of confidential information must be legally and ethically appropriate. In research purposes, disclosure should not take place without approval of the Local Research Ethics Committee.

Monitor clinical and financial outcomes and ensure break clauses are built in to enable the CCG to terminate the agreement if it becomes apparent that it is not providing expected value for money / clinical outcomes.

5.16 Any commercial sponsorship that is offered and/or accepted must be declared and approval must be sought from the Chief Executive or and Chair prior to accepting sponsorship using the form attached at Appendix 3. Other forms of sponsorship:

5.17 Organisations external to the CCG or NHS may also sponsor posts or research. However, there is potential for conflicts of interest to occur, particularly when research funding by external bodies does or could lead to a real or perceived commercial advantage, or if sponsored posts cause a conflict of interest between the aims of the sponsor and the aims of the organisation, particularly in relation to procurement and competition. There needs to be transparency and any conflicts of interest should be well managed. For further information, please refer to Managing Conflicts of Interest in the NHS: Guidance for staff and organisations. Speaking at a Meeting / Conference

5.18 Should an individual be asked to speak at an event and there is an offer of payment and delivering it during contracted hours, then there are two choices open to the individual in conjunction with agreement with the line manager:

The payment should be credited to the CCG and the relevant department within which the individual works, including the Governing Body as a “department” for GP members / Lay Members to be assigned to. Any such payments must also be declared using the form at Appendix 3. If there is no payment but other benefits are offered, such as accommodation, travel expenses, etc. then this must be declared using the form at Appendix 3.



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The individual takes annual leave and the payment is made to them as a private matter between the organisation making the payment and the individual involved with the CCG. However, GPs in particular need to be mindful of the potential conflicts of interest that may still arise between their role within CCG and as a private contractor of services to the NHS. For further information please see the Conflicts of Interest Policy.

Gifts, Hospitality and Sponsorship Register

5.19 The following must be declared as soon as reasonably practicable using the form at Appendix 3:

All offers of gifts from suppliers and contractors, other than low cost branded promotional items under the value of £6.00;

All offers of gifts from other sources (e.g. patients, families, service users) with a a value of more than £50.00;

Hospitality with a value of more than £25.00; and

All offers and/or acceptances of sponsorship.

5.20 Where gifts and hospitality have been offered and declined, they must be declared and recorded if the amount would have been subject to such a declaration.

5.195.21 All completed hospitality/gift/sponsorship forms mustshould be submitted to the Head of Corporate Governance for incorporating into the central register.

5.22 In order to demonstrate openness the register is available on the CCG’s website. Also, the register is reviewed by the Audit Committee on a quarterly basis.

5.23 Although all individuals must declare gifts, hospitality and sponsorship, the CCG will only publish those declared by decision makers. Decision makers are defined as follows:









Management, administrative and clinical staff involved in decision making concerning the commissioning of services, purchasing of good, medicines, medical devices or equipment, and formulary decisions; and

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Management, administrative and clinical staff responsible for processing payments in behalf of the CCG.

5.205.24 In exceptional circumstances, where the public disclosure of

information could give rise to a real risk of harm or is prohibited by law, an individual’s name and/or other information may be redacted from the publicly available register. Where an individual believes that substantial damage or distress may be caused, to him/herself or somebody else by the publication of information about them, they are entitled to request that the information is not published. Such requests must be made in writing. Decisions not to publish information must be made by the Conflicts of Interest Guardian for the CCG, who should seek appropriate legal advice where required, and the CCG will retain a confidential un-redacted version of the register.

5.25 All persons who are required to make a declaration of gifts or hospitality will be made aware that the register will be published in advance of publication. This will be done by providing a fair processing notice that details the identity of the data controller, the purposes for which the registers are held and published, and contact details for the data protection officer. All decision making staff will be made aware, in advance of publication, that the register(s) will be kept, how the information on the register(s) may be used or shared and that the register(s) will be published. This will be done by the provision of a fair processing notice that details the identity of the data controller, the purposes for which the registers are held and published, how the information on the register(s) may be used or shared and contact details for the data protection officer. This information will also be provided to individuals identified in the register(s) because they are in a relationship with the person making the declaration.

5.26 All individuals who are not decision makers but who are still required to make a declaration of interest(s) or a declaration of gifts or hospitality will be made aware that the register(s) will be kept and how the information on the register(s) may be used or shared. This will be done by the provision of a separate fair processing notice that details the identity of the data controller, the purposes for which the register(s) are held, how the information on the register(s) may be used or shared and contact details for the data protection officer. This information will also be provided to individuals identified in the register(s) because they are in a relationship with the person making the declaration. Inappropriate Offers of Hospitality/Gifts/Sponsorship

5.215.27 All staff and members must notify the Head of Corporate Governance of any inappropriate/overly generous offers of hospitality/gifts/sponsorship within 2 weeks of the offer being made. This includes any offers that would constitute a bribe, i.e. offers of a financial or other advantage as an incentive or reward to improperly perform your function or activities. For further information, please see the Anti-Fraud and Bribery Policy. The Head of Corporate Governance will ensure the Audit Committee is made aware of the inappropriate offer at the next meeting.

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6. Outside Employment

6.1 In accordance with the CCG’s Working Time Regulations Policy, individuals who are directly employed by the CCG must notify their line manager of their intention to undertake secondary employment by completing the Declaration of Secondary Employment form. Any existing outside employment must be declared on appointment, and any new outside employment must be declared when it arises. Amongst other things, the purpose of this is to ensure that the CCG is aware of any potential conflict with their CCG employment. For further information, please see the Conflicts of Interest Policy.

6.2 Examples of work which might conflict with the business of the CCG include:

Employment with another NHS body;

Employment with another organisation which might be in a position to supply goods/services to the CCG including paid advisory positions and paid honorariums which relate to bodies likely to do business with the CCG;

Directorships e.g. of a GP federation or non-executive roles;

Self employment, including private practice, charitable trustee roles, political roles and consultancy work, in a capacity which might conflict with the work of the CCG or which might be in a position to supply goods/services to the CCG.

6.3 Permission to engage in secondary employment will be required and the CCG

reserves the right to refuse permission where it believes a conflict will arise. 7 Contracts for Goods and Services 7.1 All staff who are in contact with suppliers and contractors (including external

consultants), and in particular those who are authorised to sign Purchase Orders or place contracts for goods, materials or services, are expected to adhere to professional standards of the kind set out in the Code of Conduct of the Chartered Institute of Purchasing and Supply (CIPS).

7.2 Fair and open competition between prospective contractors or suppliers for

NHS contracts is a requirement of NHS Standing Orders and of EU Directives on Public Purchasing for Works and Supplies. This means that:

No private, public or voluntary organisation which may bid for NHS business should be given any advantage over its competitors, such as advance notice of NHS requirements. This applies to all potential contractors, whether or not there is a relationship between them and the

CCG, such as a long‐running series of previous contracts.

Each new contract should be awarded solely on merit, taking into account the requirements of the NHS and the ability of the contractors to fulfil them.

7.3 Individuals should ensure that no special favour is shown to current or former

employees or their close relatives or associates in awarding contracts to private or other businesses run by them or employing them in a senior or relevant managerial capacity. Contracts may be awarded to such businesses

http://www.cips.org/Documents/About%20CIPS/CIPS_Code_of_conductv2_10_9_2013.pdf

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where they are won in fair competition against other tenders, but scrupulous care must be taken to ensure that the selection process is conducted impartially, and that individuals who are known to have a relevant interest play no part in the selection. Such interests must also be declared in accordance with the Conflicts of Interest Policy.

7.4 Individuals must not seek, or accept, preferential rates or benefits in kind for

private transactions carried out with companies with which they have had, or may have, official dealings on behalf of the CCG. This does not apply to officers’ and members’ benefit schemes offered by the NHS or trade unions.

7.5 Every invitation to tender to a prospective bidder for CCG business must

require each bidder to give a written undertaking not to engage in collusive tendering or other restrictive practice, and not to engage in canvassing the CCG, its employees or officers concerning the contract opportunity tendered.

8 Intellectual Property 8.1 Any patents, designs, trademarks or copyright resulting from the work (e.g.

research) of an individual, carried out as part of their work with the CCG, shall be the Intellectual Property of the CCG.

8.2 Approval should be sought from the appropriate line manager prior to entering

into an obligation to undertake external work connected with the business of the CCG, e.g. writing articles for publication, speaking at conferences.

8.3 Where the undertaking of external work, gaining patent or copyright or the

involvement in innovative work, benefits or enhances the CCG’s reputation or results in financial gain for the CCG, consideration will be given to rewarding employees subject to any relevant guidance for the management of Intellectual Property in the NHS issued by the Department of Health.

9 Confidentiality 9.1 Information concerning the CCG which is not in the public domain must not at

any time be divulged to any unauthorised person. Similarly, patient data or personal data concerning staff must not be divulged, in line with the Data Protection Act, 1998. This duty of confidence remains after termination of employment and applies to all individuals within the CCG.

9.2 Care should be taken that confidentiality is not breached inadvertently by, for

instance discussing confidential matters in public places, such as whilst travelling by train, or by leaving portable IT equipment containing confidential information where it might easily be stolen, such as on full view in a parked car. Data should only be distributed using mechanisms with an appropriate level of security.

9.3 Individuals must maintain confidentiality of information at all times, both

commercial data and personal data, as defined by the Data Protection Act. 9.4 Individuals should guard against providing information on the operations of

the CCG which might provide a commercial advantage to any organisation (private or NHS) in a position to supply goods or services to the CCG. For

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particularly sensitive procurements/contracts, individuals may be asked to sign a non-disclosure agreement, a copy of which can be found at Appendix 4.

9.5 Please note that nothing in this policy prevents an individual from raising a

concern in line with the CCG’s Whistleblowing Policy. 10 The Bribery Act 2010 10.1 The Bribery Act 2010 defines bribery as:

“Inducement for an action which is illegal, unethical or a breach of trust. Inducements can take the form of gifts, loans, fees, rewards or other privileges".

10.2 This can be broadly defined as the offering or acceptance of inducements,

gifts, favours, payment or benefit-in-kind which may influence the action of any person. Bribery does not always result in a loss. The corrupt person may not benefit directly from their deeds; however, they may be unreasonably using their position to give some advantage to another.

10.3 The Act also introduces a corporate offence of failing to prevent bribery where the organisation (which includes all NHS bodies) does not have adequate preventative procedures in place.

10.4 Should members or staff wish to report any concerns or allegations they have

a number of options available to them:

Report all suspected irregularities to the Chief Finance Officer who is also the contact point for NHS Protect, the Police and External Audit.

Contact the Local Counter Fraud Specialist on 01904 725145 / 01423 554548 for any potential fraud related queries.

Contact the NHS Protect Fraud and Corruption Reporting Line o 0800 028 4060 o www.reportnhsfraud.nhs.uk

Contact the Public Concern at Work line on 0207 404 6609

Follow the CCG’s own Whistleblowing Policy guidelines

10.5 Failure to disclose or providing falsified information is considered as gross misconduct and may lead to internal disciplinary action and/or include the involvement of the CCG’s Local Counter Fraud Specialist in line with the CCG’s Anti-Fraud and Bribery Policy.

11 Equality Impact Assessment (EIA)

11.1 A full Equality Impact Assessment is not considered to be necessary as this

policy will not have a detrimental impact on a particular group. 12 Monitoring Compliance and Effectiveness 12.1 Effectiveness is monitored by the Audit and Governance Committee through

regular reports on declarations made in line with the policy.

http://www.reportnhsfraud.nhs.uk/

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12.2 Individuals should be aware that a breach of this policy could render them

liable to prosecution as well as leading to the termination of their employment or position with the CCG.

13 Associated Documentation

Managing Conflicts of Interest Policy

Anti‐Fraud and Bribery Policy

Working Time Regulations Policy

Procurement Policy

Whistleblowing Policy 14 References

HSG(93)5 Standards of Business Conduct for NHS Staff

Nolan Principles of Public Life

The Codes of Conduct and Accountability in the NHS 2004

The Code of Conduct for NHS Managers 2002

Professional Standards Authority ‘Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England’ 2012

Bribery Act 2010

Chartered Institute of Purchasing and Supply (CIPS) Code of Conduct

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Appendix 1 – The Seven Principles of Public Life (Nolan Principles)

Selflessness - Holders of public office should act solely in terms of the public

interest.

Integrity - Holders of public office must avoid placing themselves under any obligation to people or organisations that might try inappropriately to influence them in their work. They should not act or take decisions in order to gain financial or other material benefits for themselves, their family, or their friends. They must declare and resolve any interests and relationships.

Objectivity - Holders of public office must act and take decisions impartially, fairly and on merit, using the best evidence and without discrimination or bias.

Accountability - Holders of public office are accountable to the public for their decisions and actions and must submit themselves to the scrutiny necessary to ensure this.

Openness - Holders of public office should act and take decisions in an open and transparent manner. Information should not be withheld from the public unless there are clear and lawful reasons for so doing.

Honesty - Holders of public office should be truthful.

Leadership - Holders of public office should exhibit these principles in their own behaviour. They should actively promote and robustly support the principles and be willing to challenge poor behaviour wherever it occurs.

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Appendix 2 - Standards of Business Conduct – Quick Guide

Make sure you understand the guidelines on standards of business conduct, and consult your line manager if you are not sure.

Make sure you are not in a position where your private interests and NHS duties may conflict.

Declare to any relevant interests in line with the Managing Conflicts of Interest Policy. If in doubt, ask yourself: i. Am I, or might I be, in a position where I (or my family/friends) could gain from the connection between my private interests and my employment? ii. Do I have access to information which could influence purchasing decisions? iii. Could my outside interest be in any way detrimental to the NHS or to patients' interests? iv. Do I have any other reason to think I may be risking a conflict of interest?

If still unsure - Declare it!

Declare the offer and receipt of gifts and hospitality within 2 weeks (except refreshments/meals provided at meetings, training etc.) using the form at Appendix 3. Items worth more than £10 should only be accepted in exceptional circumstances and only with the approval of the following:

Declare the offer and receipt of gifts and hospitality as soon as possible.

Report any inappropriate offers of gifts/hospitality/sponsorship to the Head of Corporate Governance within 2 weeks of the offer being made.

Obtain permission from the Chief Executive and Chair (using the form at Appendix 3) before accepting any commercial sponsorship agreement.

Adhere to the code of conduct of the Institute of Purchasing and Supply if you are involved in any way with the acquisition of goods and services.

Inform your line manager if you are intending to take on outside work, including any potential conflicts of interest this may cause.

Do not abuse your past or present official position to obtain preferential rates for private deals.

Do not unfairly advantage one competitor over another or show favouritism in awarding contracts.

Do not misuse or make available official "commercial in confidence" information.

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Appendix 3

RECORD OF HOSPITALITY/GIFTS/SPONSORSHIP – DECLARATION FORM This form should be used to record any offers and/or acceptance of hospitality/gifts, and sponsorship agreements. Both declined and accepted offers should be declared in line with the following rules:

Gifts from suppliers or contractors:

All gifts of any nature offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business should be declined, whatever their value.

Subject to this, low cost branded promotional aids may be accepted where they are under the value of £6.00 in total, and need not be declared.

Gifts offered from other sources:

Gifts of cash and vouchers to individuals should always be declined.

Modest gifts of less than £50.00 can be accepted and do not need to be declared.

Gifts valued at over £50.00 should be treated with caution and only be accepted, with senior approval, on behalf of an organisation, not in a personal capacity. These must be declared.

Multiple gifts from the same source over a 12 month period should be treated in the same way as a single gift in respect of the £50.00 threshold.

Hospitality - meals and refreshments:

Under a value of £25.00 – may be accepted and need not be declared.

Of a value between £25.00 - £75.00 – may be accepted and must be declared.

Over a value of £75.00 – should be refused unless (in exceptional circumstances) senior approval is given. These must be declared.

Hospitality - travel and accommodation:

Modest offers to pay some or all of the travel and accommodation costs related to attendance at events may be accepted and must be declared.

Offers which go beyond modest (i.e. first class travel and accommodation and foreign travel and accommodation),or are of a type that the organisation itself might not usually offer, need senior approval, should only be accepted in exceptional circumstances, and must be declared.

Senior approval

If you wish to accept gifts worth more than £50.00, hospitality worth over £75.00, or offers of travel/accommodation which go beyond modest (see above), this must be approved by the following, who must sign Section 9:

Requesting Individual Approving Manager

Chief Executive Non-Executive Members of Governing Body

CCG Chair

Directors CCG Chair

Chief Executive

Other Individuals Relevant Director or Deputy Director

If you have declined gifts worth more than £50 or Hospitality worth over £25.00 respectively, this must be declared.

If you wish to enter into a sponsorship agreement, this must be approved by the Chief Executive and Chair, and they must complete section 9 below.

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Name:

Position within the CCG:

Are you responsible for contract monitoring, ordering or approval powers? Yes / No (please delete as appropriate) If yes, please specify:

Details of Hospitality/Gifts/Sponsorship Offered and/or Accepted

1.Details of the hospitality/gift/sponsorship:

2. Approximate value:

3. Reason why the hospitality/gift/sponsorship is being offered:

4a. Name of organisation/individual offering hospitality or gift/sponsorship:

4b. Name of the organisation representative:

5. Products/services provided by the organisation/individual to NHS Leeds CCGs, where applicable:

6. Are the products or services being offered either used or ordered by the individual in the course of their duties?

Yes / No (please delete as appropriate)

7. Decision: Declined / Accepted (please delete as appropriate)

8. Declaration: I declare that the information I have given on this form is correct and complete. I

understand that if I knowingly provide false information this may result in disciplinary action

and I may be liable for prosecution and civil recovery proceedings. I consent to the

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disclosure of this information for the purposes of prevention, detection and prosecution of

fraud.

Signed: Name: Designation: Date:

9. Approved: Yes / No (please delete as appropriate)

If yes, reason for approval / If no, reason offer declined (Continue overleaf if necessary):

Signed: Name: Designation: Date:

Please return completed forms to Head of Corporate Governance for inclusion

on the register.

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Appendix 4 – Non Disclosure Agreement Template

NHS Leeds CCGs Partnership - express requirement for confidentiality You have been requested to be involved in [INSERT DETAILS] (the “Project”). NHS Leeds CCGs Partnership or other parties participating in the Project may provide you with, as part of your role in respect of the Project, access to certain confidential information relating the Project (whether before or after the date of this letter), in writing, by email, orally or by other means (including from or pursuant to discussions with any other party or which is obtained through attendance at meetings related to the Project) and trade secrets including, without limitation, technical data and know-how relating to the Project, including in particular (by way of illustration only and without limitation) [EXAMPLES] and including (but not limited to) information that you may create, develop, receive or obtain in connection with your engagement on the Project, whether or not such information (if in anything other than oral form) is marked confidential (the "Confidential Information"). Accordingly we draw to your attention that as part of your role for NHS Leeds CCGs Partnership you are required to: 1.1. maintain the Confidential Information in the strictest confidence and not divulge

any of the Confidential Information to any third party without the prior written permission of NHS Leeds CCGs Partnership; and

1.2. not make use of, reproduce, copy, discuss, disclose or distribute the

Confidential Information other than for use as part of your role in the Project. The above obligations in respect of this Confidential Information are supplemental to any prior representation, understanding and commitment (whether oral or written) between us. The terms of this Letter can only be changed by a written document, agreed upon by both of us and signed by duly authorised persons. These provisions shall be governed and construed by English law. Yours faithfully

For and on behalf of NHS Leeds CCGs Partnership By signing this letter you agree to comply with these terms.

Signed:

Date:

Print Name:

23

Appendix 5 - Policy Consultation Process

Title of document Standards of Business Conduct Policy

Author Governance Leads

New / Revised document Revised July 2017

Lists of persons involved in developing the policy

Paul Crompton – Head of Corporate Affairs (LSECCG) Helena Coates – Governance Manager (LSECCG) Laura Parsons - Head of Business and Corporate Services (LWCCG) Stephen Gregg – Head of Governance and Corporate Services (LNCCG)

List of persons involved in the consultation process:

As Above Audit Committee

Key: * Items will only be included on the agenda if there is any information to report

LEEDS HEALTH COMMISSIONING & SYSTEM INTEGRATION BOARD WORK PROGRAMME 2017-18

ITEM JUL

2017

SEP

2017

NOV

2017

JAN

2018

MAR

2018

MAY

2018

Notes

STANDING ITEMS

Welcome & apologies X X X X X X

Declarations of interest X X X X X X

Minutes of previous meeting X X X X X X

Matters arising X X X X X X

Action log X X X X X X

Patient Voice X X X X X X

Questions from Members of the Public X X X X X X

GOVERNANCE ITEMS

Committee Terms of Reference X X

Committee Annual Reports X

Committee Chairs’ Summaries X X X X X X

Review of new arrangements X

ASSURANCE

Board Assurance Framework and Risk Register X X X X X X

STRATEGY

Leeds Health & Care Plan X X X

CCG Strategic Objectives X X

System Integration X X X

CCGs Operational Plan X

Organisational Development Plan X X

Leeds Local Delivery Plan X

COMMISSIONING

Integrated Quality & Performance Report X X X X X X

Finance Report X X X X X X

Chief Executive’s Report X X X X X X

Business Case / Procurement Approvals* X X X X X X

POLICIES

Policy Approval* X X X X X X

ITEMS FOR INFORMATION

Director of Public Health Annual Report X

Safeguarding Annual Reports X

West Yorkshire & Harrogate CCGs Joint Committee Minutes / Summary

X X X X X

Agenda item: LHCB 17/18